Ear Injection of AM-101 May Stop Tinnitus

Phantom ringing of the ears also known as tinnitus is an extremely frustrating condition that afflicts many people. Often triggered by hearing nerve damage, there's no good treatment to fix this condition once it sets in.

Until possibly now... 

AM-101 made by Auris Medical is an experimental drug containing esketamine hydrochloride embedded within a hyaluronic acid gel formulation. It works by blocking the NMDA receptors of the cochlear inner hair cell.

Normally, when there is trauma sustained by the cochlea whether it be loud noise or viral infection, excess amount of a neurotransmitter called glutamate gets release. The problem is that too much glutamate also triggers hearing nerve death due to over-excitation via the NMDA receptor. When these hearing nerves die, it leaves the brain cells responsible for hearing in a permanently switch-on state leading to tinnitus, even if there's no sound present.

AM-101 is hypothesized to block the NMDA receptor from being over-stimulated by the glutamate neurotransmitter thereby preventing hearing nerve death.

But, does it work?

According to one small prospective, double-blind, randomized, placebo-controlled study involving 248 patients, it DOES work to a significant degree.  42% reported their tinnitus was half as quiet as before compared with 14% in the placebo group. After 90 days, 57% of those taking the active gel said their tinnitus was 'much improved' or 'very much improved'.

Of course, the trick is to administer the drug before nerve death has set in after which it would be too late. In the study, only patients with onset of ringing within 3 months were eligible to participate.

Patient also need to realize that the drug is administered by injection through the eardrum and into the middle ear space. This injection technique is commonly used in the treatment of sudden nerve hearing loss where steroids are injected. Watch video of this injection method below.

Unfortunately, AM-101 is not available except under research protocols currently and is undergoing FDA clinical trials. The preliminary results are very promising however.

Reference:
Efficacy and Safety of AM-101 in the Treatment of Acute Inner Ear Tinnitus—A Double-Blind, Randomized, Placebo-Controlled Phase II Study. Otology & Neurotology: April 2014 - Volume 35 - Issue 4 - p 589-597

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Hearing Loss Over Time

It is well-known that professional musicians have a higher risk of hearing loss and tinnitus compared to non-musicians. According to one study, the risk for musicians is 1.5x for hearing loss and nearly 4x for tinnitus.

And although people understand that as you get older, hearing loss increases, what is less clear is how quickly hearing loss occurs over time.

After analyzing over 3 million subjects, here is the graph of hearing loss with age. Intuitively, I thought there would have been a "jump" in hearing loss after a certain age. The graph indicates no such "jump," but rather a continuous increase of hearing loss from the earliest age studied (19-21 years).

This gentle slope does suggest that the vast majority of hearing loss is due to the slow accumulation of noise-induced nerve damage over time and that the vast minority of hearing loss is secondary to an acute event whether from infection or sudden loud noise exposure (i.e., gunshot without hearing plugs).

Source: http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full

Reference:
Incidence and relative risk of hearing disorders in professional musicians. Occup Environ Med doi:10.1136/oemed-2014-102172

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Law Firm Launches Website for Tinnitus Sufferers

It would be a sad day indeed if a patient google searches a medical condition or symptom and the first page of results are all pointing to a law firm.

In perhaps the beginning towards this possibility, personal injury law firm, Mercury Legal Online, has launched a website dedicated to patients who suffer tinnitus and hearing loss sustained from time working in a job that contained a lot of loud noise without using hearing protection. Thanks to @earsurgeonuk who brought this to my attention.

The website even provides a compensation calculator, requirements to make a claim, and an infographic about tinnitus in general...


Source:
Law firm launches website dedicated to tinnitus sufferers. Digital Journal 9/8/13

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Medications that (Might) Help Tinnitus?

The blunt answer is that there is no drug or supplement that has been consistently found to help with tinnitus (ringing of the ears).

Here's a partial table showing all the research that has been done either proving or disproving effectiveness to treat tinnitus (info collected from this review paper).

For a more comprehensive list going over 17 drugs, click here.

Drug	Research That Supports	Research That Disputes	Conclusion
Benzodiazepines (alprazolam, diazepam, clonazepam)	#1, #2, #3, #4	#1, #2, #3	Caution due to addiction and may worsen tinnitus if stopped.
Antidepressants (nortriptyline, amitriptyline, trimipramine, sertraline, paroxetine)	#1, #2, #3, #4, #5	#1, #2, #3, #4, #5, #6	TCA may benefit only in patients with depression symptoms
Anticonvulsants (carbamazepine, gabapentin, vigabatrin, tiagabine)	#1, #2, #3, #4, #5, #6, #7, #8, #9	#1, #2, #3, #4, #5, #6, #7	Mixed results
Antiglutamatergics (caroverine, memantine, acamprosate)	#1, #2, #3, #4	#1, #2, #3, #4	No conclusion.
(Anti)Dopaminergics (sulpiride, piribedil)	#1, #2, #3	#1	Studies are weak.
Ginkgo Biloba	#1, #2	#1, #2, #3	Not effective.
Melatonin	#1, #2, #3	#1	Potentially helpful.

For more meds, click here.

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Cicadas Can Cause Permanent Hearing Loss!

Cicadas are pretty darn ugly... But beyond their ugliness and making cars look pretty messed up... the sound they make is not only irritating, but potentially harmful.

Sometime the end of this April 2013, billions of large flying insects called cicadas will make their appearance along with their characteristic stridorous noise. The male cicadas are the ones making this mating noise with "tymbal" soundmakers amplified by large resonance chambers found on body.

Occurring every 17 years, this year's swarm is known as Brood II and has not been seen since 1996. Expected to cover much of the East Coast, the buzz created by these insects can reach 90 decibels... about as loud as a jackhammer. If one is right next to your ear, the sound can reach 120 decibels are equivalent to sandblasting or a loud rock concert. [see noise chart]

At 90 decibels, possible hearing damage may occur if a human ear is exposed to this level noise for more than 8 hours a day. At 120 decibels, less than 15 minutes of exposure can induce possible permanent hearing loss.

So... keep a pair of ear plugs in your purse or pants pocket and use them if the sound starts to get too loud.... or too irritating.

Sources:
17 years in the making, this spring's cicada invasion generates early buzz. NBC News 4/10/13.

Cicada. Wikipedia

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How Much Caffeine is Present in Coffee? Decaff? Chocolate?

© Radu Razvan Gheorghe | Dreamstime Stock Photos

There are quite a few ENT problems that can potentially be due to caffeine intake. Even death has been attributed to high caffeine intake in young adults who drink a lot of energy drinks like Red Bull.

In any case, caffeine can contribute to (some proven, some suspected, some debatable):

• Tinnitus
• Meniere's Disease
• Migraine Headaches
• Headaches
• Dizziness
• Reflux
• Lump in Throat Sensation (Globus)
• Chronic throat clearing
• Dry throat
• Phlegmy throat

Alcohol and salt are other big as well as under-recognized items that may cause similar ENT issues.

As such, caffeine abstinence is one of the first things to be tried with some of these conditions. What many people may not realize is how prevalent caffeine is even in some food items not normally considered to contain caffeine. Such unrecognized items include tea, chocolate, and even decaffeinated coffee (it has been de-caffeinated, but not to the point of being caffeine free).

Here is an infographic showing relative caffeine amounts in a variety of beverages taken from C&EN:

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Mozart May Help with Tinnitus

Currently, there is no fast, good, and cheap way of resolving tinnitus. Tinnitus is in essence hearing a ringing or buzzing that does not exist in reality. At best, it may be something you hear, but does not bother.

At worst, it can literally drive a person crazy.

Neuromonics is perhaps one of the very few treatment protocols that has been proven to work resolving/improving tinnitus in 80-90% of patients over a period of months.

However, it is expensive... typically around $6000 out-of-pocket.

In a study out of Italy, a group of patients between 22 and 78 years of age who suffered from tinnitus were told to listen to Mozart's Sonata k448for 1 hour daily for 1 month. This was followed by instruction to listen to Beethoven's Fur Elisesonata for 1 hour daily for another month.

For all the parameters investigated, there was a general significant improvement between the pre- and post-listening evaluation. Significant improvement in several parameters were seen even after a single exposure to Mozart's sonata.

So apparently listening to Mozart may not help only baby's to become smarter (debatable), but it can help adults as well.

It's also cheap... about as much as it takes to download the songs from a music store.

Some other thoughts that may require additional research...

• What if a patient hates classical music?
• Does "how" a patient listens to the music affect results? (Playing the music in background while doing some other activity versus doing nothing other than listening to the music.)
• How long does the improvement last after treatment?
• What about other songs by Mozart?

But... all in all... given it is cheap... it certainly can't hurt to give it a try.

Reference:
The Mozart effect in patients suffering from tinnitus. Acta Oto-laryngologica. Posted online on October 1, 2012. (doi:10.3109/00016489.2012.684398)

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Sheryl Crow Blames Brain Tumor on Cell Phone Use

On the inaugural episode of Katie Couric's new talk show Katie, Sheryl Crow described her history with a brain tumor called meningioma which was found in her right temporal lobe. This diagnosis was reported in a previous blog post.

Most interestingly, during the show, she blames the meningioma on excessive cell phone use years ago when she was on the phone for hours promoting her records using one of those archaic analog cell phones.

The relationship between cell phone use and brain tumors including benign tumors like meningioma has been discussed in prior blog posts.

Watch the interview here:

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New Webpage on Cochlear Hydrops

Sense of ear fullness or clogging is one of the most common reasons to see an ENT. Common causes of such a symptom include eustachian tube dysfunction, sudden sensorineural hearing loss, or fluid in the middle ear. However, cochlear hydrops is another potential, but rare cause for ear fullness.

Other symptoms that a patient with cochlear hydrops may exhibit include:

• roaring sound in the ear
• fluctuating hearing loss
• noise sensitivity
• speech/sound distortion

A new webpage has been written regarding this problem and treatment for it.

Check it out here!

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