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Identifying Hearing Loss in Children

April 7th, 2019

hearpeers_banner_children-1_900ad06cb892f1764e680bdff06000c6e28The ability to hear is really important for babies and young children. In the first few years of life they develop speech and language skills faster than at any other time. As recently as 30 years ago,  it wouldn’t become obvious to caregivers that children had hearing impairment until they were around two years old – when it became obvious that they weren’t yet talking.

But today even newborns can be tested and treated for hearing loss. Research has demonstrated that detection and intervention for hearing loss before six months offers significantly better outcomes than later intervention. Hearing screenings for newborn children has become universal across the United States – children with hearing loss are identified and treated at a much younger age.

Roughly 14 babies per 10,000 have a hearing loss, and fifty out of every 10,000 older children are impacted, with cases being diagnosed between ages 3 and 17. There are several possible causes for hearing loss in children – congenital and acquired. It’s important that parents, caretakers, physicians, teachers and others know the signs of hearing loss. If it remains undiagnosed, it can cause significant development and emotional problems for children. But diagnosing the problem can help children remain on track with language and developmental skills.

Congenital hearing loss is present at birth. There are both non-genetic and genetic factors that cause congenital hearing loss. Genetic factors account for more than 50 percent of all hearing loss in children, whether present at birth or developed later in life. Non-genetic factors include birth complications, premature birth, brain disorders, certain medications, and infections. Drug or alcohol abuse by the mother and smoking during pregnancy are also risk factors.

Hospitals routinely perform hearing screening on infants in the first hours after birth. If an infant fails the initial screening, he or she is usually scheduled for a second screening a few weeks later. Sometimes, infants who pass the hearing screening at birth may exhibit signs of hearing loss as they age.

One way to determine if your child’s hearing is developing appropriately is by monitoring important speech and hearing milestones. From birth to four months, your infant should:

  • Startle at loud sounds
  • Wake up or stir at loud noises
  • Respond to your voice by smiling or cooing
  • Calm down at a familiar voice

From four months to nine months, your infant should:

  • Smile when spoken to
  • Notice toys that make sounds
  • Turn its head toward familiar sounds
  • Make babbling noises
  • Understand hand motions like the bye-bye wave

From 9 to 15 months, your infant should:

  • Make various babbling sounds
  • Repeat some simple sounds
  • Understand basic requests
  • Use her voice to get your attention
  • Respond to his name

From 15 to 24 months, your infant should:

  • Use many simple words
  • Point to body parts when you ask
  • Name common objects
  • Listen with interests to songs, rhymes and stories
  • Point to familiar objects you name
  • Follow basic commands

Older children can have hearing loss that is either permanent or temporary. Here are some things to look for if you think your toddler or preschool-age child might have hearing loss:

  • Has difficulty understanding what people are saying.
  • Speaks differently than other children her or his age.
  • Doesn’t reply when you call his or her name.
  • Responds inappropriately to questions (misunderstands).
  • Turns up the TV volume incredibly high or sits very close to the TV to hear.
  • Has problems academically, especially if they weren’t present before.
  • Has speech or language delays or problems articulating things.
  • Watches others in order to imitate their actions, at home or in school.
  • Complains of ear pain, earaches or noises.
  • Cannot understand over the phone or switches ears frequently while talking on the phone.
  • Says “what?” or “huh?” several times a day.
  • Watches a speaker’s face very intently – many children’s hearing loss escapes detection because they are successful lip readers.

If you notice that your infant or child shows any of the above signs, make an appointment with our doctors. There has never been more hope for children with hearing loss, even those with profound loss. If you suspect it might be an issue with your child, don’t hesitate to come in with your questions and to have your child tested.


A Careful Balance: Living with Both Pets and Allergies

March 7th, 2019



Puppies may be fat, furry balls of energetic joy to some people, but they mean wheezing, sneezing, itching and coughing to others. Pet allergies can be exasperating – but furry companions are so ubiquitous that for those who are allergic to them, the symptoms are near impossible to avoid altogether.

Just about every warm and fuzzy critter we bring into our homes can cause allergies: cats, dogs, birds, hamsters, even ferrets. But it’s not the pet hair, or the dander itself, that causes allergies – it’s a specific protein in the dander that causes a reaction. These proteins can be found in animal dandruff, urine and saliva. The proteins are tiny and easily launched into the air everywhere a pet goes (or has recently been).

Common symptoms of pet allergies include a stuffy nose, runny eyes and coughing … very much like seasonal allergies. Other symptoms can range from mild — itchy throat, nasal congestion, and sneezing — to a more severe, asthma-like response, including wheezing, and shortness of breath.

To help the house allergens of your cat, dog or hamster in your home, there is a lot you can do to manage your animal allergies. Before you try the following tips, it’s a good idea to make sure you really are allergic to dander. If you’re not sure you are allergic to dogs, cats, or other pets, make an appointment so that we can help identify which specific allergen is triggering your symptoms.

The best way to find relief from allergies is to avoid exposure to the things you’re allergic to – but this isn’t always possible, or desirable. If you need to live with a pet, try keeping healthy boundaries. Keep your bedroom pet-free. This can significantly decrease levels of allergens in that space. Try switching to special bedding designed to be less permeable to allergens. Or try a HEPA filter to remove tiny airborne pollutants from the air you breathe. Don’t settle for a close (and cheaper) substitute – de-ionizers and purifiers may actually make allergies worse by releasing harmful ozone gas.

Keep your space clean. Vacuum often and change furnace filters frequently to reduce the dander in the air. Shampoo rugs regularly, and change bedding (people and pet) frequently. Wipe down walls where pets often rub. If it’s an option, choose hard-surface floors over carpets and wipeable furniture over upholstery to reduce the number of places where allergens can build up.

Bathing your pet can help in the short-term, but the benefits are transient, lasting just a few days. More effective is giving yourself a scrub by washing hands and face frequently. Over-the-counter allergy medications, such as antihistamines, can relieve mild allergy symptoms like nasal congestion and itchy eyes, but they won’t help asthma-type symptoms, such as wheezing and chest tightness. Talk to our doctors if you think you’ll benefit from prescription allergy medication or shots.

But understand that no matter how careful you are, you’ll likely still be exposed to dander. Pet allergens are “sticky,” making it easy for people to carry them on their clothes. You’ll even find them in places that have no pets, such as schools, workplaces, and pet-free homes. But you can alleviate the worst of your symptoms by being careful and attentive in the space you live.


Older People with Hearing Loss at Risk for Depression

February 7th, 2019


New research shows further evidence that older people with hearing loss have more symptoms of depression. The greater the hearing loss, the greater the risk, according to the data. These findings suggest that treatment of age-related hearing loss, which is underrecognized and undertreated among all elderly, could be one way to head off later-life depression.

People with hearing loss usually find communication difficult, which can lead to stress, fatigue and social isolation. And social isolation leads to depression, especially in older adults. But it wasn’t until recently that researchers were able to show that is was more of a problem than previously thought.

Many people older than 70 have at least mild hearing loss, but relatively few are diagnosed or treated. Hearing loss is the third-most occurring condition in older adults. Presbycusis, the most common form of hearing loss is associated with aging, occurs gradually. It is characterized by loss of the highest frequency consonant sounds and trouble understanding speech in the presence of background noise.

Between 25 and 40 percent of those over the age of 65 have hearing loss. Unfortunately, for the majority of older adults, hearing loss goes undetected and untreated. Only nine percent of internists recommend hearing tests to their older patients. And even with testing, only 25 percent of those whose hearing loss is treatable take action to get hearing devices.

“Hearing loss is easy to diagnose and treat, and treatment may be even more important if it can help ease or prevent depression,” said lead researcher Justin Golub.

Age-related hearing loss is known to raise the risk of other conditions, such as cognitive impairment and dementia. But there are few large studies trying to discover whether hearing loss may lead to depression in the elderly – particularly in Hispanics, a group in which depression may be underdiagnosed because of language and cultural barriers.

This researchers analyzed health data from 5,239 individuals over age 50 who were enrolled in the Hispanic Community Health Study/Study of Latinos. Each participant had an audiometric hearing test – an objective way to assess hearing loss – and was screened for depression.

They found that individuals with mild hearing loss were almost twice as likely to have clinically significant symptoms of depression than those with normal hearing. Individuals with severe hearing loss had over four times the odds of having depressive symptoms.

Because the research did not revisit the participants over time, it has limits. It couldn’t show that hearing loss caused depressive symptoms – just that there was an association at that point in time. Although the study focused on Hispanics, the results could be applied to anyone with age-related hearing loss. “In general, all older individuals should get their hearing tested and consider treatment,” says Golub.


The Underappreciated Neck: What’s inside

January 7th, 2019

neck8The neck tends to be one part of your body that works hard, but doesn’t get enough credit. It serves as a flexible connection between your head and the rest of your body and contains many nerves and blood vessels vital to your health and continued viability. Your neck contains numerous important structures, including:

Spinal cord. The cervical portion of your spinal cord is located in your neck. Your spinal cord sends messages through nerves from your brain to your body, and from your body back to your brain. The spinal cord stretches all the way down the length of your back.

Vertebrae, disks and ligaments. The vertebrae are bones that encase and protect your spinal cord. Intervertebral disks are located between each vertebra and help to absorb shock and allow your spine greater flexibility. Ligaments in your neck stabilize your vertebrae and help hold them in place.

Nerves. A network of nerves in your neck sends signals to your brain and body. When a vertebral disk places pressure on the nerves in your neck, you may experience neck pain. Many of the nerves in your neck stretch into your arms, which is why problems with the neck often lead to arm and shoulder symptoms, in addition to neck pain.

The Tubes. The pharynx is a hollow tube that connects your nose and throat to your esophagus and trachea. Your larynx, or voice box, sits just below your pharynx. It contains your vocal cords, which give you your voice. Your trachea is the tube that allows air to flow between your mouth, nose, and lungs. The esophagus provides a passageway for food and liquid to move from the mouth into the stomach.

Glands. The thyroid is an essential gland that is located in the front of the neck. It produces hormones that help regulate metabolism. The parathyroid glands are small glands adjacent to the thyroid gland. They release a critical hormone that helps control the amount of calcium in the blood. Lymph nodes are located in many parts of your body, including the neck. They help to drain impurities out of the body and contain infection-fighting blood cells.

While the neck is connected to the spine, it is not as sheltered as the rest of the backbone. This means this slim structure is prone to problems. Neck pain generally arises from muscle strain. But since your neck is so complex, there can be other, more serious causes of neck pain. If you are having neck pain, it is important to see your doctor, especially if your neck pain is intense or persistent, or is accompanied by other worrisome symptoms such as fever, severe headache, or numbness or weakness in the arms or legs.

Most neck pain improves gradually with home treatment. Seek immediate care if severe neck pain results from an injury, such as a motor vehicle accident, diving accident or fall. Contact one of our doctors if your neck pain:

- Is severe
- Persists for several days without relief
- Spreads down arms or legs
- Is accompanied by headache, numbness, weakness or tingling

Learning Physical Balance Benefits Kids

December 15th, 2018

toddler-balanceFor some kids it comes naturally. Hopping on one foot, jumping rope and walking along a wall is second nature. For others it takes a little practice. But having good balance can be learned! It’s a function that can be improved with practice and is a skill worth having. Teaching your child good balance at an early age will set her up for better body awareness, coordination, and even concentration.

Physical balance is the foundation on which many other physical skills are built. Because kids are spending more time bent over computers and shouldering heavy backpacks, experts believe that their balance is becoming more challenged. Continuously hunching over a screen or carrying extra weight can affect posture and balance, which could lead to less coordination or even problems with gait.

The solution is … well … fun. Common games like hopscotch and tag promote balance. And kid-appropriate activities in yoga and Pilates can also help. There are also simple exercises families can do at home to boost stability.

Researchers are connecting balance to mental, not just physical, functioning. When kids stabilize themselves from an unstable pose, they learn how to focus faster and more efficiently. Kids with learning problems, who often have less than optimal balance, can particularly benefit from balance training. If you free up the mental capacity they are using to concentrate on balance, they have the mental resources to focus on other things.

Balance-Building Exercises for Children

Under One Year: Once your baby begins to sit up, let her grab your fingers and pull herself into a sitting position. Slowly move your hands toward her, just enough so that she begins to rely on her own sense of balance. If she begins to teeter, gently support her back into an upright position. Repeat as long as it is fun for her.

One to Three Years:
Boot Balancers:
Sit in a chair and have your child stand in front of you with his arms extended from his sides. Reach your hands underneath his arms (but don’t support his weight) so you can catch him if he loses his balance, and have him step up onto the tops of your shoes. Make a game of how long he can balance himself on your feet.

Stork Stands: Together with your child, stand straight with your feet shoulder-width apart, hands on hips. Stand on your left leg, bending the right leg slightly behind you. Hold this pose for two seconds, then slowly extend your right leg straight out and slightly in front of you without touching the ground. Hold for two seconds and repeat the exercise standing on the right leg, resting your opposite foot on your supporting leg if you need to rest. Once this feels easy, try extending your arms out in front of you or overhead. Playing Simon Says with your child, alternating as leader, can make this drill even more fun.

Three Years and Up:
Balance Beam Lunges: Have your child stand on a long board (a 2-by-4 is fine). She should place her left foot several feet forward on the beam and lunge down until her left thigh is parallel to the ground (her right knee will bend as she deepens the pose). After she holds this position as long as she can, have her repeat the move with the other leg. With practice, your child can lunge with her arms extended out from her sides. For a challenge, raise the board six inches by placing wood or cinder blocks under both ends.

Wheelbarrows: Have your child stand behind a basketball or large ball that will support her body weight and then place her hands, fingers pointing forward, on it. Keeping her feet planted, she should roll the ball forward, alternating hands. Once she rolls it as far from her feet as she can without losing balance, she should roll it back to its original position. Repeat as many times as she’s able.

From Parenting Magazine

Say What? How to Treat Short-Term Laryngitis

November 15th, 2018

Screen Shot 2018-11-15 at 11.01.09 AMYou never really appreciate just how valuable your voice is … until you lose it. You can hear it coming – you may start to hear a bit of cracking or huskiness in your voice … and then croaking … until no sound comes out at all. Was it the enthusiastic cheering at your daughter’s soccer game that’s to blame? Or too much singing in the shower?

Laryngitis indicates a problem with your larynx (also called the voice box). Your larynx contains your vocal cords and is important for talking, breathing and swallowing. Inflammation or irritation from overuse or infection causes your vocal cords to swell and distorts the sounds that air carries over them – making your voice sound hoarse. If there is too much swelling you may not be able to make your voice heard at all.

Although it is annoying and can be painful, laryngitis usually isn’t serious. Laryngitis that lasts less than a few weeks is often caused by upper respiratory infection from a virus. Laryngitis caused by bacterial infection is actually quite rare.

Laryngitis usually gets better on its own. If you have hoarseness that doesn’t go away after a few weeks, make an appointment so that we can determine what is going on. Long-term (or chronic) laryngitis lasts longer than 3 weeks and can have various causes, such as allergies, smoking, acid reflux, exposure to toxins, post-nasal drip, alcohol, or more serious diseases.

One of the best ways to treat laryngitis, and certainly the simplest, is not talking – at all. Whispering does not actually rest your voice. In fact, it can actually agitate your vocal cords and make your hoarseness worse. If you have laryngitis, try communicating by writing or texting. You may also get some relief by using a cool mist humidifier and avoiding irritants like cigarette smoke. Antibiotics are only effective against infections caused by bacteria. Since almost all infections with laryngitis are caused by viruses, antibiotics likely won’t help.

Relief for Short-Term Laryngitis:

  • Breathe moist air. Use a cool-mist humidifier to keep the air in your home or office moist. Inhale steam from a bowl of hot water or a hot shower.
  • Rest your voice as much as possible. Avoid talking or singing too loudly or for too long. If you need to speak before large groups, use a microphone or megaphone.
  • Drink plenty of fluids to prevent dehydration (avoid alcohol and caffeine).
  • Moisten your throat. Try sucking on lozenges, gargling with salt water or chewing a piece of gum.
  • Avoid decongestants. These medications can dry out your throat.
  • Avoid whispering. This puts even more strain on your voice than normal speech does.

Eczema can Occur Anywhere – Even in Your Ears

October 20th, 2018

Screen Shot 2018-10-26 at 11.40.47 AMEczema is no walk in park. It’s an annoying and sometimes painful condition tied to the immune system. It causes inflamed, itchy, cracked, and rough patches of skin all over the body. Eczema affects almost one third of people on the United States – some will outgrow it, but others struggle with outbreaks their entire life.

To add insult to injury, eczema happens in places you might not expect … in the ears, for instance. Ear eczema can be an extremely irritating and at times painful condition. It can range from slight dryness of the outer ear to extensive skin loss and soreness, as well as infection of the external and internal parts of the ear. It can affect the entire ear, including the lobes, the ear opening, canal and the eardrum itself. It is important to focus on prevention and control as if left untreated, eczema or infection can spread outwards to the surrounding skin.

Eczema may appear as a result of exposure to something that causes an allergic reaction. Everyday items can cause outbreaks inside the ears – soaps, gels, earrings, hearing aids, earbuds or even wearing glasses. Objects you might try to use to clean or scratch the ear can also be problematic. Ear piercing does not cause eczema, but can lead to problems when you wear certain types of earrings or studs. If you have a nickel allergy, wear only hypoallergenic jewelry.

It’s always best to consult the doctor if you think you may have eczema in the ears. A professional can give you effective treatment and help to prevent flare‐ups. Treatment of ear eczema will depend on the cause and type, but there are things that you can do at home to prevent outbreak and spread. You can gently wash the inside of your outer ear with water or an emollient wash. You can also use a damp cotton tip very gently in the bowl area of your ear, but do not insert it into the ear canal.  Never try to wash further into the ears – you may damage the skin of the ear canal. After washing, dry your ears thoroughly – using a warm (not hot) hair dryer. Avoid scratching the inside of your ears, especially with a foreign object – not only can these damage your ear canal skin or drum, but they can also set up an allergic reaction. The use of ear candles is not advised.

If you go swimming, use ear plugs. You can get custom‐made ear molds to fit your ears. Apply an emollient cream/ointment to treat dry skin around the  ears and in the entrance to the ear canals, and refined petroleum oil or sunflower oil for loosening ear wax (but consult first with a healthcare professional first). Using water is not recommended, nor are wax loosening products as they may encourage the buildup of debris and cause more inflammation and irritation.

Ear eczema can be an extremely irritating condition. Since it is difficult to see in the ears without special equipment, it is often hard to know what is going on in there, particularly in the case of young children. If ears become uncomfortable, don’t ignore it – it is always best to see your health care professional and get to the bottom of the itch.

Itchy Ears: Causes and Possible Solutions

September 26th, 2018

Screen Shot 2018-10-26 at 11.40.05 AMGot an itchy ear? It may be more than someone dropping some gossip behind your back, as the old wives tale goes. There are several reasons the ear canal (the tube that connect your outer ear to your eardrum) can become irritated or itchy. How to get relief depends on what’s making you scratch.

But be warned … no matter the cause, it’s never a good idea to stick an object in your ear. You could damage your inner ear, including the tiny bones that help you to hear.

Itchy ears might be caused by an earwax buildup. Even though wax is a natural way for your body to clean dead skin cells and dirt out of your ears, too much can make them itch. But don’t use a cotton swab to remove the wax, as it can act as a plunger, pushing the wax deeper inside where it can get stuck. Try instead over-the-counter ear drops to break up the wax. If that doesn’t help, make an appointment with one of our friendly doctors. They can use a special tool to safely remove built-up wax.

On the flip side, ears can also get itchy if they don’t have enough wax inside, so don’t clean out your ears too often!

Itchy ears can sometimes be a sign of an ear infection. When you have a cold, the flu, or allergies, the bacteria and viruses in your body can also infect your ear. But infections can also happen when you aren’t even sick. Swimmer’s ear occurs when water stays in your ear after spending time swimming. Too much moisture wears away the natural layer of defense against germs in your ear canal. To stop the itch, you’ll need to treat the infection. Some may go away on their own, but our doctors can also prescribe ear drops. You may need to take them a few times a day for a week. Other infections may need a course of antibiotics.

The skin in your ears is much like the skin on the rest of your body. Itchiness may be caused by eczema or psoriasis, as it affects the rest of your body. The skin inside your ears could be itching because of an allergic reaction. Products like hair spray or shampoo could cause a reaction to sensitive skin. Objects that contains certain metals (nickel), like earrings can cause irritation as well. Plastic, rubber, or metal objects your use near or inside your ears, such as earbuds or a hearing aids, can also cause a rash called contact dermatitis.

If you have a concern about itching in your ears, feel free to make an appointment to discuss the best way to resolve this irritating condition.

Gearing Up for Fall Allergy Season

August 4th, 2018

fall-allergiesIt’s August, and the pollen of spring and blooms of summer are finally beginning to fade. So how come you’re still sneezing? Fall allergies can trigger just as many symptoms as spring and summer, unfortunately. Ragweed is the biggest culprit – it starts to release pollen with cool nights and warm days in August, but can last into September and October. About 75% of people allergic to spring plants also have reactions to ragweed.

Mold is another fall trigger. Mold spores love wet spots outside, such as piles of damp leaves. Or your fall issue may be dust mites. They can get stirred into the air the first time you turn on your heat in the fall and trigger sneezes, wheezes, and runny noses. Mold and dust mites are common in schools, so returning to the classroom can trigger allergies for some kids.

Our doctors can help find out what’s causing your watery, itchy eyes and runny nose. They’ll talk to you about your medical history and symptoms, and may recommend a skin test. To do this, the doctor will place a tiny amount of the allergen on your skin – usually on your back or forearm – and then prick or scratch the skin underneath. If you’re allergic to it, you’ll get a small, raised bump that itches like a mosquito bite. Sometimes a blood test may also be used to figure out a cause.

There are medications you can use to ease symptoms of allergies. Steroid nasal sprays can reduce inflammation in your nose. Antihistamines help stop sneezing, sniffling, and itching. Decongestants help relieve stuffiness and dry up the mucus in of your nose. Immunotherapy in the form of allergy shots or oral tablets or drops can also help you feel better. You can buy some allergy medications without a prescription, but talk to our doctors to make sure you get the right one.

To manage symptoms on your own try staying indoors with the doors and windows closed when pollen is at its peak (usually in the late morning or midday). Before you turn on your heat for the first time, clean your heating vents and change the filter. Bits of mold and other allergens can get trapped in the vents over the summer and will fill the air as soon as you start the furnace. Use a HEPA filter in your heating system to remove pollen, mold, and other particles from the air. Use a dehumidifier to keep your air at between 35% and 50% humidity, and consider wearing a mask when you rake leaves so you don’t breathe in mold spores.

Care for Your Ears During Summer Swimming

July 4th, 2018

swimmers-earThere is nothing like dunking yourself in cool water to avoid blistering summer heat. If you avoid swimming for fear of swimmer’s ear, a popsicle can only do so much to keep you cool. There are steps you can take while enjoying a summer swim to help your ears stay healthy while you stay cool and comfortable in the water.

First, pick your pool carefully. Avoid swimming in bodies of water that may be contaminated with bacteria. Check for regular cleaning and disinfecting schedules if using a public pool. Research pollution level warnings before planning a swim in local rivers, lakes or ponds.

They may not look cool, but wearing a swimming cap helps protect your ears from getting wet while you are swimming. It is important to put the swimming cap on properly with the ears completely covered. To put it on, stretch the swimming cap open. Lean forward and slide the cap on, slowly moving your hands downward as the cap slides onto your head. Once the swimming cap reaches your ears, remove your hands completely and tug the cap down until snug.

Or, wear ear plugs as an alternative to a swimming cap to prevent water from entering the outer ear canal. Ear plugs come in both disposable and reusable versions; people who do not have latex allergies should consider using reusable latex plugs. Just be sure not to push the plugs too deep into your ear.

When you are done swimming, dry your ears thoroughly. Tilt your head and pull your earlobes in different directions to help drain the water. Use a clean, soft towel to pat your outer ear, and tilt your head to the side to allow any water that has gotten into the inner ear to drain out. Or, use a blow dryer on its lowest setting. Hold it a foot out away from each ear for about 30 seconds. It is possible to buy over-the-counter eardrops to help dry up any leftover water. But don’t put eardrops in your ear if you have had any ear pain, ear surgery, or have a tear in your eardrum.

If you have pain or discomfort inside your ear or a pussy oozing from your ear after swimming, make an appointment so that we can help you get back on the pool floatie faster!