The Sound That Never Disappears

The Sound That Never Disappears-The Enigma of Perpetual Sound

Robert M. Blumm, PA-C Emeritus, DFAAPA

Clinical Consultant for CM&F

Sound is ephemeral by nature—a fleeting wave that travels through air, water, or solid objects before dissipating into silence. Yet, the notion of a sound that never disappears has captivated human imagination for centuries. This enigmatic concept finds its roots in ancient mythologies and modern scientific explorations, weaving a rich tapestry of cultural and intellectual intrigue.

Mythological Origins

Ancient cultures often spoke of divine or supernatural sounds that echoed eternally. The Greeks told tales of the Sirens, whose haunting melodies lured sailors to their death. Similarly, Hindu mythology speaks of the "Om" sound, the cosmic vibration underpinning the universe, resonating eternally.

Our cultural and lived experience promotes the power of sound. Vanishing from our high-tech world is the acknowledgment of the power, and necessity, of silence.

Personal Experience

I was a combat medic in Vietnam from 1966-1968 and endured mortar attacks on our base and our positions. When we were in a firefight, we used our weapons to the full extent: we used 50 and 60 caliber machine guns, M 79 grenade launchers, our support artillery which sometimes hit 100 yards from our position. And I cannot forget, courtesy of the Army helicopters, the blaring melody of Puff the Magic Dragon! The Air Force dropped 500-pound bombs and, of course, the sounds of our M-16 rifle fire to repel the Viet Cong along with pistol fire. Would you believe they never gave us any hearing protection because it would prevent us from knowing where the VC was? So, tens of thousands of other grunts and I left that theater of operations with hearing defects and, of course, tinnitus.

General Information

Tinnitus affects each patient differently, but the source is very similar in most patients. Can you imagine why a patient would request a consultation with you? They cannot get peace and are constantly buffeted by sound. Some techniques and treatments can assist your patient in tolerating the sounds. Still, they all pay a price, fatigue from loss of sleep, stress, depression, irritability, headaches. Further issues include problems at their place of employment, marital and family problems. The final insult of this disease is that there are some who take their lives, yes, they commit suicide. This is why we must aggressively attack this problem, by at least using our powers of referral as they need specialized care. No medication, surgery, or device can guarantee a cure. That, my colleagues, is a morbid prognosis.

Where is the Location of this Disease?

Tinnitus is a phantom sound that may occur in one or both ears. I have had patients ask me to put my stethoscope by their ear and listen to it. Unfortunately, it is not heard by others, which creates a sense of insecurity in the patient. It can sound like buzzing, such as standing near a bee hive, hissing, such as that which originates with a viper, sizzling, like Mom’s bacon on a Saturday morning, roaring, like a waterfall, chirping, like a nest full of birds, or the ringing that I live with 24/7. It is different for everyone, to an extent, but what remains constant is that it is there constantly. Yes, it affects quality of life and makes it difficult in some cases, to focus or concentrate. It affects 25-20% of the general population and is more prevalent in males, which gives us the excuse to be inpatient or make outbursts over minutia.

Will you be a Candidate for this Disease?

?I have spent 47 years of my life in an operating room, and many surgeons could not work without loud music. You may have heard it termed “closing music.” Can you imagine working with a neurosurgeon for eight hours on a craniotomy and hearing nothing but heavy metal music? This would cause the suicide of many great first assistants in surgery. Who else may be vulnerable? Firemen, police and other law enforcement officers, disaster alarms, landscapers as they blow away our leaves, the poor guy on the streets of Manhattan using a jackhammer. Lifestyle choices, such as smoking, drinking alcohol to excess, drinking eight cups of coffee rather than water, can all contribute to the onset of tinnitus.

How Can Your Patient Treat Tinnitus?

This, my friends, is the magic silver bullet. Diagnostic tests will probably start in the Otolaryngology Department. The following professional will most likely be a physical therapist or an audiologist. I have seen all three. You may need laboratory work to diagnose cardiac disease or vitamin deficiencies. It gets better. You may need to suggest an MRI or CT scan. I would leave this option open to the specialists, where these tests are ordered more frequently. Using a fan at night before sleeping, a white noise machine, or other suggested masking devices can offer therapeutic relief. They need a good P.E., not a ten-minute time slot. If you are a super clinician, you may need a half hour to gather coherent information that would make you sound like an expert on your referrals. Remember that there exist other differential diagnoses such as an acoustic neuroma, a malignancy in the brain, or the result of a URI that has not disappeared after ten days. Could this be Meniere’s Disease? Is it secondary to head trauma or better known as TBI? An eustachian tube dysfunction should be considered as well as MS, HPT, diabetes, thyroid disease, migraines, RA, Lupus, and osteosclerosis. Do not forget that medications can also be the culprit. Certain antibiotics can be causative, NSAID overuse is also common. Cancer drugs, antimalarial drugs, and antidepressants may also be a contributing factor. Do a review and perform a medication reconciliation. Don’t always be comfortable with that performed by your CMA. And now, what is our malpractice warning?

Malpractice Warning

Whenever we treat a patient, we need to consider that someday, someone will cause our patients to go into litigation, and this is the agony we receive for doing our job and caring for patients. This is why note-taking is so essential. Unless you have a great scribe, your omission of facts or focused diagnosis may come under the searchlight of a good malpractice lawyer. Yes, there are medical acts of commission and omission. Considering that I mentioned the word suicide in this article, just imagine the front-page story of a clinician who missed a supposedly unimportant consideration, and the outcome was the death of a patient and a multi-million-dollar lawsuit by the surviving family. This gets national attention and can be a mega million-dollar settlement. When considering these potentials, are we financially solvent to address this or are we content with our malpractice insurance? Are we being as diligent as if caring for an ICU patient? The best way to address this is to secure an excellent policy that is Occurrence in nature and is called a Personal Liability Insurance Policy. Think this over carefully as your entire future is at stake.

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