Includes the following article: Are We Poisoning Our
Ears? Questions may be submitted online through the
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directly to: DigiCare Hearing Research &
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or opinion.
"ARE WE POISONING OUR EARS?
By Max Stanley Chartrand, M.A.,
DigiCare Hearing Research & Rehabilitation
IF YOU TAKE ASPIRIN, DRINK COFFEE, SMOKE (CIGARETTES
OR MARIJUANA), DRINK ALCOHOL, OR USE CERTAIN DRUGS
(LEGAL OR ILLEGAL), YOU MAYBE POISONING YOUR EARS.
EVERY DAY, THE MEDIA REPORTS findings linking toxic
substances to cancer, blindness, nerve disorders,
toxic shock, heart attack, congenital deformity, and
a slew of other maladies.
But what about hearing loss and deafness?
Some 28 million Americans have impaired hearing -
more than any other disability. Yet, the connections
between what we take into our bodies and the effects
upon hearing have not received the same level of
attention from both media and medical professions.
Is it because hearing loss is an "invisible"
handicap?
Those cases of hearing impairment that do receive
medical treatment and/or amplification correction
are rather casually labeled "etiology unknown."1
Recent data supports the (often preventable)
cause-effect relationship between hearing health and
toxicity or ototoxicity.
LIKE BODY/LIKE EARS
Almost all health problems affect the human hearing
mechanism to some degree. For example, if one is
suffering from a pH imbalance malady such as
diabetes, hypo- or hyperglycemia, or gout, the ear
will likewise be highly affected.2 Hypertension
(high blood pressure), in its myriad manifestations,
will also have a deleterious affect upon the fluid
levels of the inner ear and balance mechanism.
Vascular disease can cause even more problems with
the ear: infection, tinnitus, epithelial atrophy,
tumor growth, etc. Stroke, which can cause paralysis
of the nervous systems and/or brain function, may
likewise impair the neural system of hearing and
communication ability.
Remedies used to solve each of these problems can
cause even more new risks for the ear.
Volumes have been published about the toxic effects
of such common substances as food preservatives,
pesticides (both natural and artificial), alcohol,
tobacco, caffeine, refined sugar, legal and illegal
narcotics, certain dyes, and petroleum products.
But very little is said of these same toxins
relative to the ear.
HEAR TODAY/DEAF TOMORROW
My first personal exposure to ototoxicity came when
I was very young. I already had substantial
bilateral high frequency sensorineural loss from
young childhood as a result of a double case of
mumps.
Then at the age of 11, I developed chronic strep
infections requiring powerful - and later
prophylactic doses of antibiotics to control.
Streptomycin, arithromycin, E-mycin were among the
new "wonder drugs" that took strep and rheumatic
fever out of the fatal category and made them
manageable.
After a few weeks of taking these antibiotics,
however, my world grew more silent; my ability to
understand speech rapidly deteriorated. Mentioning
this to my ear specialist, I was told, "You're just
imagining things. You hear me okay, don't you? So
there, it's not affecting your hearing at all!"
Years later, when I began work as a hearing health
professional, a man who had just been released from
the hospital for heart bypass surgery was referred
to me . The problem? He went in hearing "normal,"
and came out hearing next to nothing.
I requested a list of medications administered
during his hospitalization. Mega doses of systemic
dihydrostreptomycin had been used.
Although the relationship between streptomycin and
deafness had been discovered in the 1970s, few on
the front lines of the medical profession were aware
of these startling findings.
Today, we still find this crucial knowledge somewhat
unknown among health professionals. The toxic
effects of certain antibiotics (aminoglycosides),
have been found to cause deafness in individuals who
have a predisposition toward renal disease or
weakness (see Figure 1).
While aminoglycoside antibiotics play a vital role
in fighting disease, understanding its affects via
the kidneys and other organs has prompted caution
and almost "use of last resort" in many instances.
The advent of so many effective non-aminoglycoside
antibiotics has somewhat diminished the incidence
ofototoxicity resulting from antibiotic
administration.
Diuretcs, as used in control of high blood pressure
and water retention, have also been found to have
significant ototoxic effects in some individuals.
Some of these have variously been identified as:
mannitol, furosemide, and hydrochlorothiazide.
Caution should be exercised in the use of these
diuretics in cases where progressive sensorineural
loss, Meniere's disease, vertigo, tinnitus, or, most
of all, renal disease or weakness exist.
There is a close association between blood-potassium
levels and the use of these and other diuretics
which can have a profound effect upon cochlear
potentials and balance.
RISKS/BENEFITS
Questions arise: Will the lifesaving benefit out\veigh
the possible consequences of this medication?
A case in point is the use of the drug digitalis in
the treatment of congestive heart failure. Another
is the use of cobalt in cancer x-ray therapy.
An array of chemotherapeutic substances would also
fall into this context. These substances can cause
significant damage to the hearing system; however,
the importance of saving a life outweighs the risks.
Aspirin (and salicylates used as food preservative),
iodine, caffeine, alcohol, nicotine, lead (and other
heavy metals), mercury, cyanide, arsenic, sulfur,
and benzol are known ototoxic substances. Each of
these take a different tack in their effects upon
hearing, depending on the individual. The body's
ability to eliminate toxins has a direct bearing on
their effects.6
BLAST FROM THE PAST
For older Americans, common causes of ototoxicity
existed in the days when sulfa drugs and quinine.
were used routinely to combat various pandemic
disease.
Household products and paints which contained large
amounts of lead and mercury, not to mention any
array of early petrochemical substances, had
significant effect on later hearing ability.7 A side
note to this is the prevalence of overdiagnosed
dementia, which could be attributable to oto- and
cerebrotoxic drugs often used in geriatric
applications.
STREET DRUGS: Ear Warfare
Ototoxic data in regards to illegal (street) drugs
is conspicuously absent. However, correlated
research has produced some pretty startling
revelations.
At issue are the effects from such drugs as heroin,
cocaine, crack, hashish, marijuana, PCP, and LSD.
Four general effects were found:
1. Abnormal brainstem response among children born
of mothers who were users of
cocaine and other/drugs has been found. In brauistem
auditory evoked response (BAER) tests, abnormal
interpeak intervals resemble those found in babies
with perinatal oxygen starvation, acute jaundice,
and hydrocephalus (fluid on the brain).8
2. Otitis externa (pseudo-monas, fungus, virus\
offtis media, and viral/and bacterial infection of
the cochlea are known to be caused by drug
addiction.9 Of particular note among heroin addicts
is chronic and sometimes fatal infection called
sabacute bacterial endocarditis, one of the most
serious health threats among heroin addicts and
other users.10
3. Sign (T'cant change in higher brain/multisensory
function has been fo)lnd in users of several drugs
such as heroin, cocaine, barbiturates, amphetamines,
and marijuana. What this portends is abnormal or
subnormal receptive/expressive communicating
ability, similarly to what has been found in
patients with pathological mental illness.11 The
toxic effects of these drugs interfere with numerous
multisensory functions involving the auditory
system: spatial perception, short-term, memory
(speech discrimination), and long-term memory
(goal-orientation and logic).12 Recent
psychopharmacological data point to considerable
cognitive and communicative dysfunction as a result
of drug abuse.13
4. Deprivation/Lifestyle. In areas of society where
drug use is rampant, one also finds very high
incidence of malnutrition, accounting for high
infant mortality rates and congenital deformities.
Malnourishment has been found to be at the root of
inner ear afflictions,14 allergy, eustachian tubs
dysfunction, tinnitus, and many immunological
disorders. Consequently, the drug user environment
has a profound effect upon hearing health.15
ALCOHOL ABUSE
Because of society's widespread acceptance of
alcohol, there are innumerable documented
connections between its abuse and hearing health.
Prolonged use of alcohol can cause destruction of
nerve fibers of the brain and brainstem regions.
This causes central auditory processing deficit
(CAD), as well as language processing dysfunction at
the higher cortical levels.16
Muscular atrophy is another result of alcohol abuse,
affecting the middle ear muscles which normally
contract to protect the ear from noise damage.
Effects upon the kidneys and liver leave one
abnormally prone to ototoxicity from prescription
drugs (discussed above) and other toxic substances.
17 Stupor and coma, common in patients suffering
from alcoholism, impairs cognition and motor-action,
both critical in communication.18
CAFFEIENE & NICOTINE
Caffeine has also received attention as a causative
factor in cases of Meniere's disease (vertigo,
tinnitus, and hearing loss) and in causing or
exacerbating tinnitus conditions (or ringing in the
ears). Since it is found in such common substances
as coffee, tea, cola drinks, and diet pills, its use
is quite widespread.
Vascular disease, hypertension, and mutagenic
disturbances (during pregnancy) are just a few of
the maladies connected with caffeine use.19 Because
of decreasing renal tubular reabsorption of fluid in
the kidneys, there is increased sensitivity to
ototoxic substances.20
Nicotine is a virtual poison to the body. If the
amount of nicotine contained in one cigarette were
injected intravenously, it would cause certain
death. Because of the low absorption rate, however,
the fatal effect is built up over years, shortening
the lifespan considerably.
Because there are over 1,000 identified carcinogens
(cancer-causing elements) in tobacco, the most
significant threat to hearing health appears to be
malignant and benign tumor growth.
Tobacco-caused tumors in the head and neck area are
mostly found in the laryngeal and mucosal glands.
Other tumor pathologies (in the outer ear, middle
ear, cochlea, and retrocochlear area) can also be
brought on by tobacco use.
Nicotine affects every organ in the body, but be-
cause of its fat-solubility, it particularly finds
quick entry into the brain. Because of high nicotine
concentrations in the brain, withdrawal causes
depression, irritability, poor concentration,
anxiety, and sleep disturbance, all of which have a
deleterious affect upon auditory perception. 21
NOW, THE CHALLENGE
Good hearing health is predicated upon good health
habits in general. What is good for the mind and
body is good for the ears. Here are some important
protective guidelines:
-Have your hearing tested at least annually,
especially prior to and following a hospital stay.
-Avoid substances to which you are known or
suspected to be allergic
-Avoid tobacco and alcohol; consume caffeine only in
moderation.
-If you have predisposition toward renal disease,
avoid aminoglycoside antibiotics and certain
diuretics ask your doctor.
-Observe good health habits in nutrition, exercise,
sleep, and maintain positive mental attitude.
Following these guidelines will provide your best
shield for protection against ototoxicity and will
promote good hearing health at the same time.22
REFERENCES:
1 Chartrand, M.S., Hearing Instrument Counseling,
2ne ed., Livonia. MI: National Institute for Hearing
Instruments Studies, 1999.
2 Chartrand, M.S., "Allergies: The Hearing Link,"
Hearing Health, June/July 1992.
3 Jerger, S., and Jerger, J., Auditory Disorders: A
Manual for Clinical Evaluation, Boston: Little.
Brown, and Company, 1931.
4 Oda, M.. Preciado. M.O., Quick. C.A., and
Paparella, M.M., "Labyrinthine Pathology of Chronic
Renal Failure el al," Kansas City, MO: Am
Laryn-Rhin-Oto Society, 1974-
6 Rowan, R.L., How to Control High Blood Pressure
Without Drugs, New York: Charles
Scribner's Sons. 1986.
6 Haachek, W.M., and Roussea, C.G., Handbook of
Toxilogic Pathology. San Diego: Academic Press,
1991.
7 Viecellio, P., Handbook of Medical Toxicology,
Boston: Little, Brown, and Company, 1993.
8 Shin, L,. Cone-Wesson, B., and Reddix, B.,
"Effects of Maternal Cocaine Abuse sn
the Neonatal Auditory System," International Journal
of PediatrJc Otorhinolarynology, N3. 16. pp.
246-261, 1988.
9 National Institute on Drug Abuse, "Marijuana and
Health: Seventh Annuai Report," Washington, D.C.:
Gov. Printing Office, 1979.
10 Osborn, H., "Medical Management of toxic
Overdosage of Behavior-Modifying
Drugs," Psychobiology and Psychopharmacology, ed.
Finch, £., Markham, Ontario: The Hatherleigh Co.,
Ltd., 1988.
11 Goldfrank, L.R., Fiobenbaum, N. and Weisman,
R-S., "General Management of the
Poisoned and Overdosed Patient," Hosp Phys, July,
1981.
12 Pearlson, G.D., "Psyciatric and Medical Syndromes
Associated with PCP Abuse," John
Hopkins Medical Jour. 148: 26-33, 1981.
13 ei-Guebaly, N., "Alcoholism and Drug Dependence,"
Medicine North America, 34:3217-3223. 1983.
14 Goldfrank, L.R., "General Perspective,"
Toxicological Emergencies, ed. Goldfrank, L.R., New
York: Appleton-Century-Crofts, 1982.
15 Bricklin, M., Natural Healing, Emmaus, PA; Rodaie
Press, 1976.
16 Bannister, E.W. el al. Contemporary Health
Issues, Boston: Jones & Bartlett, 1933.
17 Victor, M., and Adams. R.D.. "The Effect of
Alcohol on the Nervous System," Res
Nev Mental, 32: 626-623, 1963.
18 Valliant, G.L. The Natural Causes of Alcoholism:
Causes, Patterns, and Paths sl
Recovery, Cambridge, MA: Harvard Press, 1983.
19 Osborn, H., op.cit.
20 Coatill. D., Dalsky. G.. and Fink, W. "Effects of
Caffeine Ingestion at al," Med Sci in Sports and
Exercise, 10:166-168. 197B.
21 Bannister, E.W., op. cit.
22 Berstein, D.A., and McAlister, A. "The
Modification of Smoking Behavior", Addictive
Behavior, 1:89-102. 1973.
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