Sunday 29 November 2015

Dizziness: Probe before You Treat

From personal experience of running a dedicated vertigo clinic for a decade now, it appears that when people experience dizziness for the first time, the experience is so terrifying that they are often short of vocabulary to describe the sensation they feel. This lack of clarity in symptom description often mislead inexperienced physicians into the wrong treatment. 
Generally, the presenting complaint is always "I am feeling dizzy". Now the issue is this can mean several things to several people:
Feeling like blackout / lightheaded which may direct physician towards the cardiovascular system
Feeling like drunk while walking which may direct physician to the neurological system
Feeling as if the whole world is spinning or as if the subject is spinning which directs physician to the vestibular system
Feeling like seeing double which may direct clinician to the ophthalmology 
And so on. 
So when confronted with the dizzy patient, the challenge confronting clinician is what does the client mean by "I am feeling dizzy"
The interesting thing in ORL is that dizziness as a symptom, in most countries where English is a second language, is regarded as a block symptom which should not be accepted without probing for the details. It is similar to saying "I have catarrh" which can be taken to mean either 'I have stuffy nose', or 'I have blocked nose' or 'I have runny nose'
The interesting aspect is most GPs have little interest, training and understanding in diagnosis and management of the dizzy patient, but would nevertheless have commenced patients with dizziness on medications before referral to ORL surgeons. 
It would be nice for GP clinicians to make sure they're on the same page with patients presenting with dizziness before commencement of treatment. 
So when next you're experiencing dizziness, make sure you explicitly describe your symptom to your GP and that he understood these, before accepting treatments offered. 

Tuesday 10 November 2015

Why Buying OTC ‘Hearing Aids’ Might be Bad for You and Yours

Significant Hearing loss is known to affect about 5 per cent of people world wide, and the prevalence is believed to be higher in some countries that others. Data from the hearing loss clinic (that I run for the past 10 years) revealed that out of every 10 people diagnosed with hearing loss, 4/10 will require hearing aids, 2/10 will require ear surgery, 3/10 will require cochlear implants, and the remaining 1/10 cannot be helped and will require  vocational training. 

Of the 4/10 that require hearing aids, only 1 to 2 can afford it. This is where it gets more interesting. With the currently available technology, Hearing aids are fast becoming valuable ‘consumer electronics’ objects. Like cars. Like iPad. You can get different models and make that make a whole world of difference beyond merely amplifying sound. A pair of these digital and programmable devices cost between $2,000 and $6,000. 

These high-tech, costlier devices provide best amplification and their fittings often require 2 important processes: hearing measurements (called audiometry) and hearing aids impression taking. The impression is taken to ensure perfect fit into the ear canal, since hearing aids without a perfect fit may result in leakages, described as acoustic feedbacks, manifesting as annoyance noise perceived while the hearing aids are being used. The effect of this is tendency of the wearer to become non-user. 


Now it is on the issue of cost and time to fitting (it takes between 2 - 4 weeks between the impression taking and hearing aids fitting in most developing countries where hearing aids are not manufactured) that a new market niche is being created. This ‘instant hearing aids’ providers utilize silicon ear pieces of variable diameter coupled to cheap sound amplifiers to provide cheap, instant, pick and pay ‘hearing aids’.

This is similar to picking prescription lenses from a supermarket / shopping mall when you have mild refractive error. Now the debate is whether these amplification devices should be classified as “hearing aids”. 

According to Yee, Chan & McPherson (2015), Hearing aids sold directly to consumers in retail stores or through the internet, without individual prescription by audiological professionals are termed over-the-counter devices. These amplifiers cost between $300 to $500, provide low frequency amplifications (and this explains why they are not good for your old grannies’ age-related hearing loss) and for others with significant hearing loss beyond the low frequency range, and are not FDA approved! 

The interesting thing about these hearing amps market is they are currently incorporating interesting hearing aids features like directional microphones, and bluetooth connection to smart phones!

In developing countries like Nigeria, these hearing amps are being distributed and marketed as ‘low cost hearing aids’ to appeal to indigent majority who cannot afford FDA approved devices. The truth is OTC ‘hearing aids’ provide sound amplification for people with mild-moderate hearing loss. They are ‘one-size-fits-all’ devices, unlike prescription hearing aids which are programmed to address the user’s specific hearing impairment. 

When next you handed your granny a ‘pick and pay’ “hearing aids”, try to follow up and see why granny dislikes wearing his/her hearing aids. 

Further Readings:

  1. Anne Eisenberg. Just Don’t Call Them Hearing Aids. New York Times. Available online at http://www.nytimes.com/2014/03/23/technology/just-dont-call-them-hearing-aids.html?_r=0 . Accessed 11/11/2015
  2. Yee Z, Chan T, McPherson B. Oveer-the-counter Hearing Aids: A Lost Decade For Change. BioMed Research International Volume 2015 (2015), Article ID 827463, 15 pages http://dx.doi.org/10.1155/2015/827463