Help for Tinnitus

What is tinnitus? Tinnitus, or ringing in the ears, is a symptom that affects around 30 million people in the U.S. Of these, 1 in 5 report that their tinnitus is severe enough to be considered disabling. People with severe cases of tinnitus may find it difficult to hear, work, or even sleep. Tinnitus is not always characterized as ringing. Some people describe it as roaring, clicking, hissing or buzzing.

What causes tinnitus? Tinnitus is a symptom, not a disease. Some of the underlying problems that may be responsible include hearing loss, exposure to loud noises, and a side effect of medications. It may be surprising to some to learn that aspirin is one of the medicines most likely to cause tinnitus. Other medications that can be responsible include certain antibiotics (e.g. chloramphenicol, erythromycin, gentamicin, others), quinine and diuretics (e.g. furosemide). Tinnitus can also be a symptom of other health problems, such as allergies, anemia, arterioslcerosis (hardening of the arteries), high blood pressure, tumors (e.g. acoustic neuroma) and heart problems. In many cases, however, a specific cause is never found.

What should I do about my tinnitus? Those with the recent onset of tinnitus should undergo medical evaluation. If a specific underlying cause can be determined, it may be treatable. For example, if a minor cause such as wax accumulation in the ear canal is found, treatment can be curative.

Can the ringing itself be stopped? When no specific cause for tinnitus is found, treatment is aimed at managing the symptoms. Most individuals with tinnitus will respond favorably to one or more of the following treatments:

Self-care measures - Factors that can make tinnitus worse and should be avoided include smoking, alcohol, and caffeine. Those who are regularly exposed to loud noise at home or at work should wear earplugs or special earmuffs to protect their hearing. Since high blood pressure can cause tinnitus it is important to have this checked and treated if it is found to be too high.

Hearing aids - with tinnitus have some degree of hearing loss. For example, age-related hearing loss (presbycusis), is commonly associated with tinnitus. Use of a hearing aid will make it easier to hear as well as making the tinnitus less noticeable.

Sound therapy utilizes the principle of distraction to mask tinnitus with a less annoying sound. Electronic devices, such as white noise machines, produce sounds similar to that of radio static. This distracts the individual from hearing the noises produced by their tinnitus. Some of these devices are small enough to fit into the ear. If the tinnitus is mild, a fan or soft music may be enough to accomplish the same thing as a white noise machine.

Medications - No specific medication consistently helps to treat tinnitus. The ones that have helped in certain instances include antihistamines, antidepressants (e.g. amitriptyline and nortriptyline), and the anti-anxiety medication, alprozolam (Xanax, Niravam). Acamprosate (Campral), a drug used to treat alcoholism has shown promise as a treatment for tinnitus, but has not yet been approved for this use by the U.S. Federal Drug Administration.

What about severe or disabling tinnitus? If the above measures are unsuccessful, other treatments can be considered. Cognitive Therapy, originally developed as a treatment for depression and anxiety, uses relaxation and thought remodeling to improve the patient's attitude towards tinnitus. Cognitive Therapy does not decrease the perceived loudness of tinnitus, but has a positive effect on the way in which people cope with the problem. Tinnitus Retraining Therapy is a form of educational counseling that helps the sufferer to “habituate” or filter out the tinnitus so that it does not reach conscious perception. Transcranial Magnetic Stimulation (rTMS), a treatment occasionally used in treating depression, has shown some promise in treating tinnitus, and is currently undergoing additional clinical trials.

If you have any questions about tinnitus, please log into your account and send us your question. We are here to help.

Assessing and Addressing "Belly Fat" Part 2: What are the best ways to lose "belly fat"

Last week we looked at the use of the Body Mass Index (BMI) and waist circumference measurement in assessing obesity. Frequently, people are bothered by the presence of visible (subcutaneous) abdominal fat and don't consider the dangerous health consequences of visceral fat, the fat that is deep in the abdomen surrounding the internal organs. Excessive amounts of visceral fat sets the stage for the development of the metabolic syndrome, a condition associated with high blood pressure, elevated cholesterol, and type 2 diabetes. Better known is the fact that generalized obesity increases one's risk for heart attack, stroke, and certain types of cancer.

Fortunately, there are measures that can be taken to address excess belly fat:

1. Lose weight overall. If you could stand to lose a few pounds (as most of us could), the best way to lose fat from the belly is to lose weight overall. This is best achieved by a combination of regular physical activity and caloric restriction (dieting). For most people, this is neither an easy nor a rapid process. The most lasting results from weight loss programs usually come from slow, steady progress, not from extreme diets or exercise programs. Emphasize complex carbohydrates (fruits, vegetables, and whole grains) and lean protein over simple carbohydrates such as white bread and refined-grain pasta. Pay attention to portion size. Reduce saturated fat sources of food from your diet, such as red meats and high-fat dairy products, such as cheese and butter. Dietary fat should come from foods that are higher in monounsaturated and polyunsaturated fat, such as fish, nuts, and olive oil. Use the BMI and waist circumference to monitor your progress. When these become normal for your weight and height, a marked improvement in your belly fat is almost certain.
   


2. Exercise to assist with weight loss. Many studies have shown that getting regular exercise, along with dieting, is the best way to lose weight. Weight loss occurs whenever more calories are burned than consumed. To illustrate, you need to burn approximately 3,500 calories to lose a pound of weight. If you burn 300 calories during a workout (e.g. walking 3 miles), it takes about 12 workouts to lose one pound. By cutting your caloric intake by 300 calories a day along with a 300-calorie bout of exercise, it takes half as long to lose that same pound of weight. A recent study from Duke University demonstrated that aerobic exercise (walking, swimming, cycling, etc.) was better than resistance training ("pumping iron") in reducing visceral fat and improving risk factors for heart disease and diabetes. In their study, aerobic exercise burned 67 percent more calories than resistance training. For most healthy adults, the American College of Sports Medicine (ACSM) recommends performing moderate aerobic activity, for at least 150 minutes a week or vigorous aerobic activity, such as jogging, for at least 75 minutes a week. More than this may be required during the initial stages of a weight loss program. Although not as effective in burning calories, the ACSM also recommends performing 8 to10 strength-training exercises, with 8 to 12 repetitions of each exercise, twice a week.
   


3. Establish life-long exercise and eating habits.
   
   After losing weight, continuing to eat sensibly and exercise regularly, appear to be the keys to maintaining that weight loss. That was an important finding from the National Weight Control Registry (NWCR), a study of 4,500 men and women who were successful in losing at least 30 pounds and keeping it off. After monitoring this group for 10 years, 94% of them were participating in regular physical activity. The most common form of activity, reported by 76% of participants, was walking. Most of these individuals spent approximately 1 hour per day exercising. Walking is an excellent life-long activity since it is easy on the joints and muscles and does not require special equipment or skills. A second finding of those who were successful in maintaining their weight loss is that they continued to consume a reduced calorie/low fat diet. Women in the NWCR study reported eating an average of 1,306 kcal/day (24.3% of energy from fat) and men reported consuming 1,685 kcal (23.5% of energy from fat).

Many people ask about targeting belly fat with specific exercises. The general term for this is called "spot reduction". Abdominal "crunches" for example are thought to be a way to specifically target belly fat. Unfortunately, spot reduction is almost impossible to achieve. Sit-ups, for example, are beneficial for abdominal muscle strengthening, but sit-ups alone will not get rid of the layer of fat that is covering the muscles. Nor will abdominal strengthening exercises address the deeper, visceral fat. Overall weight reduction through dieting and regular exercise is the best way to reduce ''belly fat''.

For information on weight loss diets, consider contacting our dietician at eDiet. Write to me through eFitness and I'll be happy to help with your exercise program.

Assessing and Addressing "Belly Fat" Part 1: The role of the Body Mass Index (BMI) and Waist Measurement

According to recent statistics, over two-thirds of adults in the U.S. are overweight or obese. While the "middle-age spread" is considered by many to be an inevitable aspect of aging, it should be recognized that along with an increasing waistline comes increased health risks. The development of an "apple shape" to our bodies is an indication of increased deposits of visceral fat. As compared to a more obvious "beer belly", visceral fat lies deep in the body around the abdominal organs. It is of significant concern as it has been linked to an increased risk for cardiovascular disease and type 2 diabetes. Additionally, in women it is associated with an increased risk of breast cancer and the need for gallbladder surgery.

What is the BMI and what does it tell us about our health? The body mass index (BMI) is a measure of body fat based on height and weight. The American Heart Association and National Institutes of Health consider this the primary tool in assessing obesity. The BMI calculator on the National Heart, Lung, and Blood Institute's (NHLBI) website receives 1.6 million visitors a month and ranks #1 on Google. The NHLBI has even made a BMI Calculator App available for the iPhone. Based on the results of BMI calculation, individuals are ranked from being underweight, normal, overweight or obese. In general, the higher the BMI, the greater the risk of developing certain diseases. For example, someone with a BMI of 30 or higher, would be in the "obese" category—a group that has been shown statistically to have an elevated risk of heart attack and stroke.

Shortcomings of BMI in assessing obesity. The BMI provides meaningful information in most people, but it does have some limitations in assessing obesity since it depends solely on the weight and height of a person. For example, some people are naturally stocky and have a BMI in the overweight category, when in fact their weight is due to muscle mass and a heavier bone structure rather than excess fat. The BMI can also underestimate body fat in an older person who has lost muscle mass. Conversely, even with a BMI in the normal range, someone could be carrying more body fat than is good for him or her. As a result, it is best to use a second assessment tool to get a more accurate assessment of obesity.

What measuring your waist can tell you. The recommended tool to use along with the BMI to assess body fat distribution is waist circumference. It correlates well with an individual's visceral fat and the risk of obesity-related morbidity and mortality. According to the National Institutes of Health, when the BMI is between 25 (overweight) and 35 (obese), a high waist circumference is associated with an increased risk for type 2 diabetes, high cholesterol, hypertension and cardiovascular disease.

How is the waist measurement performed? Follow these steps and consult this table to assess your risk:

1. Place a tape measure around your bare waist, just above the hip bones.
   
   
2. Make sure that the tape is level all the way around and fits snugly and not pushing into the skin.
   
   
3. Relax, breath out, and measure your waist.

Women with a waist measurement of 35 inches (89 centimeters) or more indicates an unhealthy concentration of belly fat. In men, a waist measurement of 40 inches (102 centimeters) or more is cause for concern.

How else can body fat be measured? In most instances, a combination of BMI calculation and waist measurement provides enough information to assess one's health risks due to obesity. Other ways of assessing for obesity include measuring skinfold thickness with calipers, underwater weighing, electrical impedance, and computed tomography. However, these methods tend to be impractical, expensive, or unreliable. If your personal assessment indicates that you need to work on your "belly fat", next week we'll look at some ways of doing this.

What the Tongue Says About Health

The bulk of the tongue is made of muscle that is covered with a moist tissue called mucosa, the same tissue that lines other parts of the inside of your body, including the nose, mouth, and lungs. Small bumps called papillae cover the upper surface of the tongue and between these are the taste buds. The primary functions of the tongue are to help you form words and to chew and swallow. At any point in time, up to 15% of adults will have some condition affecting the tongue. These can vary from harmless curiosities to life-threatening conditions. Just as abnormalities of the eyes or skin can be an indicator of disease, certain medical conditions can be suspected based on abnormalities affecting the tongue. These abnormalities include pain, changes in the normal color of the tongue, and alterations in the normal tongue surface.

1. Growths and ulcerations

   • Cold sores are caused by a herpes virus and more commonly occur on the lips. Cold sores tend to be recurrent since the virus stays in the body, becoming reactivated due to factors such as fever, menstruation, stress, or fatigue. Cold sores will resolve on their own but can also be prevented or treated with anti-viral medications.
     
     
   • Aphthous ulcers are small, painful ulcers commonly known as "canker
     sores". The cause of canker sores is unknown, but may develop after a minor injury to the mucosa of the mouth or from sensitivity to certain foods, such as nuts. Aphthous ulcers are unrelated to herpetic cold sores and resolve on their own in a week or so.
     
     
   • A persistent growth or ulcer on the tongue could indicate the presence of oral cancer, most commonly, squamous cell carcinoma. Oral cancer is more common in people who smoke and/or drink alcohol heavily, but can also be caused by the human papilloma virus (HPV). When a persistent tongue growth is detected, biopsy is usually needed to distinguish benign conditions from cancer.
     
     
   • Benign lesions appearing on the tongue include fibromas (fibrous tumor), cysts, and papillomas (wart-like growth).
     
     
   • Tongue enlargement can occur with a severe form of hypothyroidism known as myxedema. Sudden swelling of the tongue can be caused by an allergic reaction or a side effect of medications.
     

2. Color changes

   • White patches on the tongue may be due to lichen planus, yeast (Candida albicans) infection, or to leukoplakia. The most common finding in people with lichen planus are itchy, purplish skin lesions near the wrists or ankles. Candida infections affecting the mouth (thrush) occur more due to a suppressed immune system, as a side effect of taking a corticosteroid medication (e.g. prednisone), or in infants. Leukoplakia is a white patch affecting the mucous membranes of the mouth. It is thought to develop from chronic irritation such as rubbing against a rough tooth or ill-fitting dentures. Leukoplakia is usually benign, but can progress to cancer in rare instances.
     
     
   • Hairy tongue, also known as "black hairy tongue", is a harmless condition in which the tongue looks hairy or furry because the papillae grow longer and don't shed like normal. Most people who have hairy tongue are coffee or tea drinkers, often in addition to using tobacco. Debris or bacteria collect between the enlarged papillae causing the discoloration. Practicing good oral hygiene and eliminating contributing factors is the usual treatment for hairy tongue. Some people find that using a toothbrush or tongue scraper help to remove the elongated papillae.
     
     
   • Geographic tongue is one of the most common tongue abnormalities, resulting from inflammation of the surface on the tongue (glossitis). It appears as red patches that are surrounded by wavy, white border. This creates a map-like, or geographic, appearance. Geographic tongue usually does not cause symptoms, although some people with this condition report a burning sensation or an irritation of the tongue with hot or spicy foods. When symptomatic, geographic tongue can be treated with topical steroids or antihistamine rinses.
     
     
   • Red tongue can indicate a nutritional deficiency of iron, folic acid, vitamin B12, riboflavin, or niacin. The redness is due to inflammation and loss papillae on the surface of the tongue. Correcting the underlying deficiency addresses this tongue condition.

3. Tongue pain

   • Minor infections or irritations are the most common cause of tongue soreness. Cold sores, canker sores, and glossitis are common causes.
     
     
   • Burning tongue syndrome (or burning mouth syndrome) is a cause for tongue pain without an obvious source. An altered sense of taste and dry mouth are common accompanying symptoms. Burning tongue syndrome occurs most frequently in women around the time of menopause. Treatment can be challenging since there is no obvious cause. Two treatments that have been shown to work in clinical trials include a lozenge form of the anticonvulsant medication clonazepam (Klonopin), alpha-lipoic acid (a strong antioxidant), and capsaicin, the substance that makes peppers hot.

Many tongue abnormalities are harmless and do not require treatment. If uncertain of the cause of a tongue lesion, however, it is best to have a biopsy performed or consult with an oral surgeon or Ear Nose and Throat specialist.