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Thursday 11 January 2007, 3.00-3.30pm
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BRITISH BROADCASTING CORPORATION



RADIO SCIENCE UNIT



CHECK UP

Programme 8. - Ears



RADIO 4



THURSDAY 11/01/07 1500-1530



PRESENTER:

BARBARA MYERS



CONTRIBUTORS:

TONY WRIGHT



PRODUCER:

DEBORAH COHEN



NOT CHECKED AS BROADCAST





MYERS

Hello, once out of childhood we tend to take our ears and our hearing pretty much for granted. So it comes as a bit of a surprise, I suspect, when we reach middle age and find that we don't hear as well as we used to. Are people mumbling or is it me? Sometimes it's because ears are blocked with wax, wax secretions tend to become drier and harder as we get older. Sometimes it's because the ears themselves seem to be ringing. But often as not what we're experiencing is age related hearing loss. It's a bit like needing reading glasses, it's something we don't always like to acknowledge. Is it inevitable? Could exposure to loud noises make it worse? Will the condition continue to deteriorate? Is it worth getting your ears tested and considering if and when you're ready for a hearing aid?



Well call us now to put your questions to Professor Tony Wright, he's from the Ear Institute at University College, London. The number 08700 100 444 or e-mail checkup@bbc.co.uk.



We've got Bob Clark on the line first, he's from Rustington, and he's having problems - I hope you can hear us Bob - what are your hearing problems then?



CLARK

My only problem is hearing in a noisy environment. I'm fine if it's quiet, I can hear as well as anybody, but if there's any noise around, such as in a party or something like that then I really can't hear conversation at all.



MYERS

Now I think this is probably something that Tony Wright, our expert today, hears a lot from patients coming to see him, am I right?



WRIGHT

You're absolutely correct Barbara.



MYERS

So what's the problem - what's going on - are we talking about age related hearing loss?



WRIGHT

Well I think in Bob's case we are. As we all age the small microphones in the inner ear wear out and especially those ones that detect high frequency - high pitch - sounds. So while there's no problem in one-to-one conversation, as soon as we get into background noise where we need all the information that we can get to pick out one voice from many you start to have problems, it's called the cocktail party syndrome.



MYERS

So Bob you're normal, may I ask what sort of age you are?



CLARK

I'm 55.



MYERS

Fifty five, so is this the kind of - sort of age that this starts to hit people?



WRIGHT

This is exactly the sort of age that this kind of problem in background noise happens. We've just lost enough of the microphones that the hearing appears to deteriorate when it's working under difficult conditions, that is in background noise.



MYERS

Bob, have you ever done anything to jeopardise your hearing?



CLARK

Not that I can think of no, no, usual sort of discos when I was younger but that was a long time ago obviously. But that's exactly my problem, as I say, when it's quiet I can hear just as well as anybody, in fact better than my wife can, but come in conversation then she can hear in a party and have a conversation but I can't hear a thing unless the person next to me is really shouting in my ear and that's sort of quite embarrassing.



MYERS

You've described the problem very well Bob and obviously Tony's agreeing that this is one of those things that happens but I know what's underpinning your question is what you can do about it, if anything. But let me, before we get to that answer, perhaps I can bring in Sue Wray who's also waiting to speak to us and has, I think, a similar sort of problem, caused possibly by loud noise in the first place Sue?



WRAY

I think so yes. In the '60s and '70s I can remember going to concerts where I sat in front of a speaker or stood in front of a speaker and came out with my ears literally ringing for hours afterwards. But we also have a family history of hearing loss, so I probably didn't help it.



MYERS

And are you finding that it's particularly difficult in a noisy environment where lots of people are chattering?



WRAY

What I'll find is very much like Bob does. If I go to a restaurant where there's background music I can hear the background music and can't hear the person sitting opposite me.



MYERS

So what's the solution in that case, if we agree that this is a problem and a lot of people do suffer this problem?



WRIGHT

At present we've got no way of putting the microphones back or resurrecting them or getting them to work again.



MYERS

By microphones we should just be quite clear - we've got microphones here in the studio and I wouldn't like to think I've got a microphone like that in my ear, so you're using an analogy here?



WRIGHT

I'm using an analogy. In the ear there are about 15 - in each ear there are about 15,000 small microphones which convert sound to an electrical signal which goes then off to the brain. They wear out with ageing but also they're beautifully delicate, very sensitive and therefore easily damaged. So the combination of ageing and some previous noise is enough to cause an additional loss which makes hearing in background noise worse again.



MYERS

And does it affect everyone or everyone to some extent?



WRIGHT

Well if - the age related hearing loss affects everyone but it's to a greater or lesser degree. And some people have tough ears and their ears do not wear out so quickly as others. The same thing with noise exposure - some people have tough ears and do not get easily damaged. The ageing rockers seem to have tough ears and those pop stars who have weak ears give up quite quickly because they can't perform.



MYERS

Well I don't think Sue actually was a rocker, although she listened to rock music by the sounds of it. So are we talking hearing aids, are we talking about loss actually that's going to get worse so really if you do want to be able to hear and get on with life in the normal way you might want to think about a hearing aid for perhaps Bob and Sue?



WRIGHT

There are two questions there. The one is it going to get worse? As time goes by the hearing test, the audiogram, that we do would probably look worse but the effect on you, on your hearing, won't be significantly greater for many, many years.



MYERS

Oh so it's as though you've reached and crossed a threshold but it doesn't necessarily mean it's downhill all the way?



WRIGHT

It does go downhill but very gradually. As I said the hearing test may appear worse but the effect isn't so marked on the individual. Now it's not that you can't hear higher frequencies but they just have to be louder before you hear them. And so the only way that we can help that now is by using some form of hearing aid to put back the sound at those pitches that you can't normally hear, to try and rebuild the spectrum of hearing.



MYERS

Sue, had you thought that this might be an option for you, are you reaching that stage?



WRAY

Yes I did, I went to my GP who referred me for a hearing test and at the hearing test I was told I had significant hearing loss. But the consultant, when I asked him about a hearing aid, said it wouldn't be any use to me because I could hear some frequencies normally and because of that a hearing aid would amplify everything and this would make ordinary frequencies uncomfortable. I wondered if perhaps with new technology now whether the digital hearing aid would be the solution to that?



MYERS

Very good question, you're asking the right person.



WRIGHT

Sue, I don't know how long ago it was that you spoke to the consultant.



WRAY

I think it's about seven years ago now.



WRIGHT

Well things have definitely moved on since then and with the newer digital aids it is possible to break down - to get into your ear exactly what your ear needs to hear better. And the way that digital aids work is a great advance on some of the older analogue aids and we can put in exactly the sounds that you need to hear which should help. But it does take time to learn to use a hearing aid, it's not like putting glasses on, your brain has to relearn to take in and to understand the new sounds that you haven't heard for many years.



MYERS

Would this account for the fact that I think something like a quarter of people who have gone out and got themselves a hearing aid, whether on the high street or through the NHS, actually don't wear them, they can't get on with them, you hear that a lot?



WRIGHT

There are probably lots of hearing aids in top drawers of bedroom cabinets and partly that's because it was sometimes difficult to tune the older ones to match the person's hearing loss because they weren't digital. And secondly, because you do have to acclimatise to a hearing aid. It takes time for your brain to learn to hear again. Hearing's a very complex - very complex and you have to retrain yourself to hear, especially in background noise.



MYERS

But the results are worth it?



WRIGHT

I think - my experience with digital hearing aids over the last four or five years has been they are certainly worth it for the majority of people.



MYERS

So I hope that's been helpful and Bob if you're still listening I hope that's also been helpful to you. But can I bring in an e-mail now from Jill, who's answering or would like us to answer a simple but important question, as she puts it. If one starts to wear a hearing enhancement aid, as she calls it, before hearing loss becomes a real problem does it accelerate the progress of hearing loss?



WRIGHT

The simple answer to that is no it doesn't. To cause noise damage requires a significant noise input to the ear, to damage the small microphones and there aren't hearing aids that would do that for you. If there's only a slight degree of hearing loss the hearing aid would be limited in its output, so it couldn't cause noise damage.



MYERS

Okay, that's clear, thank you very much. We'll go to Mrs Osbourne in Leicestershire who's got ringing in her ears. Very disturbing?



OSBOURNE

Yes hello. Yes it's beginning to be. I started in my early 50s in bed at night thinking that I could hear soft rainfall outside and then gradually you realise that it was in my head. And then it has developed into ringing but not being too problematic until very recently, I've just turned 61 and just these last few weeks it's becoming really loud, something like standing next to a telegraph pole - there's a ringing and there's also a buzzing.



MYERS

And have you had any conversations with your doctor about it?



OSBOURNE

No, no I mean I'm in the process of changing doctors at the moment but I do intend to pursue it. But I read something recently, an article in the Sunday papers, discussing acoustic neuroma.



MYERS

Right, well let's get a definition of acoustic neuroma and whether that could be a cause of the ringing in your ears or whether there's perhaps something more straightforward going on. So over to Tony Wright.



WRIGHT

Well the difficult question is your first question but acoustic neuromas are very rare but benign nodules that grow on the - actually they usually grow on the balance nerve although they're called acoustic nerves. If they grow by the time they're diagnosed, they grow very, very slowly but can cause problems. There's only about 400 a year in England and Wales, so it is a rare event - acoustic neuromas. But if your noises are one-sided, in one ear, rather than just ...



OSBOURNE

No it is both sides actually.



WRIGHT

But if it's one-sided then us doctors, we don't like one sided symptoms. So if you've got one sided tinnitus with some hearing loss then you really should be looked at to have acoustic neuroma excluded.



OSBOURNE

It does seem to be louder in one ear than the other but it is - I'm pretty sure it's in both ears.



MYERS

So in a way I think Tony's saying it's quite a good thing that it's in both ears but I'm sure it's of no consolation to you, as it makes it quite bothersome.



OSBOURNE

I need to be sure, yes.



WRIGHT

So the way through this for the noises is that it would be sensible at some time to have a hearing test, to see what the hearing levels are like. And if there's a big difference between the two ears then the process is to go on to try and exclude and underlying acoustic neuroma or other problem that could be causing this one sided symptom.



OSBOURNE

I do also have very bad circulation.



WRIGHT

That's probably not related to this. But going back to the noises. As the hearing wears out, as we've spoken about to the last two correspondents, as the hearing wears out and sound isn't getting to the brain what you're starting to do is to hear your own ear working, you're starting to hear the electronics of your own ear. And if you take normal people and put them in a perfectly silent room they all get noises. And then you put them back into sound and the noises disappear. So some forms of tinnitus, which is what you're describing - the ringing noise in the ears - is because there's some associated hearing loss.



MYERS

What's the trick to dealing with it though, if in a way it's something that is going on, it's your perception of a sound?



WRIGHT

So - Barbara thank you, exactly right - it is the perception. Anything in the hearing pathway is perceived as sound. And normally sounds like this don't reach perception, they're in the system but normally they're filtered out before they get up to perception. But what's happened with you with some hearing loss, some of those sounds that are in the system are getting through and you're perceiving them. So the idea is not to be in silence - not to be in silence, to have sounds around. So at night time if you could have some music playing on a bedside clock, very gently, or seashore music.



OSBOURNE

Yes, that's the kind conclusion I come to first thing in the morning when I wake up it's particularly loud, it seems to be when I've been horizontal for any length of time that it is worse.



WRIGHT

It may just be because your brain's been switched off at night that the perception's greater. But if you can be - don't be in silence, it's very helpful, it allows the brain to rehabituate - to get used to those sounds in the system.



MYERS

So there's nothing serious going on and that's your general message to anyone who is having this tinnitus, this ringing in the ears, ignore it if you can, which is difficult obviously, give yourself some other sound to relate to, as it were, perhaps listen to the radio.



WRIGHT

The first thing you said - there's nothing to worry about - you do need to, if it's one-sided and if it's progressive you really should be - I think you should be looked at because there are things - conditions - that cause it. The vast majority of them - cause of tinnitus patients - don't have an underlying disease or condition as such.



MYERS

That's helpful to know.



WRIGHT

But it should be - I think it should be looked at if it's progressive, if it's one-sided, and it's causing you symptoms - problems.



MYERS

Thanks very much. We'll move on Mrs Osbourne to a caller - not a caller, an e-mail I've got here from Nick. Nick has a constant build up of ear wax, he says it's been going on for five to six years, wondering what to do about it, he says olive oil doesn't help. So ear wax - he obviously finds it a problem, he's been trying to get rid of it, it's not working, what would you say about that?



WRIGHT

Ear wax is lovely stuff ...



MYERS

Lovely stuff!



WRIGHT

Lovely stuff.



MYERS

That's not how most people think of it.



WRIGHT

But it's wonderful, it's made up of layers of skin which mixes up with the oil and some modified sweat from the little glands inside the ear canal and it kills bacteria, kills fungus, it's waterproof, it's sticky, you need it - it's good stuff to have.



MYERS

Well that's not what your mother tells you when she says clean your ears out.



WRIGHT

It's fine to clean out the curly bits on the outside but it's not fine to start sticking things down the ear canal.



MYERS

What ever?



WRIGHT

What ever - it's not often you can say always in medicine but that's one of the times because normally the wax is - the skin and the wax migrates out of the ear canal and it's normally self cleansing but performs a protection of the skin - of the delicate skin of the ear itself.



MYERS

So leave well alone. And even olive oil ear drops are not a good idea, or any ear drops perhaps?



WRIGHT

Olive oil and sodium bicarbonate are the most benign, but certainly many of the ones that you can buy over-the-counter have preservatives in them which are really very irritating to ear canal skin.



MYERS

So best left alone but if it really does built up and sometimes you do get a sense that there's something between you and what you're trying to hear, can you get impacted ear wax that does need to be removed?



WRIGHT

Yes you can do. Most impacted wax is due to people with cotton buds just pushing the poor old wax back down the ear canal as it's trying to escape. And so gradually it cannot escape and then does build up. It only causes a hearing loss when it's completely blocking the ear canal. If there's a gap past it the sound can get through and you hear normally. But if it does accumulate for that reason and it needs removing then it does need removing under careful conditions. And if you've had a previous history of ear disease or you've had previous perforations or any trouble with your ears then it really shouldn't be syringed, which is one of the common ways of doing it. And nowadays the ear syringes are better controlled, the pressure of the water that goes in is controlled and it should be a safe procedure.



MYERS

Do you think we're causing problems for ourselves with regard to ear wax by using in ear headphones, you see - I mean everyone has them now with their music players and so on - would that push wax in when it should be coming out?



WRIGHT

It's very difficult to get - push - with the in the ear plugs to get them round the first corner in the ear canal to push the wax back. There are very few deep ear canal phones that people use ...



MYERS

And that would be true of ear plugs - not really a problem if you go swimming, for instance, they're quite useful, they're not pushing the wax in?



WRIGHT

They do not push the wax in is a general principle, it has to be pretty difficult to - with an ear plug or an ear phone - to get the wax back into the place where it can't get out.



MYERS

We've got another caller now Janet Burrow in Newbury got problems with itchy ears, wherein lies the itch Janet, whereabouts in your ear?



BURROW

Yeah hi, it's right deep down, it feels as if it's right in my inner ear, but it's deep down, far out of reach for me to reach to scratch. It feels like I've got loads of ants walking around inside there and it's enough to keep me awake at night and I find I've permanently got my finger either pushing around at the front of the ear or inside trying to relieve it. It's been like it now for about two or three years. I've seen the GP who's given me drops but I follow the course of drops and while I'm putting them in it gives me some relief but as soon as I've finished the course it's there again.



MYERS

What could this be Tony do you think?



WRIGHT

Well the skin of the ear canal is the same as the skin - the skin of the outer ear canal is the same as the skin of the rest of the body and it can get all of the skin conditions that you can get anywhere - eczema, psoriasis - or on the scalp that seborrheic dermatitis where you get dry flaky scalp skin. So there are lots of skin conditions that can cause symptoms like this. Sometimes the skin can get sensitive and certainly some ear drops are very good at irritating sensitive skin. The itching can come from a lot of other causes in the ear - you can become sensitive to hair shampoo, hair sprays, all these sorts of sensitisers can give you the same - that terrible itchy sensation. The one thing you shouldn't do though really is to scratch it with anything hard or even cotton buds because the skin is delicate. And once you break the skin then it's likely to get infected. And then you have to use antibiotic ear drops which again sensitise the skin and make it more itchy, so you can end up with a vicious of itch, scratch, infection causing more itch.



BURROW

But the itch was there before I used the drops so that could have been caused by - what you think shampoo or ...?



WRIGHT

Well there are lots - I said that's the trouble doing it over the telephone, there are lots of things that can cause problems with the single symptom of itch.



MYERS

So might this be a case - you said I think that you'd already been to see the GP, perhaps a visit to the ENT specialist, would you say Tony in this case?



WRIGHT

Well if it's been persistent for two and a half years I don't know whether it's associated with any discharge?



BURROW

No, no I don't have a problem with a wax, I have no problem with hearing, I don't push things in my ear because I've heard people like yourself mention that previously and I'm careful not to push things in. I quite enjoy the relief I get from putting the drops in because it's cold and for a little while it desensitises it but then, as I said before, it comes straight back. So I don't consider I've done anything to cause it and there are no outward symptoms. The only thing that was significant was when the GP actually pushed the scope in to look it triggered it immediately and he said you've got incredibly sensitive ears.



MYERS

Last word on this?



WRIGHT

I'm sure it needs looking at and the appropriate medication - topical medication, some drops or ointment - just to calm the whole thing down.



MYERS

Sorry to hurry you but I want to go to Kay, who's in Cheshire with hearing not so good, can't go to concerts because she finds that they're rather too loud - so your hearing's too good is it perhaps Kay?



KAY

Yes I think it is really because I can hear the slightest sound when I'm in my lounge, even with the television or the radio on I can hear the little tiny rattle of the letterbox when the postman puts letters through, even though I'm some distance away and through different rooms to my hall. So I find that if I go to concerts my ears just throb and it's so unpleasant I've stopped going to concerts.



MYERS

Let's get some top advice on this one then.



WRIGHT

This sounds very much as was dignified by the name hyperacusis where normal sounds just for you appear much too loud and very distressing and it can be a very distressing symptom. I assume your hearing's - your hearing's otherwise normal?



KAY

My hearing is extremely good.



WRIGHT

And this is a common presentation and what's happening is that it's not your ears that are the problem but the way your brain is processing the sounds coming in, the electrical signal coming in and just for some reason it's taking some of them and making them appear over loud. I mean clearly they're not over loud because it's not affecting other people.



KAY

Ah but other people are perhaps going deaf and don't know it so the noise is turned up louder when they're playing - sort of - a disc jockey for instance plays - the music is extraordinarily loud and one has to shout to be able to be heard by people near me.



WRIGHT

You said you even heard the click of the letterbox in the room next door ...



KAY

No it's not just next door it's through rooms and a hall and into a porch and I can hear that sound.



WRIGHT

So you've got a very sensitive ear. These are quite difficult to manage but the thing to do is not to plug up the ears with wax plugs to keep the sounds down and that some of the clinics in hospitals now, in the audiology departments, have hyperacusis - have retraining clinics which help you overcome this problem and if that's serious you should really seek advice through your local ENT.



KAY

Really? Because I really can hear too well?



WRIGHT

Yes and it's a question of retraining.



MYERS

And so a last word on all this, if I may Tony, people who are having loss of hearing, perhaps even recognising it having heard others talking on the programme today, go to the GP, get a hearing test, maybe get a hearing aid, you know, deal with it perhaps?



WRIGHT

Yeah certainly, deafness is one of the commonest disabilities in this country, the second commonest, and perhaps one in seven of the population have problems, will need some help and it is there.



MYERS

Good. Well thank you very much. I hope we have been helpful today, there's more information, as always, if you call our free and confidential helpline, that's 0800 044 044. You can listen to the programme again on our website. But this is the last in our current series of Check Up, I look forward to being back with more medical topics and more of your questions on the 2nd March.




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