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TINNITUS – THE END OF QUIET MOMENTS?

Tinnitus is the perception of sounds that have no external source. The severity of tinnitus varies from an occasional awareness of ringing, hissing, buzzing, roaring, clicking, or other rough sounds in one or both ears, to an unbearable and incessant noise that drives some people to consider suicide.

Tinnitus isn’t a “phantom sound” or “condition” — it’s a symptom of an underlying medical problem, such as noise trauma, age-related hearing loss, ear injury, or disease of the circulatory system.

Tinnitus is relatively common, but in rare cases it can be a symptom of a serious underlying condition, such as a vascular tumor or a slow growing acoustic neuroma (a generally benign tumor that forms on the vestibular nerve that leads from the inner ear to the brain).

Tinnitus facts: If you have tinnitus you aren’t alone. More than 50 million Americans have tinnitus symptoms. 9 in 10 patients with tinnitus also have hearing loss, and 1 in 5 patients find the symptoms hard to endure. 10-15% of Americans experience chronic troublesome tinnitus, lasting more than 6 months.

Tinnitus is frequently caused by prolonged exposure to loud sounds from industrial, recreational, or military noise, or from a sudden impulsive sound from an explosion, gunshot, etc. Tinnitus can also be caused by ear injuries, cardiovascular disease, age-related hearing loss, wax build-up in the ear canal, medications (aspirin, certain antibiotics, diuretics, chemotherapy), ear or sinus infections, misaligned jaw joints (TMJ), head and neck trauma, and Meniere’s disease.

Auditory Pathways and tinnitus. Sound waves travel through the ear canal to the middle and inner ear, where sensory hair cells in the cochlea help transform the sound waves into electrical signals. (See the figure) The electrical signals then travel through the auditory nerve to the auditory cortex of the brain, where they are processed. When hair cells are damaged (figure inset)  by loud noise or drugs known to cause hearing loss, the brain doesn’t receive the signals it expects. This stimulates abnormal neuron activity, which causes the illusion of sound, or tinnitus.

What are the consequences? Tinnitus causes fatigue, stress, sleep difficulties, trouble concentrating, memory problems, anxiety and irritability, and trouble with both work and family life. The degree to which tinnitus invades a person’s life depends on the volume, frequency, and duration of the perceived noise, and on the emotional reaction provoked by that irritation. Tinnitus is no laughing matter; the fear and depression associated with tinnitus can destroy a person’s well-being.

Tinnitus can’t be cured…but it can be managed! Our Doctors of Audiology have the knowledge and training to help you manage your tinnitus. They will assess the personal impact of your symptoms, and then present options for alleviating those impacts. The initial assessment takes 2 hours, and guides us in determining the best therapy for you.

The goal of tinnitus management is to “train your brain” to ignore tinnitus sounds as unimportant. This process is called habituation, and empowers tinnitus patients to overlook the disturbing emotional trauma of tinnitus, in the same manner that many of us have learned to overlook the disturbing effects of a train whistle at night. Other tinnitus remediation therapies include sound therapy, which can be supplied by smart phone apps through hearing aids.

Tinnitus therapy is highly tailored to account for your perception of symptoms and their disturbing impacts. There is no “one size fits all” therapy! Effective treatment strategies generally focus on counseling, sound therapy, relaxation, and stress-reduction methods. If you have tinnitus AND hearing loss, hearing aids can improve your hearing while relieving the negative impact of your symptoms, and this can help restore your quiet moments!

Dr. Li-Korotky, AuD PhD is a Gold member of the American Tinnitus Association

The Bend Oregon Hearing Tech Expo

Pacific Northwest Audiology had a full house in attendance at our Hearing Tech Expo on Wednesday, Feb 8, at the Mount Bachelor Village Conference Center.

Event Collage

Dr. Li began the day with a very well received talk on age-related hearing loss (her PhD thesis at the world renowned Karolinska Institutet in Sweden). The Doctor also reviewed new scientific studies which strongly linked untreated hearing loss and dementia. 

Dr. Odgear, also from Pacific Northwest Audiology, was the second batter, and he knocked it out of the ball park with his talk on hearing trends and the future of hearing tech. 

We convened for a hot lunch buffet, which consisted of Brisket of Beef Au Jus, baked beans, potato salad and a creamy coleslaw.  According to my polling, everyone thoroughly enjoyed the buffet!

We shook things up after lunch and reconvened in an adjacent room, which we had set up for interactive tech activities, led by Dr. Muto-Coleman from Resound. By the end of the session, everyone was able to put the pieces together…the past, present, and future of hearing tech.

Our next event will be the third week of May. Call Kat for early details at 541-678-5698

Hearing Aids Improve Brain Function

A new study, “The benefit of amplification on auditory working memory function in middle-aged and young-older hearing impaired adults,” by Jamie Desjardins, PhD, an assistant professor in the Speech-Language Pathology Program at The University of Texas at El Paso (UTEP), found that hearing aids improve brain function in mature adults with hearing loss.

Texas study, hearing aids restore cognition

Previous Studies

Previous studies have shown that untreated hearing loss is associated with serious emotional, medical, and social consequences, including unnatural mental decline and dementia. These disabilities often result in reduced job performance, lower income, and a generally diminished quality of life. Declining cognitive function is also associated with a loss of auditory working memory, the ability to pay attention to conversations in noisy environments. Working memory is important because it is critical for understanding speech.

Sustained hearing loss causes problems because the brain must allocate extra resources to the task of understanding speech. When this occurs, other areas of the brain associated with cognitive functions are “starved”.

As Desjardins explained, “If you have some hearing impairment and you’re not using hearing aids, maybe you can figure out what the person has said, but that comes with a cost. You may actually be using the majority of your cognitive resources, your brain power, in order to figure out that message.”

Purpose Of  The UTEP Study

As we age, our thinking and memory skills naturally decline. The purpose of the present study was to assess the effect of hearing aid use on the auditory working memories of middle-aged and young-older adults with mild to moderate sensorineural hearing loss. Sensorineural Hearing loss is caused by damage to the inner ear or the nerve from the ear to the brain, and isn’t typically correctable with surgery. The study included 24 adults in their 50s and 60s with bilateral (involving both ears) hearing loss who had never before used hearing aids. 

Cognitive skill trends can be measured by changes in working memory, the ability to process information during conversations. For the present study, cognitive tests were used to measure the working memory, selective attention, and speech processing speed of study participants before and after wearing hearing aids. 

Study Results: Hearing Aids Improve Cognitive Function

Results from this study indicated significant improvements in the auditory working memory of participants after 6 weeks of hearing aid use. Why is this important? Using hearing aids in the early stages of age-related hearing loss, even mild hearing loss, can have a positive impact on working memory performance. 

According to Desjardins, “Most people will experience hearing loss in their lifetime. Think about somebody who is still working and they’re not wearing hearing aids and they are spending so much of their brainpower just trying to focus on listening. They may not be able to perform their job as well. Or if they can, they’re exhausted because they are working so much harder. They are more tired at the end of the day and it’s a lot more taxing. It affects their quality of life.”

An Allied Study

Another study recently published in the Journal of the American Geriatrics Society by researchers at the French National Institute for Health and Medical Research in Bordeaux France found that “Use of hearing aids attenuates cognitive decline in elderly people with hearing loss”. 

The bottom line of this study? Hearing aids appear to have a positive effect on thinking and memory functions, by restoring communication abilities and promoting social interaction, qualities that are known to reduce isolation and resulting depression.

Final Comments

Hearing impairment is one of the most common health problems in the United States. It affects more than 9 million Americans over the age of 65 and 10 million Americans between 45 and 64, but only 1 in 5 people who need hearing aids actually wear them. That means 4 in 5 people with hearing loss are tossing dice that only allow bad outcomes.

Our take-away from these studies? We have choices and those choices effect the way we live. We urge older adults with hearing loss to seek qualified treatment by a Doctor of Audiology.

Patient-Centered Hearing-Health Care vs. Sales-Centered Hearing Care

The Bottom Line

The following table compares the professional business model, represented by doctor-level audiologist such as those working at Pacific Northwest Audiology, and the corporate business model, represented by “Big Box”, manufacturing, and franchise retailers.

The bottom line is that when you select a hearing care provider you also accept their business model…and the consequences of that model. You can choose patient-centered hearing-health care by a Doctor of Audiology, or volume sales-centered care by a technician.

Given the increasing evidence linking medical, emotional, and social consequences to hearing loss, we hope the table guides you to your best choice for a hearing provider.

 

AuD vs. Dispenser table 3

Hearing Aids Can Prevent Mental Decline

Hearing Aids prevent cognitive decline

An increasing number of research efforts are linking untreated hearing loss to thinking and memory problems, including dementia and Alzheimer’s Disease. Many of these studies indicate that hearing aids should be used as early as hearing loss symptoms can be verified, but evidence supporting hearing aids as a preventive therapy have been largely theoretical. That has changed recently, with new research just published in the Journal of the American Geriatrics Society by researchers at the French National Institute for Health and Medical Research in Bordeaux France. The study followed 3,670 adults, age 65 and older over a 25-year period.

The main findings of this ground-breaking research indicate that “Use of hearing aids attenuates cognitive decline in elderly people with hearing loss”. The study found that people treated with hearing aids for their hearing loss showed the same rate of cognitive decline as a control group with no prior hearing loss. As a contrast, people with untreated hearing loss scored significantly lower baseline scores on the Mini-Mental State Examination (MMSE), a well-established test for determining cognitive function.

The bottom line? Hearing aids appear to have a positive effect on thinking and memory functions, by restoring communication abilities and promoting social interaction, qualities that are known to reduce isolation and resulting depression.

What does this mean to an aging population? “These results argue in favor of screening and rehabilitation of hearing disorders in elderly people,” said Prof. Amieva, a leading researcher in the Neuropsychology and Epidemiology of Aging at the University of Bordeaux, France. “We now have a set of data that is sufficiently robust to assert that hearing loss induces accelerated cognitive decline in the elderly, and hearing aids can attenuate this decline.”

Dr. Li-Korotky, AuD, PhD, F-AAA , is Board Certified in Audiology, and CEO of Pacific Northwest Audiology.

Hearing Loss Linked to Dementia

A Cautionary Tale

Mounting evidence has established a  strong link between untreated hearing loss and diminished cognitive function, including dementia. Studies also link untreated hearing loss to other medical and emotional problems, including depression.

This is a cautionary tale, but a light shines brightly to guide our passage away from danger: Hearing Loss Can End Badly—but we have options!

First, the bad news. Mounting evidence has established a strong link between untreated hearing loss (HL) and diminished cognitive function, accelerated mental decline, rapid rates of brain tissue loss, and other disabling conditions, such as dementia and Alzheimer’s disease. People who don’t hear well tend to withdraw from social activities, and that can lead to depression and early mortality.

The link between HL and dementia is reinforced by statistical and brain scan studies from hearing and social neuroscience research, and backed by compelling theories for how HL promotes dementia.

Dr. Frank Lin from John Hopkins Medicine has identified three primary pathways to dementia and other bad health outcomes:

  1. HL increases the cognitive load on the brain. Struggling to understand speech causes the brain to focus on sound processing at the expense of memory, thinking, and learning processes. Robbing Peter to pay Paul leads to a cascade of bad consequences, leaving seniors vulnerable to dementia and Alzheimer’s disease.
  2. Even mild HL hastens brain tissue loss, and seniors with untreated hearing problems are much more susceptible to brain tissue loss and other unwanted brain structural changes than seniors with normal hearing. This is significant because the brain tissue loss occurs where memory and sensory integration are processed, causing a negative feedback loop that leaves seniors vulnerable to dementia.
  3. People who can’t hear well tend to avoid social engagement. This puts them at a higher risk for becoming socially isolated, lonely, and depressed—and that exposes them to a perfect storm for developing dementia and early death.

Now the good news: new research just published in the Journal of the American Geriatrics Society by researchers at the French National Institute for Health and Medical Research in Bordeaux, France found that hearing aids reduce the threat of accelerated cognitive decline. The Bordeaux study revealed that elderly people with HL who used hearing aids were spared the augmented levels of cognitive decline suffered by others with HL who didn’t use hearing aids.

Social neuroscience research found similar results

Dr. Cacioppo is the Director of the Center for Cognitive & Social Neuroscience and Chair of the Social Psychology Program at the University of Chicago. Decades of research inform the doctor that we are social by design. That means we are hard wired to connect with others. In fact, our need for social interaction is as fundamental as our need for food and water because the consequent social behaviors helped us survive & reproduce.

Highlights from social neuroscience research:

  • Socially connected people are more likely to have good physical health and psychological well-being.
  • People with strong social networks generally live longer. They also have lower rates of anxiety and depression.
  • Forming strong social bonds creates a positive feedback loop of social, emotional and physical well-being.
  • Conversely, lack of social bonding often contributes to a negative feedback loop of isolation, deep loneliness, and antisocial behavior, often leading to bad health outcomes for aging adults, including depression and dementia!

But you can’t connect with people if you can’t hear them, so it is vitally important that hearing and communication problems aren’t keeping you from a socially rewarding life.The bottom line? Hearing empowers social health and social health empower life!

See our Brochure on Hearing Loss and Dementia, here

 

Breaking News - Hearing Aids prevent Dementia study

 

Tinnitus: The End of Quiet Moments

Tinnitus is the perception of sounds that have no external source. The severity of tinnitus varies from an occasional awareness of a noise (ringing, hissing, buzzing, roaring, clicking, or rough sounds) in one or both ears, to an unbearable and incessant sound that causes a variety of psychological stresses.

Tinnitus isn’t a “phantom sound” or a single disease, but a symptom that can be associated with many causes and made worse by other factors.

Tinnitus is relatively common, but in rare cases it can be a symptom of serious disease such as vascular tumor or acoustic neuroma (a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear).

Tinnitus facts: If you have tinnitus you aren’t alone. More than 50 million Americans have signs of tinnitus. 9 in 10 patients with tinnitus also have hearing loss, and 1 in 5 patients find the symptoms hard to endure. 10-15% of Americans experience chronic tinnitus, lasting more than 6 months.

See our Brochure on Tinnitus, here

Untreated Hearing Loss

The consequences can be severe but treatment offers hope!

Untreated hearing loss has been linked to disabling medical conditions such as dementia, Alzheimer’s disease, depression, and cardiovascular disease. Studies and observational evidence indicate that untreated hearing loss can damage your physical, emotional, and social health and well being.

Your family, friends, and others will not escape these changes. In a very real sense they will share the unwanted consequences of your hearing loss.

The good news is that the worst effects of hearing loss can be moderated with hearing aids, cochlear implants and post-fitting rehabilitation. When people with mild-to-profound hearing loss use hearing aids, they experience less depression, less anxiety, and less emotional stress… while showing significant improvements in their quality of life and well-being.

Given the undesirable consequences of untreated hearing loss, it would be a good idea to get a hearing exam by a well qualified Audiologist, especially if you suspect that you are developing hearing problems. Being more safe than sorry has real meaning when the consequences of inaction are potentially so severe.

See our Brochure on Untreated Hearing Loss, here

Age-Related Hearing Loss (ARHL)

Seeds of a Growing Problem

The population of the U.S. is getting older. According to the Administration on Aging, the aging ‘baby boom’ generation will produce a dramatic increase in the population through 2030. In 2009, people over 65 represented 12.9% of the population, but by 2030, they will represent 19.3%. The population over 65 is expected to double between 2008 and 2030 to a projected 72.1 million.

Why should we be concerned with an Aging Population? Because Hearing loss is the third most common chronic health condition among older adults! According to the National Institute on Deafness and Other Communication Disorders (NIDCD), 36 million Americans have impaired hearing, including 17% of our adult population. The occurrence of hearing loss increases with age. Approximately one third of Americans between 65 and 74 and nearly half of those over 75 have hearing and communication problems.

The Symptoms and Progress of ARHL

ARHL (also known as presbycusis) is a gradual and progressive hearing loss that affects most individuals as they age. Due to the slow progression, adults with ARHL may not realize that their hearing is diminishing …but if they do …they may accept it as normal aging. ARHL has a serious impact on the elderly because it diminishes their ability to communicate and reduces their functional independence. This limits their opportunities to participate effectively in their daily lives.

To those with ARHL, sounds often seem less clear and lower in volume. Muted murky sounds make it increasingly difficult to hear and understanding speech. Individuals with ARHL may experience several of the following:

  • The speech of others may seem mumbled or slurred.
  • It may become difficult to distinguish high-pitched sounds such as “s” and “th”.
  • Conversations become difficult to understand, especially when there is background noise.
  • A man’s voice may become easier to hear than the higher pitches of a woman’s voice.
  • Certain sounds may seem annoying or too loud.
  • Tinnitus (a ringing, roaring, or hissing sound in one or both ears) may develop.

Is ARHL the Same for Men and Women?

ARHL typically begins with high frequency hearing loss (degeneration of the hair cells lining the bottom of the Cochlea) and later affects the lower frequencies (apex of the Cochlea) as well. Paradoxically, several research studies indicate that while men develop high frequency hearing loss with age, women tend to have more problems discerning lower frequencies (250-1000Hz), possibly due to biologic factors such as hormones, or cardiovascular disease events (CVD) such as hypertension, coronary heart disease, stroke, and diabetes. While low-frequency hearing loss is related to CVD events in both genders, women tend to show this relationship more than men on audiograms. The figure (above) shows the gender reversal pattern, using average audiograms of 341 males and 346 females aged 50-89 years (Journal of the American Academy of Audiology (1993;4:42-49).

Although precise causes for this pattern require more research, the bottom line is that women with ARHL have more problems with low-pitched vowel sounds (o, a, ah, i, e), and men have more problems with high-pitched consonant sounds (d, t, sh, s, f, th). Since the softer high-pitched consonant sounds carry the meaning of speech, those (especially men) with pronounced high-frequency hearing loss often have problems understanding what is being said, especially in an environment with background noise.

About the Author

Dr. Li-Korotky is a nationally acclaimed research scientist and clinician, and the President of Pacific Northwest Audiology in Bend OR. The Doctor earned an MD with an emphasis in otology and otolaryngology, a PhD in audiology with a thesis on Age-Related Hearing Loss, and a Clinical Doctor of Audiology degree (AuD).

Hearing Loss and Dementia

The Problem

An increasing number of independent scientific studies are showing strong evidence that hearing loss is more than just a nuisance of aging. The message is disturbing: people who experience hearing loss as they age may also have a significantly higher risk of developing cognitive disorders, including dementia. Cognitive function is an intellectual process that allows us to become aware of, perceive, or comprehend ideas. It involves all aspects of perception, thinking, reasoning, and memory.

The Evidence

A 2011 study (Hearing Loss and Incident dementia) was conducted by researchers at Johns Hopkins University School of Medicine in Baltimore in partnership with the National Institute on Aging. Dr. Frank Lin and others found that older adults with hearing loss were more likely to develop cognitive problems than others who retained normal hearing as they aged, and the risk of developing dementia increased with the degree of hearing loss. The study found that people with severe hearing loss were five times more likely to develop cognitive problems, and even mild hearing loss doubled the risk for serious cognitive impairment Las Vegas.

In a follow-up study (Hearing Loss and Cognitive Decline in Older Adults, 2013) Dr. Lin and colleagues substantiated that older adults with hearing loss were more likely to develop thinking and memory problems than older adults with normal hearing, and the degree of cognitive degeneration was directly related to the amount of hearing loss. The study found that cognitive capabilities for those with hearing loss declined 30 to 40 percent faster than they did for a group with normal hearing. According to Dr. Lin, The results of the study should prompt an effort to make age-related hearing loss a public health priority.

Other studies indicate that hearing loss accelerates atrophy in auditory areas of the brain, making it more difficult for older adults to comprehend speech. “Your hearing ability directly affects how the brain processes sounds, including speech,” says Dr. Jonathon Peelle, PhD, research associate in the Department of Neurology at the University of Pennsylvania. “Preserving your hearing doesn’t only protect your ears, but also helps your brain perform at its best.”

Pathways to Dementia

Although the studies could not determine a direct link from hearing loss to cognitive degeneration, researchers proposed several pathways that could lead from hearing loss to dementia, and these are summarized in the figure. The first pathway (gold arrows) is known as “cognitive load.” As hearing loss progresses, the brain must devote greater resources to auditory processing (speech and sound) at the detriment of thinking and memory. Another pathway (blue arrows) leads from hearing loss to social isolation, prompted by increasing communication difficulties. Social isolation has been well established in previous research as a risk factor for cognitive decline. A third pathway (green arrows) is known as auditory deprivation. When the hearing nerves and regions of the brain responsible for hearing are deprived of sound, they atrophy, a process that can accelerate the onset of dementia. An argument could be made that some other, yet-to-be-determined physiologic factor may serve as a common cause for both hearing loss and dementia, but many researchers agree that there is strong evidence to support a causative link from hearing loss to significant cognitive decline in older adults.

Epilogue

Although we don’t have clear evidence that hearing aids, cochlear implants and other rehabilitative measures will reduce or prevent cognitive degeneration, many clinical researchers are convinced that these interventions improve the lives of their patients. As Dr. Lin noted, “they are able to engage again: they
are no longer isolated.”  So…there are no downsides to treatment…but there may be serious downsides to letting hearing loss go full course!