Ask the Audiologist

Dear Dr. Frieda:
I think my husband's hearing got worse after heart surgery.What can we do?

-Virginia J.

Dear Virginia:
Yes Virginia, there is a definite connection between cardiovascular health and hearing. There have been numerous scholarly studies that have looked at the relationship between the two. We are well aware that for many people, hearing deteriorates as a result of aging. This is manifested in two ways. First, we begin to lose sensitivity to sound. Second, our ability to clearly understand speech declines, even when the speech is loud enough to hear comfortably. Statistically, hearing loss is the third most prevalent chronic health condition, after arthritis and cardiovascular disease. It's more prevalent that vision problems.

There are many causes for hearing loss. These include noise exposure, diseases, medications, genetics,cardiovascular disease and anoxia.

The ear requires a rich blood supply in order to function well. When the blood supply is interrupted as in chronic cardiovascular disease or even in the course of some cardiovascular procedures, it causes changes to the structures of the ear including the stria vascularis, the Organ of Corti and the internal audiory artery. Subsequently, hearing is affected. Studies have shown that adults 65-85, with a history of cardiovascular disease had significantly poorer hearing than people without cardiovascular disease. Interestingly, when studies look at myocardial infarctions, women seem to be affected more than men. Some experimenters have even suggested that hearing loss may be an early marker for cardiovascular disease because hearing loss seems to preceede heart disease.

Other studies have looked at people who did not have cardiovascular disease, They suggest that individuals with good cardiovascular health and excellent muscle tone have better hearing as well. It has been suggested that good muscle strength and excellent cardiovascular health may, in fact stave off hearing loss and maintain good hearing sensitivity longer because of increased flow of oxygen, and increased glucose supply to all the organs and structures of the auditory system.

Please discuss these findings with your cardiologist and then schedule an appointment with an audiologist who is familiar with these studies and who can help you understand your husband's hearing loss and it's possible impact on communication.

Best of Luck, Dr. Frieda

Dear Dr. Frieda:
Sometimes when I get anxious about something, I start feeling dizzy. Is that normal?

-Joan B.

Dear Joan:
Recent studies have looked at the relationship between anxiety and dizziness and have found a connection that seems to go both ways. Sometimes, the anxiety brings on the dizziness and sometimes an episode of dizziness brings about a period of anxiety.Measures of anxiety are higher in dizzy patients than they are in the general population. Over 50% of patients with dizziness disorders meet the criteria for anxiety disorders. No matter how severe the dizziness, people who experience it will rate their depression as much higher than do those people who don't experience dizziness. They also have higher rates of panic disorders.

There is no clear cut protocol on how to deal with both the dizziness and anxiety . Treatment strategies have included cognitive behavior therapy, vestibular rehabilitation, and/or medications. Speak with your audiologist and physician to explore your options.

Best regards, Dr. Frieda

Dear Dr. Frieda:
My father’s digital hearing aids no longer work and need to be fixed or replaced. The VA hospital wants him to come in to have him retested. This is no easy task as he (85) suffers from the advanced stages of Parkinson’s. I’m not even sure he can perform the functions of the test. In addition, the trip is one hour each way. I would like to bring the hearing aids in alone. Is it possible for the hearing aids to be replaced without additional testing?

Sincerely,
-Larry

Best of luck. Thank you for a great question.

Dr. Frieda

Welcome back to this column. A while ago someone asked about a "hearing" pill that could improve hearing. I could find no substantive evidence even after calling government agencies, but I promised to keep looking. Finally, I may have found something.

The military was studying a substance called N-acetylsystine (NAC) . They provided a report that the pill did not provide significant protection from noise. The data were not published in a peer review journal. But it has been called the "hearing pill" and it may be the substance which is used in internet and catalog sales..We consumers have to be very careful about believing research claims which may be misleading or worse. It seems to me that if there were a pill to restore our hearing, with good scientific basis behind it and no unnecessary risks, the otolaryngologists and audiologists would be shouting about it from the rooftops. There are no miracle pills...yet.There are, however, some things that we can do to try to prevent hearing loss.

• Protect your hearing from unnecessarily loud noises.
• Choose your genes carefully, as more than 50% of all hearing losses are thought to be genetic.
• Stay in good health and exercise regularly to continue good circulation to your head and your ears.
• Follow a heart healthy diet that includes anti-oxidants, and fermented foods like yogurt and cheeses.

Research into diet and its effect on hearing is looking at Resveratrol a substance found in red wine, as well as selenium and magnesium. Stay tuned. We will continue to review the literature and report back to you.

Best regards,

Dr. Frieda

Dear Dr. Frieda:
Dr. Toback, my father is 95, was diagnosed with Diabetes Melitus at about age 90, and his current in-ear hearing aids are about 5 years old. He tests his blood sugar regularly and supposedly had OK numbers today. He tells me that this afternoon, the Veterans Administration audiology clinic checked his blood glucose, and then refused to do an audiology exam because his glucose numbers were too high. I understand that diabetes can be connected to hearing but I wonder if this experience is really consistent with best practice in audiology, especially for the extremely elderly. It's hard to get a 95 year old to the doctor and the outcome is quite inconvenient not only to him but to the family. My mother thinks we should find a private audiology clinic that won't be so picky. I don't know if that's a good idea. Is it or isn't it a normal part of the audiology protocol to test blood sugar in a person who's diagnosed with diabetes? If so, is it normal to postpone the test when blood sugar is temporarily too high?

Thank you,
-MG

It is not within our scope of practise to test blood sugar or even to ask what the sugar levels are. We do understand that it is difficult to get your father to his appointment but we have confidence in the services being performed at the VA centers and do not recommend that you go elsewhere.

It may be helpful for you to call the VA and tell them about your concerns. I am confident they can give you an explanation of what happened.

Best regards,

Dr. Frieda

Hi, Dr. Frieda:
Why are hearing aids so expensive? My dad got aids in the 1980s and he didn't pay nearly what he is being quoted today. Thanks
-John

Dear John:
I remember the 80s. Hearing aids then were less expensive than they are today. That's true. However, during that time hearing aids were mainly "analog" meaning they were not computerized. The technology was simpler, if less satisfactory. We had less choices in terms of technology or hearing aid sizes. The average price of an aid in 1980 was $1000.00. When experts look at that price and average it out for cost per day of use the cost came out to about $.68 in 1980s or $1.68 in 2004 when accounting for inflation. Considering that today's hearing aids are almost exclusively digital, with a longer battery life, and a longer life expectancy, the average cost per day is actually lower, on average about $1.50 per day.

We are achieving greater patient satisfaction with hearing aids that perform more reliably and for a longer period of time, than we were able to do in the 80's, and we are doing it for less money. I think we have alot to be proud of.

Thanks for a great question and good luck.

Dr. Frieda

Dear Dr. Frieda:
My father needs a hearing aid, and was wondering if this is covered by Medicare.
- KS

Dear KS:
Thank you for your question. Unfortunately, at this time, Medicare does not cover any part of a purchase of hearing aids. Medicare does cover the cost of audiological assessments when performed by a physician or audiologist but it does not allow us to bill for hearing aid- related tests or services. Our legislators in Washington had been presented with a bill that would have allowed a tax credit for hearing aids, but that bill just seems to be languishing somewhere. My colleagues and I urge you and all your friends to contact your Senators and Congresspeople and urge them to pass this bill.

Bst Wishes, Dr. Frieda

Dear readers:
Welcome back. I've been on a lengthy journey which began when someone e-mailed me with a question concerning dietary supplements and their role in improving hearing health. Was it really possible to take a pill that would restore our hearing? Why hasn't the government told us about it? It was too good to be true.

I started by calling the FDA. As I already knew, they do not comment on non-perscription drugs, but they referred me to the Federal Trade Commission. The clerk there told me that supplements are not within their scope of practise and suggested that I call my local health department. I pointed out that web-based businesses do not necessarily have to follow local regulations, but the clerk insisted that the FTC had no interest or jurisdiction in this matter. She suggested that I call yet another agency. I had enough. In all, I spent over an hour on the phone trying to get an unbiased opinion on these dietary supplements only to be pushed around by clerks.

I will continue researching this question of the effectiveness of dietary supplements but I fear that the various government agencies will be of little help. In the meantime, if it sound too good to be true, it probably isn't.

Stay tuned. Dr. Frieda

Hello Dr. Frieda:
I keep telling my husband he's hurting his ears when he mows the lawn but he says the noise doesn't bother him. If the noise doesn't bother him does that mean it's not hurting his ears?
- Joannie J.

Dear Joannie:
Being exposed to excessively loud noise is the number one reason for developing hearing loss. The loss occurs because the noise damages the tiny hair cells in the inner ear. There are over 25,000 little hairs in a space of about 37mm. Initially, the hair cells go into shock when exposed to loud noise. One may notice a severe ringing in the ears, a hearing loss and a feeling of fullness. Over time those symptoms go away and hearing returns. Given enough exposures, the hair cells do not recover, they wither away and hearing is damaged permanently. The hair cells do not regrow. The death of the hair cells signals the beginning of hearing loss .Even if your husband is not aware of it, ear damage occurs each time he mows the lawn unprotected.

How loud is too loud? If you can't carry on a conversation in the presence of the noise, it's too loud.

Who is most at risk? Policemen, firefighters, especially chauffeurs on fire trucks, military personnel, factory workers, and construction workers. However, even a single exposure to a very loud sound can cause permanent damage.

How loud is it? Experts agree that any sound over 85 decibels has the potential to damage your ears. Lawn mowers typically produce a noise level in excess of 85 decibels. Standing next to a jet engine exposes you to over 120dB. Other examples of dangerously loud sounds are:

• motorcycles: 95-120 dB
• concerts: 120 dB
• motor boats: 85-115 dB
• gunshots: 145-167 dB
• snowmobiles: over 95 dB

You can prevent hearing loss due to noise exposure but taking a few simple precautions. Use ear plugs or special ear muffs when exposed to loud sounds. A combination of ear plugs and muffs together is even better. Be aware that plugs and muffs made for noise abatement carry an "NRR" or 'noise reduction rating', a number that gives you an idea of how much noise they will cut out. Perhaps the next time you are looking for an idea of what to give your husband as a gift, you'll consider noise controlling ear muffs and give him the gift of good hearing.

As always, your husband and you should schedule a hearing screening with an audiologist or hearing care specialist to establish a baseline reading against which future tests can be compared. Just as you have your eyes checked annually, you should have your ears checked too.

Best regards, Dr. Frieda

Hello and welcome back. I did not receive a question regarding the following topic. Rather, I was reading a book this weekend on food supplements, diet and hearing loss. The writers, two nutritionists, stated unequivocally that there was no association between diet, diabetes and hearing loss. I know they are wrong. There is a wealth of information which shows a very strong correlation between hearing loss and diabetes mellitus. It reminded me of an article I read recently in the Journal of the Association for Research in Otolaryngology. The authors, in Europe, performed a very large study of over 4,000 individuals between the ages of 53 and 67 to study the relationship between medical and environmental factors and hearing loss. They also compared their results to those of previous studies. Their findings are summarized below:

• They found that smoking increased the chance of developing a hearing loss and was dose-dependent.The more one smokes the higher the chance of developing hearing loss.
• Tall people hear better than short people.
• Moderate intake of alcohol actually has no deleterious effect on hearing.It seems to have improved hearing.
• In their discussion of genetics, they attributed 58% of hearing loss for people 56-65 years old, to genetics. As people got older, the genetic causality dropped a bit to 47%.

Environmental factors also affected hearing, particularly when combined with other factors:

• Noise exposure regardless of the duration of exposure or use of ear protection, was associated with hearing loss for individuals who had more than one year of the exposure
• In some studies, exposure to noise and organic solvents like Styrene had an additive affect on hearing. In other words, the combination of the two agents together produced a greater effect on hearing than either one alone.
• Smoking and noise exposure together also may have a worse effect than either one alone.

Medical factors were also studied:

• Some studies have reported that the higher the HDLs, the less the hearing loss. The authors suggested that HDLs may have a protective function for hearing.
• Some studies have found that the presence of cardiovascular disease, including stroke had an effect on hearing.
• For reasons the authors do not explain, tall people have a lesser chance of developing a chance of hearing loss than short people.In one of their sub-studies, very short subjects in their fifities had a much higher incidence of hearing loss than tall subjects.
• There was a strong correlation between a very high or a very low Body Mass Index (BMI) and hearing loss.The higher the BMI the greater the hearing loss.
• Although there is some variability between the various studies published on the relationship between hearing loss and other factors, the two most important risk-factors for hearing loss were noise exposure and cardiovascular disease.The authors of this study concluded that the best way to retain good hearing is through a healthy lifestyle: reduce cardiovascular disease, stop smoking and bring your BMI to normal...and don't forget that a bit of alcohol may actually be good for you.

Best of luck to all of you. Thanks for visiting this site. Come back often to check on new developments in the fields of hearing and hearing aids. I welcome your questions and comments.

Dr. Frieda

Dear Dr. Frieda:
y cousin’s son who is 3 seems to be very sensitive to sound. Especially loud sounds. It seems to hurt him or make him afraid. Someone suggested this might be a psychological disorder and that he should wear earmuffs. So now when he doesn’t like a noise he wears his earmuffs and seems to be comforted. I can’t help but think maybe there is something linked to his hearing. Is this a sign of hearing loss or problem? PS: his mother also wears earmuffs on occasion?
- Caring Cousin in LI

Dear Caring Cousin:
Thank you for a wonderful and timely question. The hypersensitivity to loud sound which you describe may be a result of recurring ear infections, possibly undiagnosed. When a child has fluid in the ear, the whole world sounds muffled, as if the child is underwater. Once the condtition improves, everything seems very loud and children often put their hands over their ears. Using earmuffs may help temporarily but you need to explore other options. Start by talking to an ENT( ear, nose and throat physician). The ENT may be looking at allergies, enlarged tonsils or other underlying causes to rule out or rule in otitis media, with effusion. Only when all other medical causes have been ruled out, you should speak with your audiologist about the feasability of using specialty earmolds to cut down the loud sounds. I think you will agree that small, unobtrusive earmolds are more acceptable than walking around with earmuffs, for both the child and his mother.

Best of luck, Dr. Frieda

Hello Doctor:
My grandson seems to be getting a lot of ear infections but the doctor won't put in tubes like my children had. Have there been any new developments?
- Marie J.

Dear Marie:
Nothing surpasses the physicians' expertise in this matter. Your grandson's pediatrician or primary care physician follows guidelines set up by a variety of governing boards on the topics of ear infections, antibiotic use and indications for surgery. I suggest that you take this column to his physician and get his/her opinion.

Let's start our discussion with Otitis Media with Effusion (OME), which is a buildup of fluid in the middle ear (the area just beyond the ear drum). There may be an association between OME and colds in young children.  It is thought that ear infections are of viral origin, and would not respond to antibiotic treatment. Typically, we expect that a child will cry and tug at the ear when they have an earache, but sometimes the child shows no reaction. In the past, the physician would prescribe antibiotics which may or may not have had a positive affect on the symptoms. Sometimes, the treatment involved several trials with different antibiotics. This resulted in overuse of antibiotics, the development of antibiotic resistance and little benefit to the child. Current guidelines limit the use of antibiotics for OME and stress prevention of ear infections.

Among the prevention tools is a suggestion published in EAR AND HEARING journal in 2007 that chewing gum be used as a low cost alternative. The researchers found that when children chewed gum daily or even weekly, the incidence of OME went down, sometimes by as much as 40%. The researchers suggested that the increase in swallowing maybe responsible for the decrease in OME.

What role does the audiologist play in this treatment? Although the physician is always in charge of diagnosis and treatment of ear infections, the audiologist has tools that can provide input quickly and painlessly. We use a variety of tests but the most common test in tympanometry which allows us to look at the function of the ear drum and the middle ear very quickly. If a hearing loss is suspected, we will provide an age-appropriate hearing test using a variety of tones and speech sounds.

I hope you find this helpful. Please feel free to contact me. Best regards, Dr. Frieda

Welcome back to my column.

Although I did not get a specific question regarding the topic I am about to discuss, it is, nevertheless, my favorite topic in that it deals with psychosocial implications of untreated hearing loss. The National Council on Aging reported on a study that was completed in 1999 entitled "Untreated Hearing Loss Linked to Depression, Anxiety, Social Isolation in Seniors".

It was quite clear from reading that study that it would no longer be appropriate for anyone to think of hearing loss as " harmless". The implications were astounding. Hearing-impaired people, in this study, were more likely to report being depressed and anxious. They were less likely to participate in social interactions. And they were more likely to state that "people get angry at me for no reason".

Hearing aid users, on the other hand, reported many benefits from the use of hearing aids, including an increased sense of independence and improved feelings about themselves. Additionally, their families noted improvement in the interpersonal relationships and overall quality of life. It was interesting to note that family members actually rated many of the improvements as higher than the hearing aid wearers.

The conclusions one can draw from this study are in agreement with many other studies: properly fitted hearing aids aren't expensive, they're priceless! What is it worth to restore a person's self confidence, and self-worth? How much would you pay to see your parent resume the interactions they used to love such as going to church, travel, restaurants – or even interacting with family members?

If your loved one is hearing impaired, you owe it to them – and to yourself – to suggest a hearing screening and perhaps the use of a device so that they can resume the life they had before the hearing loss.

Dear Dr. Frieda:
My husband and I have been married for many years and I find that we are increasingly arguing. I tell him he didn't hear me and he tells me that he hears what he wants. Do other people have this problem? What would you suggest?
- Lost on Long Island

Dear Lost:
You are experiencing a problem that occurs more often that many people realize. A study done in 1998 looked at the impact of hearing loss on relationships, and found that 34% of respondents reported that they socialized less with their family and friends because they could not fully participate. Another 34% said they stopped going to the movies, and 30% said they didn't want to meet new people because of the frustration. (The numbers overlap.)

In another study of married couples, 51% said they fought because one spouse needed to repeat things to the other spouse. 40% said they argued because the volume on the TV was too loud. 40% said the spouse didn't listen.

Hearing loss isolates us from the people who matter to us the most: our spouses, family and friends. Not being able to hear is not the same as not listening. Listening is selective -- you decide when to listen. Hearing loss doesn’t allow us to decide when we hear and when we don't.

It breaks my heart to hear someone say that their elderly parent is too old to use hearing aids. Tell me, when do we get to be so old that we no longer have to hear someone say "I love you"?

My best advice to you is to bring your husband in for a complete hearing test. It will help determine the extent of his hearing loss and the rehabilitative strategies we can use to help your husband. You see, we are more than just hearing aids. We look at the entire individual, his life style, and hearing needs and then we provide information on how we get that person hearing better. Our staff looks forward to meeting you and your husband.

Dear Dr. Frieda:
My husband is hard of hearing and is hospitalized alot. Do you have any suggestions?
- Mary

Dear Mary:
Your question came at just the right time. I was just reading a study which was recently published in the Canadian Medical Association Journal (June 3, 2008) It looked at adverse events upon hospitalization for people who were hearing impaired, blind or had multiple health issues. They found that the chance of a preventable, adverse event among the study population was 29% higher than for people who were not in the study group. The lessons to be learned from this study are:

1. Whenever possible, have a family member or friend accompany you to the hospital and act as a second set of ears. We know from other studies that when we are being given important information by someone in the medical field, we only correctly understand 25% of what has been said, even when no hearing loss exists.
2. If needed, ask the admissions office or patient advocate for special assistive listening devices such as amplified telephones or ear buds for the TV. You are entitled to these by law. Take advantage of these.
3. Always bring a pad and pencil to the hospital. If you are being given information which you do not understand or do not hear, ask the staff member to write it down for you. Do not sign anything unless you understand it.
4. Take safeguards for your hearing aids while you are hospitalized. Do not wrap the aids in tissue paper or leave them in the pocket of your clothing. That is the surest way to lose them. Instead, put them into a box,clearly marked as "Mr. Jones hearing aids..do not discard". Also alert the nursing staff.

Lots of good luck and thanks for your question.
Dr Frieda

“Ask the Audiologist” is content prepared and reviewed by McGuire’s Director of Audiology, Dr. Frieda Toback, CCC/A, FAAA. This content is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.