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Healthy Advice From the Pros Column

Dr. Thibert participates in the Healthy Advice From the Pros column featured in the Green Bay Press Gazette newspaper.  Below are a number of questions answered by Dr. Thibert and featured in this column.  If you would like to submit a question, please use the "Contact" link in our website to do so.

DIZZINESS/IMBALANCE:

Q:  What is vertigo?

A:  Vertigo refers to a spinning or whirling sensation.  Subjective vertigo is when an individual feels like they are spinning.  Objective vertigo is when the room looks like it is spinning.  Regardless of the type, vertigo is a symptom not a disease.  It often occurs as a result of a disorder in the vestibular system (balance system) in the inner ear, although not always.  Treatment for vertigo or dizziness depends on identifying and eliminating the underlying cause.  The prognosis also depends on the cause of the vertigo and how well the underlying condition responds to treatment.

Q:  Is there a test to examine dizziness?

A:  Electronystagmography (ENG) or videonystagmography (VNG) are tests for dizziness that measures eye movements through computerized recording techniques.  The ENG uses electrodes to measure eye movements whereas the VNG utilizes video goggles.  The test is done in the office and typically takes an hour to complete.  There are several subtests within the ENG or VNG test battery that measure a part of the organ of balance (peripheral vestibular system) and some of the associated central pathways.  While ENG is the most widely used clinical laboratory test to assess vestibular function, normal ENG test results do not necessarily mean that a patient has typical or "normal" vestibular function.

Q:  What is positional vertigo and what causes it?

A:  Benign paroxysmal positioning vertigo (BPPV) is a brief burst of dizziness that is triggered by changes in head or body position, such as rolling over in bed or tipping your head back.  The dizziness is usually described as a whirling or spinning sensation that lasts seconds to minutes in duration followed by a brief period of imbalance.  The onset of BPPV may be spontaneous, in conjunction with an inner ear infection, following a head injury or following an extended period of bed rest.  BPPV results when calcium carbonate crystals break loose in the inner ear and get stimulated inappropriately.  It is the most common cause of vertigo and is easily treated by doing a repositioning maneuver.  At Advanced Hearing Solutions, we have successfully treated this problem on numerous patients.

Q:  I was told the CRP can cure positional dizziness.  Is that true?

A: The canalith repositioning procedure (CRP) has been shown to be highly effective at treating a specific type of inner ear dizziness called benign paroxysmal positioning vertigo (BPPV).  BPPV is a mechanical problem in the inner ear resulting in particles or crystals being loose.  When a person moves a certain way, the crystals get stimulated causing brief dizzy spells.  The CRP is a non-invasive treatment maneuver that is performed in the office to move the loose crystals back in place.  It takes minutes to complete, typically requires no medication and is very successful at resolving BPPV when administered correctly.

Q:  What is Meniere's Disease?

A: Meniere's Disease is a disorder of the inner ear that affects hearing and balance.  It is thought to be caused by an increase in the volume and pressure of fluid in the inner ear.  During a classic episode, an individual will experience roaring tinnitus (hissing or ringing in the ear) accompanied with ear pressure or fullness and decreased hearing sensitivity.  The ear symptoms fluctuate in severity and often come first followed by a severe episode of vertigo (spinning dizziness).  Many other disorders also have symptoms similar to Meniere's.  Therefore, it is important to see your physician for an accurate diagnosis.

Q:  My wife fell recently.  What can we do to decrease the chance of this happening again?

A:  There are a number of things you can do to help.  First, discuss all medications she is taking with her physician, including anything over-the-counter.  Substituting another medication may reduce her symptoms.  Get an annual eye exam.  Small changes in vision and depth perception can significantly affect balance.  Use appropriate footwear with a skid resistant sole.  The incidence of falls decreases dramatically when appropriate shoes are worn.  Remove or reroute trip hazards, especially throw rugs or cords.  Install hand rails in stairways and in the bathroom.  Use nightlights and brighter lighting in the home.  Lastly, start a safe exercise program focused on stretching, flexibility and strengthening of lower extremities.

Q:  Is Mal Debarquement Syndrome a form of motion sickness?

A:  To a certain degree, it is.  Mal Debarquement syndrome is described as a persistent rocking sensation and disequilibrium that occurs following prolonged exposure to motion environments, such as taking a cruise.  Once an individual returns to land, they continue to feel as though they are on the ship.  This sensation may last from hours to days before resolving.  Occasionally, the symptoms persist.  When this occurs, you should see your physician for evaluation and possible treatment.

 

 

HEARING AIDS: 

Q:  Are there any hearing aids available that just amplify voices and not background noise?

A:  Most hearing aids sold today have digital processors which adjust automatically to reduce background noise and enhance speech sounds.  However, there are NO hearing aids that amplify speech sounds or voices only (despite what some advertisements suggest).  Most sound environments are a combination of both speech and competing noise.  Hearing aids amplify some of both.  Noise reduction in today's newest instruments is quite remarkable but it does not eliminate all noise.  A person without hearing loss also hears noise but their brain is able to sift through the noise to comprehend most speech.  New hearing aid users need to relearn that skill.

 

Q:  I have trouble with the feeling in my fingers.  What kind of hearing aid would be the easiest for me to handle?

A:  In our experience, custom In-The-Ear hearing aids tend to be the easiest to handle for most individuals.  These aids fill up the bowl of your ear and can be inserted and removed with just one hand.  Another advantage to this style of aid is that they typically take a larger size 13 battery.  Although Behind-The-Ear or Open Fit hearing aids are larger, they have two components- the hearing aid and the tubing/ear mold.  This can be more challenging to handle if you have dexterity issues. 

Q:  Are the tiny hearing aids that fit inside your ear canal more expensive than the big ones that go behind your ear?

A:  No, not necessarily.  You are describing two different styles of hearing aids.  The style of the hearing aid has to do with what the hearing aid looks like (its shape).  However, the cost of the hearing aid is usually directly related to the technology or chip that is inside it not how big or small the hearing aid is.  In general, there are three major levels of technology; standard, advanced and premium.  Each level of technology corresponds to certain features and/or benefits the hearing aid provides.  The more features a hearing aid has, the more expensive it will be.

Q: I keep hearing about Bluetooth compatible hearing aids. What is that all about?

A: Some manufacturers now offer hearing aids that can be connected or linked directly to Bluetooth enabled electronic devices (such as mobile phones, iPods, MP3 players, personal computers, GPS systems, etc.) This is done by pairing the electronic device to a Bluetooth remote interface (Streamer, Tek or iCom) that channels or streams the audio directly into both ears through the hearing aids. The wireless connection enables the user to be hands free and hear directly through their hearing aids in stereo. Although this technology sounds complicated, it is actually very easy to use and affordable (remote interface ranges from $250 - $400 each).

Q: I need to buy a new cell phone. I wear hearing aids and was wondering if some cell phones are more compatible with hearing aids than others?

A: Not all cell phones work well with hearing aids. The most common complaint occurs when radio frequency (RF) emissions from the wireless phone interact with the hearing aid circuit resulting in interference or buzzing. When shopping for a new cell phone, look for a rating of M3 or M4 for microphone use or T3 or T4  for telecoil use. The higher the rating, the less interference is expected. If it is possible to try the cell phone in the store before purchasing it, that would be ideal to determine true compatibiltiy and audibilty with your hearing aids.

Q: Do I have to wear my new hearing aids all the time?

A: People often struggle with hearing loss for years before trying hearing aids. Consequently, you adapt to diminished hearing. When you start wearing hearing aids, your auditory system has to relearn what "normal" hearing is. The best way to achieve this is by wearing your hearing aids consistently. Even if you are at home alone, there are many soft sounds in your environment. If you only use your hearing aids in noisy settings, your auditory system may be overwhelmed because it has not beome accustomed to amplification and increased audibility. You may have to increase wearing time gradually in the beginning, but full time use is the ultimate goal.

Q: Do hearing aids need maintenance?

A: It is recommended that you wipe off the part of the hearing aid that goes into your ear canal with a soft, dry cloth on a daily basis. A lint free cloth or one that doesn't shed works best. Storing the hearing aid in a dehumidifier nightly will pull moisture away from the electronics and prolong the life of the hearing aid. If you wear a behind the ear hearing aid, you should change the tubing on your ear mold or slim tube every 6 months or sooner, as they will become hard and brittle. If your hearing aid has a wax trap, that should also be changed when clogged.

 

 GENERAL AUDIOLOGY:

Q: When do you recommend a person have their hearing tested for the first time?

A: Ideally, a hearing test will be completed when hearing is normal. This test will serve as a baseline and can be compared to all future tests. For over 75 years, May has been designated as "Better Hearing and Speech Month." This is a time to raise public awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding or hearing. During the entire month of May, our office provides complimentary hearing screens as a way to support this national program.

Q: Are Q-tips really that bad for your ears?

A: Q-tips or cotton swabs are not the problem. It's the person using them. If you stick a cotton swab into your ear canal, you are more than likely to push ear wax deeper in rather than removing it. This can impact the wax and cause a temporary hearing loss. Also, if a cotton swab is inserted too deeply into the ear canal, the ear drum could potentially be pierced. I realize it may be tempting to use cotton swabs but I would highly advise against it. Stick to the old adage of never putting anything smaller than your elbow in your ear canal and you can't go wrong.

Q: Can you tell me more about sudden sensorineural hearing loss?

A: Sudden sensorineural hearing loss (SSHL) is a rapid loss of hearing that can occur all at once or over a period of up to 3 days.  It often affects one ear and could be accompanied with ringing and/or dizziness. Although there are multiple causes, it is rarely identified definitively. A SSHL is considered a medical emergency. A person who experiences this should see their doctor immediately. A comprehensive hearing assessment should also be completed to quantify the degree and type of hearing loss. Individuals with SSHL are often prescribed steroids. The sooner treatment is initiated, the better the prognosis.

Q: Can head trauma cause a hearing loss?

A: Yes, it can, especially if the temporal bone of your skull is fractured. A skull fracture of this nature can result in permanent sensorineural hearing loss if the underlying organ of hearing (cochlea) or auditory nerve is damaged. The configuration and severity of the hearing loss would depend on the extent of the injury. Head trauma may also result in temporary hearing loss that resolves over time or is amendable to medication or surgery. For example, a blow to the head could cause an eardrum to rupture.

Q: I am getting my hearing checked soon. What can I expect?

A: A hearing test is designed to determine if a hearing loss is present, including the type of loss and severity. For accuracy, you should be tested in a sound treated booth with calibrated test equipment. The audiologist will put headphones or inserts in your ears and present different tones to you at different volume settings. You will be asked to raise your hand or push a button each time you hear a tone, even if it is very soft. This test will be repeated with a bone vibrator that sits behind your ear sort of like a headband, and stimulates your hearing nerve directly. Your responses are then plotted on a form called an "audiogram." Speech testing will also be performed to determine if you have distortion in your ears or if you are hearing speech clearly when volume is set at a comfortable level. Following the test, the audiologist will go over your findings and any recommendations he or she might have.

Q: What does presbycusis mean?

A: Presbycusis is the gradual loss of hearing that occurs in individuals as they grow older. According to the Better Hearing Institute, approximately 30-35 percent of adults between the ages of 65 and 75 years have a hearing loss. It is estimated that 40-50 percent of people 75 and older have a hearing loss. The loss associated with presbycusis is usually greater for high-pitched sounds. Presbycusis most often occurs in both ears, affecting them equally. Because the process of loss is gradual, people who have presbycusis may not realize that their hearing is diminishing.

Q: Can you please give me some tips to help with communicating with my severely hearing impaired grandparents?

A: Face your grandparents so that he or she can see your face when you speak. Move closer to that person. Be sure that lighting is in front of you when you speak. This allows a person with a hearing impairment to observe your mouth, facial expressions, gestures, and body movements that provide communication clues. During conversations, turn off the radio, television or any unnecessary background noise. Avoid speaking while chewing food or covering your mouth with your hands. Speak slightly louder than normal,  but don't shout. Shouting may actually distort your speech. Lastly, speak at your normal rate, and do not exaggerate sounds.

Q: What can be done to prevent hearing loss?

A: The short answer would be to avoid loud levels of noise at all times. However, that is not always possible. The number one thing that you can do to prevent noise induced hearing loss is to consistently wear properly fit hearing protection when exposed to high levels of noise for any length of time. For example, hearing protection should always be worn if you are firing a hand gun, working with loud power tools, handling heavy machinery or if you work in a noisy environment. If you enjoy listening to music on an iPod, turn down the volume. No one other than you should be able to hear the music from your earplugs.