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Medications, Hearing Loss, and Tinnitus with Dr. Robert DiSogra

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What if common medications like aspirin or antibiotics could be silently affecting your hearing? Join us for a thought-provoking conversation with Dr. Robert DiSogra, a trailblazer in the intersection between pharmacology and audiology. Dr. DiSogra has dedicated over 25 years to understanding how more than 2,000 drugs can impact auditory and vestibular health. His insights, shaped through collaborations with figures like Dr. George Osborne and Dr. Jerry Northern, have transformed educational courses and continue to influence audiologists worldwide.

Our discussion highlights the hidden ototoxic risks lurking in everyday medications, such as ibuprofen and aminoglycosides. We unravel the critical importance of safe dosages and the consequences of ignoring the root causes of symptoms in favor of quick fixes. This episode encourages open dialogue with healthcare providers and stresses the need for careful diagnosis and treatment approaches. It’s a call for listeners to become proactive in conversations about their medication and health, emphasizing the need to understand the potential auditory side effects of popular drugs.

We also navigate the complex world of dietary supplements and their claim to manage conditions like tinnitus. Reflecting on the 50 years since the Dietary Supplements and Health Education Act, we shed light on the placebo effect, anecdotal evidence, and the gaps in scientific backing for products like ginkgo and lipoflavonoids. In a powerful closing, we honor the life-saving role of blood donation, sharing personal stories of gratitude and the difference a single donation can make. This episode is a compelling journey through the nuanced connections between drugs, supplements, and hearing health, offering invaluable insights for both professionals and patients.

Connect with the Hearing Matters Podcast Team

Email: hearingmatterspodcast@gmail.com

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Twitter: @hearing_mattas

Facebook: Hearing Matters Podcast

Dr. Douglas L. Beck:

If you have tinnitus, the very best thing to do is not start experimenting with molecules and chemicals. I think the very best thing to do is go see a licensed hearing care professional who practices with best practices according to AAA, asha or IHS and get a comprehensive audiometric evaluation, and I don't mean just press the button when you hear the beeps.

Blaise M. Delfino, M.S. - HIS:

You're tuned in to the Hearing Matters podcast, the show that discusses hearing technology, best practices and a global epidemic hearing loss. Before we kick this episode off, a special thank you to our partners. sycle, built for the entire hearing care practice. Redux, the best dryer hands down. CaptionC all by Sorenson - Life is calling. CareCredit here today to help more people hear tomorrow. Fader Plugs - the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters podcast. I'm founder and host, Blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Good afternoon. This is Dr Douglas Beck with the Hearing Matters Podcast, and today we're honored to have my dear friend, Dr Robert DiSogra with us. And Bob has dedicated the majority of his career to promoting an understanding of the pharmacologic effects on hearing imbalance across hearing care professionals across the world. While teaching at Rutgers over 25 years ago, he questioned why his patients had clinical complaints of hearing loss, yet their test data showed no evidence of peripheral hearing loss. He then went beyond his clinical practice to initiate an unprecedented review of evidence that identified the influences of pharmaceuticals and nutraceuticals on hearing loss and tinnitus In a series of publications for audiologists over the past couple of decades.

Dr. Douglas L. Beck:

Dr DeSogra distinguished his audiology career by identifying more than 400 adverse auditory and vestibular side effects related to more than 2,000 drugs. He later developed and taught the pharmacology ototoxicity distance learning course while pursuing his own doctorate at Salus University. Dr DeSogra has left a legacy for our field. He recently served on the Academy's pharmacology task force, which explored the requirements for prescriptive privileges for audiologists. That's a mouthful, I stumbled through it, but I love you, Bob, and it's so nice to see you.

Dr. Bob DiSogra:

How the heck are you, doug? Thanks very much and thank you for your kind words. I really appreciate that Labor of love, as they say, but there was a need and I just took it upon myself to just explore it. And well, the rest is history as far as how our profession responded to my work, and I'm grateful for that.

Dr. Douglas L. Beck:

I think it's been very positive. I'll tell you, I took pharmacology courses gosh, it must have been 20, 25 years ago and I found it to be fascinating. And I know that you started getting really involved with that when our mutual friend, jerry Northern, asked you to write. I think it was 2001, 2002, an edition of Audiology Today on pharmacology right.

Dr. Bob DiSogra:

I did that. The original publication was back in 93. Oh right, what had happened is that when the AUD programs were coming online, I was talking with the late Dr George Osborne who was heading up the program at PCO, pennsylvania College of Optometry, now part of Drexel University. What happened is that he had asked me to teach the pharmacology class and he said you know, you had that publication back in 93. He says why don't you update it? And I did. And that's when all the numbers got larger and larger and I submitted it to Audiology Today and the editor, dr Jerry Northern, looked at this and he called me up and said Bob, I can't do this, bob, I can't publish this. And I was ready to accept the defeat, you know, and the rejection and walk away, but he said no, he says this is we have to do a special issue, this is. He said this was basically too good to get lost in the pages.

Dr. Douglas L. Beck:

And yeah, I call out and let me just say some people don't know Dr George Osborne because he passed quite a few years ago, I want to say 18 or 20 years ago. But he was also a dentist, so he himself had a lot of specific knowledge on pharmacology that he used every day in his patient care for his dental patients and, of course, his audiology patients. So coming from him asking you to update that, that's quite a nice stepping stone.

Dr. Bob DiSogra:

Yeah, it was very flattering, very impressive that someone of his stature and background would say to me we'd like you to update, and so on. And then, going to Jerry Northern, who had been just a wonderful pioneer in our profession, he said listen, we're going to do a special issue Now. Aaa, every once in a while did a special issue and I think historically they've only done about eight or nine. I haven't seen a special issue and I think historically they only done about eight or nine. I haven't seen a special issue in such a long time. So to have a special issue at that time was like I'm at the top of the mountain here, you know and like, and it was just so flattering for me that he looked at that work and he published it and that was in 2001. But every audiologist that was a member of AAA around the world got a copy of that and the feedback that I got from that was very positive. People said, oh, I have it hanging on my wall in my vestibular office.

Dr. Bob DiSogra:

Great stuff from around the world. So what had happened is that you know, so I'm settling in with all that. I'm getting calls to do, talks to do, you know, well, I was going to say.

Dr. Douglas L. Beck:

I think that launched your speaking career.

Dr. Bob DiSogra:

Yeah, and it actually did. And then in 2003, just a couple of years later, I got it updated because there were so many more drugs coming out and we just became more aware of other side effects that audiologists would be concerned with.

Dr. Douglas L. Beck:

And when did the book come out? Because your book on pharmacologic OTC products. When did that come out?

Dr. Bob DiSogra:

That was in the late 2000s, 2008, 2009, somewhere around there. Well, what had happened is that when I was teaching the online class at Salus, one of the students was from New Zealand and she had a copy of the booklet, and I didn't know this, but she was the president of the New Zealand Audiological Society. Fast forward two years.

Blaise M. Delfino, M.S. - HIS:

Guess you're in New Zealand, right? I love that.

Dr. Bob DiSogra:

And it was just like wow, and I still thank George for that opportunity that got me and my two sons to head over there to New Zealand. Oh yeah, and this happens.

Dr. Douglas L. Beck:

It's such a great evolution academic and clinical and social issues. Because in 1993, I was working with Jerry on an issue of Seminars in Hearing and what happened? We called it Audiology, the Scope of Practice. And Jerry and I think Jim Jerger at the time said, eh, it's not a great name because it looks like that's going to define our scope of practice. And Jerry, I think, came back with the name Audiology Beyond the Sound Booth booth Cause you know we were talking about a neurophysiology, intraocular cranial nerve monitoring, electrococleography, um somatosensory, no pharmacology.

Dr. Bob DiSogra:

I know that.

Dr. Douglas L. Beck:

No pharmacology, and we talked about legal issues as well. And so Jerry came back and he was so insightful and he said here's what we should do. We should call it beyond the sound booth, because it's not. It wasn't about audiometric clinical testing. You know airbone and speech, but it was everything beyond that, or many things beyond that, and that kind of launched my speaking career as well. And then, you know, I think we're both very grateful to Jerry for his guidance, his insight and his intellect, and he was able to recognize that these are things that audiologists need to know, because it's going to impact where we're going as a profession in the future. And so this story that you're relaying I think is very important, and I think it's very important for younger people to understand that as you become a professional, you're going to realize things that you had no idea were even in your universe, and sometimes, when you grab onto those like pharmacology for you, neurophysiology for me that actually sets the rest of your career and you never predicted it or planned on it.

Dr. Bob DiSogra:

No, not at all. Not at all. I just saw myself as private practice audiologist till the day of retirement and have a nice life and walk away, and then all of a sudden, something sparks an interest and you run with it and before you know it you still have your private practice, but you have another hat that you're wearing now in your profession, or 10 hats. And yeah, and a recognition that you never even dreamed of.

Dr. Douglas L. Beck:

So in pharmacology and audiology, let's talk about three or four areas. I want to talk about hearing, I want to talk about tinnitus, I want to talk about balance or dizziness. So in hearing, what are the most dangerous drugs? Which drugs over-the-counter or prescribed are most likely to have a negative impact on pure tone?

Dr. Bob DiSogra:

thresholds. Well, we've known about certain medications that can cause hearing loss. There's pages of documentation going back since our profession started and probably one of the most common ones was aspirin. This was before we had a lot of these other more potent medications for aspirin, but back then 20 to 30 aspirins a day for an arthritis patient was not uncommon and of course, that type of an overload created a lot of problems with the inner ear.

Dr. Douglas L. Beck:

Now stop there for a moment, if I may. If you're taking aspirin right now, whether it's baby aspirin for vascular things or whether it's multiple aspirins a day for arthritis, at what level do you become concerned If you're taking four aspirin a day, six, 12, 18?

Dr. Bob DiSogra:

Well, the smaller dosage, the 81 milligrams, that's safe. Okay. Then you get up into the 240, 480 milligrams. Okay, now you're starting to get into some areas where there's going to be maybe some changes in vascularity in the cochlear and so on. Once you start getting past 500 milligrams a day per dosage and if you're taking six or seven doses, 3,500 milligrams, like you're just you're overloading yourself. You're just like going out in the sun in the Caribbean with no sunblock on. Okay, you're gonnaing yourself. You're just like going out in the sun in the Caribbean with no sunblock on.

Dr. Douglas L. Beck:

Okay, You're going to ask for problems okay. And this is why I want to be real specific here. But the bottom line is, when you're looking at doses three, four times a day, right, so you're looking at TID, qid, something like that and you're talking about 500 to 1,000 milligrams of aspirin that's a really good time to talk to your doctor about ototoxic effects, but if you're taking two or three aspirins a day, probably not an issue.

Dr. Bob DiSogra:

Not an issue, no. And now you have other drugs. You know your Relieves, your Motrins and so on.

Dr. Douglas L. Beck:

So let's talk about that because, these are essentially ibuprofen and acetaminophen. Yeah, and at what point do we worry about ototoxic effects from either of those?

Dr. Bob DiSogra:

Well, I'm currently being treated for an arthritic condition in my neck, and my neck specialist orthopedic doc tapped me at 3,000 milligrams of acetaminophen a day.

Dr. Douglas L. Beck:

And that acetaminophen is Tylenol. Yeah, and at 3,000, you feel comfortable. You're not worried about ototoxic effects.

Dr. Bob DiSogra:

I haven't had any issues with that, and that's only on a PRN basis. So really it's there when I need it, but it's not that I'm on a regular dosage, and if I was, I would start to talk to the doctor about well, what's the long-term effect on this?

Dr. Douglas L. Beck:

And what about ibuprofen? Because ibuprofen is an NSAID or non-steroidal anti-inflammatory drug, and I think a lot of people take Advil Motrin. These are all the same drugs. They're all ibuprofen and there are generics. At what point do you worry about those?

Dr. Bob DiSogra:

What happens? You have capillary constriction, okay, in the inner ear and what happens is that, you know, when there's capillary constriction, so there's oxygen in the blood going up to the nerve cells in there and then there's going to be some problems. Okay, it may start out as tinnitus and if it continues because of discomfort you're experiencing, which is why you're taking that medication, it could turn into hearing loss. So you're dealing with the non-steroidal and the inflammatories, so this is what they can do, but, again, always look at the cause of why you're taking this. You know when patients would come into my office, I would tell them your hearing loss is a complaint to you, but to me it's a symptom and I need to find out those pieces of the puzzle. And so just tell me everything and let me sort it out for you. And I think it's the same thing.

Dr. Bob DiSogra:

I think a lot more patients are having better dialogue with their doctors about their medications, with so many direct-to-consumer ads on the television about prescription meds and discuss this with your doctor, and that's great. Ok, it opens this with your doctor and that's great, okay, it opens up a dialogue. And again, you can self medicate, which is another issue that you have with over the counter medications and that's a whole different issue. But again, you know, for the people that are on this podcast, clearly you know, just remember that pain is a symptom. Hearing loss is a symptom, you know, and when you treat the symptom and it's not going away, there's the underlying cause. Has to be further explored.

Dr. Douglas L. Beck:

I'm glad you remind us of that, because in all of healthcare I would like to think that what we do is diagnosis first, treatment second. But we don't necessarily. We have a symptom and we treat the symptom. We never really got to the diagnosis, and that symptom can be hearing loss, it can be tinnitus, it could be dizziness, it could be vertigo, and then, of course, we have all sorts of antibiotics and antivirals. Now Is there a particular red flag that you see in antibiotic? Which ones are the most common that we worry about?

Dr. Bob DiSogra:

ototoxic effects. The aminoglycosides okay, those antibiotics, they've been around for the longest time, yeah, and, as a matter of fact, I met the chief researcher who developed streptomycin okay, which was developed here at Rutgers in here in New Jersey many years ago. And what happens with these antibiotics is anywhere up to like 20 to 60% risk, depending on the individual's health and any other comorbidities that might be a player over here. So there is a risk of hearing loss. And again, this data is accessible to consumers and, of course, the physicians have access to it also, and there's nothing wrong with asking questions like this. But it's better to ask the questions and get some guidance rather than to self-medicate and just go online and find out for yourself, because once you get past the three-syllable words, some people just get confused.

Dr. Douglas L. Beck:

I like that. If it's four syllables or more, you should be concerned. Three and I'm free. That's it. So aminoglycosides are certainly an issue in long-term care at high doses and, again, it's a good conversation to have with your doctor. And let me just be clear that the Hearing Matters podcast is not telling people what to take or what not to take. We're saying when it should raise a red flag and when you should have a conversation with your doctor. It's okay to ask questions. There are many patients who are oncology patients that are on chemotherapy for different cancers. Some of them are carbon-based drugs and things like that. What are your concerns there?

Dr. Bob DiSogra:

Well, before any drug gets approved by the FDA it has to go through the clinical trials, and when hearing loss was showing up with a lot of these carbon-based drugs, you know the red flag goes out in the information sheet to the physicians and so on.

Dr. Bob DiSogra:

And there's a counseling issue that has to be done here Because, in the words of my dear friend, dr Kathy Campbell, who was basically my mentor in pharmacology out in the University of Southern Illinois Kathy even said it she says the benefits outweigh the risks, and so if a person is going to have a cancer medication that's going to improve the quality of your life but there's going to be, you know, maybe some hearing loss involved with that, the counseling issue comes in. And then you know, then the hearing aid trials and so on and the family gets. Then you know, then the hearing aid trials and so on and the family gets involved. You know it's like even with the hair loss with certain chemo meds, and so you know there's a lot of counseling. So it's not just a pop a pill, feel better, walk out.

Dr. Douglas L. Beck:

No, and it's a good point. It's a good call out because there's always a trade-off in these situations and the value, you know, what do you get versus what did you give. Right, that's between the patient and the physician. And of course, there are times when carboplatinum drugs are going to cause hearing loss, hair loss as well and all these other negative side effects, when you feel absolutely awful. But by the same token, it's a personal decision because if you go through that, there's a reasonable opportunity for you to beat the cancer in many respects, and it's not just oh, this drug is going to cause hearing loss, so we're not going to open that up.

Dr. Bob DiSogra:

You know the hearing loss is it goes to the bottom of the list. You know if this drug is going to get you to improve the quality of your life for the next five to 10 years, I'll deal with the hearing loss. Right, right.

Dr. Douglas L. Beck:

And I'm so glad you said that because I think a lot of young clinicians get caught up in you know. Oh, we've got to talk to the doctor and change the drugs. You know, it's not a conversation that's going to go well, I think. No, it's not at all. You know, it's certainly something to talk about if you choose. Yeah, I probably wouldn't engage with most oncologists on their selection of pharmaceuticals to treat cancer. No, I'm not qualified for that.

Dr. Bob DiSogra:

We come in much later on. I had a patient who came in, a cardiac patient came in and was on a new med and was getting tinnitus in the morning only. And you know, do the case history and you find out what the timeline is, and we pieced it all together and it turns out that the medication he was taking had tinnitus as a side effect. And the timeline just fit right into place. So I contacted the primary and I told him what I found, you know, and so on, because he referred for the tinnitus and the guy was in his like late 70s, early 80s. He had some mild, high frequency age related loss, not a big deal, not a hearing aid candidate, but the tinnitus was why he was sitting in front of me. So I spoke to the doc and I said what do you think of the possibility of maybe changing the medication or changing the dosage? So he came up and he said Bobby, listen, I'll take care of his heart, you take care of the tinnitus, okay? And I thought, okay, you know he put me down. But I asked and all you have to do is ask.

Dr. Bob DiSogra:

Two weeks later his father comes in as a patient. It's a great story, you know, but there are times I've had some dementia patients that came in and they had hearing loss and we fitted them with hearing aids and the one lady told me that she's living with a new man. I mean because he's like he's redialed back in again. I called the primary and I just said, can we lower the dosage? But he reduced the dosage like 25 milligrams down to five as a maintenance bed and and the lady said, like you know, like we're going on a cruise, he's like a whole different. You know, that's the kind of stuff that gets you real interested in this?

Dr. Bob DiSogra:

That keeps the fires burning.

Dr. Douglas L. Beck:

Tell me about OTC products and tinnitus, because you wrote a whole book on this and you know we have lots of people who will take things like lipoflavonoids, which, by the way, that's pretty much just the peel from a lemon. They will take things like ginkgo biloba and I think taking ginkgo might have value, but I think it's probably more value eating the box.

Dr. Douglas L. Beck:

Don't eat the box, I'm not recommending that but there's no proof and I know that there are some holistic centers that will say, oh, we put all our patients on this. But I have to be honest. I mean, after 40 years of studying tinnitus, I think those benefits are nice. I don't doubt that they could have happened, but I think to the largest degree, they're placebo and a lot of people want to believe it's doing better, so they're comforted by that. They find comfort there, and the New England Journal of Medicine I think it was 2016, did a whole section on placebo and they were saying something along the lines of one-third of all of our medicines are essentially placebo, that is, they're not necessarily known to cure that problem, but they do make the patient feel better. Feel better, yeah, absolutely. So tell me your thoughts on that.

Dr. Bob DiSogra:

Okay, we got to rewind about 50 years, okay, and this is the 50th anniversary of the Dietary Supplements and Health Education Act, or better to say 1974. And basically what the government did in the early 70s is that they really tackled this whole thing about dietary supplements. But the path that they took really had to do with what the manufacturers were saying on the label and what was actually in the pill or the gel or the liquid that was in the package. Okay, and the majority of the law basically specified compliance with making sure that if you said that you had 25 milligrams of Siberian ginseng root in your product, okay, and they did an analysis on that capsule, there better be 25 milligrams of Siberian ginseng root. You know in that, and that's what they were really going for. But they did not have to really demonstrate efficacy and safety. So you basically could put anything you want in there.

Dr. Bob DiSogra:

And if anybody who's listening to this or not, if anybody I know a lot of people that are listening or watching this just take any of your multiple vitamins that you might have at home or any of the supplements you may have at home. Just turn the label around and take a look at the ingredients and look at the column, you see, like the minimal daily requirement, okay, the MDR, or the required daily allowance as we used to call it back in the day. Okay, there's one column there that says what the Food and Drug Administration says as a minimal daily requirement of vitamin C and B12, whatever. Then there's another column, okay, and then you may see an asterisk, okay, and the asterisk, when you read the small print on the bottom, says you know, no minimum requirement has been evaluated. And that's most of them.

Dr. Douglas L. Beck:

Yeah, yeah, and there's a lot of asterisks on a lot of these labels but that's legal, though, that's legal Doug, because they're disclosing that they don't know, we don't know.

Dr. Bob DiSogra:

But why is it in?

Dr. Douglas L. Beck:

there. Well, if you take and I'll call them out like Centrum or One A Day, which are multivitamins, they're fine. I have nothing against either of them. But it's really an interesting label to read because you see that vitamin C, which people take 1,000, 5,000, 10,000 units of, you know the minimum is 60 milligrams. And you know, and Linus Pauling, all those years ago, 70 years ago, tried to prove that if you took enough vitamin C it would prevent colds or whatever it was, and that never panned out, and he was one of the smartest guys in the history. What did we know?

Dr. Bob DiSogra:

at that time.

Dr. Douglas L. Beck:

So the thing about supplements, two things. Number one I remember when I was in college back in the late seventies, working my bachelor's, I took a class on drugs and drug abuse and we actually went through minerals and supplements in that class and I remember hearing at that time water-soluble drugs versus fat-soluble drugs and minimal daily requirements, as you're saying, or recommended daily minimums and things like that. And I learned back then and maybe I'm wrong, but your body can only use 60 milligrams of vitamin C per day, right, that's it.

Dr. Bob DiSogra:

Anything else over the minimum daily requirement and the body doesn't need the body will pass out.

Dr. Douglas L. Beck:

Well, if it's water soluble, otherwise you're going to be storing it, right, yeah? Now the other thing about supplements is when you think about tinnitus in particular. I remember there was this ASHA publication let's say 2014, where they absolutely tested dozens and dozens of supplements and at the end they said we do not recommend supplements for tinnitus. There's no proven evidence that in controlled or random controlled trials, that there's any benefit to the patients. And so I'd like to ask you, if you have a patient with tinnitus and they tell you they're on ginkgo, or they tell you you're on lipoflavonoids, what I do, you know, is I say, well, if that's working well for you, that's fantastic. But I don't ever say, gee, there's great evidence, or gee, you shouldn't do that. I mean, if somebody's happy, right, so clinically, and I'm going to drink some coffee while we're talking here Clinically what do you do in that situation?

Dr. Bob DiSogra:

All right, I had that problem with the patient also an engineer patient who came in, and you know what I would tell the patients other than this person here, the first part of your comment. You know, when a patient comes in and they tell you that they've been taking Ginkgo or whatever they've been taking for their tinnitus, and you know, and it's really wonderful, on the outside I say well, I'm glad you found relief. On the outside I say well, I'm glad you found relief. But on the inside I'm saying I have no clue why you found relief. Okay, but probably the best story that I had and this was an eye-opener. This was an eye-opener for me and I tell the story and especially to the newer audiologists coming on up.

Dr. Bob DiSogra:

This gentleman came in, had macular degeneration and so I was asking him about his medications and over-the-counter stuff. And he was taking Bilberry, which is a form of blueberry, and he had heard from his sister's neighbor in Idaho, whose cousin's brother in Louisiana you know the trail was all over the country and that it helped. So he started taking it and he said, like you know, for the past three years his macular degeneration diagnosis has been stable. So I pulled out my PDR for herbal medicines. And I looked up Bilberry and nothing. There's not a thing in the literature that said anything about Bilberry macular degeneration. So of course you know I had just had the publication, so I'm feeling like I'm on top of the wave over here right now.

Dr. Bob DiSogra:

And I told him. I said, like you know, there's really no public. This guy was an engineer so I can talk at that level to this guy and I said, like there's really no published information about the effects. You know, the application of Bilberry in macular degeneration management. So he says so you're telling me, bob, is that if I stop this macular degeneration because you're telling me that there's no problems, that it's not indicated for that, and let's say I have a change in my macular degeneration after I stop he goes, will you take responsibility for that? And I said you enjoy that, bill Barry, as far as you want to. I mean he backed me into.

Dr. Bob DiSogra:

I wasn't prepared for that.

Dr. Douglas L. Beck:

Well, I'm so glad you bring this up, because this is a real clinical issue.

Dr. Douglas L. Beck:

Some people will say, oh, the doctors don't want you to know. The truth of the matter is, if there were a magic pill that would stop tinnitus, every physician, every audiologist, every hearing instrument specialist would know all about that. We would tell you what that is because we would like to help you. Nobody is withholding that information. What we're withholding is that people go ahead and just try different chemicals and different molecules and see what happens, because some of the effects are not very good. One of the things you shared with me was a document where you summarized the 2016 worldwide survey of 53 countries involving 1,700 respondents, and this is research on dietary supplements for tinnitus and, by the way, this is very much the same sort of thing that ASHA found when they looked at it. About 26% of all of the people involved 1,700 people took ginkgo. About 12% took lipoflavonoids, About 8% vitamin B12, 8% zinc, 7% magnesium, 5% melatonin so those are pretty common supplements. These are things that people will take when they have tinnitus, but the important thing are the results. 70% of the respondents said these drugs were not effective at all. One out of five. 19% said oh yes, it improved, but that means four out of five didn't get improvement. 10% their tinnitus got worse from the supplements and 5% had adverse reactions to these supplements.

Dr. Douglas L. Beck:

So my point is, if you have tinnitus, the very best thing to do is not start experimenting with molecules and chemicals. I think the very best thing to do is go see a licensed hearing care professional who practices with best practices according to AAA, asha or IHS. Get a comprehensive audiometric evaluation, and I don't mean just press the button when you hear the beeps. I want to see otoacoustic emissions. I want to see extended high-frequency hearing loss. I want to see, you know, ipsilateral contralateral reflexes. I want a good overall picture of your auditory system, not just press the button when you hear the beep. When I have all of that and you have tinnitus, the chance of me effectively managing that with you is about 90%. Now some people will say I don't want to manage it, I want to cure it. But most diseases, most neuro processing problems, we can't cure, we can manage. You know you think about diabetes. We can manage that very effectively. When you think about multiple cancers, we can't cure them, but we can manage them. When you talk about headaches, we can't cure them, but we can manage them. When you talk about eyesight we can't cure presbyopia, but we can manage it with glasses and contacts and other things. So good management is worth a lot, and I think that's the bottom line.

Dr. Douglas L. Beck:

On pharmaceuticals and tinnitus is there's really not one, although there are some things that contribute to tinnitus which we need to be aware of. So what we've talked about is tinnitus, and is there a supplement or a chemical or molecular cure that we might approach? I think what we've discussed and what I hope is clear to most people, is that supplements and over-the-counter cures for tinnitus really don't exist. Some people do get better. We showed one out of five do get better, but four out of five don't, and that one out of five that got better. Nobody has been able to exclude placebo. In other words, it's very likely in my mind that one out of five people with tinnitus would do better with any treatment just because we're managing them well, we're empathetic, we're taking their thoughts and concerns in and we're trying to help them. So one out of five, I think, placebo we can't rule that out. But here's the thing. We can measure tinnitus, and I want to talk about your experience with the tinnitus handicap inventory.

Dr. Bob DiSogra:

Well, what we've done with our tinnitus patients when they've come in, we'll do the THI as a baseline and then we will do whatever workup has to get done, any counseling that has to get done, amplification if necessary, and then we'll just pull out the THI three months later and then we just start going back into the same issues that they still might have. But the numbers always get better. They always get better and for some patients, you know, they're just pleased, no-transcript Okay. And sometimes that's a surprise when you hear that.

Dr. Bob DiSogra:

I mean, one of the times that I diagnosed a little child with hearing loss, you know, child was like two years old and you hold your breath because like it's a major impact statement that's going to come out of your mouth, that's going to change this whole family's dynamic. In some case I had so, you know. So you break the diagnosis professionally and you know, caringly, and so on, and the parents just sat back and they just said like, oh, I'm so glad that's it, because we thought it was something worse. And it's like, wow, I didn't expect that, you know, because they didn't teach me that in school, right, yeah, that's a good point.

Dr. Bob DiSogra:

It's a wonderful tool that's quick to administer, yeah, and the patients actually see their initial responses from three months earlier.

Dr. Douglas L. Beck:

And they just said, yeah, I know what's there, but I don't pay that much attention to it anymore. So, bob, here we are, closing in on the end of 2024. And I'm wondering does the FDA have any products that they say are approved for tinnitus management?

Dr. Bob DiSogra:

For tinnitus management. No, there are no FDA approved nutraceuticals or pharmaceuticals for tinnitus. There's a tremendous amount of research that's going on. There's a great website that the National Institutes of Health have that's accessible to consumers. It's called Clinical Trials one word, clinicaltrialsgov and then you navigate your way through this and you can just type in any type of diagnosis and it'll tell you exactly where the research is. You can zero it down to males, females, children, all ages, and it takes a while to play around with it, but once you get the hang of it, my goodness, you can find out so much information. But right now, as of the end of 2024, there are no FDA approved over-the-counter products for tinnitus or hearing loss. There's a lot of clinical research on hearing loss at pharmaceuticals, but still many in clinical trials none FDA approved right now. So if anybody wants to find out what's going on, not only with TIDIS but any pathology, clinicaltrialsgov.

Dr. Douglas L. Beck:

That's great. I appreciate that. So I think a lot of people watching this would be surprised to find out that about three or four years ago you were diagnosed with leukemia. That's correct, and I wonder if you could spend a few minutes telling us about that.

Dr. Bob DiSogra:

Yes, this was something that came out of the blue. I had no exposure to any chemicals or anything in my lifetime like that, and just had a black and blue mark on my forearm that I thought I got from just banging it because I was moving it. You know, a television holding it up, flat screen, and this black and blue mark had like many undefined margins and it was like a color I had never seen before and it was large, it almost covered my entire forearm. And then I started having experiences with and after two weeks it didn't go away and experiencing with fatigue, shortness of breath I couldn't go 10 feet without sitting down to catch my breath. And so back to the primary, all the diagnostic tests they thought it was COVID, chest x-rays, the whole package. Then they, you know.

Dr. Bob DiSogra:

So we went through like two weeks of extensive testing and it was Labor Day weekend and I called the primary up and said, like this is not getting better, you know, and I'm huffing and puffing, you know, just a tremendous amount of fatigue. And she said get to the ER. And got to the ER, my local hospital and they did further blood tests and so on and before I knew it they wheeled me up to an oncology floor and I was like what the heck is this? You know, if I get a little emotional I apologize. And my grandson was just born, like two weeks earlier, which I hadn't who, I haven't seen it. And I'm thinking like what the heck is going on here, because from the neck down, I mean, I didn't feel sick, you know, I mean you couldn't see anything, it just said you know all these blood chemistries and behaviors and one thing led to another and it was acute myeloid leukemia. And they started me on a brand new drug that was only FDA approved, like eight months earlier. It's called venetoclax and no auditory side effects. I didn't really care at that point because, you know, I just wanted to get better and I was in the hospital for two weeks and I was getting injections, I was getting orals.

Dr. Bob DiSogra:

So what happened? So I'm in the hospital for two weeks and as part of that, with all these new medications I'd never heard of before, they wanted to do a bone scan, a bone marrow biopsy, because they thought they were going to have to just change my entire immune system, which means four weeks in the hospital I still would have. You know, there was all these different horror images that were coming through my head. And all of a sudden, you know I'm discharged, I'm taking these medications, I'm getting all these MRIs and so on and I'm getting tapped, you know, and so on. And all of a sudden the numbers start coming up and up and they sent me up to the Rutgers Cancer Institute here in New Jersey, which is part of NCI. At the time I was like 71 years old and they said, like we don't have a lot of data on people your age. And I said, well, that doesn't help me right now.

Dr. Bob DiSogra:

Thank you so very much, you know. But I'm just taking a high road. You know, I'm kind of a spiritual person and my church was, you know, working with me as best that they could. And by January, 90 days later, I had this, what they call the MRD test, you know, to see if there's any detection of the cancer cells at all 0.0.

Dr. Douglas L. Beck:

And it's like whoa you know I have to break in here. So, you had this amazing recovery. But I think what people don't know is, while this is going on, you're calling me and you're probably calling eight or 10 other people and your main concern was not leukemia, your main concern was a triple A presentation we're putting together and you're going through all these details and I keep saying, bob, bob, take care of your health, bob, we'll talk when you're cured.

Dr. Bob DiSogra:

God bless you. God bless you, Doug. It meant a lot, but you know.

Dr. Douglas L. Beck:

But I mean, you know, and now I look at it in retrospect and I realize you were trying to just focus your brain on something else. I had to.

Dr. Bob DiSogra:

One of the more interesting experiences because it was. You know, we talked about medications and drug side effects and now I'm on the receiving end. You know so I'm. You know I'm hearing things that I used to talk about, but it's me. And one of the things that they did as far as the management, is that they decided to do some blood transfusions and over the course of two months I had seven blood transfusions. Funny story it was Halloween when I was getting one of my transfusions and my niece sent me some fangs, so we took a picture of me all hooked up with the blood and fangs. Oh, perfect, the nurses lost their minds. It was good.

Dr. Bob DiSogra:

But what happened is that I had seven blood transfusions and you know we talk about donating blood, giving blood. You know, give a pint, save a life. Well, as I told you earlier, I had seven strangers come into my life. These are people I never met. They had the same blood type as me. They donated blood. I got seven pints of this blood and in part, that was part of the success of the recovery that I had.

Dr. Bob DiSogra:

So when I do my lectures, I usually end the lectures by saying if you can think about donating a pint of blood. It only takes an hour to donate, but it takes three hours to get it. You know and again it's. I don't know who these people are these were seven angels that came into my life and you know when I just thank God every day that you know that they did that and I just encourage everybody that I that, when the conversation comes up, if you're healthy enough and well enough to do it, donate a pint of blood, donate to Plaza, become a donor and your local Red Cross chapter is going to help you out and in part, it saved my life. So I put that out there.

Dr. Douglas L. Beck:

Well, more than in part, it saved your life. I mean, you had the impact and you had the good fortune to be at the right place at the right time. You had the right doctors, the right medical center and you know. You've come out on the other side and you're still even more of a glorious human being. It is an honor to know you. I am so proud of you. I always enjoyed when you and I would lecture at the same facilities and that happened at least, I want to say, 20 or 30 times, right.

Dr. Bob DiSogra:

And we were in Georgia. I brought my whole class into your class, if you remember. I can't thank you enough for this opportunity, and I hope that the audience walks away with at least one thing that they can use professionally. Then we've done our job Okay. Doug, thank you so very much. You're a kind man and I love you too. Thank you very much. Thank you so much.

People on this episode

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Blaise M. Delfino, M.S. - HIS

Host
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Dr. Douglas Beck

Co-host
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Dr. Robert DiSogra

Guest