Real ENT Facts by Real ENT Specialists
August 14, 2018
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When There is No Music Playing?

Musical Ear Syndrome

By Rachel Bringewatt, Au.D., F-AAA

 

Do you ever hear a song and then have it stuck in your head all day? I think many of us can relate to that experience. The brain and our auditory memory are truly fascinating in how they react to sound and music. For some people, this phenomenon goes beyond simply having the tune, “stuck in their head,” and they hear a song playing as if it were on a radio inside their head. This is described in the literature as musical tinnitus, auditory hallucination of musical type, musical hallucinations, musical tinnitus and musical ear syndrome.

The most common types of music heard with musical ear syndrome are patriotic tunes (the star-spangled banner), Christmas carols, and religious hymns. They often seem to be songs buried deep in the auditory memory of a patient-songs they heard as a child.

Musical ear syndrome is not nearly as common as tinnitus, but it does exist in patients completely separately from other types of auditory hallucinations or “hearing voices in your head.” Most patients with musical ear syndrome tend to be women who are older in age and have sensorineural hearing loss. It is thought that the loss of hearing and stimulation of that area of the brain causes the brain to compensate by creating its own “noise”, much like we believe is occurring in many tinnitus patients.

A hearing test with a knowledgeable audiologist is the first step in evaluating this condition. An ENT doctor may be involved in checking your ears for any signs of a problem and sometimes, a neurologic examination may be recommended if there is suspicion of an underlying structural or neurological condition causing your symptoms.

There is no known “cure” for musical ear syndrome, but sometimes reassurance that this is not necessarily associated with a psychiatric problem helps reduce worry about the situation. If the musical tune you hear is pleasant, you can learn to adapt and enjoy! If it is bothersome, a more involved evaluation should be done as there is evidence that treating concurrent insomnia, depression or anxiety might resolve the symptoms.

The bottom line, musical ear syndrome is a real condition and is different than other auditory hallucinations. Your audiologist can be a great resource in discussing your symptoms and determining if you need a referral to have any further evaluation.

Still Common Even After Surgery, So Now What?

What are Nasal Polyps or Sinus Polyps?

Nasal polyps are fluid-filled growths on the lining of the nasal passages or sinuses that are painless and noncancerous. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders. They can be asymptomatic or be the cause of congestion, loss of smell, nasal drainage, and recurrent sinus infections.

Why Should I be Concerned?

The sinus and nasal anatomy contains very thin boney divisions especially between the sinuses and the brain and the sinuses and the eyes. When sinus and nasal polyps continue to grow unchecked and untreated, they can cause damage to those thin bones creating potential risks to the brain and eyes.

Treatment Options to Maintain Control of Nasal Polyps

No treatment for nasal polyps is full proof. Many ENT specialists will often try a course of steroids to try to shrink the polyps, but rarely works and patients often end up needing surgery. This still isn’t a cure-all either, however. According to studies, 35-46% of patients will redevelop polyps after surgery despite continuing a nasal steroid regimen. For patients who don’t continue a strict nasal steroid regimen, their chances of recurrence after surgery is more like 70%! Many polyp patients require multiple surgeries and continued nasal steroid therapy with periodic bouts of stronger steroids.

So, is there any good news in all this?

Yes! Fortunately, there are a few on and off label tricks your ENT may employ to try to control annoying polyps. Some of the off-label tricks that have shown to help patients with nasal polyps include using a steroid eye drop in the nose or using nebulizer steroids (usually used for asthma and other lung issues) in sinus rinses. These forms of treatment seem to be covered better by insurance (or are at least cheaper) than the newest, most-studied and FDA-approved, on-label treatment, the Sinuva steroid implant. Some patients can maintain on daily budesonide (steroid) rinses; however, for patients where this fails, the only way to avoid another surgery may be Sinuva. This implant is placed during a routine office visit. It expands into the ethmoid cavity and delivers steroid directly to the sinuses for up to 90 days. Studies on the Sinuva sinus implant show a reduction in nasal polyps, nasal obstruction or nasal congestion, a reduction in need for repeat sinus surgery, and an improvement in a reduced sense of smell.

 

So, if you are a person that just can’t kick your nasal polyps and are looking for relief, we are one of very few clinics nation-wide and certainly the first and only Omaha, Nebraska clinic currently performing Sinuva. We have placed the implant with successful outcomes in our Omaha clinic and we would be happy to discuss this option with you at your next appointment! Don’t hesitate to call or request your appointment online!

 

REFERENCES

DeConde AS, et al. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2016;126:550-555.

Lavigne F, et al. Steroid-eluting sinus implant for in-office treatment of recurrent nasal polyposis: a prospective, multicenter study. IFAR. 2014;4:381-389.

Wynn, R, Har-El, G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. Laryngoscope. 2004;(5):811-813.

Written by Rachel Bringewatt, Au.D., F-AAA, Audiologist for ENT Consultant Audiology and Omaha Hearing Aids.

Even with perfect, normal hearing in one ear a hearing impairment on the other side causes problems when you want to hear in noise. Most people with hearing loss in one ear only can hear well in a quiet environment with only one other person talking, but that all changes in a noisy restaurant or with multiple talkers.

This is because of the way our brain and ears work together to hear in noise. Our brain typically uses one ear to monitor noise, so we can become quickly aware of a sudden loud noise or any dangerous auditory signal. It uses the other to focus on the speech that we want to separate out of the noise and hear it effectively.

With hearing loss in even one ear only, this ability is lost or diminished. So, what are the options for single sided hearing loss?

  1. hearing aids for both earsIf the hearing loss can be fit with a traditional hearing aid, that is a great option. The directional microphone technology and noise reduction in the hearing aid will further assist in noise.
  2. If the hearing loss on the bad ear side is too great to be helped by a traditional hearing aid a CROS (contralateral routing of signal) hearing instrument (sometimes referred to as a cross over hearing aid) can be helpful. A CROS aid system requires a device to be worn on each ear. The ear with hearing loss wears a hearing aid that only picks up sound and then wireless transfers it to the good hearing ear where the device on that ear allows the good ear to hear for the bad ear! This way, if someone whispers speech to your bad ear, the good ear hears it.
  3. A BAHA or bone anchored hearing aid can be used as well. It is a device worn on the bad ear side and can be implanted there or worn on a band device. The BAHA picks up sound and transmits to the inner ear on the good ear side through vibration of the skull bones (bone conduction). This allows sound from the bad ear side to be heard and processed.
  4. A cochlear implant may also be a consideration in cases of single sided deafness. An evaluation with a cochlear implant team is needed to determine candidacy for this type of device.

If you have hearing loss in one ear only, I invite you to come in and chat with myself as well as one of our ENT specialists. Please feel free to request an appointment, and we will work toward getting your hearing back on track! 

Could Your Sinus Surgery be Done in the Office?

The prospect of having surgery can be very scary for many patients. You had this issue that at first seemed annoying but is now affecting your everyday life. You thought it wasn’t a big problem, but now it has grown into an issue that now requires surgery. But, what if your sinus surgery could be more like an office procedure? This is very much a reality for many sinus sufferers through a procedure known as balloon sinuplasty.

What is Balloon Sinuplasty?

Balloon sinuplasty or balloon sinus dilation is a procedure that ENT doctors can use to open blocked sinus drainage pathways. We have been doing this in Omaha now in the operating room for over a decade, so it isn’t new. The idea of doing sinus surgery in the office under local anesthetic (lidocaine) is more widely accepted than ever and has been commonplace in our clinic for the last five years.

So, how does balloon sinuplasty work?

  1. A lighted guidewire is fed into the affected sinus. This makes sure that the device is correctly positioned, and the device will open the correct drainage pathway with minimal trauma to surrounding tissue.
  2. The balloon is fed over the guidewire and inflated in the drainage pathway opening the area for better drainage of what should be an air-filled cavity.
  3. (Optional and at the Surgeon’s discretion) Saline is rinsed through the device into the sinus directly removing any active infected drainage or biofilm (what happens when a bacteria sets up shop in your sinus lining).
  4. This leaves a clean, open and healthy sinus.

Advantages of In-Office Sinus Surgery

  • LESS EXPENSIVE! There are no hospital or anesthesia fees to worry about when you have your procedure done in the office! Also, this type of procedure is now widely accepted by most insurance carriers.
  • FASTER RECOVERY! Most patients experience very little to any pain and can return to their normal activities after a couple days!
  • Some additional procedures to aid with nasal congestion can be performed at the same time.
  • Allows patients not healthy enough for general anesthesia to get relief.
  • Patients can relax in a familiar environment with familiar faces.
  • No risk of complications and side effects from general anesthesia.

Disadvantages of In-Office Sinus Surgery

  • In-office sinus surgery cannot address ethmoid sinuses or the sinuses between your eyes
  • We cannot fix a deviated septum comfortably in the office, and if the septum is too obstructive, we cannot reach some of the sinuses in the office.
  • Extensive polyp disease cannot be removed effectively in the office.

So, could your sinus surgery be done in the office? If you are looking for a faster recovery at a lower cost, you should ask your ENT specialist about in-office sinus surgery. Not every patient is a good candidate, but you won’t know if you are a candidate unless you ask! Current patients can ask via their Patient Portal. New patients can Request a Visit Online today!

 

REFERENCES

Karanfilov B, et al. Office-based balloon sinus dilation: a prospective, multicenter study of 203 patients. Int Forum Allergy Rhinol 2013 May;3(5):404-11.

Cutler J, et al. Standalone balloon dilation versus sinus surgery for chronic rhinosinusitis: A prospective, multicenter, randomized, controlled trial. AM J Rhinol Allergy 2013 Sep;27(5):416-22.

Levine, SB, et al. In-office stand-alone balloon dilation of maxillary sinus ostia and ethmoid infundibula in adults with chronic or recurrent acute rhinosinusitis: a prospective, multi-institutional study with-1-year follow-up. Ann Otol Rhinol Laryngol 2013 Nov;122(11):665-71.

Which is Better: Allergy Skin Test or Allergy Blood Test?

What are allergies?

Allergies are an abnormal immune response to a normal substance.

Allergies can range from mild to life-threatening, and are often cumulative, meaning that they can worsen or increase over time. However, allergies are also treatable, and by knowing what a person is allergic to, we can help devise a treatment plan. Treatment can mean anything from daily medications like antihistamines to nasal sprays to immunotherapy like allergy shots depending on the cause and/or severity.

What is allergy skin testing?

Allergy Regions United StatesAllergy skin testing involves using a comb-like device to place allergens on the surface of the skin to measure the reaction.

You could react right away, or it might take 15 to 20 minutes. If you don’t react, you are not allergic to the substance. If a reaction is not clearly negative or clearly positive, the allergy nurse may inject a less concentrated version of the antigen just under the skin to see if the prick test was giving a false positive. Clinics throughout the same city are likely to have similar panels of allergens they test; however, if you have had allergy testing somewhere else, it might be worth retesting if you are having issues. Note in the picture to the right that even Nebraska and Iowa (still very close together) are considered to have different allergen profiles!

What is allergy blood testing?

Allergy blood testing involves testing blood to determine the amount of a substance known as IgE, which is the antibody produced during an allergic reaction. 

Allergy blood testing can refer to RAST or radioallergosorbent testing, ImmunoCAP, or ELISA testing. Blood is drawn, and tests are run to determine the amount of a substance known as IgE, which is the antibody produced during an allergic reaction. RAST testing is the oldest form of allergy testing but is also considered to be the less sensitive in detecting allergies, especially for patients with allergic rhinitis. Studies have shown ImmunoCAP to be the most sensitive and most preferred version of allergy blood testing nationwide, and it is the FDA’s recommended type of blood testing. Some studies compare ImmunoCAP sensitivity to that of skin testing; however, it is still widely held by the allergy and immunology community that for patients with allergic rhinitis, skin testing is still the gold standard. ELISA testing is mostly only used for food allergy testing, but this method is questionable in both theory and validity.

Why would my doctor order allergy skin testing over blood testing or vice versa?

Allergy skin testing is considered the best option because it is more sensitive and less expensive.

However, not every patient is a candidate for this type of testing – patients on a beta blocker, patients with life-threatening or unstable heart disease, patients with severe asthma, etc. To these patients, the risk of anaphylaxis from testing is too dangerous. So, for these patients, blood testing may be their best or only safe option.

Below is a break down of items that interest allergy patients when determining if they would like to proceed with allergy testing.

ITEMS OF INTEREST

SKIN TEST

BLOOD TEST

Accuracy

MOST ACCURATE

LESS ACCURATE

Same Day Results

YES

Could take up to a week.

Risk for Severe Reaction (anaphylaxis)

HIGHER RISK

No risk.

Covered by Insurance

YES

Not covered by some insurance carriers. You will be required to sign that you are willing to accept charges for this kind of testing if not paid by your insurance.

Can Test Environmental Allergies

YES

YES

Can Test Food Allergies

YES

YES

Can Determine Allergy Shot Treatment

YES

NO – not sensitive enough to determine exact concentration of serums.

Can Determine Allergy Oral Drop Treatment (which may or may not be covered by insurance)

YES

YES

 

References

Chinoy B, et al. (2005) Skin testing versus radioallergosorbent testing for indoor allergens. DOI:10.1186/1476-7961-3-4.

Negini AC, et al. (1985). ELISA in diagnosis of respiratory allergy. A comparison with RAST and skin tests. Ncbi.nlm.nih.com/pubmed/3890599.

Van Hage M, et al. (2017) ImmunoCAP assays: pros and cons in allergology. DOI:10.1016/j.jaci.2017.05.008.

Kumar, P, et al. (2013) Basic and clinical immunology – 3018. Immunocap vs. skin prick testing for inhalant allergens. DOI:10.1186/1939-4551-6-S1-P194.





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