Pearls of Wisdom

Posts for: February, 2014

By Paige Peterson, AuD, PhD, CCC-A, FAAA, ABA
February 26, 2014
Category: Hearing Loss

 

It is widely known that Austin is known as the “Live Music Capital of the World.” We embrace it, we celebrate it and quite frankly it is one of the best things about living in ATX. At any given time you can find live music of any genre somewhere in Austin. 

The spring kicks off festival season with SXSW on March 7th and about a week after SXSW ends I will inevitably receive phone calls from festival goers concerned because their ears are ringing. Our previous blogs on tinnitus, temporary threshold shift and use of hearing protection addressed many of the concerns that I will be hearing. More often than not when I broach the idea of hearing protection to people I am met with resistance. Why? Because they show, they reduce the quality of the music, and they are not perceived to be cool. All of these concerns can be addressed with custom hearing protection.

Recent studies show that Noise Induced Hearing Loss (NIHL) is on the rise, and not among the population you might expect. It is in our children and the youth.  It is estimated that almost 20% of the US population between the ages of 9-18 have NIHL. I’ll take a moment while that sinks in. NIHL is completely preventable, which is the worst part of all. On the way to this year’s Super Bowl stadiums were competing to be the loudest. At one point Seattle was trying to exceed 140dB, a level that causes instantaneous hearing loss and can induce pain. This is also the level used in hearing loss research to deafen chickens to observe how they can regenerate their hearing. As the quest to be the loudest is glorified to our youth they will develop hearing loss, a disability widely associated with age.

To the thousands of people who visit our fair city to enjoy the live music and everything Austin has to offer, please protect your ears. For  audiophiles, or those consistently around noise, please have some custom musician’s earplugs made for yourself. Swirl some colors together and let your ears Keep Austin Weird!

They will last for many years, and you will be able to enjoy music into your golden years.

Our office can be reached for custom protection at  (512)258-2300.

Paige Peterson, AuD, PhD, CCC-A, FAAA, ABA

 

Dr. Paige Peterson is an Audiologist at Great Hills ENT in Austin, TX and specializes in hearing related disorders including tinnitus and hearing loss, neurophysiological disorders as well as dizziness/balance disorders.  Dr. Peterson is Board Certified in Audiology and is currently accepting new adult and pediatric audiology patients. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, hearing aids, dizziness/vertigo and sleep disorders.


By Mark T. Brown, MD, FACS
February 13, 2014
Category: Sleep Medicine
Tags: Sleep Apnea   austin   Mark Brown   Texas   Legislation   Sleep   Dentistry   TSBDE  

 

There is a proposed rule change in front of the Texas State Board of Dental Examiners (TSBDE) to allow dentists to primarily diagnose and treat Obstructive Sleep Apnea with a physician’s participation. As I state in the letter below, sent to the TSBDE, I am proud to collaborate with dentists in the care of my patients with Sleep Apnea.

 

“The Texas State Board of Dental Examiners is considering changes entitled “CHAPTER 108. PROFESSIONAL CONDUCT, SUBCHAPTER A. PROFESSIONAL RESPONSIBILITY, 22 TAC §108.12” that is a misdirection in the care of Texas Sleep Apnea patients. As a board certified sleep physician, I am in a position to help patients make good decisions regarding their sleep health. I am proud to include dentists in that care. However, dentists are not qualified to be the primary caregivers diagnosing and treating Sleep Apnea. Dental education is not broad enough to make a dentist an expert in the medical complications of sleep apnea. They are able to provide a device, the Mandibular Advancement Device (or MAD), that has limited applicability in sleep apnea therapy. In the right patient the MAD is very beneficial. The number of “right patients” is a small percentage of the whole. My fear is that a dentist will see a morbidly obese patient, determine rightly that the patient has sleep apnea, apply their tool (the MAD) which inadequately treats the patient.. It only takes ONE patient premature death due to poorly treated Sleep Apnea to make this rule change a bad  idea.

 

Please do not pass this rule change. The right answer is to continue to work with the medical sleep community, collaborating to provide good care for patients with Sleep Apnea.”

Mark T. Brown, MD FACS 

 

Dr. Mark Brown is an Otolaryngologist (Ear, Nose and Throat) specialist at Great Hills ENT in Austin, TX. Dr. Brown is Board Certified in both Otolaryngology, Head and Neck Surgery as well as Sleep Medicine. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, dizziness/vertigo and sleep disorders.

 


February 10, 2014
Category: Sinus
Tags: ENT   austin   Surgery   Allergy   Sinusitis   AustinTX  

 

I may be correct in saying that nobody ever really WANTS to have surgery. It involves IVs, anesthesia, uncertainty, and it HURTS. That being said, surgery is often the solution to a medical problem that is not fixed by medication.  Sinus surgery has changed tremendously over the last few decades. This blog is intended to dispel myths that often frighten people about it and/or cause them to postpone treatment and prolong suffering.

Sinusitis is inflammation of the sinuses-these are air filled cavities in the face-the exact purpose of which is unknown.  However, we think the sinuses humidify the air we breathe, lighten the skull, and resonate the voice. That being said, they can fill with infection, lead to pain, drainage, fatigue, and infect surrounding structures. For acute sinusitis (less than 4 weeks), an antibiotic with a nasal steroid and sinus rinse will usually fix the problem. Occasionally, this doesn’t work and the infection becomes chronic (lasting 12 weeks or more). Often, a prolonged course of antibiotics (3 weeks!), nasal and oral steroids, and a sinus rinse will solve the problem. When this does not do the trick and we see evidence of persistent disease on a CT scan, we will recommend surgery. Obviously, this is an oversimplification-but-you get the point.

When surgery is the “next step,” we often hear the following questions/concerns:


Q: “MY (insert relative here) had sinus surgery 20 years ago and they PACKED his nose-He said it was the WORST thing in the world…do you pack the nose?”

A: No, we do not pack the nose. This is something that surgeons used to do quite frequently after surgery to prevent bleeding or scar tissue growth. Today, we have absorbable packing and ointments we can place in the nose to prevent bleeding, and our surgical techniques have changes to minimize risk of scarring

Q: “Do you SCRAPE the sinuses??”

A: No, we do not scrape the sinuses. The point of surgery is widen the opening where the sinuses naturally drain, and to avoid damage to the mucosa (tissue lining the sinuses) as much as possible. We can irrigate the sinuses and remove inflamed growths such as polyps. But, no scraping.

Q: “Will sinus surgery prevent me from ever having another sinus infection?”

A: Unfortunately, no. The purpose is to open the sinuses up and remove diseased tissue. You can still get sinus infections in the future, but we may treat them with “topical” antibiotics and steroids (in the sinus rinse) which will reach the cavities better because they are more open.  Your risk of developing future problems depends on why you had this in the first place (severe allergies, polyps, fungus, etc.)

Q: “I had sinus surgery 10 years ago, and now I am having problems again. What are you going to do differently?”

A: You may have recurrent disease for a number of reasons; however, our goal in surgery is the same. Because you had surgery before, things may scar certain ways that predispose you to infection again-Often, we will use “image guidance” which is a new technology that helps us identify structures in the nose during surgery to ensure good drainage (and correct identification of infected areas).

Q: “Are you going to use balloons on me?”

A: Balloon sinuplasty is a new technology that uses a balloon to widen the natural opening of the sinuses. It can be a helpful tool in sinus surgery (especially the frontal sinus) or used alone. Not all doctors offer this procedure, and some patients are not good candidates for this technology, so this will need to be a discussion between you and your physician.

 

 


By Paige Peterson, AuD, PhD, CCC-A, FAAA, ABA
February 04, 2014
Category: Hearing Loss

 

    Let’s face it, once you hit a certain age your mail box becomes littered with the inevitable hearing aid advertisements.

  • “Save BIG on High Quality, DIGITAL Hearing Aids, this week only!!”
  • Free Hearing Test, Otoscopy, and Two-week Trial Period!  Come in TODAY 
  • “Skip the Office - Cheap Online Hearing Aids.”

Do these sound familiar? My guess is yes.  My typical patient comes into my office telling me that they hear just fine, it is the mumbling of family members, poor room acoustics, the quality of telecommunication signals or their spouse being in a different room that is giving them issues. Now, I will readily admit that some of these do play a part in communication difficulties; the reality is that these are all tell-tale signs of hearing loss.

    Historically, one could only purchase a hearing aid through a local hearing aid dealer, a big-box department store hearing aid franchise or an audiologist. Now, hearing aids are being re-labeled as “personal sound amplifiers” as well as other things to get around the Food and Drug Administration (FDA) regulations requiring hearing aids to be prescribed and dispensed by trained professionals. With online vendors, insurance companies, mail-order vendors, Cabela’s and Wal-Mart entering into the picture things are getting more and more confusing. So, where in the world do you start?

How to Compare in Your Search for Hearing Aids?

    In today’s age, I don’t know a single person who doesn’t shop around for everything from an alarm clock to television to even your doctor. Websites like CNET, Yelp, Angie’s List,  Amazon and Cars Direct make the world seem somewhat transparent when it comes to buying goods.  My friend wears Brand X hearing aids, they get good reviews on Consumer Report, so that is what is best for me, right? NO! Hearing aids cannot be purchased solely on technology reviews, friend recommendations or cosmetic reasons because:

1)      Nothing is Free and Trial Periods set you up to Fail.

The advertisements that say you get a free hearing test or otoscopy? Yeah, well most of the time the people you think are testing   your hearing are only screening you because they are not allowed by law to give you a full diagnostic hearing test to determine the origin of your hearing loss. This is a big deal. Maybe your hearing loss is from a growth in your middle ear, a tumor or just plain old hearing loss. Wouldn’t you like to know? Also it is good practice to look into an ear before you put something into it. Otoscopy is standard practice and not a billable code, so it is always “free” in the sense of the word.  Research shows that it takes a minimum of 30 days for your brain to accept a new signal. A “Trial Period” of two weeks sets you up for failure. Your brain is still in  “Fight or Flight” mode.

2)      Everyone’s hearing loss is unique to them.

The damage pattern on your inner ear (sensory cells) and perhaps a combination of neural and amplifier complications make your loss quite different than your friends/family. Not every hearing aid works the same. They all process sound differently; you need to find the technology that YOUR brain likes the best.

3)      Not every style is made for EVERY hearing loss.

Plain and simple. If you have great low frequency hearing WHY would you put something down in your ear canal that plugs your head up? Physics is simply not your friend here, and I don’t care who says they can get rid of the “head in the barrel feeling” completely, they are lying. If you are wearing an aid that doesn’t belong with your type of hearing loss, you probably will end up hating it.

4)      There are six (6) main hearing aid manufacturers in the world.

That’s it, six. They own just about every other hearing aid manufacturer on the planet. And they make money by rolling their now “old” technology down the hill. They rebrand for wholesalers like Costco and Sam’s for a smaller price tag, but it is not the same   aid as the parent company. Don’t fall for that. If you are going to compare apples to apples, compare the new technology from the main six manufacturers. You cannot and should not compare old to new technology. Yes the older stuff is cheaper, but you will be buying a new one sooner than you’d like.

5)      Not everybody needs the Mercedes-Benz of hearing aids.

Your lifestyle and communication needs may not warrant it. If you want the premier hearing aid, that is one thing. But realistically most people don’t need that to see maximum benefit. This is where it is important to talk to a qualified professional about hearing aids and not a sales man. You wouldn’t show up to Wal-Mart for knee surgery would you? No, you’d go to an orthopedic surgeon. Believe it or not hearing aids are the same way, go to someone who has the education and credentials to help you.

6)      Hearing aids do NOT work like glasses.

You have probably had hearing loss for a while now. Typically it is gradual, and we only seek help when it starts to impact our quality of life. Chemically nerves work quite similarly to a muscle.You wouldn’t expect to run the Boston Marathon overnight if  you’d been sitting on the couch for ten years would you? No, so why do you expect that of your brain when you put hearing aids on? You are going to need adjustments and an acclimatization period for your brain to accept the new signal.

7)      All hearing aids are digital.

They have been since about 1996. Don’t go somewhere because they offer the promise of digital technology. In today’s market, it is just a buzz word to get you in the door.

8)      I just paid $10,000.00 for hearing aids.

No you didn’t. This is a common thought and nothing could be farther from the truth. No hearing aid costs that much. At most, the providers cost for hearing aids averages $2000. So for a set maybe $4000 in actual hearing aid costs. The remainder is the services. Now these are important for the first 45 days or so. You need the fitting, adjustments and additional testing to show for a fact that you are getting benefit from the aids. But they then tell you that you get services for two years? One year? You are essentially paying up front for services that you will never use. So ask about these. Or worse yet, you are buying them online or for what you think is a great price, but you don’t get real in-person, competent adjustments. There is a big difference between where my computer thinks your hearing aid should be programmed and what actually gives you benefit.

 

So what do I look for? 

    Simple, providers with the highest expertise and credentials.  I hope that by now you are starting to see that when it comes to treating your hearing loss, it is not just the technology of the device that is going to help you. It is the knowledge and the skillset of the person who is fitting the hearing aid that is the most important. Believe it or not, there is a LOT of physics, knowing why you change the settings you do, understanding of the anatomy and physiology of the ear as well as the brain and how the device is going to interact with that that leads to your success. In recent news the New York Times, Hearing Loss Association of America and the Food and Drug Administration have  released articles and announcements that have been targeted to the hearing loss population. They all agree, you can buy the most advanced technology on the market at the lowest price, but if the person behind the computer doesn’t know what they are doing it won’t do you any good.

 

Paige Peterson, AuD, PhD, CCC-A, FAAA, ABA

 

Dr. Paige Peterson is an Audiologist at Great Hills ENT in Austin, TX and specializes in hearing related disorders including tinnitus and hearing loss, neurophysiological disorders as well as dizziness/balance disorders.  Dr. Peterson is Board Certified in Audiology and is currently accepting new adult and pediatric audiology patients. Great Hills ENT serves the greater Austin area including the Arboretum, Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. We are proud to provide excellent care to our patients for general Ear, Nose and Throat (ENT) services, hearing loss, hearing aids, dizziness/vertigo and sleep disorders.