Au.D

Musical ear syndrome, also known as musical hallucinations or auditory hallucination, is more common than you might believe. It can cause enormous stress on the individual experiencing it. It is more likely to be a song or music without words but a few people have reported to me that they hear songs with words. I find in my practice that people are embarrassed to tell anyone about what they hear and are secretly afraid that they are going crazy.  

One source estimates that auditory hallucinations affect more than five percent of the population! In cochlear implant patients, up to 22 percent of the implantees experienced the hallucinations before or after the implant. Musical ear syndrome can occur in people of all ages, with normal hearing, with or without traditional tinnitus and who are not experiencing sudden stress in their life.  

Musical Ear Syndrome is a Non-Psychiatric Condition 

The majority of the people who have this condition have hearing loss. People may think the music is coming from a neighbor’s house or a car sitting outside the house. I had a patient come in with a family member who told us that her mom would start banging on the wall of her apartment telling the neighbor to turn down the music. Another individual became so distraught and accusatory of the other tenants that they were asked to leave the apartment complex where he lived. 

Although MES is not a “scary” disease, persistent hallucinations may disturb patients and affect their quality of life. Patients should be educated about the syndrome and firmly assured that they are not mentally ill. It is important to remember if the room is quiet then the music or sound you hear may be more noticeable.  

Causes of Musical Ear Syndrome 

The causes of musical ear syndrome are not known definitively. There is a theory that the loss of hearing causes the area of the brain that receives sound (auditory cortex) to be hypersensitive. That area of the brain becomes sensory deprived because of the hearing loss. One study using electroencephalography found that musical ear syndrome has some neural similarities to tinnitus but had additional activation of the area of the brain associated with music and language production. The scientist could actually see the part of the brain responsible for processing music and language responding as if there were music being played during the test! If the music stopped and the person no longer heard the music, the response the scientist saw also stopped.  

A cause for phantom noise can be medication use. There are more than 368 medications and other substances that can cause hallucinations including some very commonly prescribed medicine such as Zyrtec and Claritin, and many of the mood altering medications. You can go online and type in the name of any medication you take and then the words auditory hallucinations and see what you find. Do not stop any medication, simply make an appointment with your doctor and talk about the information you learned online.  

There are people who report the music only when they hear the air conditioner or heater running. Others report the music begins when the refrigerator motor turns on. The theory is that the brain hears the cyclic nature of the sound and actually modifies it into a more complex sound from a memory.  

Stress can exacerbate the sounds. It is always good to look at your lifestyle and see if there is a healthy way to manage stress through food choices, exercise and seeing a professional as needed.  

Treating the Syndrome 

One treatment is to reduce or eliminate a drug that might be causing the musical ear syndrome. This is always done under medical supervision. If your doctor advises you to change medication, take notes to document how you feel and if the sound changes or goes away completely. Another treatment is to wear hearing aids. You need to have a hearing test to determine if you have hearing loss and if hearing aids would be of benefit. By wearing hearing aids, you can focus sound to all the hearing areas of the brain to try to stimulate it properly so the brain does not create sound on its own. One option is to turn on music or the TV to introduce sound to the room and see if that “drowns out” the sound you hear in your head.   

As you may have noticed, there is not one particular formula to stop musical ear syndrome; you may need to try various treatments. Work with professionals to find the best option for you and your lifestyle. QCBN 

By Karon Lynn, Au.D. 

Hypertension, or high blood pressure, is a major risk factor for stroke and heart disease, which affects nearly 70 million adults in the U.S., according to the Centers for Disease Control and Prevention. This adds up to one in three adults! In addition to people with hypertension, the CDC states that one in three adults is living with elevated blood pressure or prehypertension. Prehypertension is not hypertension, but the blood pressure levels are above what is considered normal.   

What is Blood Pressure?  

Blood pressure is a measure of the force of blood against your blood vessel walls. When your blood pressure is taken, two numbers are noted. The top number is the systolic reading. This measures the pressure when your heart pushes blood out. The bottom number is the diastolic reading, which measures the pressure when your heart is relaxed between beats and is not pumping any blood. If the blood pressure is high, it means that your heart is pumping the blood through your arteries very fast. This excessive force causes damage to the smooth lining of blood vessel walls, resulting in areas where fatty plaque (made of fat, cholesterol and other substances) can build up and make a bump. The bump gets bigger as more plaque sticks to it.  The long-term effect of this is that the blood vessels collect a significant amount of fatty plaque, which diminishes or stops blood flow. This can occur anywhere in the body. In some people, the plaque bump will rupture and cause a traveling blood clot.  

What Causes Hypertension?  

The exact causes of hypertension are not known. Several factors increase the risk of having high blood pressure such as high salt intake, smoking, obesity, lack of physical activity, significant alcohol consumption, stress, age and, of course, genetics. A recent study showed that only half of Americans with hypertension have it under control. A contributing factor to this is that hypertension is usually not something you feel. Most people do not know when their blood pressure increased and need to have their blood pressure checked to even know if they are within normal limits or not.  

Hypertension and Hearing Loss 

If an individual has high blood pressure, the blood vessels are damaged all over the body. This includes the vessels that carry blood to the ears. Studies show that people who have an increase in blood pressure have a higher rate of hearing loss. If the blood pressure stays high for a long period of time, it will permanently damage the hearing organs. For a person who has high blood pressure for a short time, the hearing may return to normal once the blood pressure is lowered. Because hearing loss affects quality of life, it is important to address the underlying cause of hearing loss rather than simply putting hearing aids on someone as the hearing continues to worsen.  

Hypertension and Stroke 

There is a high correlation between hypertension and the incidence of a first stroke. Eight out of 10 people having a first stroke also have hypertension, making it extremely important for a person with hypertension to seek medical attention. This fact also shows us that a yearly well visit examination with a primary care physician is important to manage your health, even if you feel good.  

Sudden Change in Hearing 

The American Heart Association published an article about the relationship between sudden hearing loss and hypertension. Researchers found that there is a clear correlation between sudden change in hearing and blood pressure. The exact specifics are not well understood yet, but a sudden change in hearing is a significant warning flag and should not be ignored. This study showed that a person with sudden severe hearing loss was 150 percent more likely to experience a stroke within two years of the change in hearing.  

Staying Healthy 

The body changes as individuals age, making it important to have routine medical checkups even if you feel fine. The physician can help you manage your changing body and keep you informed of anything that may need attention before it causes significant disability.  Part of the well visit examination will be focused on your history and family history of diseases. Physicians will check blood pressure, check for diabetes and cholesterol levels, as well as any physical concerns you have. You can ask for vision and hearing exams as well. Stay informed about your physical and hearing health to maintain the best quality of life. QCBN 

By Karon Lynn, Au.D. 

Hearing loss is described by type and degree of loss. The type of hearing loss is determined by the location of the dysfunction. The degree of loss is determined by how much power is needed to hear sound. The ear is divided into the outer ear, middle ear and inner ear. In this article, I will discuss at the outer and middle sections of the ear as well as any hearing loss that may originate in these areas.  

Outer Ear Anatomy and Function 

The outer ear extends from the pinna (the area your glasses sit on) through the entire ear canal. The shape and structure of the pinna and the ear canal assist in increasing particular pitches or frequencies that you hear. These frequencies are increased by 10-12 dB because of the design of the pinna. The shape of the pinna helps to localize sound and determine the elevation or height of a sound. In addition, the outer ear helps to distinguish sounds that come from in front of you verses those that come from behind you. The canal protects the middle ear and houses glands that secrete an oily substance that helps keep the canal healthy (and that insects find noxious!). 

Hearing Loss of the Outer Ear  

If the pinna is absent, you can still hear as long as the canal is completely formed. However, if the canal is absent or only partially open, a hearing loss will be evident. A hearing loss occurs when the sound is unable to reach the middle ear. This impairment creates a conductive hearing loss. A conductive hearing loss can be caused by anything obstructing the ear canal. Examples of possible obstructions are: excessive wax, a foreign object, collapsed canal or external otitis, which is excessive inflammation of the canal wall and is very painful! 

Middle Ear Anatomy and Function 

The middle ear is a small air filled cavity that is lined with mucous membrane. Inside this cavity are the smallest bones in the body called the ossicular chain. These tiny bones are connected together by ligaments and two tiny muscles. The middle ear bones’ primary function is to increase the level of sound into the inner ear by 25-30 dB. This is due to the lever mechanism of the ossicular chain and the size difference between the eardrum and the connection to the inner ear. Air is introduced into the middle ear via a tube called the eustachian tube. This tube extends from the middle ear to the upper part of the throat. This tube is designed to remain closed and will open to equalize pressure when a person yawns or swallows. The air in this cavity allows the eardrum to vibrate and in turn send sound vibration into the inner ear.  

Hearing Loss of the Middle Ear 

If there is a hole in the eardrum, absent eardrum or a significantly scarred eardrum, a conductive hearing loss may occur. If the bones of the ossicular chain become soft, spongy or the attachments between the bones become stiff and inflexible, a conductive loss occurs. Abnormal eustachian tube function will result in abnormal positive or negative pressure in the middle ear. Prolonged negative pressure creates a buildup of fluid in the middle ear cavity, causing a conductive hearing loss. Abnormal middle ear pressure may cause your own voice to sound louder than normal to you when you speak. This may be extremely distracting if it occurs for a long period of time.  

Treatment for Conductive Hearing Loss  

Surgical treatment and hearing aid treatment for conductive hearing loss has vastly improved in the last 15 years. Conductive hearing loss may be a medically manageable condition; an ear infection may require treatment; an eardrum may be repaired or replaced and if the ossicular chain is not functioning normally or is missing, a surgeon can replace it with a titanium device. For some people with conductive hearing loss, medical treatment completely resolves the problem; however, if the middle ear damage or abnormality is extensive, the surgery may not return the hearing to normal. In this case, it is best to supplement medical management with hearing aids. Traditional hearing aids provide amazing benefit for conductive hearing loss and will help the individual once again connect with the world around them. The BAHA bone anchored hearing aid is another option if a person is not able to wear a traditional hearing aid. Some individuals with chronic drainage or with a canal that is not open are great candidates for the BAHA. QCBN 

By Karon Lynn, Au.D. 

Hearing loss is described in types and degrees of loss. The type of hearing loss is determined by the location of the dysfunction. The degree of loss is determined by how much power is needed to hear sound. The ear is divided into the outer ear, middle ear and inner ear. This article is an introduction to the anatomy and function of the inner ear organ and the hearing loss that may originate in this area.  

Inner Ear Anatomy 

The inner ear is made up of the cochlea and the vestibular (balance) system. Here, we will focus on the hearing organ or cochlea. The cochlea is responsible for receiving a mechanical sound and changing it into an electrical signal. This electrical signal is what the brain will use to hear and understand. The cochlea is a fluid-filled organ that looks like a snail shell. Inside the snail shell are layers of tissue, which support flexible nerve cells that move in response to sound. As the nerve cell is moved, it creates the electrical signal that is sent into the brain. 

Inner Ear Hearing Function 

The cochlea is designed to change a sound wave (mechanical energy) into an electrical impulse. As sound enters the cochlea, it travels around the “snail shell” in a very specific manner. The vibration activates (or moves) the nerve cells along the membrane according to its frequency. The lower frequencies are registered nearer the center of the organ and the higher frequencies are activated near the entrance from the middle ear. As the sound travels around the circle, it vibrates the nerve cells causing the proper response to send on to the brain. This vibration is key to the function of the cochlea. 

Inner Ear Hearing Loss 

The most common hearing loss is nerve deafness. For years, people were told that when they have nerve deafness and that nothing could be done to help. Actually, the vast majority of people who wear hearing aids have this type of hearing loss. Sensorineural hearing loss, or nerve deafness, is usually evident only in portions of the cochlea. There will be varying degrees of damage throughout the nerve cells, depending on how much trauma the cochlea suffered and what frequencies were involved. The excessive sound can rupture the tips of the cells; fuse sensory cells together, damage the area through which the cells transmit signal, and even change the vascular pathways inside the organ. The vulnerability of the inner ear is dependent upon several factors, such as smoking, hypertension, lipid levels, age, gender and other genetic factors. 

Trauma is just one of the causes for sensorineural hearing loss. Other causes are ototoxic medication, autoimmune disease, history of hearing loss in the family, heart disease, diabetes and many other medical conditions. Many people feel that just because they are getting older they will have hearing loss. If your gene pool is strong for the hearing organ, then you may not acquire hearing loss. If you did not expose your ears to loud noise, then you may not suffer hearing loss. 

Treatment for Sensorineural Hearing Loss 

For the majority of people with sensorineural hearing loss, treatment involves making sound louder. The trick is to increase only the sounds you need with the least amount of distortion. How do you focus the increase in sound to the specific areas in the cochlea but continue to allow the cochlea to use its natural ability to hear? The answer is open fit hearing aids! The computer in the hearing aid will focus the energy to specific frequencies and set the maximum energy it will produce in each area to keep the sound comfortable. Because of the open fit, natural sound also goes into the ear canal, complementing the hearing aid generated sound. 

If trauma has occurred either by excessive noise, medical history or even medications an individual takes, then we know the pathways into the area of the brain that makes sense of all the nerve signals may also have suffered damage. The current “treatment” for the nerve areas of the brain is stimulation. Keep the brain stimulated and you will have the best outcome. Properly fitting hearing aids, with the necessary ongoing adjustments as you get used to the sound, is the ideal treatment for sensorineural hearing loss. The newer technology gives more people the opportunity to join the hearing world with the least amount of distortion. This means the quality of the sound is better and people are more likely to wear the aids all day long! QCBN 

By Karon Lynn, Au.D. 

One of the most common questions I hear is, “How should I clean my ears?” There are a few methods for keeping ears clean, but first, let’s learn a little about the ear canal. 

The Purpose of the Ear Canal 

The ear canal protects the eardrum, migrates dust and dirt out of the canal, funnels sound to the eardrum and, finally, modifies sound. The eardrum is the end point of the ear canal. The canal is shaped like a test tube and houses hair follicles and wax producing glands. The actual shape of the ear canal is unique on all people and can even be an oval shape at the opening and then change into a round shape closer to the eardrum. Some people have ear canals that are collapsed shut and open if you pick up on the outside of the ear. The shape of the canal may contribute to the difficulty in managing the wax. Every time I look into an ear canal, it is an adventure to find the eardrum! 

Types of Wax 

People produce ear wax at different rates and some people only have wax build-up in one ear. There are no rules when it comes to wax production. There are different types of earwax: sticky wax (I call it honey wax), flaky wax and oily wax. If wax stays in the ear canal long enough, it dries out and can stick to the canal wall similar to a scab. Wax will collect dead skin and old hairs and can eventually begin to look like a birds nest! (After getting your hair cut, ask the barber/hairdresser to clean all the hair out of the bowl of your ear so the tiny cut hairs do not go into your ear canal.) Wax is only an issue if it builds up enough to block sound from going to the eardrum or if you wear hearing aids and the wax blocks the receiver of the aid.  

To Clean or Not to Clean 

First, ask your health care provider if you have a hole in the eardrum. If you have a hole in the eardrum, it is important NOT to clean your own ear canal. You do not want to introduce germs through the eardrum with oils or water. If your ear canal has an odor, tell your health care provider. 

Wax tends to make your ear feel itchy if it dries out or collects in one area. The canal may become itchy if you remove all the natural oils by cleaning out the canal too much.  If you are prone to dry skin on other areas of your body, your ear canals may produce flakey dry skin with minimal wax in it. If you are under the care of a dermatologist ask if you can put a tiny amount of the skin medicine in your canal once every few months.    

The difficulty people have is trying to maintain a balance of moisture to keep the skin happy but not have significant wax build-up. Some people are able to clean their ear canals with cotton swabs after every shower and not have any problem. However, it is generally recommended that people with small, twisting or collapsing ear canals not clean with a cotton swab. Never clean deep into children’s ear canals with a cotton swab. 

Cleaning Ears with No History of Perforation 

Normal canals with normal eardrums are relatively easy to take care of but it is wise to have at least one otoscopic exam every year to make certain that your chosen wax management strategy is successful. I recommend that you drip one or two drops of mineral oil into your ear canals two times a month to keep the wax moist and keep it from sticking to the canal wall. Moist wax will naturally migrate out of the ear toward the opening.  

Most people do not need to wash out the oil because it is absorbed by the wax. If you want to wash out your ear, use a solution of 1/3 white vinegar to 2/3 body temperature water or 1/3 hydrogen peroxide to 2/3 body temperature water. Please do not use an ear candle or coning; simply do a good old-fashioned rinse every other month. Keep a routine schedule rather than waiting until your hearing has diminished. Clean them monthly because the more wax you have the more difficult it is to get out. QCBN 

By Karon Lynn, Au.D. 

As many as 50 million Americans suffer from tinnitus, a debilitating health condition commonly known as “ringing in the ears.” Musicians, factory workers, veterans and many others endure its effects, including problems with concentration, sleep, anxiety and depression. Tinnitus affects a wide range of people, including those who are exposed to continuous noise and even people who use home improvement tools. It is the leading service-related disability among U.S. veterans, according to the American Tinnitus Association. For many people, the noise in their head is all they can hear; it can be louder than the person’s voice on which they need to focus! 

Many who experience chronic tinnitus use sound devices or machines that “mask” their ringing with white noise. But masking typically offers only short-term relief to those who struggle with the perception of buzzing, hissing, whistling or clicking and does not reduce the level of tinnitus or the loudness of it. There is a new product out and now available to the public called the Levo System.  

This new technology is taking a different approach by retraining the brain to ignore the tinnitus sounds, and has shown the potential to alleviate the condition altogether in some individuals. The Levo System is an FDA-approved medical device that mimics the specific sound of a person’s individual tinnitus. The audiologist working with the tinnitus sufferer creates a profile of the noise by using a system of “noise makers” in the Levo System software. Once the sound match is obtained, it is loaded into a modified iPod Touch that is taken home to be used at night while sleeping. The custom sound match of the tinnitus is heard through ear buds or soft headphones worn while sleeping.  

The current research shows us that over time the brain naturally learns to ignore the tinnitus sound, diminishing its effect on daytime activities and quality of sleep. The loudness of the tinnitus is reduced and some people report only being aware of their tinnitus if they stop and concentrate on it. This change in both awareness of the sound and the loudness of the sound can drastically improve quality of life to tinnitus sufferers over time. The software inside the system tracks the volume the individual sets the masker, and the day and time it is used.  

In the past, the masking sound from the available devices was not able to match the tinnitus as closely as this and was worn during the day. This nighttime therapy appears to teach the brain not to consider the sound as “an internal sound” but slowly re-trains the brain to integrate this matched external sound so that it “habituates” to it. For example, the external sound of a heater blowing is ignored by the brain; then, when the heater turns off, you might realize the sound is gone and that you were not aware of it while it was running. This is a skill the brain is able to do with sound created outside of your body. Another example is living near the train tracks. Many people learn to “unfocus” on the noise the train makes and are able to sleep despite the noise in their house.  

Patients report the greatest improvement when they are involved in making the decisions about their day-to-day treatment. This system puts the tinnitus sufferer in a position of control.   

The Levo System software houses a tracking system that traces the emotional perception of the sound by using the tinnitus sound index that is filled out to record the current severity and negative impact the tinnitus has on daily life. It also tracks the amount of masking needed to cover up what the brain hears. The user is able to increase or decrease the loudness they need to mask what they hear each evening. This is plotted on a graph and provides a visual tool on the progress over time. The goal is that over months of use the volume needed to mask the tinnitus is reduced more and more. It reportedly makes the tinnitus sound a soft distant companion rather than a screaming intrusion that you hear 24/7.  

The system can be reprogrammed if the tinnitus changes sound to a new sound match. There are soft headphones or earbuds that can be worn, depending on the desire of the person. The price includes the programming by the audiologist, administration of the tinnitus sound index, instructing the user, the office visits and the device. The system price can range from $4,000 to $6,000, depending on geographic location of the fitting. QCBN 

By Karon Lynn, Au.D.