I am a Veteran who suffers from the condition known as tinnitus. I welcome the possibility of relief. How do I obtain this? Does the Veterans Health Administration (VA) now have this available?

Tinnitus is a very common problem that most people will experience in their lifetime. It appears to be caused when there is some damage or irritation in the inner ear. Tinnitus has many causes but the most common causes are hearing loss and medications. I recommend that everyone with tinnitus be evaluated by an otolaryngologist to make sure there is not a more serious condition affecting the ear. Sometimes an MRI of the brain is necessary. Once anything more serious is ruled out, then treatments for tinnitus can be addressed. While there is no specific cure for tinnitus, treatments available have seen some success. They have some success. The treatments may not get rid of the tinnitus but may make it more tolerable. One of the best treatments for tinnitus in patients with hearing loss is a hearing aid. Not only do aids improve hearing, they drown out or mask the tinnitus. If you don't have hearing loss, tinnitus maskers, either worn in the ear like a hearing aid, or on a table, are very effective. There are some commercially available maskers that are programmed to one's tinnitus frequency. There is some evidence that certain medications may help if you are under a lot of stress. Another recommendation is to watch the amount of caffeine and salt in your diet. Any of these treatments should be available at any hearing healthcare provider, including the VA.

Once a week I volunteer at church to work with the kids. I have noticed that some of the loud noises little children can make actually cause me physical pain. I feel like wearing ear muffs! Why are my ears so sensitive?

Many people suffer from sensitivity to certain sounds. We call this hyperacusis. In some patients, it has to do with them having very keen hearing. Perhaps an irritation to the inner ear leads to hyperacusis. I recommend you be evaluated by an otolaryngologist since this can be a sign of recent hearing loss. It can also be a sign of certain inner ear diseases that can lead to a condition called recruitment where the inner ear tries to compensate for the hearing loss, thus making certain sounds seem too loud. Unfortunately, there is no absolute cure. In some cases of sudden hearing loss or certain inner ear disease, medications and diet restriction, such as limiting salt and caffeine, may be beneficial. While this may sound counter intuitive, if there is a hearing loss, a hearing aid may help as it appropriately amplifies certain frequencies, in theory, preventing recruitment. This sensitivity is not doing further damage to your hearing. If these sounds are truly uncomfortable, I advise you to wear ear plugs for your comfort.

I've heard that wood-burning stoves can cause ear infections in children. I'm concerned about my newborn because our wood stove is the only source of heat in our home. Is this true, and if so, can I do anything to prevent ear infection while still using the stove?

It has always been felt that children exposed to smoke, in particular cigarette smoke, are more susceptible to ear infections. Smoke affects the lining of the nose and middle ear and causes an infection since the normal fluid in the middle ear cannot drain. Smoke from a wood-burning stove is no different. It contains a lot of residue that can cause respiratory infections and ear infections. If this is your only source of heat, you should follow these recommendations: Make sure you only burn clean and dry wood. Also, do not burn any paper as this creates more smoke. Check to see if your stove is a low-emission stove. These are usually certified by the EPA. If not, you might consider replacing the stove with a low-emissions model. Try to keep the child as far away from any smoke as possible. Consider breast feeding if possible. Newborns are also shown to have better immune systems and therefore less ear infections if they are breast fed.

If I get a cochlear implant will I still need to use my hearing aid?

The potential to restore hearing that has resulted from the development of the cochlear implant (CI) is probably one of the most rewarding aspects of a neurotologist's career. Restoring hearing to an individual who is profoundly deaf never ceases to amaze me.
A CI is a small electronic device implanted into the inner ear through surgery. It enables individuals who are bilaterally profoundly deaf to understand speech. It is a prosthetic substitute for hearing. Hearing aids amplify sound and depend on the integrity of the inner ear to provide clarity. A CI replaces the work done by the damaged inner ear by directly stimulating functioning auditory nerves within the cochlea by electric pulses.
CIs provide significant benefit but individual results vary. There is no way to predict accurately the degree of benefit a person will derive with a CI. Initially after a person receives a CI, I encourage him or her to practice listening with the implant alone for several hours a day to become acclimated to it. There is no hard and fast rule about using a hearing aid with a CI. The signals each uses are different—the hearing aid uses acoustic signals and the CI uses electrical signals. I've heard people who use both say they are "in balance," but generally speaking, a CI may be more functional, depending on the hearing aid. To determine if you should continue to use a hearing aid after receiving a cochlear implant, some guided trial and error with your hearing healthcare practitioner will likely be needed.

Are two cochlear implants better than one?

Generally, the answer is yes. Having hearing in both ear, with two CIs, provides a distinct advantage when listening in noisy places and in general hearing acuity. When sound is heard with both ears it is easier to hear soft speech, to better understand speech in difficult listening situations and to determine the direction from which sound is coming. At least 4,000 individuals have bilateral implants at this time. Both implants can be performed simultaneously or you can do one at a time, sequentially.

Would a cochlear implant work for listening to music?

Cochlear implants are designed to help patients understand speech. Music is more complex than speech. However, some individuals can better appreciate music with a CI. This is especially true of percussion and metallic pitches. With some imagination, CI users who once had hearing and enjoyed music may recall the notes and rhythm of their favorite music to supplement they beats and pitches they can hear with their CI. For others, music is unrecognizable. Robert Fearn, a young researcher at University New South Wales, has written his thesis on this subject and is working with Cochlear, Ltd., on coding strategies to improve CI users ability to appreciate music. Click here for more on Fearn's thesis.

I have trouble hearing in restaurants. Is this the start of a downhill journey for my hearing?

This is a common complaint. A high-tone, nerve type of hearing loss is usually the problem behind difficulty understanding in noisy environments. Consonant sounds, the ones that enable us to understand words, are in the high frequencies. In quiet environments, we may be able to understand most words, but in noise, the high-frequency sounds do not come through, leaving only the low drone of background noise. Sometimes hearing aids that only amplify high frequencies can help. The new open-fit hearing aid is especially effective in these situations. Difficulty hearing in noise does not mean you are going deaf. However, about one in three persons over the age of 60 has a hearing loss. After the age of 80, about two out of every three people have significant hearing loss—which is still a long way from being deaf. Most people with this age-related hearing loss can be helped with hearing aids.

I sometimes have little spells of dizziness. Someone told me I might have Meniere's disease. What exactly is that?

Meniere's disease is a condition of the inner ear characterized by fluctuating low-frequency hearing loss, fullness in the ear, tinnitus and severe, episodic room-spinning vertigo. The attacks last between several minutes to eight hours. Usually Meniere's involves only one ear but in about 14 percent of cases, it may develop in the opposite ear. Proper diagnosis of Meniere's disease requires a medical history, a physical examination, hearing and balance tests and an MRI. Research on environmental and biological factors that may cause Meniere's is in progress with the hopes of developing preventative measures and effective treatment. Visit the "HH Dictionary" at www.drf.org for more information on Meniere's disease.

Why do my ears itch and what can I do about it?

Itching ears are usually due to dry skin in the ear canal, most likely caused by your efforts to keep your ears clean. It is not necessary to compulsively clean ears or to dry ears after showering or swimming. And I do not recommend using cotton swabs to clean or dry your ears. This removes the wax that protects and lubricates the ear canal. If the problem persists even after trying these recommendations, consult with your physician about prescribing steroid eardrops or lotion, which may help.

Many of my family members have hearing loss - my grandparents, uncles and dad. I'm only in my 20s but I have noticed that I can't always hear people very well even when we are talking one on one. It gets especially bad when I am in a crowded place. I've even avoided going to loud restaurants and pubs. Could my difficulties be genetic and what can I do to make it better?

One of the earliest signs of hearing loss is difficulty hearing in noisy environments. Your hearing difficulties could certainly be of genetic origin. The degree and rate of progression of hearing is variable between individuals, even those with genetic losses. A hearing test (audiogram) by a hearing professional can accurately determine your level of hearing. If significant hearing loss is present then you might benefit from amplification. In certain types of hearing loss, medical or surgical intervention may be of benefit.

While I was in an herbal remedies shop I saw the owner was doing an ear-candle cleaning on a customer. It was fascinating. When the hollow candle had burned down as far as it could safely burn, the woman performing the procedure unwound the remainder of the candle to expose a yellowish substance that was sucked out of the ear. Could that really have been ear wax? Are these ear candles recommended?

Ear candles supposedly remove cerumen (wax) from the ear canal by generating a negative pressure and pulling the wax out of the ear canal. These candles, however, do not generate the negative pressure required to remove cerumen and are therefore ineffective. The debris found after use is not cerumen but debris from the candle itself. Unfortunately, not only are ear candles ineffective but some injuries from their use have been reported.

My ears ring quite a bit. My husband thinks it has to do with the fact that we go up and down mountains daily, changing our elevation as much as 2,000 feet. Could a change in elevation cause my ears to ring?

Ear ringing, or tinnitus, is a frustrating problem. Tinnitus is really a symptom of an ear and/or brain pathway abnormality and not a disease entity itself. Ringing can be a result of middle ear pressure changes, as seen with traveling in different elevations, noise exposure, or due to medications or after an upper respiratory tract infection. Tinnitus can originate in the ear or brain and can vary in severity. The evaluation of tinnitus begins with a complete head and neck exam, ear examination and a hearing test. Oftentimes a CT scan or MRI is ordered based on findings noted on the hearing test (audiogram). Tinnitus in one ear will usually prompt a more significant evaluation by your doctor than would ringing in both ears. Developing coping strategies is usually the only treatment available. Using background noise to distract the brain, some antidepressant medications or a masking device placed in the ear (much like a hearing aid) can reduce the perception of ringing.

Sometimes I am walking in one direction and seem to shift slightly to another direction and must make a conscious effort to correct myself. I look like I'm drunk—not able to walk a straight line. I have some stiffness in my back which could contribute to the problem but I have also always wondered if the problem is with my equilibrium. Occasionally I seem to be lightheaded as well. Is it possible I have a balance disorder?

Humans rely on contributions from vision, the sense of touch (proprioception) and the vestibular system to maintain normal balance. The vestibular system is divided into central (brain pathways) and peripheral (inner ear) components. Disturbances in balance can result in a sensation of movement of oneself or the environment (vertigo), disorientation or lightheadedness. Problems with general health, hormone levels, blood counts, drugs people take and heart or blood pressure fluctuation cause imbalance most commonly. The inner ear is often blamed for vertigo and balance disorders but is only truly at the source of the symptoms in 15 to 20 percent of cases. The sensation of lightheadedness, inability to walk a straight line and changing directions without intending to can all result from poor balance function. Yes, even stiffness in the back and neck can contribute to the symptoms you describe. The evaluation of this type of medical issue begins with a thorough physical by your primary care doctor with a referral to a neurologist or ENT doctor as needed. Even in cases where a cause can be identified, treatment can be disappointing. Exercise is essential to maintain good function in almost all patients with disrupted balance.

What are some dos and don'ts to improve hearing health as a person ages?

Healthy hearing habits are critical to preventing hearing loss and tinnitus. Monitoring the known side effects of your medications, using hearing protection whenever exposure to loud music or sound is expected and maintaining a healthy diet all encourage improved hearing later in life. Federal agencies (OSHA, for example) provide guidelines for permissible noise level exposures in the workplace. If you are at work and are concerned about your hearing due to occupational noise exposure, you should address this with your supervisor. Noise-induced hearing loss is an additive problem. Once you have a hearing loss, further exposure can compound damage to the inner ear sound receptors. While working around the house with machines, care should be taken to minimize noise exposure as well. Finally, prudent use of headphones, CD players and stereos can minimize hearing damage. We will all get some degree of hearing loss due to aging (presbycusis) but hearing loss in addition to that is very much dependent on our listening habits.

What do you recommend for good daily care and cleaning of ears for both children and adults?

For the most part, daily care of the ears is unnecessary for both children and adults. Ear wax production is normal for all children and adults and is usually not a problem unless it occludes the ear canal causing hearing loss. Most otolaryngologists prefer their patients not to use cotton-tipped swabs because of how easily ear trauma can occur. Swabs can also further compact wax in the ear canal.

Recently, I attended a wedding reception with a very loud band. The music was uncomfortably loud and gave me pain in my ears. After 30 minutes I had ringing in my ears. My concern was for a two-year-old boy whose mother had him dancing right in front of the band. Wouldn't music that loud cause damage to a young child's ears? Mine were still ringing a day later.

Loud noises can cause hearing loss. Sometimes the loss is of short duration (say after a concert) and is called a temporary threshold shift. On occasion the loss is long-term and irreversible and is called a permanent threshold shift. The degree of hearing loss depends on both the duration and intensity of the noise. Very loud noises (over 100 decibels) can cause hearing loss even with very short exposure (approximately one hour). We are all exposed to noises (power tools, music headphones, power lawnmowers, etc.) that prior generations were not exposed to. It is important that we remain conscious of the harmful effects of noise on our hearing and do what we can to protect ourselves from extreme noise exposure.

When my husband turned 58 his ears quit making earwax completely, even though he previously had an abundance of earwax. Is too little or too much earwax something to be concerned about?

Production of ear wax varies among individuals. Wax is a normal part of the makeup of the ear canal, having some positive properties including inhibition of bacterial growth as well as being a water repellant. Wax consists of a variety of substances including wax from cerumen glands in the ear canal and skin that turns over (exfoliates) from the skin of the ear canal. An abundance of wax is problematic only if the canal is blocked and causes hearing loss. A lack of wax, for the most part, also poses little problem.

Why do I feel pain in my ears when I have a sinus infection?

It is not uncommon to have pain in the ears from sinusitis without actually having an ear infection. Pain in the ears, termed otalgia, is common with a variety of head and neck disorders including sinusitis, laryngitis and pharyngitis (sore throat). The pain felt in the ears is actually transmitted via nerve connections from the sinuses to the ears and is called referred pain or referred otalgia. Otalgia should always be investigated as it may represent underlying disease in other areas of the head and neck.

At times I notice a sense of fullness, or popping and cracking in my ear. It is intermittent throughout the year, but more prevalent in the spring and fall and when I fly. What makes my ear feel this way?

Rapid changes in pressure, such as an airplane ascending or descending, as well as a cold or allergies, can cause this sensation of fullness. Usually the Eustachian tube, a canal connecting the back of the nose to the inner ear, regulates ear pressure so both sides of the ear drum are equal.

With colds and allergies, however, membranes in the nose become swollen, and may block the opening to the Eustachian tube, resulting in that stuffy-ear sensation. The rapid changes that occur in air pressure when a plane ascends or descends, or when one scuba dives, also sometimes impair the Eustachian tube's ability to equalize.

There are some simple measures to help reduce these sensations. When flying, chew gum during take off and landing or try swallowing, yawning or any other exercise that helps the muscle connected to Eustachian tube expand and contract. Pilots and some seasoned air travelers take over-the-counter decongestants that contain pseudoephedrine to prevent such occurrences or use nasal spray to help mitigate the effects of flying. Always check with your doctor before trying any medication.

My teenagers love to play their music loud - so loud I can feel the vibrations and I have to shout at them to be heard. I fear this exposure to noise will harm their hearing, if not now, then in the future. How can I tell if my teenagers' hearing is damaged?

Many everyday items - like a car stereo's subwoofers or the headphones of an MP3 player or personal satellite radio - could indeed pose a threat to your children's hearing health if the volume is inordinately high. Repeated, long-term exposure to loud sounds (anything measuring 85 decibels and beyond), may permanently damage the tiny hair cells and nerves needed for hearing. When this occurs, it is called Noise-Induced Hearing Loss (NIHL). We may see an increase in NIHL in the coming years due to the proliferation of personal listening devices capable of producing ear-splitting volumes above 110 decibels.

If you're struggling to know when loud is too loud for earphones, stand next to your children while they are using them. If you can hear the song's lyrics, the volume is too high and may cause hearing loss. After playing the stereo or listening to headphones, ask your teens if they experience any ringing in the ears (tinnitus) or a sensation of "fullness." If so, it could be a sign of temporary hearing loss, which could become permanent with repeated exposure, so you should schedule an appointment with an audiologist or an ear nose and throat doctor. These medical professionals can gauge whether or not hearing loss has occurred and, if so, the extent of the damage.

My child spends hours in the pool every day. Sometimes at night she complains of an earache. What can I do to prevent swimmer's ear in the first place and keep it from becoming an ear infection?

Swimmer's ear is a common problem that is fairly easy to prevent and treat. It comes in two forms - the acute, painful variety and the chronic, itchy plugged-up-ear type. Both forms are caused by the ear canal being constantly wet. The moisture makes the skin in the canal swell a bit and lose its ability to repel bacteria. Acute swimmer's ear is painful as the skin is thin and tightly stretched to the canal bone. The chronic form is characterized by cheesy debris that plugs the ear canal.

The key to treatment is cleaning the ear canal. Ear doctors use suction and curettes to quickly rid ears of debris. Beware of cotton swabs; they push the debris deeper into the canal. Once cleaned, prescription antibiotic eardrops quickly clear up the infection.

Prevention is important. Avoid the old-fashioned alcohol and vinegar drops because alcohol burns and affects wax formation. (Wax is desirable because it repels water and protects the skin.) A few drops of the mildly acidic formulation known as Otic Domeboro helps prevent infection and cuts down on debris formation.

I'm 45 years old. My wife teases me about having a selective hearing loss but I am starting to wonder if I might have real hearing loss. At what age should I begin regular hearing check-ups and how often should I get them?

Listening and hearing are related but different. For a message to be "heard" the brain has to pay attention to it, which becomes more difficult as we get older. At age 45, the average person has no significant age-related hearing problems with either the ears or the brain. However, a 45-year-old who has worked 20 years in hazardous noise may, in fact, have a substantial amount of hearing loss.

One easy way to determine if a hearing examination is needed is to have a conversation with your wife without distractions (TV, background talking, etc.). If her softly spoken (not whispered) message is not completely understood, it is time for an examination.

Hearing loss often develops gradually and so slowly that one adapts to the change in perception without even noticing. However, once hearing loss crosses the threshold of 40-decibel hearing loss (dB HL), the effect on normal communication is very noticeable. Between 25-dB HL (the upper limit of normal hearing) and 40-dB HL, hearing may indeed seem selective because some words are easier to understand than others.