tinnitus relief

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Our Johns Hopkins specialist explains the condition and offers tips for tinnitus relief.

An old Irving Berlin song begins with the lyrics, “I hear music and there’s no one there.” When the speaker wonders why, he’s told, “You’re not sick. You’re just in love.” A lovely and romantic notion. But for the millions of people that suffer from tinnitus, the sounds that occur only inside their own head can cause great stress and anxiety, even interfering with their sleep and daily activities.

An estimated 50 million American adults have experienced tinnitus at some time, and one in five of those with tinnitus seek medical attention. It is most common among the elderly and is listed as the most common service-related disability among military veterans—tinnitus is believed to be linked to long-term noise exposure, such as that caused by firearms or loud music.

What is tinnitus?
Tinnitus is the clinical name for ringing in the ears, but it can also include other phantom sounds like buzzing, clicking, hissing, whooshing and pulsating, for which there are no apparent external sources. There are two types: primary tinnitus has no obvious cause and is often associated with hearing loss, while secondary tinnitus is associated with an underlying disease or condition and may also be accompanied by hearing loss. The American Tinnitus Association lists a variety of causes for this condition that include:

  • damage to nerve endings and stiffening of bones in the inner ear
  • advancing age
  • exposure to loud noises
  • allergies
  • high or low blood pressure
  • diabetes
  • thyroid problems
  • wax buildup
  • certain medications
  • head and neck tumors.

Johns Hopkins pediatric otolaryngologist David Tunkel, M.D., led a panel to develop guidelines to help primary care physicians and specialists treat and manage tinnitus (October 2014 issue of Otolaryngology—Head and Neck Surgery). The following information and suggestions come from the guidelines published by Dr. Tunkel’s committee and from the American Tinnitus Association.

What should I do if I think I have tinnitus?
Have your doctor diagnose your condition by reviewing your medical history and giving you a physical exam to rule out other possible conditions. He or she will look inside your ear canal and may find a treatable cause, such as earwax or fluid behind the eardrum. You should also have a hearing test to see if hearing loss is accompanying the tinnitus.

What treatments are available?
Tinnitus may go away on its own, but when it lasts for more than six months, and when tinnitus is bothersome, one or more of the following may be helpful:

  • Hearing aids can make the tinnitus less noticeable.
  • Cochlear implants may help mask tinnitus with ambient sounds or suppress tinnitus with the electrical stimulation they send through the auditory nerve.
  • Counseling and cognitive behavioral therapy can teach people how to cope to reduce the impact of the tinnitus.
  • A variety of sound therapy devices and methods may help. Such therapies range from devices that supply background noise such as a smart phone, CD or MP3 player or radio, to specialized devices made just for the treatment of tinnitus.
  • Treatment by a dentist to correct your bite can bring relief if you suffer from a dysfunction of the jaw known as TMJ (temporomandibular joint).
  • There is no convincing clinical evidence to prove that products such as Ginkgo Biloba, melatonin or zinc help patients with tinnitus. Similarly, there is no proof that medications injected through the eardrum, magnetic stimulation or acupuncture can improve tinnitus.

 

Where can I find help if I have tinnitus? Your doctor can provide information and suggest self-help books. Support associations and resources are also available. For more information, visit the American Tinnitus Association, the American Academy of Otolaryngology-Head and Neck Surgery and National Institutes of Health.

 

Johns Hopkins pediatric otolaryngologist David Tunkel, M.D.

 


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257937032_14920719b3_zThis year marks the 50th anniversary of the Older Americans Act (OAA). The OAA, initially passed in 1965, supports a wide range of home and community-based services that promote healthy aging and independence. These programs and services such as Meals-on-Wheels, caregiver support, job training and elder abuse protection are vital because the population in the United States is growing older. This May in honor of the anniversary of OAA, the Administration for Community Living’s theme for Older Americans Month is “Get into the Act.”

Senior Citizens Month, now called Older Americans Month, was established in 1963 after a meeting between President Kennedy and the National Council of Senior Citizens. Since then every president has issued a formal proclamation asking Americans to pay tribute to older citizens in their community. According to the Census Bureau’s Facts for Features series on Older Americans Month there were 44.7 million people older than 65 years of age on July 1, 2013. By the year 2033 the population 65 years of age and older will outnumber people younger than age 18, in the United States, for the first time.

This year’s theme, “Get into the Act,” empowers us to raise awareness of opportunities to maintain and enhance the quality of life for the population aged 65 and older. We can do this by encouraging our older citizens to participate in their communities in an active way. One way older Americans can connect with people in the community and make a difference in the lives of others is by volunteering. Howard County Library System and Howard County Hospital: A Member of Johns Hopkins Medicine have volunteer opportunities to help keep older adults engaged and involved. In addition the Volunteer Center Serving Howard County (VCSHC) can connect citizens with local non-profit and governmental agencies looking for volunteers. There is a growing body of research that shows an association between volunteering and mental and health benefits. These benefits may include greater levels of well-being and increased strength and energy. Volunteering may even help you live longer!

Another way older people can connect with people in the community is by taking advantage of the wide variety of programs and services offered at any of the six Howard County Senior Centers. The new fitness center at the Ellicott City 50+ Center, located adjacent to the HCLS’s Miller Branch, just opened. Stop by and see the spacious lobby, reception area, classroom, group exercise room, and equipment room. The facility has much to offer.

I’m lucky to have both my parents still living, and to live in a wonderful neighborhood surrounded by many retirees. I feel my children have benefited from these intergenerational connections. President Obama said in his proclamation, “During Older Americans Month, we lift up all those whose life’s work has made ours a little easier, and we recommit to showing them the fullest care, support, and respect of a grateful Nation.”

Please, take an extra moment this May to celebrate and recognize the older people in your life, and in your community. Also, say “thank you” to all those who care for and work with the older population. You will be glad you did, and you just might make someone’s day.

Nancy Targett is an Instructor & Research Specialist at the Miller Branch. She lives in Columbia and is the proud mom of three boys and a girl and a Siamese cat.

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girl in field with allergies

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To help you survive this allergy season, HCGH allergist and immunologist Dr. Michael Goldman answers your allergy questions:

Q: What are some tips to survive allergy season?
Most people should expect to be able to manage their allergies through environmental control and medications. Trees in this area typically begin pollinating in March and continue through early June while grasses pollinate in May and continue through early July. Weeds, such as ragweed, start in mid-August and continue through October. To control pollen allergies: keep the pollen out by closing your windows during allergy season. Keeping the windows closed is better than installing an air filter. Also, take a shower before going to bed to remove allergens that have accumulated during the day on your hair and body.

Q: What medicines can help my allergies?
Medications called antihistamines block histamine that is produced by the body in response to allergens or irritants, and relieve a runny nose, sneezing, itchy nose and/or eyes. There are several long-acting, over-the-counter antihistamines available. Decongestants can help with nasal congestion, but should not be used in young children or in adults with hypertension, enlarged prostate or narrow angle glaucoma. Antihistamine eye drops can soothe itchy eyes. Nasal steroids are very good at treating nasal symptoms of allergies, but must be used every day and can take more than a week to reach maximum effect. I recommend avoiding nasal and eye decongestants, which can become addictive.

Q: At what point should I see an allergist?
If controlling your environment and medications are not enough to help your allergies, it is probably time to see the allergist. A board-certified allergist can accurately diagnose what you are allergic to and interpret tests in the context of your symptoms. Based on the testing, other environmental measures to control allergen exposure might be suggested or different medications might be prescribed. If symptoms persist, allergen immunotherapy, or desensitization, may be recommended. Immunotherapy now comes in two forms: allergy injections (allergy shots) and sublingual immunotherapy (drops or tablets under the tongue).

Q: Can my allergies lead to sinus infections?
Allergies can increase the risk of upper respiratory tract infections including recurrent sinus and ear infections. You may wish to consider testing to see if allergies are contributing to these conditions in you or your child.

Q: What are the pros/cons of steroid nasal spray?
Nasal steroids are very effective at controlling nasal symptoms of allergies. There is a small risk of growth effects in children and this should be monitored. A small percentage of patients are intolerant of nasal steroids due to nosebleeds. If you experience bleeding, you should stop the nose spray.

Q: What is the effectiveness of a saline nose rinse?
The saline nose rinse has not been well studied. Some people find rinses helpful, and others find it not to be worth the trouble. If you do find it helpful, you want to be sure to use distilled water to prevent introducing infection into the nasal cavity.

Q: How can I calm my itchy eyes?
Resist the urge to itch. Itching will introduce pollen into your eye from your finger tips and the skin around your eyes and make it worse. There are over-the-counter and prescription antihistamine eye drops that can help, and cool compresses (wet, clean washcloths) may feel soothing.

Q: What are some common misconceptions about allergies?
The term “hay fever” is a misnomer. Allergies do not actually cause an increase in body temperature, but people can feel feverish, sick and uncomfortable due to their allergies. Allergies can affect quality of life as much as many other chronic diseases. Allergic secretions are clear when you have a runny nose or watery eyes. If secretions are thick, yellow or green, they could be a sign of an infection.

Michael Goldman, M.D., is an allergist and immunologist with Allergy & Asthma Center of Central Maryland in Columbia.

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asthma

Allergies are one of several important triggers for asthma in the majority of asthmatics – especially those who developed asthma younger in life. Understanding your asthma triggers is important.
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Asthma Answered: How You Can Live Life to the Fullest

HCGH allergist and immunologist Michael Goldman answers your asthma questions:

Q: What does an asthma attack feel like?
The classic symptoms are a cough, wheezing, chest tightness and shortness of breath. However, everyone can experience asthma differently. For some, the only symptom is a cough. Typically asthma symptoms worsen with triggers such as colds, respiratory infections, allergen exposures (e.g. pollens, dust, pets), cold air and exercise.

Q: How do you diagnose asthma?
For most people, asthma is diagnosed by reviewing symptoms and responses to asthma medications. A special breathing test, before and after an asthma inhaler, can help determine the severity.

Q: How are allergies involved in asthma?
Allergies are one of several important triggers for asthma in the majority of asthmatics – especially those who developed asthma younger in life. More than 80 percent of 10 year olds with asthma have allergies contributing to inflammation of the bronchial tubes. Common allergy triggers for asthma include year-round allergens such as dust mites, cats, dogs, and even cockroaches and mice. Seasonal triggers include spring or fall pollens such as trees, grass and ragweed. Molds can also contribute to allergic asthma. Food allergies can trigger an asthma attack in those patients with food allergies, but are not a cause of ongoing asthma. The best way to tell if allergies are contributing to your asthma is to have allergy testing.

Q:  How can I prevent asthma attacks?
Understanding asthma triggers is important. Avoiding pets, if you are allergic to them, may be necessary. For those with frequent asthma symptoms, daily medications are used to prevent symptoms. Inhaled steroids, in the lowest dose effective to control symptoms, are the gold standard to treat persistent asthma. All asthmatic patients should have a short-acting rescue inhaler to use if symptoms develop. If you need the rescue inhaler more than every four hours you should contact your physician.

Q:  What are some common misconceptions about asthma?
While asthma symptoms may come and go, asthma should be considered a chronic disease just like hypertension or high cholesterol. Treating asthma when you are well is important to prevent symptoms over time and help you when you get sick. This often entails taking daily medications or controlling allergens and other triggers even when you feel perfectly fine. This is important to know. It is not a good idea to stop daily asthma medications unless you are in contact with your physician. These medicines prevent ongoing symptoms and lessen the severity of flares.

Asthma can vary in severity from mild to severe. For some people the only symptoms are mild chest tightness and cough during and following an upper respiratory infection. It may worsen with exertion or cold air at that time, but not when otherwise healthy. For others, asthma can be a daily and nightly struggle, with symptoms interfering with daily quality of life. If you are having asthma symptoms more than two times per week, you should see your provider to see if a daily, preventative medicine is appropriate, such as an inhaled steroid.

All patients with asthma should have a short acting bronchodilator, a “rescue” inhaler. These medications should be used as needed, when symptoms develop, or for some people, prior to exercise. If you need to use them more frequently than every four hours, you should seek medical attention. Your asthma may not be in control.

Q: When is asthma an emergency?
If you are suffering from severe shortness of breath, making it difficult to talk, very rapid breathing, your lips turn blue, or you need to use chest or neck muscles to aid in breathing your should seek medical attention immediately. Oral steroids may be necessary with asthma episodes, but long-term use of oral steroids is restricted for only the most severe asthmatics.

With appropriate attention and medical care, asthma can be controlled and you or your asthmatic child should be able to lead a perfectly normal life, able to do almost everything non-asthmatics can do. Some of the world’s best athletes have asthma. It should not be a barrier to all you want to do.

Michael Goldman, M.D., is an allergist and immunologist with Allergy & Asthma Center of Central Maryland in Columbia.

 


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Parkinson's Risk ChartWe can define risk as the probability of damage or injury caused by some event which could be reduced by avoiding the situation or taking some pre-emptive action. These are often sudden events that may lead to sudden loss of functional capacity. The most common are falls that result in traumatic injuries.

Avoid high-risk activities

It is obvious that most of us should not be tight-rope walking over a body of water containing sharks, but some things are not as obvious. If you are planning an activity, think about the likelihood of some unintended consequence. If there are severe consequences and the risk is significant, you should probably avoid the activity.

Falls can be game changers

Many people with advancing Parkinson’s disease (PD) develop balance problems, which can lead to falls and traumatic injuries. Changes in your medications are not likely to improve your balance, but physical therapy can help, and physical therapists can train you to properly use assistive devices, such as canes and walkers. If you have a balance problem and your physician and physical therapist recommend that you use a walker, that is a good pre-emptive action you can take to reduce your risk of falling.

Unfortunately, falls are fairly common in PD as the disease advances, although they are rarely a problem early in the disease. When a patient falls, they can fracture anything from their hip to their arm. In my experience, people who suffer traumatic injuries never walk as well again. Falls are game-changers and should be prevented, if possible. Physical therapy and training in the use of assistive devices, such as canes and walkers, can reduce your risk of traumatic injuries.

How you can reduce your risk of falling

  • Be cooperative if physical therapy is recommended.
  • Use a walker or cane if your “team” recommends it.
  • Consider when/if to stop driving (most of us do at some point).
  • Install grab bars in the shower.
  • Hold onto railings when walking on stairs.

The following is an example of how a hip fracture can result in severe consequences. The graph shows that the patient was able to walk back and forth down our short hallway in about 12 seconds for many years. However, following a hip fracture, they struggled to walk the same distance in 30 seconds.

Parkinson's Hip Fracture Chart


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Woman walking ThinkstockPhotos-147919046Having treated people with Parkinson’s Disease for over 20 years, I have come to realize that the key to being healthy is to . . . well . . . be healthy. This includes exercising your mind and body, eating healthily, and maintaining an ideal body weight.

Meaningful exercise involves sustained and ongoing physical activity sufficient to increase the heart rate and the need for oxygen for at least 20-30 minutes. You can do this with formal exercise, such as walking, jogging, treadmill walking or swimming, participating in sports such as tennis, soccer, golf or fencing or even doing chores, such as raking leaves or shoveling snow. Try to do some kind of exercise at least three to four times a week.

In addition to the general health benefits of exercise (cardiovascular, reduction in osteoporosis/fracture risk, and the burning of calories) there is evidence from recent research studies that indicates that exercise may be helpful in the following ways:

  • Walking on a treadmill improves your walking.
  • There is slower disease progression and better quality of life.
  • There is a reduction in the risk of dementia and mild cognitive impairment.
  • There is improvement in depression and anxiety.
  • Sleep is improved.

So, develop a regular exercise program and stick to it. It should be considered a primary treatment strategy in Parkinson’s disease. The choice of exercise is up to you and should be tailored to your interests and limitations. You might ask your physical therapist to help design the program and, if you have heart disease, you should consult with your cardiologist about a suggested protocol.

The most important thing about exercise is that you do it!


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