Archive for June, 2009

June 30, 2009: 9:22 am: Dr. NeilOtotoxic Drugs

by Neil Bauman, Ph.D.

A lady explained:

I have recently started taking HRT [hormone replacement therapy] (estrogen only) via a transdermal patch 50mcg, for the last 11 weeks. Since starting HRT I have had a constant pain deep inside my left ear, with intermittent nerve pain radiating behind the ear. It can happen anytime and last from 1 min to 1 hr to all day.

My doctor has examined my ear but can not find anything wrong. I decided to stop the HRT for one week. The pain subsided quite dramatically, however my menopausal symptoms got worse. My doctor suggested I start a lower dose 25mcg. With the lower dose, the pain is mild compared to what it was, (I can live with it), the pain behind the ear has gone and my menopausal symptoms are manageable.

Do you think HRT could have caused this ear problem?

I haven’t heard of ear pain specifically associated with HRT, although it is a reported side effect of Progesterone and a number of “hormone” drugs, so I wouldn’t be at all surprised if that is what is happening. (Incidentally, a number of antidepressants have ear pain as a side effect too—all the SSRIs for example.)

The fact that when you stopped the HRT the pain went away is very strong circumstantial evidence that the pain was indeed related to the HRT. Also, the fact that the pain came back when you restarted the HRT is strong corroborating evidence. The clincher is that taking a reduced dose gives you reduced pain.

Obviously, taking the lowest dose that will control most of your symptoms is a wise way to go. Alternately, you could dump the HRT completely and use alternate medicine—herbals, etc. which can help relieve your symptoms without the painful side effects.

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June 26, 2009: 9:19 am: Dr. NeilHearing Aids

by Neil Bauman, Ph.D.

A lady explained:

Last night, all of a sudden my ear began itching so I took my hearing aid off and with my little finger I was scratching in my ear canal. When I put my hearing aid back on, it started to give feedback all the time. This morning I’m still getting enormous feedback when I put my aid in. It’s driving me crazy. What can I do?

There are two likely causes of your feedback. The good news is they are both easy to fix.

When you were scratching your ear, you likely dislodged a piece of wax (or other debris) and either one of two things happened.

One, the dislodged wax is now blocking your ear canal, so when you put your hearing aid in, the wax butted up against the hole in the ear mold, basically blocking it. The result is feedback. It’s basically the same thing as your hearing aid squealing when you cup your hand around it. This is not as true of modern aids that have feedback suppression.

Two, when you put your hearing aid on, you pushed the wax into the hole in the ear mold—again causing the feedback.

The first thing to check is your ear mold. If any wax is blocking the hole, clean it out. That should fix your problem.

If the ear mold hole is clear, then you likely need to clean out your ear canal. When we wear hearing aids, the body’s natural action to work wax and anything else in our ear canals out over time is prevented by the ear mold. Thus, each time we put in our hearing aids, we push wax further into the ear canal until it completely blocks it.

Therefore, it is a good idea to have your ears regularly cleaned out to prevent this from happening again in the future.

Epilogue: This lady went to her ear doctor, and he found her ear canal was completely plugged with wax. Cleaning out her ear canal instantly solved the feedback problem.

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June 22, 2009: 8:58 am: Dr. NeilCochlear Implants

by Neil Bauman, Ph.D.

A lady wrote:

I have bi-lateral Meniere’s and was recently approved as a candidate for a cochlear implant. Your article “Which is the Best Cochlear Implant?” published December 6, 2007 mentions one surgeon in Baltimore as being “one of the top rated CI surgeons anywhere”. Could you tell me how us non-medical people can find a list or ranking of CI Surgeons? What was your source that told you Dr. Niparko was top rated? A medical journal? A magazine article? I’d love to see the source so I could find a top rated CI surgeon near me.

As far as I know, there is no list ranking cochlear implant surgeons as such. What you need to do is “listen around” and see who’s name comes up the most often in relation to cochlear implant surgery; who is thought of most highly; who has a particularly good success ratio with few complications; who has done hundreds or thousands of CI surgeries; etc.

When you do this you’ll hear names like John Niparko and other good CI surgeons. Those are the ones you want to go to.

One way to “listen around” is to join on-line groups specializing in cochlear implants such as the SayWhatClub‘s CI list (click the button on “Joining”) and ask the people there which surgeon they had, and who they recommend in their area. You’ll learn a lot that way.

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June 18, 2009: 8:55 am: Dr. NeilCell Phones, Hearing Aids

by Neil Bauman, Ph.D.

What will they think up next? Did you ever want to change the settings on your hearing aids, but felt embarrassed, and didn’t want to be obvious about it? That is where a remote control comes in handy. I loved to be able to do this with the remote that came with my old Widex Quattros. I could change programs, adjust the volume, or turn on or off the T- coils or microphones, even if the remote was in my pocket. No one had a clue that I was doing that.

Now Starkey Labs, the makers of Starkey hearing aids has come up with these features, but with a new twist. Their new “S” Series hearing aids have a cool feature built in called T² technology.

With T² technology, your cell phone can double as a remote control. T² technology allows you to use your cell phone (or any touch-tone phone for that matter) to conveniently switch memory settings, adjust the volume, or mute your “S” Series hearing aids.

To learn more, click on Starkey “S” Series hearing aids, then click on “View Features” to learn a bit about the T² technology and other features of these new hearing aids.

If controlling your hearing aids via remote control is something you always wanted, and you are “married” to your cell phone, maybe the new Starkey “S” series is something you might want to investigate.

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June 14, 2009: 8:52 am: Dr. NeilCoping Strategies

by Neil Bauman, Ph.D.

A mother explained:

We have a 5-year-old daughter who is hard of hearing, and wears hearing aids in both ears. She received speech therapy and hearing support at her pre-school as well. Her speech is delayed from not being able to hear for so long.

We’re having a hard time disciplining her because she’s not understanding what we’re saying and we’re not understanding what she is telling us. We talk it out, but she gets frustrated and just starts crying.

The problem I think we’re having is that she is not understanding when we tell her something is right or wrong. Her right ear has a moderate to severe loss and her left ear has a moderate loss.

Do you have any advice on what to do when it comes to explaining the rules and disciplining children with hearing loss?

You have raised a most important point. I have had experience on both sides of this issue—first as the hard of hearing child, and then later, as the parent of a hard of hearing child.

Before you discipline a hard of hearing child, you have to be sure that they willfully disobeyed. If they didn’t know something was wrong, because they never heard previous warnings, its not their fault, its yours for not communicating in a way that they could hear (understand).

Therefore, you need to use all the normal hearing loss coping strategies—get close, face the child, cut out background noise, make sure there is light on your face and not in your child’s eyes, etc., etc. before you begin talking. If you don’t do this and then punish a child, the child is traumatized because they don’t have a clue why they are being punished.

I still remember when I had just turned 4, my mother was in the hospital having my brother, and my dad was home looking after my sister and me. The first night my dad developed severe ulcers and the ambulance took him to the hospital. Co-workers of my dad’s, but strangers to me, came to look after us for a few days.

Was I ever terrorized! I was punished for things I didn’t even know were “wrong” because I couldn’t hear/understand what these strangers were saying. They assumed that I was being disobedient, when in fact, I didn’t have a clue what they wanted me to do. Such situations can leave deep emotional scars.

Therefore, before you jump down a child’s neck, you first have to find out their understanding of what they did. For example, if you say, “Don’t jump on the sofa” and the child does it, you need to ask, “What did I say about jumping on the sofa?” For all you know they never heard the first word “don’t” and thus heard you tell them it was ok to jump on the sofa and thought, “Wow, this is great!” They may not have even heard the word sofa at all, and so didn’t have a clue what you were talking about.

Children can become very anxious when they don’t know the rules, and thus punishments seem to come out of the blue at random.

Also, always reinforce what you are saying with visuals. For example, in the above example, when you say “Don’t jump on the sofa,” at the same time you should be shaking your head so even if they don’t hear the “don’t” they see it. By the same token, nod your head when you tell them to do something.

I can remember lots of times not understanding what I was supposed to be doing because I only got part of the message/warning/command. All you need to miss is one word and it completely changes the meaning, and with our poor
ears, we miss a lot more than just one word!

To be sure your child understands you, here’s a simple rule. Have your child repeat back to you any warnings, orders or instructions you give him. Say, “tell me what I just told you to do/not do” so I know you understood me. only what he repeats back is what he heard/understood/can remember. You need to take that literally, and in its narrowest sense. Don’t read into it more than he just said.

Let me give you an example of this from my adult life so you can see how even making the smallest assumptions about what we hear can have major consequences. A number of years ago, I was a volunteer firefighter on the Canadian prairies. There were large grain farms as far as the eye could see. As you can imagine, we had a lot of field fires in the spring and fall when the farmers were out working their fields.

Because I couldn’t hear much, the chief typically had me doing “support” roles rather than active firefighting, although I was trained in everything and had to step in at a moment’s notice if they were short-handed. On field fires I was often designated to drive the water tanker.

On one such fire call, the chief told me to take the tanker. I asked, “Where’s the fire” He said, “3 miles east and 4 miles south.” I repeated it back to be sure I got it right—3 miles east and 4 miles south. I repeated it again to be sure, and the chief, deputy chief and captain all heard me repeat it back.

I took off immediately in the tanker (a lumbering cow to be sure) and I hadn’t gone a mile before the other trucks all passed me and were soon long out of sight. When I got to the intersection 3 miles east and 4 miles south of town there were no fire trucks, no signs of a fire—nothing.

I got on the radio but couldn’t reach them—just static. They were down in a coulee and their signal couldn’t get out. What do I do now. I’m alone in the water truck and can’t understand anything on the radio. Where do I go? I know I’m at the right location.

There was a little rise in the road behind me, so I turned around and drove to the crest and radioed again, “Where are you?” Back came the reply, “Where are you? We’re out of water!”

I said, I’m 3 miles east and 4 miles south and you’re not here.

That’s when I discovered I didn’t have the whole message. You see, we always used as our reference point for out of town fires, the intersection of the road to the town and the north-south highway, so that is what I used.

For some strange reason, this one time, they used an intersection 4 miles south of town on the main highway as their reference point (and I never heard that). So when I repeated back what I had heard, the chiefs and captain mentally read into it that I was starting 4 miles south of town just like they were thinking—yet they all heard exactly what I had repeated back and I had not repeated anything about a different reference point. The result was I had the water they needed, but was exactly 4 miles north of where it was needed!

This kind of thing happens with our hard of hearing children too. Therefore, ask them to repeat back your orders and instructions, and only what they repeat back is what they understood—nothing else. It is up to you to be sure that they have all the essentials included. If they don’t, try again (and again) until they get it right.

Remember, earlier I said to also use visuals (nod or shake your head). Well, in our fire department, it was standard procedure that the first or second person arriving at the hall would find the location of the fire on the map and make a prominent circle around it so everyone coming in later could see where it was. All truck drivers were supposed to check the map before the left the hall so they knew where they were going.

Most of the time the chief and I got there first—he worked across the street and I lived right beside the fire hall, so I typically marked the map as he scribbled the directions down. But this time I was working out of town so didn’t get there in time to do that—and no one else had bothered to mark the map. Thus I had no means of visually checking where the fire was. To hard of hearing people, that’s how important those little visuals are when added to any verbal instructions.

When children are old enough to read, its not a bad idea to have a “book of rules” so they can be sure they understand them properly, or leave a printed note listing what they are supposed to do/not do. Make it easy for your hard of hearing child to know what is expected of them.

One more point. Few people realize that it is difficult for a hard of hearing person to remember more than one or two directions at a time. This is because we work so hard trying to understand the words, that the message never really sinks in. It’s hard to recall a “fuzzy” message, and that’s all we have to work with. Therefore, if you have more than a couple of instructions, write them down so we get them all correctly.

Many’s the time I have listened to instructions and at that time, I was sure I had them, but by the time I walked out the door, too late I realized I could only remember the first one or two.

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June 10, 2009: 8:50 am: Dr. NeilOtotoxic Drugs

by Neil Bauman, Ph.D.

A lady wrote:

I have been suffering from tinnitus for several years and it drives me crazy when I’m trying to get to sleep. I have tried every thing from counting, meditation, etc. I have been to an ear, nose and throat specialist and my local doctor and I have been told I will just have to live with it. I was on Prozac for a few years. I ended up on just half a tablet, but I found it made me feel flat and I didn’t like it so I went off it. Is there any thing I could take to stop me feeling anxious, especially when I’m trying to go to sleep? After reading some posts it seems Prozac could have made my tinnitus worse, is this correct? Does Effexor make tinnitus worse?

“Live with it,” is a doctor’s typical response to complaints about tinnitus—and in one sense it is true—you do have to live with it. However, you can learn to manage your tinnitus so it doesn’t bother you. I have had tinnitus day and night for 40+ years, but it almost never bothers me because I am habituated to it.

Doctors often prescribe drugs such as Fluoxetine (Prozac) and Venlafaxine (Effexor) to help you reduce the anxiety you feel towards your tinnitus. These drugs work for some people, but for others, they actually make their tinnitus worse.

For example, Fluoxetine can cause tinnitus in about 2% of the people taking it according to the Physicians’ Desk Reference (PDR). Since multitudes of people take Prozac, this is a pretty significant number of people. Venlafaxine is no better. In fact, it causes tinnitus in about 3% of the people taking it.

Just because you have to live with your tinnitus doesn’t mean that there aren’t things you can do to help you successfully cope with it. You can learn about many things you can try to help you successfully live with your tinnitus in my book “When Your Ears Ring—Cope with Your Tinnitus—Here’s How“.

If I were anxious about my tinnitus and had trouble sleeping because of it, the above drugs wouldn’t be my choice. I’d much rather use natural means, and there are a variety of them you could try. I’ll only mention two here.

First, you could use herbals rather than drugs. Herbals are typically ever so much easier on your body—no harsh action—and have few, if any, side effects. Best of all, ototoxic side effects from herbals are almost unheard of.

There are a number of herbs that have been used for hundreds and hundreds of years—long before drugs hit the market—to reduce anxiety and promote sleep, and they did (and still do) work. You seldom hear about them, but if you are concerned about ototoxic (and other) side effects, they are a good place to start.

My choice of a herb that reduces anxiety, calms you down and helps you sleep is Valerian (Valeriana officinalis). You can get it at health food stores, or see a herbalist or a naturopathic doctor (ND).

Note: you should not take herbals like Valerian along with prescription anti-anxiety or sedative drugs without checking with your doctor or pharmacist for any drug interactions. For example, you wouldn’t want to take Prozac and Valerian at the same time as the combined action may be too much for you.

The second way to help reduce anxiety is exercise. Far too many people lack an adequate exercise program—and it can show up as anxiety and other things. A vigorous exercise program will work off that extra nervous energy and make you healthily tired, resulting (hopefully) in a good night’s sleep in spite of your tinnitus.

You might want to try these and see how they work for you.

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June 6, 2009: 8:46 am: Dr. NeilMusical Ear Syndrome

by Neil Bauman, Ph.D.

A concerned daughter wrote:

My mother, who is 83, has hearing loss and lives alone in an apartment in a quiet area. My brother lives next door. She has been hearing phantom music for some years now, and we cannot get her to accept that it is all in her head. We have taken her to several doctors for help, but they don’t seem like they want to be bothered. She has had tests which have come back fine, so she refuses to believe that it is her.

She is accusing the woman that lives next door to my brother of playing music all day. Then she is accusing my brother of continuing playing the same music when he gets home from work and all night long.

We have had people go over to her place to listen, and when they tell her they don’t hear anything, she insists that they are all crazy. We have tried everything we can to convince her that she is the only one hearing the music, and that she has MES [Musical Ear Syndrome]. She refuses to accept it. Do you know of someone we can talk to, or some place we can take tor to that will help us convince her of her problem? We are at the end of our rope and need help!

I understand. Doctor’s don’t seem to be of much help, mostly, I think, because they know nothing about Musical Ear Syndrome (MES). As a result, they don’t have a clue how to treat it—so give you the brush-off.

Unfortunately, I’m not aware of any doctor or facility that is truly knowledgeable about MES and hearing loss, and thus is qualified to help your mom.

The best information available on MES (at least in my opinion, and I’m a wee bit biased because I wrote it) is the article “Musical Ear Syndrome—The Phantom Voices, Ethereal Music & Other Spooky Sounds Many Hard of Hearing People Secretly Experience“, and my book on the subject “Phantom Voices, Ethereal Music & Other Spooky Sounds“.

Now let’s look at your mom’s situation. Blaming the neighbors for the phantom music she is hearing is unfortunately, a common tactic for those that experience MES and refuse to admit these sounds are phantom. I hear such complaints quite often. Since this phantom music often appears to have directionality, your mom “KNOWS” it is coming from the room next door (as opposed to the one across the hall, or on the other side of the street, etc.) This gives an added layer of reality to these phantom sounds, which makes it so much more difficult for her to accept that these sounds are all in her head.

Some people also “feel” their phantom music—they can actually “feel” the room or floor vibrating in time to the music. When you “hear” music, can tell exactly from which direction it is coming, and can “feel” the beat, can you blame someone for refusing to accept that the music is phantom? That’s how “real” it is to them.

From time to time, I both “hear” and “feel” certain phantom sounds so I know just how eerily real these sensations truly are. This is quite a hurdle to overcome, and is one of the problems your mom has to deal with.

When she hears the phantom music so loud and clear, it is hard for her to accept that other people can’t hear the same music she is hearing. As you explained, “We have also had people go over to her place to listen and when they tell her they don’t hear anything, she insists that they are all crazy.”

Some people even insist that these “listeners” are hard of hearing themselves, and that is why they can’t hear the music. Your mom says they are crazy instead.

You are doing the right things in getting others to listen and corroborate what you already have found out, that there isn’t any real music playing.

In my experience, a number of people in their 80s and older refuse to accept this. (People in their 60s and 70s are much more willing to accept a hearing person’s word that the music is phantom.) However, when people reach their 80s and 90s often it is like talking to a brick wall. You just can’t seem to get through to them as is the case with your mom even though they are not crazy.

I think the real underlying problem is that to her, if a person hears “voices” or music, they are crazy. That is her only point of reference, and she has held this deeply-rooted belief all her life. Therefore, if she admits that what she hears is all in her head, then she is admitting, at the same time, that she, herself, is crazy. Although she may secretly believe that she IS going crazy, she will never admit it to anyone else. Therefore, the only alternative she has (from her perspective) is to believe that the sounds are indeed real, and therefore, someone or something is causing them.

If she would listen and try to understand, you can explain that there are not one, but two kinds of phantom sounds—the kind she knows about (and fears) where the person has a mental problem, and the other kind, which we call MES (and which she has not heard anything about) that happens to many hard of hearing people who are perfectly sane (but who are, at times, completely fooled by the activity going on in the auditory circuits of their brains). This will be a new concept for her, and some elderly people have a most difficult time grasping such new concepts. Continue to drill it into her that it is her ears (actually the auditory circuits in her brain) that are not working properly, and that she is not crazy (or whatever favorite term she uses).

In addition, many elderly people have very short memory spans for current events, so what you explain to them today, they have forgotten by tomorrow. Thus each day you may need to explain over again about the phantom music.

Another important aspect of this problem is dealing with the supposed perpetrators of the “music”. What happens is the person with MES begins to think very badly towards the neighbor who is so “mean” and “inconsiderate” as to play this loud music all night long just so they can’t sleep.

The person with MES may knock on their neighbor’s door at 3 o’clock in the morning and demand they turn the music off. They may complain to the other neighbors about the “bad” neighbor, refuse to talk to them, or snub them in the dining room.

By the same token, the “bad” neighbor gets tired of all the false accusations and gossip about them and snubs her “crazy” neighbor.

Make no mistake, there are often very real interpersonal problems between those involved. Thus, you need to try to defuse this situation as much as possible. Explain to the “bad” neighbor what is going on, and how MES sounds seem so real and have direction so that they are being blamed for something this is not their fault at all.

When the neighbors and management understand what is going on, they can make allowances for her, and hopefully keep the situation from escalating.

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June 2, 2009: 7:39 am: Dr. NeilCoping Strategies

by Neil Bauman, Ph.D.

A lady explained:

I recently received your book “Help! I’m Losing My Hearing—What Do I Do Now?” My hearing loss has been a gradual loss—but now it is more pronounced. As your book points out, I am having difficulty telling people I am hard of hearing. I bluff all the time. It’s getting increasingly stressful.

I am trying to come to terms with this, but am very frustrated. I can’t understand why I can’t openly deal with it. I do wear hearing aids—they help, but not all the time.

Are there any “support groups” in my area I might be able to connect with?

The “Help” I’m Losing My Hearing” is a great little book, but I think you need to learn more about the basic reason why you bluff, then you will better understand how you can overcome this tendency. I cover this in detail in my latest book called “Keys to Successfully Living with Your Hearing Loss. You would do well to study Key No. 2 in this manual until it becomes a part of you. It contains the real secret to overcoming bluffing.

Very briefly, we bluff because it meets our immediate need to appear normal, and to keep our anxiety over not hearing/not hearing correctly to a tolerable level because we don’t know the proper way to deal with our hearing losses.

To break this cycle, we need to analyze the long-term costs of this action vs. the short-term benefits. When we only focus on the short-term benefits and ignore the long-term costs, we continue to bluff to our detriment.

Furthermore we bluff because we are using what is called emotion-focused coping strategies rather than problem-focused coping strategies. You see, the goal of emotion-focused coping strategies isn’t to help us hear better, but to make us feel better. We need to focus on using problem-focused coping strategies that help us hear better.

Yet another reason for bluffing could be that over your lifetime you have subconsciously bought into the “stigma of hearing loss”—that having a hearing loss is somehow shameful, that you are less of a person if you have a hearing loss, that you are slow and stupid if you have a hearing loss, that hearing loss needs to be hidden away, and other such thoughts.

Now that you are hard of hearing yourself, you impute these same stigmatized feelings onto yourself. You don’t want anyone to know your “shameful” secret, so you try to hide your loss by bluffing. Because bluffing doesn’t work in the long run, your overall stress and anxiety levels build up. (These are some of the long-term costs that you ignore in the heat of the moment, but they ultimately make you feel worse, not better.)

Therefore, it is so much better to be up front about your hearing loss, and tell people what they need to do in order to help you communicate with them. This ultimately gives you confidence and your anxiety level drops. A wonderful by-product of this problem-focused coping behavior is that you not only hear better, but you actually feel better too!

As far as “support groups” go, the best “in person” support organization is the Hearing Loss Association of America (HLAA). They have chapters in almost all states. You can find the various chapters here. Scroll down to the map of the USA and click on your state to find the chapter nearest you, then contact the leader of that chapter. They’ll be delighted to have you join them.

If there is no chapter near you, or if you want “support” more often than once a month, then you might want to try an on-line support group. The best one, bar none, is the SayWhatClub (SWC) To join the SWC click on the button for “Joining”. I’m a long time member of the SWC. We “meet” daily via emails.

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