Hearing Loss Help  

by Neil Bauman, Ph.D.

Hearing loss is a complex issue. Thus, there is no single simple answer—so why do so many hearing health care professionals act as if hearing aids are the sole answer?

Dr. Mark Ross, himself hard of hearing for as many years as I’ve been alive, is probably the foremost audiologist alive today, and one I highly respect. He recently wrote:

In order to deal effectively with any condition, one must first learn all one can about it. This is not done as well as it should be when it comes to hearing aids. When people arrive at a hearing aid center, everyone’s focus tends to be on the “product” (the hearing aid) and not the hearing loss or communication problems that brought the person there.

The explicit goal becomes the selection of a hearing aid, with the implicit assumption that this will solve the communication problems. But, while a hearing aid is necessary (no dispute there), it is more often than not, insufficient. In spite of all the claims of the appealing marketing ploys we are continually exposed to, there is more to helping someone with a hearing loss than providing a hearing aid, no matter how advanced it might be. (1)

I have said many times in the past, and will continue to say, that when dealing with hearing loss there are five major areas that need to be addressed—all of them equally important— and hearing aids are only one of the five.

First, a person needs to psychologically and emotionally adjust to being hard of hearing. This includes working through the grieving process in regards to their hearing loss. All of the following steps are of little use if a person doesn’t first do this. Many people try and short-circuit this process—but the end results are dismal—they permanently stuff their hearing aids in dresser drawers; they more and more withdraw from the hearing world; and, wrapped in their own little world, they slip into deep, dark depression. (If you need help dealing with this aspect of hearing loss, see my short book, “Grieving for Your Hearing Loss—the Rocky Road from Denial to Acceptance“. This little book has helped many.

Once you have worked through your grief, and in no particular order—because they can (and should) be done at more or less the same time, are steps 2 through 5.

Second, get properly adjusted hearing aids if your hearing loss is such that hearing aids can help you—and hearing aids can help about 99% of the people with hearing loss.

Third, since hearing aids are not the whole answer, especially when noise and/or distance is involved, get assistive devices (ALDs) that will supplement your hearing aids in these difficult hearing situations. (I just wrote an easy-to-read primer on these wonderful assistive listening devices.)

Fourth, learn to speechread (lipread). Speechreading, when combined with residual hearing, greatly improves your understanding of what was said. This is a most important skill, and one that all hard of hearing people should learn. (If you don’t have speechreading classes locally, don’t despair. You can learn speechreading using the Seeing and Hearing Speech program.)

Fifth, learn all the myriads of coping skills that put the odds in your favor in being able to hear and understand people. They are such simple things as getting close to the speaker, cutting out competing background noise, having light on the speaker’s face, etc. I explain many of these coping strategies in my short book “Talking With Hard of Hearing People— Here’s How to Do it Right!“.

Combining all of the above gives a person the best chance of successfully coping with their hearing loss. So resist the seductive hype of hearing aid manufactures that hearing aids are the whole answer, and utilize these other four important areas when dealing with your hearing loss. You’ll be glad you did!

(1) Excerpted from the article “What Did Your Expect? Hearing Aids—Expectation and Aural Rehabilitation” by Mark Ross, Hearing Loss Magazine. Hearing Loss Association of America, Bethesda, MD. Volume 29, No. 1. Jan-Feb 2008. pp. 21-24.

by Neil Bauman, Ph.D.

A lady wrote:

I am hard of hearing and have been so for years. I will be 69 in July. I have been told I have nerve deafness in both ears. Is there any help for people when hearing aids are between $5,000 and $6,000. Is there anything good that would help me to hear without getting hearing aids?

First, not all hearing aids are $5000 or $6000 each. For example, I wear America Hears hearing aids—and the nice thing is that ALL of their hearing aids are the same price—whether you get the entry level model, or the ones with all the bells and whistles—and that price is only $995.00 each. That’s a far cry from $5000 or $6000 each. In addition, America Hears is a very reputable (though yet not well-known) company that makes their own hearing aids right here in the USA.

Second, in addition to hearing aids, there are a whole assortment of assistive listening devices (ALDs) that can help you hear, with, or without, hearing aids. The nice thing is that the price of these devices isn’t much—typically between $100 and $200, although some are much more. In any case, they are much cheaper than hearing aids and work very well. Sometimes I use them instead of my hearing aids because in certain situations, ALDs work better than hearing aids.

Third, another nice thing about ALDs is that they typically last “forever” (at least the ones that I carry) and not just a few years like hearing aids typically do.

You have some choices that do not break the bank. If you want to learn more about these wonderful assistive devices, read my new primer on the subject.

by Neil Bauman, Ph.D.

You would think that a medication to remove ear wax would not damage your ears, wouldn’t you? Don’t bet on it.

A new study at The Montreal Children’s Hospital revealed a shocking truth—such preparations can be very damaging to our ears. Here’s the report.

A new study, led by researchers at The Montreal Children’s Hospital, has revealed that certain over-the-counter earwax softeners containing the active ingredient triethanolamine can cause severe inflammation and damage to the eardrum and inner ear.

The results of the study, recently published in The Laryngoscope, suggest that use of these medications should be discouraged.

“Patients often complain that wax is blocking their ears and is causing discomfort and sometimes deafness,” says Dr. Sam Daniel principal investigator of the study and director of McGill Auditory Sciences Laboratory at The Children’s.

“Over-the-counter earwax softeners are used to breakup and disperse this excess wax. However, the effects of these medications on the cells of the ear had not been thoroughly analyzed.” “Because some of these products are readily available to the public without a consultation with or prescription from a physician, it is important to make sure they are safe to use.”

“Our study shows that in a well-established animal model, one such product, Cerumenex, is in fact, toxic to the cells of the ear,” says Dr. Daniel.

Dr. Daniel and his team studied the impact of Cerumenex on hearing. In addition, overall toxicity in the outer ear and changes in the nerve cells of the inner ear were analyzed.

“Harmful effects to many of the cells were observed after only ONE dose,” says Dr. Melvin Schloss co-author and MCH Director of Otolaryngology. “We observed reduced hearing, severe inflammation, and lesions to the nerve cells.”

“We believe these findings are applicable to humans,” add Dr. Daniel. Overall, our findings suggest that Cerumenex has a toxic potential and it should be used with caution.” (1)

Did you notice that? Cerumenex can cause hearing loss and a number of other ear problems! Why is this just being reported now?

Actually not all of this information is new. It has been known for a number of years. For example, if you had a copy of “Ototoxic Drugs Exposed” published back in 2002, you would have already known that Cerumenex was ototoxic—that it could cause tinnitus, ear pain, and unspecified ototoxic damage—typically hearing loss.

(1) The Montreal Children’s Hospital, January 28, 2008
http://www.muhc.ca/media/news/?ItemID=28904

by Neil Bauman, Ph.D.

A veteran wrote:

My hearing loss and tinnitus is service-connected. I was exposed to constant cannon fire while in the Marine corp. No hearing protection. Marines were expected to tough it out. Now I’m paying for that silly theory with my hearing problems.

I am trying to explain to the VA doctors and audiologists about my severe sensitivity to sound. Some loud sounds hurt my ears really bad. This is causing me to have anxiety and panic attacks secondary to the loud sounds.

The VA has said that my problems are psychological so I’m now seeing a psychologist. I am very depressed because of my inability to hear well, and my tinnitus is extremely loud. I sometimes think that there are mice in my ears scratching to get out. The tinnitus and combined hearing loss is very depressing, but so also is the sensitivity to loud sounds.

Loud sounds cause me to become disoriented and dizzy and I lose my balance. Several times, upon hearing loud sounds, I have fallen. I realize that this is caused by my anxiety reactions and panic reactions to the pain of the loud sounds. My problem is that I can’t seem to make the VA medical people understand.

They just think I have to get over the depression. They think the depression is causing the problem and that when the depression goes away so will the tinnitus and sensitivity to sound. I also hear phantom sounds, which I know are a part of my hearing loss and tinnitus. But again the VA is saying no. They want to blame it on psychosis? The bottom line is that the depression, anxiety and panic disorder are secondary to my hearing problems.

Fear of sounds is called phonophobia. In your case you perceive the sounds as so loud they hurt. No one wants to be hurt—whether it is loud sounds or anything else.

However, I think that rather than having phonophobia, you have hyperacusis—where you perceive normal sounds as too loud. Hyperacusis is often the result of having your ears damaged by loud noise such as you were exposed to in the Marines.

Living with loud tinnitus day in and day out can lead to depression. Actually, this is sort of a Catch 22 situation. Depression often leads to louder tinnitus—so you want to get your depression under control in order to help control your tinnitus, but on the other hand, loud tinnitus leads to depression, so you want to get your tinnitus under control if at all possible.

You can learn to live and enjoy life even though you have tinnitus and can’t hear much. I don’t hear much at all now, and I’ve had tinnitus day and night for 35 or more years—but I don’t let it affect my happiness. My book, “When Your Ears Ring—Cope With Your Tinnitus—Here’s How” has helped many.

It’s interesting (not nice, but interesting) to note that loud sounds also cause you to lose your balance. I don’t see how it relates to anxiety reactions like your doctors think it does. To me, it seems you have a condition called Tullio’s Phenomenon in which people lose their balance from loud sounds—not from anxiety or panic.

Another name for it is Superior Canal Dehiscence Syndrome. Basically what happens is that you have a hole or thin spot in the bone separating the balance system from the hearing system. Thus when you hear a loud sound, the sound wave travels via the hole to act on the balance system. Since it is a sound signal and not a balance signal it sends false balance information to your brain. This totally confuses your brain and the result is loss of balance. Some people drop to the floor like they were knocked out. Others have vertigo and some dizziness and imbalance. Sometimes doctors can patch the hole and cure this, but other times not.

If this is what you have, then the psychologist is wrong in trying to treat you for anxiety and panic. Yes, you need to get those under control too, but you also need to have an otologist check you out for things that cause Tullio’s Phenomenon such as Superior Canal Dehiscence Syndrome.

You have several ear related problems and each one needs the proper treatment by the appropriate professional. Blaming it all on you just isn’t going to help!

by Neil Bauman, Ph.D.

A lady wrote:

I found a little dog and had him with me for one week before finding his grateful owners. Of course I had to walk him, and I fussed over him (a sheltie/Pomeranian mix—he is super cute). During that time, it seemed the ringing in my ears was much less. Perhaps it was only that I was occupied—but I think there is some healing effect beyond what we understand that pets have on us. I know it is a subject much talked about, but I never experienced it first hand (I have laid-back cats but they are different).

I think it was mostly that you had something to focus on—and when you do that, often you don’t notice your tinnitus as much. But who knows what loving a pet can do for your health in the broadest sense? Anything that helps you deal with your tinnitus is a good thing. Maybe you need to get yourself a little tinnitus-reducing dog of your own?

by Neil Bauman, Ph.D.

A lady wrote:

I just discovered references to you on the Internet while I was trying to Google information about what I now know you have coined “Musical Ear Syndrome”.

The MES reference fits me to a “T”, and I am so relieved to find that others experience this, too. I am 47 years old, and I have been hearing music all day long for about a decade. But what I’ve found is that it waxes and wanes depending on my level of anxiety or depression. Its reappearance coincides with increased stress/anxiety/depression.

I have taken Paroxetine three times since 2000. I most recently began taking it again about 12 weeks ago. Prior to that, I had heard music in my head increasingly for about six months. After beginning the Paroxetine, the MES disappeared. However, over the past two weeks it has returned, and I have noticed along with it a slight elevation in my anxiety/depressive symptoms, enough so that I am increasing my dosage.

What I was wondering is whether you have any information about why this seems to be the case with me, is it dangerous (i.e. a precursor to eventual hearing loss or dementia, etc.), should I be checked out for other causes, as I am not elderly, do not live in a totally quiet environment (though I try to keep it that way as much as possible), and am not hard of hearing. Do you think it’s linked to my depression/anxiety issues? Should I be concerned?

You are perceptive. Stress, anxiety and depression are all factors associated with Musical Ear Syndrome.

When I was researching musical ear syndrome, I found 5 things in common in many people, but since then, I’ve heard from numbers of people more or less in your boat—that do not fit the typical MES mold—but nevertheless have the same phantom music.

I’m still trying to figure out why it affects people like you—but I have noticed that anxiety/stress/depression may be a common thread.

I do not believe that it is a precursor to anything such as hearing loss or going crazy. I think it is just the way your body/brain reacts to stress/anxiety/depression.

Let me explain the roles of anxiety and depression in this. When you are anxious, essentially your body is in the “fight or flight” mode—and all your senses are heightened. This means your hearing is more sensitive too—so you hear things you wouldn’t otherwise—and maybe this includes faint phantom sounds rattling around in your auditory system that you were not otherwise aware were there. (This is also why anxious people tend to have hyperacusis—hear normal sounds as too loud—the internal volume control is turned up too high and stays there.)

Now for the role of depression. When you are depressed you normally turn your focus from the external to the internal. Thus, you become more aware of the internal workings of your body and “notice” the phantom sounds. Because you are depressed, you focus on these sounds more and more wondering what is happening to you—and these sounds become more and more intrusive and louder in the process because your limbic (emotional) system is flagging them as important since you are worrying over them. Thus begins the vicious circle.

What you need to do is get your anxiety and depression under control and hopefully these phantom sounds will begin to fade into the background again.

To learn more about Musical Ear Syndrome, read this article about it, or get the book “Phantom Voices, Ethereal Music & Other Spooky Sounds“.

by Neil Bauman, Ph.D.

A mother wrote,

My daughter has LVAS [Large Vestibular Aqueduct Syndrome]. My husband and I have not had genetic testing done to determine whether we are carriers. Am I to assume that since my daughter has LVAS, so will my son?

No—unless you both also have LVAS. The fact that your daughter has LVAS indicates that you both are carriers of the LVAS gene(s). Since you are just carriers, then there is a 25% chance your son will have LVAS, a 50% chance he will be a carrier, and a 25% chance he won’t carry the gene(s) at all. At least that is how I understand it. (I’m sure it is more complicated than the above because they don’t even know all the genes involved in LVAS yet—but it should give you a good general idea.)

Also, remember this is the average in a large population. That said, it IS possible you could have 4 kids in a row with LVAS, or have 4 kids in a row without LVAS—but on the average the 25, 50, 25 rule holds—just like you can flip a coin and get 4 heads in a row or 4 tails in a row—but it is not likely.

Just because you already have a child with LVAS doesn’t make succeeding children more (or less) likely to have LVAS. each child has the same 25/50/25 percent chance of having LVAS independent of whatever has occurred before with your other children.

To learn more about LVAS, read this article.

by Neil Bauman, Ph.D.

Recently a woman explained,

I haven’t lost my hearing, but I hear my pulse as a “squeak” frequently. It is only on the left side, but it is very annoying and sounds like a heart murmur. Any suggestions?

When you hear your pulse in one or both ears, this is a type of tinnitus called pulsatile tinnitus. Interestingly enough, as you have found, typically you only hear pulsatile tinnitus in one ear.

I’ve never heard it described as a squeaking sound before, but it is consistent with what other people hear. One lady hears hers as a high-pitched ringing sound in time with her heartbeat, while a man explained he hears a “zing, zing, zing” sound in time with his heartbeat. Thus, your “squeak, squeak”, “squeak” fits right in.

Since you are writing to me now, I assume that this is a fairly new phenomenon—and not a tinnitus sound you’ve been hearing for years.

Typically pulsatile tinnitus is related to the blood flowing in the arteries in your neck and near your ears. Normally you don’t hear such sounds, but when something changes in the blood vessels near your ears, you sometimes hear these strange (and annoying) tinnitus sounds.

There are at least 25 different known causes of pulsatile tinnitus. The three most common causes of pulsatile tinnitus, accounting for 68% of the cases, are Benign Intracranial Hypertension (BIH) syndrome, Carotid Artery Disease (CAD) and Glomus Tumors (benign masses of blood vessels that grow near the ear). The good news is that this kind of tinnitus can often be fixed once the specific cause is identified.

Generally, pulsatile tinnitus occurs when the smooth flow of blood in the blood vessels in your neck or head is interrupted. Often this is caused by atherosclerotic build up of cholesterol on the walls of your arteries, or high blood pressure. These conditions cause your blood to flow faster and/or more turbulently—thus producing these strange sounds in step with each heartbeat.

The first step in treating pulsatile tinnitus is to go to a cardiovascular specialist and see if he can pinpoint the cause and go from there.

To learn more about pulsatile tinnitus, check out the section on “Pulsatile Tinnitus in “When Your Ears Ring! Cope with your Tinnitus—Here’s How“.

by Neil Bauman, Ph.D.

A lady asked:

Can a person drink grapefruit juice, or eat grapefruit without taking medications with it and be ok, or does grapefruit affect hearing loss period?

If you are not taking any medications, eat/drink as much grapefruit as your heart desires. It doesn’t affect ears. It’s not the grapefruit that is ototoxic.

What happens is that certain drugs (which can be ototoxic) can be absorbed into your bloodstream in much higher quantities than usual if you normally have high levels of an digestive enzyme called Cytochrome P-450 3A4 (CYP 3A4 for short) in your stomach and then eat grapefruit. The furanocoumarins in the grapefruit prevent this enzyme from breaking down the drug before it is all absorbed into your bloodstream—hence you get a much higher drug dose than otherwise.

Perhaps you don’t realize it, but many drugs are not completely absorbed by your body. For example, a given drug may typically only be 10% absorbed and 90% excreted. Doctors know this, so in effect they give you 10 times the dose you need—knowing that 90% is going to be wasted and only 10% absorbed.

Now, if you have high levels of CYP 3A4 in your stomach, the furanocoumarins bind to the CYP 3A4 and prevent it from breaking down certain drugs before they are absorbed. Thus, you could end up with 10 times the dosage. If the drug is ototoxic, you just got quite an ototoxic overdose, and that could affect your ears. The highest figures I have seen related to taking grapefruit juice were for Simvastatin (Zocor), which resulted in a 1,513% increase. That’s quite an overdose!

If you normally have very low levels of CYP 3A4 in your stomach, then taking grapefruit doesn’t make much difference. In this case, your body normally absorbs much more of these drugs—so your doctor has to give you a smaller dose than to people with high levels of CYP 3A4.

Here’s the rule of thumb. If you have high levels of CYP 3A4 in your stomach, you have to be consistent in your grapefruit intake—so either always take a same amount of grapefruit at the same time, or never take it. That way, the doctor can adjust the dose to fit how your body absorbs it.

If you have low levels of CYP 3A4 then it probably won’t make much difference whether you eat grapefruit or not.

Incidentally, there are a few drugs that also bind to CYP 3A4 so you don’t want to take them at the same time either.

If you want to learn more about this fascinating subject (and to learn which drugs are sensitive to grapefruit) read chapter 10 in “Ototoxic Drugs Exposed“.

by Neil Bauman, Ph.D.

Right now we are in a transition between the existing analog TV transmission standard and the new digital TV standard. On February 17, 2009 here in the USA, all analog TV transmissions will cease, and we will enter the 100% digital TV transmission age. (Don’t confuse digital TV with high definition (HD) TV.)

This raises a number of questions concerning how captions will work with digital TVs, set top boxes, converter boxes, cable boxes, etc.

Because it was not clearly thought through from the beginning of the planning phase, this is more complicated that it needed to be is. To explain some of the things of which you need to be aware, here is my friend Steve Barber. He writes:

There are several advantages of digital captions, such as being able to control the color, size, transparency and location of the captions (depending on your equipment). In addition, captions should never garble if you’ve got a digital signal.

However, things aren’t as simple as they used to be. Originally, TVs only had one input (the antenna) so hooking them up wasn’t much of a technical challenge. Then, along came cable, satellite, VCRs, DVDs, set-top boxes, home theater equipment, caption decoder boxes (later replaced by chips in the TV) and things got more complicated.

For years, TVs have had various places to plug in all that stuff—coax connectors for the satellite and cable, RCA (composite) jacks for various other sources, and S-video on some TVs for certain connections. Even so, since 1993, the captions were normally decoded by a chip in the TV, no matter what the source.

Now, in addition to the above connectors, digital TVs also have HDMI connectors (which are supposed to allow optimum picture and audio quality).

Here’s where it gets more interesting. Captions are no longer analog signals buried in the invisible raster scan of the analog TV signal. Digital captions are stored in the signal as bits. The problem is that HDMI connectors only carry the video and audio signals. They can’t carry the digital captions. Thus, one problem is how to get captions if you use an HDMI connector from a converter box or other source.

The answer is that converter and set-top boxes will have caption decoder chips built-in, just like your TV has today. Thus, if you use an HDMI connector, you’ll have to turn on the captions in the set-top box or another source, and have it insert the captioned text into the image, which the HDMI connector can then transmit.

Alternatively, you can connect your TV from various sources with one of the other connector types, and then use your TV’s decoder chip to decode the signal. Depending on the connector, the signal may not be as wonderful as it could be, but also, depending on your TV, it may not matter. Most of the great TVs you see in the store are being run on composite connections, not HDMI. Fortunately, on most TVs you’d not be able to tell the difference anyway.

DVDs and VCRs present another problem. A few have their own tuners, and therefore have their own caption decoders built in. Thus, you may be able to use that caption decoder if you can’t otherwise get the undecoded captions to your TV.

A word about DVDs: DVDs frequently have both closed captions and subtitles. Some DVDs only have one or the other. Thus, you have to know which is which, and how to get them displayed. Also, you have to make sure they are not both displayed at once! Closed Captions have to be decoded to be displayed. Subtitles are an option on the DVD’s program menu.

If you want to see the captions encoded on a DVD, you’ll either need to have a DVD Player that has its own tuner and caption decoder (there aren’t many of them), or you mustn’t connect to your TV via HDMI. If you are connected by HDMI, you’ll need to decode the captions first in the player so they are then incorporated as part of the image which then can go via HDMI.

Subtitles are probably going to be more common on DVDs because the DVD players will let them be put in the image if you select them. Thus, if the DVD has subtitles, it’s probably the easiest solution for captions when playing a DVD.

Originally Closed Captions were designed for people who couldn’t hear, so they included environmental sounds, such as “dog barks” or “toilet flushes” as well as what was spoken. Subtitles (remember silent films or foreign films?) were originally for people who could hear, so they didn’t include environmental sounds. Even when they first appeared on DVDs, subtitles didn’t include environmental sounds. As a result, many deaf or hard of hearing people preferred the Closed Captions.

Fortunately, recent DVDs are starting to include “Subtitles for the Hearing Impaired” (SDH) and to include the environmental sounds. In the future, I think we’ll see DVDs with SDH instead of Closed Captions. That may simplify getting captions displayed when you’re using a DVD.

Your set-top box for cable or satellite, or a digital to analog converter box, will have menus (and maybe a remote button) for controlling the caption decoder in the set top box. Thus, for most people when watching TV through one of those, you’d turn off your TV’s decoder and turn on the decoder in the set top box. This should be reliable and easy, but you’ll have to understand which devices have decoders, and how to turn them on or off. Once you’ve set them up, it should be fine even though there are so many more options to understand than in the old days.

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You can find a bunch of good information at the North Carolina Hearing Loss Association website Steve maintains.