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Q&A on hearing loss & tinnitus (RE-POST)

Steve Hoffman steve at accessone.com
Wed Apr 3 11:07:24 EST 1996

The following article from the SHHH Journal is posted with
permission.  The SHHH Journal is published bimonthly by SHHH
(Self Help for Hard of Hearing People, Inc.), an international
nonprofit volunteer organization devoted to the welfare and
interests of those who cannot hear well.  For membership and
other information, contact:

       7910 Woodmont Ave, Suite 1200
       Bethesda, MD  20814

       301-657-2248    Voice
       301-657-2249    TTY

       Email:  shhh.nancy at genie.com  (Nancy Macklin)


Readers Ask:
A Physician Answers Your Questions About Hearing Health Care
by John K. Niparko, M.D.  (SHHH Journal 11/95)

Q: What ear protection should I use for airplane travel? 

A: Noise levels in most modern jet airliners reportedly do not
exceed standards of safety. However, noise levels in planes,
particularly near the rear of the plane, can be excessive.
Temporarily, hearing acuity can be reduced and tinnitus can
worsen. Because it's important to zealously protect your residual
hearing, hearing protection is a good idea. Earmuff-type hearing
protectors confer the greatest noise protection, but are not
practical for air travel (they'll make it difficult to hear the
menu from the flight attendant). Ear plugs such as sponge or wax
inserts are helpful, and custom-made soft molds are even better.
Also, I can't recommend renting the head phones -- they can add
considerable noise above the background noise already present.
Save the three bucks.                  

Q: If exposure to noise is bad for my hearing, won't my hearing
aids make noise damage worse?

A: Modern hearing aids are limited in the maximum amount of sound
they direct into the ear canal. This limit is typically set at a
sound pressure level of 85 to 90 decibels -- the level at which
noise damage consistently occurs. This setting on your hearing
aid is based on the design of the aid and the sound environment
you typically experience. Not all sounds require the same level
of amplification, and sounds in the speech range can be
emphasized. Incorrect settings of this limit can diminish the
clarity of the hearing aid or, if the setting is too high,
your hearing aid may seem painfully loud. Regular monitoring of
your hearing aid settings is advised.  

Q: I understand that automobile air bags can make an extremely
loud noise, almost like an explosion. Is there information
available as to these effects?

A:  While safety belts are effective in preventing fatalities,
air bags provide further protection from head and chest injury
with frontal impact. However, like any protection system, air bag
restraints potentially introduce some new risks.  Eye, facial,
and arm injuries have been associated with airbag deployment.
Inflation of the bag occurs rapidly and can produce a noise burst
of 170 decibels according to a recent University of Maryland
study. That's loud -- louder than just about anything you or I
will ever be exposed to, but, fortunately, it's short, lasting
less than one-fifth of a second. This has been reported to
produce a permanent mild to moderate sensorineural hearing loss.
Best advice: Drive carefully and keep the bags in their

Readers Ask:
A Physician Answers Your Questions About Hearing Health Care
by John K. Niparko, M.D.  (SHHH Journal 1/96)

Q: Have there been any advances in research on hair cell

A: Hair cells are the very specialized structures in the inner
ear that jiggle in response to the mechanical vibration of sound,
triggering impulses in the nerve of hearing. Damage to these
cells is the underlying cause of sensorineural hearing loss in
nearly all cases. Damage occurs most commonly from noise, aging,
heredity, and medications.  Prior to the late 1980s, scientists
held the belief that specialized structures like hair cells were
"fully committed" cells that had no capacity to replace
themselves in response to injury. The startling discovery that
some animals, in fact, regenerate hair cells has sparked a new
line of scientific study.  Hair cell regeneration has been
observed in both young and adult chickens and in quails. In these
animals, not only do the cells regrow, but they hook up to nerves
and appear to work quite well!  More recently, researchers
reported evidence that suggested this could occur in a mammal
(the rat), although this finding has been debated. 

     The relative ease with which hair cell regeneration can be
observed in birds compared to mammals indicates differences
between the two species in hair cell machinery. These differences
are likely rooted in the back-up system that supplies the
components needed for regeneration. 

     Where will further progress come from? Probably from gaining
greater insight into the factors needed to "switch on" this
replacement system in humans. This undoubtedly will require
greater understanding of growth promoters and the system of gene
expression needed to guide development of these cells. 

     What does this mean for those of us with sensorineural
hearing loss? To date, this research has not found clinical
expression and has not changed approaches to auditory
rehabilitation. However, the pace of this research has quickened. 
I am hopeful that it will offer a more curative approach to
sensorineural hearing loss for the future. 

Q: Does motrin cause tinnitus?

A: Motrin and several other medications comprise a class of
anti-inflammatory drugs known as the Nonsteroidal Anti-
Inflammatory Drugs (NSAIDS). They are now among the most common
medications used. The NSAIDS were developed to produce aspirin-
like suppression of inflammation, without producing the frequent
side-effects of aspirin. NSAIDS are used most commonly for relief
of joint pain and headache, but their ability to effectively
reduce inflammation makes them appropriate for use in many other

     While NSAIDS avoid or limit many side-effects associated
with anti-inflammatory therapy, tinnitus still occurs. Tinnitus
is most likely to start with dosages that exceed 1,500 mg per
day, but can occur with lesser doses. It almost always reverses
when the medication is stopped.

     One suggestion regarding the use of NSAIDS: Maintain good
hydration. Pharmacologists know that athletes who use NSAIDS and
become dehydrated in the heat of competition are highly
susceptible to kidney damage from these drugs. And because many
of the structures of the kidney appear to have patterns of
vulnerability that are similar to those of the inner ear,
drinking plenty of water while on NSAIDS potentially reduces side
effects involving the ear. A more comprehensive review of ear-
related side effects of medications may be found in the very
excellent review, "What you Should Know About Ototoxic
Medications," provided by Dr. Stephen Epstein in the
September/October 1995 issue of the SHHH Journal.

John K. Niparko, M.D., is associate professor and director of
Otology-Neurotology at the Johns Hopkins Hospital, Baltimore,
Maryland. He is also a member of the SHHH board of trustees.

Dr. Niparko welcomes your questions. Please send them to "Readers
Ask," SHHH Journal, 7910 Woodmont Avenue, Suite 1200, Bethesda,
MD 20814.

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