We Got Your Number Podcast
The podcast where science meets real talk! Hosted by Dr. Thomas Romo III MD, FACS & Dr. Alexandra Filingeri DCN RDN. We're diving into the numbers behind your health, wellness, and everything in between. Ready to decode the data? We've got your number.
We Got Your Number Podcast
Dr. Darius Kohan | The Truth About Hearing
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Dr. Darius Kohan joins We Got Your Number for a conversation about how hearing impacts daily life, aging, balance, communication, and overall wellness.
This episode covers tinnitus, hearing loss, noise exposure, swimmer’s ear, childhood ear infections, eustachian tube issues, vertigo, and the emotional side of losing your hearing.
Dr. Kohan also shares insight into treatment options, prevention, and why protecting your ears earlier in life can make a major difference later on.
Key Topics:
• Tinnitus and ringing in the ears
• Hearing loss and aging
• Loud noise exposure
• Swimmer’s ear prevention
• Ear infections in children
• Vertigo and balance issues
• When to see a specialist
Your hearing matters. Protect it, understand it, and know when to get help.
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The content shared on the “We Got Your Number” podcast is for educational and informational purposes only. It is not intended to provide medical advice, diagnosis, or treatment. Always seek the guidance of your own qualified healthcare professional with any questions you may have regarding your health, nutrition, or medical care.
I'm Dr. Thomas Romo, and I'm here with my co-host, Dr. Alexandria, Phil, and Jerry, and we want to welcome you to our podcast, We Got Your Number. We're covering many different interesting topics, medical wellness, uh, anti-aging. And today we have a very special guest, uh, a good friend of mine for many years, Dr. Darius Cohen. He is a ear, nose, and throat specialist that specializes in otology and neurootology on staff at Linux Hill, NYU, Mount Sinai, New York Ionir, Manhattan Ionir in the city. Uh, and we're gonna talk to him about all things to do with your ears, function, uh, prevention of uh problems. Uh, and so Dr. Cohen, uh, and uh welcome to our podcast. Uh the first thing we'd like to talk about uh is uh our relationship and how we got involved with Little Baby Face Foundation, uh what your uh knowledge and and what you brought to uh the foundation in that activity.
SPEAKER_03Well, first thank you for inviting me. It's very nice and uh for the beautiful introduction. Um we got together when you developed the foundation, and you started something that's great for kids, and you had a really good concept as to how to help kids who have anomalies. And my part of it was the kids who have uh missing ears, uh, microcia and atresia, meaning the ears can is gone, and it's they're born that way, and there's no ear canal, so they have a very severe hearing loss and this deformity. And we got together when you invited me, said I'm going to try to reconstruct their outer ear to give them a more normal-looking life, and then to I came along to restore hearing for them. And there are many different techniques that we've developed over the years. Some of them involve re-establishing an ear canal, drilling it out, but that had a lot of complications from past. So now we have implantable devices that we do at the same time. You make them look good and normal, and I restore some hearing to them with this implantable devices that work by going behind where you restore the ear, and we put a device that will take the sound from the outside and vibrates the skull. And by vibrating the skull, it sends the sound directly past the obstruction of no ear canal into the inner ear. So there, these kids usually have normal nerve, they just don't have a ear. So now we're bypassing the damage, and now we're gonna go directly into the nerve, and they get decent hearing. So it's like it's good looks and better hearing.
SPEAKER_01Right with the dream team, you have the structure and the function coming together to restore um hearing in these children. That's that's so beautiful.
SPEAKER_00Correct. Um and just what to that point, uh, we've been doing that for about 20 years together, and uh the uh it was all technology driven, and you're at the forefront of that technology, putting those devices on uh the their head behind their ears so that we could restore their hearing, uh, called a bone-anchored hearing aid or a Baja. Uh can you tell us a little bit about that? Yeah, because it's gone from rudimentary.
SPEAKER_03The initial one was unfortunately uh rarely used. Fortunately, now it's rarely used, but at the beginning you had to have a metal pedestal that was a little metal that stuck out of the ear, and you apply the device on the outside. And nobody likes to have a pin sticking out of the ear to the head. So the later devices that we developed uh is now implantable completely under the skin. So, and it takes only about 40 minutes to do the procedure. And no, in kids, in adults, and kids don't talk about it under local anesthesia. So we put the implant underneath, skin covers it, hair covers it, and they get the little processor that looks like a watch on smaller, and then it's on the outside magnetically attracted to the inside device and sends the sound directly through them. And there have been multiple uh generations. We went from the pin to having uh uh sofono device, which then turned into the Cochlear Corporation, Assea, which turned into the Bone Bridge, and uh even continuously getting smaller and better devices all the time.
SPEAKER_00I uh saw a kid this week, actually maybe yesterday, a nine-year-old with microcia atresia, which occurs about one in five thousand to seventy, five hundred children, no ear, no ear canal. Um, and one of the things that I wanted to be sure the mother knew was that it is a spontaneous birth defect. Uh it's not something the mother does, something they drink. Uh you don't want to, they're they're already guilty that they have a child with a birth defect, and then uh want to make sure that they know that they're uh spontaneous. Are there taking that, extrapolating that onto uh with hearing and and and prenatal and postnatal, uh are there things that mothers uh that you recommend or that are recommended to uh improve those uh those outcomes?
SPEAKER_03They're not for the prenatal, but I'll talk about it a second. I mean the latest version of the Baja is the Sentio device by the Otakan Corporation, which is the smallest. Just want to put that in because that is the smallest one. We started doing that you and I together. But the um prenatal, this is a spontaneous, this is not something that they can genetically prevent by no, it doesn't run in families that no, it's not like sometimes cleft lip can be, but this is not the case. This is not doesn't run in families, at least if we don't know. Maybe it does, we just don't know about the genetics of it. But as far as prenatal, no amount of uh vitamins, nutritional supplements is going to make a difference if this is a spontaneous mutation, it's not going to help in that respect, as far as we know. We do provide, we do think prenatal medications are bad vitamins and stuff, it's very useful for other purposes, but it will not prevent the microachia retrieval.
SPEAKER_00Well, could you extrapolate on that a little bit in that not just in microtia, but in any wellness baby management, prenatal, postnatal, do you recommend uh processes like that? Because uh Dr. Phil and Jerry's uh quite uh knowledgeable about all this as well.
SPEAKER_03She might know more about it than I when it comes to nutrition, that's your expertise. Of course, so I think please continue.
SPEAKER_01Yes, please continue.
SPEAKER_03I was gonna say uh we give uh vitamin in general the vitamins that help for the year are lipoflavonoids, we tell them ginkgabloba is good for the year, uh niacin, all of them are really basically improve the blood flow, which improve nutrition to the inner ear. So we do that prenatal, we also do it in patients who have other ear conditions postnatal, if they have tinnitus. Any the concept being that if you have better blood flow to the year, then you should have better function with better nutrition, and the year will function better. But it's it's a soft, we don't have a hundred percent documented that it always works. It does minimal if any side effects that are detrimental and the benefits uh potentially far outweigh the risk to taking the vitamins and nutritional supplements.
SPEAKER_01Yeah, I like to think about it like almost like a soft science in the sense that if the dose of the vitamin is appropriate, meaning it's not a extremely high dose, um, then the risk-to-reward ratio is is pretty appropriate. Um I really appreciate both of you talking about it being spontaneous and meaning that there is nothing that nutrition can do in this situation. I have moms that will bring babies to me, you know, for blood conditions and things that ultimately I have I have to say to them. There is no evidence-based nutrition recommendation for this, but what we can do, and I think that this is the important piece, is we can talk about general nutrition that can is age appropriate and developmentally appropriate for your child at the stage of life that they're in. So if they're on formula, if they're progressing to solids, I think that um oftentimes people don't have that information, um, which actually can make a difference, versus talking about, you know, maybe supplementations or preconception that isn't necessarily going to matter. Um Dr. Roma, we were talking about niacin, so why were we talking about niacin?
SPEAKER_00Well, I think niacin has been used uh for uh ringing in the ears, uh Darius. Is that right?
SPEAKER_03Yes, it has been. Among like the other two, that more popular overall for ringing is lipoflavonoid. They're so popular they actually go on the television to see advertising for different versions of lipoflavonoids, which are in the B family of vitamins. And there's ginkabeloba, but niacin's been along for a long time. It's usually given 50 milligrams twice a day. You can go even higher for that. Um, nobody complains that it makes them worse by taking it. It helps a lot potentially. Side effects are pretty much non-existent, so it's good to help the underlying tinnitus. We don't really know what it does, but we do know that it does help based upon anecdotal and some studies as well. Also, talking about the things that help the tinnitus, uh the noises in the ear, um, it's actually very common. Every person on this planet, you and me, you guys might who invited me will have tinnitus at one point or another. It's so ubiquitous because there's so many causes of tinnitus, from viruses to infections to allow noise exposure, to a to sinus issues, to TMJ problems, uh, brain tumor, everything. And then certain things make it a lot worse. Caffeine is known to make it a lot worse. And we always tell patients to stay off the caffeine-ated beverages, because then it's not just coffee, it's teas, it's sodas, it's chocolates, especially dark chocolate. Um, and also tell them to stay off aspirin products or anti-inflammatories. And those are reversible. So if you stay off the caffeine and anti-inflammation, if the tinnitus is related to that, it gets better. So nutrition definitely has a role to play in this condition. We know that they improve. Of course, if you look on the PDR medications on the less than 1%, every medication puts down that they have a chance of a tinnitus with taking their medications. But nutrition can help. The big one is for us, we always universally throughout the world, we tell them lower the caffeine level and lower the anti-inflammatory level. There's an exception in the sense if you need a baby aspirin or something equivalent for a cardiac condition, the heart trumps the ear. Right. So that's more important to have it uh no no heart attacks rather than strokes. So we tell them if your cardiologist tells you to be on the on aspirin, then you better take that aspirin.
SPEAKER_01Right. Absolutely. Yeah. Um, that's interesting. I think the caffeine point is is you know quite interesting because you ask someone how many cups of coffee do they drink a day, and you think they're gonna say two. Um, but then they have two cups of coffee, two energy drinks, and then before they go to the gym at night, they're putting pre-workout into um their water bottle. So I think it's sometimes it's these little things that we think, oh, there's no way that they're exceeding their amount for caffeine. Um, but oftentimes what I've learned from speaking to people, there's never no way. There are times when they are doing those things. Um that's interesting, and you actually educated me on the caffeine piece of the equation. I I didn't know that.
SPEAKER_00And and there, you know, the data comes and goes because it's it's who knows if it's real, but you know, one month they'll talk about uh how wonderful caffeine is for you, and two months later they'll tell you how bad it is for you.
SPEAKER_02And and and caffeine has good side effects as well.
SPEAKER_03Supposedly outside of my field or yours, they say that it potentially is preventive of colon cancer and has other benefits, but I'm just talking about tinnitus. From tinnitus point of view, you want less. And then when the patients tell you only have a cup of coffee a day, then I always ask the corollary question, how big a cup?
SPEAKER_02And then somebody came in with a thermos that was like this big, you said, just like just drink that once a day. It's like, is it no, no, no? That's not a cup.
SPEAKER_01Yeah. Um, when talking about niacin, so it's it's it's very interesting that um you know you see a benefit when it comes to hearing, because niacin's primary role, or one of the things that it does, is and I I always talk about metabolism on this podcast because that's the area that I love to talk about, um, is niacin, one of its primary roles is in um how our body yields energy. So in the metabolic process um pathways, the electron transport cycle, um, and the um Krebs cycle and electron transport chain. So that's where we see if like you look at data and you look at like what is niacin's function, you see it working as a coenzyne or a cofactor, helping um yield energy from the food that we eat. So interestingly enough, um, we had you know, niacin was trending, NAD supplements were trending a month or two ago, and people were overdoing it. Um, do you ever see patients if they're taking 50 um milligrams of niacin twice a day, do they report like any tingling sensation or burning or um they call it like a niacin flush, like red skin, anything along those lines?
SPEAKER_03I have seen like flush, like I'm having right now. So that's like a flush, but uh it's not um it's not often. I don't they don't if they have a benefit from the tinnitus uh diminishing, it's like you put into perspective what's more important. Yeah, and they they will they will get the threat flush and they don't care. Yeah. As long as the tinnitus can be very, very annoying. Especially it's worse in a quiet environment. Usually when you want to rest at night, you want to sleep, or you're at home, or you're concentrating, and all of a sudden the sound around you is just roaring in your head. And that's really that's when we have to worry about uh no the patient getting so upset. They even seek uh no psychiatric treatment at a time because they can't sleep. Right, they're not focused. But meanwhile, during the day, when there's a lot of ambient sound in the environment, the mind automatically will focus on that and will not focus on the tinnitus. And they don't really care during the day, it's really when it's quiet, that when they want to rest and enjoy themselves, that's when it's the worst.
SPEAKER_00And do uh devices, noise, white noise devices, uh listening to waves or something like that while you're sleeping?
SPEAKER_03They've been around for a very long time. The white noise maker. Um, we tell patients if it's too quiet at night, have some noise in the background, it could be soft music, something doesn't bother your partner, whoever that person is, and you want to have um soft music, an air conditioner, a fan, anything that can potentially you know mitigate the tinnitus would be appropriate. And there are many different ways. Some people find one better than the other, it's their option. There are tons of devices out there that will do that for you. Yeah, um, I think it it does help. I do think it's I think it's probably the primary treatment. Right now, everybody's who has really bad tinnitus uses some sort of noisemaker in the background.
SPEAKER_00Cool. Simple, that's great. Uh well, we have a world-class uh uh hearing uh and uh balance uh physician here. So I want to ask you a question about uh hearing loss. And the hearing loss we're gonna talk about is nerve hearing loss to start with. Uh I was talking to Ali uh and one of the reasons we brought this up was uh at the Taylor Swift concerts, they were talking about uh the concerts being 90 dB or greater, uh, and it's acoustic trauma. So you've got young girls with their mothers out there with this noise, uh and then you extrapolate that onto how does that interface with hearing as you aid kind of thing.
SPEAKER_03Well, it's actually easy nowadays with internet available everywhere. All you have to do is just go and look for the OSHA regulations, which were developed by the government many years ago and been updated. OSHA regulation was meant to see for people who work, employed, and how long they can be tolerated at what level of sound. So they have you truly is very clear as to what level you can tolerate and for how long. And yes, concerts, whoever is the performer, can usually can be very loud, especially it's in the rock and roll category or metallic or along those lines. It can be well above 90 decibels, it can be up to like 100, 120 decibels, and you're really not allowed to spend more time than a few hours on the dose, and then you get the permanent damage. You may have temporary tinnitus in the ears or noises, but they can become permanent depending how long you and if you do it repeatedly, and we have patients that we all know, they come in, they go to concert, they say I have a little ringing in my ear, afterwards it doesn't sound right, but two or three days later they feel fine. But if they keep repeating this over and over again, it they will not recover. And the government has very strict criteria. I think for example, when you go to the airport, you see them wearing headphones to try to prevent that from happening. It's interesting, the ones who are suffering the most, you would not be the ones that I would have expected. It's usually servers in restaurants and clubs and bartenders. Oh because there's so much noise over there and they do it day by day, day by day, and they're exposed to this continuously. So it's not just a nice concert, it's the people who depend on their wages. If and there's no restriction on the dose environment to the employees, versus the employer tells them you cannot be exposed to this much noise continuously. And there have been studies done from a business point of view, for example, in club in restaurants especially, the level of the noise that's in the background can be pretty loud and it kind of stimulates people to eat faster and go. So there's a higher turnover, and they've been study done so that the owners, quite frankly, are aware that it is a little bit too loud, and they do it anyway because the turnover is higher and they can get more people in.
SPEAKER_00So there's a method to the magistrate.
SPEAKER_03But there are very strict regulations. In places that are regulated, they are supposed to be exposed only for so many minutes at this particular noise level, and the government puts out the ultra regulations also tell you what, so you know what is a whisper, what is uh the regular speech level, what is loud, what is potentially dangerous. It tells you exactly everything so you can correlate it. So it's not just an arbitrary number, it's a 120 decibels. Well, what does 120 decibels mean to the average person? You can actually tell one, two, and those conversations are at 7 decibels, 70 decibels. You know, whisper around 40. Uh can go up to 90 when you start having an argument with somebody else. Then you start getting to real damage damage if you go beyond 90.
SPEAKER_01Such an interesting thing to think about, and I have to say that especially in the younger generation, um, there is no thought of am I protecting my hearing? Um, you know, I think it's weekly either even going to the gym with, you know, the headphones on and blasting the music, getting into the car, blasting the music, going out on the weekend, going to these concerts, listening to extremely loud music. Um I think that there is no maybe there's a lack of of education on the fact that they can damage their ears, but it's not something that is being discussed. I mean, in similar ways, we know alcohol is bad, we know smoking is bad, um people are doing it, but I think even the conversation around that you need to be protecting um your hearing because you can damage it, I have never heard that conversation.
SPEAKER_00Yeah, it's not out there, it needs to be out there, and that's what we're gonna help it with.
SPEAKER_03I hope so. I hope it helps.
SPEAKER_01What is a question when a patient comes in to see you, and I know they see you for you know a variety of reasons. Um, what are common um questions that a patient has to ask you when regarding their hearing or like the health of their hearing?
SPEAKER_03Well, we we start out as like the first we ask them if they perceive if they have a hearing loss or not, and it's very important from a medical point of view to know if it's symmetric or asymmetric.
SPEAKER_01Right.
SPEAKER_03Um, if we're going to lose hearing, we lose it symmetrically. And there's a genetic built in us, no, there's a bell shaped curve as to where you belong, and then most of us. Most people lose hearing in their mid-60s and on, and that is genetic. And it usually is about 1 to 1.5% every year, starting in your 60s, in the mid-60s and on. And we all know as we get older, we don't have good hearing. When we are born, a normal hearing person, the hearing nerve, which is called the cochlear nerve, has about 10,000 fibers in it. It's almost like an intertwining rope.
SPEAKER_01Right.
SPEAKER_03And you have about 10,000 fibers. You can lose 3,000 of them and still have normal hearing. But after you lose more than 3,000 of those fibers, the hearing loss becomes permanent and needs to lose more and more and more. As we get older, we lose more of the fibers, we have more and more hearing. And this has been the statistics. We are in the far future not currently going to potentially be able to regenerate the cells and the fibers. The cells are called hair cells in the ear. But as of now, it's very limited that we can do with genetic manipulation. And the questions we ask the patients and they talk to us is about the hearing loss, if it's equal on both sides. We find out if there is any tinnitus or noise in the ear. From a medical point of view, we are very interested in knowing if the tinnitus is equal and if it pulsates like a heartbeat. If they tell you it's pulsating, then it becomes much more of an issue for physicians. We work up asymmetry. So if you're asymmetric in tinnitus, if you're asymmetric in hearing loss, then you need to have a workup. But it usually involves more sophisticated hearing and balance tests because the nerve for hearing also controls balance. And we also do sometimes radiologic imaging, usually MRI scans, to look for lesions on the nerve that would make it asymmetric.
SPEAKER_01Right.
SPEAKER_03So we ask the patients about family history. We want to know if this is something that every member of their family has a problem and what age they developed it. So there are a lot of questions where there's a lot of give and take between the patient and the physician and the initial visits to see what the hearing loss is about and what the tendency is about.
SPEAKER_01Something that we always talk about is the the emotional role. So I losing your hearing, you know, I can imagine is is quite psychologically um stressing. So I think on both of your perspectives, uh, what do you see from the emotional side of the patients?
SPEAKER_00What do you see from the emotional side of someone coming in?
SPEAKER_03It's it's very upsetting because uh it's associated with aging. Right. And as much as we say it's there's no ages, we try to avoid it. The reality is that, and I have lots of patients in this condition where they're in positions where they're not supposed to be losing, they want to project an image of power and confidence in the business world, and they do not want to appear that they're old compared to their peers. And wearing hearing aids to them is like a no-go because they don't want to admit it. They don't want to admit it to their spouse, they don't want to admit it to their family because again, it's a sign of age. We all want to live long, healthy lives, and you don't want to be told, just think of the coralate Tom with how many cosmetic procedures you do because patients come in and you look at them and you say, You look great for your age, whatever that is, and they don't think so because they remember themselves the way they were 20 years ago, and every little you know change of age, they say they want it reversed. So it's not just vanity, it's the it's how they feel inside. Some of them have nothing to do with it's just they feel that they're aging and they want to look what they used to, they want to reverse the process if it's doable safely, and they come to you for that. And they come to the the the to me, they don't necessarily, as soon as you tell them you could use a hearing aid, that they would hear normal. And the first thing they ask is how big is the hearing aid is and how visible it is. And we try to explain to them at a certain point in life, you know, we there've been thousands, I'm talking, I'm not exaggerating, thousands of studies that show that if you don't hear well as you get older, it promotes dementia. It doesn't prevent it, but it promotes it. So, and it's a very insidious. It starts out like I'm I'm 67. So it starts out people like me, you have grandchildren, and they're very noisy, and they make a lot of noise. So he's like, uh maybe I'm not gonna spend so much time with them because you know it's really annoying. Then your spouse wants to go to a fancy restaurant that's noisy, and you think, I know, honey, can we just go to this other place? Because it's and you start pulling back from society, you start pulling back incredible where there's a noisy environment. To some extent, it's good, to another extent, the more you was drawn to yourself, the worse it gets. And that's when dementia is getting promoted because you're not focusing and interacting with people, you're not engaged with everybody, and you're pulling back. And we need socially, we need to be social. We're social animals. We have to be social, we have to interact with the environment. If we don't interact, it promotes dementia. So there's so many blockages as far as the patients perceive into the hearing aids, which is not real. The the current hearing gates are so inconspicuous, you can be intimate with somebody and they wouldn't even know you're wearing them. Right. There's a particular one or two that are really completely in the year. No surgery, nothing. From mild to moderate hearing loss, you can shower with them, you can go about your business, you really shouldn't swim with them, but you can shower every day, you don't have to take them out. It's really very inconspicuous. So there's so many options out there depending upon your hearing loss. To me, if celebrities would wear hearing aids and people who we respect or we admire would wear them, I and it would be almost visible. I think it would be great from that point to be people wearing them. Nobody thinks twice about people wearing ear, glasses. No, it's like it's a fan, it's a symbol of no, oh, it could be fashionable. I wish we could make the hearing aids fashionable.
SPEAKER_01I I love that you said that. You know, I mean we think about celebrities and even like weight loss trends and taking weight loss medications and it becoming such a you know culturally appropriate thing. I do agree, right? We should have celebrities showing off their hearing aids. Absolutely, yeah.
SPEAKER_00They're they drive the uh you know, the culture. And uh I I've said that for years that we ought to have hearing aids with little wings on them or some little design on them. So that but I think it's becoming more acceptable. As the baby boomers are getting older and they're starting to wear the herring aids, uh, they're just gonna eventually have to do it. So hopefully it means uh something uh uh that culturally for that. Um so I think that's really great. Uh I want to talk to you a little bit about um about because we're uh finally in New York in June, we're uh getting the heat and everybody's starting to get into the swimming pools, uh, and we're talking about uh getting what's called swimmer's ear. Um how do you get that? How do you prevent it? What do you do? Uh because people are going to be seeing that more and more. What do you think about q-tips?
SPEAKER_03Well, it's very common in this summer season, and then the middle of the winter everybody goes down south for vacation. So if you have a lot of wax in the ear, which some people do, some people don't, we wax is normal. This is not scientific, but to explain to patients, I tell them think of the wax like perspiration of the ear. So we will make wax, some more than others, some perspire more than others. So you have a lot of wax in the ear, and if it doesn't get cleaned properly, or if you keep using q-tips, that instead of helping you take it out, you're pushing them in and you're stuffing the ear canal. Then when the the wax is a very good nutrient for germs, we have germs all over the body, it's normal. And even fungus. And then if you have you know a lot of wax in there and it gets moist, and then it becomes nutrition for germs, and it's kind of triggers infections. I think using constant use of earbuds, you know, irritates the skin, and that also promotes infection. If you have it, it just irritates the skin and the barrier, the natural barriers that we have are being broken. The germs are there already, they're already all over our bodies. It's not that necessarily the water is dirty or anything, it's just there. It just needs, it's looking for nutrients. You provide the means of nutrition for the germs and a way to penetrate into the deeper part of the skin, the barrier is broken, infections will start.
SPEAKER_00Yes.
SPEAKER_03Dry your ears very well when you go swimming when you're done. Companies that made commercial products called swim ear, that's the name, others equivalent. They're basically a combination of uh white vinegar, alcohol, and water in one third each, and then they put drops at the end of a swim day to try to sterilize the ear. And I tell patients you can buy a commercially made product, you can also make this yourself. It's just white vinegar using your salad and alcohol and water. You put equal parts, you take an eye dropper and you put four or five drops once or twice a day. It air, it it clears the ear, it sterilizes the ear, prevents infections after a long day swimming.
SPEAKER_00Yeah.
SPEAKER_03So there are a few things we can do to help.
SPEAKER_00That's fantastic. I'm sure a lot of mothers uh will be doing that. Yeah, that's interesting. Because you're right, you could make that up with a dropper bottle from the pharmacy and just have that available when the kids get out of the pool for the day. Uh and would be very helpful.
SPEAKER_03The only caveat to this is if God forbid the kids has already a perforation or something in the eardrum, then it will burn. Otherwise, it does not burn or cause any problem. Uh the high likelihood of it doesn't cause the perforation, but if you have one already for other causes, then it will burn. Otherwise, it won't cause.
SPEAKER_00Well, so let's now you've you're moving into um uh another area further in. So we have the ear canal, then you have the eardrum, and then from the eardrum behind the eardrum is that space, middle ear space, and the eustacean tube. Everyone knows about that who's been in an airplane because their ears pop. Uh, and and you can explain that, I guess, a little bit better. But uh middle ear infection, more common in young babies, young children, anything preventative for that too? Uh uh, when do you when do you get interventional and do uh tubing to pressure equalizing tubes? Or is that out of vogue? Uh children learn to speak what they hear, so if they have a fluid in their ears, they're not hearing on that side of their head very well. Uh that's a really uh an important uh uh problem that uh mothers are gonna have.
SPEAKER_03Um visits to the year to the ENT specialists is uh probably if not number one cause, probably second or one for it's because of ear infections due to the middle ear infections, not outer middle ear infections.
SPEAKER_00Really?
SPEAKER_03So I don't know how clear this shows up, but um this is a model of the year. Okay. So we have the ear canal, okay, then we have the eardrum over here, okay, and then beyond the eardrum is the three bones for hearing in the middle ear. But what I really want to point out too is this long eustacean tube that goes and drains into the nose. So it goes from the ear and it goes into the nose, and it's quite long, and it's supposed to be like a drain, a pipe for the ear. Right. And basically, that most of the ear infections overwhelmingly are because this tube does not function properly. In kids, it's immature. The normal angle in an adult is vertical, it kind of goes down. In kids, it's more horizontal until they mature, so it's easier for things to go retrograde back into the ear from the nose. And also it's very soft in the first place and it can collapse easily. That's why you see the kids complain of pain on flights, especially on the descent of the flight, sometimes on the ascent, but the descent for short. The kids could are blocked. That's why we tell you pediatricians tell that their moms, no, no, the descent, let them drink something. Because whenever you swallow, you force the eustacean tube open. So as they're drinking or eating, it forces it open. There are many things we can do to try to improve the eustacean tube function. Because if it does get clogged and it doesn't let the ear drain, the ear, the tissue inside the middle ear makes fluid, almost like a cleansing fluid, and then it has to drain out. If it doesn't drain out, it builds in, and if it doesn't circulate, it becomes infected. And what can cause blockage here? Often adenois in children, which are very big allergies, and any age can cause this to swell up. Um, you know, you have polyps and all sorts of allergies, and this blocks off, that's when you have fluid collecting. If it doesn't circulate, it becomes infected. Then we're talking about antibiotics. We're talking about if that fails and the congestions fail to open the eustacean tube, we put little tiny drains in the tubes in the ear in the eardrum to be able to let everything drain from the eardrum out. So if you have no ecorus this way, we create an ecorus the other way. It helps, but the tubes can be caused infections themselves and they can once in a no, once in a while cause a perforation after the tube comes out. And you can only you don't want to do too many tubes. The policy right now is that if you have three ear infections a year needing antibiotics, we tell the patients and the moms you have to put the tube in to train. Usually one set of tubes is enough for the kids to recover, and when they mature, it lets the ear the eustacean tube heal and they're fine. In others, after the tube comes out, the fluid rolls right back up. That's the case for kids ages five and over and adults at any age. If this is not the way to do it, you can actually treat the eustacean tube itself by dilating it. So you can go to the this is relatively new technology, only last few years. You can go through the nose, get to the opening of the eustacean tube, which is in the back of the nose, thread a balloon up to the maximum, inflate the balloon to 12 atmospheres for two minutes only, and then you pull the balloon out. And it dilates the balloon, it's very effective long term to try to allow better drainage. We can kids with big adenoids, we'll take out the adenoids first. There's so many ways we can treat them, but the main culprit for most year patients, it's the eustacean tube getting it clogged. That's where the problem starts. That's great news.
SPEAKER_00Uh and you said the balloon plastic for the eustacean tubes, five and over? It's five and over. It's amazing the proof for kids. It's because it's so common. I think as you just said, um uh it's probably one of the most common things uh gonna have uh mothers wanting to come in, the pediatrician's gonna send them in after they've had two or three or four, five bouts of uh middle ear infections, they're gonna see the ENT doctor, and the mothers are frustrated, and uh, and I can imagine uh you've got to manage that infection uh and and cutting the eardrum, putting a tube in there to try and equal and let the fluid drain out, equalizing the pressure uh is also a pretty frustrating thing.
SPEAKER_03I I should point out, I mean, officially I think the initial indications for 12 and over, then they said they can go up to seven, and I know that it's going to come up with indications to five, but I don't think it's yet officially done. But it's been the it's they're they're they're being done but off label for five. But uh they they are indicated for for the kids. It started out at 12 and then they lowered the age. In kids, you have to do them in the operating room, which makes it difficult because they cannot stand still. For adults, even like teenage and over, they're cooperative. You can do this in the office with just anesthetizing the nose and decongesting it, and then you get into the station tube to be able to dilate. So it's easy done in the office, very little risk to the patient. Um, you sometimes get a little bit of nosebleeds, but not horrible nosebleeds, but mild.
SPEAKER_00Yeah.
SPEAKER_03But if they're little, you have to put that's where the decision comes in with the parents. Is it bad enough that you want to take them to the operating room for another general anesthesia? Because it's much easier to convince somebody to have it done in the office and they feel like this is going to benefit you with little potential side effects while versus taking somebody to the operating room. That's a different level of stress on the kid and the parents. But it's it's amazing there, very, very effective.
SPEAKER_00Well, that's what we like to hear uh and all our um uh outcomes is effectiveness. Uh we're gonna take you one more uh try, it's gotta be a pretty diverse uh and diffuse uh problem, uh, but uh and uh it's called dizziness. Um the cochlea is the nerve component of hearing, uh, but the semicircular canals, which are right near there, the macula, uh they're uh they're also hooked in that uh nerve part of the ear and can or cannot be the cause of dizziness. And that must really be a problem when you have people come in uh because I would send you all my dizzy patients if I had any.
SPEAKER_01Yeah.
SPEAKER_03It's it's absolutely true. And that's one of the most common complaints of patients when they come to an ear specialist, the dizziness.
SPEAKER_01Right.
SPEAKER_03There are two kinds of really dizzy. You have to very the doctor has to figure out if this is lightheaded dizziness or if this is inner-ear dizziness, which is what we call peripheral coming from the ear. A lot of the dizziness out there has nothing to do with the ear. You have fluctuations in your blood pressure, anemia, your sugar level. Um, there are other things, your irregular heartbeats. So you have other causes of dizziness which have nothing to do with the ear, but those patients usually have more like light-headed disequilibrium. They postural, they're lying flat, they get out as elderly, they get out quickly out of bed, the blood pressure changes and they feel labile, hypotension, they get dizzy for a few seconds. But then my focus is to first make sure that it is not coming from outside, no, if it's ear-related or not ear related. Correct. In ear-related dizziness, most of the symptoms are vertiginous, they have spinning, they have a hallucination of motion, they feel that they're off. And they can be very severe with nausea, vomiting, they can be so debilitated, they'd be crawling on the floor. And they come in attacks. They can be a few minutes to hours, and then they recover, and then they next day have another attack. When it's more insidious and it's like soft, this equilibrium is more likely to be of a central or could be the brain degenerating, the heart, the blood pressure, etc. Once we differentiate within which is is it central or is it peripheral coming from the ear, then I focus on the peripheral. The neurologists, the cardiologists focus on the central medical problems. When it comes to the ear, there can be inflammation of the nerve, usually through a virus. There are crystals inside the inner ear that can get dislodged. The analogy I give patients is think of the crystals like the games the children play, where they have little pegs and circles and they have to put everything in the right spot. So the crystals embedded in the inner ear components, semicircular canals, the vestibule, and they can get dislodged. If they get dislodged, they start free-floating in the fluid in the ear, that's when you get severe vertigo. And young, healthy patients, they tend to go back by themselves after a day or a short period of time. In other patients, they don't, then we start doing balance maneuvers, different kinds of positioning maneuvers, or we actually have vestibular therapists, which are physical therapists, who understand the balance system very well, they can manipulate the head in such a way that slowly the crystals go back into their original position. And once you have had one episode, you have about 40% chance of having more in the future. So they also teach the patient what to do if this happens again. So they can do it on their own without having to run to a doctor or a vestibular therapist. Well, medication really doesn't hide the symptoms but does not help. So when we give patients things like dramamine or meclasine or benzodiazepines like Valium and Clonapine, they'll feel better, but it doesn't solve the underlying problem.
unknownRight.
SPEAKER_00Yes, yeah. Well, uh that's those are things that I hope uh uh AI and uh and uh all you know uh new computers and things and medicine will help figure some of this stuff out. Uh we uh appreciate you being here today. Uh it's the best uh someone everyone has to listen to this podcast because they just got the best uh uh evaluation and data about uh hearing and their ears. Uh it's it's it's you you just compacted it all into a half an hour uh project, and we're so thankful for you being here today.
SPEAKER_03Thank you for inviting me. If I could help somebody and educate, I'll be more than happy. Uh it's a win-win.
SPEAKER_01Yep, this is an episode that our audience needs to listen to. If you want to learn more about your health, your hearing, issues with your children with ears from one of the best doctors, then you have to tune in to this episode of We Got Your Number.
SPEAKER_00And if we want to get a hold of Dr. Cohan, how do we do that?
SPEAKER_03Oh, call my office in New York City 212-472-1300. I'm on the my email, you know, I'm on the web, uh Darius Cohan MD. I have a website and I'm on Instagram, Facebook, so you can always find me. I'm available, and so a lot of my colleagues as well. We we do this all the time, and we look forward to treating as many patients as we can to help. That's what we're here for.
SPEAKER_00Well, we thank you very much for today participating in this, and uh thank you, uh Ali, today for uh bringing in this topic.
SPEAKER_01So interesting. Thank you so much, guys. We got your number.