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Six Myths of Tinnitus

Six Myths of Tinnitus

 Murray Grossan, MD.
 About the author: Dr. Grossan is an otolaryngologist and head and neck surgeon with the Tower Ear, Nose and Throat Clinic at Cedars-Sinai Medical Center in Los  Angeles and the founder of the Web based Grossan Sinus & Health Institute (http://www.grossaninstitute.com). He is author of Free Yourself from Sinus and Allergy  Problems Permanently.

Today we demand scientific data, objective evidence, and mathematical analysis of experimental findings. But when you have a condition called Tinnitus where there is little objective evidence, we end up with non-objective concepts – myths.

Myth one: Stress causes tinnitus.

Stress does not cause tinnitus

Certainly stress can aggravate and make any condition worse, including tinnitus, but it is not a cause or originator of tinnitus. A stress reaction to tinnitus is common because we are born with a fight/flight reaction when we hear danger sounds. Until we identify that tinnitus is not a threatening tiger, the stress center continues to produce fight/flight response.

Why is this important? Among the ten million persons who have symptomatic tinnitus, the myth that it is caused by stress prevents patients from seeking diagnosis and therapy.

Often the onset is dismissed as a symptom of job or financial stress and therapy is therefore delayed.  Or, the patient feels that she bears a personal responsibility for causing her tinnitus.

Myth Two: There is not treatment for Tinnitus

Another myth about tinnitus is that there is no treatment for it. The American Academy of Otolaryngology has published Clinical Practice Guideline:Tinnituts   www.entnet.org with specific therapies that includes

Sleep Improvement

Stress Reduction

Masking/Distraction

Cognitive therapy

See: http://oto.sagepub.com/content/151/2_suppl/S1.full.pdf+html

Any single one of the therapies discussed by the guidelines can be of benefit to the tinnitus patient. There are many clinics and clinicians that administer therapies of value such as Tinnitus Retraining and Neuronomics.

What is the origin of this “just learn to live with it“ myth?  Part of it originates in the days when various therapies were being promoted for tinnitus cure. The doctor seeing their patients spend money on these “cures “ and getting little or no benefit, decided it was best to save the patient’s money and discourage spending it on unproven cures.  Medications recommended to increase circulation to the inner ear were of little benefit, since tinnitus is not due to poor circulation to the inner ear.

Another origin of the no treatment is available for tinnitus myth is the placebo effect. Unless special care is taken, and the tinnitus is measured, placebo errors can allow for enthusiastic cures to be announced, followed by disappointments.

Doctors are well aware of the placebo effect. When I did a study of EMG for biofeedback therapy for tinnitus, my office was directed to play a role of avoiding niceties or pleasantries. No test patient was greeted with beaming smile, or “so nice to see you today Mrs. Sloan,” and I avoided personal contact too. Patients were escorted to the treatment room, given instructions to lower the EMG dial reading, and afterward quietly rescheduled. Small wonder a patient commented on how cold my office personnel were! However, I was confident on reporting benefit in lowering stress factors involved in tinnitus and was able to show changes in volume and symptoms.

Myth 3:   Tinnitus can’t be measured.

There are several measurements of tinnitus that are suitable for research and therapy.

Tinnitus can be matched as to sound and volume.  This is usually performed by an audiologist using the audiometer sounds.

Further measurements are Tinnitus Inhibition. If a masking sound is introduced, and the patient’s tinnitus is no longer heard, we measure how long that inhibition lasts after the masking sound is stopped.

Various patient questionnaires are standard, used in tinnitus clinics, and are valuable for measuring tinnitus effects. These are no fewer objectives than other standard commonly used psychology tests and each of these have significant journal publications and studies that verify their value. The standard measurements include:

Tinnitus Severity Index

Tinnitus Reaction Questionnaire  

Tinnitus Handicap Inventory

Times Functional Index

 Each of these has been used for years, have had multiple journal publications to verify their use and are accepted for literature and research.

When the audiologist matches the exact sound that patient is hearing, it is valuable to then provide matching sounds for masking, inhibition or accommodation.

Various web sites offer tinnitus sounds for downloading. See www.drgrossantinnitus.com

Myth 4:  Tinnitus is best treated by a Neurologist

Tinnitus due to Meniere’s disease, cochlear hydrops, impacted cerumen, migraine/migraine equivalent; Schwannoma, etc are best investigated and treated by otolaryngologists.

Myth 5:   Best treatment for Tinnitus is Xanax or other benzodiazepam

It is true: Xanax and similar benzodiazepams do reduce symptoms. They also reduce symptoms of a painful tooth or a fractured tibia, but is that the best therapy?  The dentist repairs the tooth; the orthopedist repairs the fracture; the otolaryngologist should follow the Academy protocol.

Myth 6: Every patient with tinnitus should first get an MRI.

The yield for MRI where there isn’t an obvious indication is minimal. Certainly, in a unilateral tinnitus with hearing loss, MRI is indicated. But MRI for tinnitus in a machinist with symmetric hearing loss is not.

The majority of tinnitus is from noise trauma and MRI here rarely gives a useful yield.

Conclusion:

Joseph Campbell has explained many of the ancient and current myths and how they reflect our emotional needs. But the myths surrounding Tinnitus are causing harm because doctors are not offering patients therapy that is available and patients are not seeking these therapies.

The guidelines of the Academy are clear, and patients who suffer from tinnitus are benefitted when doctors are familiar with them and use them to treat their patients. Best, therapy is when the patient is treated as a whole person that includes the factors known to be of benefit.

Otherwise we will see more cases like the tragic 44-year-old woman in the Netherlands, who chose to be euthanized because of her tinnitus.

For more information, visit:
www.grossaninstitute.com
www.ent-consult.com

 

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SIMPLE AND SAFE METHOD FOR THE REMOVAL OF EAR WAX

Dr Fernando R Kirchner Fernando R. Kirchner MD.
Ex tenured Professor Ear, Nose and Throat and Head and Neck Surgery
Retired Clinical Associate Professor of Family practice
Midwest University Medical School. USA
Fellow of American College of Surgeons.
Ex Member NIH Study Group
Web site: http://www.ferdsjourney.com

Our first aim for this paper is to review the structure of the human ear canal, describe its functions, and outline a safe and economical method of wax removal that is available to the public.
Anatomically the ear canal is formed by a deep bony tube that ends at the eardrum, and a peripheral cartilaginous portion that is part of the auricle.
The ear canal’s two functions are: first, to keep this passage open to permit air sound waves to reach the ear drum, and second, to clean itself by an automatic cleansing mechanism.
These two functions are very important to humans and other species, because without them, hearing would be significantly impaired, due to the fact that air sounds, and sounds in liquids, such as the fluids of the inner ear, have different acoustic properties. This impairment clearly is experienced when one tries to hear under the water, and it is overcome by the trasducer effect of the tympanic membrane and the small bone located in the middle ear.
Since the ear canal is a closed canal, its self cleansing mechanism is equally contributory to this function. This property is produced by the constant cellular migration from the surface of the ear drum to the outside walls of the ear canal. It suffices to paint a dot of India ink on the surface of the ear drum to demonstrate by repeated observations, the migration of these dots to the periphery of the canal. Additional information on weekly ads of pharmacy stores.
Anatomy Of The Ear Read entire article.

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Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo

OLYMPUS DIGITAL CAMERA Gary S Flom MD FACS FAAP
American Board of Otolaryngology
Fellow American College of Surgeons
Fellow American Academy of Pediatrics
About the author: Dr Flom is a Board Certified Otolaryngologist. He practices in Metro Atlanta and is a Fellow of the American College of Surgeons as well as the American Academy of Pediatrics. His special interests include chronic sinusitis, tinnitus, vertigo and upper airway allergies.

It is paroxysmal, because the movement that causes symptoms won’t always set off their dizziness. And it may totally go away for several weeks then return.

It is important to keep a written or mental journal of head positions or activities that elicit the vertigo. This will help with safety against falling by avoiding those positions when standing or walking. It will get better over time as the brain learns that the signals it is receiving are not correct.

People struggling with BPPV should avoid activities that may turn out to be dangerous. They should avoid climbing a ladder. And avoid tilting their head back unless they are safely seated. There have been many instances of a person with BPPV falling from a ladder while changing a light bulb. Not only are they a few feet above the ground, but while tilting their head back to look at the bulb, vertigo sets in and they stumble.

Anatomy Of The Ear

Also, getting out of bed can cause a fall. While a person with inner ear floating crystals (the cause of BPPV) sleeps, the head is immobile for several hours. The crystals settle in the inner ear due to gravity. An analogy would be to think of a beach bucket with water and sand in it. Shake the bucket for a few moments, then set it down. The sand will slowly float to the bottom. This is what happens in the inner ear of a person with floating crystals, as the inner ear is fluid filled. Now, when the person awakens and gets out of bed, the head movement sets the crystals in motion and can send a very powerful message to the brain signaling movement which is well beyond the actual amount of lifting their head off of the pillow. If they jump out of bed too fast, they could very likely fall. I counsel people with BPPV to arise slowly and in stages when getting out of a chair or bed. When getting out of bed, they should first raise their head off the pillow and hold that position for a few seconds until vertigo subsides, as many will get their first episode of the day at that point. Then they should bend at the waist and sit up in bed, remain sitting up for a few moments. Finally, swing their legs off the bed and slowly stand up looking forward with their eyes looking in a neutral forward direction. It is also useful, for many, to sleep with their head elevated. View pharmacy products and read reviews on these products on CVS ad and Walmart pharmacy ads.
Try one of those bed pillows that are used for reading in bed, seem to work better than stacking pillows which typically end up sliding around.

Similarly, getting out of a chair should be done in movement stages. The longer a person with BPPV has had their head motionless, the more likely that head movement will bring on vertigo.

Showering can also present challenges, and should be done carefully avoiding head positions that cause vertigo or dizziness. The risk of falling or slipping is very real because of the combination of BPPV and wet slippery footing.

Fortunately, with BPPV, the vertigo eventually subsides, but may take several weeks or even a few months. The symptoms suddenly appear one day, tend to get worse over several days, stabilize for some time, then slowly resolve. As it is going away, every day is a little better than the day prior, so you know you are on the road back to normal balance.

NeilMed Ear Spin Safe

Intended for EAR HYGIENE: cleaning of debris, itch relief, exfoliation, water extraction, and superficial wax around the ear and outer ear canal.

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(1961)

Eustachian Tube Dysfunction

Eustachian Tube Dysfunction

Dr Arthur Wu Arthur Wu, MDArthur Wu, MD
Board Certified Otolaryngologist and Fellowship-trained Rhinologist at Cedars-Sinai Medical Center
Fellow of the American Rhinologic Society
www.beverlyhillssinus.com
About the author: As the head of the Beverly Hills Sinus Institute, Dr. Wu has a passion for helping patients with nasal and sinus problems. His advanced training has given him the skills to treat the most difficult of sinus cases, and a large volume of his patients are those that have failed medical treatment or had previous unsuccessful sinus surgery.

Eustachian tube dysfunction is one of the most common complaints an Ear, Nose,& Throat surgeon sees in his or her clinic. Patients with eustachian tube dysfunction may complain of ear pressure, muffled hearing, and ear popping or clicking. The eustachian tube is a tube connecting the ear with the nasal cavity. When you yawn or swallow, the eustachian tube opens and pressure equalizes between the ear and the outside world. Like the nasal cavity, the ear also produces mucus and is normally drained by the eustachian tube. If the eustachian tube does not function normally, mucus may build up in the ear causing hearing loss and muffled hearing. It may also lead to recurrent ear infections. Conditions such as nasal allergy and chronic sinusitis can cause inflammation of the eustachian tube and lead to dysfunction. Medical treatment includes nasal steroid sprays, nasal antihistamine sprays, oral antihistamines, decongestants, and saline rinses. Temporomandibular joint (TMJ) disorder can also cause similar symptoms of ear pressure and popping. An Ear, Nose, & Throat physician can help to delineate if a patient’s symptoms is from the eustachian tube or TMJ.

Anatomy Of The Ear

Patients with eustachian tube dysfunction may fail medical therapy and require surgery. Traditional treatment of eustachian tube dysfunction includes placement of a pressure equalization tube (PE tube), which simply creates a semi-permanent hole in the eardrum, allowing pressure to equalize through it directly. Normal PE tubes usually last for about a year and may need to be replaced chronically. Recent advances in technology have led to the development of a technique to help recuperate the normal function of the eustachian tube instead of circumventing it. Balloon eustachian tube dilation involves placing a guide catheter into the eustachian tube orifice. A balloon is then threaded over the guide wire and then gently inflated, dilating the eustachian tube. The dilated eustachian tube is now able to equalize pressure between the ear and the nasal cavity. Though a fairly new technique, studies demonstrate that the benefits of this type of surgery may last much longer than standard PE tubes.

NeilMed Ear Spin Safe

Intended for EAR HYGIENE: cleaning of debris, itch relief, exfoliation, water extraction, and superficial wax around the ear and outer ear canal.

NeilMed Clearcanal - complete ear wax removal kit

NeilMed Clearcanal – Dr. Mehta’s ear wax removal complete kit

Read reviews of pharmacy products and healthy food for vitamins good for people having hearing problems.

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Hearing Loss and Cognition

Hearing Loss and Cognition

Dr.Jonathan M. Lee Jonathan M. Lee, MD
Assistant Professor, Dept. of Otorhinolaryngology
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
About the author: Jonathan M. Lee is Assistant Professor of Clinical Otorhinolaryngology: Head and Neck Surgery, Department: Otorhinolaryngology: Head and Neck Surgery
http://www.pennmedicine.org/providers/profile/jonathan-m-lee

Hearing loss is very common, and as people gets older the risk of developing significant hearing loss increases. As many as 30% of people aged 65-74 may have age related hearing loss, and that increases up to 50% for patients older than 75. This difficulty hearing may be obvious, and it may start slowly and progress gradually. Some patients only initially notice trouble hearing in noisy environments with a lot of background noise, such as restaurants and shopping malls.
The diagnosis of age related hearing loss involves a thorough history and physical examination, as well as a audiogram or hearing test. While there is no cure for age related sensorineural hearing loss, the use of a hearing aid can significantly improve a patient’s ability to communicate.

Anatomy Of The Ear

In the past, age related hearing loss has been seen as inevitable and the prevailing attitude has been for many patients to “live with it”. Only 15% of patients who would benefit from a hearing aid actually end up obtaining one. New research from the Health, Aging and Body Composition study, however, has demonstrated that the cognitive abilities of older adults with hearing lost declined 30 to 40 percent faster than in those subjects with normal hearing. Moreover, the level of decline in brain function was directly related to the degree of hearing loss. Patients with hearing loss developed significant impairment in their cognitive abilities approximately 3 years earlier than normal participants. This cognitive decline may also be linked to higher risk of developing depression or dementia. You might find some medical products for instant relief on CVS weekly ads. Current CVS Ad is available on given page.
Given this new information, it is important for patients and physicians to understand that there may be a significant negative impact of untreated hearing loss. More research is necessary to find out if the use of hearing aids can actually make a difference in the rate of cognitive decline in patients with hearing loss.

NeilMed Ear Spin Safe

Intended for EAR HYGIENE: cleaning of debris, itch relief, exfoliation, water extraction, and superficial wax around the ear and outer ear canal.

NeilMed Clearcanal - complete ear wax removal kit

NeilMed Clearcanal – Dr. Mehta’s ear wax removal complete kit

Read reviews on Weekly Ads.

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