June 27, 2006 Issue

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


Volume 1, Number 5                          June 27, 2006
Publisher: Neil Bauman      neil@hearinglosshelp.com
            http://www.hearinglosshelp.com
    Copyright Center for Hearing Loss Help 2006

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

                                                               -- Neil Bauman, Ph.D.

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In this issue
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1. Beware of (Ototoxic) Drugs that Can Damage Your Ears

2. Answers to Your Questions

3. Subscriber-only Special

4. Understanding Hearing Loss

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



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1. Beware of (Ototoxic) Drugs that Can Damage Your Ears
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Doxycycline and Hearing Loss


A man wrote: "My doctor is considering giving me low-dose
Doxycycline to treat my ocular rosacea. Can you tell me how safe
this drug might be for someone with a moderate sensorineural
hearing loss?

I was given tetracycline as a child (which badly discolored my
permanent teeth) and took it again for a number of years for acne
as a teenager. After learning about ototoxic drugs, I’ve wondered
if the Tetracycline might have contributed to my hearing loss.
Although the Tetracycline drugs are promoted as relatively safe,
I do have concerns about using Doxycycline. Is there any
information about this drug, in regard to ototoxicity?"

Information on the ototoxicity of many drugs is quite sketchy.
Drugs in the Tetracycline family are no exception. Here is what I
can tell you about them.

The Tetracycline family of antibiotics includes drugs such as
Tetracycline, Chlortetracycline, Doxycycline and Minocycline to
name some of the more common ones.

Often drugs in the same family have much the same ototoxic
properties. Thus, if Tetracycline did indeed damage your ears,
you could expect more damage from Doxycycline.

In order to determine whether there might be a connection between
your taking Tetracycline and your hearing loss, you need to think
back and see whether there is any correlation in time between
when you took the Tetracycline and the appearance of your hearing
loss. If your hearing loss occurred shortly after you first took
the Tetracycline, and got worse after the second bout, then there
would seem to be a strong cause and effect relationship. However,
if you did not get a hearing loss until many years later, I
would doubt that the Tetracycline caused it.

Although Tetracycline and Doxycycline are not listed in the
Physicians' Desk Reference (PDR) as causing hearing loss,
Minocycline is. However, we get a different story when looking
through the Canadian equivalent--the Compendium of
Pharmaceuticals and Specialties (CPS). There we find
Tetracycline, but not Doxycycline or Minocycline listed as
causing hearing loss.

From that, it would appear that hearing loss is not a big problem
with the drugs in the Tetracycline family. As you have already
noted, the Tetracycline family is generally not thought to be all
that ototoxic--at least to most people. However, there are a
number of exceptions. Some people do indeed suffer from hearing
loss after taking one of the Tetracyclines. I have had several
people contact me in this regard.

For example, one man had a severe ototoxic reaction to
Tetracycline that left him with a severe/profound hearing loss in
both ears. Another man took Chlortetracycline for a strep throat
that left him with a permanent hearing loss. Yet another man took
Doxycycline for a urinary tract infection and lost much of his
hearing as a result. Still another man took Doxycycline for 10
days to treat his cold. He reported, "the hearing in my already-
impaired right ear suddenly reduced to virtually zero and remains
there."

Thus, it is wise for you to be wary, especially since you already
have a hearing loss. This is because people with hearing losses
are even more susceptible to the ravages of ototoxic drugs than
those with normal hearing.

Will the Doxycycline affect your hearing? I don't think anyone
knows for sure. Thus, you are going to have to decide for
yourself, based on your earlier history with Tetracycline,
whether you want to risk taking the Doxycycline and having to put
up with any resulting ototoxic side effects or not. At least you
now know what you are dealing with.

If you choose not to risk it, you might want to investigate other
drugs that are not known to be ototoxic, or look at other options
such as herbal remedies.

For more information on ototoxic drugs in general read our
various articles on ototoxic drugs.

For complete information and individual listings on the known
ototoxic drugs and chemicals, go to Ototoxic Drugs Exposed.



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2. 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.
______________

Memory Loss and Confusion from Taking Diclofenac


A daughter wrote:

"I am very concerned for my 78-year old mother. She was
prescribed Diclofenac for 15 days, then complained of severe
tinnitus on Day 16, and was overcome by a severe attack of
vertigo on Day 17, lasting 4 days. When she could finally walk
(with a great deal of help), the Dr. noted severe hearing loss in
her right ear. An MRI did not indicate a tumor or any sign of
stroke.

Now, 9 weeks later, she no longer complains of dizziness and her
gait is better, but she is very fatigued and nauseous to the
point of vomiting 2 to 3 times a week. Of most concern is her
mental confusion and short term memory problems, which have only
become apparent since the vertigo attack. Can all of this be due
to the Diclofenac?"

Drugs can, and do, cause a number of unwanted side effects such
as your mother is experiencing that can flip her world upside
down in an instant.

Diclofenac, one of the non-steroidal anti-inflammatory drugs, is
definitely ototoxic to some people and can cause hearing loss,
tinnitus, dizziness, vertigo and ear pain. Unfortunately, it
seems your mom got 4 out of 5. In addition, she has memory
loss, mental confusion, vomiting and fatigue. Not nice at all.

The Diclofenac apparently damaged BOTH her cochlear (hearing)
system causing the hearing loss and tinnitus, and her vestibular
(balance) system causing the dizziness, vertigo and other
weird side effects.

Let me explain what likely happened to her balance system as that
seems to be giving her the most problems at this time.

Your balance system comprises three entirely different systems
that your brain uses to keep you erect. These are the balance
parts of your inner ears (vestibular system), your eyes, and your
proprioceptive system (pressure sensors in your legs and feet).
If all three systems send the same (or complementary) balance
information to your brain, all is well. However, if one system
suddenly begins sending "garbage," this immediately confuses your
brain and typically vertigo (a spinning sensation) and vomiting
is the result.

After some weeks, your brain learns to largely ignore the bad
balance signals. When it does that, the vertigo typically goes
away. At this point, you might think your balance system is
recovering, but not so. It is still just as damaged. However,
your brain is learning how to work around this damage.

Few people realize that damage to your vestibular system can also
result in the problems your mom is now experiencing--namely short
term memory problems, mental confusion and fatigue. Here's how
these relate to your balance system.

Keeping your balance is largely a subconscious activity. You
don't have to consciously think about varying the pressure on
your toes to keep yourself from falling over. The subconscious
parts of your brain automatically take care of this for you.
However, when your vestibular system is damaged, the subconscious
balance system no longer works properly. In fact, often you have
to consciously work to maintain your balance.

When you do this, you use the conscious parts of your brain that
you normally use for thinking and memory functions. So, instead
of being used exclusively for thinking and memory functions, the
conscious parts of your brain are now busy helping you maintain
your balance. As a result, your conscious brain doesn't have
enough "brain power" left over to properly do its real job. The
result is that your short term memory becomes erratic, and you
become confused because you can't remember instructions, or even
what someone was just talking about.

In addition, all this extra conscious effort to maintain your
balance is tiring. Hence the fatigue. Furthermore, because of the
hearing loss, your brain now has to work much harder in order to
understand speech--and this too is very tiring.

These are just a few of the MANY different effects that damaging
your balance system can have on your body. For a more in-depth
overview of the many ototoxic side effects of drugs, see Chapter
3 in Ototoxic Drugs Exposed.

Few people realize just how far-reaching the effects of drugs can
be on our bodies. If they did, they wouldn't be so quick to take
drugs for every little ailment, but save drugs for life-
threatening conditions. Learn about drugs before you take them.
You don't have to let drugs flip your world upside down.


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3. Subscriber-only Special
==================================================


As is our custom, with each issue we bring you a subscriber only
special that is only available to you, our loyal subscribers to
HearingLossHelp e-zine.

Since the above two articles deal with how ototoxic drugs can
damage our ears, and have other far-reaching effects on our
bodies and lifestyles, this issue's special puts in your hands
the one comprehensive resource that can help you avoid all these
problems--the book "Ototoxic Drugs Exposed."

--> Chapter 2 tells you what ototoxic drugs are.

--> Chapter 3 explains the many side effects ototoxic drugs can
have and how they can affect you.

--> Chapter 4 lists the many risk factors related to taking
ototoxic drugs, and even more importantly, shows you how you can
reduce this risk.

--> Chapter 12 lists 743 ototoxic drugs and their ototoxic side
effects so you can be proactive about not damaging your ears.

--> And as a bonus, Chapter 14 lists 148 chemicals that can also
damage your ears.

Until July 18th, you can get this invaluable book for only 35.99,
a savings of 10% off the regular price.

Take advantage of this discount offer and get your very own copy
of "Ototoxic Drugs Exposed," by clicking here.

You MUST click on the above link to take advantage of this offer.



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4. Understanding Hearing Loss
==================================================

What Is A Reverse-Slope Hearing Loss?


A lady asked: "What is a reverse-slope hearing loss? I have never
heard of this terminology for hearing loss, Would you please
enlighten me?"

Sure thing. Hearing losses go by some strange names such as
cookie-bite loss, ski-slope loss, reverse-slope loss, etc. These
names come from the SHAPE of the hearing loss when it is plotted
on an audiogram.

The most common is the ski-slope hearing loss. The ski-slope loss
is where you have reasonably good hearing in the low frequencies
(shown on the left side of the audiogram), but you don't hear
much at all in the high frequencies (shown on the right side of
the audiogram). The audiogram thus looks much like a ski hill
sloping DOWN to the right.

A reverse slope loss, as its name implies, is just the opposite.
Hearing loss is mostly in the low frequencies, with little or no
loss in the high frequencies. Thus a reverse-slope loss slopes UP
to the right. Reverse-slope losses--especially the extreme
version I have, are very rare.

If you want to learn more about the strange names associated with
the various kinds of hearing losses, and see the shapes they form
on audiograms, read my short, illustrated article "Kinds of
Hearing Losses."

If you want to learn more about reverse slope hearing losses and
just how weird hearing is with this kind of loss, watch for our
in-depth article "Reverse Slope Hearing Loss" that will be posted
to the HearingLossHelp website in July.



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


Why Won't My Daughter Wear Her Hearing Aids?

A mother wrote: "My 2-year-old daughter really hates wearing her
hearing aids. She has been fitted with bilateral hearing aids
since she was 3 months old.

We have had many different ear molds made. We have adjusted
settings on her hearing aids many times. I have recently taken
her to a new audiologist to see if she can help this situation.
She turned up her hearing aids to see if this would help her to
see the benefit of her hearing aids. This has been a very
frustrating experience since she was 7 months old and learned to
pull them out. I have tried many measures to make her wear her
hearing aids including setting time limits where she has to wear
them, putting her in time out when she takes them out, rewarding
her with praise when she has worn them for an extended period of
time, etc. I do well to get her to wear them two hours a day. She
still gets upset when I get her hearing aids out and make her
wear them, and often when I leave the room she pulls them out.
She has group speech therapy with 2 other children that have a
hearing loss similar to hers and their parents don't have this
problem.

She has seen 2 audiologists that specialize in pediatrics and
both of them I think are at a loss of what to do. She does
perform better with her hearing aids on in the sound booth than
when they are off.

I am her parent and I know that hearing aids are extremely
important but I don't have to wear them and I am afraid they are
hurting her. I do not know what they feel like on my daughter's
ears, and she is not old enough to tell me why she does not like
them. I feel as if everyone thinks I am being ridiculous and a
negligent parent by not forcing her to wear them every waking
hour. I would love for her to wear them all of the time and I get
so excited if we have a few good days where she wears them for 5
to 6 hours. There is nothing more that I want than for my child
to hear more clearly but I don't want her to be miserable either.
I don't think that it is fair just because she is a child and I
am an adult that I spank her, put her in timeout, act angry at
her, etc. if she takes her hearing aids out. Do you have any
insight into all of this."

I hear you. You are caught between the professionals that say she
MUST wear her hearing aids all the time, and your daughter who
much of the time hates wearing them and thus yanks them out. The
professionals are theoretically correct, but your daughter is
taking a practical approach as I'll explain later.

In your letter, you reveal several clues as to what the problem
really is, and thus the solution to all of this. Let me explain.

At the outset, you need to determine whether your daughter's
refusal to wear her hearing aids is an act of rebellion (defying
your authority as a parent as many two-year-olds do), or if there
is some other cause.

I do not believe your daughter is rebelling against you. Here's
why.

1. Punishments aren't working. Neither are rewards. When the pain
exceeds the gain, the bad behavior stops. This is not happening.
Neither rewards nor punishments are working. To me, this
indicates that there is a fundamental problem that needs
correcting, so you need to look further.

2. She doesn't hate her hearing aids as such, in fact, she is
quite proud of them. You write, "I don't feel that she feels
different with her hearing aids in. In fact she is quite proud
(because they are pink) and she wants to show them to people when
she has them in." Also, she has classmates with hearing aids too
so doesn't feel different. So it is not "wearing" the hearing
aids themselves that is the problem, it is something about
wearing them.

3. She reacts the same way each time you get her hearing aids
out. You write, "She still gets upset when I get her hearing aids
out and make her wear them, and often when I leave the room she
pulls them out." Some people would have you believe that she just
needs to get "used" to wearing her hearing aids. You've been
doing this for well over a year, and if this was the problem it
would have ended long since.

Thus, I don't believe she is rebelling either against the hearing
aids or your authority, but is reacting to the pain they are
causing her. All her actions are consistent with this.

In fact, you are questioning this yourself. You write, "Many
times I have questioned whether the hearing aids were hurting
her. It has been very difficult for me as a parent to force my
child to wear them when I question if these things are painful to
her. " To your credit you have replaced her ear molds several
times thinking that it was the ear molds that are hurting her. In
addition, you have had her hearing aids adjusted numerous times,
all to no avail.

The audiologists don't seem to have a clue what to do. One even
turned up her hearing aides "to see if this would help her to see
the benefit of her hearing aides," and I bet just the opposite
happened. She is now even more insistent on NOT wearing them.

I think the real problem is that her hearing aids are not
adjusted properly and are allowing some, or all, sounds to be
amplified to the point where she feels pain.

This becomes clear when you write: "We went to a baseball game
and were standing in line for the concession stand, it was very
noisy and in a confined area. She immediately became upset and
within 30 seconds she was pulling her hearing aides out. She
can't stand them in any noisy environments--restaurants and
WalMart, etc. She also lives in a very lively house. She has a
four year old brother with whom she loves to rough-house and play
loud games. She also has some difficulties with loud noises such
as the hair dryer even without her hearing aids in."

You need to understand that there are two kinds of "sounds being
too loud." The first one is the one everyone is familiar with--
typical noisy situations can get so loud that the sounds
eventually become painful. Any audiologist worth her salt knows
this, and sets the hearing aids so that they won't amplify above
this level. Thus after a person gets used to wearing hearing
aids, and their brain gets used to hearing louder sounds again,
this is not a problem.

However, there is another kind of "loudness" that few people know
about, and few audiologists really understand. It goes by the
fancy name of recruitment. With recruitment, even normal,
everyday sounds can be PERCEIVED as so loud that they are
painful.

I believe this is your daughter's problem. When she perceives
sounds as painful, she yanks her hearing aids out. Since she
can't tell you this is happening, she does the only thing she can
do to stop the pain.

Recruitment accompanies hearing loss. If you have a sensorineural
hearing loss, you WILL have recruitment to some degree or other.
Your daughter seems to have a severe case, just like I have. That
is why I understand what she is going through. To learn more
about recruitment, read my article called "Recruitment."

Louder sounds recruit. So can softer sounds. For example, just
putting a glass on the table makes a little "thunk" sound--but
that particular sound blows the top of my head off (figuratively
of course) because, to me, that sound is excruciatingly loud. So
are dogs barking and many other sounds.

It's hard to believe how much these sounds can hurt unless you
have experienced recruitment for yourself. If you observe your
daughter, you'll likely notice she yanks her hearing aids off as
the sound level increases or certain sounds are present.

As you have discovered, some audiologists do NOT have a clue how
to really adjust hearing aids to fit a person. Many just use
the manufacturer's standard algorithm and fit according to that.
This does NOT work if you have recruitment!

For 50 years I wore hearing aids that could not effectively
compensate for my recruitment. Thus whenever certain sounds were
around, I yanked them out--for 50 years. Recently, I got hearing
aids that can be set to control most of my recruitment. Now I
finally can wear my hearing aids under most listening conditions!
It's wonderful!

If your daughter's hearing aids are not adjusted properly to
account for her recruitment, no wonder she can't stand them and
yanks them out. You should be able to tell if sounds are
recruiting for her. If a sound that is NOT too loud to your ears
causes her to startle, blink or jump, that sound is recruiting
and hurting her.

You mentioned that one audiologist turned up your daughter's
hearing aids to see if this would help her to see the benefit
of her hearing aides. I cringed when I read that because this is
the WRONG thing to do. Sounds are already too loud for her to
stand (except in quiet settings) and turning them up makes it
even worse! This just exacerbates her recruitment problem.

The solution to recruitment is to set the compression on her
hearing aids such that NO sounds can ever exceed the recruiting
level, whatever that level is.

Her audiologist needs to test for recruitment at EACH standard
test frequency, and then set the compression appropriately in
those channels that contain any recruiting frequencies.

Another point. Do her hearing aids have automatic volume
controls, manual volume controls or automatic volume controls
with manual overrides?

You should NEVER have automatic volume controls UNLESS you also
have manual overrides--especially for those with recruitment! If
you can control the volume manually, then you just turn it down
in noisy situations. It's that simple. This will go a long ways
in controlling recruitment in many, but not all, situations.

To sum this all up, until you get your daughter's hearing aids
properly adjusted for her, don't make her wear them in any except
quiet situations. You might be surprised to know that many adults
dump their hearing aids in dresser drawers and don't wear them
because of this very same unresolved recruitment problem, and
they CAN say that their hearing aids are hurting them.


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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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