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Tinnitus

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Joseph B Touma, MD
Tinnitus

Approximately 36 million Americans-about one out of every seven-complain of tinnitus or noise in the ears. Of this number, more than 7 million have severe symptoms that require medical attention. Tinnitus can be very stressful, sometimes exceeding a person’s ability to cope with the condition.

Tinnitus is often described as roaring, “crickets,” ringing or buzzing in the ears.

The most common causes of tinnitus are:

  • Aging
  • Anxiety
  • Exposure to loud noises
  • Medications, such as aspirin and other drugs that can damage the hearing nerve
  • Excessive use of caffeine and alcohol
  • Obstruction of the external ear canal
  • Middle ear infections, abnormalities of the middle ear bones, a hole in the eardrum or
    some inner ear diseases
  • Growth pushing against the hearing nerve
  • Systemic diseases, such as thyroid problems, diabetes or high blood pressure

Tinnitus can often be treated by eliminating the cause of the problem. This may involve removing an obstruction of the ear canal, repairing a hole in the eardrum, controlling an infection, removing excess fluids in the middle ear, eliminating aspirin and other medications or controlling high blood pressure.

If tinnitus is not due to any treatable cause, several steps can be taken to improve a person’s ability to cope with the condition:

  • A hearing aid can often both improve hearing and mask tinnitus.
  • Avoid loud noises.
  • Avoid nicotine and stimulants, such as caffeine.
  • Improve the diet, reduce salt and avoid hypoglycemia.
  • Reduce anxiety and stress.
  • Provide background noise, such as music from a radio.
  • Participate in exercises and other activities.

An ear specialist should be consulted if tinnitus is limited to one ear or is associated with hearing loss or dizziness.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Swimmer’s Ear

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Joseph B Touma, MD
Swimmer’s Ear

Swimmer’s ear, or acute otitis externa, is a common problem, especially in the summer. It is caused when moisture and humidity in the outer ear encourage bacteria and fungus to grow beyond normal levels and cause an infection.

Swimming, itching and flaking, as well as superficial scratches in the external ear from cotton swabs or any hard object used to clean the ear can accelerate the growth of bacteria, leading to an infection.

The first symptom of swimmer’s ear is usually itching. If the condition progresses, a person will experience severe pain in the ear and swelling of the ear canal. Lymph nodes under the ear may also swell; a low-grade fever, stopped-up feeling and hearing loss will follow.

The best treatment for swimmer’s ear is prevention. The most important preventive measure is to avoid placing cotton swabs or any hard object inside the ear.

Keeping the ear dry is also very important. After swimming or showering, use rubbing alcohol in the ear to dry the canal quickly. To do this, tilt the head so the outer ear can be pulled back and pour several drops of rubbing alcohol into the ear canal. White vinegar in the ear will also help prevent infection because it helps maintain the ear’s normal acidity. However, never use alcohol, vinegar or over-the-counter drops in the ear if there is a hole in the eardrum. Ear drops and antibiotics will usually control the infection. However, if the swelling is severe, your doctor or an ear specialist might need to pack the inner ear to allow the drops to reach deep into the ear canal.

Special advice to swimmers:

A drop or two of oil in each ear before swimming can create an insulating film in the ear canal and reduce the effect of moisture. After showering, alcohol, vinegar, a mixture of both or commercial antiseptic ear drops are recommended.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Noise, Ears & Hearing

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Joseph B Touma, MD
Noise, Ears & Hearing

Loud noises are a part of life. The sound level of heavy traffic or an alarm clock is about 80 decibels. A chain saw or pneumatic drill registers about 100 decibels. A rock concert, thunder clap, or rifle blast can generate sound ranging from 120 to 140 decibels.

Some warning signs of dangerous noise levels are the need to shout over background noise to be heard, noise that hurts the ears, ringing in the ears or temporary hearing loss after exposure to noise.

Continued exposure to loud noise can gradually damage your hearing as severely as a singe explosion close to the ear. Noise can accelerate the normal deterioration that occurs as you age.

The best treatment for nerve damage is prevention. Earplugs can reduce sound intensity by 10 to 15 decibels. A good pair of earmuffs can reduce it by 20 to 30 decibels. Even though it may seem inconvenient to wear earplugs or earmuffs, these devices can protect your ears from noise pollution. They should be worn whenever you work with machinery, cut the grass or shoot a gun.

The Occupational Safety and Health Administration (OSHA) strictly regulates the amount of noise exposure and the length of exposure allowed in the workplace. OSHA requires mandatory ear protection for employees exposed to noise above a certain level.

If a person has already suffered permanent damage and hearing loss, hearing aids can be very helpful.

Ringing in the ears can be caused by exposure to loud noises, but loud ringing in only one ear should be investigated by an ear specialist to rule out other causes, such as a benign growth on the hearing nerve.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Everyday Noise & Your Health

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Joseph B Touma, MD

It is a known fact that noise over a certain level can produce hearing loss. Unfortunately the emphasis is on industrial noise induced hearing loss. Non- industrial noise exposure can equally be harmful to the hearing. It is established that noise over 85-90 decibels can produce hearing loss. Many non-industrial noise sources emit high levels, such as lawn mower (110-120 decibels), hair blower (110-115 decibels), target shooting and hunting (140-150 decibels), and jet airplane (130-140 decibels). Head set stereos (walkman) can reach 130 decibels, and rock concerts (125-140 decibels). These are a few examples of exposure to hazardous non-industrial noise. Fortunately, simple measures can be taken to protect the hearing, such as wearing ear muffs or foam rubber ear plugs when shooting, lawn mowing, leaf blowing, etc. Keep the volume down when listening to personal head set stereos and wear ear plugs when attending loud rock concerts.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Hearing Implants For Deafness: A New Frontier

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Joseph B Touma, MD
Hearing Implants For Deafness: A New Frontier

Advanced technology has led to recent breakthroughs in hearing implant devices benefiting a certain segment of the hearing impaired population who previously could not be helped.

Several implants are now available:

Cochlear Implants: This technology is designed specifically for the severely hearing impaired who could not benefit from conventional hearing aids or other reconstructive surgery. While this technique is not new, in recent years advanced technology has allowed the implantation of up to 24 electrodes, which fit directly in the cochlea, where the nerve of hearing starts. A receiver is implanted under the skin and directly connected with the electrodes. An outside processor is placed opposite to the receiver and is coupled with it through a magnet. The electrodes stimulate different areas of the cochlea, depending on the pitch received. The sound is somewhat different than natural sound, but with intensive speech and audiological rehabilitation, this device will improve the ability to hear, understand, and communicate.

There are two kinds of patients who benefit from cochlear implants. The prelingual, or those who are born deaf, require more rehabilitation, The postlingual, or those who later acquired severe hearing loss, are much easier to rehabilitate. While cochlear implant surgery is delicate, it is performed under general anesthesia on an outpatient basis. The implant will be activated approximately four weeks after the surgery.

Bone Anchored Hearing Aids (BAHA): The receiver and processor are combined together. The device is directly anchored to the skull through the skin. Indications for this implant are:

1) those with chronically draining ears who did not benefit from previous surgery
2) those with conductive hearing loss who did not benefit from reconstructive surgery of the
hearing conduction mechanism
3) patients who cannot tolerate hearing aids yet have good cochlear nerve
4) patients with deformed ear canals and congenital malformations

Advantages of BAHA include improved sound quality. There is no dampening of the high frequencies because there is no attenuation of the skin that separates the processor from the receiver. In addition, the small size device is directly attached to the bone.

Audiant Implant: The principle and the indications are the same as BAHA. However, it is now mostly replaced by the bone anchored hearing aids (BAHA).

Implantable Hearing Aids: The FDA recently approved the first implantable hearing aid. This breakthrough is the beginning of a new generation of amplification devices. At the present time it is restricted to adults with moderate hearing loss and fair ability to understand.

In summary, there are very exciting developments in the implantable hearing devices front. Many patients who could not be helped previously with conventional measures are now good candidates for such devices.

Joseph B. Touma, M.D. F.A.C.S. of the Touma Ear and Balance Center is actively performing most of these advanced hearing and rehabilitative surgeries. A cochlear implant team is now in place, consisting of the ear surgeon, an audiologist, and a speech therapist.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

What is a Hearing Aid?

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Joseph B Touma, MD
What is a Hearing Aid?

A hearing aid is a device designed to help utilize the auditory system to its fullest. Essentially the function of a hearing aid is to make everything louder. When one loses their hearing, they lose their ability to detect soft sounds. The hearing aid just makes these soft sounds loud enough to be audible.

There is not a hearing aid that exists today that will “cut out” background sounds completely. However, utilizing the latest technology available we are able to maximize your hearing in difficult listening situations.

When you decide to purchase hearing aids, the audiologist will take impressions (or molds) of your ears, as the hearing aids are custom built to fit only your ears. The impression is then sent to the hearing aid manufacturer who will build the hearing aid.
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Types of Hearing Aids

At this time there are two different types of hearing aids available: Conventional and Programmable.

When a conventional hearing aid is ordered, the audiologist sends the impressions of your ears along with a circuit “matrix” so the manufacturer can build the hearing aid to match your specific hearing loss.

If you choose to order programmable hearing aids, the audiologist sends the impressions to the manufacturer, but rather than putting in a “conventional” circuit, they put in a programmable computer chip. The audiologist then programs the hearing aids in the office. This type of hearing aid is flexible enough to change as your hearing loss changes. These changes can be made in the office in a matter of minutes as opposed to several days for the conventional type of hearing aid.

Both types of hearing aids are excellent. With the technological advances that are available today, we are better able to restore a more normal sensation of hearing. There is no comparison between the hearing aids of five years ago and the hearing aids of today.

Adjusting to Your Hearing Aid

It will probably take you a while to get used to your new hearing aid. During this time, it is important to keep in mind that your aid will not make your hearing “normal” again, but it will make sounds louder, enabling you to participate in conversations and hear sounds that you may have missed before.

The first week is often the most trying period. You may here strange “new” sounds, like the hissing of a radiator, and you may be distracted by an array of background noises, such as the hum of a refrigerator or the sound of a knife on a dinner plate. Some everyday sounds, like rustling the newspaper or running water, will sound different. Your own voice may seem loud or strange to you. Your hearing aid should fit comfortably. Report any discomfort, pain, or irritation to your audiologist as soon as possible.

By the second week, you should be more comfortable wearing your aid, and better at identifying sounds. After the third week, you may get the feeling that your hearing is worse when you remove the aid, but this is a sign that you are getting accustomed to hearing again!

Care of Your Hearing Aid

1) Avoid situations where your hearing aid could fall any distance on to a hard surface. Be seated or hold the aid over a table rather than over the floor when changing the batteries, performing maintenance, or inserting it into the ear.

2) Keep the hearing aid dry. Remove the aid before swimming or taking a shower. Always store the aid in a dry place and keep it away from sources of dampness. Never attempt to dry it in any type of oven or with a blow dryer. Do not leave your aid in a pocket of clothing to be laundered.

3) Keep the hearing aid away from excessive heat or direct sunlight. Never leave it on a radiator, near a stove, in a sunny window, in a car glove box, or any other hot place. Do not wear the aid when using a hair dryer or near a sunlamp or heat lamp.

4) Remove the hearing aid before applying hair spray. It may damage the microphone. If you are often in dusty environments (wood shop, outdoors, etc.), your hearing aid may require more frequent cleaning and maintenance.

5) Store your hearing aid out of reach of youngsters or pets. It should be stored in its case when not in use. Open the battery door when not wearing the aid to prevent excessive battery drain.

6) Do not attempt to repair your own hearing aid. Never attempt to open its case. Do not wash or lubricate any part of the aid.

7) Cleaning: Keep the ear mold and tubing free of obstruction. Clean with a damp cloth and remove any accumulated wax with the provided wax removal tool. Clean the case of the aid by wiping carefully with a dry cloth or tissue. See your audiologist or hearing aid specialist twice a year for cleaning and maintenance.
 

Consumers with questions or complaints about the dealer should contact :

West Virginia Board of Hearing Aid Dealers
Department of Health
1800 Washington Street, East
Charleston, West Virginia 25305

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Endoscopic Middle Ear Surgery

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Joseph B Touma, MD
Endoscopic Middle Ear Surgery

Recent inventions of extremely small and high quality scopes made it possible to inspect the middle ear space by introducing the scope through a small incision in the eardrum. This procedure is performed under topical anesthesia and lasts only a few minutes. It can be performed in the office or the operating room. The patient can resume normal activities immediately after the end of the operation. However, water in the ear should be avoided for a few days. This technology will reduce the number of surgical middle ear explorations, which are usually performed under general anesthesia and in the operating room.

Indications of middle ear endoscopic inspection are limited, however, it can give very valuable information in diagnosing round or oval window fistulae (rupture of the membranes), the condition and integrity of the middle ear bones in cases of conductive hearing loss, the existence of recurrent cysts in the middle ear and the attic, and other middle ear pathology.

This technology is now available at the Huntington Ear, Nose & Throat Specialists, P.L.L.C. by Joseph B. Touma, M.D. (Ear and Balance Specialist).

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Ears and Airplane Travel

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Joseph B Touma, MD
Ears and Airplane Travel

The ear has three compartments: the outer, middle and inner ear. The middle ear is filled with air supplied by the Eustachian tube, which connects it with the back of the nose. The Eustachian tube keeps air pressure in the middle ear equal to the air pressure in the environment.

Discomfort in the ears is often due to the changes in air pressure in the middle ear. Changes in altitude cause the volume of air inside the middle ear to change. Air expands at high altitudes and contracts at low altitudes. The change in volume is usually compensated for by the Eustachian tube, which equalizes air pressure.

Problems occur if the tube is blocked because of a cold, sore throat, allergy, growth, cleft palate or anatomical abnormality. Because oxygen is continuously absorbed from the lining of the middle ear, a vacuum occurs, causing hearing to become blocked and muffled.

Marked changes in altitude, such as those that occur when flying, can create a similar problem, especially in noncommercial airplanes when the cabin is not pressurized adequately.

If the blockage continues for a long time, fluids can build up in the middle ear requiring treatment with decongestants, antibiotics or drainage.

Repeated swallowing is the easiest way to get rid of the problem. Yawning, chewing gum or sucking on a piece of candy can also be helpful. If this doesn’t unstop the ear, relief can sometimes be achieved by holding the nose and gently blowing air against it to pop the ears. Breathing vapors from a Vick’s inhaler through each nostril can also provide relief.

To avoid problems when flying, prevention is the best remedy. Don’t fly if you have a head cold, allergy attack or sinus infection. If you have to travel, it is wise to bring your sinus or allergy medication and nasal decongestant spray with you.

If the ear blockage doesn’t go away within a few days after air travel, or if you experience dizziness, bleeding, continuous pain or severe hearing loss, see an ear specialist immediately. Usually, the problem can be resolved with medication or a simple office procedure.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Deafness and the Elderly

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Joseph B Touma, MD

Hearing loss among the elderly is a widespread problem often compounded by feelings of loneliness, anxiety and depression, and many hearing-impaired persons withdraw from society. But the first stop in overcoming a hearing impairment is learning to accept a handicap nearly 25 million Americans share.

All senses decline with age. Declining hearing is the result of normal wear and tear on the hearing nerves. Other circumstances that can accelerate this process include genetic and metabolic factors, exposure to noise, medications damaging to the hearing nerve and diseases of the inner ear.

The most important part of treatment is prevention, slowing down the aging process by avoiding noise and medications toxic to the ears, such as some antibiotics and fluid pills.

The first symptoms of hearing loss usually start around age 50. Sound may be confused in noisy environments, and people often complain they can hear but can’t understand. A person may also notice noise or ringing in the ears. At this stage, many people don’t realize they have a hearing loss because only high-frequencies of sound are affected, and a person may hear well in a quiet environment.

When a hearing impairment begins interfering with a person’s normal activities, several measures are available to help.

Hearing aids are one solution. Modern electronics and miniaturization make hearing aids better than ever before.

Through counseling, family and coworkers can learn to communicate with a hearing- impaired person by speaking distinctly and not competing with background noise. Victims of a hearing loss can also sharpen their skills at reading facial expressions and gestures.

In addition, several assistive-listening devices are available to help the hearing impaired. These include closed-captioned televisions and amplifiers for televisions and telephones; lights and vibrators to replace doorbells, alarm clocks and telephone ringers.

Hearing loss among the elderly is usually equal in both ears. If the loss is more severe in one ear than the other, or if there is more noise in one ear, the hearing loss may be caused by something other than aging. In this case, a medical evaluation by an ear specialist is needed.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

How to Clean the Ears

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Joseph B Touma, MD
How to Clean the Ears

Nature provides many safety mechanisms to protect the ears and keep them clean. The anatomy of the outer ear and ear canal is adapted to catch dust and small objects before they enter the ear.

Hair on the entrance of the ear canal catches any remaining dust or particles before they enter the canal.

Another protective measure is the shedding of the outer layer of skin lining the ear canal. The shedding skin continuously moves outward, in effect “mopping” the ear canal.

Wax catches most of the foreign bodies and works itself to the outside of the ear canal and forms an invisible or slightly yellowish film at the entrance to the canal. This film is usually removed when the ears are washed with soap and water.

You should never use a hard object to clean your ears. These objects can scratch the thin and delicate skin of the ear canal and cause a painful infection. Even soft cotton swabs should be avoided because they push ear wax inward and interfere with the ear’s natural cleaning process.

If the ear becomes stopped-up with wax, it can be cleaned with an ear syringe filled with equal amounts of white vinegar and warm water (cold or hot water will cause dizziness). Using the syrine, pull the ear back and flush it over the sink several times until the return is clear. Avoid plugging the entrance of the canal while flushing.

If the wax is very hard, a softener such as Debrox (follow the instructions on the label) can be used before flushing the ear. Don’t irrigate if the ear is infected or there is a hole in the eardrum. 

In summary, the best way to clean the outer ear is by using soap and water, rinsing it thoroughly, and drying with a soft towel.

The inside of the ears can be dried with rubbing alcohol if there is no infection or hole in the eardrum. It is important never to put cotton swabs or any hard object inside the ear.

If an earache, a “stopped-up” feeling, hearing loss or impacted wax is present, the family physician or an ear specialist should be consulted.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277


Joseph B. Touma, M.D., F.A.C.S.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277