Dr. Wright's Blog

Meniere’s disease: symptoms, diagnosis and professional treatment

Woman with vertigo from Meniere's disease I Broadmead Hearing

What is Meniere’s disease?

Meniere’s disease is a long-term, progressive illness that damages the organs of the inner ear responsible for hearing and balance.

Symptoms of Meniere’s disease:

  • Long episodes of vertigo
  • Hearing loss
  • Pressure
  • Loud tinnitus in the affected ear

In the early stages, hearing sensitivity may recover after each episode.  As the disease progresses, hearing loss almost always reaches profound levels rendering the ear functionally deaf.

Who is most likely to get Meniere’s disease?

According to the Mayo Clinic, adults are most likely to get the disease.

  • Young-to middle-aged adulthood (40s-50s)
  • Peaks at about 60 years of age
  • Appears to affect men and women* equally

Roughly 200/100,000 (0.2%) of people in the U.S. have Meniere’s disease. While the Framingham Heart Study found that 1.48% of the US population reports a history of Meniere’s disease, it’s largely agreed that the reason for this discrepancy likely due to the tendency of primary care physicians to diagnose all cases of recurrent episodic vertigo as Meniere’s without first having ruled out other possible causes.

What causes Meniere’s disease?

In short, no one knows. That said, several theories can explain how the disease progresses and why it occurs. Researchers are approaching the root of the issue.

What is known is there is a connection between Meniere’s disease and a condition called endolymphatic hydrops; a situation in which the fluids of the inner ear get out of balance during vertigo caused by Meniere’s. The fluid imbalance is thought to cause the sensation of pressure in the ear and contributes to vertigo, tinnitus, and hearing loss.

 

Water cup showing imbalance associated with vertigo

 

Medical researchers at the University of Colorado believe this fluid imbalance reveals a pressure-regulation problem that decreases blood flow to the organs of the inner ear. In a young, healthy person, the blood flow is not completely interrupted because the vasculature in the ear, head, and neck are all intact. However, in older individuals with assumed vascular issues, the interruption in blood flow can be so complete that it causes a mini-stroke (similar to a transient ischemic attack, or TIA) in the inner ear.             
Re-oxygenation and recovery after this event are less successful each time, explaining the decline of function in the affected ear as the disease progresses.

How is Meniere’s disease diagnosed?

Most clinics in Canada and the US use the following criteria:

  • Two episodes of vertigo, each lasting 20 minutes or longer but not longer
    than 12 hours
  • Hearing loss verified by a hearing test
  • Tinnitus or a feeling of fullness in the affected ear
  • Exclusion of other known causes of these problems

Diagnostic procedures may include:

  • Thorough case history
  • Hearing assessment
  • Medical imaging to rule out other condition
  • A balance assessment

Treatment of Meniere’s disease

Stopping the vertigo associated with Meniere's disease

There is no true ‘cure’ for Meniere’s disease. However, physicians, otolaryngologists (ear, nose, and throat doctor), Audiologists, and other health professionals on the care team have several tools available to them to help manage the symptoms of Meniere’s disease.

Different professionals may recommend the following treatments:

Primary care physicians

Managing: dizziness/vertigo

  • Motion sickness medications: reduce the spinning sensation and alleviate associated anxiety.
  • Anti-nausea medications: control nausea and vomiting during an episode of vertigo.
  • Fluid regulation medications: help manage the buildup of fluid in the inner ear. This may include a recommendation for a low salt diet.

Ear, Nose, Throat specialists

Managing: dizziness/vertigo, or preventing these symptoms from recurring

  • Middle Ear Injections, of steroids or ototoxic (toxic to the ear) antibiotics to reduce the incorrect balance messages from the inner ear so that the other ear can compensate.
  • Surgery, to decompress or even add shunts to the organs of the inner ear responsible for our sense of balance to help with fluid balance. Removal of the hearing and balance organs in a late-stage Meniere’s ear that has already lost all of its hearing ability or cutting through the vestibular nerve to preserve hearing in an affected ear are also possibilities.

Audiologists

Managing: the functional aspects of hearing

  • Hearing aids to manage the consequent hearing loss and preserve communicative function.
  • A hearing aid CROS system to provide stereo sound awareness if one of the ears is functionally deaf.

Other complementary treatments may include:

  • Vestibular rehabilitation: typically provided by physiotherapists, occupational therapists, kinesiologists, or registered athletic therapists.
  • Vestibular acupuncture: provided by acupuncturists.

If you are experiencing balance and hearing issues come and see us. Our Audiologists can evaluate and diagnose balance-related diseases and help you deal with the hearing loss associated with Meniere’s. While there isn’t a cure, treatment can reduce the frequency and severity of the vertigo.

Book online or call to schedule an appointment at the Broadmead Hearing Clinic: 250.479.2969 or Oak Bay Hearing Clinic: 250.479.2921.

 

*Harris, J. P. and T. H. Alexander (2010). "Current-day prevalence of Meniere's syndrome." Audiol Neurootol 15(5): 318-322.

Hearing is An Expression of Love

Hearing is an expression of love heart

 

This story is from several years ago, but it still rings true today. It was a weekend that my mom and her sister were at our house for dinner.  My mom was talking about her experience using hearing aids to her inquiring sister.  Her sister was noticing hearing loss and was trying to get a sense from my mom of what it would be like to use hearing aids. I stood chopping veggies in the kitchen overhearing this conversation with keen interest and it was a simple statement that my mom made that gave me pause.

This is what she said….. “Wearing my hearing aids is a gift I give to the people who I am with.”

I found this interesting because many times in the clinic I hear people with unaided hearing loss tell me, “It's not a problem for me, but my spouse would say otherwise."

Hearing aids are an act of love

Using hearing aids is an act of love to the people around you. Why? Because taking steps to improve communication in a relationship is an act of kindness to the ones you love. 

To show them that what they have to say is meaningful. 

To be able to participate in conversations.

To communicate clearly with less effort.

Good communication can be a love language

Have you ever heard of the 5 Love Languages? (There's a quiz you can take to find out which is yours.)

These are different ways that we each give and express love. They are: 

  1. Words of Affirmation
  2. Acts of Service
  3. Receiving Gifts
  4. Quality Time
  5. Physical Touch

Think about how hearing plays into being able to give and receive love: the ability to hear words of affirmation, being able to enjoy quality time together. Hearing also is part of touch because couples who communicate better are also often closer physically.

Communication is a two-way street

So this Valentine's day, you can give flowers or take efforts to improve communication by accepting that if one person in a relationship is expressing a problem then it is not just her/his problem, it is a communication problem which by definition is a two-way street. 

Or, best case scenario, you can do both. Happy Valentine's Day!

If you're ready to improve your communication, please book hearing evaluation or call us at the Broadmead Hearing Clinic: 250-479-2926 or Oak Bay Hearing Clinic: 250-479-2921.

Photo by Ryan O'Niel, Unsplash.

Tinnitus Success Story

Broadmead Hearing Tinnitus Treatment

 

My patient Susan had severe tinnitus and I thought I would share my chart notes about her progress with tinnitus because it is inspiring.  If you are someone suffering with tinnitus, know that there are non invasive and organic options out there.

What is tinnitus?

Tinnitus is the perception of sound that cannot be attributed to an external source. It is often described as a ringing, humming, or buzzing sound. It can vary in volume and pitch and be intermittent or constant. Tinnitus can be caused by hearing loss, noise exposure, head injury, thyroid problems, muscle tension in head/neck, certain medications or other health concerns.

Tinnitus is a symptom that wears many hats. It may be:
  • Up to 60 different sounds
  • A single sound or multiple noises 
  • Low, medium or high pitched
  • Intermittent or constant
  • Perceived in one or both ears

Susan's chart tells a story

August 20:  Hearing evaluation.  Tinnitus is "very distressing". High pitched whistle that she hears bilaterally as well as a static and intermittent clicking noise.  She is sensitive to loud sound and is avoiding social situations for fear the noise will make her tinnitus worse. She reported having cranial sacral therapy which seems to reduce the loudness of her tinnitus for a few months but it returned. Tinnitus Functional Index scores were high on all sub-tests. She has seen a local ear, nose and throat doctor and all medical reasons for the tinnitus have been ruled out.  Counseled on tinnitus management strategies and recommended sound therapy with Audiological counseling. She reports she is now in a "state of distress".  She rates the tinnitus as a 9/10

August 28:  Fitting of the sound generator to the left ear. She felt anxious during the fitting process and was was nervous that introducing more sound to her "already loud ear" would make things worse.  She had difficulty inserting the device initially but improved with instruction.  Real ear measurements on the masker showed adequate gain.  She was counseled extensively regarding habituation and instructed how and when to use the device.

September 11:  Improvements with insertion of the device and data logging in the device show consistent use.  Still noticing the tinnitus and reports it as bothersome, but finds she is less sensitive to loud sound.  Changed the frequency response of the tinnitus masker to have a higher frequency peak. Continued counseling on autonomic responses and habituation process. 

September 30:  Doing well.  Significant reduction in the perception of the tinnitus over the past 3 weeks.  Finds her sleep and irritability are improved overall. She is using them 10-12 hours per day.

November 23:  End of the 3-month trial period. She hasn't used the sound therapy device since the end of October because, while she hears the tinnitus, it is very soft and not bothersome.  I asked her if she wanted to return the device, but she chose to keep it to have it "as a crutch" in case the tinnitus came back or in case she has a bad day. Current tinnitus rating is a 2/10.

There is relief from tinnitus

If you would like to try a tinnitus sound support device, please book a comprehensive tinnitus evaluation or call us at the Broadmead Hearing Clinic: 250-479-2926 or Oak Bay Hearing Clinic: 250-479-2921.

Originally published November, 2015.

 

What Does 'Wheel of Fortune' Have To Do With Hearing?

Hearing loss makes it hard to fill in the gaps in background noise

Originally published March 15, 2017

How do they do it?  How is it that some contestants can see:

__ o_ _     _un

and know that it says home run while the rest of us are still guessing at the answer?

The brains behind the answer

A winning contestant has a strong visual processing ability in the visual cortex in the brain which allows them to see what is not there. Visual processing can be used as an analogy for auditory processing. With hearing loss, the ear is unable to deliver the full auditory spectrum to the brain, so the brain is forced to work really hard to fill in the blanks to understand the message. 

Filling in the gaps

We hear with our brains

Some brains are excellent at the task of filling in the gaps. Think of a group of 20-year-olds at a bar not appearing to have any problems hearing one and other. It is because their brains can fill in the blanks in the sounds that background noise is masking. As we age, the brain’s ability to filter out background noise changes. Studies show that changes in the volume of the auditory cortex of the brain (it shrinks over time) affect our ability to identify words in challenging listening environments.

Hearing also changes over time. Age-related hearing loss is called presbycusis. (It happens with our eyes too. You may be more familiar with the term presbyopia which is why we need reading glasses.) Presbycusis is what makes it difficult to hear conversations, especially when there’s background noise.

So it’s a bit of a double whammy on the game board – our hearing and our brains change as we age. But not all is lost. All we need is some help filling in the blanks. Hearing aids are an important part of this equation. Hearing aids will help deliver a more complete spectrum of sound to the ear so the brain doesn't need to work as hard.

Our processing abilities are unique

Auditory processing abilities are different for each person. That’s why two people with identical hearing loss can function quite differently depending on how well or how poorly they process auditory information. You won’t be able to detect how well you process auditory information yourself, but your Audiologist can.

The bottom line is that the older we get, the more we need better, higher quality signals to reach our brains to understand the message. If you are noticing you’re straining to fill in the gaps, speak with an Audiologist. Call us at the Broadmead Hearing Clinic: 250-479-2926 or Oak Bay Hearing Clinic: 250-479-2921 or request an appointment online.

Image: Santoli

What's inside a hearing aid?

What's in a hearing aid?

Updated from the original Oct, 2016 post.

Hearing aids are becoming smaller and yet more powerful with every advancement in technology. You might be wondering, how can they fit all of that technology in such a tiny space? What exactly goes inside a hearing aid?  

All hearing aids have 5 basic components:

  1. Microphone
  2. Amplifier
  3. Loudspeaker
  4. Battery
  5. Computer chip (this is programmed by the Audiologist.)
  6. Bonus - most new hearing aids also have a wireless connection

The role of the microphone, amplifier & loudspeaker

The microphone picks up the acoustic signal in the environment and converts it to an electrical signal. Most hearing aids have more than one microphone to pick up sound in a more directional manner, which prioritizes sound coming from the front of the listener. The sound is then analyzed by the computer chip.

Next, the processed sound is sent to the amplifier. The amplifier sends the signal to the loudspeaker which emits the sound into the ear canal towards the tympanic membrane where it can then be processed by the inner ear. Most new hearing aids also have a wireless antenna for connecting to other wireless devices (e.g. cell phones, tablets, and audio players).

Hearing aid batteries

Disposable batteries:
 
Modern hearing aids use four common button cell, zinc-air battery sizes, indicated by a colour code on the sticker. 
 
 
Zinc-air batteries use air as an energy source and the tab seals air holes on the battery. When the tab is removed it takes about two minutes for the hearing aid battery to activate.
 
The more powerful the battery, the higher the number. The expiration on the battery package will indicate the good-until date. How long batteries last depend on how many hours the hearing aids are worn each day and the power of the hearing aids. A rule of thumb is:
 
  • 10: 3-6 days
  • 312: 10-14 days
  • 13: 2-3 weeks
  • 675: 3-4 weeks

Rechargeable batteries:

 
Some hearing aids have rechargeable batteries built in. This means the batteries do not need to be removed. Instead, the hearing aids are placed on a docking station each night and will charge overnight.

Hearing aids are mini computers

Today’s hearing aids are digital devices which means the “natural” sound waves are converted into digital bits (0,1) that will be processed by the hearing aid. This digital signal processing gives Audiologists much more control over the settings in the hearing aids. Instead of having devices that “amplify all sounds,” we can selectively amplify only the frequencies where the hearing loss occurs to protect your ears from further damage. We can selectively enhance soft speech while leaving loud speech alone, which makes for a more comfortable sound environment.

We can also adjust how quickly or effectively the hearing aids deal with background noise. In addition, hearing aids can better distinguish between different types of “noise.” It will adapt differently based on whether the background noise is a continuous sound, such as a car engine, or whether it’s a more variable sound such as music or other speech.

Wireless connection

New hearing aids can transmit sound from Bluetooth® devices, such as smart phones, a laptop computer, or tablet.

You don't have to hold the phone to your ear or hearing aid to hear the sounds.  The interface has a microphone inside that picks up the sound of your voice so the person you are talking with can hear you. Their voice is transmitted directly into both hearing aids for a binaural (both ears) listening experience.

Man with hearing aids sitting at a desk and using a smartphone

Hearing aids will keep advancing

This is a fascinating time for hearing technology. Hearing aids are benefitting from every new advancement in computer technology. According to hearing aid manufacturer Starkey, “The processing power of the printed circuit board inside a Halo hearing aid is magnitudes greater than the computers aboard the Apollo 11 spacecraft that took astronauts to the moon.”

If you have any questions, or want to speak with an Audiologist about hearing aids please contact us at Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921.