Do you have difficulty catching words in a conversation or on TV? Do you have to ask people to repeat themselves? Perhaps you’ve even started avoiding certain social gatherings. If so, you’re probably suffering from hearing loss. This common problem affects a third of people who are 65 and older, and half of people over age 75.
Hearing loss can result from exposure to loud noise over time—a jackhammer if you’re in construction, rock concerts if you’re an ardent fan. Prolonged exposure to loud noise damages the sensitive nerves in your inner ear. It can also be a side effect of some medications, or the result of infections such as meningitis or measles. Even simple things, such as using a Q-tip to clean your ear, can rupture your eardrum and damage your hearing. Your age, of course, and your family history also put you at risk.
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.
“I became an ear, nose and throat specialist because I wanted to take care of people of all ages, from infants to people a century old,” says Dr. Gersten.
As an ENT specialist, Dr. Gersten treats a variety of conditions, from sleep disorders to sinusitis. He values all the medical and surgical options he can use to treat his patients, depending on their desires and what is most appropriate for their condition. “One of the most rewarding things for me about being a doctor is the friendships that I develop,” says Dr. Gersten, “and having the opportunity to meet my patients’ kids, and their kids’ kids.”
Dr. Gersten practices out of PAMF’s Fremont and Dublin Centers. Learn more about him in this video, which is part of a series highlighting the diverse voices of PAMF physicians.
“I leave the waves to my patients,” said Douglas Hetzler, M.D., FACS, an ear, nose and throat specialist at Palo Alto Medical Foundation Santa Cruz. But while surfing holds no allure for him personally, Dr. Hetzler, whose peers have dubbed him “Michelangelo of the Ear Canal,” has spent years perfecting a surgical technique to treat “surfer’s ear”-a serious auditory condition that robs surfers and kayakers of their hearing and, eventually, their sport.
Read More about PAMF Doctor Pioneers, Perfects World Famous Fix for “Surfer’s Ear”