What’s that Racket Inside My Ears?

You are not alone

If you suffer from the sound of what is commonly called “ringing in the ears,” you most certainly are not alone. In fact, 50 million Americans report tinnitus — that’s the term that describes the noise that people hear in their ears that others cannot hear.

In addition to ringing, tinnitus is also commonly described as sounding like crickets, hissing, frying, static, humming, buzzing, roaring, or can be just plain hard to describe! Tinnitus is prevalent in persons who have made their living or have had their fun around noisy equipment and/or toys. In fact, noise exposure is by far the greatest contributor to tinnitus. Working around farming or heavy equipment, use of small machinery such as chainsaws and power tools, and firearms can all increase the risk of having tinnitus. On the other hand, a smaller percentage of persons with tinnitus report a negative history of noise exposure. For them, the tinnitus may caused by another non-metabolic source, such as head trauma, or is induced by a substance the individual has taken at some point in life.

Medical causes of tinnitus

Tinnitus can also be caused by a variety of medical causes, with diabetes being the most common metabolic cause of tinnitus. Other contributors of tinnitus include hypertensionhyperthyroidism; drug induced, cardiovascular diseasezinc deficiencyotosclerosis; impacted earwax; anemia; and, rarely, auditory tumors.

If you have tinnitus and you are not greatly bothered by it, then, in a way, you can count yourself fortunate. For you, the perception of the tinnitus doesn’t greatly affect you mood or your sleep patterns. When it’s there, you would prefer that it not be there, but you can shift your attention away from it and carry on with life without additional effort.

However, of the 50 million individuals who report tinnitus, about 15 million report it to be bothersome enough that that it affects their lifestyle, including disrupting sleep, concentration, and attempts to relax.  This tinnitus sufferer is bothered enough by the noise that the individual tends to talk, or shall I say, complain, about it to a spouse, family member, or loved one. In fact, the person they are complaining to is nearly as tired of hearing about it as the affected person is of hearing it. Many tinnitus sufferers in this category report that their tinnitus causes them to feel stressed, irritable, unable to focus, may disrupt sleep, or just plain makes it difficult for them to relax in a quiet room.

Unfortunately, some individuals with tinnitus are severely bothered by it — around 2 million Americans. These are individuals who report that their tinnitus is severe enough that it is debilitating to them. The tinnitus tends to have some degree of control over this individual’s behavior or mood, and the affected person has increased difficulty shifting their attention away from the tinnitus. Psychometric tinnitus measures place this patient in the “severely affected by the tinnitus” category. Also seen with some patients in this category is the emergence of intolerance for loud sounds, or even the strong dislike for certain sounds. This is generally known as hyperacusis, which is treated prior to treating the tinnitus.

Regardless of whether the individual affected by tinnitus is coping well with it or finds it debilitating, the questions and concerns regarding the tinnitus are usually the same: What caused my tinnitus? Do I have a life threatening condition? Am I going to lose my hearing? Will it get worse? And, what can I do to get rid of it? Finding answers to these questions is not always easy. Many persons affected by tinnitus have already heard these words: “Nothing can be done about it,” or “You need to learn to live with it.” In fact, many individuals with tinnitus do not contact their physician or seek out the help of an audiologist because of the widespread belief that tinnitus cannot be treated. Fortunately for the tinnitus sufferer, tinnitus can be treated. A review of current tinnitus treatments and reported clinical outcomes reveals that tinnitus treatment is effective — and in the majority of patients, is quite effective and can alleviate the impact that tinnitus has on the patient’s quality of life.

Tinnitus treatment

Treatment is most effective when a multidisciplinary approach is taken, that is, when the treatment focuses on reducing both the patient’s perception of the tinnitus as well as their reaction to the tinnitus, and includes both the audiologist and the physician. Coordination of tinnitus treatment can be housed either in an audiology practice or in an otology practice. The audiologist, or Doctor of Audiology (Au.D.) who has elected to receive advanced training in tinnitus treatment is responsible for targeting the maladaptive changes that have occurred in the patient’s auditory processing center of the brain as well as redirecting or reducing the emotional reaction to the tinnitus. The audiologist will conduct comprehensive hearing and tinnitus evaluations, which include such measures as pitch and loudness measures of the tinnitus and minimum masking levels required to cover the patient’s tinnitus. The audiologist also administers and interprets the psychometric tests used to measure any tinnitus related impact on daily living. Once the tinnitus evaluation is conducted and the psychometric data is interpreted, the audiologist maps out the tinnitus treatment. Sound therapies, which may be recommended, can include ear-level tinnitus or combination tinnitus and hearing aid devices aimed at reducing the contrast between the patient’s hearing level and their tinnitus, which is necessary to reduce the strain that the brain creates trying to hear well. This strain on the brain to receive sound where absence of sound exists is the source of most patients’ tinnitus. The audiologist may also recommend sound therapy systems for sleep, which may include a bedside tinnitus devices or a sleep therapy sound pillow.

Cognitive behavioral counseling is implemented by the audiologist to decrease the awareness of the tinnitus. If the patient’s tinnitus reaction is severe, or if the tinnitus is exacerbating the patient’s major depression or anxiety, a psychologist becomes an important member of the tinnitus team. The brain of the tinnitus sufferer has already labeled the tinnitus as important, further activating the autonomic nervous system and the limbic system whenever the tinnitus is perceived. The instructional counseling provided is based on the individualized correlation of subjective and objective measures taken at the tinnitus evaluation.

The patient’s physician (M.D. or D. O.) or health care practitioner (P.A. or N.P.) is responsible for conducting the review of the patient’s medical, family, and psychosocial history, including current medications, and will recommend medical interventions as necessary. The physician, who may be an otologist (specialist of diseases of the ear), may order imaging scans to further isolate the cause of the tinnitus.

 So, what exactly is that racket?

Generally speaking, it is a neurological response that the higher level auditory centers of the brain issue in response to deprivation of sound. The reaction that the person has to the tinnitus is influenced by the autonomic nervous system and the limbic system. If treated correctly, the loudness of the tinnitus can almost always be reduced along with the impact that the tinnitus has on everyday function.  Using current treatment methods, there is good prognosis for improving the quality of life for the tinnitus patient. Furthermore, the investigation into tinnitus is as strong as ever, with ongoing research into new methods of treatment.  “Nothing can be done” often isn’t the final answer.

Hearing Loss

Bad Grades Can Mean Bad Hearing

Every parent is biased, but you always knew your kid was bright: early talker, thoughtful questions, accurate drawings in preschool. Why would they lag academically? Why would they be getting B’s, C’s, or D’s, with comments about disengagement and lack of effort? You reluctantly brainstorm possibilities: ADD, dyslexia, bullying, Asperger’s.

Some parents may be relieved, and others troubled, to add hearing impairment to the list.

To many, the diagnosis feels simplistic. But parents often look for signs of deafness, dismissing the symptoms of milder impairment, while unrealistically expecting small children to know that their hearing has gotten worse. And in a surprising proportion of cases, problems in school stem from this simple (and often treatable) source.

Small odds, big consequences

Normal hearing tests in infants are always a relief, but they can’t guarantee normal hearing through childhood. Untreated ear infections, mumps, measles, head injury, medication side-effects, perforated ear drums, loud noises, and rare congenital diseases with late onset can all affect hearing later in life. Younger ears tend to show less wear and tear but are by no means immune. Depending on how it is defined and measured, hearing loss from all causes affects .1–.5 % of all children.

This rate is reassuringly low, but for children with symptoms, testing is definitely in order. What’s more, untreated hearing loss can have serious developmental consequences. School-age children learn language, social skills, and mathematical concepts at an incredible pace. This learning may feed a virtuous cycle, where the capacity for learning gets a once-in-a-lifetime boost. Those who miss out, for any reason, may never catch up as adults.

Background noise

How could such a serious problem fail to get quickly noticed? The answer is simple and universal: the “signal” is low, and there’s plenty of “background noise.” The signs of mild or moderate hearing impairment are counterintuitive to many. A child may easily hear a parent’s voice in the kitchen but miss half of what the teacher says in a noisy classroom. They may also struggle to understand people with unfamiliar speech patterns.

Meanwhile, the relentless changes of childhood mean lots of confounding noise. Parents may blame ignored commands or odd pronunciation on normal development. Children, meanwhile, may not remember their old hearing abilities — especially if the decline was gradual. Adults often expect their kids to react to poor hearing with concern and frustration, and they expect them to complain at once. But kids are not adults. They may not notice a long-term trend, and they may not have a long-term baseline against which their current hearing seems abnormal. “Long-term” is a thin concept for someone whose age can be shown with fingers.

What to look for

Academic difficulties are just one of many signs that a child may have hearing loss. Here are some others:

•Unclear or unusual speech relative to peers

•Difficulty following simple directions

•TV or computer use with high volume

•Failure to respond to one’s name

•Need for phrases to be repeated

•Illogical responses to questions

•Watching other children for cues to appropriate behavior

•Complaints of ear ache, pressure, or pain

If any of these or other worrisome traits applies to your child, make an appointment with an audiologist. Just as you would never neglect your child’s nutrition, make sure their mental, social, and emotional diet isn’t compromised by poor hearing.

Hearing Loss

Cognitive Decline and Untreated Hearing Loss — Is There a Link?

Why live with untreated hearing loss?

As a doctor of audiology with 21 years of experience, naturally I would have an interest in the effects that hearing loss has on one’s ability to effectively communicate with family, friends, and coworkers. But what I find even more intriguing is why a person chooses to live with hearing difficulties rather than seek treatment for it. Currently only 3 in 10 persons with hearing difficulties seek treatment for their hearing loss, and even more astonishing is the fact that it takes the average person with hearing loss a whopping seven years to seek that treatment!

What finally triggers action?

Common responses from my patients go something like this: “It (my hearing) finally got so bad…It came to a point where I just couldn’t understand conversation. I have to do something about it.” Or, “I finally missed something really important because I didn’t hear it. The time has come to do something.” Additionally, I’ve had many wives in my office accompanying their husband, reporting: “I can’t take it anymore. He stands there in a group conversation and doesn’t participate. He doesn’t say anything… he doesn’t know what it being said to him. He misses what our friends are saying to him, or he just nods his head. I’m embarrassed.”

Clinically, I am aware of the top two reasons why a person chooses to ignore their hearing problem. Reason #1: My hearing isn’t bad enough. Reason #2: I can get along without hearing instruments. Actually, a number of years ago, we audiologists would say, “When you are ready to do something about your hearing loss, then it is time to get a hearing aid.” Today, however, the research is clarifying why one should seek amplification for hearing loss much earlier than we previously recommended. What follows is a summary of just three studies which identify cognitive decline with untreated hearing loss. And, just to be clear, “untreated” means not correcting the hearing deficit, either medically or with the use of a hearing aid.

Recent research findings

Let’s look at some recent research findings on untreated hearing loss and cognitive function. In 2011 Johns Hopkins University published a study in the Archives of Neurology  which demonstrated the direct correlation between the participants’ degree of hearing loss and their risk of later developing dementia or Alzheimers disease. Their conclusions were fascinating, and, as I reflected on my patients over the years, I realized that the findings are not surprising. Some of the study conclusions are:

• For each 10 decibel loss of hearing, the participant’s risk of dementia rose about 20 percent;

• Participants with hearing loss at the beginning of the study were significantly more likely to develop dementia by the end. In fact, participants with mild, moderate and severe degrees of hearing loss had two times, three times, and five times, respectively, the increased risk of developing dementia; and,

• Seniors with hearing loss were significantly more likely to develop dementia over time than those who retained their hearing.

In summary, the authors conclude that the increased incidence of dementia in the hearing impaired subjects is possibly due to the strain of deciding sounds over the years which may overwhelm the brain.

In 2005, researchers at Brandeis University published a study in Current Directions in Psychological Science  which concluded that older adults with mild to moderate hearing loss must expend so much energy on hearing accurately that their ability to remember spoken language suffers as a result. I use the following example with my patients: Your brain strives to operate effectively and efficiently. When the auditory centers have full access to sound, information is transmitted effectively across the brain’s networks, which allows the brain operate like, let’s say, a Ferrari. However, when one has untreated hearing loss, the auditory signal going up to the brain is incomplete. Consequently the brain is drained of valuable resources in its effort to perform the same listening task. The brain operates more, shall we say, like a 1973 Pacer.

Additionally, in 2011 researchers at the University of Pennsylvania published a study in the Journal of Neuroscience  on the effects of hearing loss on speech comprehension. Their findings were also not surprising:

• Those subjects with untreated hearing loss had less brain activity on (f)MRI scans when listening to complex sentences; and,

• Those subjects also had less gray matter (think: brain networks) in the auditory cortex, suggesting that in certain parts of the brain related to the understanding of speech, atrophy may occur more rapidly when hearing diminishes.

This study makes a strong case for hearing technology, though the decreased speech comprehension ability is likely a result from a convergence of things happening in the brain of the hearing impaired person, including the effects of decreased social interactions of the hearing impaired person. As well, the study emphasizes that cardiovascular fitness is also important in aiding brain health.

“Is there anything I can do to prevent hearing loss?”

Yes! While the influence of genetics can’t be controlled, one can control some of the variables which cause hearing loss. Let’s start with excessive noise exposure. Noise induced hearing loss is common — quite common, in fact, here in the North Country. I see patients every day who live the effects of noise induced hearing loss. While some of these patients have grown older and wiser and now recognize the importance of using hearing protection, others have still not embraced this habit.  Exposing your hearing to dangerously loud sounds at any age will irreversibly damage your hearing. Examples of dangerous noise sources include farming equipment, heavy equipment, firearms, riding and push mowers, snowblowers, woodworking  and construction equipment, chainsaws, and even heavy-duty wet/dry vacuums. When using these items, one needs to use hearing protection. Always. Hearing protection comes in a variety of forms, and it doesn’t matter for most of the above noise sources which form you use, rather that you use some form of hearing protection, whether it is foam plugs, muffs, or custom earplugs. Hunters do well with shooting plugs designed especially for the sport.

Diet and exercise also influence one’s susceptibility to hearing loss. Eating a diet rich in antioxidants — such as vitamins C and E, magnesium, and lycopene — may help to preserve hearing. This shouldn’t be surprising, as overall vascular health includes the auditory mechanisms as well.

So what is the take-home message?

Seek help for your hearing loss sooner rather than later, preferably when the hearing loss is only mildly impaired. Vigilantly protect your hearing from damaging noise sources. Take action to improve your cardiovascular health. Eat a healthy diet. Take steps other than early treatment of hearing loss to reduce your risk of dementia, including reducing chronic stress, anxiety, and depression. Continually engage in new challenging tasks. Talk with an audiologist about hearing treatment options. Remember, untreated hearing loss affects more than just the affected individual.

Hearing Aids

Spatial Sound Technology Is Making a Big Impact on Speech Understanding

What is spatial sound technology?

Hearing instruments with spatial sound technology use wireless right-aid-to-left-aid communication to help the hearing-impaired listener’s brain organize the sources of sound in an environment. Organizing where sounds are originating from will help the brain select which sound (i.e., which speaker) they want to listen to, and they will be better able to follow that sound or another sound of their choice over time. Spatial sound technology allows hearing instruments to talk back and forth with each other, similar to how our natural brain allows for communication between the two ears.

Hearing instruments without spatial sound technology do not talk back and forth with each other, which can prevent a listener from gaining additional information about where sounds are occurring around them in the environment. These hearing instruments work independently on each side of the head, with each instrument trying to maintain equal loudness of a desired sound. This impacts the hearing instrument user when they are in areas of complex, competing noise (i.e., crowds, or places with heavy background noise). The natural perception differences between ears that occur when a sound is closer to one ear than the other are not maintained.

With spatial sound technology, each hearing instrument maintains different loudness levels on each side of the head, depending on the location and distance of the sound source. The listener, therefore, can place the sound source easier, which will help to organize the sounds in the environment, help the listener select which sound they want to listen to, and help the listener to follow that speech signal.

We are happy to further discuss with you the application of this technology. Spatial sound technology is currently available in the AGX9 level of technology.

Hearing Loss

Dizziness Is Not Normal!

But it is dangerous — and treatable!

A healthy person usually takes his or her sense of balance for granted. Most people don’t find it difficult to transition from walking on the sidewalk to walking on the grass, or to get out of bed in the middle of the night without stumbling or feeling unsteady.

Dizziness is a sensation of light-headedness, faintness, or unsteadiness, and vertigo has a rotational, spinning component, resulting in the perception of movement either of the self or of surrounding objects. Disequilibrium simply means unsteadiness, imbalance, or loss of equilibrium that is often accompanied by spatial disorientation.

Almost everyone experiences a few seconds of spatial disorientation at some point — for example, when watching a 3-D movie. However, episodes of dizziness or vertigo, whether lasting for only a few seconds or for days on end, are a primary sign of vestibular dysfunction/balance disorder, especially when linked to changes in head position. Because of the many possible causes of dizziness, obtaining a correct diagnosis can often be difficult, but it is possible and necessary. Mainstream medicine often minimizes the importance of a correct diagnosis, but there are excellent professionals in our area who specialize in vestibular diagnosis and treatment. Since your balance system and hearing system are both parts of your inner ear, the diagnosis begins with a comprehensive hearing evaluation.

People with vestibular disorders commonly experience cognitive disturbances affecting memory, attention, and concentration and can also experience emotional challenges due to their inability to remain independent or to care for a loved one. Additionally, the increased risk of falling can be devastating and life threatening; as we all know, a broken hip can drastically impact the quality and length of one’s life. Do not ignore these symptoms. Although head injury and advancing age are common causes of dizziness, almost half of all cases have no identifiable underlying cause. The most commonly diagnosed balance disorder is benign paroxysmal positional vertigo (BPPV). BPPV, if diagnosed accurately, can often be treated and cured by a specialized professional and is most often covered by insurance. Call your local AudigyCertified™ provider, and they will make sure you are given the attention you deserve and are connected with the professionals you need.

Hearing Loss

Catch the Latest in Hearing Loss Prevention: Fish Oils!

Good nutrition has been shown to reduce incidents of hearing loss in the aging boomer crowd or to slow down hearing loss associated with age.

The American Journal of Clinical Nutrition says…

Participants who had two or more servings of fish per week, compared with participants who had less than one serving of fish per week, had a significantly reduced risk (42%) of developing age-related hearing loss. There was an association between consumption of one to two servings per week of fish and a reduced risk of a progression of hearing loss. Their conclusion: omega-3 fatty acids, well-studied nutrients, now include reduction in age-related hearing loss as another of their multitude of benefits.

Let’s repeat that: a 42% reduction in hearing loss in the senior population by including fish in their diets twice a week. Not bad at all.

The objective of the Blue Mountains Hearing Study, conducted at several universities and clinical institutes in Australia, was to correlate the intake of omega-3 fatty acids and the presence of presbycusis. Researchers examined the senior population over several years to accumulate the data required to draw the conclusion that micronutrients — especially omega-3 — showed a positive impact on test subjects’ ability to hear.

“Dietary intervention with omega-3 polyunsaturated fatty acids could prevent or delay the development of age-related hearing loss,” lead researcher Paul Mitchell reported. The study, published in The American Journal of Clinical Nutrition, also pointed out that supplements of omega-3 (long-chain omega-3 fatty acids) lowered the risk of hearing loss by 14%.

Important? Let’s put it this way: Roughly 36 million Americans report some degree of hearing loss. We could drop the number significantly if we just ate more fresh fish.

Other nutrients that have been studied as possible defenders against hearing loss include:
•Vitamin C, found in citrus fruits
•Magnesium, a mineral found in many vegetables
•Vitamin E, found in fish (including shellfish)

Other studies have shown that certain micronutrients — vitamins, minerals, and compounds — can also lessen the likelihood of hearing loss related to age. A report released in 2007 showed that when 728 men and women between the ages of 50 and 70 consumed increased amounts of folic acid, it seemed to delay presbycusis in the lower frequency ranges. Another study recommends eating more beta carotene to prevent premature hearing loss.

Remember the old saying: You are what you eat. So eat better foods and hear better longer!

Adapted from an article found in