Most hearing loss isn't caused by getting older. That's the first thing Nancy Duncan wants people to understand, and it reframes everything that follows. Nancy is a doctor of audiology who opened her practice in 2003 and now runs four locations with 23 employees. She's spent more than twenty years watching the cause of hearing loss shift — from factory and farm noise, which OSHA largely brought under control, to what she calls self-inflicted damage: firearms without protection, car stereos, headphones turned up past the point of safety. She explains why that matters far beyond the ears. Untreated hearing loss pulls people out of conversations and out of relationships, quietly, over years. It exhausts the brain, because someone straining to hear is filling in gaps all day long. And it carries a documented association with dementia risk and with falls. Nancy calls hearing the number one preventable risk factor for dementia. Then there's the second half of this conversation, which is about business. Audiology is a strange field — a medical practice with a retail model bolted on, selling a device people don't want, don't believe they need, and don't want to pay for. Nancy now teaches other practice owners how to handle that, and her methods generalize well past healthcare. She breaks down the theory of marginal gains, why she rewrote her practice's vocabulary, and how a Polaroid camera in each office turned into the thing patients talk about most. What you'll learn: • Why most hearing loss is preventable, and what the evidence on age actually shows • The headphone volume test you can run in five seconds • What OSHA's 80-decibel threshold means for anyone outside a factory • Why ringing ears that "stopped bothering you" is bad news, not good • What to do instead of Q-tips — and why ear candling is worse than useless • How untreated hearing loss affects promotions and earnings at work • The theory of marginal gains, and simple swaps that changed how patients respond • Why she stopped saying "delivery" and started saying "device activation" • How to build a customer journey people actually talk about Chapters 00:00 Intro 00:51 From speech pathology to audiology 03:00 What audiologists actually treat 04:35 Why it's a doctoral-level field 05:14 Most hearing loss is preventable 06:42 Brain fatigue, falls, and dementia risk 08:53 Why the person with hearing loss is the last to know 09:24 Headphones, volume, and the five-second test 11:32 Silence, cortisol, and tinnitus 13:04 Q-tips, ear candling, and what to do instead 15:33 The business behind the practice 17:23 Creating a journey of moments 20:54 Marginal gains and simple swaps 23:02 How she works with other businesses 27:57 Hearing loss, promotions, and earnings 28:58 Where to find Nancy Connect with Nancy Duncan, Au.D. DuncanHearing.com Nancy@DuncanHearing.com Fix My Fees FixMyFees.com · @fixmyfees Got a business worth talking about? Reach out: Tavious@fixmyfeesteam.com Keep more. Grow more. Live better. This conversation is general information, not medical advice. If you're concerned about your hearing, see a licensed audiologist or your physician.