February 23, 2008 Issue
HEARING
LOSS HELP E-zine
"The premier e-zine for people with hearing loss"
Volume 3, Number 1 February 23, 2008
Publisher: Neil Bauman
neil@hearinglosshelp.com
http://www.hearinglosshelp.com
Copyright Center for Hearing Loss Help 2008
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"Hearing loss may change your life,
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— Neil Bauman, Ph.D.
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================================================== In this issue ==================================================
1. News Items
2. Beware of (Ototoxic) Drugs That Can Damage Your Ears
3. Answers to Your Questions
4. Coping Strategies
5. Information on Hearing Aids, Cochlear Implants and/or Assistive Devices
===============================================
1. News Items
===============================================
Hearing Aids Are Not the Whole Answer, So Why Do We Act
as if They Are?
by Neil Bauman, Ph.D.
Hearing loss is a complex issue. Thus, there is no single
simple answer—so why do so many hearing health care
professionals act as if hearing aids are the sole answer?
Dr. Mark Ross, himself hard of hearing for as many years as
I've been alive, is probably the foremost audiologist alive
today, and one I highly respect. He recently wrote:
"In order to deal effectively with any condition, one must first
learn all one can about it. This is not done as well as it should
be when it comes to hearing aids. When people arrive at a
hearing aid center, everyone's focus tends to be on the
"product" (the hearing aid) and not the hearing loss or
communication problems that brought the person there.
The explicit goal becomes the selection of a hearing aid, with
the implicit assumption that this will solve the communication
problems. But, while a hearing aid is necessary (no dispute
there), it is more often than not, insufficient. In
spite of all the claims of the appealing marketing ploys we are
continually exposed to, there is more to helping someone
with a hearing loss than providing a hearing aid, no matter how
advanced it might be." (1)
I have said many times in the past, and will continue to say,
that when dealing with hearing loss there are five major areas
that need to be addressed—all of them equally important—
and hearing aids are only one of the five.
First, a person needs to psychologically and emotionally
adjust to being hard of hearing. This includes working through
the grieving process in regards to their hearing loss. All of the
following steps are of little use if a person doesn't first do this.
Many people try and short-circuit this process—but the end
results are dismal—they permanently stuff their hearing aids in
dresser drawers; they more and more withdraw from the
hearing world; and, wrapped in their own little world, they slip
into deep, dark depression. (If you need help dealing with this
aspect of hearing loss, see my short book, "Grieving for Your
Hearing Loss—the Rocky Road from Denial to Acceptance". This little book has
helped many.
Once you have worked through your grief, and in no particular
order—because they can (and should) be done at more or less
the same time, are steps 2 through 5.
Second, get properly adjusted hearing aids if your hearing
loss is such that hearing aids can help you—and hearing aids
can help about 99% of the people with hearing loss.
Third, since hearing aids are not the whole answer, especially when noise
and/or distance is involved, get assistive devices (ALDs) that will supplement
your hearing aids in these difficult hearing situations. (I just wrote an
easy-to-read primer on these wonderful assistive listening devices.)
Fourth, learn to speechread (lipread). Speechreading, when combined with
residual hearing, greatly improves your understanding of what was said. This is
a most important skill, and one that all hard of hearing people should learn.
(If you don't have speechreading classes locally, don't despair. You can learn
speechreading using the
Seeing and Hearing Speech program.)
Fifth, learn all the myriads of coping skills that put the odds in your favor
in being able to hear and understand people. They are such simple things as
getting close to the speaker, cutting out competing background noise, having
light on the speaker's face, etc. I explain many of these coping strategies in
my short book "Talking
With Hard of Hearing People— Here's How to Do it Right!".
Combining all of the above gives a person the best chance of
successfully coping with their hearing loss. So resist the
seductive hype of hearing aid manufactures that hearing aids
are the whole answer, and utilize these other four important
areas when dealing with your hearing loss. You'll be glad you
did!
(1) Excerpted from the article "What Did Your Expect? Hearing
Aids—Expectation and Aural Rehabilitation" by Mark Ross,
Hearing Loss Magazine. Hearing Loss Association of
America, Bethesda, MD. Volume 29, No. 1. Jan-Feb 2008.
pp. 21-24.
—o—o—o—o—o—o—o—o—o—o—o—
Getting Captions On Your New TV—The Good, the Bad and the Downright
Frustrating
by Neil Bauman, Ph.D.
Right now we are in a transition between the existing analog
TV transmission standard and the new digital TV standard. On
February 17, 2009 here in the USA, all analog TV
transmissions will cease, and we will enter the 100% digital
TV transmission age. (Don't confuse digital TV with high
definition (HD) TV.)
This raises a number of questions concerning how captions
will work with digital TVs, set top boxes, converter boxes,
cable boxes, etc.
Because it was not clearly thought through from the beginning
of the planning phase, this is more complicated that it needed
to be is. To explain some of the things of which you need to
be aware, here is my friend Steve Barber. He writes:
"There are several advantages of digital captions, such as
being able to control the color, size, transparency and
location of the captions (depending on your equipment). In
addition, captions should never garble if you've got a
digital signal.
However, things aren't as simple as they used to be.
Originally, TVs only had one input (the antenna) so hooking
them up wasn't much of a technical challenge. Then, along
came cable, satellite, VCRs, DVDs, set-top boxes, home
theater equipment, caption decoder boxes (later replaced by
chips in the TV) and things got more complicated.
For years, TVs have had various places to plug in all that
stuff—coax connectors for the satellite and cable, RCA
(composite) jacks for various other sources, and S-video on
some TVs for certain connections. Even so, since 1993, the
captions were normally decoded by a chip in the TV, no
matter what the source.
Now, in addition to the above connectors, digital TVs also
have HDMI connectors (which are supposed to allow optimum
picture and audio quality).
Here's where it gets more interesting. Captions are no longer
analog signals buried in the invisible raster scan of the analog
TV signal. Digital captions are stored in the signal as bits. The
problem is that HDMI connectors only carry the video and
audio signals. They can't carry the digital captions. Thus, one
problem is how to get captions if you use an HDMI connector
from a converter box or other source.
The answer is that converter and set-top boxes will have
caption decoder chips built-in, just like your TV has today.
Thus, if you use an HDMI connector, you'll have to turn on the
captions in the set-top box or another source, and have it
insert the captioned text into the image, which the HDMI
connector can then transmit.
Alternatively, you can connect your TV from various sources
with one of the other connector types, and then use your TV's
decoder chip to decode the signal. Depending on the
connector, the signal may not be as wonderful as it could be,
but also, depending on your TV, it may not matter. Most of the
great TVs you see in the store are being run on composite
connections, not HDMI. Fortunately, on most TVs you'd not be
able to tell the difference anyway.
DVDs and VCRs present another problem. A few have their
own tuners, and therefore have their own caption decoders
built in. Thus, you may be able to use that caption decoder if
you can't otherwise get the undecoded captions to your TV.
A word about DVDs: DVDs frequently have both closed
captions and subtitles. Some DVDs only have one or the
other. Thus, you have to know which is which, and how to get
them displayed. Also, you have to make sure they are not both
displayed at once! Closed Captions have to be decoded to
be displayed. Subtitles are an option on the DVD's program
menu.
If you want to see the captions encoded on a DVD, you'll
either need to have a DVD Player that has its own tuner and
caption decoder (there aren't many of them), or you mustn't
connect to your TV via HDMI. If you are connected by HDMI,
you'll need to decode the captions first in the player so they
are then incorporated as part of the image which then can go
via HDMI.
Subtitles are probably going to be more common on DVDs
because the DVD players will let them be put in the image if
you select them. Thus, if the DVD has subtitles, it's probably
the easiest solution for captions when playing a DVD.
Originally Closed Captions were designed for people who
couldn't hear, so they included environmental sounds, such as
"dog barks" or "toilet flushes" as well as what was spoken.
Subtitles (remember silent films or foreign films?) were
originally for people who could hear, so they didn't include
environmental sounds. Even when they first appeared on
DVDs, subtitles didn't include environmental sounds. As a
result, many deaf or hard of hearing people preferred the
Closed Captions.
Fortunately, recent DVDs are starting to include "Subtitles for
the Hearing Impaired" (SDH) and to include the environmental
sounds. In the future, I think we'll see DVDs with SDH instead
of Closed Captions. That may simplify getting captions
displayed when you're using a DVD.
Your set-top box for cable or satellite, or a digital to analog
converter box, will have menus (and maybe a remote button)
for controlling the caption decoder in the set top box. Thus,
for most people when watching TV through one of those,
you'd turn off your TV's decoder and turn on the decoder in
the set top box. This should be reliable and easy, but you'll
have to understand which devices have decoders, and how to
turn them on or off. Once you've set them up, it should be fine
even though there are so many more options to understand
than in the old days."
_______________
You can find a bunch of good information at the
North Carolina
Hearing Loss Association website Steve maintains.
—o—o—o—o—o—o—o—o—o—o—o—
Are You a Hard of Hearing Musician?
by Neil Bauman, Ph.D.
If you are like many people, when you lose some/most/all of
your hearing, one of the things you really miss is music. This
is especially true if you are/were a musician, whether amateur
or professional.
Maybe you weren't aware of it, but their is an organization
especially for you called the "Association of Adult Musicians
with Hearing Loss (AAMHL). If you are interested in joining
them, check out their web site.
—o—o—o—o—o—o—o—o—o—o—o—
Hearing Loss Increasing in Mexico (and here too!)
by Neil Bauman, Ph.D.
Hearing loss among younger people is reaching alarming
proportions. Here are some excerpts of a recent report out of
Mexico showing the conditions there—and we here in the USA
are probably not all that much different—at least in regards to
excessive noise.
The report begins, "The excessive noise found in the main
cities of Mexico and the improper use of certain antibiotics are
seen as the main reasons for an increase in the number of
hearing impaired Mexicans...
A study carried out in a suburban area of Mexico City
measured the noise levels in two schools, two manufacturing
plants, a shopping center and a block of flats. Researchers
found noise levels between 90 and 100 dB." (1)
Sustained sounds above 80 dB are believed to cause hearing
loss, and these sound levels are much higher. Remember
each 10 dB increase represents a tenfold increase in
sound pressure.
The report continues: "135 subjects aged between 15 and 49
years were screened for hearing disorders. Researchers
found that 35% of the participants suffered from severe hearing damage. Surprisingly, the group aged between
15 and 29 years was more severely affected by hearing damage.
Researchers concluded that the higher incidence in the
youngest group may be due to unrestrained use of personal
stereos. More and more people try to drown out the
background noise by listening to music on their MP3 players,
thus increasing their risk of suffering from hearing loss."
In addition to noise, the misuse of ototoxic antibiotics is
another factor causing this hearing loss epidemic.
Unfortunately, most antibiotics are ototoxic to some degree,
while the Aminoglycoside class of antibiotics is extremely
ototoxic. Adding to this problem is the fact that such highly-ototoxic antibiotics are often readily available in developing
countries. Mexico is no different. "Unfortunately, any adult can
obtain antibiotics without medical prescription in Mexico."
One thing this report doesn't mention is that when you
combine noise with certain ototoxic drugs, the resulting
hearing loss is much worse that what would have been
caused by either noise or drugs by themselves.
(1) Hear-it Press, January 31, 2008
**************************************************
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===============================================
2. Beware of (Ototoxic) Drugs That Can Damage Your Ears
===============================================
Ear Wax Removal Medication (Cerumenex) Found to be
Ototoxic
by Neil Bauman, Ph.D.
You would think that a medication to remove ear wax would
not damage your ears, wouldn't you? Don't bet on it.
A new study at The Montreal Children's Hospital revealed a
shocking truth—such preparations can be very damaging to
our ears. Here's the report.
_____________
A new study, led by researchers at The Montreal Children’s
Hospital, has revealed that certain over-the-counter earwax
softeners containing the active ingredient triethanolamine can
cause severe inflammation and damage to the eardrum and
inner ear.
The results of the study, recently published in The
Laryngoscope, suggest that use of these medications should
be discouraged.
“Patients often complain that wax is blocking their ears and is
causing discomfort and sometimes deafness,” says Dr. Sam
Daniel principal investigator of the study and director of McGill
Auditory Sciences Laboratory at The Children’s.
“Over-the-counter earwax softeners are used to breakup and
disperse this excess wax. However, the effects of these
medications on the cells of the ear had not been thoroughly
analyzed.” “Because some of these products are readily
available to the public without a consultation with or
prescription from a physician, it is important to make sure they
are safe to use."
"Our study shows that in a well-established animal model, one
such product, Cerumenex, is in fact, toxic to the cells of the
ear,” says Dr. Daniel.
Dr. Daniel and his team studied the impact of Cerumenex on
hearing. In addition, overall toxicity in the outer ear and
changes in the nerve cells of the inner ear were analyzed.
“Harmful effects to many of the cells were observed after only
ONE dose,” says Dr. Melvin Schloss co-author and MCH
Director of Otolaryngology. “We observed reduced hearing, severe inflammation, and lesions to the nerve
cells.”
“We believe these findings are applicable to humans,” add Dr.
Daniel. Overall, our findings suggest that Cerumenex has a
toxic potential and it should be used with caution.” (1)
_____________
Did you notice that? Cerumenex can cause hearing loss
and a number of other ear problems! Why is this just being
reported now?
Actually not all of this information is new. It has been known
for a number of years. For example, if you had a copy of
"Ototoxic
Drugs Exposed" published back in 2002, you would have already known
that Cerumenex was ototoxic—that it could cause tinnitus, ear
pain, and unspecified ototoxic damage—typically hearing
loss.
(1) The Montreal Children's Hospital, January 28, 2008
http://www.muhc.ca/media/news/?ItemID=28904
—o—o—o—o—o—o—o—o—o—o—o—
Grapefruit Juice and Ototoxic Drugs
by Neil Bauman, Ph.D.
A lady asked: "Can a person drink grapefruit juice, or eat
grapefruit without taking medications with it and be ok, or does
grapefruit affect hearing loss period?"
If you are not taking any medications, eat/drink as much
grapefruit as your heart desires. It doesn't affect ears. It's not
the grapefruit that is ototoxic.
What happens is that certain drugs (which can be ototoxic)
can be absorbed into your bloodstream in much higher
quantities than usual if you normally have high levels of an
digestive enzyme called Cytochrome P-450 3A4 (CYP 3A4
for short) in your stomach and then eat grapefruit. The
furanocoumarins in the grapefruit prevent this enzyme from
breaking down the drug before it is all absorbed into your
bloodstream—hence you get a much higher drug dose than
otherwise.
Perhaps you don't realize it, but many drugs are not
completely absorbed by your body. For example, a given drug
may typically only be 10% absorbed and 90% excreted.
Doctors know this, so in effect they give you 10 times the
dose you need—knowing that 90% is going to be wasted and
only 10% absorbed.
Now, if you have high levels of CYP 3A4 in your stomach, the
furanocoumarins bind to the CYP 3A4 and prevent it from
breaking down certain drugs before they are absorbed. Thus,
you could end up with 10 times the dosage. If the drug is
ototoxic, you just got quite an ototoxic overdose, and that
could affect your ears. The highest figures I have seen related
to taking grapefruit juice were for Simvastatin (Zocor), which
resulted in a 1,513% increase. That's quite an overdose!
If you normally have very low levels of CYP 3A4 in your
stomach, then taking grapefruit doesn't make much
difference. In this case, your body normally absorbs much
more of these drugs—so your doctor has to give you a smaller
dose than to people with high levels of CYP 3A4.
Here's the rule of thumb. If you have high levels of CYP 3A4
in your stomach, you have to be consistent in your grapefruit
intake—so either always take a same amount of grapefruit
at the same time, or never take it. That way, the doctor can
adjust the dose to fit how your body absorbs it.
If you have low levels of CYP 3A4 then it probably won't make
much difference whether you eat grapefruit or not.
Incidentally, there are a few drugs that also bind to CYP 3A4
so you don't want to take them at the same time either.
If you want to learn more about this fascinating subject (and to
learn which drugs are sensitive to grapefruit) read chapter 10
in "Ototoxic
Drugs Exposed".
—o—o—o—o—o—o—o—o—o—o—o—
Will Taking Levofloxacin Make My Tinnitus Worse?
by Neil Bauman, Ph.D.
A man explained, "I have had tinnitus now for 6 years. It was
brought on by an inner ear infection. However I have suffered
very little or no noticeable hearing loss. My tinnitus has been
chronic and constant, never stopping. It is a hissing, whistling
sort of pitch. Usually it is low, always noticeable to me but
lately seems louder.
I was recently diagnosed with diverticulosis and my Dr. has
prescribed Metronidazole and Levaquin. My question to you
is, am I at risk for hearing damage or permanently making my
tinnitus worse? I explained the situation to my Dr. but she
affirmed that these are safe for my treatment. I am depressed
because the tinnitus has been very hard for me to deal with
over the past 6 years. I just want to make sure I am doing the
right thing."
You are wise to check out the side effects of drugs before
you take them. Metronidazole is mildly ototoxic and may cause
tinnitus although I don't think it very likely as only one source
has reported tinnitus. It is not listed as causing hearing loss. I
don't think I'd worry about this drug.
However, Levofloxacin (Levaquin) is another matter. It is
moderately ototoxic. In addition to my usual published
sources indicating it can cause tinnitus, I've had a number of
people tell me their stories, and for most of them it resulted in
bad tinnitus. One person also reported hearing loss. So this
isn't a drug you'd really want to take since you already have
enough tinnitus as it is—but of course, the choice is up to you
in consultation with your doctor.
This man also asked, "If tinnitus is listed as a possible side
effect to these medications , does one necessarily get tinnitus
from taking them? Can I perhaps take them and not make my
tinnitus worse and yet solve my other problem?"
Yes, you may take these drugs and not get tinnitus. Not
everyone that takes these drugs gets tinnitus. In fact, it may
be a reasonably small percentage that do get tinnitus from
taking them. The real problem is knowing which group you are
going to fit into—the small unfortunate tinnitus group, or the
large non-tinnitus group. Since there is no way of knowing
ahead of time, I warn people so they can decide for
themselves whether they want to take this risk or not—especially as in your case, you already have bad tinnitus, and
you don't want to do anything to make it worse.
It looks like all the Quinolone family of which Levaquin is a
member can cause tinnitus, but perhaps some of them are not
as likely to cause tinnitus as are Levofloxacin and
Ciprofloxacin (another common Quinolone)—I really can't say.
Finally, this man asks, "Is there a safer medication or
treatment to this?"
Again, I can't really say—remember I'm not a medical doctor—so I can't prescribe or treat medical conditions. I just provide
information to help people make more informed decisions.
However, I was looking in one of my books and it says that
Cefadroxil (Duricef) is also used in treating diverticulosis—and
this drug is not listed as causing tinnitus, nor have I heard any
reports of people getting tinnitus from it. If your doctor agrees
that this drug will do the job, it would almost certainly be much
easier on your ears than any of the Quinolones. Its worth
asking your doctor about it.
If you want to check out the ototoxic side effects of the
Quinolones (or any other ototoxic drugs for that matter) look
them up in "Ototoxic Drugs Exposed". This book contains
information on the ototoxicity of 763 drugs known to damage
ears (and a number of chemicals too).
**************************************************
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**************************************************
===============================================
3. Answers to Your Questions
===============================================
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.
Squeaking Tinnitus with each Heartbeat—What's Going On?
by Neil Bauman, Ph.D.
Recently a woman explained, "I haven't lost my hearing, but I
hear my pulse as a "squeak" frequently. It is only on the left
side, but it is very annoying and sounds like a heart murmur.
Any suggestions?"
When you hear your pulse in one or both ears, this is a type of
tinnitus called pulsatile tinnitus. Interestingly enough, as you
have found, typically you only hear pulsatile tinnitus in one ear.
I've never heard it described as a squeaking sound before,
but it is consistent with what other people hear. One lady
hears hers as a high-pitched ringing sound in time with her
heartbeat, while a man explained he hears a "zing, zing, zing"
sound in time with his heartbeat. Thus, your "squeak, squeak",
"squeak" fits right in.
Since you are writing to me now, I assume that this is a fairly
new phenomenon—and not a tinnitus sound you've been
hearing for years.
Typically pulsatile tinnitus is related to the blood flowing in the
arteries in your neck and near your ears. Normally you don't
hear such sounds, but when something changes in the blood
vessels near your ears, you sometimes hear these strange
(and annoying) tinnitus sounds.
There are at least 25 different known causes of pulsatile
tinnitus. The three most common causes of pulsatile tinnitus,
accounting for 68% of the cases, are Benign Intracranial
Hypertension (BIH) syndrome, Carotid Artery Disease (CAD)
and Glomus Tumors (benign masses of blood vessels that
grow near the ear). The good news is that this kind of tinnitus
can often be fixed once the specific cause is identified.
Generally, pulsatile tinnitus occurs when the smooth flow of
blood in the blood vessels in your neck or head is interrupted.
Often this is caused by atherosclerotic build up of cholesterol
on the walls of your arteries, or high blood pressure. These
conditions cause your blood to flow faster and/or more
turbulently—thus producing these strange sounds in step with
each heartbeat.
The first step in treating pulsatile tinnitus is to go to a
cardiovascular specialist and see if he can pinpoint the cause
and go from there.
To learn more about pulsatile tinnitus, check out the section
on "Pulsatile Tinnitus in "When Your Ears Ring! Cope with
your Tinnitus—Here's How".
—o—o—o—o—o—o—o—o—o—o—o—
Chances of Children Having Large Vestibular Aqueduct Syndrome (LVAS)
by Neil Bauman, Ph.D.
A mother wrote, "My daughter has LVAS [Large Vestibular
Aqueduct Syndrome]. My husband and I have not had genetic
testing done to determine whether we are carriers. Am I to
assume that since my daughter has LVAS, so will my son?"
No—unless you both also have LVAS. The fact that your
daughter has LVAS indicates that you both are carriers of
the LVAS gene(s). Since you are just carriers, then there is a
25% chance your son will have LVAS, a 50% chance he will
be a carrier, and a 25% chance he won't carry the gene(s) at
all. At least that is how I understand it. (I'm sure it is more
complicated than the above because they don't even know all
the genes involved in LVAS yet—but it should give you a good
general idea.)
Also, remember this is the average in a large population.
That said, it IS possible you could have 4 kids in a row with
LVAS, or have 4 kids in a row without LVAS—but on the
average the 25, 50, 25 rule holds—just like you can flip a coin
and get 4 heads in a row or 4 tails in a row—but it is not likely.
Just because you already have a child with LVAS doesn't
make succeeding children more (or less) likely to have LVAS.
each child has the same 25/50/25 percent chance of having
LVAS independent of whatever has occurred before with your
other children.
To learn more about LVAS, read this article.
—o—o—o—o—o—o—o—o—o—o—o—
Large Vestibular Aqueduct Syndrome (LVAS)—Why Did It Just Show Up Now?
by Neil Bauman, Ph.D.
A lady asked: "To have Large Vestibular Aqueduct Syndrome
(LVAS), both parents have to have the gene, right? And their
parents before them have had to have the gene? I come from
a big family, and no other relative has had a hearing issue. If it
is inherited, I would think you would see it more in the family
history. I've started to tell family members about my son's
diagnosis and that it is an inherited gene. They look at me like
I have lost my mind! They all say they don't know of anyone
that has a hearing problem in the family."
First, remember this is a recessive trait—so yes, both parents
have to have at least one gene of the gene pair to give the
child LVAS. However, one parent could have one gene from
one of their parents who could have one gene from one of
their parents, etc., and LVAS would never show up until finally
someone in the family (in this case you) married a person who
also carried the LVAS gene.
Second, your son has a mild to moderate hearing loss. Maybe
there really are some in your family that also have LVAS but
have such a mild hearing loss no one was ever aware of it.
Third, we don't have a clue how many people are walking
around with LVAS and never have a hearing loss—we only
know some of those that do have the hearing loss. Until they
test the general population for LVAS, they'll never have a
handle on just how often it causes hearing loss vs. not causing
hearing loss.
Thus, there are 3 possibilities why your son has LVAS (which
is passed genetically) and a hearing loss although it doesn't
appear to be in your family.
This mother concluded, "I'm beginning to believe that I
caused my son's hearing loss because of something I did,"
You are right. You did! You married his father didn't you? But
that wasn't a bad thing, was it?
—o—o—o—o—o—o—o—o—o—o—o—
Will My Tinnitus Ever Go Away?
by Neil Bauman, Ph.D.
A man wrote, "I do not expose myself to high noise levels
either in my occupation or leisure. I do not listen to iPods etc.
However, 5 days ago after a night out, when leaving a bar with
loud music, my hearing felt dull. While my hearing appears
normal, I now have a feeling of fullness and a constant ringing.
I have scared myself silly reading all the forums and panicking
that after 5 days, this may be permanent. Has tinnitus been
known to go after 5 days?"
I'd call going to nightclubs exposing your ears to loud sounds
in your leisure time. You may have been exposing your ears to
more loud sounds than you realize.
The feeling of fullness you are experiencing is actually
indicative of a temporary threshold shift. In other words you
do have a hearing loss significant enough that your brain
notices it—thus you get this "blocked" feeling. The constant
ringing (tinnitus) is another sign that the noise was far too
loud, and you exposed your ears for far too long.
I'm glad you have "scared yourself silly". Hopefully, you will
now carefully protect your ears in the future. Too bad you
hadn't done that before. At the very least, have some foam
ear protectors in your pocket, and put them in your ears
before you go into noisy places, or leave as soon as the
racket gets too loud.
Now to explain about tinnitus and whether it will go away.
Typically the way it works is that the first few times you expose
your ears to loud sounds the tinnitus goes away reasonably
rapidly—hours or a day or so—but the more you expose your
ears to loud sounds (and the louder the sounds are), the
longer it takes for the tinnitus to go away. Finally, if you don't
wise up and protect your ears, it will never go away.
I doubt this was your first time in a night club, so I fear you
have been exposing your ears to excessive noise for some
time.
The main thing now is not to expose your ears to any louder
sounds in order to give them time to "heal" if they will. After a
month or so, re-evaluate your tinnitus and see whether it has
gone away. In the meantime don't dwell on your tinnitus or it
will only appear to get worse. You need to totally ignore it by
focusing on the loves of your life and let the tinnitus fade into
the background.
In a month or so, it wouldn't hurt to go to an audiologist and
have a complete audiological evaluation to see the state of
your hearing. That way you'd know if there was any permanent
damage. I wouldn't go now—give your ears time to recover,
and hopefully the temporary threshold shift will go away.
—o—o—o—o—o—o—o—o—o—o—o—
Can Musical Ear Syndrome (MES) Be Caused by Anxiety or Depression?
by Neil Bauman, Ph.D.
A lady wrote, "I just discovered references to you on the
Internet while I was trying to Google information about what I
now know you have coined "Musical Ear Syndrome".
The MES reference fits me to a "T", and I am so relieved to
find that others experience this, too. I am 47 years old, and I
have been hearing music all day long for about a decade. But
what I've found is that it waxes and wanes depending on my
level of anxiety or depression. Its reappearance coincides
with increased stress/anxiety/depression.
I have taken Paroxetine three times since 2000. I most
recently began taking it again about 12 weeks ago. Prior to
that, I had heard music in my head increasingly for about six
months. After beginning the Paroxetine, the MES
disappeared. However, over the past two weeks it has
returned, and I have noticed along with it a slight elevation in
my anxiety/depressive symptoms, enough so that I am
increasing my dosage.
What I was wondering is whether you have any information
about why this seems to be the case with me, is it dangerous
(i.e. a precursor to eventual hearing loss or dementia, etc.),
should I be checked out for other causes, as I am not elderly,
do not live in a totally quiet environment (though I try to keep it
that way as much as possible), and am not hard of hearing. Do
you think it's linked to my depression/anxiety issues? Should I
be concerned?
You are perceptive. Stress, anxiety and depression are all
factors associated with Musical Ear Syndrome.
When I was researching musical ear syndrome, I found 5
things in common in many people, but since then, I've heard
from numbers of people more or less in your boat—that do not
fit the typical MES mold—but nevertheless have the same
phantom music.
I'm still trying to figure out why it affects people like you—but I
have noticed that anxiety/stress/depression may be a
common thread.
I do not believe that it is a precursor to anything such as
hearing loss or going crazy. I think it is just the way your
body/brain reacts to stress/anxiety/depression.
Let me explain the roles of anxiety and depression in this.
When you are anxious, essentially your body is in the "fight or
flight" mode—and all your senses are heightened. This means
your hearing is more sensitive too—so you hear things you
wouldn't otherwise—and maybe this includes faint phantom
sounds rattling around in your auditory system that you were
not otherwise aware were there. (This is also why anxious
people tend to have hyperacusis—hear normal sounds as
too loud—the internal volume control is turned up too high and
stays there.)
Now for the role of depression. When you are depressed you
normally turn your focus from the external to the internal. Thus,
you become more aware of the internal workings of your body
and "notice" the phantom sounds. Because you are
depressed, you focus on these sounds more and more
wondering what is happening to you—and these sounds
become more and more intrusive and louder in the process
because your limbic (emotional) system is flagging them as
important since you are worrying over them. Thus begins the
vicious circle.
What you need to do is get your anxiety and depression under
control and hopefully these phantom sounds will begin to fade
into the background again.
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===============================================
4. Coping Strategies
===============================================
Don't Tell People "I am Hard of Hearing"—Instead, Say
"Here's How You Can Communicate With Me"
by Neil Bauman, Ph.D.
A college student explained, "Last semester, I was getting
really depressed about how isolated socially I am in my
graduate program. I tell my classmates I'm hearing impaired,
but only one or two of them ever bother to talk to me
before/during/after class. It got so bad, I started seeing a
counselor on campus once a week. Last time I met with her, I
was complaining about this issue—that when I tell my peers
that I can't hear, no one inquires how they can communicate
with me, and after that seem to avoid conversation. It makes
me feel even more invisible! Her response was interesting.
She suggested that perhaps a lot of people might be afraid of
offending me more by asking questions about my disability—like one might refrain from offering physical help to a stranger
in a wheelchair, rather than risk sounding condescending and
patronizing."
Another lady wrote, "I have found that when I tell people that
I'm hearing impaired, they back off, or they come up right to
my face and talk. I've had very few who will take the time and
talk with me. It's like it's too much of a bother. I get frustrated
at times and feel very lonely to the point of not going out at
all."
I know how you ladies feel. I've had similar experiences
dealing with my lifetime severe hearing loss. You are
blaming other people for not wanting to put out the effort to
talk with you. Did you ever think these people are afraid about
how to talk to you?
When you tell people you are hard of hearing, what you are
really doing is warning them to stay away because
communication is going to be difficult or impossible. And as
you have found, it works!
Much better is to say in the same breath, "I have a
hearing loss, but I can converse with you quite well if you...." (and here you tell the person exactly what
you need him/her to do so you can understand). This will differ
with each person and situation. This shows them that they
can converse with you without a lot of hassle.
What you have now done is explain that although you can't
hear well, there IS a way that communication can be
successful, and then you tell them one or two simple
things you most need them to do (look at me, get close,
speak into my microphone, or whatever). Now they are not
afraid to talk to you. They know they can do those simple
things without embarrassing themselves, so they are much
more willing to talk to you.
So the secret is, put them at ease by showing them
what they need to do to make the conversation a success.
The results may surprise you, so go for it!
—o—o—o—o—o—o—o—o—o—o—o—
Pets and Tinnitus Reduction
by Neil Bauman, Ph.D.
A lady wrote, "I found a little dog and had him with me for one
week before finding his grateful owners. Of course I had to
walk him, and I fussed over him (a sheltie/Pomeranian mix—he
is super cute). During that time, it seemed the ringing in my
ears was much less. Perhaps it was only that I was occupied—but I think there is some healing effect beyond what we
understand that pets have on us. I know it is a subject much
talked about, but I never experienced it first hand (I have laid-back cats but they are different)."
I think it was mostly that you had something to focus on—and
when you do that, often you don't notice your tinnitus as much.
But who knows what loving a pet can do for your health in the
broadest sense? Anything that helps you deal with your
tinnitus is a good thing. Maybe you need to get yourself a little
tinnitus-reducing dog of your own?
—o—o—o—o—o—o—o—o—o—o—o—
Losing Balance from Loud Sounds and Sensitivity to Sound
by Neil Bauman, Ph.D.
A veteran wrote: "My hearing loss and tinnitus is service-connected. I was exposed to constant cannon fire while in
the Marine corp. No hearing protection. Marines were
expected to tough it out. Now I'm paying for that silly
theory with my hearing problems.
I am trying to explain to the VA doctors and audiologists about
my severe sensitivity to sound. Some loud sounds hurt my
ears really bad. This is causing me to have anxiety and panic
attacks secondary to the loud sounds.
The VA has said that my problems are psychological so I'm
now seeing a psychologist. I am very depressed because of
my inability to hear well, and my tinnitus is extremely loud. I
sometimes think that there are mice in my ears scratching to
get out. The tinnitus and combined hearing loss is very
depressing, but so also is the sensitivity to loud sounds.
Loud sounds cause me to become disoriented and dizzy and
I lose my balance. Several times, upon hearing loud sounds, I have fallen. I
realize that this is caused by my anxiety reactions and panic
reactions to the pain of the loud sounds. My problem is that I
can't seem to make the VA medical people understand.
They just think I have to get over the depression. They think
the depression is causing the problem and that when the
depression goes away so will the tinnitus and sensitivity to
sound. I also hear phantom sounds, which I know are a part of
my hearing loss and tinnitus. But again the VA is saying no.
They want to blame it on psychosis? The bottom line is that
the depression, anxiety and panic disorder are secondary to
my hearing problems."
Fear of sounds is called phonophobia. In your case you
perceive the sounds as so loud they hurt. No one wants to be
hurt—whether it is loud sounds or anything else.
However, I think that rather than having phonophobia, you have
hyperacusis—where you perceive normal sounds as too loud.
Hyperacusis is often the result of having your ears damaged
by loud noise such as you were exposed to in the Marines.
Living with loud tinnitus day in and day out can lead to
depression. Actually, this is sort of a Catch 22 situation.
Depression often leads to louder tinnitus—so you want to get
your depression under control in order to help control your
tinnitus, but on the other hand, loud tinnitus leads to
depression, so you want to get your tinnitus under control if at
all possible.
You can learn to live and enjoy life even though you have
tinnitus and can't hear much. I don't hear much at all now, and
I've had tinnitus day and night for 35 or more years—but I don't
let it affect my happiness. My book, "When Your Ears Ring—Cope With Your Tinnitus—Here's How"
has helped many.
It's interesting (not nice, but interesting) to note that loud
sounds also cause you to lose your balance. I don't see how it
relates to anxiety reactions like your doctors think it does. To
me, it seems you have a condition called Tullio's
Phenomenon in which people lose their balance from loud
sounds—not from anxiety or panic.
Another name for it is Superior Canal Dehiscence Syndrome.
Basically what happens is that you have a hole or thin spot in
the bone separating the balance system from the hearing
system. Thus when you hear a loud sound, the sound wave
travels via the hole to act on the balance system. Since it is a
sound signal and not a balance signal it sends false balance
information to your brain. This totally confuses your brain and
the result is loss of balance. Some people drop to the floor
like they were knocked out. Others have vertigo and some
dizziness and imbalance. Sometimes doctors can patch the
hole and cure this, but other times not.
If this is what you have, then the psychologist is wrong in
trying to treat you for anxiety and panic. Yes, you need to get
those under control too, but you also need to have an
otologist check you out for things that cause Tullio's
Phenomenon such as Superior Canal Dehiscence Syndrome.
You have several ear related problems and each one needs
the proper treatment by the appropriate professional.
Blaming it all on you just isn't going to help!
===============================================
5. Information on Hearing Aids, Cochlear Implants
and/or Assistive Devices
===============================================
Need Help To Hear Better—Hearing Aids and Assistive
Devices
by Neil Bauman, Ph.D.
A lady wrote, "I am hard of hearing and have been so for
years. I will be 69 in July. I have been told I have nerve
deafness in both ears. Is there any help for people when
hearing aids are between $5,000 and $6,000. Is there
anything good that would help me to hear without getting
hearing aids?"
First, not all hearing aids are $5000 or $6000 each. For
example, I wear America Hears hearing aids—and the nice
thing is that ALL of their hearing aids are the same price—whether you get the entry level model, or the ones with all the
bells and whistles—and that price is only $995.00 each. That's
a far cry from $5000 or $6000 each. In addition,
America
Hears is a very reputable (though yet not well-known)
company that makes their own hearing aids right here in the
USA.
Second, in addition to hearing aids, there are a whole
assortment of assistive listening devices (ALDs) that can help
you hear, with, or without, hearing aids. The nice thing is that
the price of these devices isn't much—typically between $100
and $200, although some are much more. In any case, they
are much cheaper than hearing aids and work very well.
Sometimes I use them instead of my hearing aids because in
certain situations, ALDs work better than hearing aids.
Third, another nice thing about ALDs is that they typically last
"forever" (at least the ones that I carry) and not just a few
years like hearing aids typically do.
You have some choices that do not break the bank. If you
want to
learn more about these wonderful assistive devices,
read my new primer on the subject.
—o—o—o—o—o—o—o—o—o—o—o—
Hearing Stereo with One Ear (good solution)
by Neil Bauman, Ph.D.
In the December edition of this eZine a lady wanted to know
how to hear both stereo channels in a single ear bud as she
only had one working ear. I wrote, "The neatest would be if
you could find a single earbud wired to a stereo plug."
At that time I was not aware of any. Fortunately Barry Leeper
of Scan Sound, Inc. saw this article and wrote:
"We have developed a single earbud, called "1- BUD," that mixes both the left
and right channels of stereo audio into one ear. This will be especially helpful to those who have
lost their hearing in one ear and want to use a single earbud
for both audio channels from their iPod [or other audio device]
in their other ear."
I've not tried it, but their "1-BUD" looks like the real McCoy for this application.
—o—o—o—o—o—o—o—o—o—o—o—
Invisible (Completely Implantable) Hearing Aids Are Coming
by Neil Bauman, Ph.D.
Clinical trials for invisible (internal) hearing aids are underway.
They are seen as a boon to those people who refuse to get a
hearing aid because of the negative social stigma attached to
wearing hearing aids.
In addition, these hearing aids are also waterproof (unless
your head leaks!) and obviously will work while you sleep (so
you could hear the baby crying—good if you are the caregiver—bad if you are trying to sleep)!
One such device is the Carina, developed by Otologics, of
Boulder, CO. The microphone, implanted beneath the skin
behind the user's ear, picks up the sound. The sound signal is
processed and amplified and sent to a tiny vibrating
transducer that is attached to one of the bones of the middle
ear. From there the signal works through the rest of the
auditory system the normal way.
According to an article in the Hearing Review, "The device is
powered by a battery that is recharged when the user places a
small radio transmitter against the head for 60 to 90 minutes.
The transmitter is held to the skin by a magnet in the implant.
An inductive coil in the implant converts the radio energy to
electricity and recharges the battery with it. The battery can
stay inside the body for at least 5 years, according to the
company, before it needs to be replaced. The implanted
components are hermetically sealed together to protect
against leaks, so the electronics, microphone, and inductive
coil are replaced as well. However, the piston in the middle
ear remains in place." (1)
I find the results of the Phase I trials rather revealing. The
above article reports, "Twenty subjects with moderate to
severe hearing loss were implanted in one ear. (Seventeen of
the subjects had worn conventional hearing aids prior to the
study.) The subjects did somewhat worse than with the
hearing aid they had previously worn: their ability to hear a
range of single-frequency tones dropped between 5 and
12 decibels, and mean word-recognition scores dropped from the low 80 percent range to the high 60 percent range."
Notice that not only did they not hear as well, they also lost a
fair amount of discrimination. In other words they couldn't
understand as much of what they heard as compared to
wearing conventional external hearing aids.
Rather interestingly, "a satisfaction survey found that the
subjects felt that the device not only improved their hearing,
but also sounded more natural than their old hearing aid" even
though the clinical testing results showed otherwise. This
reveals just how desperately hard of hearing people want to
appear "normal".
The big question is whether the Carina is worth the extra cost
($19,000.00 in Europe) and the risks associated with the
surgery to implant it when compared to conventional hearing
aids.
Gerald Loeb, a professor of biomedical engineering at the
University of Southern California, is the voice of reason. He
argues that "implanted hearing aids should outperform
conventional ones before they can be considered worth the
extra cost and risk. He also questions the emphasis on
making an invisible device: 'How big an issue is it to have a
little appliance on your ear when the whole world is walking
around with cell-phone headsets and iPod earpieces?""
I'm certainly not against this new technology. I just think it
prudent to wait until all the bugs are worked out, and the
cost/risk to benefits ratio improves.
(1) "The Hearing Review", September 11, 2007
—o—o—o—o—o—o—o—o—o—o—o—
Implantable Hearing Aids—Should I Get One Now?
by Neil Bauman, Ph.D.
A lady wrote: "I have a progressive loss rated at "severe"
currently. At the rate I’m going, I’ll probably not be helped by
hearing aids within 10 years. Many of the ALD’s I have
purchased have not really been enough help, I am getting
more desperate about means to stay in the "hearing world".
I have looked into the implantable hearing aid trials by
Otologic. I have "passed" their criteria as a candidate and
await an opportunity to ask pertinent questions before
proceeding with the costly implant. What is your opinion of this
device?"
Many people have been eagerly waiting for a fully-implantable
hearing aid. They cite the benefits of being able to wear it in
the shower, or while swimming and while sleeping. Of course
the real push behind totally implantable hearing aids is that
they would be totally invisible so no one could tell you are hard
of hearing by looking at you.
However, there are some down sides and problems with
implantable hearing aids. Let's look at these so you can make
a more informed decision how you want to proceed.
First, implantable hearing aids (at least the current ones in
trials) will only work if you have a functioning inner ear.
Basically it just vibrates (more vigorously) the bones in the
middle ear—so if your cochlea is not working well, it will only be
of limited help—just like conventional hearing aids.
Unfortunately, most hearing loss (90+% in adults) is
sensorineural. In other words the inner ear is damaged and no
matter how vigorously you vibrate the middle ear bones, you
cannot completely make up for the missing hair cells in the
inner ear.
Second, tests reveal you won't hear as well with the internal
microphone of implantable hearing aids as you would with an
external microphone. The internal microphone is hidden
behind skin so it can't pick up the sounds as well as one open
to the air.
Third, there is the problem of replacing the batteries whenever
they ultimately die. This would require minor surgery to
replace the whole internal "hearing aid".
The current crop of implantable hearing aids will be more
useful to people with more moderate, stable hearing losses,
and to those with certain middle ear problems that can be
overcome by vibrating the bones more vigorously.
At present, I think this is much more of a vanity device than
any improvement in the quality of hearing.
Because you have a progressive hearing loss, and because
the worse your hearing gets, the less any hearing aid will help
you including implantable hearing aids, I fear you would be
wasting good money on it. The way things are going, in a few
years you will likely need a cochlear implant anyway.
Personally, I'd stay with powerful BTE hearing aids,
supplemented with assistive devices, until the time comes for
a cochlear implant.
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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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