Dr. Meier on Ask the Doctor

When it comes to language, it may be true. According to recent research by audiologists at Auburn University, there could be an advantage to listening with our right ears, especially for children and noise-distracted adults.

The phenomenon is known as the right-ear advantage: Speech heard through the right ear reaches the part of the brain that processes it in about 20 milliseconds. Speech heard through the left ear, however, takes anywhere from 3 to 300 milliseconds longer to reach the same part of the brain.

Why? The speech we hear in our right ears can travel directly to the left hemisphere of our brains, which is generally thought to be where language is processed. Speech received by the left ear takes a less direct route, resulting in a lower processing speed. From the left ear, sound signals travel first to the right hemisphere of the brain. Then, they are relayed via the corpus callosum — a broad band of nerve fibers that connects the hemispheres — which finally passes them onto the left hemisphere. This means that, even though we can hear with both ears, our brains more efficiently process speech heard with the right ear because those signals arrive more quickly.

In children younger than 11, the right ear advantage is the most noticeable. A typical 7-year-old will correctly repeat information heard by the right ear about 70 percent of the time, compared to only about 55 percent of the time when the information is heard by the left ear. A 9-year-old is accurate about 80 percent of the time with their right ear and 75 percent with their left. An 11-year-old is about as accurate as most adults, which is close to 90 percent in both ears.

The right-ear advantage is more apparent in children whose myelin membranes are less developed. The myelin is an insulating sheath that facilitates faster impulse transfers through the corpus callosum. Because the myelin develops with age, the right-ear advantage tends to dwindle over time. In fact, for most adults this phenomenon isn’t noticeable unless we are processing complex information that exceeds our basic memory capacity.

When adults hear the same speech in both ears at the same time, there is no perceivable advantage with the right ear. Rather, problems occur when we receive signals that have to compete with each other. When adults are trying to pay attention to multiple sources of speech at the same time, memory capacity is quickly exceeded, and the right-ear advantage comes back into play. In these studies, distracted adults are shown to have anywhere from a 7 to 40 percent advantage when using their right ear.

With this in mind, the next time you lean in to talk to someone in a noisy room, check which ear you’re leaning towards — is it the right one?

Sources: http://online.wsj.com/public/resources/documents/print/WSJ_-A002-20180203.pdf

The lacrimal apparatus is what is responsible for creating tears and moving them from the eyes to the nose. It is possible for the lacrimal system to become obstructed and prevent tears from draining naturally. This is known as nasolacrimal duct obstruction. When tears cannot drain, this can present as excessive tearing, or epiphora, and it can occur either intermittently or continuously.

Excessive clear tearing is the most common symptom of nasolacrimal duct obstruction. Occasionally it will also be accompanied by a mucus discharge from the eyes. Dacryocystitis is a less common symptom — this is an infection of the region between the eye and nose, and can occur repeatedly in those with a lacrimal blockage. Patients with dacryocystitis often report tenderness in the area between the eye and nose.

There are several possible causes for nasolacrimal duct obstruction. The most obvious is facial trauma, which can create scarring inside of the lacrimal apparatus or tear the nasolacrimal duct. In surgery to correct facial trauma deformities, injury to the lacrimal apparatus may occur unintentionally. Other types of facial surgery such as sinus surgery and head and neck cancer surgeries can also injure the lacrimal system.

Another cause of nasolacrimal duct obstruction is bacterial infection, which leads to inflammation within the duct. Infection and inflammation can lead to scarring, which can reduce passage within the duct or block it entirely. Autoimmune diseases can also cause inflammation in the nasolacrimal duct, which can create a blockage without any infection.

Although the above causes are easy to understand, more often than not, nasolacrimal duct obstruction occurs without any apparent cause. Middle-aged individuals are most likely to experience it, and some researchers believe osteoporosis and hormone changes may play a role.

To determine if you have an obstruction in your nasolacrimal duct, a rhinologist may apply fluorescent dye in the corner of an eye to see if saline is transferring into your nose. If the dye is not noticeably passing through your lacrimal apparatus, an injection of the same substance may be attempted into the tear duct. If the duct still appears obstructed, an x-ray can be used to determine the location of obstruction.

If there is a physical obstruction, your rhinologist may perform a dacryocystorhinostomy (DCR) to remove it. A DCR creates a direct opening from the lacrimal sac (within the lacrimal apparatus) to the nasal cavity. The opening is held open with either sutures or stents, and it allows the tears to drain naturally into the nasal cavity. The procedure can be done externally, through an incision between the nose and eye, or endoscopically, which can be less painful and won’t leave any visible scarring. DCR is a procedure with minimal risks and postoperative effects. Patients can expect minimal bleeding and some scarring within the nose, and those who have the procedure enjoy a 90 percent success rate.

If you are having issues with excessive tearing, please call and make an appointment with one of the specialists at Nevada ENT and the Reno Tahoe Sinus Center. We can help determine the source of your symptoms and give you information on treatment options individually tailored to your situation.

Sources: Epiphora, American Rhinologic Society

Kevin C. Welch, MD

http://care.american-rhinologic.org/epiphora

Dacryocystorhinostomy (DCR), American Rhinologic Society

Vijay Ramakrishnan, MD
Todd Kingdom, MD

http://care.american-rhinologic.org/dacryocystorhinostomy

 

Allergies can make you miserable. With itchy eyes, a runny nose, sneezing and congestion, enjoying yourself during beautiful summer months can be difficult. Try these simple tips to keep your summer allergies under control and have fun this summer!

Keep Indoor Air Clean

Unfortunately, there isn’t a product that can magically eliminate all allergens in your home. However, when using the air conditioning in the house or car regularly, changing the air filters and keeping the indoor air dry with a dehumidifier can greatly help.

Reduce Exposure

Try and reduce your exposure to things that can activate your allergies like staying indoors on dry or windy days. Understanding that spending all summer indoors is impossible, plan ahead and look at local weather or pollen levels.

If outside chores are calling your name, either wear a pollen mask or delegate the chores like lawn mowing or weed pulling. After outdoor chores or activities, remove the clothes you wore outside and shower to remove all the pollen from your hair and skin.

Rinses Those Sinuses

Rinsing your sinuses, or nasal irrigation, is a beneficial way to relieve symptoms for those who struggle with allergies or just general nasal congestion. Nasal irrigation is flushing out your nasal cavity with a saline solution. The solution is a simple mixture of purified water and salt, used in combination with a squeeze bottle or a neti pot. Directly rinsing your sinuses or nasal passages will flushes out mucus and allergens in your nose.

Over-the-counter remedy

If the tips above aren’t cutting it, there are several types of nonprescription medications that can alleviate your allergy symptoms.

• Oral antihistamines can help relieve sneezing, itching, a runny nose and watery eyes
• Decongestants, such as pseudoephedrine, can provide temporary relief from nasal stuffiness
• Nasal spray can ease allergy symptoms and doesn’t have serious side effects, though it’s most effective when you begin using it before your symptoms start

Consult a Doctor

For some, taking precaution or using over-the-counter medications isn’t enough to alleviate their allergy symptoms. So, consult your doctor to determine the best course of action for your allergies, whether they are seasonal or year around.

For more information on all Rhinology questions or to schedule an appointment with one of our physicians, please visit https://nevada-ent.com/ or call 775.322.4589.

 

Summer; the best time for outdoor activities like swimming, live concerts, fireworks and even yard work. To get the most out of your summer but also to protect your hearing, here are some preventative measures to keep in mind during these summer activates.

Live Concerts

Outdoors concerts are the best during the summer but can be just as harmful because of the high volume of decibels during the concerts.

Decibels are a unit used to measure the intensity of a sound or the power level of an electrical signal by comparing it with a given level on a logarithmic scale.

The typical person can generally accept 85 decibels for a maximum of eight hours a day, followed by at least a couple hours of recovery time. Most live concerts are at a volume of 100 to 110 decibels which decrease the length of exposure time.

There are two options for all concert goers, placing oneself as far away from speakers as possible or wearing ear plugs. Earplugs can decrease the noise by 20 to 30 decibels.

Both are good options to avoid ringing in the ears after the concert has ended.

Fireworks

Between Fourth of July, baseball games and local events, fireworks are a staple during the summertime. Although fireworks produce between 140-150 decibels, they generally do not cause problems because the explosions are short-lived and happen in the sky.

However, it’s always better to be safe than sorry. Keeping your distance, around 500 feet, is an easy way to still enjoy the beautiful show but also keep your hearing safe.

Using earplugs is an inexpensive and efficient way to protect your hearing. Various types of earplugs are able to reduce different level of decibels.

Water Activities

The best way to cool off can also be the most common cause of ear trouble during the summer. Swimming in any type of water can cause water to get trapped in the middle ear.

The middle ear is the part between the eardrum and the oval window. It transmits sound from the outer ear to the inner ear. Getting water trapped in the middle ear can cause an infection to develop.

Wearing earplugs or custom-molded ones can prevent trouble or pain.

Outdoor Equipment

Equipment like lawnmowers and weed whackers can produce up to 100 decibels so wearing earplugs is a key protective measure. Some people prefer to listen to music through headphones while doing yard work, this isn’t the same as using earplugs and can be harmful.

Listening to music requires the music to be louder and drown out the sound of the equipment.

Be aware of your proximity to the loud sound and remember to use ear plugs if you need to. There are a variety of earplugs that are best for different types of activities including swimming and attending concerts.

For more information on all Otology questions or to schedule an appointment with one of our physicians, please visit https://nevada-ent.com/ or call 775.322.4589.

 

 

We’d like to congratulate our very own Dr. Van Duyne for competing in the 14th Annual Reno-Tahoe Odyssey. Dr. Van Duyne and the rest of “Outrunning 50” won and set a new record for the Senior Women division.

Congratulations to Dr. Van Duyne who participated!

Septal deviation is a common condition, with a significant portion of the population having their septum deviate to one side or the other. Commonly some degree of nasal trauma may cause a deviated septum. Many people are asymptomatic from this, however a few can have nasal obstruction symptoms on the side that is deviated. In these patients, septoplasty (i.e straightening the septum), can be performed. It is usually an outpatient procedure, performed under general anesthesia. After the operation, the patient can breathe better on the affected side. If the deviated septum is more posteriorly placed, endoscopic septoplasty is a good option for the patient. This approach can be done without packing or splints afterwards, and the recovery is easier. Commonly an inferior turbinoplasty is performed concurrently because the turbinates can be swollen due to allergies, or to compensate for the extra space on the non deviated side.

Josh Meier, M.D. F.A.R.S

Like many surgical procedures, septoplasty may sound like a foreign and complicated procedure. However, it addresses a rather ordinary issue — nasal obstruction. If nasal obstruction has been a debilitating issue for you, septoplasty may be the right solution. If you experience nasal obstruction or are considering a septoplasty, here is what you need to know.

Nasal obstruction can occur for a variety of reasons. When the cause is the nasal septum, your doctor may suggest a septoplasty to correct it. The nasal septum is made up of both cartilage and bone, and divides the nose into left and right sides. It is covered with a thin membrane known as the mucosa, which functions like a layer of skin — it protects the cartilage and bone, and keeps the inside of the nose moist. If you have a deviated septum, this simply means that your septum is crooked. However, a deviated septum can easily obstruct airflow, blocking one or both nasal passages.

To determine the cause of nasal obstruction, your doctor will sometimes perform a nasal endoscopy. An endoscope is a thin, flexible device equipped with a tiny camera and a light. In this case, it is inserted into the nose, projecting a magnified image onto a screen. An endoscopy is often enough to diagnose the problem. A CT scan can also be used, but is not usually necessary.

If your doctor determines that a deviated septum is the cause of your nasal obstruction, then septoplasty can correct the deviation and improve airflow. This is the most common reason for septoplasty. A septoplasty can also be part of a larger operation, such as sinus surgery or nasal tumor removal, but this is less likely.

Septoplasty is generally performed on an outpatient basis; this means you come in and go home on the same day. The surgery is done in an operating room, under general anesthesia, unless you and your doctor have determined that local anesthesia is a better option. During the surgery itself, your doctor will attempt to straighten the deviated, or crooked, cartilage and bone. This requires the mucosa, or the inner “skin,” to be lifted off that cartilage and bone so that it can be reshaped, or in some cases, removed. Once the septum is reshaped and/or parts are removed, the lining is laid back down, and the surgery is complete.

After surgery, you can expect splints or packing inside your nose, or possibly dissolvable stitches. There may also be some swelling and/or draining of fluid. During recovery, you may have nasal stuffiness, and your doctor might want you to use a saline spray or irrigation, but overall, the pain should be mild. Most symptoms clear up in the first week, and then you can look forward to breathing easy.

Sources: http://care.american-rhinologic.org/septoplasty_turbinates
http://care.american-rhinologic.org/nasal_endoscopy

Hearing loss and dementia seem unrelated to the majority of us. Aside from the fact that they both accompany aging, one has to do with one’s ears, and the other has to do with one’s brain.

However, multiple studies have shown they are actually closely related. In the latest study from researchers at the University of Wisconsin, cognitively healthy adults in their fifties and sixties who had been diagnosed with hearing loss were shown to face double the risk of developing dementia within five years.

Other studies have shown that risk of dementia increases as hearing loss increases. According to a study by a researcher at Johns Hopkins, mild, moderate, and severe hearing loss made the odds of dementia two, three, and five times higher in the next decade or more, respectively. What’s more, cognitive impairment seems to occur faster in those who have hearing loss. Older adults with hearing loss experienced mental decline an average of 30-40 percent faster.

This correlation affects many of us. Hearing loss is a common ailment in late middle age. At age 65, about one in three adults experiences hearing loss. For adults over 70, two in three have some degree of hearing loss. Dementia is slightly less common, but still prevalent — about one in three Americans will die with some form of dementia.

Why is this the case? We don’t yet know. One possibility is that a brain pathology we’re not aware of is responsible for both symptoms. Another potential reason is that hearing loss causes social isolation. When individuals are no longer able to interact with their surroundings as much as they used to, their brains deteriorate. A third theory is that because hearing is responsible for a fair amount of brain stimulation, the loss of hearing stimuli leads the brain’s functioning to weaken overall. It’s also possible that having to decode noise continually puts too much strain on the mind, leaving it weak and vulnerable to degeneration.

Protect your hearing early in life by limiting your exposure to loud noise. At 90 decibels of uninterrupted sound, the limit of safe noise exposure is eight hours. For each six decibels increase of uninterrupted sound thereafter, the limit of safe exposure is reduced by half.

Also, be on the lookout for symptoms such as excessive ear wax, repeated ear infection, pain, itching, ringing or sudden hearing loss. If you have any of these symptoms, see an otolaryngologist as soon as possible. Ear damage can worsen over time when the issue causing it remains unresolved.

If you already have hearing loss, speak with your otolaryngologist to see what treatment is ideal for your situation. Don’t put off buying a hearing aid if it means you can’t follow along with your friends’ and family’s conversations. Stay social and keep your brain engaged. Additionally, follow a healthy diet and exercise program — the healthier you are overall, the healthier your mind is likely to be.

Sources:
https://www.hear-it.org/hearing-loss-and-dementia
https://www.hear-it.org/why-there-link-between-hearing-loss-and-dementia
https://www.theguardian.com/science/2017/jul/17/hearing-loss-could-pose-greater-risk-of-potential-dementia-in-later-life-study
https://jamanetwork.com/journals/jamaneurology/fullarticle/802291
https://bhsl.wiscweb.wisc.edu/wp-content/uploads/sites/114/2017/07/TFields_AAIC2017_final.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527366/
https://www.alz.org/facts/
https://www.webmd.com/healthy-aging/features/hearing-loss-dementia#1
http://www.hearingloss.org/content/basic-facts-about-hearing-loss