January 23, 2007 Issue

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


Volume 2, Number 1                January 23, 2007
Publisher: Neil Bauman      neil@hearinglosshelp.com
            http://www.hearinglosshelp.com
    Copyright Center for Hearing Loss Help 2007

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

                                                               -- Neil Bauman, Ph.D.

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Please recommend and/or forward this issue of Hearing Loss Help
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In this issue
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1. Hearing Loss Issues

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

3. Answers to Your Questions

4. Tips for Successfully Coping with Noise

5. Subscriber-only Special

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



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1. Hearing Loss Issues
==================================================

Doctors, Prescription Drugs and Naming Names

by Neil Bauman, Ph.D.


A lady recently took me to task for my reply in my Blog article
"Gentamicin and Balance Problems" (October 22, 2006)
regarding "the Blog entry about the RN who used an antibiotic in
her ear which had a hole in it and was thus severely damaged."

In that Blog I had quoted the RN's sister as saying: "What I find
even more appalling is the arrogance which we have witnessed
first-hand. We even went to the President of the [name of state
omitted] Ear, Nose and Throat Foundation for testing and help,
and he simply denied that Gentamicin could have caused her
vestibular damage, even bragging about having testified against a
woman in a Gentamicin lawsuit."

After reading the above, this lady wrote: "If you do not name
names, then it assists those people who are negligent. Why leave
out the name of the institution where the President not only is
ignorant, but parades his ignorance? Consumers have a right to
this information. It appears irresponsible to assist in hiding
names when you can name them and protect others. Hiding behind
libel laws when truth is on your side is not something I find
admirable when the potential for harm exists."

I explained that there are a number of reasons I do not name
names. Here are some of the main ones.

1. I don't have the whole story--only the patient's side. Often
they don't tell me everything. Who knows what the doctor really
told them. Therefore, before naming names, its only fair to
thoroughly investigate each case, and that is not what I do.

2. I do not always know the names of the doctors/institutions as
the people that tell me their stories don't always name names in
the first place. Some do, and some don't.

3. According to several sources, doctors are responsible for the
death of more than 100,000 people in the USA each year (mostly
from over-prescribing drugs). Thus, there are a lot of names that
could be named. I don't know who all these are. If I named one
name, a person may go to a different (and perhaps even worse
doctor thinking since I didn't name him/her, he/she must be ok).
(In addition, another 1 to 2 million people each year are
hospitalized due to doctor "error" again often the result of
prescribing the wrong drugs/wrong dose etc. That's a lot of
incompetence/mistakes/carelessness each year.)

4. Since staff move around a lot, if I named a given institution
as being bad, the next year, they might now be good (but their
bad name would be permanently floating around on the Internet),
and a formerly good institution could now have a bad doctor.

5. I do not have the time or money to defend myself against all
the lawsuits that could be brought against me. If I'm spending my
time tied up in court, I'm not doing what I do best--which is
educating people on how to protect their ears, and how to cope
with their hearing losses. As the saying goes, "there are no
winners in a lawsuit."

As a result, I think it much better to warn people, in general
terms, what they should watch for. A person that is forewarned,
can then do their own "due diligence" and educate themselves both
as to their condition and as to the competency of the doctors
they might go to, and not just blindly follow the orders of their
doctors. Thus they hopefully will be able to spot a less than
good doctor when they come across one.


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Rate Your Ear Doctor

by Neil Bauman, Ph.D.


Some people have suggested that I keep a list of the particularly
good doctors for treating various ear conditions--and a separate
list for the bad ones. I like this suggestion, but I do not have
the time to do this either. Furthermore, it is not my focus.

Fortunately, such a service already exists, although I didn't
know about it either until a lady brought it to my attention a
few days ago.

Here's the deal. Go to Rate Your MD  where you can look up
doctors by state and see what others have said about them.
You are then free to leave your comments, based on your own
experiences with this doctor--whether good or bad.

I especially encourage you to leave comments about good ear
specialists so others will know who is particularly good for the
various ear conditions for which you have gone to that doctor.

As of today, 58,677 doctors have been rated on this site at least
once. There are now more than 97,000 ratings on this site with
roughly 2,000 to 3,000 being added daily. If this keeps up
eventually, people will have a fairly reliable source of finding
good doctors and avoiding bad doctors.

As you might expect, the bad doctors are opposed to this site,
while the good doctors welcome it.

I encourage you to do your part to warn others of the bad doctors
out there, and point them to the competent, caring, knowledgeable
doctors that can help them. This is one positive way you can
help!


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

by Neil Bauman, Ph.D.


When you go to your doctor about a specific aliment, the last
thing on your mind is that the treatment your doctor prescribes
is going to totally change your lifestyle because of some
ototoxic side effect--but it happens all the time.

Here is one man's story.

"About 6 months ago I was diagnosed with prostatitis. Never
having experienced prior prostate problems, nor any significant
hearing issues (I am 40 years old), I happily accepted my
doctor's course of treatment. This was to involve a 2 week course
of Ciprofloxacin.

At the time of the consultation with the doctor I was advised
there was a low risk of tendon damage if I were to exercise too
vigorously. Apart from that I was advised that the drug was
"generally well tolerated".

As the appointment to diagnose the prostate problem was early in
the morning, I took the first dose of Ciprofloxacin later that
same day, and then another dose that same night. At approximately
1:30 AM that very night, I was suddenly awoken from my sleep by a
loud ringing in my ears--the like and severity of which I had
never experienced before. I was completely unable to sleep that
night. I don't mind admitting that the symptoms were so
distressing I felt extremely panicky about it.

Over the next 2 days, the situation with my ears did not improve.
I only managed a couple of hours sleep during this entire time. I
contacted the doctor three days after commencing the
Ciprofloxacin. I explained to him that I was suffering very
distressing ringing in my ears, and that I did not think I would
be able to complete the course of medication with these side
effects.

After much discussion however (and considering that the symptoms
of the infected prostate were quite severe and distressing on
their own account), we both decided I would try to "stick it out"
for the full two-week course.

I did manage to see out the two weeks, but it was perhaps the
most distressing and uncomfortable two weeks of my life that I
can ever recall. I only managed to sleep for perhaps 30 minutes
each day on average. The loud ringing in the ears never went away
and--perhaps as a combined result of all these factors, I felt
that my sanity was deserting me.

Ever since that course of Ciprofloxacin I have suffered repeated
"attacks" of tinnitus. In the 6 months since I took it, I have
had probably 6 or more of these episodes--and at their worst they
are of the same severity as the original attack. The only saving
grace appears to be that the attacks are usually shorter lived
and I have the token "comfort" of (thus far) knowing that they
generally subside within a few days (although just in this last
week, I have suffered two major attacks each lasting two days).

But even when these attacks do subside, I now seem to suffer from
a permanent "noise floor" in my hearing (the combined aural
effect of a very high frequency pure sine-wave together with a
low-pitched fizzing sound). I don't ever recall experiencing
these symptoms previously. Admittedly, I had always been aware of
an extremely low level noise floor in my hearing, but nothing
approaching this and it certainly did not impact my life to any
degree whatsoever."

There you have it--another real-life story on the ototoxic side
effects of drugs that were never explained to the patient
beforehand. This man was not warned about the horrible tinnitus
he might experience. Even the PDR only says that tinnitus occurs
in less than 1% of the people taking Ciprofloxacin. When you
think of it, that is still a lot of people getting tinnitus from
just this one drug. I have received similar reports from several
other people, so obviously getting tinnitus from taking
Ciprofloxacin is not rare!

Thus, you always want to know all the side effects, including the
ototoxic side effects, that you may experience before you decide
whether you want to risk taking any given drug your doctor may
prescribe. Remember, its your body and your ears, and you have to
live with the resulting side effects--not your doctor.

If you would like more information on the ototoxicity of the 763
drugs known to damage ears, click on Ototoxic Drugs Exposed.

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**************************************************


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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.
______________

Sudden Hearing Loss--What Should You Do?

by Neil Bauman, Ph.D.

A young man pleaded, "Please help, I have experienced severe
hearing loss in my left ear. I am already deaf in my right ear. I
currently have a cold, nothing serious, and am praying this is
the cause.

I have been taking Prozac for 3 weeks now. I also take
Propranolol when needed for anxiety.

My right ear developed a cholesteatoma and I had a mastoidectomy
when I was very young leaving me almost totally deaf in this ear.
I have always coped fine as the hearing in my left ear has always
been perfect.

Three days ago I woke up with my hearing down to about 15%. I saw
one doctor yesterday who gave me a decongestant and asked me to
take olive oil drops for the wax in there and see her in a week.
I am very scared about this, Please give me advice ASAP. I have
read worrying stories on the net."

You are right to be concerned over this significant sudden
hearing loss--even more so since your other ear is deaf. The
first thing you want to determine, if possible, is whether this
loss is from the wax in your ear, or from your being stuffed up
by the cold, or whether it is something else, and thus is a true
medical emergency, in which case you want to see an ear
specialist now.

Let's look at each of these factors in turn.

I can't see that ear wax would cause massive hearing loss
overnight. Typically, ear wax builds up and slowly fills the ear
canal and causes increasing conductive hearing loss. Even if the
wax shifted and suddenly blocked your ear canal, you would still
be able to hear via bone conduction--but at a lower level. It
would not cause you to lose most of your hearing.

The same goes for colds. If the results of the cold clogs up your
middle ear, you would also have a conductive hearing loss.
However, even if you are congested, you don't lose 85% of your
hearing overnight! As with the ear wax, you would still be able
to hear via bone conduction.

The two drugs you are taking are both ototoxic and can cause
hearing loss. Although Prozac (Fluoxetine) can cause hearing
loss, I wouldn't expect it to act quite so fast. I'd expect it to
take 3 or more months. Even then it should not cause sudden
hearing loss--but you never know--everyone is different.

Propranolol can also cause hearing loss, so it might be a
contributing agent, but a rather doubt it in your case.

My feeling is that you may have had a viral attack. Thus you
should treat it as a medical emergency until it is proven
otherwise. This means you want to get in to see an ear specialist
now. Any ear specialist that won't see you today doesn't
understand about hearing loss being a medical emergency and is
not a doctor you want to go to.

I suggest you read my short article on how to decide whether your
hearing loss is likely a medical emergency or not called Sudden Hearing Loss--Medical Emergency or Just a Cold? After you have read it,
click on the links there, and read the two articles to which it
refers. Then you can decide for yourself what you want to do.

Me? I'd hurry to a knowledgeable ENT or preferably otologist
today and see what they suggest. The common treatment for sudden
hearing loss is a course of steroids (Prednisone) and also, if
they suspect a virus, an antiviral drug as well. Time is of
essence if this is a viral attack.

There are no guarantees that treatment will bring your hearing
back--but you are giving yourself the best chance. You should
also be aware that the latest research indicates that spontaneous
hearing recovery without any treatment whatsoever occurs in from
30% to 60% of the cases of sudden hearing loss. As a result,
taking a wait-and-see attitude may work--but if it doesn't, by
the time you finally seek medical help, it will be too late for
the drugs to do much good.


**************************************************

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==================================================
4. Tips for Successfully Coping with Noise
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What Are Safe Sound Levels?

by Neil Bauman, Ph.D.


A man wrote:

"While doing research I have found that many web sites have
different views on safe exposure times to loud sounds. Some web
sites will say that you should not be exposed to noises that
exceed 80 dB for more than 8 hours, other say 85 dB and some even
say 90 dB. I don't know which one is right. Do you have, or know
where I could get, a reliable 'safe exposure time' table?"

I can well understand your confusion based on reading the various
links you sent.

Part of the confusion is between what researchers currently say
is damaging levels of sound, and what the politicians/bean
counters actually write into the Occupational Safety and Health
Administration (OSHA) regulations, and how often they update
these regulations.

In the past, it was considered that 90 dB was the safe limit for
an 8-hour day's exposure to sound. Then they cut the time in half
for every 5 dB above that level.

The problem is that sound levels double for each 3 dB increase,
so this wasn't accurate in the first place. It looked good on
paper, and was easy to calculate, but it did not reflect reality.

Later, researchers discovered that 90 dB was still causing
hearing loss, so OSHA set the regulations lower to 85 dB. But
this time they got the incremental business correct. So for every
3 dB increase, the safe exposure time is halved.

Each state (and each province in Canada) sets their own
regulations. As a result, some use the older standard, and some
the newer one. For example, Ontario in Canada just last month
changed their regulations down from 90 dB to 85 dB. It can take
years for the government departments to keep up with the
findings of the researchers.

The current state of affairs is that "they" consider it safe for
your ears to be exposed to 80 dB of sound for 8 hours. Next
year, "they" may find that this is still too high and drop it
some more.

You see, everyone's ears are different. Some ears are more
"robust" than others, and thus can stand higher levels of sound
without damage. I think they are trying to set the safe levels
for all ears, not just the robust ones.

Therefore, if you keep the sound level down to well below 80 dB
(some recommend around 70 dB), the feeling is that you will not
damage your hearing at all.

If you take the 85 dB level as a base, then for each 3 dB
increase in sound level, you reduce the time by half. So it would
be:

85 dB 8 hours
88 dB 4 hours
91 dB 2 hours, etc.

If you take the base as 80 dB (which I feel is more realistic),
then the table would be

80 dB 8 hours
83 dB 4 hours
86 dB 2 hours
89 dB 1 hour, etc.

The thing a person should ask themselves is simply, "Why stay as
close to the ear-damaging line as possible, rather than stay as
far away from it as possible?" This should be especially
significant in light of the fact that these "safe levels" keep
dropping as more research is done.

To further complicate matters, safe sound levels are affected by
certain pollutants in the air, especially organic solvents (and
even tobacco smoke). For example, when the pollutants in
factories and mills are kept at the "safe" OSHA level and the
noise is kept at the "safe" OSHA level, they found that hearing
loss was still occurring. Thus, in the presence of such
pollutants, the safe sound levels must be dropped even further.

Another factor to consider is that these are average sound
levels. This means that at any given time there may be very loud
ear-damaging sounds, and then the rest of the time, lesser sound
levels, but the "average" says it is safe.

Much better to wear sound dosimeters that record the actual sound
levels as they vary from moment to moment, and use that to
calculate the safe exposure time.

Therefore, I suggest that you take the most conservative figures
in calculating safe sound levels. I'd suggest using the one with
the base of 80 dB and going from there. However, recognize that
if you have particularly sensitive ears, even this may not be
enough, especially if there are certain pollutants in the air.

As you can see, it is not simple to nail down a safe standard
that works for everyone in all situations. So to be safe, protect
your ears more, rather than seeing how close to the line you can
go.


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5. Subscriber-only Special
==================================================

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

This issue's special is for the eBook version of our popular and
powerful book "Ototoxic Drugs Exposed". This book lists the
ototoxic side effects of 920 drugs and chemicals (including the
above-mentioned organic solvents) that can damage your ears.

The printed edition sells for $39.99 plus shipping, while this
eBook normally sells for $29.99. If you always wanted "Ototoxic
Drugs Exposed," but didn't feel able to afford it, now is your
chance to get it at the unheard of price of only $19.99!
Furthermore, four our overseas friends, because it is an eBook,
there is no shipping charge and you can download it immediately--
no waiting time. (Note: the eBook version is identical in content
to the printed edition--just that you have to read it on your
computer.)

Order it now while you are thinking about it because this special
will only be available until January 31st at midnight.

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

To purchase this eBook edition of Ototoxic Drugs Exposed at this
special price, here is your special link.


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

Cochlear Implants--When's the Right Time?

by Neil Bauman, Ph.D.

A concerned mother wrote:

"My 14 year old son has been hearing impaired in both ears since
birth. His hearing has remained pretty stable until now. He has
been able to use hearing aids effectively. His recent hearing
test showed that his hearing dropped significantly in his left
ear, especially in his high frequencies. It was mentioned to me
at his last appointment that if his hearing doesn't come back up,
or if his hearing has not changed, they may start screening for a
cochlear implant.

My questions for you are:

Does a cochlear implant always kill all residential hearing?
Currently he has moderate-severe to profound loss.

Would you recommend a CI if the rest of the ear is not profound?

Is there any advice that you could give us to help us if we are
faced with making the decision about our son receiving a CI?"

I hear you. You are agonizing whether to get a cochlear implant
(CI) now and risk your son's residual hearing, or wait until some
unknown time in the future. But how will you know when the right
time comes? That is your real question.

Let me give you a basic rule of thumb that will help make this
decision a lot easier for you. It is simply this. When hearing
aids no longer provide significant help for your son, then it is
time to consider a CI. However, if his hearing aids are giving
him significant help, then you probably will want to hold off on
the CI.

The reason for this is that, yes, the operation to insert the
electrodes into the inner ear often does "kill" any residual
hearing, although I know some people that still hear very low
frequency sounds even with their cochlear implants off.

Thus, if you wait until he gets no significant help from his
hearing aids, even if he loses all his residual hearing with the
CI (and it doesn't work for some reason--although the success
rate is over 98%), he is no worse off than before. In other
words, he has nothing to lose.

When considering getting a cochlear implant, the basic
consideration isn't how much hearing loss he has (typically
severe or worse), or how bad his discrimination is (typically
about 40% or worse), but whether hearing aids still significantly
help him. If they do, stay with them. It is cheaper (and safer
since CI operations have risks, however slight).

However, when his hearing aids no longer give him significant
help, then you won't have to agonize over this issue any more.
You'll know that getting a cochlear implant is the only option
available if he wants to hear again. Thus, you will feel
comfortable making the decision because now you know that the
time is right.


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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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