Tinnitus: What’s That Ring?
What’s that sound? Is it the ringing of sleigh bells or is it all in your head?
At some point in their lives, many people experience a ringing, buzzing, hissing or other similar sound in their ears that isn’t audible to anyone else. This is called tinnitus, and it’s one of the most common clinical conditions in the United States.
The American Tinnitus Association reports that approximately 50 million people have tinnitus. For most people, tinnitus is transient and minimally bothersome, but 20 million people will be so bothered by the condition that they will seek medical advice. Some of these patients may turn to tinnitus retraining therapy (TRT), which targets both the neural and perceptual (psychological) aspects of chronic tinnitus.
While it’s difficult to determine all tinnitus causes, the most common one is noise exposure, such as listening to loud music, or being around explosions or firearms. In these cases tinnitus may occur with or without hearing loss.
Other possible causes of tinnitus include impacted earwax, high doses of aspirin, certain antibiotics, jaw misalignment, Ménière’s disease (a disorder of the inner ear that can affect hearing and balance), head injury or, in rare cases, a tumor on the auditory nerve (which carries signals from the inner ear to the brain).
Some tinnitus or perceived noise is normal. For example, in a soundproof booth a person would likely become more aware of these “head sounds” because they aren’t drowned out by outside noises. For this reason these sounds are more evident during an ear infection or when fluids block the ear canal and muffle outside noises.
Someone experiencing “pulsatile tinnitus,” when the sound is like a pulse or heartbeat in the ear, may have a vascular or middle ear issue and should see an audiology specialist as well as an ear, nose and throat (ENT) specialist. Someone experiencing tinnitus that isn’t pulsatile, or is related to sudden hearing loss or impacted earwax, should see an audiology specialist who can help determine the cause and arrange referrals as needed.
Many tinnitus treatments are available, and they differ depending on the cause of the condition. These range from medication to electrical stimulation and surgery. These treatments offer varying degrees of success in addressing the neural component of tinnitus.
In some cases, however, the condition may also have an important perceptual or psychological component. Chronic tinnitus may lead to depression, anxiety and insomnia in some patients. In these situations, TRT may provide the best results.
The goal of TRT is habituation, or a change in the patient’s perception of tinnitus at both a conscious and subconscious level. This treatment targets both the neural and perceptual components of tinnitus through use of sound generators and directive counseling.
During TRT, a patient receives a tinnitus assessment, counseling and treatment using U.S. Food and Drug Administration (FDA)-approved devices. These devices may include ear-level amplification, sound generators or units providing a combination of these approaches. TRT is a several-month process that includes the use of these devices in combination with counseling.
Tinnitus is a very common condition, and its causes and symptoms are wide-ranging. In some cases the condition can be chronic and uncomfortable. Luckily TRT and other medical treatments are available to provide relief.
This blog post was contributed by Amy Nelson, doctor of audiology (Au.D.), Palo Alto Medical Foundation.
What Is Celiac Disease?
What’s all the talk these days about gluten free food and gluten free diets?
Gluten is a protein found in foods containing wheat, barley or rye. The consumption of gluten by susceptible individuals causes celiac disease, which affects the digestive system. People with celiac disease who eat foods containing gluten experience an immune reaction that damages the lining of their small intestines. This damage interferes with the intestines’ ability to absorb certain nutrients. Over time this can deprive many of the vital organs of important nourishment.
The most common symptoms of celiac disease are abdominal pain, vomiting, bloating and diarrhea. Less common symptoms are depression, irritability, joint pains, upset stomach, cramps, rashes and weight loss. Infants and young children seem to have more of the digestive symptoms than do adults. Read More about What Is Celiac Disease?
ABCDEFs of Vitamin Supplements
Vitamins are compounds that are essential for our bodies to function properly. They cannot be made by the human body, and so we need to obtain them through the foods we eat in a healthy and balanced diet. Many people have questions about vitamin supplements – and wonder whether they should take them or not. In this blog post, I will offer some answers to frequently asked questions on a few of the more common vitamin supplements.
- Vitamin A: Food sources include liver, milk, egg yolk and butter. Vegetarians do not need to take vitamin A supplements if they eat an adequate variety of vegetables containing carotenoids. Supplementation is only recommended by the World Health Organization (WHO) to prevent blindness in underserved countries. Most people should avoid vitamin A, since higher intake, specifically retinol, increases risk of osteopenia (bone thinning) and fractures, and can be harmful to the fetus at doses starting at 10,000 units per day.
- Vitamin Bs: B2 (riboflavin) and B6 (pyridoxine) supplements are generally not shown to be of benefit and they are usually obtained through a person’s diet. B12 (cobalamin) is the more important B vitamin and deficiency can be due to poor absorption and inadequate intake of vitamin B 12 containing food sources which include liver, milk, fish and meat. Vitamin B12 deficiency can also be seen among people who follow a vegan diet. Severe deficiency causes neurological disease and anemia. Less severe deficiency, even without anemia, is associated with dementia, low cognitive function, and possibly poor balance. B12 deficiency is an important cause of high homocysteine levels, especially in the elderly, and this can be associated with osteoporosis. There is no benefit for healthy people taking B12.
- Vitamin C: Vitamin C plays a minor role in preventing the common cold specifically for people engaging in high-intensity physical activity in extreme cold weather. Otherwise, there are no additional benefits found with vitamin C supplementation. In my own experience, it does seem to have some benefit in shortening the duration of colds and there is some evidence to support that.
- Vitamin D: The benefit of vitamin D supplementation is mainly seen in older adults, who should be taking the equivalent of at least 800 units daily. Vitamin D deficiency or insufficiency is extremely common and can contribute to the development of osteoporosis, falls and fractures. Individuals who are especially at risk are those who live in institutions (nursing homes, etc.), are being evaluated for osteoporosis, and in patients with problems with gastrointestinal malabsorption such as those with Crohn’s disease. The Institute of Medicine has defined the upper limit for vitamin D supplementation as 4000 units daily. The true benefits of vitamin D supplementation in young, healthy adults have yet to be proven. It is recommended for older adults.
- Vitamin E: I recommend avoiding vitamin E since no studies show benefit, and doses of 400 or more units per day have been associated with death from all causes.
- Vitamin F (Folic Acid): The only well-established benefit of vitamin F is taking it during pregnancy to prevent neural tube deficits in the developing child. Recommended dose is 400-800 micrograms per day.
- Multivitamins: There is no evidence that routine multivitamin supplementation prevents chronic diseases in healthy adults. Consider taking a multivitamin in cases of alcoholism, malabsorption, a vegan diet, a history of gastric bypass surgery, or other chronic health conditions which may require vitamin supplementation. Parents of children should consult with a pediatrician to determine specific needs.
- Vegetarians & Vitamin Supplements: If you are a vegetarian, vitamin B12 is the most important supplement to consider. An individual can supplement B12 at a recommended daily allowance (RDA) of 2.4 micrograms daily.
You can learn more about nutrition and healthy eating on the Palo Alto Medical Foundation (PAMF) Nutrition website and on PAMF’s South Asian nutrition and healthy eating website.
Ronesh (Ron) Sinha, M.D.
This blog post is contributed by Ronesh (Ron) Sinha, M.D., PAMF Internal Medicine. Dr. Sinha works closely with the South Asian community to help reduce heart disease and diabetes risk, and provides corporate health lectures to promote wellness in the workplace. Dr. Sinha holds clinical faculty positions at the University of California, Los Angeles; Stanford University School of Medicine, and the University of California, San Francisco School of Medicine. He teaches Stanford and UCSF medical students.
Holiday Eating Can Be Healthy
Yes, Virginia, you can keep a healthy diet during the holidays, even when sugar plum fairies are dancing in your head.
The trick? Don’t deprive yourself – have a little of your favorite treats and still maintain good overall nutrition. In this video, Linda Shiue, M.D., shares her top tips for healthy eating during the holidays, including:
- Don’t deprive yourself
- Pre-eat: have some fruit before the party
- Chose foods carefully
- Drink in moderation
- Don’t forget to exercise
- Get enough sleep
A Trusted Partner
Neurosurgeon Stephen Ryu, M.D., makes every effort to stay abreast of his challenging field of medicine. “Neurosurgery is an amazing specialty that requires treatment of simple to very complex problems,” Dr. Ryu says. “There is never a dull day at work for me. It’s a challenge to stay on top of all the developments and technologies, but I feel I owe it to my patients to do so.”
While he is dedicated to the science of neurosurgery, he feels strongly about the personal connection he has with his patients. “People often come to me with concerns about their health, having been diagnosed with a condition of the brain or spine,” he says, “so my first job is to understand their feelings before I even address what brought them in.” Often his patients can be treated with non-surgical options. When surgery is required, trust is paramount. “I want my patients to know that my care team and I will be there for them through the journey,” Dr. Ryu says in this video, which is part of a series highlighting the diverse voices of PAMF physicians.
Stay Connected!
