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A relative of one of our staff has recently been experiencing a very disruptive set of symptoms related to the ears. This 45 year-old female experiences extreme episodes of dizziness (usually spinning) following exposure to loud noises or coughing/sneezing/straining experiences. Loud noises also sound distorted, and her own voice sounds louder in her head. Her life has changed drastically, to say the least.

She has been diagnosed with Superior Semicircular Canal Dehiscence (SSCD). This rare condition is caused by a malformation in which bone is missing at the border of one of the semicircular canals. When this happens, the inner ear fluid motion that accompanies loud noises or internal changes in pressure, such as coughing, causes the balance organs near the canal to function incorrectly. The symptoms listed above typically follow. Other common symptoms are low-frequency conductive hearing loss in the affected ear, constant dizziness, inability of the eyes to focus on stationary targets and the illusion of motion in visual targets.

Diagnosis is made based on the symptoms, as well as various diagnostic tools. Audiometry, acoustic reflexes, high-resolution CT imaging and specialized vestibular testing can confirm this condition and guide treatment.

More severe cases require treatment if normal life or common activities are disrupted. Surgery is an option that can relieve symptoms. The missing bone region can be “plugged”, which prevents the fluid and surrounding membrane from bulging during loud sounds or changes in internal pressure. All good outcomes begin with a patient who pays attention to symptoms and seeks help. A careful analysis of symptoms, clinical signs and diagnostic results can result in correct diagnosis and appropriate treatment. Do not wait if you or someone you know is experiencing unusual problems with hearing, balance or dizziness. As always, we want to keep you on a clear path to good hearing and ear health.

Simple strategies to preserve your hearing

Many activities we enjoy or perform while working are known to be dangerous to the organs of hearing. These organs are located in the inner ear (cochlea) and are easily damaged by exposure to noise of sufficient loudness and duration. Countless patients have been diagnosed with hearing loss that is most likely caused by exposure to noise.

Occupational hazards, such as construction work, factory machinery, power tools and the like are commonly noted. Recreational noise, such as motorcycles, tools, music, lawn mowing and firearms are also frequently implicated. These activities can damage a group of inner ear structures known as outer hair cells. When these cells are damaged or destroyed by noise, they impair our ability to hear soft sounds, particularly in the high frequency. Clarity is typically impaired, even when low pitch hearing is spared. Unfortunately, this is a permanent condition. Inner ear structures cannot be regenerated.

With intelligent use of hearing protection strategies, we can reduce the damage and preserve our hearing. Strategies include restructuring of the environment, limiting exposure time and the use of protective products.

Loud devices, such as power tools and musical instruments, should not be used in small spaces, where reverberations can multiply the sound produced. Move to a larger space with absorptive surfaces, such as curtains, drop ceilings or carpet when possible. Always limit headphone use with loud music.

Limiting the time spent in noisy areas will reduce risk as well. OSHA workplace regulations recognize that decreases in sound levels increase allowable exposure time. If a project requires noisy equipment, break up the time into segments, and give your ears a break.

Finally, there is no shortage of hearing protection products. These are often available in hardware, sporting goods and music shops. Plugs can be either custom-molded or generic. Remember to replace foam plugs after every use. Muff-style headsets are highly effective and can even be worn over plugs for maximum protection.

It is neither difficult nor expensive to protect your ears from the hazards of loud sounds and still be productive and enjoy music and other activities. Be wise and always allow us to keep you on a clear path to good hearing and ear health.

Many causes of dizziness

Because we specialize in disorders of hearing, balance and dizziness, we see many patients with a variety of symptoms. Many have difficulty hearing, some are bothered by noises in their ears (tinnitus), some suffer disruptive dizziness, and some report poor balance. Earlier blog articles have explored the ways in which hearing, tinnitus, vertigo and imbalance can be related. This month we examine various causes of dizziness.

“Dizziness” is an inexact term many people use to describe sensations which make them feel unstable, typically in the head. Dizziness may include light-headedness or “wooziness”, with a general dulling of the senses, often for brief spells. This is commonly a feature of orthostatic hypotension (momentary low blood pressure in the head following a change in position), circulatory disorders, side effects of prescriptions or interactions of several drugs.

“Vertigo” more precisely describes an illusion of motion in the head or body. Vertigo is common in disorders of the inner ear balance organs. Positional vertigo (BPPV) is very common. This involves incorrect placement of calcium crystals in the ear. The ear responds inappropriately to head movements when these “ear stones” interfere with normal fluid movement in the semicircular canals. This condition is very treatable and requires no medications or surgery.

The central nervous system (brain, brainstem, cerebellum and other nerve structures) can also produce dizziness and/or imbalance. Certain “red flags” in our VNG test battery can often be uncovered for further investigation. Migraine disorder is also known to often produce vertigo, even if headaches are minimal.

Thyroid and diabetes conditions can also cause similar issues. Needless to say, a complaint of dizziness does not guarantee any specific diagnosis. Our diagnostics take into account history, symptoms, medications, other medical conditions, and our extensive test battery. Only when we discover the root cause(s) of the problem can we recommend the best treatment. As always, we seek to keep you on a clear path to good hearing and ear health.

Born deaf vs acquired hearing loss

Those of us who deal with the ears and hearing impairment often make distinctions based on the onset of a patient’s hearing loss. There are many patients who gradually lose their hearing, due to heredity, noise exposure, aging or other factors. Some lose function more rapidly, as through disease, head trauma or sudden noise trauma. These people have one thing in common: hearing was a primary mode of communication prior to the loss. It is understandable that hearing loss will disrupt social interaction. Listening to speech, music and environmental sounds can no longer be taken for granted. Depression, decreased cognitive function and social isolation frequently result.

There are also many people who were born deaf or lost hearing very early in life. They may not have been able to learn language by listening to their parents. For many deaf children sign language becomes a primary communication tool. Captioning and printed words are also used. Cochlear implants and high-powered hearing aids have made it more possible for a deaf-born child to adapt to the hearing world. The Deaf culture, however, has embraced many modes of communication that do not require hearing.

Many deaf people do not feel they have “lost” their sense of hearing. On the other hand, hearing people who have lost hearing during their lives have definitely lost an important connection to their world. This is why it is so crucial to identify and treat acquired hearing loss as early as possible. Studies have found the average person waits seven years to take action on a suspected hearing loss. Do not separate yourself from the people and sounds you want to hear any longer than necessary. Help is available. As always, we want to keep you on a clear path to good hearing and ear health.

Clear Choice Hearing and Balance wishes you a happy and healthy 2016.

Receiving a diagnosis of cancer is a life-changing experience. Fear and uncertainty are natural reactions, with complex plans for treatment following extensive diagnostic work. Treatments can be highly aggressive, ranging from surgery to radiation to chemotherapy. A patient’s options may produce life-saving results, although many have side effects and risks of their own. A link exists between cancer treatments and hearing loss and other ear damage.

Chemotherapy may utilize many different drugs, depending on the type and location of the tumor or cancerous cells. Platinum plays a key role in several major medications. Drugs like cisplatin and carboplatin are well known for their toxicity to the ears. Several other types of drugs, such as methotrexate and nitrogen mustard, also may be damaging to parts of the ear. When chemicals are introduced to the body through the bloodstream or digestive tract, they cannot necessarily be sent only to the site where they are needed. An agent that can destroy cancer cells may also affect normal tissue. The ears are not immune, and typically both are affected. Hearing loss and/or tinnitus may result.

Radiation therapy of the head or neck may also adversely affect ear function. This may take the form of irreversible inner ear damage (sensory loss of hearing) or Eustachian tube dysfunction, which may be treatable. Radiation may only effect one ear.

Effects of damage from cancer treatments include impaired balance, impaired hearing, increased risk of poor communication and social isolation. Employment may be put at risk from untreated hearing loss. Quality of life suffers greatly with these developing problems. Patients undergoing these therapies should have their hearing and balance function monitored, particularly if they suspect changes in function. Hearing aids, as well as augmentative listening products and strategies, may help these patients with communication. Balance therapy may aid in restoring balance function lost to aggressive treatment.

If you or someone you know is facing these treatments, be aware of possible risks to the ears, and do not hesitate to ask for answers or monitoring. The link between cancer treatments and hearing loss is well established, yet not widely known outside of the hearing healthcare community. Call us for more information. We want to keep you on a Clear Path to good hearing and ear health.

A hearing loss/diabetes link

Hearing loss has long been associated with many health problems or diseases. These conditions may directly cause ear damage, such as in labyrinthitis, rubella, middle ear infection and others. In some cases the treatment itself may affect ear function, such as chemotherapy or the use of certain classes of antibiotics. Research is now providing statistical data from studies showing hearing loss is more prevalent in patients with certain health conditions. The presence of the condition may suggest a greater likelihood of developing hearing loss, or the loss itself may be an early sign of the disease.

As hearing status has been given more attention in the medical world, primary physicians are encouraged to acquire about ear problems and possible loss of hearing. In the case of diabetes, hearing loss may be an early indicator of yet-undiagnosed disease. This is particularly true of the more common Type 2 (adult onset) diabetes. Recent studies have found that this increased incidence of hearing loss may lead to earlier diagnosis and treatment of diabetes. Diabetics (type 2) are more than twice as likely as non-diabetics to have loss of hearing.

While the physiological connection between diabetes and hearing loss is not always clear. It is believed the damage is mostly linked to blood vessel and nerve damage. These effects can interfere with the function of the inner ear and the conduction of nerve impulses between the ear and the brain.

A modern focus on preventive medicine must take into account risk factors, early symptoms and early diagnosis. Of course hearing is important in its own right for communication. Now, however, we see all the more reason to check the status of adults’ hearing. Hearing loss could signal serious health concerns. Do not wait if you suspect a problem. As always, we seek to keep you on a clear path to good hearing and ear health.

Sudden hearing loss

It is well known among hearing healthcare practitioners that the average person waits seven years between the first suspicion of a hearing problem and a first trip to an audiologist. This is partly due to the insidious nature of typical hearing loss. It “sneaks up on you” and tends to progress slowly. There may be no additional symptoms other than difficulty hearing. These people will often seek help, realizing they should have scheduled the appointment years prior. Luckily, for most it is not too late to receive the help they need to improve their hearing and communication.

Lately, however, we have seen an alarming number of cases of sudden losses of hearing. This is a situation that must be dealt with promptly. What causes these sudden changes, and why do we want to see you so soon?

Sudden loss of hearing may take several forms. One or both ears may be affected. Other symptoms may accompany hearing change. These include dizziness, pain, tinnitus, drainage, “plugged” or “full” ear sensations. The problem may originate in the ear canal, middle ear, inner ear or the nerve pathway leading to the brain.

Causes of sudden loss of hearing include: middle ear fluid, head trauma, ear wax, autoimmune responses, Meniere’s disease, drug interactions, growths along the auditory nerve, anemia, labyrinthitis, swelling of ear canal tissues, outer ear infection, interruptions in blood flow and other factors.

Prompt medical attention is required for sudden losses of hearing. A diagnostic hearing/middle ear evaluation from an audiologist will provide an otolaryngologist with information that will guide treatment or additional diagnostic tools, such as MRI or CT studies. Courses of steroids or antibiotics may be ordered or surgery recommended. There may be a critical time window, after which hearing may not improve. Waiting is the wrong strategy. If you or someone you know has a sudden drop in hearing, let us be your first step. Call immediately for an appointment. We want to keep you on a clear path to good hearing and ear health.

The hearing-tinnitus connection and positive implications for patients.

Several times in a typical week patients will say during the course of an office visit, “I don’t really hear my tinnitus when I have my hearing aids on”. These patients are among the majority of tinnitus patients who have significant hearing loss. These comments often elicit a response from us such as “I wish I could record you saying this, so others who need help could hear it from you.” It is well-established that hearing loss is underdiagnosed. Only 14% of people with hearing loss wear hearing aids, according to research. This statistic has been consistent. Tinnitus (TINN-itus or tin-EYE-tus) is also under-treated, mostly due to the fact patients are unaware of treatment options. Many are told there is nothing that can be done. They must “live with it.”

A previous blog entry highlighted the value of improved hearing for good balance function. Hearings aids allow the wearer to better experience his surrounding environment. Orientation in space is improved, particularly if vision is less than perfect. Increased hearing is also its own reward, of course. Conversation becomes easier, and safety concerns lessen. Now we are also seeing the value of increased hearing on improving tinnitus symptoms. This comes from research as well as reports from patients. Two symptoms are improved with one treatment plan.

These benefits will not happen, of course, if the instruments are not programmed properly by a well-trained professional. But if selected and handled properly the benefits of hearing aids far exceed mere amplification of sound. A diagnostic evaluation is the first step. Many patients have benefitted in ways they did not expect. Allow us to help put you and keep you on a clear path to good hearing and ear health.

The recently televised 2015 US Open golf tournament brought with it the usual drama of great players, a difficult course, golfers who played well but faded, and others who persevered and won and spectacular shots. This year’s tournament, however, featured another kind of drama that was televised internationally. Australian golfer Jason Day suffered a severe bout of vertigo on the course and almost did not finish. As the weekend progressed, we learned he had positional vertigo and managed to finish the tournament on the leaderboard, despite extreme discomfort and dizziness. Commentator Greg Norman mentioned several times Day had been treated with an “Epsey” (Epley) maneuver. Just what happened to Jason Day, and why was he able to finish the tournament?

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common disorders of dizziness and imbalance. It is highly treatable, and we help many patients with this condition. It often appears suddenly and without warning. Turning the head upward or downward are the most common triggers. The reason it is so readily treatable is that it is not a disease per se. It is not an infection or chemical imbalance requiring medication. When a group of calcium crystals migrate from the inner ear balance organ (saccule) to one of the semicircular canals, they interfere with fluid flow and stimulate incorrect balance sensors during head movements. The ears send mismatching nerve impulses to the brain. The result is dizziness, blurred vision and often nausea.

Jason Day benefitted from a maneuver credited to Dr. John Epley, an otolaryngologist from Portland, OR, who discovered that a sequence of movements allows gravity and the density of the crystals to clear the canal and restore normal function. Day also required medication (selected to suppress the vestibular system), as he was competing in a game that requires frequent bending and head movement. Most patients, however, do not need medication if they avoid provoking positions or movements for several days.

We commend Jason Day for his determination and toughness on the course AND for bringing BPPV and the Epley Maneuver to the attention of the public. We also thank Dr. Epley for discovering this simple and useful maneuver. Many people suffer for years needlessly if they are unaware help is available. Medications alone cannot cure this type of vertigo. As always, we want to keep you on a CLEAR PATH to good hearing and ear health.

On Wednesday, June 3, we visited The Village at Unity, an excellent senior living facility in Greece. Over thirty residents joined us for our presentation “Balance, your ears and hearing”. Balance problems and dizziness are very common complaints to physicians among seniors. Our focus was educating the residents about the ears as our primary organ of balance, as well as problems that affect balance and produce vertigo or other types of dizziness.

We had a great time interacting with the residents, answering questions and providing information about problems that can affect a person’s wellbeing, safety and risk of falls. One area of discussion that surprised many was the relationship of good hearing to balance and safety. We use our hearing to help stay balanced. Improving hearing can improve our sense of balance in our environment by providing cues about objects or people around us. Hearing can decrease our fall risk!

Another topic of interest was our comprehensive vestibular evaluation, designed to confirm or rule out ear-related causes of dizziness or imbalance. Positional vertigo is another very common (and very treatable) disorder many suffer with needlessly. Along the way we touched on the topics of hearing loss, hearing aids and tinnitus.

We look forward to another opportunity to interact with the residents regarding other topic relating to the ears and hearing. We enjoyed it thoroughly. As always, we hope to help keep you on a Clear Path to good hearing and ear health!