Hearing Loss Help  

by Neil Bauman, Ph.D.

A man asked:

I was wondering if you could comment on Transcranial Magnetic Stimulation? I read in an article that this treatment has helped people with tinnitus.

A lady with Musical Ear Syndrome asked:

I have read that something called Transcranial Magnetic Stimulation reduces auditory hallucinations. Is this safe?

Good questions. People suffering with severe tinnitus or from hearing other phantom sounds (Musical Ear Syndrome (MES)) are always on the lookout for any new therapy that might alleviate their tinnitus or MES symptoms.

The new kid on the block (only developed in 1995) goes by the fancy name of repetitive Transcranial Magnetic Stimulation (rTMS for short).

Transcranial Magnetic Stimulation works on the principle that a varying magnetic field will induce an electrical current in nearby “structures.” In this case, the nearby “structures” are the cortical areas of your brain.

A doctor typically holds a powerful electromagnet (basically a coil of wire encased in plastic) over the frontal regions of your skull and delivers magnetic pulses for about 20 minutes a day for 5 days. The treatment alters the biochemistry and firing patters of neurons in the cortex—that is, the part of your brain nearest the surface.

The frequency of the stimulation determines whether it speeds up or slows down the cortical activity in your brain. Numerous studies have revealed that chronic tinnitus is associated with increased activity in the primary auditory cortex. Therefore, in the case of tinnitus and auditory hallucinations, you want to slow down this activity.

Studies show that using a low-frequency (1 Hz) rTMS actually does reduce the “excitability” of the cerebral cortex, and can cause long-lasting inhibitory effects in tinnitus perception—up to 6 months or more.

In one study, after 5 days of rTMS treatments, there was a highly significant reduction in tinnitus perception, whereas people who received the sham treatment did not show any significant changes. This is good news.

However, rTMS certainly isn’t the whole answer for tinnitus and other phantom sounds. For example, in one study it had good effects in 25% of the people studied, partial effects in 28% of the people, and no effect in 47%. If this holds true for all people with tinnitus, then rTMS won’t help half the tinnitus sufferers. However, if you are one of the lucky ones, you may receive partial or omplete reduction in your tinnitus—so you may want to pursue rTMS therapy if nothing else is working for you.

So far, rTMS therapy shows promise, but there are still many unanswered questions such as: how safe is it? How long will the suppression ultimately last? Does it work for all kinds of tinnitus?

Although it is used in other countries, here in the USA, the FDA has yet to approve rTMS for regular use, so it is only being used in clinical trials at the present.

My personal opinion is that rTMS indeed shows promise in reducing or eliminating tinnitus and auditory hallucinations. However, I’d wait until further research determines that it is totally safe. For example, I’d want to be very sure that rTMS treatments don’t slow down other parts of my brain. My brain is already running slow enough as it is!

by Neil Bauman, Ph.D.

A grandson wrote:

It seems like my grandma may suffer from tinnitus or “aural hallucinations” as she’s complained of hearing music when she’s at home. We’ve discovered that there’s actually no music playing anywhere nearby. Only she can hear it. She asked me to ask you this; “Why is it that she only seems to hear this music in her own house?”

Good question. There’s a simple answer. Basically your grandma hears such phantom sounds when:

a) she is in a quiet environment such as her house, and

b) she does not have her mind focused on other things.

When she is out and about, there are many other sounds for her brain to hear. Furthermore, she is focusing on the things she is doing so doesn’t think about the phantom music. As a result it often fades into the background. (The same can be true when she is working around the house.)

However, when she is at home relaxing, and particularly when she wants to lay down and rest (or sleep at night), the phantom music starts up, or at least becomes more intrusive. At this point, typically there is little or no background noise around. Also, she is not focusing on any tasks—her mind is relaxed—and that is the ideal breeding ground for these phantom sounds.

I can’t guarantee this is the reason in your grandma’s case, but it is the most likely reason.

One way for her to try to overcome these phantom musical sounds is to put some soothing music on the stereo or listen to the radio as she falls asleep. This gives her brain real sounds to listen to, and hopefully the phantom music will fade away.

by Neil Bauman, Ph.D.

A lady wrote:

I have been searching the internet for an answer to my rather severe hearing loss. About 15 years ago, I began seeing a local doctor who was ‘fresh out of medical school.’ He told me that a facial infection I had was due to an infection that had been caused by dental work I’d had done five years prior. I also had been given my ‘own home supply’ of Keflex to treat that infection which I proceeded to take over and over again throughout that five year period.

I had ‘motion sickness’ that began almost immediately while taking Keflex. I definitely remember that I had no problem at all with motion sickness before taking Keflex. During and after treatment, I couldn’t even (and still cannot) ride in the back seat of a car due to terrible motion sickness.

I also noticed a ringing in my ears within a year following the dentistry work and a year into my Keflex therapy.

I had periodic severe pain in my right ear that began a couple of years before I stopped taking the Keflex.

In addition, I also noticed my eyes jerking horizontally. I probably was taking Keflex on and off for about three years before the symptoms began.

Furthermore, I began to notice the hearing loss about a year after I quit taking the Keflex.

I took no other medications during that time—absolutely none.

My current doctor told me he would not give me Keflex again for the infection, and that “if taken for longer than ten days, Keflex can cause deafness.” He had just finished medical school and said that a memo had passed his desk in medical school stating the problem with Keflex.

Can you tell me if that is true since I cannot find anything that lists Keflex as an ototoxic medication?

Shocking, isn’t it? Here you have suffered hearing loss, tinnitus, ear pain, nystagmus, and motion sickness from taking Keflex over the years, and yet you can’t readily find information as to whether this drug is ototoxic or not?

Keflex is the brand name of the generic drug Cephalexin, one of the drugs in the Cephalosporin family.

One of the reasons you are having trouble finding out whether Keflex is otototxic or not is that it is not listed in the Physicians’ Desk Reference (PDR) as being ototoxic. However, Keflex is indeed ototoxic.

According to The Compendium of Pharmaceuticals and Specialties (CPS), the Canadian drug bible, Keflex can cause hearing loss, tinnitus, dizziness and vertigo.

In case you didn’t know this, drugs in the same family often have much the same ototoxic side effects. For example, the PDR lists Cefuroxime as causing dizziness and hearing loss. Another Cephalosporin (Cefaclor) can cause dizziness, ear pain and vertigo. Cefpodoxime can dizziness, tinnitus and vertigo. So you see that this class of drugs is indeed ototoxic to some degree.

As your current doctor pointed out, most antibiotics are only safe for your ears if taken for a maximum of 7 to 14 days. After that, all bets are off.

Unfortunately, in your case, you took this drug many, many times over a 5-year period and thus you unwittingly damaged your own ears.

The motion sickness should have been your first clue—indicating this drug was damaging your vestibular (balance) system. As time went on you got tinnitus. For many people tinnitus is often the first indicator that they are damaging their ears.

Then you noticed the ear pain, another ototoxic symptom.

Still later, your eyes began jerking sideways (horizontal nystagmus). This indicates that your balance system was being damaged on one side worse than the other. Again, unfortunately, neither you nor your eye doctor connected this with the ototoxic effects of the Cephalexin.

Finally, you began to notice your hearing dropping. In actual fact, your hearing very likely had been dropping all along—most of it in the very high frequencies—so you didn’t notice it right away. By the time your hearing loss became noticeable, it was already too late to do anything about it.

This goes to show that although Cephalexin isn’t the most ototoxic of drugs, you still have to be careful because it can cause severe and permanent hearing loss and other ear problems as you have discovered.

In the future, you should avoid this drug and all drugs in the same class, and also be very cautious with any other known ototoxic drugs as your ears are obviously sensitive to the effects of such drugs. What happened in the past is a good indicator of what can (and likely will) happen in the future if you take more ototoxic drugs.

For information on the ototoxicity of Cehpalexin, the rest of the Cephalosporins and the 763 other drugs known to damage ears, go to Ototoxic Drugs Exposed.

by Neil Bauman, Ph.D.

As hard of hearing people, we have the right to choose what we want people to call us. Overwhelmingly, we prefer to be called “hard of hearing people.” Yet many well-meaning, but misinformed, people persist in referring to us as “hearing impaired.”

The term “hearing impaired” was supposed to be the politically correct term to be used when referring to all deaf and hard of hearing people in a collective sense. However, this term is almost universally resented by both deaf people and hard of hearing people and, as a result, is most definitely not politically correct.

So don’t be afraid to use our preferred terms. If we say we are hard of hearing, refer to us as hard of hearing people. If we say we are deaf—use the word deaf. These are the terms we want you to use. Don’t ever say we are hearing impaired. Most of us hate that term.

If you want to talk about all people with hearing losses, either say “people with hearing loss” or “deaf and hard of hearing people.” If you want to be more specific and single out one group or the other, either say “deaf people,” or “hard of hearing people.”

Actually, “people with hearing loss” is the best term since it puts the word “people” first, not our disability. After all, we are people first and foremost, but people who just happen to have ears that don’t work very well.

And while I am at it, we hard of hearing people should always say, “I have a hearing loss” not “I am hard of hearing.” Why? Because when I say “I am hard of hearing” the inference is that I am nothing but one big broken ear. However, when I say, “I have a hearing loss” I am saying that I am a person who just happens to have a hearing loss—but the hearing loss doesn’t define me, any more than my tall height defines me. It is just one of the many characteristics that goes into making me me.

by Neil Bauman, Ph.D.

Back in November 18, 2005, I wrote about Paul English and his voice menu “cheat sheet” for getting through to a live person when you dial various big companies in my article “Press “H” for Human—Getting Through Voice Menu Hell.”

This project has grown so big that now it has a website of its own and many, many more companies have been added to the list.

If you have a hearing loss and can’t understand voice menus well (or at all), this gives you the secrets for getting through to a live humans

To access this GetHuman database go to http://gethuman.com/us/ It will get you out of voice menu hell and make your life much easier.

by Neil Bauman, Ph.D.

A lady asked:

How does the hybrid cochlear implant work better than hearing aids?

Interesting question, or perhaps I should say, interesting answer coming up.

Actually, the hybrid cochlear implant is a misnomer. It really should be called the short-electrode cochlear implant. A hybrid implies that two different things are being married together, and this is not what happens with the short-electrode cochlear implant.

Since, in this case, you would wear BOTH a cochlear implant (CI) and a hearing aid in the same ear, this is not really a hybrid device. The only thing that is truly hybrid, would be the resulting hearing—half from the cochlear implant, and half though the hearing aid, or via natural hearing.

I have heard talk of marrying a short-electrode cochlear implant and a hearing aid together to form a true hybrid—but that is something for the future. In fact, even the short-electrode CIs are still in trials, and are not yet available to the general public.

Now let’s look at why a short-electrode CI would give you better sound than a hearing aid.

Hearing aids can only help you when you have significant numbers of working hair cells for each frequency being amplified. Most people with a hearing loss have relatively good low-frequency hearing and little or no high-frequency hearing.

If such a person were to wear a hearing aid, the hearing aid would amplify the lower frequency sounds very well, but would not really help much, or at all, in the higher frequencies. This is because in this case most/all of the hair cells in the higher frequencies have died off. Since it is the job of the hair cells to insert the sound signal into the auditory nerve, if there are no working hair cells, then no signal gets passed to the auditory nerve, and you don’t hear anything in that frequency.

The result is that no matter how much your hearing aid amplifies any high-frequency sounds, you still won’t be able to hear them.

This is where cochlear implants come in. They bypass these dead hair cells and “inject” the sound signal directly into the auditory nerve—thus your brain hears these sounds in spite of the dead hair cells.

So for a person with a ski-slope hearing loss (meaning they hear some/much low-frequency sounds and little or no high- frequency sounds), a cochlear implant for the high frequencies and a hearing aid for the low frequencies is theoretically an ideal solution. This is the niche that the hybrid or short-electrode CI is being designed to fill.

In order to understand a bit better why this works, we need a bit more understanding of how the cochlea works. The cochlea is a snail-shaped organ. Hair cells are arranged along the length from the base (large end) of the cochlea to the apex (small end). The hair cells near the base are stimulated by high frequency sounds and the ones closer to the apex are stimulated by low-frequency sounds.

When they insert the electrodes of the CI into the cochlea, some damage occurs to the existing hair cells, thus destroying some (or all) of your residual hearing. If they used normal-length electrodes, they would damage/destroy your relatively good low-frequency hearing.

Thus they have designed a short electrode that only penetrates a short distance from the base of the cochlea where high frequency sounds are picked up (and where most of the hair cells are already dead), and leaves undamaged the upper portions that is still working quite well for low-frequency sounds.

As a result, by wearing a short-electrode cochlear implant, you would hear the high-frequency sounds. At the same time, you would wear a hearing aid to amplify the lower frequency sounds and bring them up to normal levels. (If your low-frequency hearing is still good enough, you wouldn’t even have to wear a hearing aid.)

The beauty of this combination is that it leaves your lower-frequency hearing working normally (with amplification from a hearing aid if necessary). Thus, you will still get the full richness of lower frequency sounds so you can hear, understand and appreciate music for example.

Unfortunately, with today’s technology, the cochlear implant, while a miracle device, doesn’t give the richness to sound that lets us enjoy music to the fullest. This is because a cochlear implant has somewhere between 24 and 128 electrodes to cover the whole frequency spectrum as opposed to many thousand hair cells in the normal ear.

Think of the difference you’d hear if you tried to play a piano where someone had yanked out 6 or 7 of the 8 keys in every octave. That is analogous to what you would hear via a CI as opposed to normal hearing.

If you can’t hear anything (e.g. in the high frequencies), then hearing via the CI, imperfect as it is, is much better than not hearing anything at all in those frequencies.

This is why wearing a short-electrode CI and a conventional hearing aid would give you the best of both worlds if you have a severe ski-slope hearing loss.

Note: if your hearing is stable, the short-electrode CI is a great choice. However, if your low-frequency hearing is continually dropping, you might be better off getting a conventional CI from the start. Otherwise, when your low-frequency hearing drops to a low level, you will have to have the short-electrode array surgically removed and replaced with a standard-length CI electrode array.

by Neil Bauman, Ph.D.

Many hard of hearing people (including myself) often have difficulty conversing in restaurants. This spoils the dining experience. However, if you think about your needs, and plan ahead, there are a number of things you can do to greatly improve your chances of hearing in such situations.

One of my favorite coping strategies is to dine during off hours—either before or after the crowds. This way the restaurant is relatively empty. As a result, the noise level is much lower, In addition, I can request a seat in a low-noise area rather than having to take the only table available.

The noisiest areas in restaurants are typically near the kitchen doors or wherever the busboys collect the dirty dishes, near the cashier, and any high traffic areas–such as near the main entrance or near the restrooms.

Another strategy I use, if I have a choice, is to request a booth rather than a table. This is because booths tend to be quieter and often have a wall on one side that blocks any sound from that direction. In addition, with a booth, the waiter/waitress can’t stand behind you and ask for your order. He/she has to stand at the end of the booth in your field of view so you can readily see to speechread.

Another effective strategy is to learn which restaurants have loud music playing and avoid them. Find those that have soft background music. If the music is too loud, request that the volume be turned down. Some will do this for you, but in my experience, many refuse. I just don’t go back to them again.

Another strategy is to go to well-lighted restaurants, or sit by a window (if it is still light outside). This makes it easier to speechread.

Some restaurants are pretty dark because they turn down the lights for the ambience it gives. This makes speechreading anyone difficult. In such cases, I choose a table that is as well-lighted as possible. Look for one with the light directly over the table.

Classy restaurants may use candles as their main source of light. However, a romantic candle-lit dinner quickly looses its charm if you can’t hear your partner. If you find yourself in this situation all is not lost. There are two things you can do to help improve the situation. First, if the candles are in the center of the table, and between you and your partner, move them to one side or the other. This will make speechreading much easier as the light is no longer in your eyes. If this does not provide enough light, ask the waiter for some more candles. Line them up on both sides of your table and you should have adequate light without destroying the intimate atmosphere.

Each of these coping strategies can improve your dining experience, and best of all, they are all free!

by Neil Bauman, Ph.D.

A man explained:

Almost 5 years ago I suffered from Sudden Sensorineural Hearing Loss in my right ear. I have been told that it was the result of a virus and at present no help exists.

I have found some help with the use of a behind-the-ear hearing aid in my right ear and a completely-in-canal hearing aid for the left ear, but I need more help. What should I do?

When your doctor said “no help exists” he really meant that no medical help exists. This is true since too much time has gone by since this hearing loss occurred. However, that doesn’t mean that there is no help. On the contrary, there is help available. What you need is help in learning how to successfully live with your hearing loss. One great resource is the book “Help! I’ve Lost My Hearing—What Do I Do Now?”

As you have already discovered, hearing aids are not the whole answer to hearing loss. Yes, they do help in many situations, but they are not the whole answer.

In fact, there are 5 areas you need to address in order to successfully cope with your hearing loss. Hearing aids are just one of the five. Too many people think hearing aids are all they need. This is just not so.

The five areas you need to address in order to successfully live with your hearing loss are:

1. Psychologically adjust to your hearing loss. This includes working through the grieving process in relation to your hearing loss. (If you don’t do this, you are not even ready to wear hearing aids—and likely won’t.) The grieving process is explained in the short book “Grieving for Your Hearing Loss—the Rocky Road from Denial to Acceptance“. This book has helped many people deal with their hearing loss.

2. Wear properly-fitted hearing aids. The emphasis here is on “properly-fitted” hearing aids. So often, people do not wear their hearing aids because they are not properly adjusted to their specific hearing needs.

3. Use assistive (and alerting) devices to supplement your hearing aids. There are many, many of these devices—ranging from amplified telephones, to loop systems and personal amplifiers, to doorbells that flash red lights in your house, to simple things such as turning on the closed captioning on your TV so you can read the words you don’t hear. You can learn about some of these wonderful devices here.

4. Practice Speechreading (lipreading) all the time. The easiest way to do this is to always watch peoples faces when they are speaking. There is also an excellent CD,called “Seeing and Hearing Speech” that will really help you with improving your speechreading abilities.

5. Use the many coping strategies available to you in most situations such as get closer to the speaker, cut out background noise as much as possible, have the speaker face you and have adequate light on his face, etc. The short book, “Talking with Hard of Hearing People—Here’s How to Do It Right” explains many of these simple and free techniques that make life so much easier.

Using all 5 together greatly improves your ability to communicate with other people with the least stress and strain to you. I know. I use them all the time.

by Neil Bauman, Ph.D.

I continue to be amazed (appalled would be a better word) by the number of people who contact me because the drugs their doctors prescribed for their various ailments ended up afflicting them with permanent and distressing tinnitus and often other ear problems as well.

Here is one woman’s story. Take it as a warning of what can happen when you blithely take drugs without carefully checking out their side effects first.

This lady wrote:

I recently read the article you had on the Clarithromycin & tinnitus. I have been doing research on the Internet on both this drug and Metronidazole because of my problem.

On April 21st, my doctor prescribed Prevacid (Lansoprazole) for a stomach condition I had after a endoscopy. One week later, my doctor prescribed Metronidazole and Clarithromycin in addition to the Prevacid.

On May 2nd my ears started ringing and from then on I could not sleep. The next day I called my doctor. The nurse told me to stop taking the Metronidazole. After not sleeping for 3 days I called them back. She told me to stop taking all the medications.

I went 4 days without sleeping and felt very disoriented and wired and my ears still were ringing. She prescribed Alprazolam to help calm me down and sleep. A week later, after not being on the medicine, I went back to the doctor, and he prescribed Doxycycline. It is now August 3rd and my ears are still ringing non-stop 24/7.

I went to an Ear, Nose, & Throat doctor about 3 weeks ago. He told me I now have sensorineural hearing loss, and my ears would most likely ring forever. Furthermore, I could lose my hearing.

I never had any problem with my ears before this, and I wasn’t taking any other drugs. I haven’t been on any medications at all now for over 2 months. I am scared to even go to the doctor now. I do not feel that I can trust one now after this has happened.

All the doctors I have been to around here think I am crazy when I tell them I think the medications did this to me, because I was fine before this. It started when I was taking them. It’s like they don’t want to take the blame for not thinking before prescribing drugs. I feel like I have been ruined for life now.

I hear you. Unfortunately, the drugs you were prescribed can, and as you now well know, do cause tinnitus.

Clarithromycin causes tinnitus in 2% of the people taking it according to the Physicians’ Desk Reference (PDR), and hearing loss in 1%. I believe these figures are very conservative and the true incidence is much higher.

One man told me that after taking Clarithromycin for just 3 days for a sinus infection he got severe tinnitus that has never stopped since. In addition he lost much of his hearing.

Doxycycline can cause hearing loss and tinnitus also. Doxycycline can (and does) cause significant hearing loss. For example, one man explained that after he took a 10-day course of Doxycycline, “the hearing in my already-impaired right ear suddenly reduced to virtually zero and remains there.”

Lansoprazole, a proton-pump inhibitor, is also listed in the PDR as causing both hearing loss and tinnitus.

The Metronidazole you took can also cause tinnitus, but it is not so listed in the PDR, so it may not be very common.

After taking 3 drugs that are known to cause both tinnitus and hearing loss, it is not surprising that you are one of the ones that now have both of these ototoxic side effects.

Unfortunately, once tinnitus starts, it can take days or weeks after stopping a medication before it goes away—if indeed it ever goes away. Sometimes it goes away, and other times in is permanent. You see, removing whatever triggered tinnitus in the first place is no guarantee that your tinnitus will go away. Often it doesn’t. Thus, you have to learn how to “habituate” to your tinnitus so it will not bother you.

If you now have a significant hearing loss, getting and wearing hearing aids can help keep your tinnitus under control. In addition, there are a number of other things you can try that are explained in my book, “When Your Ears Ring! Cope With Your Tinnitus—Here’s How.” This book has helped many.

For information on the more than 450 drugs known to cause tinnitus (and other ototoxic side effects too), see the book Ototoxic Drugs Exposed.”

by Neil Bauman, Ph.D.

A lady asked:

Is there any difference between lipreading and speechreading?

Yes and no. How’s that for an answer?

Technically, lipreading is watching the lips to extract whatever speech information you can, while speechreading is watching the lips, tongue, teeth, cheeks, eyes, facial expressions, gestures, body language and anything else that gives clues as to what the person is saying. Thus speechreading encompasses lipreading, plus much more.

For example, a person impatiently drumming her fingers on the table, a person nervously shifting his weight from foot to foot, a person pointing at a certain place or a person with a quizzical expression on his face certainly aren’t part of lipreading, but they are part of speechreading as these actions are all part of what the person is communicating.

Looking at it from the historical perspective gives a totally different answer. This is because speechreading is the newer term now used in the USA and Canada for what we formerly called lipreading. You see, in the UK, they still use the older term lipreading, but they really mean speechreading. Furthermore, those of us who have talked about lipreading for the past several decades find it difficult to give up this term. For example, while I try to use the term speechreading, at times I slip up and revert to calling it lipreading. Thus, in practical terms lipreading and speechreading both really refer to the same thing.

To learn more about speechreading, read our article Speechreading (Lipreading).