By Dr. Max S. Chartrand Ph.D.
'My head feels plugged up when I wear these hearing aids!' exclaimed my new patient, a middle-aged female who had used her new instruments for less than a week.
'Mmmmm, let me see,' I said as she removed her hearing instruments.
I quickly inspected them to see if the earmold vents were plugged. They were not. An otoscopic exam and a screening tympanogram both revealed a fluid-filled middle ear cavity. No sign of redness.
'Hmmmmm.. .your ears feel plugged up because they are,' I assured her. 'Do you have allergies?'
'Oh, no, I don't think so.'
'Do you have sinus drainage, hay fever, or anything of that nature?'
'Oh, I do have that once in a while. I thought you meant: am I allergic to anything?'
That was exactly what I meant.
A visit to her physician revealed that she was, indeed, suffering from airborne allergies (pollen, spores, household dust) which caused her eustachian tubes not to open every third or fourth swallow, as they normally should, to equalize pressure in the middle ear. The result was a fluid-filled middle ear cavity and a fluctuating conductive hearing loss of about 45 dB in the low frequencies. Coupled with her permanent high-frequency sensorineural (nerve) hearing loss, she did, indeed, feel 'plugged up.'
UNDER-DIAGNOSED CONDITION
The 20th century's two most prevalent yet under diagnosed health problems are hearing loss, affecting 12%, and significant allergies of all types, affecting more than 50%, of the general population. These two health problems are generally elusive in their own way and therefore achieve high marks on life's misery index, once properly attributed through timely health and medical examinations. In the case of allergies, one may be allergic to certain foods, drugs, medicines, toxins, spores, dust, pollen, and/or a wide variety of everyday substances. The problem is that the myriad sources of allergens, overlapping symptoms, and the often resulting infections and disease can mask allergy as a recognized and treatable factor in one's health.
A CASE OF FRIENDLY FIRE
In the Gulf War of 1991, some of the most tragic losses on the battlefield were from 'friendly fire' -- good guys accidentally shooting other good guys.
Most allergies share that same dubious distinction: they are the good guys responding to perceived enemies. To protect itself, the body responds to a supposed danger, creating symptoms identical to pathological disease.
In many individuals, the predisposition to allergy is heredity; some conditions, such as asthma, are generally accepted as psychosomatic and emotionally-related.
In either case, it is common that, starting in infancy, the antibody IgE is produced by the body to ward off al allergens, causing an overreaction and, therefore, swelling of tissues, increased mucous production, spasm of smooth muscles, itching, and accumulation of inflammatory cells. The stage is set for bacteria growth, particularly in the upper respiratory system. Wheezing, runny nose, headache, burning eyes, and middle ear fluid accumulation may result.
ALLERGIES IN SMALL CHILDREN
The undeveloped eustachian tubes (the tube in the back of the throat that connects with the middle ear cavity) of infants and small children are particularly sensitive to even small irritations due to allergy. One of the most common problems in young children is chronic otitis media (recurring middle ear infection). In most cases, the underlying cause appears to be airborne or food allergy. The resulting infection is secondary. Yet, it is often the infection that receives the treatment, not the allergy that creates the infection in the first place.
So the cycle of allergy, fluid build-up, infection, and antibiotic treatment continues over and until the child's eustachian tube has finally matured (lengthened) and he outgrows some of the allergies experienced so prevalently during early childhood. Some times, this vicious cycle is superficially broken by the physician placing tubes in the ears (myringotomy) or by removal of the adenoids and tonsils.
By venting the eardrums, fluid build-up from allergy is kept under control. However, the unprotected middle ear cavity is then subject to bacterial infections by direct exposure to air and water. Resulting scar tissue on the eardrum may cause a mild hearing loss for the child. In the case of removal of the tonsils and adenoids, these procedures were once very common in medical practice, but today are carried out only as a 'last resort.' However, the continual pattern of allergy, secondary infection, and antibiotic course can finally bring about the state of malfunc tion requiring removal of these two important immunological glands.
Not all cases of otitis media and tonsillitis are caused by allergy; yet recent studies find that up to 50% of subjects respond to treatment without antibiotics as well as others who are prescribed antibiotics. The caution here is that overuse or constant use of antibiotics predisposes the individual to future im mune deficiencies and more allergies later in life.
In certain areas of the country, where airborne allergens are particularly high, the cycle of allergy (as primary cause) and infection (as secondary cause) could be more effectively managed if the allergy received medical atten tion before infection sets in.
Meniere's Disease and Allergy: A Connection?
Meniere's Disease (or endolymphatic hydrops) is a condition of the ear which usually exhibits the symptoms of vertigo (nausea), tinnitus (head noises), and hearing loss (particularly low frequency). Because of lack of fluid (endolymph) resorption in the cochlea (inner ear), the result is feelings of pressure and the symptoms listed above. Attacks may last minutes or hours and occur unexpectedly at any time of day or night. Hence, many tragic cases of sudden deafness and stark lifestyle changes have been shared by sufferers of Meniere's. Known as Meniere's Syndrome in its lesser stages, sudden hearing loss sometimes occurs, or more often, fluctuating hearing loss. In some cases, complete deafness results.
Another complication is accompanying recruitment, especially hyper-recruitment, where gradual increase of sound is sensed as a rapid increase, instead.
In general, the condition is known as idiopathic because the cause is rarely known and occurs unilateral ly (one ear only) in approximately 75% of cases.*
According to Dr. Jack Pulec, M.D., of Los Angeles, California, the most common cause of Meniere's Disease is allergy, particularly food allergies. In another report, allergy to sugar and caffeine was suspect. Yet, people with Meniere's very often do not receive a complete food allergy assessment before medical treatment begins. Of course, there are other causes of the condition, but none so universal as allergy. While many of the symptoms of Meniere's may he medically managed by artificial or surgical means, it is important that the primary cause of the Meniere's first he established before the proper remedy can be determined.
THE ALLERGIC EAR CANAL
The ear canal is often a reflection of the state of health of the whole person. A pH balance problem such as diabetes mellitus, hyperglycemia, and hypoglycemia, will also appear in the ear in the form of mild irritation (itching) or even chronic external otitis (pain and in fection), often due to fungus and/or yeast, and, in chronic cases, psuedomonas.
Other causes of pH imbalance might involve high blood pressure resulting from high sodium, low potassium in the body (again, fungus, yeast). By treating symptoms only (relief of itching or infection) and not the cause, the problems persist.
It is frequently reported that hearing aid users have a higher-than-normal incidence of ear itching and pain, yet in actuality, wearing the instru ments only exacerbates the problem, making it appear more pronounced. With or without the earmold in the ear, the problems are there, although not as obvious. This is especially true in cases of pseudomonas and fungal growth. Untreated, the problem is always there, possibly noticed only while wearing hearing aids.
Persons who have skin allergies elsewhere on the body can also expect allergic symptoms in the ear canal. Hearing aid shells and earmolds are therefore available in non-allergenic or hypo-allergenic materials to accommodate the problem. In addition, a more strategic wearing schedule may be necessary for the new hearing aid user who has skin allergies.
Information about allergies must be shared with the audiologist or hearing instrument specialist. Avoidance of this vital information can cause unnecessary failure in the adaptation and rehabilitation process.
In today's specialized healthcare system, it is sometimes easy for one not to interrelate the various cond of the body. hearing loss is probably the most overlying condition because it is affected by such a wide variety of other health conditions.
Only a complete hearing health assessment, looking at the total person, can paint the true picture of one's hearing health and special needs. This must be accomplished by one trained in such assessments.
Allergies of all kinds are SO common in the general population, it is important that its af fects upon hearing health he sear ched out and considered in the overall aural rehabilitation program. Only then may those with hearing loss successfully take advantage of the marvels of ad vanced hearing technology and rehabilitation. And, once again, enjoy the colorful world of sound.
BIBLIOGRAPHY
Brackelt. 0. Macon AB. Ross. M: Assesment and Management of Maè htaflrg /.np.s Children. Austin. TX: P,o-ed. 1991.
Chartrand, MS: Hearing lnstrument Counseling: Practical Applications for Counseling the Hearing lmpaired, Livonia, MI: National Institute for Hearing Instruments Studies. 1991.
Hoover, S: Tinnitus and Allergy, Proceedings III Inter. nat Tinritus Scm Mueniter. 1987.
Kieste,. Edwin .1'.. ed: Ne Family Medical Guide. Des Mo IA: Mor Corporation, 1 929.
Newby, HA: .4udiology (SIN cdl. E Cihi. NJ:P,eht,ce-H&I. Inc., 1982.
Vade, C: Home Encyclopedia of Symp:cnrs A/let. ge'rs. a,,d Tb Nolumal fle,r,ed,eo. V'/e Nva NY:
Perke, Pr.ibi.shirrg. 1991.
DigiCare Hearing Research & Rehabilitation, Rye, CO. Fax 719-676-6882.
