Exploring the Relationship between Hearing Loss and Musicality with Srishti Nayak, PhD, of the Vanderbilt Music Cognition Lab

Hello and welcome to another episode of this Week in Hearing. I’m your host Brian Taylor. And this week we’re going to be exploring the complex relationship between age related hearing loss and the ability to perceive and engage with music. Some of you may know that about a month ago JAMA Otolaryngology published a really interesting two page article on musicality and hearing loss. And here today to help us explore this relationship between musicality and hearing loss we’re really pleased to have the lead author of that paper, Dr. Srishti Nayak. Srishti is a scientist and researcher at the Vanderbilt Music Cognition Lab. And I want to take the time, Srishti, to welcome you to this Week in Hearing. It’s great to have you with us. Thank you so much Brian. It’s really nice to be here. Yeah, I’m excited to talk to you. That article which was published I think in early December in JAMA Otolaryngology I thought it was really something I don’t really know much about and I’m glad that you were able to take the time to be with us. So before we get into the topic at hand, I think our viewers would like to know a little bit about your background what’s your academic training what are some of your topics that you like to study, you could tell us more about. And I’m so glad you asked because I’ve had kind of a non traditional career path to get to this point. So I am PhD trained researcher in cognitive and brain sciences originally and then for my postdoctoral training I specialized in interdisciplinary music science and, and that involved some of the cognitive and brain science background that I already had. But it also introduced me to the vast world of genomics and how you can use that to study complex human behavior to complement what we do in the psychological and brain sciences. And so the lab that I did my postdoc training in is the Music Cognition Lab that I still work at five years later now. And it really kind of expanded my interest in health applications because for my PhD training I was very on the basic science side and now I’m much more thinking about what are the clinical applications of the stuff that we are researching. So I’m now a faculty member, a research assistant professor at the Department of Otolaryngology which also houses the Music Cognition Lab, which I now co-direct I did not know that Vanderbilt had a Music Cognition lab. So could you tell us A little bit more about that. When did it come into existence and what are some of the research that’s generated in that lab to date? Yeah it’s really unique and especially our positioning within the otolaryngology department. And at a major academic medical center. So the lab has had many iterations. It started out about 10 years ago. It’s actually our 10th anniversary in 2025, which is exciting. And the lab is now co directed by three different principal investigators. So it’s a multi PI model and we each run our three different research groups and we focus on quite different things. So I’ll tell you a little bit about some of the science that I’ve been personally involved with. But more broadly we have a part of the lab that studies music and social engagement and human development in both typical and atypical development. And that group is directed by Dr. Miriam Lentz, also faculty in the Department of otolaryngology. Then we have Dr. Reina Gordon, who directs the rhythm, language and genetics group, where they’re really doing a lot of nuanced work on the genetic overlaps between musical rhythm and language and many other traits that are related to those two things. And that’s where I got a lot of my postdoc training. And now I’m running my own research group, Behavioral Health, Speech and Hearing. So the acronym is actually the interesting part. Its BHaSHa, which actually in Hindi, which is one of my native languages, means language. So it kind of combines my interest in speech and hearing, my training in language, and the interest in now behavior and health and how all of that relates. So yeah, so that’s the kind of what the lab does. Yeah. In the recent past, we’ve actually made some really interesting scientific breakthroughs in understanding the genetic architecture of musical traits. Like people’s ability to be good at rhythm in certain ways, like how well can you clap to a musical beat? Things like that. Right. And so there are actually genomic signatures to these traits that we know from just colloquially and just like having friends of different kinds, we know that some people are really good at rhythm and some people are not as good at it. So you have this variety in the population and there’s a genomic signature to that. So our group has made a lot of breakthroughs around that and then digging into how that’s related to language development and language skills across the lifespan. Well, and I think we’ll dig into a little bit of that in a few minutes here. But I think we all know it makes perfect sense for a university in Nashville to have a music lab that studies these things. So. Yes, and actually our lab, the physical space where I am right now is right on Nashville’s Music row. So we actually have this, you know, we’re physically connected to the music community as well. Many, many starving musicians I’m sure are not too far down from your Yeah, we see the billboards everywhere. Everyone’s, you know, winning an award or the other. Well, let’s turn our attention to let’s first talk about age related hearing loss because I think that’s one of the themes in this two page article. So maybe just to kind refresh our viewers how common is age related hearing loss and how does it impact health and well being? Yeah, so you know, as you can tell from my sort of research background, I only got into studying hearing loss relatively recently, about two years ago. And you know, one of the statistics that I was really struck by when I first started reading in this field is that age related hearing loss is way more prevalent than anybody thinks about. It’s about one in three people in the US above the age of 70 have some kind of hearing loss. And what’s even more interesting for me as someone who used to study you know, develop the development of different processes is that the prevalence of hearing loss if you look at different age bands. So like, you know, if you look at people in their 40s, 50s, 60s, 70s and so on, the prevalence nearly doubles with every decade of life until it gets to this one in three. Staggering number. Yeah. No. Being someone in the profession of audiology for 35 years, I’m always, I always appreciate a fresh perspective. So thank you for that. Which leads me to the next question. From your perspective, why is early detection of a hearing loss in adults, why is that so important? Yeah, I mean, I think there are a lot of implications for health and, well, being more broadly of hearing loss. Right. So you know, people with hearing loss can be at greater risk for other kinds of things happening in their, in their everyday life. So increased risk of falls, increased risk of factors of social isolation. So something that I think about often as someone who’s interested in language is even something simple like not really being able to hear the conversation around you very clearly and having to strain to listen. Sometimes it’s like it’s so fatiguing that you kind of withdraw from the conversation. Right. Or it’s frustrating. Right. Yeah. And it’s easier to just like withdraw. And you know, those can have compounding effects when, when you think about it on an everyday basis. Right. And I see this a lot actually with my grandmother who you know, has a hearing aid and you know, was screened for hearing loss and they did find that she has significant hearing loss. But even with the hearing aid, like, you know, it’s like she misses some of the jokes. Like she’ll, you know, so like she’s not as engaged as she used to be when she could hear like really clearly. Right. And so, and so that’s sort of the well being aspect. But there are also like, you know, there’s more risk for injury, there’s more risk for not being able to hear objects in your environment and being more at risk for things like that. And it’s just when you think about it on a day to day basis it decreases the quality of your life in some ways that are significant, including for brain health, because you’re fatiguing your brain to some extent to keep up with the surroundings. And I know this is a little bit off the topic, but I know some of the colleagues in your department, Ben Hornsby comes to mind, has done some important work around fatigue. Fatigue and aging. And aging brain. Exactly. Something that. Anyway let’s turn our attention to musicality. I think that’s a term that a lot of our viewers are probably not too familiar with. Tell us more about that term musicality. What does it encompass? Yeah, you know it’s a great question and I’m actually really glad that we’re getting to talk about this viewpoint piece at length because a two page limit is actually really hard to deal with when you’re trying to explain like all your different thoughts about these things. So, so yeah, we get that question a lot. Like every time there’s a new student in the lab, we have a conversation about like what is musicality? Right. And so I think. So there’s, there’s music, which is the thing of music, the stimulus that you’re hearing, the thing that you’re engaging with. But human musicality, many people have thought about what this means and you know, a working definition is any way in which the human system, whether that’s your perceptual system, your cognitive system or your overall biology, any way in which that engages with music can be considered your musicality. So whether you really like music because you feel very rewarded when you listen to it, that’s something that can be musicality. Whether you are really good at playing an instrument, that can be musicality. Whether you tend to listen to music on repeat, obsessively, that can be a feature of musicality. Right. And so it’s all the aspects of both aptitude, what we’re good at, as well as engagement, what we’re drawn to and what we’re actually doing with music. And all of those features become important in the research because you measure them in very different ways as well. Well, I know one thing in that two page article and by the way, we’ll have a link to that article in the show Notes so people can download it and read it for themselves. But one of the one of the items that you mentioned in that article is that there’s a traditional clinical perspective and this relationship between musicality and hearing. So could you maybe tell us a little bit about what you mean by this traditional perspective on a, between these two, between musicality and hearing? Yeah, sure. So you know, when I’m talking about a traditional clinical perspective, I’m really talking about the perspective that is most represented in the, in the research and in the clinical world. Right. So, so it’s not really about individuals perspectives or opinions. It’s more about like what do we most see represented when we’re talking about this field. And traditionally in this field there’s been these two types of clinically relevant approaches. One is to think about very at a very important level, like how does increased engagement of music, especially loud music at high frequencies or at as in high frequencies of engagement, not sound frequencies but at high loudness levels for a consistent basis, how does that damage your hearing? Right. And that is really relevant and especially in Nashville where we have so many professional musicians and we know that there is evidence that, you know, musicians who engage with, you know, certain types of instruments for like much of their lives, like they are more at risk and they need to protect their hearing in certain ways to you know mitigate that risk. Right. So that’s one perspective. There’s a lot of evidence for that music at certain levels in certain forms can damage your hearing. The other perspective is that when you have decreased hearing quality or, you know, when you have hearing loss, or when you’re not being able to pick up all of the different nuances in the sound stimulus, you may start engaging less with complex music because you won’t enjoy it as much. Right. That is also true to some extent. So you have these. So when you read the literature on musicality and hearing from an otolaryngology perspective or an audiology perspective perspective, you’re really seeing these studies and you’re seeing this evidence. And so that’s what I’m calling the traditional perspective. Okay, so let’s compare the traditional perspective that you just reviewed with the new framework that you introduce in this article. You call it the MAPLE framework, which is an acronym, and I’ll let you explain that. But tell us about your new framework and how that might differ from this traditional perspective. Right. So what got me really interested in thinking about musicality and hearing from a new lens is that there is a lot of evidence that musicality and other communication traits like language and speech perception and, you know perceiving the rhythms of speech, including communication, things that are not in speech, like reading. A lot of these features of human beings are actually genetically linked with music and musicality. And the genetics is very new. But more, if you look at 20 years of research, it’s very behaviorally linked. What you see is that there are these very consistent correlations. People who have higher scores on musical related tests have higher scores on things like language tests and assessments. It made me think about how, you know, biology doesn’t really care about how we break up the world into different pieces to study it in different ways. Right. So, you know, we might only be thinking about language, but language is part of the human communication capacity and so is hearing. Right. So we don’t have that much research on musicality and hearing in the genetics field, and hardly any actually. And that’s what kind of got me interested in, like, can we think of hearing traits as a subset of broader communication capacity in humans? And then what are the connections with musicality biologically and behaviorally? So the perspective that we’re pitching in this opinion piece is that we need to think about the direction that’s like, because you have the biological predispositions for high musicality, you may also have predispositions that protect you against hearing loss. Something about the auditory system, the motor system, the brain, the genes, coming together to have this. So if we see a positive correlation between musical abilities and hearing, or musical engagement and hearing, it’s not just because people with better hearing want to do more music. It might be that there’s a genetic piece that affects both and in fact, people who are really, really musical, they may persist with their musicality at high levels, even when they can’t hear everything perfectly. Right. So it feels a lot more inherent. Yeah, that’s really interesting. So that’s where you come up with this work, this framework that goes by the acronym of MAPLE. So could you explain how those five elements kind of fit together to explain this approach or perspective? Yeah, I’m all about the acronyms now. Whether I can remember what they stand for, that’s a different story. So MAPLE, I do remember, stands for Musical Abilities, Pleiotropy, Language and Environment M, A P, L, E. Pleiotropy is referring to genetic pleiotropy, which in a very simple terms is a set of genes that do multiple things. So it’s the genetic overlap or the shared genetic influences on two things. So the MAPLE framework proposing, it’s basically like a theoretical framework that has a bunch of testable predictions. So it’s not like we’ve proven it, but we’re basically said here’s what we think might be going on as a field or as an interdisciplinary space of multiple fields. Let’s all test these hypotheses, let’s all test these predictions, and let’s see if it’s actually working the way we think it’s working. So we’ve now in the last couple of years started testing the predictions of the MAPLE framework, which is music and language have shared genetic influences. And we are finding that it’s like the evidence is showing that that is the case in many different studies that have come out since the MAPLE framework. So this musicality and hearing work that my group is now undertaking is an expansion and an application of the MAPLE framework because that one was limited to musical abilities and language abilities. Whereas now we’re saying, you know what, let’s think about musical engagement. Let’s think about not just their perceptual abilities, but all of these other aspects of musicality. And let’s think about communication even more broadly. Anything related to human communication might be part of the same framework. And so can we find evidence for that that is useful, for example, for hearing health? Yeah, let’s talk a little bit more about this. A lot of our viewers are clinicians. We have a lot of viewers who are hearing aid wearers are, that are tied into the industry in somehow some way. So tell us a little bit more maybe about how musical abilities correlate with communication abilities. Is it, I guess I’m curious to know, is, is there a way for a clinician to assess indirectly communication mobilities by looking at musical abilities, or vice versa. So I think we’re so many steps away from that right now. And while I am not personally a clinician, I do consult with many clinicians on all of these projects because they’re so clinically relevant. I think the first step would be, are clinicians even convinced that a musicality profile for someone is relevant to what’s going on in the rest of their health? There are many initiatives right now that are about musicality and health, music as medicine, music and health. Right. So the first step is that we actually need to find enough evidence that it’s going to be useful to know somebody’s musicality profile when you’re thinking about hearing health. Now, that is the case with professional musicians. Like when a professional musician is getting hearing health care. There are probably many, many things that clinicians are thinking about really carefully. What we don’t have is something that’s generalizable, not at the extremes of the distribution, but really at the whole population distribution level. Because for a long time we didn’t know just how much musicality varies in the population. So we’re used to thinking about, like, the expert side of it. Right. And there’s even a lot of work on the disordered side of it. So people who have rhythm impairments, for example. But if you think about every single person who goes into the doctor, every single person who gets an audiology screening, every single person who gets a hearing screening, what can their place in that spectrum tell us about, you know, 10 steps down? How can we be more sensitive to different musicality profiles? So I think. I think it’s a lot of the laying of the groundwork right now in the evidence. Right. So I’m just kind of picking your brain about this, but can you give me an example maybe of somebody who would come into a clinic, you know, let’s say an older gentleman, older lady what would be a profile of somebody that has high musicality versus low musicality? You know, just talking in very general terms. Yeah. What your hypothesis is. Yeah, so we could. There are many really good questionnaires and surveys that we’re in fact using in our research that could very easily be administered in a clinic setting or even by the PCP. Right. So how many, you know, how many times a week do you engage with music, Singing or playing an instrument? You know, how many, you know, how many social situations do you do music in? Right. Do you do music more by yourself or are you in these like, social you know, context with music? Like are you in a choir or something? Right. You know, how long have you played an instrument? Right. How – how much, like, you know, we often ask about noise exposure. Like if someone has an occupational hazard where there’s a lot of noise at work, we would take that into account. Right. But we’re not always taking into account the musical profile. So like how many hours a day do you have headphones on and are you listening to music at a loud volume? Like, like, you know, stuff like that. If you, if you look at the interactions between the stuff create noise damage and the stuff that might create some kind of protective factor we may have a bigger picture of what everybody’s like musical background is. Now again, the point of the viewpoint is really to say like, we don’t have the evidence for this. We are not ready to say what does the musical profile tell us. But what we don’t have is like we’re trying to generate the interest by many different people in the field to be like, could this be super relevant maybe. And there’s evidence to believe that it would be really promising to study these things especially given some really interesting genetic architecture correlations between like when you do large studies of musical rhythm abilities and you do large studies in genomics of hearing loss, there are genetic correlations between those things, which is fascinating and can tell us more about the biology, the mechanisms and so on. Yeah, tell us a little bit more about that. The relationship that you find genetically. Yeah. So there’s been a couple of studies that you know, including stuff that we’re working on right now that show that the genetic sort of underpinnings of something like musical rhythm are very correlated in terms of like the directions of the influences and the size of the influences genetically with something like age related hearing loss. So there was a. So to get into like the exciting part of the science, right? No doubt a little bit. So you have this giant study that’s done in like 300,000 people and it basically tells you, okay, for all of these people, there’s distributions in their hearing loss levels, so there’s all of this variation. How can the genetic variation between those people actually correlate with the actual variation in the hearing loss? So now you find a bunch of sort of interesting points on the genome that vary in correlation with how the hearing loss varies. So you. So now someone else has done that study. But the cool stuff about these genomic studies is that I can now go in and say, okay, let me look at the results of that study and let me do a genetic correlation based on those results between that and another study that someone else has done on musical rhythm. The same thing, genomic variations related with musical rhythm. And so we did that, we did a genetic correlation, and we found that much beyond chance. So statistically, significantly, you find these genetic correlations between higher musical ability and higher hearing health, so less hearing impairment. And that is kind of what we would predict with this MAPLE framework kind of model where something in the genes is affecting both in a positive direction. It’s interesting. I wanted to also ask you your thoughts on is it. Again, this is speculation. I granted that somebody that has high musicality would they be potentially better outcomes with amplification? You know, it’s a really important question. So you know, I want to shout out one of my colleagues in the department, Dr. Alex Gelbard, who I had a really interesting conversation with once about musicality and hearing. And, you know, he was like, you know, we think about rehabilitation, but what about prehabilitation? Right? And so it’s like, is there something about being a highly musical brain? Right? Like having a highly musical perceptual and cognitive and auditory system that has been trained over the years by being highly musical? Is there something about that that gives you better outcomes for something like once you have a hearing aid are there things that you can pick up on that are more nuanced? And we already know that musicality both the genetic predisposition to high musicality as well as actually measured high musicality does correlate with things like how well you can pick up rhythms and speech. So, you know, speech, prosody, perception. Right. So it’s not that much of a leap to say, like, you know, a lot of what we’re trying to process when we have hearing impairment is like, speech. It’s not the only thing, but it’s a lot of the nuanced, higher order sort of auditory processing we’re trying to do. Right. And is there Something about your brain being able to fill in the gaps. Right. A little bit better. In addition to the hearing amplification. Exactly. Like, I love that term, pre habilitation. Me too. And I was like, I’m stealing this, you know that. Right. And he was like, you can have it. I mean, maybe down the road there’ll be some sort of a genetic test or some kind of a screening using music that will tell you that a person’s predisposed to get better or more benefit from hearing aids or from. Exactly. And, and this screening piece is really like, as someone who’s not a clinician, like, this is where I can contribute. Right. So we’re, we’re building the evidence. If we find that when we measure musicality in five different ways and we look at the genetic data at a really large scale in the population level, at the population scale, if we find that there’s something about people profile as measured by just questionnaires, then we have more nuance to say, okay, a good screener is something that can be consistent and also robust and that there’s a good evidence base for five years down the line, maybe we will have this kind of evidence. And we’ll be able to say, you know, it’s actually not people’s melody perception skills that make them more susceptible to these like, good outcomes. It’s actually like, are they good at rhythm because then they can hear speech better or something like that. And you know, to clarify, this is evidence that I hope to find someday, but it’s just right now the viewpoint is my opinion. Right? Yeah, no, you grounded us in that, which is great. So tell us. You know, my last question to you is where do you see this over the next three to five years? Where do you see the science taking these concepts? Can you give us flavor for where that’s where we’re going? Yeah. I mean, my hope is that every single person is going to read my viewpoint and be like, oh my God, they’re right. We should all start studying musicality when we think about hearing now. Right. But short of, short of that we, we think that where this can head is that there are. So there’s kind of like interesting, like scientific there’s two places where there’s momentum being built up. Okay. So one is in like music and health research in general, we want to see more hearing, health, relevant variables being represented in music and health research because music and health can be about all kinds of things. But we don’t know yet if that’s going to include automatically hearing health. So we want to advocate for that, right? So music and health people, this might be of relevance and this might be a place we can make a big contribution. The other big thing that’s happening is the omics revolution, right? The genomics and like the all kinds of other omics that I don’t even know yet about because I’m still, you know, learning, right? But even with genomics, like you have, for example, the big study that our lab did on, you know a genome wide association study of musicality, it was like the first really big one of musicality ever, right? So what we want to see is more genomic scientists getting interested in these relationships with musicality. Because we can’t just study one musicality trait and call it a day. We need the nuance, right? Rhythm is not the only thing that’s relevant. So we want to see. And you know, I’m part of this consortium, it’s called the Musicality Genomics Consortium. And our sort of point, like our, our goal is to like represent better musicality traits in the sort of genomic sciences. And so when you do these both at the same time, I, in conjunction with all the amazing people doing genetics of hearing loss research at all levels, right? Like animal models, large scale human genomics, all of that together, I think that if we have it in our mind that musicality and hearing might be connected in interesting ways, we will be able to recognize those patterns and integrate them better in the long run. It sounds like an exciting future. A lot of things, a lot of questions to try to address. I’m going to be in a job for at least five years, so that’s good for me. Good to know all. We hope to have you on many times over the years. Thank you so much. So Dr. Srishti Nayak, who is a scientist and researcher at Vanderbilt’s Music cognition lab. Srishti thank you so much for your time. This has been an excellent conversation, very informative. Thank you so much Brian. Really good fun to be able to expand on my little two page paper. We look forward to having you on again. Thank you so much.