Vitamin B12, Cobalamin, is essential for the body to properly use iron and form red blood cells. Red blood cells contain hemoglobin which carries oxygen to all parts of the body. The nervous system also relies on Vitamin B12 for the creation and maintenance of the myelin sheath that lines the nerve cells. Deficiency can cause degeneration of the spinal cord, changes in the brain and peripheral neuropathy. Vitamin B12 deficiency can also lead to atrophy of the optic nerve.
Cobalamin is only found in animal sources; therefore strict vegetarians are at risk for deficiency. Vitamin B12 is bound to animal protein and released by gastric acids. It is stored in the liver and therefore it may take up to two years following the cessation of intake for signs of deficiency to manifest. The deficiency is found in approximately 10% of all individuals over the age of 80 years due to decreased production of intrinsic factor by the stomach, which binds to B12 for absorption. Absorption of Vitamin B12 can be enhanced by Vitamin C and can be inhibited by Antacids and Aspirin. Tea and coffee, which contain tannins, also inhibit absorption. Excessive use of nicotine and alcohol can deplete the body of Vitamin B12.
Most teens and adults need 2 micrograms of B12 per day.
There are many symptoms to Vitamin B12 deficiency. The most telling sign is glossitis (inflammation of the tongue). Other symptoms include unsteady gait, loss of position sense, weakness of the legs, numbness of the feet, pale skin, shortness of breath, irregular rapid heartbeat and loss of appetite. Occasionally there are complaints of memory loss, hearing difficulties, tinnitus and delusion.
A blood test (B12 level) to check the red blood cell count is the main diagnostic tool for identification of a B12 deficiency. Since unsteadiness is frequently reported; audiometry, ENG, and MRI are often performed. Most patients are relieved of their symptoms with B12 supplements either orally on a daily basis, monthly in the form of injections, or via nasal gel.
Audiologists may see B12 deficient patients due to their complaint of balance difficulties. Audiometry and ENG may reveal normal results; however downbeat nystagmus and benign paroxysmal positional vertigo have been recorded in patients with Cobalamin deficiency.
Tinnitus is a symptom, not a disease. It is the sensation or perception of sound that is not in the environment. It can be described as buzzing, hissing, whooshing, rushing, roaring, ringing, clicking or like crickets or steam. It can be localized to one or both ears. It can be constant, pulsating or intermittent and can change in pitch and intensity. It may or may not be associated with a hearing impairment. There are approximately 50 million Americans suffering from Tinnitus. It is estimated that 90% of those patients have some degree of hearing loss.
Two major clinical studies used hearing aids in tinnitus treatment:
◊ The Better Hearing Institute sent their newsletter subscribers an online survey on Tinnitus in August 2008. 230 Hearing Care Professionals responded with results suggesting that six out of ten patients (60%) experience minor to major relief of their Tinnitus when wearing hearing aids. One in five (22%) receive major relief. Less than 2% of patients had a worsening of their Tinnitus and 39% received no benefit.
◊ The Hearing Review published a study conducted in August 2006, “Using Open-Ear Hearing Aids in Tinnitus Therapy”, concluding that patients with mild to moderate sloping hearing loss in the 2-6kHz frequency range may experience benefit from open- fit hearing aids. The pitch of tinnitus is often perceived in the range of 2-6 kHz, and because open fit hearing aids do not occlude the canal and amplify low frequencies, good amplification with 2-6 kHz can be achieved. Sometimes 10-15dB is all that is needed to mask out the tinnitus.
There are ongoing studies, one with a target date of December 31, 2009 from a major hearing aid manufacturer. This company is examining a program originally designed for relaxation that has been used as a tool for tinnitus treatment. The open-fit technology uses a high frequency sound input for its relaxation program. This program has tones, melodies and other sounds that can be adjusted by the user. Data is being collected from hearing care professionals trained in tinnitus management on individuals who have used this program for 3 months or more and those who discontinued use because of no benefit.
Hearing aids may be used as a choice for tinnitus relief by:
◊ Amplifying outside sounds, which make the tinnitus less obvious.
◊ Distracting the patient away from the tinnitus by hearing other sounds.
◊ Decreasing the sensation of tinnitus by increasing the background noise.
◊ Increasing amplification of low level sounds for treatment.
“ Soldiers exposed to the deafening din of battle have little defense against hearing loss and are often reluctant to wear protective gear like ear plugs that could make them less able to react to danger. But what if a nutritious daily “candy bar” could prevent much of that potential damage to their hearing?” (Joseph M. Miller, Ph.D., U of M Health System’s Kresge Hearing Research Institute, 28 March 2007).
About 10 million people in the U.S. alone are suffering from noise-induced hearing loss, including veterans and youth exposed to blaring music under headphones. Researchers at UM and UF are hoping to reverse the rise in NIHL by implementing a “cocktail” of vitamins and the mineral magnesium.
Recent studies at the University of Michigan, University of Florida, and NIDCD have revealed that noise exposure triggers the formation of molecules (free radicals) known to cause hair cell death. Free radicals are highly corrosive molecules that exist naturally within the human body and destroy the inner/outer hair cells during and after noise exposure. Free radical formation begins and then peaks several days after exposure.
Prior to these studies, scientists believed that exposure to loud noise damaged the hair cells by the pure force of the loud sound vibrations. In this case, the only prevention was to reduce exposure and/or to use hearing protection.
U-M researchers have discovered that the combination of vitamins, when mixed with magnesium, can prevent noise-induced damage by blocking some of the cellular reactions. Vitamins A, C, E and magnesium, antioxidants which protect cells from the damaging effects of free radicals, are already widely used supplements and therefore do not require FDA approval.
A clinical study investigating the combination of vitamins A, C, E and Magnesium (Auraquell-TM, UM Kresge Hearing Research Institute) taken one hour before noise exposure, as a once-daily treatment in pill form for five days, was very effective with an 80% success rate at preventing permanent NIHL in animals.
Testing has been implemented in a set of four multinational human clinical trials, all funded by the NIH – military trials in Sweden & Spain, industrial trial in Spain, and a trial involving students at UF who listen to music at high volumes on iPods and other PDAs.
Animal studies thus far have shown a reduction in threshold shifts, ranging from 45 dB to 10 dB, representing a greater than 1000 fold improvement in hearing sensitivity. Guinea pigs were treated one hour prior to noise exposure and again immediately post-noise exposure. Daily treatments continued for five days post noise exposure. Post-noise nutrient doses may scavenge the free radicals that continue to form post exposure. Ten days post treatment, auditory sensitivity was evaluated, revealing the improved thresholds.
Reduction in NIHL was achieved by prevention of sensory cell death in the Organ of Corti. The animal studies were done by using a control group (saline), Mg group, ACE group, and ACEMg group. When the antioxidants were administered alone, NIHL still occurred; only with the addition of Mg was the improvement in the post-noise thresholds noticed.
Magnesium is a vasodilator and may have the added benefit of reducing swelling of the auditory nerve by preventing the noise induced calcium influx. The calcium influx contributes to the free radical damage.
Auraquell-TM will be regulated in the U.S. by the FDA’s Dietary Supplement Health and Education Act of 1994 (DSHEA), and label claims for the product will be made following 21 CFR 101.70 regulation and not through the IND/NDA process. This will allow the manufacturer, Otomedicine, Inc., to launch Auraquell-TM with defined and FDA-approved health claims in a shorter amount of time (4-5 years). Auraquell-TM will be a preventative treatment used in conjunction with conventional hearing protection.
In addition to prevention of NIHL, studies are underway to research the role of free radicals in drug-induced hearing loss and age-related hearing loss. Miller’s research has also shown that local application of “Thiourea” (antioxidant) can prevent hearing loss without compromising the efficacy of the anti-cancer medication, Cisplatin, to destroy cancer cells.
“Other people would likely benefit by consuming a pill or nutritional bar before going to work in noisy environments, or attending noisy events like NASCAR races or rock concerts, or even using an iPod or other music players,” (LePrell, Ph.D)
Truth be told, I have never been a believer in extended warranties. If you ask the so-called experts, most will advise you to avoid them at all costs as a waste of money. When it comes to hearing aids, I make an exception. All too often, I have seen costly repairs and worse lost or damaged hearing aids that are expensive to replace. It is not cut and dry though. Extended warranty coverage for hearing aids is not necessary for all hearing aid users. So, how do you know? Does it make sense for you to invest in this protection? I have adapted a 7-question guide of things to consider before purchasing an extended warranty and help you decide when if this coverage is for you.
Question 1: Are you buying a high-reliability product?
There’s a big difference in product reliability rates. Believe it or not, the style of your hearing aid has a lot to do with the frequency of repair. Why, you ask? Hearing aids are some of the most miniature, complex, and fragile devices. They are constantly subject to environmental wear and tear, in addition to heat, moisture, and the ever constant battle with wax. Thus, as a general rule, the smaller the aid and the further in your ear canal the electronics are seated, the higher the rate of repair. Thus, the average rates for different styles of hearing aids are:
CIC (completely-in-the-canal) – every 7-9 mos.
ITC (In-the-canal) – every 9-12 mos.
ITE (In-the-ear) – every 12-15 mos.
BTE (Behind-the-ear) – negligible, lowest repair rate of all styles
(Hearing Aid Repair Rates, Michael Block, 2001)
The question becomes, how much risk are you willing to live with?
Question 2: Is the person using the hearing aid likely to be careless, forgetful, or treat it in a rough manner?
To pick up where I left off before about how hearing aids are the most miniaturized, technological devices…very simply, they don’t stand a chance of survival when they’re in the hands of a klutz. Even the biggest of hearing aids is a small device. They can be easily, lost or misplaced. If you have protection against such instances, you will be able to use the hearing aids without worry.
Question 3: Is the cost to replace or repair the product less than the cost of the extended warranty?
Consider these estimates:
Cost to repair a digital hearing aid: $189 to $230.
Cost to replace a digital hearing aid: $1600 (US avg/aid)
Cost of a !-year extended warranty: $200 (HearUSA cost/unit)
At HearUSA, we offer extended warranties for up to two additional years after the manufacturer’s original one-year warranty. This includes coverage for repair, as well as a one-time loss. There is a deductible in the event of loss – typically $450…but for less than the cost of one repair, your warranty will have paid for itself.
Question 4: Does the cost of the extended warranty exceed 20% of the product’s purchase price?
This is a nobrainer! See the above estimated expenses.
Question 5: What is exactly is covered under the extended warranty?
Read the contract. Extended warranties can be different from every hearing provider. Check to see if the protection is for repair, loss, damage, and if there are deductibles.
Question 6: Do I already have coverage?
Most new hearing aids come with a standard one-year manufacturer guarantee at the initial purchase. It is possible if you had an insurance discount or other provider program (such as the AARP Hearing Discount Program from HearUSA) that you already have extended coverage. For instance, members of the AARP program, already receive with every new hearing aid purchase a full 3-year repair, 3-year loss, and 3-year supply of batteries automatically.
Question 7: Is my hearing aid indispensable?
How do you replace irreplaceable? Fact: We know that hearing aids improve not only the quality of life for the person with hearing loss, but also for those around this person. We know that hearing aids can truly make a difference socially, physically, mentally and emotionally when used and working in the optimal condition. I believe that if you are willing to make the decision to get help for your hearing, you owe it to yourself to make sure you invest in the best protection and reliability available. You owe it to your ears!
Have you ever heard the phrase “If you don’t use it, you lose it?” I’m sure you have and guess what…this same philosophy about the rest of our body also applies to our ears. Our ears require auditory stimulation in order to help us process and understand speech.
What does this mean? This means that if you have a diagnosed hearing loss, even a mild loss, your ears are not receiving stimulation in the areas where your loss occurs. This, in turn, can cause a decrease in your ability to understand speech that worsens if it is ignored (Emmer, 1999). So, you are probably wondering how one goes about getting auditory stimulation?
Proper stimulation comes from hearing aids. Hearing aids provide amplification in the area of the hearing loss, which in turn provides auditory stimulation to the damaged inner ear hair cells. The faster we can diagnosis and treat hearing loss with hearing aids, the better the chances of maximizing your hearing potential.
As an Audiologist, the most important advice I can give you regarding hearing loss and hearing aids is “Don’t wait” and if you have hearing aids “Wear them full time.”
Have you ever wondered what the inside of a hearing aid looks like? One of my patients accidentally stepped on her hearing aid, unfortunate for her, but it gives us a chance to show you what the inside of a Siemens hearing aid looks like.
Be the First to Comment 
