Auditory and Speech Disorders

The Link Between Cardiovascular Disease and Hearing Loss: A Growing Role for Audiologists

The Link Between Cardiovascular Disease and Hearing Loss: A Growing Role for Audiologists
By Dr. Ha-Sheng Li-Korotky AuD, PhD, MD

A growing body of research is showing a significant correlation between cardiovascular disease and low-frequency hearing loss. Moreover, the studies underscore a growing need for Audiologists and Physicians to work in partnership for the best health outcome of patients.

Most of the studies focus on the consequences of decreased blood supply due to cardiovascular compromise, and the downstream negative effects on the inner ear blood vessel health. The inner ear is extremely sensitive to blood flow, and there appears to be a strong relationship between the health of the cardiovascular system (heart, arteries, and veins) and hearing. These studies indicate that a healthy cardiovascular system promotes healthy hearing, but inadequate blood flow and resulting damage to the blood vessels of the inner ear can contribute to hearing loss.

A recent study, Audiometric Pattern as a Predictor of Cardiovascular Status: Development of a Model for Assessment of Risk, suggests that low-frequency hearing loss could be a marker for cardiovascular disease rather than a result of the disease, and low-frequency audiometric patterns can be used probabilistically to predict cardiovascular health. An underlying premise of the study is that vascular aspects (decreased blood supply) of cardiovascular disease show up as abnormalities in the condition of inner ear blood flow before they are revealed in the heart, brain, arteries, kidneys, or eyes, due to the inner ear's extreme sensitivity to blood flow.

Key findings in this study indicate that low-frequency hearing loss could be an early indicator of cerebrovascular disease (an indicator of stroke potential) or a predictor for developing cardiovascular disease. Findings were presented in 2009 at a Combined Otolaryngology Spring Meeting by David R. Friedland, MD, PhD., and published in The Laryngoscope (119:473-486, 2009).

Dr. Friedland summed up the important potential application of the study: "We propose that low-frequency hearing loss is a marker for cardiovascular disease rather than the other way around. Low-frequency hearing loss would thus represent a potential predictor of impending cardiovascular events or underlying disease. We suggest that clinicians may use the audiogram as a sensitive and reproducible screen for cardiovascular compromise".

Considering the strength of the evidence, researchers conclude that patients with an audiogram pattern of low-frequency hearing loss present a higher risk for cardiovascular events, and that appropriate referrals may be necessary, especially if they have no history of vascular compromise.

Audiologists commonly refer patients to Physicians when they suspect medical problems. These studies (and others which will be highlighted in future articles) should promote a call to action for physicians to refer more patients to Audiologists when they suspect hearing loss. Many Audiologists have AuD academic credentials, significant medical knowledge, and the advanced diagnostic equipment necessary to uncover the potential for underlying medical conditions. In any case, these and other studies suggest an increasing role for Audiologists to support the overall health of patients.

Dr Li-Korotky has AuD, PhD, and MD credentials. She is well respected as a researcher and clinician, with 20+ years of rich experience and more than 100 scientific publications.

The Doctor is particularly interested in medical aspects of hearing loss and the growing role for Audiologists to diagnose and predict the probability of underlying medical conditions.

Dr. Li-Korotky is the President of Pacific Northwest Audiology, and her LinkedIn profile can be found here,

Article Source:,_PhD,_MD/1450653

Myths About Dizziness - The Truth Behind Two of the Most Common

Myths About Dizziness - The Truth Behind Two of the Most Common

Myths About Dizziness - The Truth Behind Two of the Most Common
By Herb Silverstein, MD

Myth: I'm so dizzy; I must have had a stroke

Truth: There are many causes of dizziness, and not all are life-threatening
Benign positional vertigo (BPV) is the most common cause of dizziness. It is caused when the tiny crystals in your inner ear - those responsible for balance - break free and float around in the inner ear fluids. When the head moves in certain positions, these floaters tickle the balance cells, causing transient vertigo.

There are other causes of dizziness as well. Labyrinthitis is an inflammation of the inner ear caused by viral infection or other causes. Its symptoms, which include dizziness, usually last for several hours and then diminish.

Meniere's disease is another cause of dizziness. Although the causes of this condition are varied, the symptoms include a build up of excessive inner ear fluid, causing pressure. This results in hearing loss,
stuffiness in the ear, and debilitating recurrent vertigo spells that can last hours.

So how can you tell what is causing your dizziness? If you have BPV you will likely experience room-spinning vertigo that occurs with looking up, down or rolling over in bed and lasts a few seconds.

Labyrinthitis is marked by violent vertigo with nausea and vomiting lasting for hours. There is usually no hearing loss or other ear symptoms, and an attack may be followed by weeks of unsteadiness or temporary vertigo when rolling over in bed.

Meniere's disease is accompanied by recurrent bouts of vertigo, possible nausea, and vomiting lasting 30 minutes to hours. Meniere's disease is usually accompanied by hearing loss, pressure in the ear, and roaring or ringing in the ear.

Luckily, all of these conditions can be successfully treated. BPV is treated in the office, where a vestibular therapist performs a maneuver called the Semont Maneuver that moves the crystals away from the balance cells. Ninety percent of patients with vertigo are cured with this treatment, which occasionally it needs to be repeated.

Labyrinthitis is treated with oral medication to reduce the dizziness sensation and replacement of fluids for any associated nausea and vomiting. In severe cases, hospitalization is required to provide medications intravenously until the symptoms subside.

Meniere's disease is treated with a variety of medications and surgical procedures, all designed to help reduce the frequency of vertigo attacks. Among the medications used to treat Meniere's disease are diuretics, circulatory medication, sedatives, and steroids

Despite these possible causes of dizziness, stroke cannot be ruled out, as it is also a cause. A stroke occurs when the blood flow to the brain is interrupted and the brain cells are deprived of oxygen. There are several symptoms of stroke, including

o sudden onset of dizziness or vertigo;

o difficulty walking or loss of coordination;

o numbness or weakness of the face, arm or leg;

o confusion;

o difficulty with speech; and

o severe headache.

If any of these symptoms suddenly occur, the person should be rushed to the emergency room for evaluation and treatment. Every minute that the brain is deprived of oxygen the potential for brain damage increases, so it is imperative that a suspected stroke be evaluated by emergency room physicians immediately.

Myth: My balance is bad because I am getting old, and I'll have to live with that
Truth: Age is not a factor in maintaining healthy balance function

Your balance mechanism works like a tripod. The three arms of the tripod are the balance canals in the inner ear, eyesight, and sensations from the joints and muscles in your legs and feet. Sensory messages from three sources are sent to the brain, where they are organized into meaningful information. Based on this information your brain then sends out new messages - instructions to your muscles to maintain your balance.

There are many causes of dizziness and imbalance. Confused messages, blocked message pathways, or weakness in the brain or the tripod limbs all can cause imbalance. Other possible reasons include:

o lack of circulation to the balance area of the brain,

o drop in blood pressure when you move from sitting to standing (orthostatic hypotension),

o inner ear disorders,

o vision problems,

o diseases of the bones and joints,

o side effects of medication, and

o drug interactions.

Additionally, an irregular heart beat or heart condition and neurological diseases may cause lightheadedness, dizziness, or imbalance.

But the majority of balance problems result from dysfunction in the inner ear balance canals. And dysfunction of two tripod limbs at the same time makes it even more difficult to maintain balance.

In order to correctly diagnose the cause of your dizziness you should be evaluated by an ENT physician. This evaluation includes specialized tests that measure inner ear and balance function. In some instances, a neurologist or other specialty physicians may need to be consulted.

You can note some basic symptoms yourself and share them with your doctor, aiding in the diagnosis process:

o If your imbalance occurs only for a short time when getting out of bed or when rising from a sitting position, it can be due to a transient drop in blood pressure.

o Unsteadiness or imbalance only when walking can be related to problems in the balance center of the brain or the balance canals in the inner ear.

o Vision problems can also be a cause of dizziness or imbalance.

Sometimes there are multiples causes of dizziness, which may require more specialized treatment. But in most instances, dizziness and imbalance can be treated by initiating Vestibular Rehabilitation (VR).

VR is an individualized program of home exercises and activities designed by a therapist with specialized training in balance disorders. Prior to starting VR, your musculoskeletal system will be assessed by testing the strength, coordination, and range of motion in your arms and legs. The therapist will also observe your balance when walking.

With this information your therapist can design a program to meet your specific needs. Then your progress is monitored at regular follow-up appointments.

The goal of VR is to decrease dizziness and increase balance function, improving general daily activity levels. Remember, age is not a factor in maintaining healthy balance function!

Herbert Silverstein, MD, FACS is president and founder of the Florida Ear & Sinus Center and the Ear Research Foundation, in Sarasota, FL. He has been consistently recognized since 1979 as one the "Best Physicians in the USA." He has been a leader in Meniere's Disease treatment for more than 25 years, developing surgical and diagnostic procedures; inventing instruments (such as the Microwick); teaching medical students, residents and fellows; and helping people from all walks of life.

Article Source:,_MD

Scientists Tie Sudden Deafness To Sleep Apnea



People who have sleep related breathing disorders maybe prone to sudden deafness, new research shows. According to a report published in the Archives of Otolaryngology Head & Neck Surgery, Taiwanese scientists have found a link between sleep apnea and sudden deafness.

Taiwanese researchers investigated the association between sleep apnea and sudden hearing loss across a national population. To get their data, they used the Taiwan Longitudinal Health Insurance Database to randomly extract information from 19,152 male and female patients. Of this number, they identified 3192 patients whom had been diagnosed with sudden sensorineaural hearing loss (SSNHL), the remaining 15,960 patients did not have the disorder and thus served as controls.

Their results showed that men with sudden hearing loss were more likely to have suffered from sleep apnea than healthy men in the control group. Interestingly, researchers found no such association between sudden deafness and sleep apnea in women.

The Taiwanese scientific team said that further research into the differences between the sexes as well as the underlying mechanisms of the disorder is needed.

Sleep apnea is disorder characterized by slow and interrupted breathing patterns. It often results from too much relaxation in the throat and tongue muscles. When these muscles become too relaxed, the air passages are cut off, leading to lack of oxygen to the brain and a drop in blood pressure.

The human body is a remarkable creation of God, with all of the organs of the body interacting with each other and the external environment in complex ways. Since the brain needs oxygen to survive, oxygen deprivation could lead to life threatening consequences. Because every cell of the body needs oxygen and nutrients which are transported by the circulatory system, it's possible that lack of blood to the ears could contribute to auditory problems.  

Fortunately, sleep apnea is treatable, and people can be taught to maintain normal breathing patterns during sleep.

For more information on sleep apnea, visit the National Heart Lung and Blood Institute.


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Article Source 

Sheu, J., Wu, C., & Lin, H. (2012). Association Between Obstructive Sleep Apnea and Sudden Sensorineural Hearing Loss: A Population-Based Case-Control Study Archives of Otolaryngology - Head and Neck Surgery, 138 (1), 55-59 DOI: 10.1001/archoto.2011.227


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How Do You Define Tinnitus?

How Do You Define Tinnitus?
By Samantha Kortley

Tinnitus is the name of a little known medical condition where
an individual hears sound in their ears. People with this
condition describe hearing a ringing sound; however, others hear
a whistling sound, a humming sound, the sounds of crickets,
songs, beeping noises, tunes, whining noises, whizzing and other
odd sounds. Some people even experience a roaring sound in their
heads which can become very annoying as well as distracting.

So I guess the best Tinnitus definition would be a condition
that at its mildest is an annoying ringing in your ears that
comes and goes, all the way up to a full blown crisis with
painful, constant, nagging noise that takes over your quality of
life and makes it miserable.

Tinnitus can become a lot more than just annoying, it can
change your life. Some patients suffer from Tinnitus to such a
degree that they can no longer live a normal life. These sounds
can be heard quietly, like background music, or it can be so
loud that it interferes with your hearing of normal external
sounds and can be extremely painful. It goes on and on and
sometimes it gets so bad you just want to scream.

Tinnitus can sometimes be heard by a doctor, in other words,
the sounds can be heard outside the patient's body. This type of
Tinnitus is usually due to an unrelated outside medical
condition. Tinnitus can be a symptom from other medical
problems, and it can help diagnose those problems you don't know
you have. Tinnitus can also occur or become more prominent when
an individual has a fever or a non-ear related medical

The most common causes of Tinnitus start with infections of the
ear (both inner and middle ear infections), the placement of
foreign objects within the ear, excessive wax build up, nasal
allergies which affect the amount of fluid in the ear and taking
too much of some medications, such as aspirin. Interestingly, a
low Serotonin (hormone) level can cause Tinnitus, as well as
major depression.

Tinnitus can also be caused by Cochlea damage. The Cochlea has
this tinny hair like things that help send sound to the brain,
and it helps keep us upright. Swimming accidents, sports
injuries, dental surgery, allergies and sinus infections can
cause it as well. Tinnitus is more common than one might think.
A study has been done on a group of Tinnitus-free individuals
that showed that almost 95 percent were able to hear a pulsing,
buzzing or whistling noise when placed in a silent chamber.

There is an epidemic of hearing damage in the US due to
exposure to high levels of noise, and noise is the second most
common cause of Tinnitus. The noises can come from many
different sources, like your favorite concert, or musical act.
It can come from a noise source on the job, like in Industrial
occupations. Thanks to OSHA, the Occupational Safety & Health
Administration, most industrial work places furnish some form of
ear protection, but not all. Just guard your hearing, it's

About the Author: Samantha Kortley, now cured, enjoys helping
others find relief from Tinnitus. Her new book, Ear
Ringing...Tinnitus Answers, enlightens sufferers with everything
they need to know about Tinnitus and the ear ringing that for
some has yet to stop. Catch her at;


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What is Auditory Processing Disorder (APD) or Central Auditory Processing Disorder (CAPD)?

What is Auditory Processing Disorder (APD) or Central Auditory
Processing Disorder (CAPD)?
By Guennadi Moukine

Auditory Processing Disorder can be defined as difficulties in
the perceptual processing of auditory information by the Central
Nervous System. Put simply APD is a deficit in the neural
processing of auditory information. The child has normal hearing
but experiences difficulty in discriminating, processing and
understanding sound signals. Difficulties discriminating between
speech and noise /sounds are a common experience for the child
with APD. Auditory processing disorder can often go undetected
but can significantly impact a child's ability to cope with the
language requirements of a classroom and to develop essential
reading and writing skills. Typically a child with APD copes
well in a one to one context but experiences difficulty in large
classroom environments.

Signs of Auditory Processing Disorder

APD can even impact the child's ability to socialize and follow
conversations. Typically a person with Auditory Processing
Disorder may experience difficulties in the following:

Children with APD may exhibit:
* Short attention span
* Difficulty following instructions
* Easy distraction
* May be noise sensitive or reactive to loud noises eg. Vacuum
* May be overwhelmed by very noisy environments

School-aged children with APD may exhibit:
* Difficulty following complex verbal directions
* Spelling and reading difficulties
* Language delay / disorder
* Poor sound / phonological awareness needed for literacy
skills (reading and writing)
* Difficulty maintaining attention to auditory information
* Frustration and distractibility
* Difficulty with sound localization
* Difficulty following the flow of discussions
* Difficulty listening / comprehending when there is background
* Difficulties with short term auditory memory

Facts about Auditory Processing Disorder

* Boys are 3 times more likely to have auditory processing
disorder than girls
* Almost 75% of children with APD have had a speech or language
* Children with APD often have a history of middle ear
infections (otitis media)
* A child with Auditory Processing Disorder does not have an
intellectual or cognitive problem

What to do?

Consult an audiologist or speech pathologist in your area. An
Audiologist can only conclusively diagnose Auditory Processing
Disorder however Speech Pathologists do have an important role
in supporting diagnosis and some forms on intervention
particularly relating to language processing and literacy.

Treatment of Auditory Processing Disorder

Depending on the type of difficulty that your child is
experiencing will indicate the treatment approach.

Environmental Strategies
* Seat the child close to the teacher and at the front of the
classroom (within 3 meters to teacher)
* Seat the child away from distracting noise such as fans,
heaters and open windows
* Improving the acoustic environment of the classroom to reduce
the reverberation of noise and reduce the amount of background

Carpet on floors
* Teachers to face the students when giving instructions and
write keywords on the board.
* Teachers to check and clarify if the student has heard and
understood instructions
* Give the child a 'listening buddy' who they can use to check
their understanding of instructions

Listening Devices

If recommended by the audiologist and or speech pathologist a
listening device may assist. A listening device reduces the
interference of noise between the speaker and listener.

Speech Therapy

A speech pathologist can help your child develop skills
important for the development of literacy / listening skills
that are frequently affected by auditory processing
difficulties. A speech pathologist will treat skills such as:
* Developing listening skills
* Identification of sounds, discriminating between sounds,
breaking words into sounds, blending sounds and identifying
rhyming words.

About the Author: For more information about Auditory
Processing Disorder, visit
Guennadi M (AusBusiness Review, Editor)


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