Empowering Steps Beyond Treatment: Safeguarding Against Decline
What starts with a commitment to the medical treatment of hearing loss and tinnitus leads to a promise to take best care of yourself by following a holistic and comprehensive treatment plan. Our simple motto that hearing care is health care means it is important that we think beyond the ears and assure you live your best, healthiest, life. We remain steadfastly committed to helping each patient understand how (in addition to treating their hearing loss) they can actively age, remain confident and stay fiercely independent.
Like treating all major medical conditions, the initial prescription (be it a pill to reduce your cholesterol, a round of radiation, an injection to control A1C levels, etc.) must be combined with a healthy lifestyle. The body has an incredible ability to provide relief and heal itself—but only when given the right resources.
We commit to a holistic approach to treating sound, mind, and body. We not only help you hear your best, but we can also help you live your best life as you age and prevent decline. From the technology we use to help you hear your best every day and keep you mentally sharp, we can also help you to increase overall health by discussing diet, supplements, and exercise.
What you hear matters.
Your brain is always on. Your ears are always on too. This means your brain is constantly stimulated by the vast neural network from your ears. Until it is not. Then what happens?
There is a general belief that activities which stimulate the mind, i.e., hearing, can help to slow cognitive decline. Data tells us that treating hearing loss may even slow the progression of dementia.
What starts out as subtle cognitive changes that are seemingly associated with aging goes on to affect an older adult’s day- to-day function. As we age, there are certain expected cognitive declines that we will all experience. However, with increased risk of cognitive decline and dementia associated with hearing loss, it is important to know the differences of ‘normal aging’, MCI (mild cognitive impairment) and dementia.
Early stages of significant cognitive decline (first seen in MCI) include problems with memory, language, thinking, judgement, and visual perception. Fortunately, most people are still ‘with it’ enough to notice these issues and can seek early intervention. Family and close friends may also notice a change. But these changes often are not severe enough to significantly interfere with daily life.
Common signs and symptoms of cognitive decline include:
- Memory loss such as forgetting names, places, or recent events.
- Problems with organizing or planning—struggling with multitasking.
- Difficulty with recognizing faces.
- Difficulty finding words—often losing vocabulary.
- Misplacing items.
- Problems calculating a tip or paying bills.
- Slower recall which could either be visual or verbal.
MCI along with hearing loss can increase your risk of later developing dementia caused by Alzheimer’s or other neurological conditions, which is why addressing risk factors early such as the medical treatment of hearing loss is critical to preventing dementia.
The proper medical treatment of hearing loss and tinnitus is designed to provide auditory feedback and cognitive stimulation that your brain needs.
What you feed your body matters.
Much like an expensive car, your brain functions best when it gets only premium fuel. Eating high-quality foods that contain lots of vitamins, minerals, and antioxidants nourishes the brain and protects it from oxidative stress—the “waste” (free radicals) produced when the body uses oxygen—which can damage cells.
Diet
Unfortunately, just like an expensive car, your brain can be damaged if you ingest anything other than premium fuel. If substances from “low premium” fuel (such as what you get from processed or refined foods) get to the brain, it has little ability to get rid of them. Diets high in refined sugars, for example, are harmful to the brain. In addition to worsening your body’s regulation of insulin, they also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function.
Just as there is no magic pill to prevent cognitive decline, no single almighty brain food or supplement can ensure a sharp brain as you age. Nutritionists emphasize that the most important strategy is to follow a healthy dietary pattern that includes a lot of fruits, vegetables, legumes, and whole grains.
With that said, certain foods in this overall scheme are particularly rich in healthful components like omega-3 fatty acids, B vitamins, and antioxidants, which are known to support brain health and often referred to as ‘brain foods’. Incorporating many of these foods into a healthy diet on a regular basis can improve the health of your brain, which could translate into better mental function.
Research shows that the best brain foods are the same ones that protect your heart and blood vessels, including the following:
- Green, leafy vegetables. Leafy greens such as kale, spinach, collards, and broccoli are rich in brain-healthy nutrients like vitamin K, lutein, folate, and beta carotene. Research suggests these plant-based foods may help slow cognitive decline.
- Fatty fish. Fatty fish are abundant sources of omega-3 fatty acids, healthy unsaturated fats that have been linked to lower blood levels of beta-amyloid—the protein that forms damaging clumps in the brains of people with Alzheimer’s disease. Eating fish 1-2 times a week can be healthy for your brain (but be sure to choose varieties that are low in mercury, such as salmon, cod, canned light tuna, and pollack). If you are not a fan of fish, ask your doctor about taking an omega-3 supplement, or choose terrestrial omega-3 sources such as flaxseeds, avocados, and walnuts.
- Berries. Flavonoids, the natural plant pigments that give berries their brilliant hues, also help improve memory, research shows. In a 2012 study published in Annals of Neurology, researchers at Harvard’s Brigham and Women’s Hospital found that women who consumed two or more servings of strawberries and blueberries each week delayed memory decline by up to two-and-a-half years.
- Tea and coffee. The caffeine in your morning cup of coffee or tea might offer more than just a short-term boost! In a 2014 study published in The Journal of Nutrition, participants with higher caffeine consumption scored better on tests of mental function. Caffeine might also help solidify new memories, according to further research. Investigators at Johns Hopkins University asked participants to study a series of images and then take either a placebo or a 200-milligram caffeine tablet. More members of the caffeine group were able to correctly identify the images on the following day.
- Walnuts. Nuts are excellent sources of protein and healthy fats, and one type of nut might also improve memory. A 2015 study from UCLA linked higher walnut consumption to improved cognitive test scores. Walnuts are high in a type of omega-3 fatty acid called alpha-linolenic acid (ALA), which helps lower blood pressure and protects arteries. That’s good for both the heart and brain.
In considering that poor diet is now the leading killer globally and mental disorders account for the largest burden of global disability, the fact that diet appears to play a role in mental as well as physical health (as well as increasing the risk of dementia) must be taken very seriously.
Supplements
Yes, proper diet is critical. However, there are a variety of supplemental nutritional needs that are difficult to come by (even with a great diet) that our brains require as we age to help maintain sharp mental acuity and positive cognitive function. Natural supplements can combat certain health, lifestyle, and environmental factors that can increase the risk of cognitive decline and dementia, including:
- Inflammation
- Poor Diet
- Insulin Resistance
- Lack of Exercise
- Poor Sleep
- High Blood Pressure
- Toxins
- Stress
- Social Isolation
Below is a short list of some of the most effective supplements available today that support healthy cognitive function as we age.
CoQ10 (Coenzyme Q10)
This naturally occurring antioxidant that reduces the proliferation of free radicals is produced in the human body for cellular growth and maintenance. Unfortunately, levels of CoQ10 decrease as we age. CoQ10 supports nerve health, the protection of brain tissue from oxidative damage and reduces the action of harmful compounds that can lead to brain disease. In addition, CoQ10 supports healthy cardiovascular function and may reduce the risk for repeat heart attacks and helps combat side effects of cholesterol-lowering statins.
Ginkgo Biloba
This naturally occurring ingredient derived from a tree in Asia can support a healthy inflammation response, supports the production of important brain-building factors, supports recovery from heavy metal/mold exposure, supports healthy blood flow, and supports the brain’s repair from physical trauma.
Phosphatidylserine
This is hard to say but the simple ingredients support a healthy blood sugar response, provide important building factors, and support the brain’s recovery from trauma. The 80+ million Americans living with diabetes or pre-diabetes are at particular risk of cognitive decline given the inability of the body to effectively manage glucose levels.
Coffee Fruit Extract
Derived from the same plant as the coffee bean (although often discarded in favor of the coffee bean!) helps support healthy blood sugar response and increases the brain’s production of key building factors like brain-derived neurotrophic factor (BDNF) that build proteins found in the brain.
Yamada Bee Propolis
Extracted by bees and combined with specific plant proteins to help protect themselves, this supplement supports healthy inflammation response, supports healthy blood sugar levels, supports the production of brain-building factors, supports recovery from exposure to heavy metal and mold exposure, supports normal blood flow, and supports brain repair from trauma.
Turmeric
Many Americans have this tasty spice in their kitchen cabinets, but it is too often left unused! Curcumin, a substance found in Turmeric helps support healthy inflammatory response, provides brain-building compounds, and supports recovery from heavy metal and mold exposure.
Gotu Kola
This herbal extract (from the parsley family) is commonly found in traditional Chinese medicine. This derivative has been used for thousands of years and helps support a healthy inflammatory response, healthy blood flow, and supports brain repair from trauma.
Don’t forget, what you do with your body matters too!
Have you heard that ‘sitting is the new smoking’? When we sit around and let our brains wonder ‘what will be the cause of our demise’, most of us think about heart disease, diabetes, cancer, dementia, old-age, pneumonia, disease, etc. But, according to new data the chair you sit in most is one of the biggest threats to your health. No, this doesn’t mean you should immediately go and throw out your favorite chair, rather it’s time to consider having ‘the talk’ with your favorite chair and let it know you need to get out and stretch your legs more!
Rather than try and come up with our own novel scary statement about how we need to get up from our chairs and be more active, we believe Dr. James Levine, a professor of medicine at the Mayo Clinic has said it best:
“Sitting is more dangerous than smoking, kills more people than HIV, and is more treacherous than parachuting. We are sitting ourselves to death…. the chair is out to kill us.”
—Dr. James Levine, Mayo Clinic
To put it in to perspective—we were not designed to sit. Think about it—we are bipedal for a reason and sitting isn’t the reason. The body is meant to stay in perpetual motion until rest is required. Humans have been on the planet way longer than the chair was invented.
If right about now you are thinking ‘but I exercise, so this can’t apply to me’, unfortunately that doesn’t hold true. Yes, exercise is good for you, and we all need to do more of it; but it doesn’t negate the damage we do to our bodies by sitting for extended periods of time, day after day. Thus, it stands to reason that more exercise is not the answer to sitting too much. Sadly, 10 hours of stillness in a chair (which is not uncommon for people at work) cannot be offset by 1 hour of exercise.
Sitting for long periods of time changes you. It changes your metabolism. It changes the way your body behaves and stores nutrients. In fact, your metabolism can slow down by as much as 90% after only 30 minutes of sitting.
Sitting too long increases the risk of nearly everything that can kill you, including increased rates of:
- Type-2 Diabetes
- cardiovascular disease
- obesity
- disturbed sleep
And increased risk of:
- back and neck pain
- cancer
- deep vein thrombosis
- anxiety and depression
- Alzheimer’s and dementia
- premature death
So, what is the best way to combat ‘sitting too much’. While this is particularly hard for those who work at a desk, it can also be a challenge for many people living with the social isolation that accompanies hearing loss. For starters, get in the habit of standing and/or walking at least once every 20 minutes. With the advent of computers that fit on our wrist, we can now set up simple re minders that get us to ‘stand’. We particularly like smart watches that will not stop reminding you until you stand up!
The goal is to gradually extend our periods of standing and increase the frequency of taking short walks. This is not about engaging in a newfound cross-fit exercise program, but rather increasing the frequency (not the intensity) of physical movement. There are many things we can do every day to increase our standing-to-sitting ratio. When you are at home or work, here are some simple things you can do each day to change your sit ting habit:
- Drink a lot of water (while good for you, this also has the advantage of making you walk to the bathroom more often).
- Talk and walk (when reaching out to a friend or col league on the phone, take the call ‘to-go’ and walk around).
- Pay your bills standing up (instead of sitting at your desk to pay your bills- stand at the counter-height island and pay your bills!).
- Meet up for a coffee and a walk (next time you meet somebody for a coffee why not walk and talk rather than sit down).
- Park further from the entrance to wherever you are going (i.e., take the furthest available spot at the supermarket).
- Take the stairs (now that you drink lots of water, try and use the bathroom furthest away in your house, preferably up or downstairs!).
In addition to the extra movement that you will have from sitting less, a little bit of exercise truly goes a long way. A simple regular exercise regimen can increase your metabolism, help you keep cancer, diabetes, heart disease and obesity at bay, and keep you socially active (i.e., the opposite of social isolation!). If you do not know what pickleball is—it is the fastest growing sport in our country for those over 50 years young. Although we have unofficially nicknamed the game ‘tiny tennis’, it provides BIG benefits by increasing heart rate, burning calories, requiring hand-eye coordination, boosting your balance, and we guarantee you will smile when you play (which is a great workout for your face muscles!).
Always take the opportunity to talk to your hearing healthcare provider and primary care physician about a holistic approach to living your best life.
Proudly Canadian and Independently Owned and Operated 
Unraveling the Intricate Symphony
in Long Term TinnitusUnderstanding The Physiology of Tinnitus
Tinnitus is not just a burden or scar that results from excessive noise or old age.
Tinnitus in the vast majority (>90%) of people is the result of progressive degenerative damage to the ear-to-brain neural connections. I know that may sound scary and overwhelming, but if the truth scares you into reading this and seeking treatment – then so be it!
First, let’s dive into the cochlea (inner ear) and learn about where it all begins in most patients. Then, we will review how the damage in the ear leads to damage in the brain. This means we must provide some detail on how the ear and the brain work together. So yes, let’s dive into the physiology of hearing (how we hear), how it interacts with the brain, and what the pathophysiology (cause) of tinnitus is.
Hearing starts when sound waves enter the ear canal; sound then travels down the ‘S-shaped’ curvy ear canal and activates movement of the eardrum. The sound then travels across the ossicles (aka, the three tiniest bones in the body affectionately known as the hammer, anvil, and stirrup). These vibrating bones then send a literal tidal wave of fluid that travels down the spiraling cochlea (the snail-shaped organ that houses the receptor cells of hearing). Once inside this conch-shell-shaped organ, there are microscopic hair cells that process the incoming wave of sound.
The tiny yet powerful receptor hair cells are the point of origin where the ear and brain establish their network of millions of neural connections that extend from the ear throughout the brain. These expanding neural fibers from the ear extend to nearly every nook and cranny of the brain and interact with the brain centers responsible for emotion, memory, decision-making, processing, and, of course, hearing!
Along this neural superhighway, sound information is analyzed, fragmented, and transformed into a discrete neural activity that tells our brain about the frequency (pitch), intensity (volume) and duration (length of time) of the sound. The higher up and deeper into the brain these neural signals travel, the more neural coding and perception of sound takes place to uncover information like what or who made the sound, where the sound is coming from and what the sound means to you.
The harsh genetic truth is that our mammalian DNA pre-determines the damage to this ear-to-brain neural network as we age. This is why tinnitus is considered a progressive (gets worse over time) degenerative (the nerves become damaged and die) disorder (not normal).
Researchers from across the globe have come to understand over the past 20 years that external factors (not related to our DNA), such as living in a loud world with access to pharmaceuticals that impact the nervous system, can ramp up the speed of the neural degeneration by several decades. Hence, tinnitus starts for many people in their 40s and 50s and only gets worse over time without treatment.
What ELSE can break down the ear-to-brain connections?
While age, noise, and ototoxic (poisonous to the ear) medications can directly result in tinnitus, several other medical conditions can lead to tinnitus.
One of the most common non-auditory medical conditions that affects nearly half of all adults in the U.S. is cardiovascular disease. While people with heart disease obviously worry about their heart, what many don’t realize is that compromised blood flow to the brain can damage the ear-to-brain connections, lead to tinnitus, and diminish cognitive function.
Another medical condition that can negatively alter ear-to-brain neural structures and speed up degeneration is diabetes. Over 130 million Americans are either pre-diabetic or diabetic. There is a significantly increased risk of experiencing tinnitus, living with hearing loss, and marked reductions in memory, learning, and cognitive performance.
The list of ‘other’ medical conditions that impact the ear-to-brain nervous system and result in millions of older adults living and suffering from tinnitus include:
Take the next step:
The Concept of Tinnitus and Damage to Your Ears
in Long Term TinnitusWhy is the concept of tinnitus so important?
Well, for starters, nearly 90% of people with hearing loss have tinnitus and vice versa – over 90% of people with tinnitus experience hearing loss. Depending on the research you cite, there is evidence that these numbers are even higher. But here is why this topic is so important – over 54% of people with tinnitus find it bothersome and annoying, and report that it gets in the way of enjoying life. This is a staggering number – with over 25 million in the U.S. and close to 750 million worldwide. Therefore, we must talk about tinnitus more, and we must let people know that effective treatment options are available.
In addition, we can’t talk about tinnitus and not talk about so-called “hidden hearing loss”. One of the most common statements from patients is, ‘I have tinnitus, but I was told that I have normal hearing’. Here’s a little secret that most people in hearing healthcare don’t even know – ‘normal hearing’ as measured by a traditional hearing test (the audiogram) is a farce. The issue is – many hearing healthcare providers do not understand the premise that tinnitus is often (50% of the time) the first symptom of ear-to-brain neural damage. Rather than understand the science, most providers tend to rely on statements like ‘but the patient isn’t complaining about hearing loss’ or ‘but the hearing test says the hearing is normal’.
The term ‘hidden hearing Loss’, as coined by brilliant scientists at the Massachusetts Eye and Ear Infirmary, means – damage to the auditory system that results in symptoms of tinnitus and/or hearing loss that traditional hearing tests cannot detect. The more appropriate medical term for this is subclinical hearing loss and tinnitus (or early-stage tinnitus and hearing loss).
The perception of tinnitus is a sign of a progressive degenerative disorder and an ear that is no longer appropriately stimulating the brain. Therefore, the withering neural connections go haywire and falsely tell the brain it is hearing sounds that are not present.
Like the concept of phantom limb, the concept of tinnitus is neurologically similar. Once the doctor has severed the nerves from hand to brain, the reason the brain can still feel the hand is because the central system has gone haywire. As we age, listen to loud sounds, take medicine that impacts the ear, etc., we are left with the perception of phantom sound. This is called subjective tinnitus. Subjective tinnitus accounts for 99% of all types of tinnitus.
A minuscule percent (less than 1%) of people with tinnitus have ‘objective tinnitus’. This type of tinnitus is not self-perceived (aka not a phantom sound) and can be recorded by a microphone (and, in some cases, even heard by other people). Spontaneous muscle contractions or vascular deformities can lead to this rare form of tinnitus, and in some cases, surgery can stop the tinnitus.
Here are the top five adjectives’ patients have reported over the past 20 years about their subjective tinnitus:
Now, let’s discuss Van Gogh. Everybody’s got their theories about what happened with Van Gogh and why he cut his ear off. But most historians will tell you, if you investigate his writings and if you understand everything he did, Van Gogh was not mad. He, if anything, is a perfect example of how tinnitus can drive people to harm themselves. So, if you’re asking, did you just say that Van Gogh cut his ear off because of tinnitus? Yes. That is the most widely accepted story about his self-mutilation. He reportedly suffered from tinnitus. He also suffered from vertigo, hearing loss, hyperacusis (sensitivity to loud sounds) and otalgia (ear pain). Today, this would likely be diagnosed as Meniere’s Disease.
Fast forward to the 2000s, and fortunately more people are willing to share their stories of tinnitus—for example, Huey Lewis. Huey Lewis is a great entertainer who was forced to retire due to his debilitating tinnitus. He has spoken publicly about his depressive state and that he had contemplated suicide multiple times because of tinnitus. If you just do a quick Google search, you’ll see countless tragic stories about people who have committed suicide to end their suffering from tinnitus.
The multimillionaire owner of Texas Roadhouse committed suicide because of tinnitus. He noted that COVID dramatically exacerbated his tinnitus. It’s estimated that 15% of people who’ve had COVID suffer from post-COVID tinnitus. Although the connections between COVID and tinnitus are not well understood, it is plausible that the virus impacts the ear-to-brain neural connections.
There are many different reasons a person can get tinnitus. We know that obesity can impact circulation, which can impact hearing, which can cause tinnitus. We know that diabetes and the accompanying neuropathy can compromise blood flow to the ear and thus lead to tinnitus. We know that smoking can compromise blood flow to all parts of the body, including the ear, which can lead to tinnitus. We know that many medications can cause damage to the ear and lead to tinnitus, including chemotherapy and many over-the-counter pain relievers.
But what is the number one risk factor for tinnitus?
The number one risk factor is age. Unequivocally, age is the most common risk factor for developing tinnitus.
With age comes a natural breakdown of the neural pathway connecting the ear to the brain. This progressive degenerative condition is called presbycusis (age-related hearing loss) and is routed in our DNA. Yes, it’s genetic – therefore, there really isn’t much we can do about it, and there’s no sense in being mad at your parents for it! Most mammals, whether they walk upright or on all fours, will experience presbycusis with age – and therefore are likely to experience tinnitus.
In addition to age – we must acknowledge that our post-industrial revolution life is a lot louder than our ears were designed to handle. Thus, the more ‘use and abuse’ we put on the hearing system, the younger we are likely to experience tinnitus and hearing loss. Throw in a round or two of chemo or some long-term use of pain relievers, and you get yourself a Molotov cocktail that wreaks havoc on the ear-to-brain neural connections and results in tinnitus starting in our 40s and 50s, not in our 60s or 70s.
But why is tinnitus so different in every person?
The simple answer is that it is a personal perception, i.e., it is a subjective experience. Thus, it will be different for everybody. The experience of tinnitus will vary greatly depending on where exactly the damage is, what caused the damage and, believe it or not, how the person copes with the experience of tinnitus. Yes, a person’s coping skills and history of mental illness, depression, and anxiety all factor into the perception of tinnitus and the extent to which it impacts a person’s life.
Among numerous individuals experiencing tinnitus, it affects their sleep patterns, their thoughts and emotions, and ability to work and concentrate on tasks. It can get in the way of their hearing (even the ones who don’t necessarily complain about having hearing loss). While tinnitus can impact everybody differently, it often will impact every situation in everyday life.
Take the next step:
Understanding Tinnitus
in Long Term TinnitusRinging in Your Ears: Understanding Tinnitus Causes, Management, and Relief
Current estimates are that nearly 50,000,000 American adults live with tinnitus and almost 1.5 billion people worldwide. Along with hearing loss, tinnitus is the most common sensory disorder on the planet! And while the ‘Average Joe’ may think of people with hearing loss as ‘suffering in silence’, the exact opposite is true for most as the ringing can be incapacitating.
Please visit www.salushearing.com for more information regarding tinnitus and hearing loss.
Tinnitus is often described as the experience of hearing a sound in your ears, sometimes in your head. In medical publications and dictionaries, you will most often find the definition of tinnitus as the phantom perception of sound. The key word in that definition is phantom.
Some people with tinnitus only notice the sound in a quiet room, whereas many others experience the sound all day long, and it can interfere with daily life. These phantom sounds can cause depression and anxiety, affect concentration, sleep, and work, and get in the way of hearing. And tinnitus is experienced by over 90% of people living with hearing loss. (And vice versa – over 90% of people with tinnitus have some hearing loss.)
Nearly every patient with tinnitus is seeking the answers to ‘why’ they have the ringing and ‘how’ they can get rid of it. The simple answers for a vast majority of cases are:
The initial cause of tinnitus can vary; however, the #1 cause (by a landslide!) is aging, followed by noise exposure, either a single intense noise (like a shotgun blast) or long-term exposure either from work or play (musicians, concert attendees, carpenters, machinists, landscapers, etc.), medication, and virus (i.e., Covid). Regardless of the cause, the underlying pathology in almost every patient is the same – a breakdown of the neural integrity of connections between the ear and brain (the ear-to-brain connections). Irrespective of the cause of the neural damage, the result is nearly the same – ringing in the ears and/or head that can be effectively treated in (90%) patients.
The remaining 10% of tinnitus cases can result from other medical conditions, including:
In some patients, prescription and over the counter (OTC) drugs, such as pain relievers, can result in damage to the auditory system and cause or exacerbate tinnitus. Several hundred drugs listed in the Physician’s Desk Reference (“PDR”) cite tinnitus as a possible side effect! In some, but very few of these cases, the tinnitus may reduce or disappear when the prescribed medication is discontinued. While some of the drugs on this list are life-preserving medications, i.e., chemotherapy, many everyday non-prescription medications, including NSAID pain relievers like ibuprofen, acetaminophen, and acetylsalicylic acid (aspirin), can significantly increase the risk of developing tinnitus.
The Theory of Tinnitus: when the brain is not adequately stimulated by the ears (even in the very earliest stages of hearing loss), the brain will increase neural activity to make up for the missing input – and the result is that you will hear a sound (that you shouldn’t be hearing!). The more technical way to describe this is that tinnitus is most often the result of a ‘central gain’ in neural activity that occurs when there is a loss of proper neural stimulation from the ear (after there is damage to the cells inside the ear and in the brain).
This ‘central gain’ results in the false, aka phantom, perception of a sound and is neurologically analogous to an amputee’s perception of a ‘phantom limb’.
For example, in cases where a limb is amputated (perhaps as the result of a traumatic accident or injury sustained while at war), the peripheral nervous system that connects that limb to the brain is damaged. Hence, the central nervous system (the brain) will undergo adaptive changes, resulting in the person erroneously perceiving the limb as still being connected. In some cases, the amputee can even feel extreme pain in that missing limb.
Our ears do not have traditional ‘pain receptors’; rather, the perception of ‘pain’ that results from damage to the ear is perceived as a ‘phantom sound’ (tinnitus). As the brain tries to adapt to the decrease in sound stimulation from the ears and the damage to the nerves in the brain, it will begin to experience a gain of activity that results in our (false) perception of sound.
Understanding Tinnitus – Treatment Options: Unfortunately, too many patients think there is nothing that can be done about the ringing. Frankly, in most cases, this isn’t true. Below are some of the most effective treatment options available for managing tinnitus:
Tinnitus and Sound Stimulation: The single-most effective treatment option available for patients suffering from tinnitus is prescriptive technology capable of stimulating the ear-to-brain neural connections. This technology is FDA-regulated for individuals with tinnitus. In fact, 100% of clinical studies between 2010 and 2020 indicated that patients who use tinnitus treatment technology have a significant reduction in their daily tinnitus experience – with some even reporting that ‘the ringing is gone all day.’
Tinnitus and Brain Training: Treating tinnitus with sound stimulation may be enhanced with brain training in many patients by providing additional support to the brain. Exciting new research was recently published in the Journal of American Medical Association (JAMA), pointing to a new BrainHQ game that can significantly reduce a patient’s perception of tinnitus.
‘Researchers found that patients with tinnitus, in the group with tinnitus, had improvements in tinnitus perception, memory attention, and concentration as compared with patients in the control group.’
~Dr. Piccirillo. Journal of American Medical Association, Otolaryngology
Take the next step:
Now That You Started Treatment, What Else Can You Do to Prevent Decline?
in Long Term HearingEmpowering Steps Beyond Treatment: Safeguarding Against Decline
What starts with a commitment to the medical treatment of hearing loss and tinnitus leads to a promise to take best care of yourself by following a holistic and comprehensive treatment plan. Our simple motto that hearing care is health care means it is important that we think beyond the ears and assure you live your best, healthiest, life. We remain steadfastly committed to helping each patient understand how (in addition to treating their hearing loss) they can actively age, remain confident and stay fiercely independent.
Like treating all major medical conditions, the initial prescription (be it a pill to reduce your cholesterol, a round of radiation, an injection to control A1C levels, etc.) must be combined with a healthy lifestyle. The body has an incredible ability to provide relief and heal itself—but only when given the right resources.
We commit to a holistic approach to treating sound, mind, and body. We not only help you hear your best, but we can also help you live your best life as you age and prevent decline. From the technology we use to help you hear your best every day and keep you mentally sharp, we can also help you to increase overall health by discussing diet, supplements, and exercise.
What you hear matters.
Your brain is always on. Your ears are always on too. This means your brain is constantly stimulated by the vast neural network from your ears. Until it is not. Then what happens?
There is a general belief that activities which stimulate the mind, i.e., hearing, can help to slow cognitive decline. Data tells us that treating hearing loss may even slow the progression of dementia.
What starts out as subtle cognitive changes that are seemingly associated with aging goes on to affect an older adult’s day- to-day function. As we age, there are certain expected cognitive declines that we will all experience. However, with increased risk of cognitive decline and dementia associated with hearing loss, it is important to know the differences of ‘normal aging’, MCI (mild cognitive impairment) and dementia.
Early stages of significant cognitive decline (first seen in MCI) include problems with memory, language, thinking, judgement, and visual perception. Fortunately, most people are still ‘with it’ enough to notice these issues and can seek early intervention. Family and close friends may also notice a change. But these changes often are not severe enough to significantly interfere with daily life.
Common signs and symptoms of cognitive decline include:
MCI along with hearing loss can increase your risk of later developing dementia caused by Alzheimer’s or other neurological conditions, which is why addressing risk factors early such as the medical treatment of hearing loss is critical to preventing dementia.
The proper medical treatment of hearing loss and tinnitus is designed to provide auditory feedback and cognitive stimulation that your brain needs.
What you feed your body matters.
Much like an expensive car, your brain functions best when it gets only premium fuel. Eating high-quality foods that contain lots of vitamins, minerals, and antioxidants nourishes the brain and protects it from oxidative stress—the “waste” (free radicals) produced when the body uses oxygen—which can damage cells.
Diet
Unfortunately, just like an expensive car, your brain can be damaged if you ingest anything other than premium fuel. If substances from “low premium” fuel (such as what you get from processed or refined foods) get to the brain, it has little ability to get rid of them. Diets high in refined sugars, for example, are harmful to the brain. In addition to worsening your body’s regulation of insulin, they also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function.
Just as there is no magic pill to prevent cognitive decline, no single almighty brain food or supplement can ensure a sharp brain as you age. Nutritionists emphasize that the most important strategy is to follow a healthy dietary pattern that includes a lot of fruits, vegetables, legumes, and whole grains.
With that said, certain foods in this overall scheme are particularly rich in healthful components like omega-3 fatty acids, B vitamins, and antioxidants, which are known to support brain health and often referred to as ‘brain foods’. Incorporating many of these foods into a healthy diet on a regular basis can improve the health of your brain, which could translate into better mental function.
Research shows that the best brain foods are the same ones that protect your heart and blood vessels, including the following:
In considering that poor diet is now the leading killer globally and mental disorders account for the largest burden of global disability, the fact that diet appears to play a role in mental as well as physical health (as well as increasing the risk of dementia) must be taken very seriously.
Supplements
Yes, proper diet is critical. However, there are a variety of supplemental nutritional needs that are difficult to come by (even with a great diet) that our brains require as we age to help maintain sharp mental acuity and positive cognitive function. Natural supplements can combat certain health, lifestyle, and environmental factors that can increase the risk of cognitive decline and dementia, including:
Below is a short list of some of the most effective supplements available today that support healthy cognitive function as we age.
CoQ10 (Coenzyme Q10)
This naturally occurring antioxidant that reduces the proliferation of free radicals is produced in the human body for cellular growth and maintenance. Unfortunately, levels of CoQ10 decrease as we age. CoQ10 supports nerve health, the protection of brain tissue from oxidative damage and reduces the action of harmful compounds that can lead to brain disease. In addition, CoQ10 supports healthy cardiovascular function and may reduce the risk for repeat heart attacks and helps combat side effects of cholesterol-lowering statins.
Ginkgo Biloba
This naturally occurring ingredient derived from a tree in Asia can support a healthy inflammation response, supports the production of important brain-building factors, supports recovery from heavy metal/mold exposure, supports healthy blood flow, and supports the brain’s repair from physical trauma.
Phosphatidylserine
This is hard to say but the simple ingredients support a healthy blood sugar response, provide important building factors, and support the brain’s recovery from trauma. The 80+ million Americans living with diabetes or pre-diabetes are at particular risk of cognitive decline given the inability of the body to effectively manage glucose levels.
Coffee Fruit Extract
Derived from the same plant as the coffee bean (although often discarded in favor of the coffee bean!) helps support healthy blood sugar response and increases the brain’s production of key building factors like brain-derived neurotrophic factor (BDNF) that build proteins found in the brain.
Yamada Bee Propolis
Extracted by bees and combined with specific plant proteins to help protect themselves, this supplement supports healthy inflammation response, supports healthy blood sugar levels, supports the production of brain-building factors, supports recovery from exposure to heavy metal and mold exposure, supports normal blood flow, and supports brain repair from trauma.
Turmeric
Many Americans have this tasty spice in their kitchen cabinets, but it is too often left unused! Curcumin, a substance found in Turmeric helps support healthy inflammatory response, provides brain-building compounds, and supports recovery from heavy metal and mold exposure.
Gotu Kola
This herbal extract (from the parsley family) is commonly found in traditional Chinese medicine. This derivative has been used for thousands of years and helps support a healthy inflammatory response, healthy blood flow, and supports brain repair from trauma.
Don’t forget, what you do with your body matters too!
Have you heard that ‘sitting is the new smoking’? When we sit around and let our brains wonder ‘what will be the cause of our demise’, most of us think about heart disease, diabetes, cancer, dementia, old-age, pneumonia, disease, etc. But, according to new data the chair you sit in most is one of the biggest threats to your health. No, this doesn’t mean you should immediately go and throw out your favorite chair, rather it’s time to consider having ‘the talk’ with your favorite chair and let it know you need to get out and stretch your legs more!
Rather than try and come up with our own novel scary statement about how we need to get up from our chairs and be more active, we believe Dr. James Levine, a professor of medicine at the Mayo Clinic has said it best:
To put it in to perspective—we were not designed to sit. Think about it—we are bipedal for a reason and sitting isn’t the reason. The body is meant to stay in perpetual motion until rest is required. Humans have been on the planet way longer than the chair was invented.
If right about now you are thinking ‘but I exercise, so this can’t apply to me’, unfortunately that doesn’t hold true. Yes, exercise is good for you, and we all need to do more of it; but it doesn’t negate the damage we do to our bodies by sitting for extended periods of time, day after day. Thus, it stands to reason that more exercise is not the answer to sitting too much. Sadly, 10 hours of stillness in a chair (which is not uncommon for people at work) cannot be offset by 1 hour of exercise.
Sitting for long periods of time changes you. It changes your metabolism. It changes the way your body behaves and stores nutrients. In fact, your metabolism can slow down by as much as 90% after only 30 minutes of sitting.
Sitting too long increases the risk of nearly everything that can kill you, including increased rates of:
And increased risk of:
So, what is the best way to combat ‘sitting too much’. While this is particularly hard for those who work at a desk, it can also be a challenge for many people living with the social isolation that accompanies hearing loss. For starters, get in the habit of standing and/or walking at least once every 20 minutes. With the advent of computers that fit on our wrist, we can now set up simple re minders that get us to ‘stand’. We particularly like smart watches that will not stop reminding you until you stand up!
The goal is to gradually extend our periods of standing and increase the frequency of taking short walks. This is not about engaging in a newfound cross-fit exercise program, but rather increasing the frequency (not the intensity) of physical movement. There are many things we can do every day to increase our standing-to-sitting ratio. When you are at home or work, here are some simple things you can do each day to change your sit ting habit:
In addition to the extra movement that you will have from sitting less, a little bit of exercise truly goes a long way. A simple regular exercise regimen can increase your metabolism, help you keep cancer, diabetes, heart disease and obesity at bay, and keep you socially active (i.e., the opposite of social isolation!). If you do not know what pickleball is—it is the fastest growing sport in our country for those over 50 years young. Although we have unofficially nicknamed the game ‘tiny tennis’, it provides BIG benefits by increasing heart rate, burning calories, requiring hand-eye coordination, boosting your balance, and we guarantee you will smile when you play (which is a great workout for your face muscles!).
Always take the opportunity to talk to your hearing healthcare provider and primary care physician about a holistic approach to living your best life.
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Aging is inevitable. Decline is optional. What do you choose?
in Long Term HearingFrequently Asked Questions
Below is a handy-dandy resource section for you and your loved ones to help guide you through some of the most Frequently Asked Questions (FAQs).
Is it really such a big deal if I do not treat my hearing loss?
Unfortunately, yes. Untreated hearing loss is linked to life-threatening medical conditions including mental decline, dementia, falls, hospitalizations, and even premature death. The time to act is now as hearing loss cannot be ‘managed’ by just making people speak louder!
Who are some familiar faces that have treated their hearing loss?
To name a few… Whoopi Goldberg, Stephen Colbert, President Ronald Reagan, William Shatner, Jody Foster, Halle Berry, Peter Townsend, President Bill Clinton, and Huey Lewis.
Will I be able to afford treatment?
Yes. Membership programs are more affordable than your cable and cell phone bills. Most patients can also take advantage of their insurance benefits and Health Savings Accounts to make their payments lower than the cost of coffee per day.
It is a great day when you can tell a patient that a treatment decision doesn’t have to be a financial decision!
Is treating my hearing loss and tinnitus painful?
No. Modern treatment technology and testing procedures are painless. In fact, most of today’s technology is completely invisible and so lightweight.
How much work / family time will I miss because of treatment?
Not much. After the initial visits, most appointments are anywhere from fifteen to forty-five minutes.
I am a snowbird and want to know what happens to me when I am not at home for several months per year?
If you are lucky enough to have that home-away-from-home, then we suggest you enjoy it to its fullest! We will provide you with all the technology supplies and needs before you go away, and we are never more than a phone call away. If needed, we can even do a telehealth ‘zoom conference call’ and talk you through any troubles. We guarantee—treating your hearing loss will make your life better and never be a burden or stress.
What are some of the warning signs that I might have some signs of early-stage hearing loss?
The four most common signs of hearing loss are:
What are some of the “side effects” of untreated tinnitus?
Tinnitus can have a profound impact on a person’s ability to hear, concentrate, sleep and emotional state of mind. Most often, tinnitus is caused by hearing loss and should be thought of as your internal alarm telling you that something is wrong and requires your attention asap!
What makes a hearing healthcare specialist (Audiol ogist or Board-Certified Hearing Instrument Specialist), more qualified than a PCP or an ENT?
Hearing healthcare providers specialize in the medical treatment of hearing loss and tinnitus. Whereas your PCP is your ‘general health contractor’ that oversees all your healthcare needs, and the ENT specializes in swallowing and speech, breathing and sleep issues, surgical intervention of hearing loss, allergies and sinuses, head and neck cancer, skin disorders, and facial plastic surgery.
Why should I choose a specialist to treat my hearing loss?
Unique treatment requirements and otherwise difficult auditory problems are common everyday scenarios for your hearing healthcare provider. In the interest of receiving the most efficient and effective treatment possible, choose a hearing healthcare specialist.
How do I know if my provider is an Audiologist or Hearing Instrument Specialist?
Only healthcare providers can belong to the Excellence In Audiology™ network of providers. Most Audiologist and Hearing Instrument Specialist are also accredited by the American Academy of Audiology (AAA), American Speech-Language-Hearing Association (ASHA) and/or the International Hearing Society (HIS).
What is a treatment coordinator?
During your initial consultation(s), you will be assigned a patient contact person—we call this person a “treatment coordinator”- with whom to schedule appointments, confer with scheduling and, of course, answer all questions you may have.
Why are follow-up visits important?
These are wonderful opportunities for your provider to ‘fine-tune’ your cognitive stimulation and maximize your treatment and for you to get further details or answers to any lingering questions you may have.
Why is early treatment so important?
To put it simply: A Mild Hearing Loss is a Major Problem! Although we recommend that everybody over the age of 50 years young have regular hearing evaluations, you are never too young to treat your hearing loss at the first signs. Unfortunately, even a Stage 1 hearing loss (sometimes referred to as a ‘mild hearing loss’) can increase your risk of mental decline and dementia by as much as 200%! Like every medical condition, it is important to ‘catch it early and treat it early!’.
Is there such a thing as being ‘too old’ to start treatment?
No. Although many patients try to reason their way out of treatment by saying ‘what’s the point, I only have a few years to live’ the benefits of treatment, whether they be for 6 months or 6 years, positively impact your overall social, emotional, physical, and cognitive health and may help you live longer!
What if I do not believe in treating my hearing loss (after all, my parents never did)?
Well, you’re entitled to your opinion, but this is like saying you do not believe the earth is round (our apologies if we just offended any ‘flat earthers’). You can hide from it, pretend it is not there, refuse to acknowledge it or believe that you can ‘manage’ without medical intervention, but the simple fact remains—if you are not aware of the potential risks, you are likely to suffer from them.
What is tinnitus?
When the ear breaks down from age, noise exposure, medications, viruses, genetics, etc., the nerves that travel from ear-to-brain break down. This results in a ‘surge’ of neural activity (referred to as Central Gain) that is perceived as sound. Nearly 90% of people with tinnitus have hearing loss (and vice versa).
Where should I start to look for treatment if I am concerned about my hearing loss (or for a loved one)?
If you suspect that you have hearing loss (or have been told by somebody to get your ears checked), go to the website www.salushearing.com to find a local hearing healthcare provider that you can trust subscribes to best practices. Please, stay away from anybody who partakes in sleezy sales tactics.
Why should I address tinnitus?
Tinnitus is most often one of the first signs of hearing loss. Because hearing loss is gradual (for most patients) they often notice the ringing in their ears before noticing a change in hearing. This ‘alarm’ inside your head is telling you that something is wrong, and it needs to be medically addressed ASAP.
What is treatment technology?
The way we treat hearing loss today is different (way better!) then even a few years ago. While traditional hearing aids were good at making sounds louder—they made EVERY sound louder—even the ones that were harmful and annoying! Today’s technology is specifically designed to address the cognitive aspects of hearing loss, tinnitus and associated cognitive deficiencies. When treatment is done right, you will hear as naturally as possible.
What are the primary benefits of treatment?
To summarize, the five medical benefits of treatment include:
How do I get started with treatment?
It is simple: just make an appointment with your local hearing healthcare provider (which you can find on the website www.salushearing.com) for an initial consultation. Most practices will offer a free initial consultation to see if you are a good candidate for their treatment program.
How will treatment impact my brain?
New treatment technology has been found to effectively increase memory recall, processing speed and selective attention. The increased brain activity from treatment may also eliminate your increased risk of falling and losing your independence at home.
Is medical treatment of hearing loss and tinnitus appropriate if I am in my 30’s or 40’s?
Yes, especially because we now know that the early treatment of hearing loss is the #1 modifiable lifestyle factor to reduce your risk of developing cognitive decline and dementia.
Why are traditional hearing aids still sold?
Frankly, we have no idea! If it were up to us, we would ban the sale of all traditional hearing aids. We believe that as medical professionals we are ethically bound to only provide the best treatment available and never compromise on patient care.
Is so-called “invisible technology” effective?
Yes. As the technology we use to treat hearing loss continues to advance, the ‘packaging’ this technology comes in has become smaller and nearly invisible. While providing the right treatment is the priority, we can make your technology as discrete and invisible as possible. Long gone are the ‘beige bananas’ on people’s ears!
What are some of my payment options in addition to insurance?
Our core value is to treat every patient. To do this, we have met the challenge of making treatment affordable for all. Gone are the days of patients and families paying thousands of dollars up front (in fact, if you are ever told that you must pay in full—we suggest you politely excuse yourself from the appointment and run far, far away!). With membership programs that are compatible with insurance benefits and Health Savings Accounts (HSA’s), we can help patients afford medical treatment for a few dollars per day.
What if I have a “hearing emergency” before or after office hours?
If you are experiencing a hearing emergency that cannot wait for regular office hours, most practices have a special number to call before, during or after business hours. If this information is not given to you readily, ask how your hearing healthcare practice handles office emergencies. We know that ‘stuff happens’ and that it doesn’t always happen 9-5 pm Monday through Friday, which is why we are always available to our patients.
Do I have to worry about moisture or sweat hurting my hearing technology?
While full submersion of any computerized technology is never encouraged, today’s hearing technology is both moisture and dust resistant and can stand up to a beating!
Can I wear a mask while I wear my hearing technology?
A lot has changed in recent years and now that masks have become ‘normal’ today, you need not worry that they interfere with treating your hearing loss. Because most patients feel that treating their hearing loss is a ‘natural’ process and something they don’t actively think about, we remind patients to be careful when wearing anything on their ears that can accidentally cause your technology to fall off and get lost. (Most new technology has a ‘GPS homing beacon’ built into it and you can use your phone to find any lost technology!).
In addition to treating my hearing loss, what else can I do to keep my mind and body healthy?
Treating hearing loss is one of many things that older adults can do to look and feel their best. A proper diet with brain healthy foods and supplements is a vital component to maintaining mental acuity and sharpness as we age. Talk to your hearing healthcare provider about ‘what else’ can be done to actively age.
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How to Get More Information
in Long Term HearingUnlocking the Secrets: A Guide to Accessing Abundant Information
There are several ways to get information about a hearing healthcare practice. First, we want to address the ways we do not recommend.
We do not recommend Yelp. Yelp is, unfortunately, not at all what it seems and is frequently the subject of lawsuits from business owners and under regulatory scrutiny centered around the poorly policed manipulation of reviews and even flooding of fake reviews by “bots” no less! Some companies can use Yelp as competitive warfare while other companies turn around and sell the business owner under negative-review-assault “reputation management services.” So, beware! Get the information you need from truly trusted sources.
Google is a great starting point and a valuable place to check out patient reviews and rankings. It takes effort to put together one’s thoughts and go online and leave a review. Before starting treatment, always check out the quantity and quality of reviews for hearing healthcare practices in your community.
First, the best thing to do is make certain you get all your questions answered by the hearing healthcare specialist and the practice’s treatment coordinator. Do not hold back. Put them on the spot. Be assertive. Do not feel you have to be deferential to the guy in the white coat (which is part of the reason we do not wear white coats, ever!). Our goal in this is to have every patient and every family member fully knowledgeable about every aspect of the treatment so that they have zero anxiety.
If you have a quick follow-up visit scheduled, these are wonderful opportunities to either ask questions you may have missed the first time or get further details from your provider directly. You will always leave our offices with the treatment coordinator’s name, email, and phone number. Now that you know where to get your most burning audiology questions answered, here are some simple tips we have amassed over the years to help you easily and effectively get the information you need:
How To Get Your Questions Answered
Knowing where to find the information you need is only half the battle; follow these tips and you will know how to get what you are looking for as well.
Regardless of how many questions you have, or your comfort level with technology, phone calls or in-person visits, your hearing healthcare specialist should offer an option that fits your schedule and makes all your unresolved issues crystal clear.
Take the next step:
Shouldn’t My Treatment Be Guaranteed?
in Long Term HearingEnsuring Reliable Care: The Quest for Guaranteed Treatment
Healthcare is notorious for having no guarantees. Nearly every one of us knows that medical care can go horribly wrong. Guarantees are controversial in all kinds of healthcare including audiology. Many of our colleagues are upset by the very idea of the word guarantee. One even huffed-and-puffed saying, “what do you think you’re doing with this guaranteed nonsense? We are not operating a car shop, installing mufflers, and guaranteeing them for five thousand miles. We are doctors!” (Feel free to conjure up an image of some stuffy doctor banging his fists on the table—that is close to what happened!)
His doctor ego was mightily offended. But we doubt you will be with the challenge of deciding who should be your family’s trusted hearing healthcare specialist. So, yes, we think there should be a guarantee! In fact, many guarantees!
There is also a second, separate set of responsibilities to you as a customer, including access, convenience, responsiveness, and “red carpet service.”
We include the above five guarantees in your treatment program.
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Understanding Your Hearing Disorder
in Long Term HearingDecoding the Spectrum: Navigating Your Hearing Challenges
Diseases and disorders of the ear come in all shapes and sizes, degrees, and stages. While the most common cause of hearing loss and tinnitus is aging, the truth is, it is not your age, rather it is your genes. Most of us will inevitably suffer with hearing loss as we get older, not because of working in noise or going to too many rock concerts (not that they make matters any better!), rather most species of mammals (including us) carry genes coded for age-related hearing loss. Presbycusis is the official medical jargon used by specialists when diagnosing this type of hearing loss.
The next most common cause of hearing loss is exposure to loud noises. Unfortunately, proper hearing health is not a common topic in most ‘health classes’, therefore the public has no idea how noisy and how harmful most of our surroundings are. Another misnomer of hearing loss is that a ‘hearing hangover’ (i.e., when you go to a loud concert and your ears ring!) is something we can rebound from. Most scientists and clinicians once believed that this temporary ringing in the ears was something you could recover from and go right back to hearing normally. This is not true.
In the past 10-15 years, study after study has proven, repeatedly, that these ‘hearing hangovers’ have a permanent effect on the auditory system and cause massive damage that cannot be recovered or healed. You might be saying to yourself ‘is this for real…. my hearing was back to normal 2 days after that last wedding I went to.’ The facts are that the damage was real, but the damage will not manifest itself in the form of detectable hearing loss for up to 2-3 decades (20-30 years!). Hopefully, this has your attention now as you think back to all those loud restaurants you went to, the factory you worked in for 6 months, all the times you weed-wacked the lawn, and that rock band you were in when you were a teenager. When you combine your history of noise exposure (both big and small) plus your genetic predisposition to hearing loss as you age… you may have a perfect storm brewing that creates disabling hearing loss and tinnitus.
Rounding out the next most common forms of hearing loss and tinnitus are medication-induced, Meniere’s Disease and sudden-onset. While most prescription drugs that impact the ears are necessary and lifesaving/prolonging, many prescriptions have a side-effect of damaging cells in the ear (technically it is called ototoxicity—meaning it is toxic to the ear). Strong antibiotics such as Ciprofloxacin can be damaging to the ear. Many chemotherapies used for the treatment of cancers have a component that is deadly to the cells in the ear. Even commonly available OTC drugs such as Aspirin and NSAIDS can increase the likelihood of developing hearing loss and tinnitus. And too much quinine (found in tonic water) can damage the ears too!
One of the most disabling causes of hearing loss, which presents with the triad of symptoms, i.e., hearing loss, tinnitus, and dizziness, is Meniere’s Disease. The cause (or pathophysiology) of this disorder is the result of excess fluid trapped inside the inner ear. The overload of fluid will impact both the auditory and balance centers and send misguided information to the brain, rendering the patient deprived of sound input and the feeling of dizziness.
Currently there is no cure for Meniere’s, but there are effective treatments available to alleviate the hearing loss and balance issues. Treatments include the following:
For most people who suffer with the instantaneous, life-altering experience of sudden-onset hearing loss, the inability to hear out of one or both ears is a crushing blow. Many times, the diagnosis of this sudden-onset hearing loss and tinnitus includes the medical term ‘idiopathic’, which is the nice way of saying ‘we have no idea why you woke up one day with this terrible hearing loss’. The most important advice for somebody who experiences a sudden change in hearing is to seek out the immediate assistance of a hearing healthcare specialist. It is possible, although not guaranteed, that immediate pharmaceutical intervention can recover some or all hearing.
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What are the Stages of Hearing Loss?
in Long Term HearingUnderstanding the Journey: Navigating the Stages of Hearing Loss
If you or a loved one have hearing loss, you are probably used to hearing words like ‘I lost 40% hearing in my right ear’ or ‘my doctor told me I have a mild hearing loss’ or (our personal pet peeve) ‘they said my hearing is normal for my age’. Frankly—each of these is wrong. Just to clarify—there is no such thing as ‘age-adjusted hearing loss’— you either have hearing loss or you don’t. There is no ‘sliding scale’ because of your age and there is no such thing as ‘normal hearing loss’—that is an oxymoron.
Understanding your diagnosis is the first step in any successful treatment plan. Using terms like ‘mild’ or ‘moderate’ do not have much meaning. Additionally, making incorrect statements like ‘40% loss’ does not help anybody and are inaccurate—until you are dead, and somebody goes poking around your ears and brain, a percentage should not be assigned to a hearing loss.
Like nearly all major medical conditions, a hearing loss diagnosis must be ‘staged’ to be best understood and to lay out realistic expectations and prognosis for treatment.
Stage 1
Early-stage hearing loss (15-40 decibels of loss) with some impact on cognitive function.
Patients with Stage 1 hearing loss are caught at the earliest phase of the disorder: thus, having the greatest prognosis for treatment. At this early stage, hearing loss may be beginning to show early signs of impacting cognitive function with some impacts on memory recall and name finding.
Although many people living with this hearing loss may consider it ‘just a nuisance’, it is important to understand that hearing loss is a progressive degenerative disorder that can significantly increase your risk of dementia, falling, and a host of other comorbid disorders.
Even at this earliest stage, these test results indicate marked damage to the nerves that connect the ear to the brain—which can have a host of downstream impacts, including tinnitus, difficulty following a conversation, and implication for memory loss and forgetfulness. Patient symptoms often include noticeable tinnitus (heard in the ears and/or head), subtle difficulty with details of speech (missing the beginning or end of what others are saying), some loss of environmental auditory awareness (i.e., difficulty hearing knocking at the door, the refrigerator, alarm, etc.). In addition, the person will notice conversation is becoming more difficult to follow in background noise (and when watching TV). Patients with Stage 1 hearing loss must be applauded for not waiting and catching this destructive disorder early—before it can fully infiltrate and wreak havoc on the brain.
Stage 1 hearing loss is correlated with a near 200% increased risk of developing cognitive decline and dementia. While that may be a shock to you, what is most important is to understand that research indicates that the early treatment of hearing loss can dramatically reduce that increased risk of dementia (and slow the progression of the disorder). Also, Stage 1 hearing loss significantly increases the risk of falling by 140% (the #1 cause of hospitalizations in older adults). However, with treatment and access to the entire auditory environment, this risk of falling decreases significantly.
Stage 2
Mid stage / significant hearing loss (40-70 decibel of loss) with noted impact on cognitive function.
Patients with Stage 2 hearing loss have most likely waited anywhere from 3-6 years before reporting their symptoms and deciding to act. Fortunately, for most patients with Stage 2, the prognosis for treatment remains high. Although there is notable damage to the neural connections from the ear to the brain, there remains enough treatable hearing to provide proper cognitive stimulation and overcome deficits in clarity, tinnitus, and auditory deprivation.
Patients with Stage 2 hearing loss often report the following host of symptoms: annoying tinnitus (sound heard in the ears and/or head), difficulty hearing others (missing when somebody is speaking to you), lack of ability to hear environmental auditory cues (difficulty hearing when people are walking towards you, safety alarms in the home, a grandchild crying from the other room). With this stage of hearing loss, it is a significant struggle to follow a conversation when with a group of more than 2 and in restaurants.
With Stage 2 hearing loss, the goal is to provide maximum neurocognitive stimulation, which the brain needs to run on all cylinders. In fact, living with untreated hearing loss is like driving 60 mph in second gear—which, over time will wear down the system and cause significant damage. The treatment of hearing loss can dramatically improve cognitive function—this has been shown in numerous studies and it is certainly something our patients have to look forward to!
Stage 2 hearing loss is correlated with a near 300% increased risk of developing cognitive decline and dementia. Again, what is most important is to focus on the positive—which is that research indicates that the early treatment of hearing loss can reduce that increased risk of dementia (and slow the progression of the disorder). Also, Stage 2 hearing loss significantly increases the risk of falling (the #1 cause of injury-related death in older adults). However, with treatment and access to the entire auditory environment, the risk of falling can decrease dramatically.
Stage 3
Mid-late stage / severe hearing loss (70-90 decibels of loss) with significant impact on cognitive function.
Patients with Stage 3 hearing loss often wait an average of 7-10 years before reporting their symptoms and seeking treatment.
While prognosis is still positive and a successful treatment plan is anticipated, hearing loss at this stage can begin to show a significant impact on cognitive function. At this stage, there is marked damage to the neural connections from ear to brain— which expand beyond the auditory centers and reach deep into the memory, sensory and emotional portions of the brain.
As a result of the neural damage, the patient will experience a myriad of symptoms, including bothersome tinnitus (sounds in the ears and/or head that interfere with hearing, sleep, etc.,), inability to hear what others are saying (even in a quiet environment), lack of ability to hear important environmental auditory sounds (i.e., difficulty hearing the phone, smoke / CO2 alarms). At Stage 3 hearing loss, most patients will begin to avoid social gatherings and isolate themselves as they will not be able to converse and interact in a restaurant or any social setting with 2 or more people.
The auditory stimulation provided at this stage will focus on the areas with the most damage, as well as the portions of the brain that remain most active for hearing. Although individual prognoses may vary, outcomes will be positive and provide access to conversation, even in noisy situations.
Stage 3 hearing loss is correlated with an approximate 400% increased risk of developing cognitive decline and dementia. Although this may seem like a ‘late stage’, all research indicates positive outcomes that can work to reduce the risk of cognitive decline and dementia (and potentially slow the progression of the disorder). Also, Stage 3 hearing loss dramatically increases the risk of falling. However, even at this stage, with treatment and access to the entire auditory environment, the risk of falling can decrease.
Stage 4
Late stage / profound hearing loss (90+decibels of loss) with substantial impact on cognitive function.
Patients with the most advanced stage of hearing loss will benefit from treatment. Period. Despite the significant neural and cognitive damage.
With many medical conditions, ‘Stage 4’ is often thought of as the ‘untreatable’ stage; this does not apply to hearing loss. At Stage 4, there is significant damage to nearly the entire hearing structure and the nerves that connect the ear to the brain. Fortunately, it is less often that we see a ‘first-timer’ patient who presents with Stage 4 on day one.
When left untreated this hearing loss is truly disabling to the person and their family. At this point in the disorder, patients will experience symptoms that alter everyday life, including constant interfering tinnitus (sounds in the ears and/or head that make hearing, sleeping, etc. difficult) inability to hold a conversation with loved ones, lack of ability to hear life-threatening environmental sounds (i.e., inability to hear smoke / CO2 alarms, emergency vehicles). Left untreated, patients with Stage 4 hearing loss will avoid social gatherings and isolate themselves as they are unable to interact with others.
Stage 4 hearing loss is correlated with a near 500% increased risk of developing cognitive decline and dementia. Although it may seem that all hope is lost at this stage, there are tremendous advances in recent technology that can help with the most profound degree of hearing loss to hear well again. All research indicates positive benefits of treatment that may reduce the risk of cognitive decline and dementia (and potentially slow the progression of the disorder). Also, Stage 4 hearing loss severely increases the risk of falling. However, even at this stage, with treatment and access to the auditory environment, the risk of falling can be decreased.
Always be sure that you understand your diagnosis and prognosis before moving forward with your recommended treatment plan.
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Why You Must be Offered a Cognitive Screening for Dementia
in Long Term HearingUnlocking Sound Wellness: The Vital Role of Hearing Healthcare Specialists Over Primary Care Advice
Dementia is the single largest unaddressed public health threat in the 21st century and we must remain on the front lines of this crisis every day.
We all know a friend, neighbor or loved one who has been touched by Alzheimer’s or dementia and understands the devastating toll this disease takes on families.
It has been nearly a decade since the first reports indicated a strong correlation between hearing loss and dementia. We live, eat, sleep, and breathe this knowledge every day. Since then, Dr. Keith Darrow has become the only National Certified Alzheimer’s Disease and Dementia Care Trainer in the field of hearing healthcare. Our practices do qualitative dementia screenings and offer patients the opportunity for genetic testing of known dementia-related genes. We also offer patients the opportunity to have an F.D.A-cleared (Food and Drug Administration) computerized test of cognitive function.
To put it lightly… we are obsessed with finding ways to help patients understand their dementia risk, improve their cognitive function, and take steps to prevent the disorders of dementia.
Every 3 seconds another person is diagnosed with dementia. That means, in the time it takes you to read this sentence, another person has been diagnosed with dementia. That is another person who has been handed down the diagnosis of fatal brain failure, another family that will have to pay the emotional toll of caring for a loved one at least ten years beyond that person’s mental capabilities. At an average cost of $57,000 per year to care for a loved one with dementia—it is also one of the costliest diseases on the planet.
Nearly 9 out of 10 older adults get their blood pressure checked when they visit their primary care doctors. Only 16% are even asked about problems with memory or thinking.
Our assessment tool, Cognivue™, is an important and innovative psychometric tool for cognitive evaluation. This test evaluates six cognitive domains: visuospatial, executive function/attention, naming/language, memory, delayed recall, and abstraction. With this tool, we also measure two speed performance parameters: reaction time and speed processing.
Every hearing healthcare practice in America should have a quantifiable means of assessing cognitive function and evaluating dementia risk. Here are two things we know, unequivocally:
Perhaps the scariest medical statistic we have ever come across was from a survey of Medicare beneficiaries: Half of Americans with Alzheimer’s disease have not been diagnosed, and half of those with a diagnosis have not been told about it. If you need to, please re-read that last sentence. Thankfully, new state laws are popping up all over our country that address this issue and require proper dementia training of most healthcare clinicians.
In 2017, the European Dementia Commission put forth the ‘holy grail’ on the state of dementia in our world. We will not bore you, or perhaps scare you, with the details, i.e., the overwhelming number of people who have dementia, the exponential increase in expected dementia diagnoses in the next 10-20 years, or all the things we do on a daily basis to increase our risk of dementia, but we will summarize how you can err on the side of caution and increase your chances of living a dementia-free life! A report, published in the Lancet (FYI—the Lancet is among the oldest, most respected, and most widely read medical journals in the world) and recently updated in 2020 lays out the ‘How To’ of preventing dementia.
NOTE: These twelve items are listed IN ORDER of percentage chance of avoiding dementia if this risk is eliminated:
Because we are obsessed with helping people prevent dementia, allow us to summarize the above findings of the Dementia Prevention, Intervention and Care Report (2020) two more ways:
We hope this gets our point across. While we certainly cannot guarantee that if you do everything on this list that you will not get dementia, we do guarantee that you are doing everything you possibly can to reduce your risk of getting dementia.
Take the next step: