Ask The Doctor - Part 1

- SHHH Workshop: Ask the Doctor
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Editor: Got hearing loss questions? The answers to some of the more common questions are in Cheryl Heppner's report on the SHHH "Ask the Doctor" workshop.

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What follows is a summary of questions and answers from a workshop totally driven by consumer questions. The doctors who provided answers were:

- Douglas Backhous, M.D., Medical Director, Dept. of Otolaryngology, Head and Neck Surgery, The Listen For Life Center, Virginia Mason Medical Center, Seattle, WA
- Paul Hammerschlag, M.D. FACS, Associate Professor of Otolaryngology, The New York University Medical Center, SHHH Board of Trustees, New York, NY

Q: I've had hearing loss for 27 years that used to fluctuate, but 7 years ago I experienced a fluctuation in my ability to discriminate speech. What advances are there for someone with my problem?

A: (Hammerschlag) A diagnosis would be needed to answer the question. You are asking about a symptom. It could be many things such as Meniere's or an autoimmune disease. Since it is in both ears, with one worse than the other, after an evaluation to see if it might be Meniere's without vertigo, a controlled medical regimen could be tried. This would mean a diuretic (if you could tolerate it), a low salt diet, and for some people, prednisone. It's probably not likely to be an autoimmune disorder because the hearing loss has not been dropping rapidly.

(Backhous): Meniere's is a symptom of fluctuating hearing loss. Fluctuating hearing loss is also being seen in genetic sources of hearing loss that have just been identified. The condition could be Meniere's in hydrops. A lot of people want a pill to fix their hearing problem, but he tends to "work people hard". First would be to try changing the diet, reducing salt, then a diuretic or blood pressure medication. If your hearing loss is fluctuating, you need to get your hearing aids reprogrammed as you fluctuate. This makes digital hearing aids a good choice for you.

(Hammerschlag) Endolymphatic hydrops just means fluid in the inner ear. It can have many causes -- genetic, allergies, Meniere's, infections.

Q: What is the difference between endolymphatic hydrops and Meniere's?

A: (Backhous): Meniere's is a syndrome. Endolymphatic hydrops is a problem that leads to Meniere's and symptoms.

Q: I was diagnosed with endolymphatic hydrops and was told that when I go through menopause, this condition may or may not change. Is this true?

A: (Backhous): He sees a lot of women in perimenopause that he sends to endocrinologists because their treatment has corrected this condition. For someone with normal hearing, the drop in hearing might not be noticed. For someone with hearing loss, it takes only a 3-5 decibel drop to put you at a disadvantage. He feels that hormonal fluctuations can impact this condition. Each problem is different. An example is that some people with Meniere's prove to be salt sensitive and some do not.

Q: I am concerned about cochlear implant surgery and the possible damage to the facial nerve. Can you comment?

A: (Backhous): Facial nerve damage is a known complication. It can be temporary or permanent. Damage to a nerve that affects taste is a more common complication. Facial nerve injuries occur in .5% of patients; damage to the nerve affecting taste occurs in 5-10%. The larger number of complications involving the latter are due to having to drill to the mastoid; the surgeon can get too close to the nerve. Most people will regain taste within 6-8 weeks but in the meantime have a metallic taste like sucking on a bottle cap. Surgeons that do a sizable number of cochlear implants have experience and thus tend to have a record showing less complications. Ask a surgeon about his experience.

(Hammerschlag): Go to a cochlear implant center; they do a high volume of surgery.

Q: I've read that cochlear implant surgery destroys the remaining hearing. I'm concerned about this. I have hearing in one ear but no speech comprehension.

A: (Backhous): A cochlear implant may destroy residual hearing, but that doesn't mean you will lose hearing on the opposite side. He has seen people retain some hearing even in the ear where the implant has full insertion. A great disappointment is that the middle ear implant is not getting to the people in the middle who struggle with both hearing aids and speech. "Nobody makes an ear like God makes an ear."

A lot of people face not knowing whether they will do worse with a cochlear implant. After doing 260 cochlear implant surgeries, he hasn't seen anyone do worse than with a hearing aid, but he has heard of it happening. Some patients have been disappointed with music; they can't tell Beethoven from Bach with a cochlear implant. Many people tend to hang onto those last few decibels.

(Hammerschlag): Currently you need 56% or less speech discrimination to qualify for a cochlear implant. For some, that's a substantial amount of hearing. For some people it's not the surgery they're afraid of, it's acknowledging that they are really deaf and their hearing is no longer functional.

(Backhous): His cochlear implant operations now average 1 hour and 15 minutes and 98% of patients go home the same day, including kids. Don't jump into a cochlear implant until you're ready to do a lot of work to make it successful.

Q: Are cochlear implants made in the U.S. or other countries?

A: (Backhous): Cochlear's implants are made in Australia and the company stocks a Denver operation run by an American team. Med-El is made in Austrialia, with an operation similar to Cochlear's in Raleigh, NC. Advanced Bionics is headquartered in California and was invented by a team at the University of California in San Francisco. It is imported to Europe. His center carries all the products with no problems.

Part Two