February 23, 2007 Issue

             HEARING LOSS HELP E-zine
"The premier e-zine for people with hearing loss"


Volume 2, Number 2                February 23, 2007
Publisher: Neil Bauman      neil@hearinglosshelp.com
            http://www.hearinglosshelp.com
    Copyright Center for Hearing Loss Help 2007

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                      "Hearing loss may change your life,
                        but your life need not be any less
                                rewarding and fulfilling
                        because you have a hearing loss."

                                                               -- Neil Bauman, Ph.D.

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Please recommend and/or forward this issue of Hearing Loss Help
e-zine to at least one of your hard of hearing friends, or to
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In this issue
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1. Tinnitus Issues

2. Beware of (Ototoxic) Drugs That Can Damage Your Ears

3. Answers to Your Questions

4. Understanding Hearing Loss

5. Subscriber-only Special

6. Information on Hearing Aids, Cochlear Implants and/or
    Assistive Devices



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1. Tinnitus Issues
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Pulsatile Tinnitus

by Neil Bauman, Ph.D.

A lady explained: "I have developed pulsatile tinnitus in my left ear which is progressing in severity. I have also been having ear pain at times in the left ear. I have seen an ENT and a doctor of audiology in the last month. Both seem to think the pulsatile tinnitus is just something I have to live with and have had no further recommendations (the doctor of audiology didn't even examine the ear). I am considering going to my local University or the Mayo clinic for another opinion to make sure there is not something else going on. Am I being just a little paranoid, or should I be investigating further?"

First, you need to be aware that doctors of audiology (Au.D.) are not medical doctors and thus are not trained to examine ears (in the medical sense). Thus don't feel slighted that your audiologist didn't do so. This is not their area of expertise. They are trained in evaluating hearing, not diagnosing medical problems. Your ENT is the medical doctor specializing in problems of the ears, nose and throat, and thus is the one who can give you a proper examination.

Second, before I answer your question, let me explain a bit about pulsatile tinnitus, and what it sounds like. Pulsatile tinnitus sounds are tinnitus sounds that are synchronous with your heartbeat. Thus, pulsatile tinnitus is generally related somehow to the blood flowing in the blood vessels in your neck and head—close enough to your ears that you can hear them.

Although pulsatile tinnitus sounds are rhythmic pulsing sounds in time with your heart beat, they have a number of variations. For example, they may be drumming, beating, pounding, throbbing, pulsating or fluttering sounds. They may have single beats, or they may have biphasic beats (like the clip-clop of a horse). They may even make swishing, swooshing or whooshing sounds (to name some of them).

Here are some of the more common causes of pulsatile tinnitus. You may have what is called a glomus tumor. Glomus tumors occur in about 12% of diagnosed cases of pulsatile tinnitus. A glomus tumor is a non-cancerous mass of intertwined blood vessels growing near your ear. The blood pulsating through them could be causing your pulsatile tinnitus.

If you had a glomus tumor, perhaps it could also be pressing on something causing your pain. I don't have a clue, of course—but a good ENT doctor (not all are good as you have found out) or a good vascular surgeon should be able to figure out what is going on, and whether it needs further investigation or treatment or not.

Another common cause of pulsatile tinnitus is "Benign Intracranial Hypertension" syndrome or BIH. BIH accounts for about 39% of all diagnosed cases of pulsatile tinnitus. BIH is increased pressure of the fluid that bathes your brain. This syndrome includes headaches and blurred vision among other things.

Pulsatile tinnitus could also be the result of Carotid Artery Disease (CAD) which accounts for 17% of all diagnosed cases of pulsatile tinnitus. With CAD, the "gunk" in your arteries (to use a fancy medical term—which is sure easier to spell than "atherosclerotic build-up of cholesterol") reduces the space inside the arteries in your neck leading to turbulent blood flow which you hear as pulsatile tinnitus.

High blood pressure, which makes the blood flow faster and thus produce more noise, is yet another cause of pulsatile tinnitus.

These are just 4 of the 25 or so known causes of pulsatile tinnitus. A good doctor will investigate and rule out all of these before he says "live with it."

Pulsatile tinnitus is typically a vascular (blood vessel) problem. Thus, quite often doctors can help it by surgery or other treatments.

Since your ENT basically brushed you off, by all means, get a second opinion. You are not being paranoid. You are simply taking charge of your ear problem, and that is good. After all, it is you who have to live with it, not your doctor.

To learn more about tinnitus in general and pulsatile tinnitus in particular, you would do well to read the book "When Your Ears Ring—Cope with Your Tinnitus—Here's How" (or see this eZine's special in section 5 for a great deal).


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2. Beware of (Ototoxic) Drugs That Can Damage Your Ears
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Tobramycin, Tinnitus and Hearing Loss

by Neil Bauman, Ph.D.

It doesn't take much of an ototoxic antibiotic to damage your ears, and it often happens when you least expect it. Following is a professional lady's story. She wrote:

"I was prescribed Augmentin and Tobradex [Tobramycin] for conjunctivitis—2 drops each eye twice a day. After the 6th dose, I suddenly developed tinnitus, louder in the left ear than the right.

I immediately stopped taking both medications, looked them up online, and was astonished to discover Tobramycin is ototoxic—alarmingly so. Ototoxicity wasn't listed as an adverse effect on the patient information page from the pharmacy! In addition, my doctor never mentioned any possible side effects.

The very next day after my last dose, I checked my hearing on an audiometer and was shocked to see my hearing had dropped to 40 dB at 6K and 8K in the left ear and 25 dB at 8K in the right. The other frequencies were good—less than 15 dB loss, and at 6K my right ear was at 5 dB. That was on Tuesday. On Wednesday, it was the same. On Thursday, all was the same except that I couldn't hear 6K in my right ear until I reached 15 dB. On Friday, all was the same except I couldn't hear 6K in my right ear until I reached 20dB. Then it stabilized.

My doctor denies any correlation between my hearing loss/tinnitus and the Tobramycin. She says I wasn't on it long enough to cause problems. On the one hand, it does seem hard to believe that I was affected after only 6 doses, but my tinnitus and hearing loss were so abrupt and coincidental to the timing of the medication.

Why on earth are doctors prescribing severely ototoxic antibiotics when they could easily prescribe non-ototoxic ones, especially for something as minor as pink eye?! There's something inherently wrong with that.

I still have the same tinnitus and hearing loss over 2 weeks later. My worst fear is that the loss will get worse, but I was hoping for some hearing recovery—is that unlikely? Do you have any suggestions?"

As you have unfortunately found out, it's amazing just how small a dose of Tobramycin (and other aminoglycoside antibiotics) can damage your ears. The Augumentin is a combination of Amoxicillin and Clavulanate and as far as I know, is not ototoxic at all. It's the Tobramycin that did the dastardly deed.

This lady was fortunate that she had access to an audiometer, knew how to use it, and immediately tested and documented her hearing loss. Most people don't have such access. Also, few would notice the drop in hearing at the higher frequencies. Thus, the myth perpetuates that such drugs don't harm hearing—but they do! How wrong can doctors be!

No matter what drugs you take, you need to do "due diligence" and make sure that there won't be nasty surprises lurking in the possible side effects your ears may experience.

One way to do this is to check out any drugs you take in Ototoxic Drugs Exposed. This book contains information on the ototoxicity of Tobramycin and the 762 other drugs known to damage ears.

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3. Answers to Your Questions
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If you have a question, or if something has been puzzling you
concerning your ears, email it to mailto:neil@hearinglosshelp.com
and put "e-zine question" as the subject. Suitable questions will
be answered here.
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Real-time Captioning—Reasonable Accommodation in the Classroom

by Neil Bauman, Ph.D.

A lady explained, "I am a full-time student returning to school after working for 30 years. Because of my hearing loss, I am now retraining in a back office setting. My hearing loss was caused by high doses of Erythromycin as a premature baby (25 weeks). One of the products I am searching for is software or something that will enable me to record my lectures in class, and have them typed out on my computer.

The voice recognition systems, like Dragon Naturally Speaking that I have looked into, do not quite do what I would like. I cannot have all my professors sit for two hours so Dragon can recognize their voices and even if they were willing, the recorded version of their voice is still different enough that Dragon software does not work. Do you know of anything else out there to assist hard of hearing people? With all of our technology advancements, certainly something has been developed."

As you have found out, the speech to text technology is not quite there yet—at least not when you have various speakers. With one speaker, a good microphone and lots of practice, it can be passable, but not perfect.

For example, I'm also trying out Dragon Naturally Speaking to caption my own presentations. Sometimes it does a fantastic job and other times what it produces is totally off the wall. I still need to work with it a lot more to get the accuracy up. Hopefully, it will prove to be quite good in the long run. However, getting it to work with any person's voice, and without preceding practice, is still some years away.

As a result, you need something else at this time. The best that is available is real-time captioning, usually shortened to CART. If you are going to a public school or university, they have to provide you with reasonable accommodations, and for hard of hearing people like yourself, CART is a reasonable accommodation.

Real-time captioning can also be recorded so at the end of the class, you have a complete written transcript of everything said in the classroom.

There are two ways you can use real-time captioning. First is to have the CART reporter right there in the classroom with you. The CART reporter hears what is spoken and types it on their steno machine that is hooked to their computer. Their computer translates this "phonetic shorthand" into proper English and displays it on a screen at the front of the room so you (and anyone else that needs it) can read it (or it could be displayed on your laptop screen if only you need the captioning.

The other way is to use remote CART. In this case, you are connected to the captionist via the Internet—so you'd need a laptop computer and an Internet connection. Your professor would have to wear a microphone and you'd have to get this signal to your laptop. That's it.

Remote CART is cheaper as there is no traveling time involved for the CART reporter and there are no minimum times. Also, if the local captionists are busy, they can hook you up with another captionist elsewhere in the country (or world for that matter).

I use remote CART for a number of my presentations. In fact, I'll be using remote CART for my presentation this afternoon. It works just as well as if the CART reporter is sitting there in person.

If your classrooms have access to a fast enough wi-fi network, and you have a wireless enabled laptop, an FM mic for the professor and the FM receiver to plug into your laptop, remote CART could work very well for you.

Of course CART is relatively expensive—in the neighborhood of $85.00 to $150.00 per hour—but the school is required to pay for it if this is what you need.

If you want to learn more about CART, check out http://www.cartinfo.org and http://cart.ncraonline.org/Consumers.

Study the information on these two web sites and you'll learn alot. The second one also has a list of all the certified CART(and remote CART) captionists in the USA.

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4. Understanding Hearing Loss
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Large Vestibular Aqueduct and Future Children

by Neil Bauman, Ph.D.
 

A young mother wrote: "My husband and I just found out over the past few months that our daughter is deaf, due to LVAS [large vestibular aqueduct syndrome]. She passed her newborn hearing test in her right ear and failed in her left, but a month later when we did the ABR [auditory brainstem response] she was not responding to sound at any level in either ear, which we were told is equal to being deaf. We are looking into a cochlear implant and are very hopeful. My question is, how likely is it that this will reoccur in future children? This is our first child, and I had always dreamed of having 3 or 4 children, now I am very scared."

Large Vestibular Aqueduct Syndrome (LVAS) is also known as Enlarged Vestibular Aqueduct Syndrome (EVAS).

With LVAS, doctors think that the extra-large vestibular aqueduct (really just a hole in your skull) allows the contents of the endolymphatic sac (on the inside of your skull) to flow (backwards) though the endolymphatic duct into the inner ear where it somehow causes hearing loss.

LVAS is a relatively new diagnosis, even though the underlying condition has been around for awhile, but no one knew about it until recently. Doctors just classified hearing loss from LVAS under "idiopathic hearing loss" which simply means hearing loss of unknown causes.

The good news is that I know a lot of kids with LVAS that have responded very well to cochlear implants. So I am hopeful that your daughter will have similar results if you choose to go through with it.

Don't be scared about having more children. They are worth it whether they have hearing loss or not. You can find a lot of help and support on the LVAS list that I set up for people with LVAS. As a matter of interest, most of those on this list are mothers in just your situation. To join this special list, click here then  scroll to the bottom where you can fill in your email address and subscribe to the LVAS list. While you are there read the whole article on LVAS.

Don't put off having more children just because there is a possibility of them having LVAS. Even if all of them had LVAS and lost their hearing, you would still love them. They will be normal except for not hearing well. I knew before my children were born that one or more of them would be born hard of hearing—and my wife and I are still glad we had them—even though one has a severe hearing loss like me.

Now to answer your question as to how likely any of your future children might have LVAS. (The following works for any other recessive hearing loss syndrome as well for that matter.) Since LVAS is a recessive hereditary trait, both you and your husband must already be carriers of the recessive LVAS gene. Furthermore, both of you need to pass this recessive gene on to your child in order for your child to have LVAS.

Remember, genes come in pairs, and you only pass on one gene of each pair to each child, so there is a 50% chance you will pass on the normal gene and a 50% chance you will pass on the LVAS gene. The chances that both you are your husband will both pass on the LVAS gene at the same time is only 25.

Here are the probabilities (assuming there is only one LVAS gene—but this is not certain, there may be more, so the probabilities may be even less than shown below.

25% chance your child will have LVAS (child receives an LVAS gene from each of you).

50% chance your child will be a carrier of the recessive LVAS gene, but will NOT have LVAS (child only receives an LVAS gene from one of you).

25% chance the child will not have any LVAS genes and thus will not have LVAS, nor be a carrier of LVAS. (child does not receive a LVAS gene from either of you).

So each of your future children only has a 25% chance of actually having LVAS.

Mind you, this is how it works out on the average. However, it could be that all of your future children will have LVAS, or none of them. Think of flipping a coin. On the average you'll get heads 50% of the time. However, it is possible to flip a coin 10 times and get 10 heads in a row (possible, but extremely unlikely). This is the way it works with having children with LVAS too.

If it were me, I'd have all the children you want. We (hard of hearing people) live happy, successful and fulfilled lives in spite of our hearing losses. There is no reason your children won't also.

As is our custom, with each issue of Hearing Loss Help eZine we bring you a subscriber-only special that is only available to you, our loyal subscribers.

This issue's special is for the eBook version of our book on tinnitus called "When Your Ears Ring—Cope with Your Tinnitus—Here's How". This book has a whole section on pulsatile tinnitus (see the first article in this issue) and other kinds of weird somatic (body) tinnitus. Of course, this book is packed with practical advice on all kinds of tinnitus, and how you can help yourself eliminate or reduce your tinnitus so it no longer bothers you.

This eBook normally sells for $14.49. If you always wanted this book, now is your chance to save 34% off the already low eBook price. For a limited time you can have it for just $9.49. Furthermore, for our overseas friends, because it is an eBook, there is no shipping charge and you can download it immediately—no waiting time. (Note: the eBook version is identical in content to the printed edition.)

Order it now while you are thinking about it because this special will only be available until March 16th at midnight.

To get this special price, you MUST click on the below link. Do not order from the regular links on the web site or elsewhere or you will be charged the regular price.

To purchase this eBook edition of "When Your Ears Ring" at this special subscriber price of just $9.49, click on the above link now.

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6. Information on Hearing Aids, Cochlear Implants and/or
Assistive Devices
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What Are CROS and Bi-CROS Hearing Aids?

by Neil Bauman, Ph.D.

No, CROS hearing aids are not angry. CROS is an acronym for "Contralateral Routing Of Sound." "Contralateral" is just a fancy word that means "on the other side." Thus, very simply, a CROS hearing aid takes the sound arriving on one side of your head and feeds it into your opposite ear.

CROS Hearing Aids

CROS hearing aids are for people who are deaf in one ear and have normal, or near normal, hearing in the other ear. They consist of two parts. The person wears what looks like two hearing aids in one of two styles—either a behind-the-ear (BTE) aid, or a large (full shell/half shell) in-the-ear (ITE) aid.

The "hearing aid" on the deaf ear basically consists of a microphone (to pick up sounds on the deaf side) and a transmitter. The transmitter sends these sounds (either via a cord joining the two "aids," or more commonly, via radio waves) to the "hearing aid" on the good ear.

This second part of a CROS aid system basically consists of a (radio) receiver (if using the wireless system) and an amplifier. It amplifies the sounds it receives from the deaf side, and then feeds these sounds into the good ear via a plastic tube (if a BTE style), or directly into the ear canal (if an ITE style). CROS ear molds are of an open fit design so they don't block the sounds the good ear hears naturally.

Incidentally, you don't need a tightly-fitting ear mold as feedback isn't an issue with CROS aids since the microphone is on the opposite side of your head—well away from the "ear mold." Besides, since the person has normal or near normal hearing, the sound doesn't have to be amplified much.

Bi-CROS Hearing Aids

Bi-CROS hearing aids are similar in many respects to CROS aids, but have this one major difference. They are for people who are deaf in one ear and are hard of hearing in their other ear.

The part that is worn on the deaf ear is identical to the CROS aid. The difference is on the side of the ear with the hearing loss. This part of the Bi-CROS system does the same thing as the CROS system did, but, in addition, it also includes a "regular" hearing aid for the hard of hearing ear.

The Bi-CROS unit combines the signals from both ears and then feeds them into the hard of hearing ear via a normal tightly-fitting ear mold, as otherwise there could be problems with feedback.

Why would you want CROS or Bi-CROS aids? The truth is, they are an excellent solution to your single-sided hearing problems, especially if you often sit so that people typically talk to you from your deaf side. For example, if you are driving a car and your right ear is deaf, you will have great difficulty (and be totally frustrated) trying to hear your passengers. A CROS aid can really benefit you in this and other such situations. With these specialized hearing aids, available from most major hearing aid manufacturers, because you will be hearing so well, you will be CROS, but not angry.

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                       HEARING LOSS HELP E-zine

Neil Bauman, Publisher               Center for Hearing Loss Help
49 Piston Court                       Stewartstown, PA 17363 USA
Phone: (717) 993-8555                       Fax (717) 993-6661
http://www.hearinglosshelp.com     neil@hearinglosshelp.com

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