Tinnitus Treatments

The cells of hair can be abnormal with birth, or damaged during the life of an individual. There are the two external causes of the damage, like the noise trauma and infection, and anomalies instrinsic, like genes of deafness.

The loss of sensory hearing (also called the neurosensory hearing impairment) also can to result from the anomalies of nerve VIII cranial. The sensory hearing impairment which results from anomalies of the central auditive system in the brain is weakening of hearing called of Exchange.

For tinnitis cure information, visit: TINNITUS REMEDIES

Since the auditive ways cross in the two directions on the two sides of the brain, deafness of a central makes is not certainly common. The long-term exposure to the environmental populations of noise of the people living close to the airports or the motorways are exposed to the sound levels commonly inside range of the dBa 65 to 75. If the life styles include external significant or open conditons of window, those the finished time of exposures can degrade hearing. The UNITED STATES EPA and various states set standards of noise at protect the people at large against these unfavourable medical risks. The EPA identified the level of the db(A) 70 per 24 exposure of hour like level necessary to protect the public against the hearing impairment (EPA, 1974).

The loss of Noise-Induced hearing (NIHL) typically is centered with 4000 hertz. The stronger the noise is, the better sure quantity of exposure east is short. Normally, the sure quantity of the exposure is reduced by a factor 2 for each dB(A) 3 additional. For example, the daily exposure of safe the quantity with the dB 85 is 8 a.m., whereas the sure exposure to the dB(A) 91 is only 2 hours (national institute for professional safety and health, 1998). Sometimes, one factor 2 by dB(A) 5 is employed.

Zimbabwe Family Mourns Aids Death

COLUMNDecember 15, 2005 Posted to the web December 15, 2005

J.J. ZhouHarare

Cousin's illness gave the author an insight into the desperate state of Zimbabwe's healthcare system.

He called me on my mobile two days after the police had flattened his home in the Harare suburb of Mbare during President Robert Mugabe's now notorious Operation Murambatsvina

He had nowhere to go, he said, and had spent the previous two wintry nights on the side of the road with his four-year old son. His wife had deserted him earlier when the ravages of Zimbabwe's urban poverty became worse than unbearable.

I told him he could come to my place. He was my first cousin and in our Shona society that meant he was family, and there was no way I could refuse to help him in his hour of need.

A four square metre wooden shack had been his home for a long time, so its destruction by the government was deeply traumatic - as it was for at least 700,000 other Zimbabweans made homeless by Drive Out The Rubbish.

He had been orphaned when he was a schoolboy back in the mid-Eighties and did not have a rural home to go back to, which is what the ruling ZANU PF government suggested to those whose homes it wrecked.

Unfortunately, I did not have much space so I could only offer him the use of my garage, which had a small cooking stove and a door with access to our house and the bathroom. Down the phone, I sensed his relief.

The garage was a much more comfortable and spacious dwelling than any he had lived in since he lost his full-time job 15 years earlier.

Once he settled in with his son, he tried his best to live a normal life.
He would cycle every morning to the market where he touted for odd jobs.
Initially, he took his son with him, but that became impractical.

So we said our maid would look after the boy, a frolicsome, cheerful child who enjoyed playing in the street with the other kids.

Then my cousin's life changed dramatically. One morning he woke up with half his face covered in a rash of ugly blisters and purple splodges.

After my doctor had conducted tests came the shocking news: my cousin had herpes but was also HIV-positive. The sores were symptoms of Karposi's sarcoma, a skin cancer that is one of the most insidious opportunistic infections associated with the HIV virus.

We were all completely shattered. To make things worse, my cousin was soon completely immobilised as immense pain developed in his spine. He now spent his days lying on his back, and could not sit up at all.

His meagre market earnings were no more. This badly dented his pride since he wanted to work and contribute to his upkeep and that of his son, no matter how menial the task he found at the market.


More and more frequently, he called me in the middle of the night to take him to the toilet because he had severe diarrhoea. He lost his appetite and went for days without eating.

The hospital did a CD4 cell count, an indicator of the strength of an individual's immune system which goes down as HIV progresses. His was 83, way under the benchmark 200, the point at which doctors put people with AIDS on anti-retroviral drug.

The hospital said they would get the drugs, but he would first have to undergo weeks of counselling before they would administer the first dose.

This was so difficult for me to understand, because you did not need to be a medical expert to see that if he was to be saved at all he needed them immediately.

I soon discovered that the hospital had in fact run out of anti-retroviral drugs and that because of the pariah status of my country, 500 per cent inflation and a dire shortage of foreign exchange they could not be procured easily.

As my cousin waited, we could see him slowly losing his zest for life.

Often he talked about the hopelessness he felt for his son's future. He was literally surviving on water. He did not even have appetite for fruit.

The doctor gave him stronger and stronger painkillers.

When the anti-retrovirals finally came he lit up with hope. We all thought, given our lack of expertise about HIV/AIDS, that the effect would be immediate, but 14 days after his first dose there was no improvement.

He had not responded positively to medication. The doctor put him on morphine, because his Karposi's sarcoma had advanced badly. His back pain had become worse.

The hospital refused to admit him, saying he was terminally ill. We did not have enough money to hire a private nurse. He asked for crutches to help him get to the toilet.

My cousin talked more and more about his son's future and began cursing Robert Mugabe. He had been a staunch supporter of Mugabe and the ruling ZANU-PF party, so much so that even when the majority of people living in Zimbabwe's towns and cities swung to the opposition Movement for Democratic Change he remained firmly behind Mugabe.

No one knows exactly what he had got up to in Mbare during the ugly events preceding the violent March 2005 general elections. I think it is possible he was a member of one of Mugabe's vigilante groups who terrorised the ordinary people of Mbare who showed open support for the opposition.

When he moved in, it struck me that he had never imagined in his wildest dreams that Mugabe could be so cruel as to destroy people's houses. It was not my cousin of old. He had seen the bulldozers for himself and military men beating up old women who could not understand why their homes were being razed.

Eventually he began messing his bed, an eventuality we had anticipated but dreaded. I thought there were limits to what I, his cousin, should be obliged to do. However, I could not ask our maid to clean him up and for cultural reasons my wife could never go anywhere near him.

Care fatigue was setting in. We asked other family members for help, but they were too busy with their lives to spare the time. I desperately sought someone to share the task of cleaning him regularly. I found his nephew, his sister's son. He was duty bound to sit through what were now clearly his uncle's death throes.

At the end, my cousin literally died in my arms as we were cleaning him, still hoping the hospital would be merciful enough to admit him and give him expert care in his last hours.

At the moment he died, his son was playing, as usual, with other kids on the street. It has not yet registered in his young mind what had happened to his father. We have taken on my cousin's boy as our own second son.

I now have to prepare mentally and spiritually for the day when my new son will ask me what caused his real father to leave this earth.

J.J. Zhou

Revellers are putting their hearing at risk

Thousands of revellers are putting their hearing at risk by listening to dangerously loud music on nights out. The charity RNID, which represents the 9million deaf and hard of hearing people in the UK, said that the party season raised the chances of people being exposed to loud music for longer.

A quiz of 1400 people aged 16 to 30 said 55% visited pubs where they had to shout to be heard more than once weekly, 75% of these for up to four hours at a time. The RNID said 44% of young people had known ringing in the ears at least once, 34% regularly or occasionally after a night.

In some venues, music as loud as an aircraft taking off had been recorded. They said revellers could suffer tinnitus, a permanent ringing or buzzing sensation in the ears, or even hearing loss. The RNID advised people not to stand near sound systems and take regular breaks from the dance floor.

Clubbers urged to protect hearing

A leading charity for deaf people has today warned thousands of revellers could be putting their hearing at risk at pubs and clubs across the country. The Royal National Institute for the Deaf (RNID) fears changes to licensing laws will mean party-goers over the festive period will be exposed to loud music for longer periods of time and are in danger of causing permanent damage to their hearing.

Charity staff polled 1,400 people aged between 16 and 30-years-old and found that 55% visited pubs and bars where they needed to shout to be heard more than once a week, with 75% of these there for up to four hours at a time.

The survey showed 44% of young people had experienced ringing in the ears on at least one occasion, and 34% reported ringing or buzzing in the ears on a regular or occasional basis after a night out.

The RNID, which works to support nine million deaf and hard of hearing people in the UK, said that in some bar and club venues, music as loud as an aircraft taking off had been recorded.

Charity chiefs today said they were concerned that unless people took steps to protect their hearing, many could start 2006 with tinnitus, which causes a permanent ringing or buzzing sensation in the ears, or even hearing loss.

Lisa McDonald, campaigns officer for the RNID, said: "With more licensed premises opening longer and playing loud, amplified music, festive revellers in bars and pubs might not realise their hearing is being put at such high risk.

"The endless round of parties at this time of year means that people will be spending more time in bars and pubs and the cumulative effects could add up to hearing loss in later life."
The RNID`s "Don`t Lose the Music" campaign is encouraging people to protect themselves against the effects of loud music.

Top tips developed by the charity to protect hearing during the Christmas party season include standing away from loud speakers when in pubs and clubs or at gigs and concerts, taking regular breaks from the dance floor and wearing earplugs specially designed for use in clubs and gigs.

Ear-plugs for orchestras at risk of being deafened by their music

Ear-plugs for orchestras at risk of being deafened by their music

The swelling sound of an orchestra may sound impressive from the stalls, but to the players the noise can be painful, and Britain’s orchestras will today be presented with a prize for efforts to do something about it.

At a meeting of EU noise experts in Bilbao, Russell Jones, Director of the Association of British Orchestras, will accept the award. Hearing loss among rock musicians is familiar but classical musicians face similar hazards.

So does this spell the end for Shostakovich and Mahler?Malcolm Warne Holland, orchestra and concerts director of Opera North, who has suffered a "dulling" of hearing on one side after 20 years as a trombone player, thinks not.

"Wagner is notoriously noisy, but loud music that is nice is much easier to endure than loud music that isn’t,” he said. “High squeaks are more tiring than louder music, and peaks of sound can be loud enough to be dangerous."

Alison Wright Read, a health and safety expert, is a specialist in helping orchestras to protect players. Her report for the ABO, A Sound Ear, advocated "noise training" for musicians and noise teams to tackle the problem, which if ignored can lead to hearing loss, pitch distortion, tinnitus and pain.

She said: "Half of brass players say their hearing can become less sensitive. Woodwind players become over-sensitive, when the brain makes the sound seem even louder."

Fortunately, there are things that can be done. One technique is to rake the orchestra at different levels, so that the brass section plays over the heads of those in front of them.

"Another idea is marking up the score so that everybody can see when there is going to be a loud passage, and is ready for it," said Ms Wright Read. "Normally musicians only have their own parts, so they can’t see when the timpani comes in."

Technical changes can help. Panels attached to the walls absorb sound and make it easier for players to hear each other, so they don’t have to play so loud.

Customised ear-plugs are also used, and Perspex screens can be put on chair backs. Mr Warne Holland also thinks about the repertoire. "When we play at Dewsbury Town Hall, for example, we would choose smaller pieces."

Marc Stevens, concert manager of The London Symphony Orchestra, said: "We’re experimenting with changing the layout of the orchestra. Having first and second strings facing each other across the conductor seems to help."
By Nigel Hawkes

Hearing Loss From Chemotherapy

Hearing Loss From Chemotherapy Underestimated Say Researchers At Oregon Health & Sciences University

PORTLAND, Oregon - By 14, Peter Johnson had survived brain cancer and a relapse of the disease in his shoulder. But it was treatment for the last tumor that would create his life's greatest challenges. Johnson, now 33, has suffered since 1986 from the effects of ototoxicity, a condition in which platinum-based chemotherapy drugs, such as carboplatin and the more common cisplatin, damage the tiny hair cells in the inner ear that vibrate in response to sound waves. This leads to progressive, irreversible hearing loss and reduced quality of life for patients.

Despite surgery and intense radiation therapy to remove the brain tumor, Johnson says the hearing loss resulting from the chemotherapy for the shoulder tumor has been the most disabling.

"The hearing loss is difficult," said Johnson, a Portland resident who started losing his hearing in 1986, about a year after his chemotherapy treatment for the shoulder tumor ended. "What I don't think the general public understands is that surviving cancer isn't the same as a broken leg. Once the leg is healed, you're pretty much back to normal. Once you survive cancer, the after-effects are numerous and you just keep discovering them."

To scientists at Oregon Health & Science University, Johnson's experience is not surprising. A new study published in the current edition of the Journal of Clinical Oncology found that ototoxicity's frequency and severity, as well as its long-term effects on development, have long been underreported by the medical community.

The research found that a well-known classification system doctors use for reporting toxicities in patients, the National Cancer Institute's Common Terminology Criteria for Adverse Events, or CTCAE, doesn't consider high-frequency hearing loss, allowing the magnitude of ototoxicity in children treated with platinum agents to be miscalculated.

The purpose of the study is "to make people aware that this is more common than people think and we need to follow this issue," said Kristy Gilmer Knight, M.S., a pediatric audiologist at OHSU's Doernbecher Children's Hospital and the study's lead author.

Knight said a major problem for doctors trying to diagnose hearing loss from ototoxicity is that it's not that obvious. "The way it manifests itself is not that children lose all their hearing," she said. "The way it manifests itself is tricky. The typical presentation is high-frequency hearing loss, and so it may not look like they're having a problem, especially when communicating one-on-one in a quiet room. And kids won't complain about not understanding what was said when they're really little."

And that can lead to development issues for children. A 1998 study that evaluated the educational performance and social-emotional functioning of about 1,200 children with minimal hearing loss found that 37 percent failed at least one grade in school compared with the normal rate of 3 percent. They also had more problems with behavior, energy, stress, self-esteem and social support.

OHSU researchers tested the hearing of 67 patients, ages 8 months to 23 years, who received platinum-based chemotherapy. Data was analyzed to determine the length of time to hearing loss using criteria from the American Speech-Language-Hearing Association, or ASHA, and the effects of treatment and patient characteristics on the incidence and severity of ototoxicity.

According to the study, hearing loss was found in 61 percent of patients, with average onset beginning 135 days after chemotherapy. This included 55 percent of children treated with cisplatin; 38 percent of children treated with cisplatin's less-toxic derivative, carboplatin; and 84 percent of children treated with both agents. Children treated for osteosarcoma, neuroblastoma and medulloblastoma, the form of brain cancer Johnson had, experienced greater incidence and severity of hearing loss.

But researchers say many of these children are falling through the cracks. The study found that while the ASHA criteria and CTCAE grading scale were similar in how they defined hearing loss progression, results from clinical trials often focus only on CTCAE grade 3 toxicity, which represents hearing loss requiring therapeutic intervention, and grade 4, which requires a cochlear implant and additional speech and language development services. The study said agreement between the CTCAE and ASHA criteria was "inadequate."

"By tradition, many published clinical trials report only grade 3 and 4 CTCAE toxicities," the study explained. "In the case of hearing loss, this would leave grades 1 and 2 ototoxicity unreported, thereby underestimating the magnitude of ototoxicity in children treated with platinum agents.

We believe that CTCAE grade 1 and 2 hearing losses are significant in children and should therefore be considered and reported." The study found that 36 percent of patients who were examined would not have been reported as having ototoxicity if only CTCAE grades 3 and 4 were considered.

Scientists want to boost awareness of ototoxicity because it may soon be preventable. Nancy Doolittle, Ph.D., associate professor of neurology, OHSU School of Medicine, and a researcher in the Blood Brain Barrier Program, which studies methods for breaching the brain's natural defense system to deliver chemotherapy compounds to tumors, has shown that sodium thiosulfate (STS) decreased hearing loss in patients with malignant brain tumors who were treated with carboplatin chemotherapy, which is given with the blood-brain barrier disruption technique. When STS was given four hours after carboplatin, ototoxicity decreased from 84 percent of patients to 29 percent.

The OHSU study team is developing protocols for a clinical trial of a second potential chemo-protectant called N-acetylcysteine, or NAC. The drug, typically used to treat people with Tylenol poisoning, prevented platinum-induced ototoxicity in rats in a study published in mid-2004. NAC may prevent hearing loss by binding to cisplatin's platinum molecules, inactivating them. And as a free radical scavenger, it hunts down highly reactive atom clusters believed to cause similar hearing loss caused by noise trauma.

The main aim is to determine a safely tolerated dose of NAC in humans. Once the safe dose is determined, Phase 2 efficacy testing begins to see if NAC, combined with STS, will protect hearing.

"One of the strategies for improving survival is increasing doses of chemotherapy," Doolittle said. "Because larger doses may cause more toxicity, we have to be able to address the toxicity. Maintaining quality of life by maintaining hearing is really important."

While the damage has been done to his own hearing, Johnson hopes drugs, such as STS and NAC, can help prevent the hearing loss in other cancer survivors. He also hopes to use his law degree and his experience as a law librarian and paralegal to advocate for others who've experienced hearing loss, which required Johnson to learn lip reading, relish television shows and movies with closed captioning, dread telephone calls and, ultimately, get a cochlear implant for his right ear.

"The fact of the matter is I could put out the same quality of work everybody else could, but I needed a half hour longer," said Johnson, who developed dyslexia as a result of the radiation treatment and chemotherapy. In his professional experiences, Johnson notes that "the real world doesn't want to give you an extra half hour to do what needs to be done, though."

Other study co-authors included; Dale Kraemer, Ph.D., associate professor, Department of Pharmacy Practice, Oregon State University; and Edward Neuwelt, M.D., professor of neurology and neurological surgery, OHSU School of Medicine and the Portland Veterans Affairs Medical Center, and director of the OHSU Blood Brain Barrier Program. The study was funded by the National Institute of Neurological Disorders and Stroke, the National Institutes of Health and the U.S. Department of Veterans Affairs.

Dr. Neuwelt, OHSU, Portland Veterans Affairs Medical Center and the Department of Veterans Affairs have a significant financial interest in Adherex, a company that may have a commercial interest in the results of this research and technology. This potential conflict was reviewed and a management plan approved by the OHSU Integrity Program Oversight Council and the Portland Veterans Affairs Medical Center Conflict of Interest in Research Committee was implemented.

Hearing Loss

HEARING:

Drop into the National Association for Deaf People’s Tallaght Resource Centre (Exchange Hall) and have your questions answered about Hearing Loss, Deafness, Tinnitus and other hearing related issues. Get information regarding entitlements, aids and appliances, family support service, support groups and upcoming activities. Sign Language and Hearing Help Classes start this month. Further information from Pauline Scott at Unit G/H, Exchange Hall, Belgard Square. Nth, Tallaght, Dublin 24. Phone 4620377 or e-mail:

Woman hopes for sound of silence

Lynn Steinman has a new scar on her collarbone, another behind her ear, but a tentative smile on her face.

The scars are a small price to pay, she says, for the chance to rid herself of the ringing in her ears that has plagued her life for more than a decade.

"Imagine a kid's tin whistle blowing in your ear 24 hours a day, seven days a week," Steinman, 56, of Aurora, said Thursday from her hospital bed in Milwaukee, Wis.

Last week, Steinman became the second person in the world to be treated for severe tinnitus with a brain-stimulation device usually used to treat Parkinson's disease, tremors and other brain disorders.

Today, doctors at the Medical College of Wisconsin may activate the device so they can monitor it for the next two weeks to see if it gives her relief.

Or, they might decide to leave it off for two weeks, before turning it on for the following two weeks, in an effort to more objectively gauge the difference the device makes.

Steinman is part of a blind clinical trial. Patients aren't told whether the device is turned on or off. "I'd better be able to tell when it's on or off," Steinman, a licensed practical nurse, said with a quick laugh.

Her neurosurgeon, Brian Kopell, implanted an electrode near her right ear and made an incision near her collarbone large enough to implant a battery pack and magnet, connected by wires to the ear.

"The idea is to interrupt the signals in the brain to make the noise go away," Steinman said in a phone interview.

Not surprisingly, she hopes doctors actually turn it on today, rather than wait two weeks.
Steinman said that by nosing around, she found out that the first person to have the procedure got something like 90 percent relief.

Her sister, Mary Eldridge, said doctors told her it may take Steinman several months to adjust to the device and get maximum relief from the ringing.

Some 50 million Americans have some degree of tinnitus; 1 million to 2 million have it so severely that it interrupts daily living.

Steinman says hers started 14 years ago when she had a bad cold. "The cold went away," she said, "but the ringing didn't."

She endured the affliction fairly well for a decade, but about four years ago it got markedly worse and the problem has been growing since.

"I even contemplated suicide once," she said. "I asked myself, 'How can I go on day after day like this?' "

It was on a tinnitus Web site that she learned about the clinical trial.
"It stuck out like a neon sign to me," she said. "I thought, 'If no one volunteers for this, how are we going to find the answer?' "

Steinman has paid for her own flights to Wisconsin, but the manufacturer of the device paid for the surgery. She stays at a sister's home when she's not at the Milwaukee hospital.

Regardless of whether the device is turned on today, Steinman will fly home to Colorado on Tuesday. Three times a day she'll dial a phone number and answer a few questions about how her ears are doing.

Two weeks later, she'll fly back to Wisconsin so the doctors can examine her again.
"I'm hoping for a good result," she said. "Not just for me, but so other people can get some help, too."