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Programmet
"Fox on Health Weekend" på Fox News Channel –
18/10-1997
(Denne
siden er fremdeles ikke ferdig oversatt)
Producerne
av Fox News Channel's program "Fox on Health Weekend"
så mitt intervju på NBC's "Today" program
september 1997 og inviterte meg til New York for å delta i
programmet deres. Det intervjuet ble sendt på direkten 18.
oktober 1997 og i reprise dagen etter. Det ble sett av ca 4
millioner mennesker.
Stephen
M. Nagler, MD, FACS
CAROL IOVANA, host:
Welcome back. Imagine you're hearing ringing in your ears.
Constant noises in your head. It's an incurable condition
called "tinnitus," and millions of people have it,
including such celebrities as Barbra Streisand, Steve Martin,
Tony Randall. And here to tell is more about it from the
Southeastern Comprehensive Tinnitus Clinic in Atlanta, Georgia is
Dr. Stephen Nagler. Thank you very much for joining us,
Doctor.
Dr. STEPHEN NAGLER (Southeastern Comprehensive
Tinnitus Clinic; Alliance Tinnitus and Hyperacusis Center):
Good morning.
IOVANA: And at the outset I want to
just let everybody know that we are going to be pronouncing this
two different ways, but both ways are correct.
NAGLER:
That's correct.
IOVANA: All right. Explain to
us what tinnitus is.
NAGLER: Tinnitus is a condition
where an individual will hear noise or sound either emanating
from the ear or inside the head as opposed to from an external
source. It very definitely has origins in physical rather
than psychological phenomenon. It affects about 40 million
Americans - about 15% of the population - about the
same percentage of the population that has arthritis. About
6 million Americans have it to the extent that it significantly
affects their lives. And 2 million Americans are disabled
from it.
IOVANA: You know, it's almost impossible to
say that it wouldn't completely take over your life. And
Dr. Nagler is very good in joining us today because he is
suffering - he does suffer from tinnitus. He has a
piece of equipment here that can give us an idea of how miserable
a condition this can be for people. And can you imagine
you're walking around telling people you're hearing sounds in
your ear - and you really are - and people looking at
you like you're crazy? Can you turn this on, and let's get
an idea? This is what the average person hears ...
(NAGLER uses tinnitus simulator.)
IOVANA:
... constantly in their ear when they have tinnitus.
NAGLER:
And when they go to a different room - as you might want to
right now - the noise follows them. And when they
cover their ears with their hands, it gets louder. And
people do sometimes think they're crazy. I did.
I thought this noise is really weird. I'm not going to tell
a lot of people about it because I'm hearing something -
that you don't. Actually I called a friend of mine, who's a
psychiatrist. I at length over a cup of coffee discussed
what it really sounds like. I talked about the quality of
the noise. The pitch. It sounds like a jet turbine.
A tea kettle. And I said, "Am I crazy?" And
she said, "Tell me - what is the noise saying to you?"
"It doesn't say anything to me. I just spent
half-an-hour telling you it's a noise!" She said,
"Yea, when it says something to you ... then,
you're crazy."
IOVANA: Right.
NAGLER:
So it's very definitely physical and not psychological.
IOVANA:
Okay. Explain to us what causes it. Can excessive
noise cause it? And does that do permanent
damage?
NAGLER: Excessive noise can do permanent
damage. It usually starts in the cochlea (Nagler points to
ear model), which is in the inner ear - the snail-like
structure in the inner ear - in a part of the cochlea called
the outer hair cells.
IOVANA: Can you point to that
again, Doctor.
NAGLER: Sorry. It's right
here. (Nagler points again.)
IOVANA: Okay.
The outer hair cells.
NAGLER: The outer hair cells
in the cochlea. In the outer hair cells. A disarray
or disorder can occur in the outer hair cells from noise
exposure, from certain medications - we can talk about that
later. Also, it can be caused by certain curable
phenomena like a middle ear disorder - some middle ear
infections or ... or otosclerosis, which is a hardening of
the bones in the middle ear. So some tinnitus is curable,
but most is not.
IOVANA: So if this condition is
brought on by an inner ear problem, that is curable.
NAGLER:
By a middle ear problem, it's sometimes curable.
But the problem is that it starts here (Nagler points to
cochlea), and it gets to the brain (Nagler points to the auditory
cortex in the brain model) where you appreciate it - where
you hear it - but on the way to the brain it goes through
several subconscious processing stations, if you will. And
one of them - the limbic system - which I don't know if
you can see in here (Nagler points to medial temporal lobe area
in brain model) this dark green area ...
IOVANA:
Just turn it around to his camera there - there you
go.
NAGLER: ... right here. The limbic system
is the seat of emotion. It attaches importance to
the signal, and it recognizes the signal as an unwanted,
uninvited intruder. It grabs it, and it won't let go.
At least this is the theory that many people are beginning to
believe. It was originally proposed by Dr. Pawel Jastreboff
at the University of Maryland.
IOVANA: So what
you're telling us essentially is that yes, you are definitely
hearing this, and not only are you hearing it, but your brain is
registering it as something that's almost intolerable.
NAGLER:
As something that's very important. A factory worker hears
loud noise all the time. He can eat - he can even
sleep in the factory, but the noise doesn't bother him. If
that guy goes home, and his newborn baby makes the tiniest peep,
that's a significant sound to him, and that registers
concern. So what the limbic system does - according to
one particular theory - is that it attaches importance to
the signal, which otherwise would be quite innocuous.
IOVANA:
Now, we've mentioned some celebrities names here -
Barbra Streisand and Tony Randall and Steve Martin,
and these people are hearing this in their ear. How do they
function?
NAGLER: It can be difficult, and the
problem is that you cannot do two important things at the same
time. You can walk and chew gum. You can drive a car
and whistle. But you can't read a book and write a letter.
And people with tinnitus find that it becomes such a distraction
on occasion that they cannot function well. Sometimes they
hear okay, but they are unable to listen well -
because they can't concentrate well.
IOVANA: Okay,
so this moves us to the next question, which is probably the one
that people out there really really want to hear the answer to,
and of course we'll take any of your calls - 1-888-TellFox -
if you have any questions about tinnitus or think you're
suffering from tinnitus. But what can people do about it
because we used the word and the term "incurable" in
our intro. It is not a curable disease, is
it?
NAGLER: It is not a curable disease unless you
are one of the rare fortunate patients where a curable disorder
underlies it, but generally not. There are several
treatment approaches. The two most prominent - the two
most common - are one, an approach called "masking,"
which is promoted by a group in Oregon led by Dr. Jack Vernon.
He's a real pillar in the world tinnitus community. And
it's the idea of wearing a device that looks like a hearing aid
that makes a sound less noxious but a sound that overrides the
tinnitus so you have control over it. And it's very
acceptable, and it works well provided that the sufferer has a
good idea of what the desired result is because it's not going to
cure, and once you take the device out, of course, the noise
is ... right there. And the second approach, which is
gaining increased popularity, is this approach we talked about
from Dr. Jastreboff that actually deals with the issues in
the limbic system and retrains the brain to filter out the
signal so that after a period of time - you don't hear it
about 90% of the time; when you do hear it, it ceases to be
annoying. And that is accomplishable in 80-plus percent of
patients after a period of time.
IOVANA: I was going
to say, and how long does that take, and is that the route that
you took?
NAGLER: That is the route that I took, but
it's not necessarily the route for everybody. And you said
that I suffer from tinnitus. I no longer suffer.
I am aware of it. I listen for it. But I don't suffer
from it, and it put me out of commission for a good long
time.
IOVANA: Okay. All right, Dr. Nagler,
thank you so much for joining us and helping a lot of people out
there.
NAGLER: I do need to add one
thing.
IOVANA: Okay.
NAGLER: The most
important thing that a patient can do besides finding a good
doctor is to join the American Tinnitus Association - be flooded
with information, literature, support research, and the number is
1-800-634-8978.
IOVANA: Thank you, Doctor, very
much. Still to come, new health warnings on a popular pain
killer. But first, the News is next.
NEWS BREAK
IOVANA: Welcome back
everyone to "Fox on Health Weekend." Just before
the News Break we were talking to Dr. Stephen Nagler
about tinnitus, and we were going to move on to another topic,
but we got so many calls and so much interest that we decided to
stay with it ... just a little bit longer. So we want
to take one of those calls, and maybe go to a few other questions
to clarify things for people who are suffering from this horrible
noises in the head and ringing in the ear, which can drive people
literally crazy and for which there is no cure. So we want
to go to a call right away. Please, we'd like to go to
Steven, who's calling us from Blairstown, New Jersey.
Hi, Steven. Thanks for calling. We need a quick
question on this. Go ahead.
STEVEN (Blairstown,
N.J.): Yea, good afternoon. I get this ringing in my
ears. I've been to a couple of doctors, and they've told me
nothing's wrong with my ears. When I drink a soda, it seems
that the noise gets louder. If I drive a long distance.
Also if I move my jaw, the pitch changes.
IOVANA:
Okay.
STEVEN: I'm wondering if there's another
doctor I can see, or is it just something that, you know -
as you said earlier - that I have to live with.
IOVANA:
Okay. Thank you, Steven, for the call. This is kind
of typical, isn't it, that you think it's another problem, but
it's ...
NAGLER: Sure is. Unfortunately
the medical community has not been enamoured with tinnitus
treatment because it can be frustrating at times and adequate
treatment sometimes is quite time-intensive. I think the
best thing to do is to find a qualified physician who has an
interest in treatment and evaluation of tinnitus.
IOVANA:
Or to call, Steven, if you can call the Association number.
Do you want to say that again?
NAGLER: I would love
to. 1-800-634-8978. They can supply you with a list
of interested health care providers in your geographical area.
It's inexpensive to join - 7¢ a day - good
investment.
IOVANA: The other important thing that
we wanted to get to that we didn't get to in the last segment is
that there is a temporary form of tinnitus that can be
brought on by eating certain things and drinking certain
things ... and even by taking antibiotics.
]NAGLER:
That's right.
IOVANA: So we have a limited amount of
time, Doctor, so I want you to run through the list because
people out there, I am sure, are listening very attentively.
NAGLER: The differential to make is the things that
can cause damage to the inner ear, which results possibly
in permanent tinnitus ...
IOVANA: We
have about a minute, Doctor.
NAGLER: ... as opposed
to things that just aggravate it. Like a lot of aspirin can
often aggravate it. Non-steroidal anti-inflammatory agents
like even something as often used as Advil® can aggravate it,
but you stop the medication, it usually gets better.
IOVANA:
How about caffeine?
NAGLER: Caffeine doesn't cause
damage, but in some people it can aggravate it. If it
aggravates tinnitus, stop it; if it doesn't bother your tinnitus,
no reason not to have a cup of coffee a day.
IOVANA:
Okay. What about antibiotics, which might be a secret
problem. You're on an antibiotic, and you don't realize
that that's what's causing the ringing of the ears.
NAGLER:
The only antibiotics that cause permanent damage are the
aminoglycoside antibiotics, which are generally given to
desperately ill patients by vein. But other antibiotics can
sometimes cause it, and the best way to do it is to find out from
your physician if tinnitus is a frequent side effect of this
particular drug.
IOVANA: Okay. And, Doctor,
once again, there's no cure, but there is treatment for it, and
if you find one of these physicians, you should be able to get
some sort of relief for tinnitus, and - more importantly - you're
not losing your mind.
NAGLER: That's absolutely
correct. It's very hopeful.
IOVANA: Okay.
Dr. Nagler, thank you very much for staying with us for another
segment.
NAGLER: Thank you, Ms. Iovana.
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