New Webpage on Cochlear Hydrops

Sense of ear fullness or clogging is one of the most common reasons to see an ENT. Common causes of such a symptom include eustachian tube dysfunction, sudden sensorineural hearing loss, or fluid in the middle ear. However, cochlear hydrops is another potential, but rare cause for ear fullness.

Other symptoms that a patient with cochlear hydrops may exhibit include:

• roaring sound in the ear
• fluctuating hearing loss
• noise sensitivity
• speech/sound distortion

A new webpage has been written regarding this problem and treatment for it.

Check it out here!

Movie Sets are Dangerous to Ears!

First it was Maggie Q, and now I learn that there are other celebrities with hearing loss due to movie set loud noise exposure.

Leonard Nimoy (Spock of Star Trek fame) suffers from right ear tinnitus due to hearing damage from a special effects explosion during filming of Star Trek episode “Arena”.

Similarly, Steve Martin suffers from tinnitus due to hearing damage sustained during filming of a pistol-shooting scene for “¡Three Amigos!” in 1986.

Here is a full list of celebrities with hearing problems.

Do Cell Phones Pose a Health Hazard? Do Cell Phone Companies Know About Them?

With all the recent news about increased glucose metabolism in the area of the brain in proximity to cell phone antennas (study abstract here), I thought it worth re-printing this blog article I wrote back in November 2010 regarding the possibility that cell phone makers may know more about health risks associated with cell phone use than they may be letting on. There’s another blog article I wrote regarding what studies ARE already out there regarding risk of developing brain tumors that I felt worth re-printing below as well.

It is true that some people may find this recent research good news for some young people as it may be the only stimulation their brain gets (joking!), but it does bring some additional concerns that may merit limiting cell phone use as well as how it is used.

I quote (myself)…

Recently, there has been much speculation on whether cell phones pose a health risk.

What I find interesting is that the cell phone makers may actually know more about these risks than they are letting on or even have evidence for them.

If you look in the small print booklet that comes with your cell phone, cell phone makers state that phones should not be in contact with your body or skin and should be kept a certain distance away when in use or when carrying around. The picture of how the Verizon ad guy is using the cell phone is exactly how you are NOT supposed to use the cell phone (cell phone pressed against the face).

For example, in the iPhone 4 small print booklet that comes in the box with the phone, go to page 5 under the section “Exposure to Radio Frequency Energy.” I quote:

“When using iPhone near your body for voice calls or for wireless data transmission over a cellular network, keep iPhone at least 15 mm (5/8 inch) away from the body, and only use carrying cases, belt clips, or holders that do not have metal parts and that maintain at least 15 mm (5/8 inch) separation between iPhone and the body.”

Now, when I use a phone and answer a call, I have the phone right up against my ear just like the Verizon ad guy. I do not keep it 5/8 inch away from my ear/head.

Now why would a cell phone maker care whether the phone is right up against the ear (so you can hear better) or not unless there is some concern that there may be a danger due to proximity/contact?

Perhaps they are protecting themselves from any possible lawsuit that may occur in the future due to health problems that will occur with phone use over time?

Kind of reminds me of the tobacco industry who for years denied that smoking posed any health risk. Now we know better.

It would be ironic if Paul Marcarelli, the actor of the “Verizon Guy” character, develops a brain tumor due to cell phone use and sues the wireless industry just like the family of David McLean, the actor of the “Malboro Man,” sued the tobacco industry for wrongful death when he developed and died from lung cancer caused by smoking.

Something to think about…

So are there studies out there suggesting that cell phones and wireless phones can lead to brain tumors like astrocytoma, malignant gliomas, and benign acoustic neuromas? Several studies published since 2009 containing long-term (10+ years) follow-up have lent support that it does.

The group at greatest risk for development of brain tumors have the following characteristics:

1) Use of cell/wireless phone younger than age 20 (the younger the age with first use, the worse the risk)
2) Use of cell/wireless phone for more than 10 years
3) The more hours of cellular phone use over time, the higher the risk of developing brain tumors
4) Risk higher with analog cell/wireless phones (instead of digital)
5) Risk higher with increased overall total exposure

By some estimates, subjects who used cell phones for at least 10 years had a 2.4-fold greater risk of developing a brain tumor.

Though unclear how exposure to a phone’s microwave radiation leads to brain tumors, it is known that the cell signal is absorbed up to 2 inches into the adult skull. Even more worrisome is that the depth of penetration is even deeper in children.

The risk is not just to the brain, but even the parotid gland which sits just in front of the ear. In one study published in 2008 revealed an increased risk of parotid gland tumors with cell phone use. Also, contact allergy is another not uncommon risk with cell phone use.

Symptoms that a patient may exhibit that may suggest a brain tumor are subtle and include hearing loss or ringing of the ear on the same side the phone is used on.

It should be noted that all currently published results are based on retrospective studies and ideally, prospective studies will be required to provide more definitive results. However, that will take a long time and perseverance on both the researchers as well as the subjects since ideally, many of the study subjects should be children who are currently using cell phones (which it seems to be nearly all kids nowadays).

In any case, to be on the safe side, it is recommended to talk on speakerphone or use a wired headset (not wireless), or avoid altogether if at all possible, especially in children.

References:
Effects of cell phone radiofrequency signal exposure on brain glucose metabolism. JAMA. 2011 Feb 23;305(8):808-13.

Risk of Brain Tumors From Wireless Phone Use. Journal of Computer Assisted Tomography, 2010; 34 (6): 799 DOI: 10.1097/RCT.0b013e3181ed9b54

Cell phones and brain tumors: a review including the long-term epidemiologic data. Surg Neurol. 2009 Sep;72(3):205-14; discussion 214-5. Epub 2009 Mar 27.

Mobile phones, cordless phones and the risk for brain tumours. Int J Oncol. 2009 Jul;35(1):5-17.

Cell phone use and acoustic neuroma: the need for standardized questionnaires and access to industry data. Surg Neurol. 2009 Sep;72(3):216-22; discussion 222. Epub 2009 Mar 27.

Cellular phone use and risk of benign and malignant parotid gland tumors–a nationwide case-control study. Am J Epidemiol. 2008 Feb 15;167(4):457-67. Epub 2007 Dec 6.

http://rcm.amazon.com/e/cm?t=fauentcon-20&o=1&p=8&l=bpl&asins=B001NZ8PHQ&fc1=000000&IS2=1&lt1=_blank&m=amazon&lc1=0000FF&bc1=000000&bg1=FFFFFF&f=ifr

Wireless and Cell Phones Increase Risk of Brain Tumors

In an ongoing controversy regarding whether cell phones and wireless phones can lead to brain tumors like astrocytoma, malignant gliomas, and benign acoustic neuromas, several recent studies published since 2009 containing long-term (10+ years) follow-up have lent support that it does.

The group at greatest risk for development of brain tumors have the following characteristics:

1) Use of cell/wireless phone younger than age 20 (the younger the age with first use, the worse the risk)
2) Use of cell/wireless phone for more than 10 years
3) The more hours of cellular phone use over time, the higher the risk of developing brain tumors
4) Risk higher with analog cell/wireless phones (instead of digital)
5) Risk higher with increased overall total exposure

By some estimates, subjects who used cell phones for at least 10 years had a 2.4-fold greater risk of developing a brain tumor.

Though unclear how exposure to a phone’s microwave radiation leads to brain tumors, it is known that the cell signal is absorbed up to 2 inches into the adult skull. Even more worrisome is that the depth of penetration is even deeper in children.

The risk is not just to the brain, but even the parotid gland which sits just in front of the ear. In one study published in 2008 revealed an increased risk of parotid gland tumors with cell phone use. Also, contact allergy is another not uncommon risk with cell phone use.

Symptoms that a patient may exhibit that may suggest a brain tumor are subtle and include hearing loss or ringing of the ear on the same side the phone is used on.

It is interesting to note that it is just possible that the cell phone industry is aware of these risks even as it denies any risk of health problems with phone use. If you look in the small print booklet that comes with your cell phone, cell phone makers state that phones should not be in contact with your body or skin and should be kept a certain distance away when in use or when carrying around. Read more about this here.

However, all currently published results are based on retrospective studies and ideally, prospective studies will be required to provide more definitive results. However, that will take a long-time and perseverance on both the researchers as well as the subjects, since ideally, many of the study subjects should be children who are currently using cell phones.

In any case, to be on the safe side, it is recommended to talk on speakerphone or use a wired headset (not wireless), or avoid altogether if at all possible.

References:
Risk of Brain Tumors From Wireless Phone Use. Journal of Computer Assisted Tomography, 2010; 34 (6): 799 DOI: 10.1097/RCT.0b013e3181ed9b54

Cell phones and brain tumors: a review including the long-term epidemiologic data. Surg Neurol. 2009 Sep;72(3):205-14; discussion 214-5. Epub 2009 Mar 27.

Mobile phones, cordless phones and the risk for brain tumours. Int J Oncol. 2009 Jul;35(1):5-17.

Cell phone use and acoustic neuroma: the need for standardized questionnaires and access to industry data. Surg Neurol. 2009 Sep;72(3):216-22; discussion 222. Epub 2009 Mar 27.

Cellular phone use and risk of benign and malignant parotid gland tumors–a nationwide case-control study. Am J Epidemiol. 2008 Feb 15;167(4):457-67. Epub 2007 Dec 6.

Will.i.am Suffers From Tinnitus

And yet another celebrity reports suffering from bad tinnitus or ringing of the ears. Black Eyed Peas’ Will.i.am spoke with Britain’s the Sun stating that the only time it doesn’t bother him is when there’s loud music. Read the news report here.

Prevention is by far the best way to avoid suffering from this debilitating condition. How does one prevent this problem? Protect your ears from loud noises!!! Wear ear plugs if loud noise exposure is unavoidable.

Unfortunately for Will.i.am who is a hip-hop star with the Black Eyed Peas, his tinnitus is likely due to loud noise exposure from his music… an unfortunate job hazard of his profession.

If you are a musician and loud noise exposure is unavoidable, get Musician’s Ear Plugs through our office which can help reduce noise exposure while maintaining music fidelity.

If you already have tinnitus, click here for more info on treatment options.

Read the news report here.

Caffeine Can Cause ENT Problems

After reading an interesting article in Forbes that described caffeine as a natural pesticide (for real!), I thought I would pipe in and report the types of problems caffeine can cause in humans from an ENT perpective…

Caffiene can contribute to (some proven, some suspected, some debatable):

• Tinnitus
• Meniere’s Disease
• Migraine Headaches
• Headaches
• Dizziness
• Reflux
• Lump in Throat Sensation (Globus)
• Chronic throat clearing
• Dry throat
• Phlegmy throat

Alcohol and salt are other big as well as under-recognized items that may cause similar ENT issues.

WP Medical Mystery: Sudden Hearing Loss

The Washington Post on 7/27/10 published a story in its Medical Mystery segment describing a patient who had sudden onset of hearing loss in one ear with tinnitus (or buzzing in the ear). This sudden hearing loss is known as sudden sensorineural hearing loss and is considered an urgent issue for which a patient needs to see an ENT as soon as possible.

Why? Because treatment is effective only if given within 4 weeks of hearing loss onset. Treatment is with either high dose prednisone and/or steroid injection directly into the affected ear, a procedure known as intratympanic steroid injection.

Read the Washington Post article here.

Read more about sudden hearing loss here.

Of note, our office provides both forms of treatment.

Bursts of Fast Irregular Clicking Noise in the Ear

Every once in awhile, I see a patient who complains of an irregular clicking noise in the ear that occurs in bursts and may last anywhere from a few minutes every few days to as long as days or weeks at a time.

Click…. click… click, click, click… 

CLICK… click, click… 

click… Click Click… click… … … … CLICK

These irregular clicking noises in the ear should NOT be confused with tinnitus. Rather, irregular clicking noises in the ear are almost always due to muscle spasms… just like “eye twitching” or “facial twitching”. BUT, instead of being able to “see” the twitching as with eye twitching, one hears the twitching instead since the muscles are located around or in the ear.

1) Palatal Myoclonus
2) Tensor tympani muscle spasms
3) Stapedius muscle spasms

The first potential cause (palatal myoclonus) can be diagnosed by seeing “spasms” of the soft palate that occurs in time with the clicking. Spasms of the soft palate can be visualized by simply looking in the mouth or by nasal endoscopy. Click here to watch a video of these spasms.

The reason one is able to “hear” the twitching is because the muscles of the soft palate extend up into the ear via the eustachian tube.

Treatment of palatal myoclonus is by botox injections to the muscles that are twitching.

Just like botox treatment anywhere else in the body, the effects are only temporary and needs to be repeated every 3-6 months.

Regarding tensor tympani and stapedius muscle spasms… these muscle are not able to be visualized as they are located within the middle ear. The tensor tympani attaches to the malleus ossicle (the “hammer” of the 3 middle ear bones) and the stapedius muscle attaches to the stapes ossicle (the “stirrup”).

Image taken from wikipedia.

Just like any muscle in the body, these muscles can also “twitch” rapidly causing the clicking noise in the ear.

Unfortunately, there is no “test” once can obtain to diagnose this problem with absolute certainty. It is based purely on history and excluding palatal myoclonus as a diagnosis (no soft palate twitching seen even though the patient is able to hear it).

Even more unfortunately, the only way this problem can be treated is surgical… the muscle gets cut. Botox can not be utilized as one needs to be able to “see” or “feel” the muscle in order to inject botox. This surgery is performed by a neuro-otologic surgeon.

See the full list of surgeons who can perform this surgery here.

Read more about this problem here.

Pulsatile Tinnitus Caused by Ear Tumor (Glomus Tympanicum)

The New England Journal of Medicine published a case report in June 2010 titled “Glomus Tympanicum” where a woman with a right pulsatile tinnitus is described. The pulsatile tinnitus was due to a tumor called glomus tympanicum.

The article includes a picture as well as video. If you watch the video carefully, you can actually “see” the pulsations.

The only way to treat this tumor is surgical excision by a neuro-otologic surgeon.

Read more about pulsatile tinnitus in general here.

WP: Anatomy of Tinnitus

I recently came across this interesting webpage published by the Washington Post describing the biological pathways that results in tinnitus or ringing of the ears, complete with pictures.

It also describes how we “hear” which is actually not with our ears, but with our brains.

Tinnitus is becoming a much more common problem with loud noise exposure whether via military service in the Gulf from all the gunfire and explosions or listening to personal music players (iPod) too loudly.

Click here to read more about it.