Hearing Loss Help  

by Neil Bauman, Ph.D.

A lady declared,

I have the new waterproof cochlear implant, but I am certainly never going to wear it in the pool when I am taking aquasize or swimming. I do not trust the manufacturer’s claims. This cochlear implant is too expensive to take the risk of damaging it from water.

The real question is, “Can you trust the manufacturer’s claims or is it all just advertising hype?” There has been so much hype in advertising that people do well to be wary of the fantastic claims many ads proclaim.

Therefore, in order to know whether it is truth or just hype, and thus whether you can/should trust the manufacturer’s claims that your hearing aid or cochlear implant is waterproof or not, you need to check the basis of their claims. Fortunately, there is an easy way to tell.

All you need to do is check out the ISO (International Standards Organization) rating regarding “waterproofness” of your hearing aids or cochlear implants. If the manufacturer rates your hearing aid or cochlear implant as meeting the ISO IPX7 or IPX8 standard, then yes, you can trust the manufacturers claim that it is waterproof and that you can go swimming with it on knowing that the water will not damage your hearing aid or cochlear implant.

I wrote a bit about this in my May 31, 2011 article: Waterproof Hearing Aids and Cochlear Implants—Here They Come.”  Here is an extract of the above article:

If you are interested in exactly what these standards mean, IP stands for “Ingress Protection”. Ingress Protection is how well your hearing aid (or any other device) keeps foreign “stuff” out. The first number relates to solid particles (e.g. dust). A level 5—like the Aquarius hearing aid and Nucleus 5 cochlear implant—are “protected against dust, limited ingress (no harmful deposit)”, while the highest level for solid particles—6—like the Neptune cochlear implant, is “totally protected against dust”.The second number is the level of protection against water (liquids). Level 7 (Aquarius & Nucleus 5) means “protected against the effect of immersion between 15 cm [6"] and 1 m [3']“, while the highest level—8—(the Neptune) is “protected against long periods of immersion under pressure”.

Note: if the rating only relates to liquid protection then an “X” is substituted for the “dust” rating so you know you are talking about the second number (liquid) and not the first number (dust).

Thus, if you see a device rated as IP6 you know it is a dust rating only. If it is rated as IPX6, you know it is a liquid rating only. If the device is rated for both dust and liquid, it would have numbers in both positions, e.g. IP56 or IP68, etc.

Below I have listed the various ISO IPX (liquid) ratings the manufacturers use, and exactly what these ratings mean.

IPX1 No protection from water.

IPX1 Protected against condensation or dripping water falling vertically.

IPX2 Protected against spraying water when tilted up to 15° vertically.

IPX3 Protected against spraying water when tilted up to 60° vertically.

IPX4 Protected against splashing water from any angle.

IPX5 Protected against low-pressure water stream from any angle.

IPX6 Protected against high-pressure water stream from any angle.

IPX7 Protected against water immersion. Immersion for 30 minutes at a depth of up to 1 meter.

IPX8 Protected against continual water submersion in underwater conditions.

Based on the above, if your hearing aids or cochlear implants have an IPX rating of 6 or less, you do not want to go swimming with them on, but if they have a IPX rating of at least 4, splashing water won’t hurt them. If your hearing aids or cochlear implants have an IPX7 rating, you can freely swim and dive underwater up to 3 feet down and do that for to 30 minutes at a time.

However, if you have truly water proof hearing aids or cochlear implants (IPX8), feel free to go swimming and diving with them on. You can be in the water and swim underwater as long as you want, and there is no restriction on how deep you can dive. Thus you can enjoy a good time in the water and can swim underwater to your heart’s content—and never have to worry about water damaging your expensive hearing aids or cochlear implants.

In case you are interested, here are the IP ratings for solid object (dust) resistance.

IP0 No protection against ingress of objects.

IP1 Protection against ingress of objects greater than 50 mm. (approximately 2 inches).

IP2 Protection against ingress of objects greater than 12.5 mm. (Approximately half an inch).

IP3 protection against ingress of objects greater than 2.5 mm. (Approximately 1/10th of an inch).

IP4 Protection against ingress of objects greater than 1 mm. (Approximately 1/25th of an inch).

IP5 Dust protected. Ingress of dust is not entirely prevented, but it must not enter in sufficient quantity to interfere with the satisfactory operation of the equipment.

IP6 Dust tight. No ingress of dust.

How good are these standards? When Siemens tested their Aquarius hearing aid under rigorous field conditions in extreme conditions of humidity over several months, there were no failures. In fact, their field tests in Queensland, Australia from December 2010 to February 2011, in the heat of the summer included some of the strongest floods and cyclones in Australia’s history. Field study participants also continued to wear the Aquarius during showering and swimming with no failures reported. (1)

Therefore, if your hearing aid or cochlear implant is rated with an IPX8 rating for water resistance and an IP6 rating for dust resistance (in other words, it is rated as IP68), feel free to wear it any time under any conditions. You do not have to worry about dust, water or moisture causing your hearing aid or cochlear implant to fail. That is how good those ratings are.

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(1) Chalupper, Josef. 2011. Beneath the Surface: Understanding the Terms “Water Resistant” and “Waterproof”. The Hearing Review. Vol 18. No 11. October 2011. p. 60.

by Neil Bauman, Ph.D.

Smoking is bad for your health. Numerous studies have proven this. Therefore, it should come as no surprise that breathing secondhand smoke is also bad for your health. Again, studies have proven this.

Now, a recent study by Dr. Anil Lalwani has shown that in addition to causing health problems and ear infections, breathing secondhand smoke can also cause sensorineural hearing loss in those that breathe secondhand smoke.

Dr. Lalwani of the New York University Langone Medical Center studied 1,533 12 to 19-year-old youths that did not smoke. He collected information on whether or not smokers lived in their homes. Each of these teens were given extensive hearing tests. They were also given a blood test to measure the level of cotinine (a substance related to nicotine) that can objectively tell how much secondhand smoke a person has been exposed to.

The results were striking. The higher the teens’ level of cotinine, the higher their chances for having resulting sensorineural hearing loss. In fact, the cotinine acted as a remarkably accurate barometer of hearing damage according to Dr. Lalwani. (1)

Sensorineural hearing loss was defined as an average pure tone level greater than 15 dB. Secondhand smoke exposure, as assessed by cotinine levels, was associated with elevated pure tone hearing thresholds at 2, 3 and 4 kHz (critical frequencies required for clearly, understanding speech) and an 183% increase in risk of unilateral low-frequency sensorineural hearing loss. (2)

Interestingly enough, 82% of the teens did not realize that they had a hearing loss. (2)

Why does breathing secondhand smoke cause increased hearing loss? According to Dr. Lalwani, “We know smoking leads to reduced oxygen in the blood, so that may be an issue. We also know that smoking causes vascular issues, so a variety of factors could be contributing.” (1)

Now comes the important question. What can you do about it? If you are a parent that smokes, the obvious answer is “Stop smoking!” Not only will stopping smoking improve your own health, but you will also improve the health of your children, and help preserve their precious hearing. That alone should make it worth the effort.

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(1) Teen Hearing Problems—It’s Not Just About the Loud Music! October 20, 2011. In: Bottom Line’s Daily Health News.

(2) Lalwani, Anil. 2011. Secondhand Smoke and Sensorineural Hearing Loss in Adolescents. Arch Otolaryngol Head Neck Surg. 2011 Jul; 137(7): 655-62.

by Neil Bauman, Ph.D.

Properly-installed loop systems can help hard of hearing people hear and understand speech dramatically better in meetings, churches and other public venues. Here in the United States, audiologist Juliette Sterkens has been working hard to increase the awareness of people with hearing loss to the benefits of loop systems.

She has just released a short “You Tube” video showing the enormous increase in understanding speech you can experience when you use your hearing aids in t-coil mode in a looped church as compared to not using the loop system. To watch/listen to this video, click here.

You can learn much more about loop systems and how they can help you hear better—whether at church or at home watching your TV—by clicking on “Looping Information“.

As a public service to help you find and experience the benefits of loop systems in public venues, the Center for Hearing Loss Help is now maintaining a listing of churches and public buildings by state. To find a looped venue near you, simply click on “Looped Public Buildings by State in the USA“.

by Neil Bauman, Ph.D.

Back in 2004 when I coined the name “Musical Ear Syndrome” for the strange musical hallucinations many hard of hearing people secretly experience, I never dreamed that someone would actually make a movie about it. But that is what has just happened. In fact, this short movie was one of 12 films nominated for inclusion in the prestigious 2011 Virgin Media Shorts film competition, the UK’s biggest short-film competition.

Ian Gamester, a Liverpool filmmaker, made the short list with a touching documentary starring his grandmother, Cath Gamester, who, after being prescribed anti-depressants by her doctor, now suffers from Musical Ear Syndrome (MES). As Ian explained, “She kept hearing the same songs again and again and thought that someone was playing a record loudly.”

Unfortunately, Ian did not win any of the three top spots at the gala judging competition on November 10, 2011, but just being nominated for this prestigious competition has helped more people become aware of Musical Ear Syndrome.

You can watch this 2 minute and 20 second black and white film here.

by Neil Bauman, Ph.D.

A recent MarkeTrak study revealed some interesting things about tinnitus and its effects on our lives—what we can do to help ameliorate the effects of our tinnitus and where hearing aids fit into the equation. (1)

But first, some background on tinnitus. Tinnitus—ringing in the ears—affects a LOT of people— somewhere between 30 and 50 million people in the USA alone.

The older we get, the more likely we are to experience tinnitus. (1) For example:

Notice that by the time people reach 55, at least one person in five has tinnitus. This rises to one person in four for seniors. That’s a lot of people living their lives listening to the phantom racket we call tinnitus.

Tinnitus affects the quality of life for many people. A study of 3,431 people with tinnitus (1) revealed:

(Note: these figures add up to more than 100% because tinnitus often affects several aspects of a person’s life at the same time.)

The good news is that almost half of the people with tinnitus report it does not affect their lives at all. Basically, they just ignore their tinnitus and live happy and fulfilled lives in spite of the racket in their ears. I’m one of these. Sure, sometimes I wish my tinnitus wasn’t there, but I choose to ignore the constant tinnitus I experience and live my life as though it didn’t exist.

That’s a bit of background on tinnitus. Now, let’s look at how we can help bring our tinnitus under control. One of the treatments that few people apparently consider to help bring their tinnitus under control is simply getting and wearing properly-fitted hearing aids.

In a study of 1,314 people with tinnitus, 52.4% found that wearing hearing aids didn’t make any difference to their tinnitus. That’s the bad news. However, looking at it the other way, the good news is that if you have tinnitus you have approximately a 50-50 chance that wearing hearing aids will help reduce the impact of your tinnitus. Any treatment that has a 50% chance of helping you is definitely worthwhile trying!

Here’s a note of caution: If you have tinnitus, you still have to be careful when wearing hearing aids because the above study further revealed that 4.2% of the people with tinnitus found that wearing hearing aids actually made their tinnitus worse. If you are one of these unfortunate people, you need to keep the volume on your hearing aids set to a level that doesn’t provoke your tinnitus. If that won’t work, you probably should not wear hearing aids.

However, the good news is that 43.5% of the people found that wearing hearing aids helped mitigate the effects of their tinnitus. Here’s the break-down of the results: 15.7% of these people reported a mild reduction in their tinnitus; 14.1% reported a moderate reduction in their tinnitus; and the really good news was that 13.7% reported a significant reduction in their tinnitus. (1)

How often did this reduction of tinnitus occur when wearing hearing aids? Of the 553 people that reported an improvement in their tinnitus when wearing their hearing aids, here’s the break down:

Notice that almost 2 out of 3 people reported that wearing their hearing aids gave them reduced tinnitus most or all of the time! That’s impressive for any tinnitus treatment.

Now here’s the best news of all. 3.4% reported that the improvement in their tinnitus continued even when they took their hearing aids off! (1)

With results like these, if you are bothered by your tinnitus and you have some degree of hearing loss, you owe it to yourself to try hearing aids and see whether they will help your tinnitus too.

This study also looked at the various things people tried in order to reduce their tinnitus. Of the 3,473 people in this study—all of whom had tinnitus—notice that only a miniscule 6.1% tried wearing hearing aids in an attempt to reduce their tinnitus. This shows how foreign it is to people’s thinking that hearing aids are an effective way to help control tinnitus. Now that you know the truth, don’t make the same mistake.

Here’s the break-down of the various ways people tried to reduce their tinnitus.

Notice the low percentages of people with tinnitus that tried each of these various treatments—the highest was only 6.8%. The total only adds up to 33.9%. Assuming each person only tried one treatment (and this is not likely), this study reveals that only one person in three even tried to help themselves deal with their tinnitus.

Why is that? Could it be that because many doctors tell people suffering from tinnitus that there is no cure for tinnitus, and that they have to live with it—thus leaving them without any hope—that these patients buy into this dismal mindset and thus don’t believe there is anything they can do to help reduce their tinnitus, and so they give up and do not try anything?

If you have tinnitus, don’t believe this. Yes, it is true that at the present time there isn’t a cure for everyone’s tinnitus. Yes, it is true that you have to deal with your own tinnitus. However, it is not true that there is nothing you can do that will help reduce your tinnitus. Do not give up hope. There are many different things you can do to help yourself deal with your tinnitus. Wearing hearing aids is just one of them. You can read about many more in my book, “When Your Ears Ring! Cope with Your Tinnitus—Here’s How“.

Now, back to this study. What were the results of the various things people tried? I have broken them down into three classes no improvement (0%), modest improvement (1-39%) and significant improvement (greater than or equal to 40%). I think these results will encourage you.

Notice that roughly somewhere between one-third and three-quarters of the people found no help with any of the above treatments. That does not mean that these treatments don’t work—just that they don’t work for numbers of people. The good news is that between one-quarter and two-thirds of the people that tried these various treatments did receive help. So these treatments DO help many people. The trick is to find which treatment or treatments work for you.

Now let’s look at the results again, but this time just zeroing in on the results of the highest level in the significant improvement category—namely 80%+.

If you could reduce your tinnitus volume and the impact it has on your life by 80% or more, that would be a real blessing, right? How many people were so “lucky”? Here are the results.

Notice that wearing hearing aids tops the list with 27% of the people that tried wearing hearing aids had a greater than 80% reduction in their tinnitus! That’s impressive. (Remember, that only 6.1% of the people in this study tried hearing aids.)

If these results hold true for all the people with tinnitus, then 13.5 million people in the USA alone would find that wearing hearing aids would reduce their tinnitus by 80+%. Millions more would find that wearing hearing aids would reduce their tinnitus by a lesser amount. Thus, if you have a hearing loss—even a mild one—wearing hearing aids should rank high on the list of things you try to reduce your tinnitus.

As I have said many times in the past, tinnitus arises from a number of different causes and affects people differently, thus a treatment that works for one person won’t necessarily work for another. The results in the various (above) tables prove this.

Since there is no single treatment for tinnitus that works for everybody all the time, and since there are many different treatments that do work in reducing tinnitus for some people, you need to try a number of them and see what works for you. If something doesn’t work for you, try something else. Unless you try, you’ll never know which treatment might reduce your tinnitus by 80% or more.

What have you got to lose? There IS something that will help you. You need to find out what it is and do that. A good plan of attack is to try several different tinnitus reduction treatments at the same time. Together they may make a significant reduction in your tinnitus. Some of that reduction may come from wearing hearing aids. Additional reduction may come from using relaxation techniques, and further reduction may come from taking herbals, or receiving counseling or wearing sound generators or listening to background music, or…the list goes on and on.

Based on the above study, if you are bothered by your tinnitus and have a hearing loss, you may find considerable relief from your tinnitus through the simple expedient of wearing hearing aids.

Note that the degree of your hearing loss and the severity of your tinnitus “are significantly related to the level of tinnitus reduction via hearing aid use. In general, people with milder degrees of tinnitus are more likely to experience mitigation of their tinnitus with hearing aids.” (1)

One final word of advice—you need to be properly fitted with hearing aids. One of the results of this study indicated that “people receiving a more comprehensive hearing aid fitting protocol are nearly twice as likely to experience tinnitus relief from their hearing aids than if they received a minimalist hearing aid fitting protocol.” (1) Don’t skim over the above sentence too fast. You need to insist on a complete and comprehensive audiological evaluation AND careful hearing aid fitting backed by real-ear measurements in order to get the best tinnitus-reduction results. When you do that, you’ve just doubled your chances that wearing your hearing aids will bring you significant tinnitus relief.

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(1) Kochkin, Sergei, et. al. MarkeTrak VIII: The Prevalence of Tinnitus in the United States and the Self-reported Efficacy of Various Treatments. The Hearing Review. Vol. 18, No. 12. November, 2011. pp. 10-26.

by Neil Bauman, Ph.D.

A student asked,

What is the relationship between the SPL dB scale and HL dB scale?

Good question. I’ll bet there are lots of hard of hearing people that are unclear about the differences between those two scales, and often treat these two terms as though they are interchangeable and mean the same thing—if they even wonder about those acronyms on their audiograms.

When audiologists measure your hearing, they measure your hearing in units called decibels (dB). The catch is that there are several decibel scales. Thus, in order to be meaningful, your audiologist indicates which decibel scale she used. The two most commonly used scales are the SPL (Sound Pressure Level) and the HL (Hearing Level) scales.

Sound meters are calibrated in dB SPL. This makes total sense because the condenser microphones used in sound meters are sensitive to changes in sound pressure in the air, just as our ears are. In contrast, audiometers are calibrated in dB HL, not in dB SPL like you would think would be done. This begs the question, “Why not calibrate audiometers using the SPL scale and forget about the HL scale?”

Here’s the reason why. Our ears do not hear equally well at all frequencies. If our ears heard all

frequencies of sound equally well, then we wouldn’t need the HL scale.

Our ears do not perceive low- and high-frequency sounds as well as they do sounds between 500 and 4,000 Hz. For example, the faintest sound a young person with normal hearing can hear at 2,500 Hz is 0 dB SPL. In contrast, at 20 Hz (a very low frequency sound), the sound needs to be much louder at 72 dB SPL in order to just faintly hear it. At the other end of the frequency spectrum, a very high-pitched sound at 15,000 Hz needs to be increased to 20 dB SPL in order for you to just detect it.

Thus, normal hearing, if plotted on an audiogram using the SPL scale, would be a curved, wavy line and look like the bottom line in Fig. 1. Since this line is both curved and somewhat wavy, it would be difficult to readily tell on an audiogram how much hearing loss a person has by frequency.

It would be ever so much easier to visualize the degree of hearing loss if normal hearing showed as a flat, straight line set at 0 dB on the audiogram. Then, any deviation from this line would indicate the degree of hearing loss.

This is the reason why they developed the HL scale. The curved SPL scale is normalized so that it becomes a flat, straight line at 0 dB. (We call this normalized SPL scale the HL scale.)

Using the HL scale, normal (“perfect”) hearing is a straight line across the top of an audiogram. When your audiologist tests you, any deviation from the 0 dB HL line indicates a hearing loss if it falls below the 0 dB line. (By the same token, if your hearing deviates above the 0 dB line, you have better than normal hearing at that frequency.)

To convert SPL readings to HL readings, audiometers are calibrated to add a specific amount to each frequency tested. This amount varies by frequency. For example, at 125 Hz, it adds 45 dB, while at 1,000 Hz it only adds 7 dB. Likewise, at 4,000 Hz it adds in 9.5 dB, while at 8,000 Hz it adds in 13 dB.

The result is that now your audiogram readily shows your hearing loss graphically in dB HL, rather than you trying to mentally visualize the degree of hearing loss if it were plotted in dB using the SPL scale.

by Neil Bauman, Ph.D.

A lady asked,

What is a good website to get a list of ototoxic drugs?

There are a number of websites that list a few of the many ototoxic drugs that are out there. One that I like is otologist Dr. Timothy Hain’s website, but this website is very conservative and just lists the more ototoxic drugs. In order to be even reasonably complete, such a list would have to contain information on more than 1,000 ototoxic substances.

A good article to read about ototoxicity (which also lists a fair number of ototoxic drugs) is my article “Ototoxicity—the Hidden Menace“.

You will also find a wealth of information on specific ototoxic drugs scattered throughout the 122 articles I have written concerning ototoxic drugs.

However, just having a list of ototoxic drugs isn’t really all that helpful. You see, 83% of the top 200 prescription drugs can be ototoxic. Thus, in order to avoid all ototoxic drugs, you’d have to avoid taking drugs in the first place!

What you really need is an annotated list detailing the kinds of ototoxic side effects a given drug can cause. For example, is the drug known to cause tinnitus or hearing loss or hyperacusis or vertigo or ear pain. You want to know how likely any given side effect will occur—is the risk of occurrence 15% or just 1 in
10,000? You also want to know how severe a side effect is likely to be if it does occur—will it just be mild dizziness or severe intractable vertigo. In addition, you want to know whether the resulting side effects are likely to be temporary or permanent.

As far as I know, the only reasonably complete source of such information that is readily available in one place and is in an easy-to-read format is contained in my book “Ototoxic Drugs Exposed“.

by Neil Bauman, Ph.D.

If you’re like me and can’t hear much, I’m sure you’ll agree that it would be nice to have “eyes in the backs of our heads” to help compensate for our lack of hearing. God didn’t choose to give us this extra pair of eyes, but guess what? The latest research reveals that we (people who are born deaf or with severe hearing losses) have better peripheral vision than our hearing counterparts.

According to researchers from the University of Sheffield in the UK, people who are born deaf or have an onset of deafness (hearing loss) within the first years of life develop the ability to capture more peripheral visual information than the retinas of hearing adults. In fact, researchers were surprised to learn that the retinal neurons in people born with major hearing losses appear to be distributed differently around the retina to enable them to capture more peripheral visual information.

Furthermore, they also found an enlarged neuroretinal rim area in the optic nerve, which shows that deaf/hard of hearing people have more neurons transmitting visual information than do hearing people. (1)

It was previously known that deaf and hard of hearing people had better peripheral vision, but the researchers thought this was because the visual areas of our brains developed more (one sense compensating for the lack in another sense), rather than because of actual physical changes in our eyes. (No doubt, there are changes in our brains too, because we do rely on our vision so much.)

I’ve known most of my life that I had better peripheral vision than those around me. I have used this peripheral vision time after time to notice the first hints of movement that would indicate that someone or something was close behind me. This made it difficult for people to sneak up behind me without me knowing it.

So, although we don’t have eyes in the backs of our heads, current research has proved that we can indeed see further around the sides of our heads than can hearing people. Dr Ralph Holme, Head of Biomedical Research at RNID—Action on Hearing loss, explained: “The better peripheral vision experienced by people who are deaf, in comparison to those who hear, has significant benefits for their everyday lives—including the ability to quickly spot hazards at the boundaries of their view.” (2)

If you are interested, you can read the complete research article here.

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(1) Retina in Deaf Allows for Better Vision than in Those Without Hearing Loss. 2011. Hearing Review.

(2) Retina Holds the Key to Better Vision in Deaf People. 2011.

by Neil Bauman, Ph.D.

A man wrote,

I am familiar with your work on ototoxic substances, which I think does a great service by bringing people’s attention to this menace. However, I have found a couple of inconsistencies in things you have written, and I am requesting clarification.

First, I believe that you recommend 50% diluted vinegar as an ear wash. However, I was quite surprised to find on the Internet that acetic acid (which is found in vinegar) is ototoxic. Are you aware of this?

Second, I have seen recommendations where you promote the use of garlic. However, I believe that your book identifies garlic as an ototoxic herb. It is hard to believe that garlic is ototoxic in any meaningful way. What evidence are you aware of that garlic is ototoxic?

Third, it would be nice if substances that produce permanent ototoxic effects were highlighted. I think the number of ‘truly ototoxic’ substances is much smaller than your book would suggest.

Thanks for your email. I’m always glad to help people understand more about ototoxicity and how it may affect them. And I’m always willing to fix things if I’ve written something wrong, so let’s look at your three points.

1. Acetic acid is ototoxic. I’m glad you brought this to my attention. I wasn’t aware of this. Somehow in all my voluminous research into ototoxic drugs over the years, acetic acid never appeared on my ototoxic “radar”. However, since you wrote me, I’ve done a fair bit of research on acetic acid to find out more about its ototoxicity. Here’s what I found.

It appears that acetic acid is only ototoxic when it gets into the middle ear (through a hole in the eardrum). I could not find any evidence that it is ototoxic when taken internally (or else people who eat pickles, salsa, relish and such-like would be hard of hearing from all the acetic acid in the vinegar in these foods), or when it is used is the external ear canal (like I recommend) when the eardrum is intact.

In the laboratory, researchers found that acetic acid kills the outer hair cells when it comes in contact with them—at least in Petri dishes—so there is no doubt that it is ototoxic to some degree. However, I still believe vinegar is perfectly safe to use in your ear canals as long as your eardrums are intact. Otherwise, don’t use it.

Incidentally, I’ve already added acetic acid into the prototype of the next edition of my drug book.

2. Garlic is ototoxic. Garlic is an excellent herb to help keep us in good health, and I use it myself with no ototoxic side effects. At the same time, I do indeed list garlic as an ototoxic herb in my book, “Ototoxic Drugs Exposed“.

I agree with you that in general garlic is not ototoxic to the average person, so where does this information come from?

The PDR for Herbal Medicines lists garlic as causing vertigo in some people, thus I have listed it. For further clarification, the PDR for Herbal Medicines mentions that it can cause vertigo in “therapeutic doses”. Obviously, high doses of concentrated garlic extract taken daily can and do cause vertigo in some people. That is why I have listed it. However, in normal doses, I don’t think garlic is ototoxic, and I have no hesitation at all in using garlic as often as I want.

The key thing to notice here is that you have to look at the ototoxic information and decide whether you fit the “profile” or not. Just because a herbal can be ototoxic under certain conditions doesn’t mean that you should avoid it. You just have to understand what those conditions are and act accordingly.

For example, say you have been taking large doses of garlic and you start experiencing vertigo, all you have to do is reduce the dose you are taking. You don’t have to avoid garlic altogether unless you are extremely sensitive to it. I explain how to apply this to several potentially ototoxic foods in much greater detail in the section at the beginning of Chapter 15 in the 3rd edition of “Ototoxic Drugs Exposed“.

3. Highlighting truly ototoxic substances. The 3rd edition of “Ototoxic Drugs Exposed” contains information on the ototoxicity of 1,060 different drugs, herbals and chemicals. To be sure, not all of them have the same degree of ototoxicity. A few of them are highly ototoxic, some of them are moderately ototoxic and many of them have a low degree of ototoxicity (or more accurately a low degree of risk of ototoxicity).

Since some people have experienced the various ototoxic side effects for each drug listed, that is why they are there. It is my duty to report this information to warn people about any possible ototoxic risks. Then it is up to each person to decide whether they are prepared to accept that risk or not.

In order to help people decide, since most people reading my drug book are not experts on ototoxic drugs, I have chosen to place all the listed drugs in 1 of 5 risk classes. Note that this is my own subjective interpretation of how much risk there might be of having an ototoxic side effect, and how bad the resulting side effect might be if you take that drug.

For example, drugs with a risk class of 4 or 5 are “truly ototoxic” drugs in my opinion. Drugs in class 3 are “iffy”, whereas those with a risk factor of 1, while ototoxic to someone somewhere, either affect people rarely, and/or do not have serious or permanent resulting ototoxic side effects.

As a matter of information, I list a total of 52 drugs in classes 4 and 5; 68 drugs in class 3 and 730 in classes 1 & 2. Thus, you can see that most drugs are not what you would call “truly ototoxic”. However, they can be ototoxic at times, but probably not all that often. This is small comfort if you are one of the unfortunate ones that gets a side effect from one of the class 1 drugs and discovers that the resulting side effect is permanent. So, even though the risk might be low, you would still want to know about it.

If the information is available, I list whether any given side effect is temporary or permanent. Unfortunately, there is little authoritative information available whether side effects will be permanent or not. I just report the best information I can find.

To complicate matters further, side effects for a given drug may be temporary or permanent. One person could take a given drug and find a certain ototoxic side effect temporary, while another person could take the same drug and discover the side effect never goes away. That’s just the way it is. There is currently no way to know this in advance.

This can even happen to the same person. For example, one man began taking a certain drug and reported to me that his ears began ringing. I suggested it might be the drug, so he stopped taking it for a week or so and found his tinnitus went away. Based on this experience, he decided to put up with the tinnitus while taking the drug for the full duration his doctor had prescribed knowing that when he finished the drug, he could give it another week or so and his tinnitus would be gone.

Imagine his shock when he did this—and discovered to his horror that his tinnitus refused to go away. It was now permanent! This too happens. Again, there is no way to tell in advance whether this will happen to you or not.

Since you don’t know in advance whether any ototoxic side effects will occur, how bad they will be if they do occur and whether they are going to be temporary or permanent, I warn people about all known ototoxic side effects whether they are high or low risk. They can then use this information however they wish. Some people may choose to take the risk and others not to. That is fine. They have made their choice based on the best evidence available to them—and that is as it should be.

Don’t let ototoxic drugs inadvertently damage your ears and leave you with hearing loss, tinnitus or balance problems. To learn which drugs are ototoxic, get the 3rd edition of  Ototoxic Drugs Exposed. This book contains information on the ototoxicity of 877 drugs, 35 herbals and 148 chemicals.

by Neil Bauman, Ph.D.

A recent study on the effects of hearing loss and dementia is scaring a lot of hard of hearing people.

For example one recent article opened with, “Older people with hearing loss are at a much greater risk for developing dementia over time than those who can hear well, according to a study by researchers at Johns Hopkins University School of Medicine and the National Institute on Aging.” (1)

Is this really true? Are we hard of hearing people soon going to be assigned to the Alzheimer’s ward just because we can’t hear well? I don’t think so. I think we need to look a bit closer at this study and its results.

This study took place in Baltimore at the National Institute on Aging. Johns Hopkins assistant professor of otology Frank R. Lin, MD, PhD, and his colleagues followed 639 people between the ages of 36 and 90 in this 12-year study. At the start of this study, 125 people had mild hearing losses, 53 had moderate losses and only 6 had severe losses. By the end of this study, 58 people had been diagnosed with dementia. (2) That’s the background.

Now the findings. “By cross-referencing their data, the researchers found that mild hearing loss was linked to a slight increase in dementia risk, but the risk increased noticeably among those with moderate and severe hearing loss.

For participants 60 and older, more than 36 percent of dementia risk was linked to hearing loss, the study said.

The worse the hearing loss, the worse the risk for Alzheimer’s as well. For every additional loss of 10 decibels of hearing capacity, Alzheimer’s risk appeared to go up by 20 percent, the researchers said.” (2)

If these research results are true, it does indeed sound bad for all of us with hearing loss. However, I think the researchers need to answer the following questions before they accept these study results as gospel. For example:

1. How long did the people with hearing loss have their hearing losses? Were they born with a severe loss like I was, or did they lose their hearing from taking ototoxic drugs (which could have damaged the workings of their brains at the same time) or did their hearing loss show up gradually as a result of aging?
2. Were the people with hearing loss aging faster than normal? For example, some people look like they’re 90 when they’re only 60. For such people you could expect dementia and early-onset hearing loss to show up earlier too. Conversely, some people that are really 90 only look 60 years old. Is their hearing also commensurate with their apparent age (60) rather than their real age (90)?
3. How well were the hard of hearing people who developed dementia coping with their hearing losses before they developed dementia? Were they the ones noted for denying their hearing losses and thus doing nothing about correcting their losses? In contrast, was there a difference in the rate of dementia among those who wore hearing aids, used assistive listening devices and otherwise practiced good hearing loss coping strategies?
4. Did dementia occur more often in those with hearing loss that basically withdrew from social intercourse than in those that retained an active social life in spite of their hearing losses?

These are the kinds of questions that researchers need to answer before you worry that dementia is in your future because you already have a hearing loss.

In any case, if you want to be proactive and try to stave off dementia, consider the following:

1. Your lifestyle: Are you doing what you can to maintain good health—physically, mentally, emotionally and spiritually? If not, that’s the place to start.
2. Your hearing health: Have you done all that you can to successfully live with your hearing loss? This includes:
   • Getting and wearing properly-fitted hearing aids.
   • Supplementing your hearing aids with assistive listening devices (ALDs) in situations where hearing aids are not very effective. (Noise and distance are the two main enemies of hearing aids.)
   • Learning and practicing good hearing loss coping strategies including speechreading and assertively advocating for your hearing needs.
3. Use it or lose it: Keep socially, mentally and physically active.
4. Your drug usage: Take only the drugs that are truly necessary. Many seniors take numerous drugs unnecessarily according to Drs. Wolfe and Abramson. Did you know that many of the drugs you take can negatively affect your mental status as well as your hearing?

There are no guarantees, but if you are effectively addressing the above points, I think you’ll discover that you have greatly reduced your risk of developing dementia no matter how bad your hearing loss is, or becomes.

_______________

(1) Pedersen, Traci. 2011. Hearing Loss Linked to Dementia. Psych Central News.

(2) Mozes, Alan. 2011. Study Suggests Hearing Loss-Dementia Link. Bloomberg Businessweek.