Hearing Loss Help  

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.

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 up to 80 dB of sound 24 hours a day. 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 (the Environmental Protection Agency [EPA] and the World Health Organization [WHO] recommend a maximum of 70 dB for continuous exposure), the feeling is that you will not damage your hearing at all.

When looking at the 80 dB as a base and 85 dB as a base, you need to realize that these are actually these are one and the same thing since they use different time limits. Those that start at 80 dB use 24 hrs as their time limit. Those that use 85 dB use 8 hours as their time limit—essentially the same thing. Here’s why.

If you take 85 dB for 8 hours, then in would be 82 dB for 16 hours and 79 dB for 32 hours. So interpolating, 80 dB is roughly 24 hours. (If you want to be technical, it is actually 25 hours and 24 minutes.) 

Below are the supposedly safe exposure times (if you take the 80 dB level  at 24 hours/85 dB at 8 hours as your base). For each 3 dB increase in sound level, you reduce the time by half.  So here is how this time/loudness scale looks:

80 dB    24 hrs.
82 dB    16 hrs.
85 dB    8 hrs.
88 dB    4 hrs.
91 dB    2 hrs.
94 dB    1 hr.
97 dB    30 mins.
100 dB  15 mins.
103 dB   8 mins.
106 dB   4 mins.
109 dB   2 mins.
112 dB   1 min.
115 dB   30 secs.
118 dB   15 secs.
121 dB   8 secs.
124 dB   4 secs.
127 dB   2 secs.
130 dB  1 sec.

According to the OSHA, unprotected exposure to continuous noise above 115 dB of any duration is not permitted.

The EPA/WHO scale looks like this—much more conservative.

70 dB    24 hrs.
73 dB    12 hrs.
76 dB    6 hrs.
79 dB    3 hrs.
82 dB    1.5 hrs.
85 dB    45 mins.
88 dB    22 mins.
91 dB    11 mins.
94 dB    6 mins.
97 dB    3 mins.
100 dB  1.5 mins.
103 dB  45 secs.
105 dB  22 secs.
107 dB  11 secs.
110 dB  6 secs.
113 dB  3 secs.
116 dB  1.5 secs.
119 dB  <1 sec.

(In all cases, I have rounded the numbers, so the precise figures are a bit different—but this is so much easier to read and understand.) 

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.

I suggest that you use conservative figures in calculating safe sound levels. At the very least, use the one with the base of 80 dB  for 24 hours, and go 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. Thus to be really safe, you may want to use the EPA/WHO base of 70 dB for 24 hours and go from there.

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.

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.

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.

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!

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, 2006regarding “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.