Month: December 2021

That recurring sound that you hear but nobody else does? It’s not all in your head. Well, not exactly.

You may be one of the estimated 50 million-plus people who suffer from tinnitus. The mysterious condition causes a sound in the head with no external source. For many it’s a high-pitched ringing, while for others it’s whistling, whooshing, buzzing, chirping, hissing, humming, roaring, or even shrieking.

The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating. One approach to managing this condition is different forms of sound therapy intended to help people tune out the internal soundtrack of tinnitus.

What causes tinnitus?

There are many possible causes of tinnitus. Long-term exposure to loud noises is often blamed. But other sources include middle ear problems like an infection, a tumor or cyst pinching nerves in the ear, or something as simple as earwax buildup. Tinnitus also can be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.

Even old-fashioned aging can lead to tinnitus, which is common in people older than age 55. As people get older, the auditory nerve connecting the ear to the brain starts to fray, diminishing normal sounds.

“Neurons (nerve cells) in areas of the brain that process sound make up for this loss of input by increasing their sensitivity,” says Daniel Polley, director of the Lauer Tinnitus Research Center at Harvard-affiliated Massachusetts Eye and Ear. “The sensitivity knobs are turned up so high that neurons begin to respond to the activity of other nearby neurons. This creates the perception of a sound that does not exist in the physical environment. It’s a classic example of a feedback loop, similar to the squeal of a microphone when it is too close to a speaker.”

At times, everyone experiences the perception of a phantom sound. If it only lasts for a few seconds or minutes, it’s nothing to worry about. However, if it pulsates in sync with your heart rate, it’s definitely something to get checked out by a physician, says Polley. If it’s a relatively continuous sound, you should see an audiologist or otolaryngologist (ears, nose, throat specialist).

Can sound therapy help tune out tinnitus?

There is no cure for tinnitus, but it can become less noticeable over time. Still, there are ways to ease symptoms and help tune out the noise and minimize its impact. Treatments are a trial-and-error approach, as they work for some people but not others.

One often-suggested strategy is sound therapy. It uses external noise to alter your perception of or reaction to tinnitus. Research suggests sound therapy can effectively suppress tinnitus in some people. Two common types of sound therapy are masking and habituation.

• Masking. This exposes a person to background noise, like white noise, nature sounds, or ambient sounds, to mask tinnitus noise or distract attention away from it. Listening to sound machines or music through headphones or other devices can offer temporary breaks from the perception of tinnitus. Household items like electric fans, radios, and TVs also can help. Many people with tinnitus also have some degree of hearing loss. Hearing aids can be used to mask tinnitus by turning up the volume on outside noises. This works especially well when hearing loss and tinnitus occur within the same frequency range, according to the American Tinnitus Association.
• Habituation. Also known as tinnitus retraining therapy, this process trains your brain to become more accustomed to tinnitus. Here, you listen to noise similar to your tinnitus sound for long periods. Eventually your brain ignores the tone, along with the tinnitus sound. It’s similar to how you eventually don’t think about how glasses feel on your nose. The therapy is done with guidance from a specialist and the time frame varies per person, usually anywhere from 12 to 24 months.

Additional approaches may help with tinnitus

Depending on your diagnosis, your doctor also may recommend addressing issues that could contribute to your tinnitus.

• Musculoskeletal factors. Jaw clenching, tooth grinding, prior injury, or muscle tension in the neck can sometimes make tinnitus more noticeable. If tight muscles are part of the problem, massage therapy may help relieve it.
• Underlying health conditions. You may be able to reduce the impact of tinnitus by treating conditions like depression, anxiety, and insomnia.
• Negative thinking. Adopting cognitive behavioral therapy and hypnosis to redirect negative thoughts and emotions linked to tinnitus may also help ease symptoms.
• Medication. Tinnitus can be a side effect of many medications, especially when taken at higher doses, like aspirin and other nonsteroidal anti-inflammatory drugs and certain antidepressants. The problem often goes away when the drug is reduced or discontinued.

"No!"

It might have been endearing as your child’s first word, but dread often kicks in when that word starts to follow parental requests. Experiencing resistance to small or big asks? Stuck in arguments that seem to go in circles and leave you exasperated with unmet requests? The good news is that this pattern can be disrupted. First, you’ll need to identify reasons behind the opposition. Then you can apply relevant strategies to see more helpful behaviors instead.

Below are some examples of opposition drivers and tips to address them.

Difficulty with transitions

If you find that your child resists a request right after engaging in an activity, it might be that your child first needs time to transition. This can be a common experience when parents make requests while children are playing video games or another stimulating activity. One way to manage this is to give your child a five- or 10-minute heads-up (whichever they might need) that you will be asking for the game to stop. This gives your child time to find a place to pause if playing a video game and to transition.

Some families find it helpful to talk with their children before playtime begins to learn what game or activities will be taking place, and how much advance notice might be helpful before the activity would need to stop. This invites collaboration and shows that you respect that not all moments are ideal for stopping a game.

Independent streak

Children almost never are in control, and resistance can show up when that wears on them. Try to fold in elements of choice and control throughout the day for children (that are within a framework you determine) to create more of a balance with your requests. Perhaps you let a young child know that they will need to wear long sleeves and pants because of the weather, but they can pick which top and pair of pants to wear that day. Another idea is to invite your child to pick a side dish for a future dinner from a premade list of a few options.

It also helps to create opportunities for your child to practice being independent. This fosters mastery and offers experiences of feeling in control. This could look like your child preparing any parts of meals that are age-appropriate (for example, a three-year-old could pour cereal into a bowl; a five-year-old could measure ingredients for baking). The kitchen counter may be extra sticky as your child learns new skills. With time, your child will be more adept, and your counters will be cleaner.

Hunger and tiredness

We need both food and sleep to recharge our batteries. When we run low on either or both, it’s extra difficult to be our best selves. If you find that your child is crankier than usual, reflect on when your child last ate and how your child slept the night before (or napped if your child is of napping age). If it’s been a while since your child has eaten and/or your child did not sleep as much as usual, your child may need to recharge before being more receptive to requests. Have your child grab a healthy snack or meal if needed. If sleep is the issue, validate to yourself that this is frustrating that there is no quick fix. Acknowledge privately they are not their usual self at this moment and may be more receptive tomorrow.

Resistance also may crop up when children are coming down with a viral illness, so keep an eye out for any symptoms that may emerge.

Mental health challenges

Everyone has off days, but a persistent pattern of resistance to requests and distress following them may suggest that a child is experiencing mental health difficulties. For example, if a child appears oppositional every morning before school, it could be that they experience anxiety about going to school and are trying to avoid the distress they experience when there. In this case, it is important to ignore the "no" bait and focus on the emotion behind the refusal. Validate or acknowledge how your child is feeling to open the door to learn more. For example, you could say, "You seem really worried about going to school. What about school has been so tough lately?"

Use a similar approach for symptoms of depression, such as withdrawing from and refusing to engage in activities: validate your child’s feelings and invite your child to share more to help you understand their experiences. Discovering what is driving the resistance can allow you to develop a collaborative plan to support your child’s needs and get extra help if needed. Cognitive behavioral therapy is an evidence-based treatment for children experiencing anxiety and/or depression. Your pediatrician can be a helpful resource for mental health treatment referrals. The Anxiety & Depression Association of America also provides treatment resources.

Sometimes, oppositional behavior is pervasive. It can include a frequent loss of temper, irritability, difficulty following the rules, defiance of authority figures, spitefulness, and more. If these behaviors occur at home and also show up in other settings, such as at school, a child may be experiencing symptoms of oppositional defiant disorder. Parent training programs such as parent management training, along with problem-solving skills training, are evidence-based treatments, and pediatricians also may be able to provide relevant referrals.

Your patience understandably can wear thin if you find yourself facing repeated resistance. That experience, though, does not have to continue. You can help shift these patterns once you discover what is driving the "no."

Breathe. Count to 10. Take a walk. These strategies have long been advised to help you pause and rethink your reaction when you’re seeing red and an inch away from exploding. Under normal circumstances — maybe a little stress at home or at work — those strategies can be useful. But you may find they’re less effective in the pressure cooker we’ve been living in since the pandemic began. What can you do to avoid reaching your boiling point?

For insight, I turned to psychologist Stuart Ablon, founder and director of Think:Kids in the department of psychiatry at Harvard-affiliated Massachusetts General Hospital. Ablon is an expert at defusing explosive behavior among kids and teens with severe developmental delays in problem solving, flexibility, and tolerance to frustration — the skills that keep us from melting down.

Pandemic stress blocks our coping abilities

Ablon says many adults are struggling with a lack of these skills right now — not because we haven’t developed them, but because pandemic stress is blocking them. “When we humans are chronically stressed, we lose access to the part of our brain that performs skills like flexibility and tolerance,” Ablon says.

Blocked skills can reduce our coping abilities to those of little children, like toddlers who scream when they don’t get their way.

Practice empathy

Ablon says it’s crucial to stay calm or “regulated” when you’re feeling mad or upset, so you can access the skills needed to maintain control. And the best way to remain calm, Ablon says, is by practicing empathy — trying to sense another person’s perspective or point of view.

“Empathy is the most powerful human regulator we have. It’s been proven to de-escalate people in the most challenging of prison settings, and it can also work on an airplane or in line at Starbucks,” Ablon says. “Think about it: when someone listens to you and tries to understand your point of view, it calms you. You can feel your heart rate drop.”

How does empathy help you?

Calming others is great, but how does being empathetic keep you from exploding? It has a domino effect.

• Trying to understand someone else's point of view may change your mind about how you want to react. It will also give you something important to do, which will keep you focused so you can remain calm.
• Being calm enables you to access coping skills like problem solving, flexibility, and tolerance to frustration.
• Accessing your coping skills strengthens your ability to keep your cool.
• Because you’re calm, you’ll keep someone else from exploding, which in turn helps you continue to stay calm.

Four steps to help you stop seeing red

To practice empathy, Ablon recommends the following steps.

• Adopt a mindset that people are doing the best they can. “We’re all trying our best to handle what the world is throwing at us, with the skills we’re able to access at that moment. None of us wants to be losing it,” Ablon says. “Think to yourself, ‘This person I’m interacting with isn’t giving me what I want, but this person is doing the best they can right now.’ If you can exude that, you will help regulate them. It’s incredibly contagious — the same way a parent who stays calm can soothe a crying baby, or a kindergarten teacher with supreme calmness can regulate a whole class.”
• Be curious, not furious. Ablon recommends asking questions without jumping to conclusions, so you can find out where people are coming from. What are their circumstances? What’s driven them to this moment? What do they need?
• Practice active listening. “One of the most powerful things you can do to regulate someone is to repeat back to them what you’re hearing from them in your own words. It makes them feel heard,” Ablon says. “So ask questions, and when you get information, reflect back what you’ve heard. It’s called active listening.”
• Offer reassurance. Remind the person you’re talking to that you’re trying to help. “Say, ‘I’m just trying to understand. I know you must have an important reason and I want to hear more. I’m not trying to get you upset. I want to work things out.’ That’s very calming and regulating,” Ablon says.

It may not be easy to remain empathetic in these challenging times. But the more you practice this skill, the more empathetic you’ll become. That can deliver significant results. “If you can stay calm and approach someone kindly and with understanding,” Ablon says, “it will head things off at the pass for both of you.”

Have family or friends in assisted living facilities? Finding the right gift can be complicated. Health issues may rule out some gifts: cross off sweets or chocolates for those who need to keep blood sugar under control. There isn’t much space for extra belongings in the apartment or room. In some cases, your giftee’s physical or mental capabilities (or both) are declining.

"Any gift you give will probably be appreciated," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center. "But it helps if it’s something the person can really use and will enjoy. Tailor it to their particular ailments, needs, and interests." Below is a roundup that can help you select a great gift for the holidays — or any other occasion.

Gifts for social engagement

"Many people feel lonely and isolated in assisted living facilities. Keeping loved ones socially connected combats that, and also helps ward off chronic disease and cognitive decline," Salamon notes. Gifts that may fit the bill include:

• A simple phone. The easier a phone is to operate, the more likely your loved one will be able to use it. That could be a landline phone with large, easy-to-read numbers ($25 and up), a flip phone ($35 and up), or a smartphone with few buttons and apps ($50 and up). Remember that cell phones come with monthly service costs; prices depend on the carrier.
• A smart speaker. If phone use is too hard for your loved one, consider a smart speaker ($20 and up) that can be programmed to dial important numbers (like yours). Commands can be said aloud at any time to make a call. Check if your loved has internet service, which is needed for smart speaker use.
• A photo book. A loose-leaf photo album (less than $20) or easily created photo book ($10 and more) with recent photos of family and friends may be a warm reminder of connections, or can be a gift to share with others in the assisted living facility. That social interaction is important for health. Plus, it will make the person feel good to see all of those photos of people who love them.

Gifts to aid independence

Health problems can make simple activities challenging. These gifts can give your loved one a little independence.

• Adaptive tools. Your loved one may be able to take back some control of dressing with a long-handled shoehorn, a button hook, or a zipper pull (less than $10 each).
• A magnifying glass. Especially handy for those with impaired vision (and who hasn’t misplaced reading glasses?), having a magnifying glass ($5 and up) is handy for reading or seeing small objects. For a nice upgrade, make it a lighted magnifying glass ($15).
• Handwriting aids. Hand arthritis or neurodegenerative conditions (such as Parkinson’s disease) make writing difficult. Ergonomically-shaped adaptive pens ($10 and up) can help your loved one jot down information or thoughts.

Gifts for sharper thinking skills

"Challenging your brain or learning new information promotes new brain cell connections, which help protect and maintain cognition," Dr. Salamon says. Give your loved one something that will make the process easy and fun, such as the following:

• A daily trivia calendar. (About $15)
• Large-print nonfiction or fiction books. ($5 and up). Audio selections are enjoyable, too.
• Large-print books of brain games and puzzles. ($5 and up)
• A print subscription to a health publication, such as the Harvard Health Letter ($24).

Gifts to ease health issues

A well-chosen gift can bring comfort and help ease health issues. Try addressing someone’s aches and pains with gifts such as:

• A microwavable heat wrap ($15 and up).
• A handheld massager ($5 and up).

Or you could address circulatory problems that make people feel cold or increase the risk for blood clots in the legs. Ideas include:

• A soft fleece blanket ($10 and up).
• Warm slippers with slip-resistant soles ($20 and up).
• Brightly patterned compression stockings with fun designs ($15 and up). Be sure to check the size so they aren’t too small for your loved one.

Gifts to track health

Even though assisted living facility staffers monitor residents’ health, your loved one may find it useful to have one of the following gifts:

• A blood pressure monitor ($30 and up). Look for one with a cuff that goes around the upper arm; inflates automatically; has a lighted background with large numbers; and is certified by the Association for the Advancement of Medical Instrumentation, the British Hypertension Society, or the European Society of Hypertension.
• A digital "stick" thermometer ($10 and up). The right one will be large and easy to hold, with a lighted background and large numbers.

Not quite right?

Keep thinking. A nice, warm fleece sweater ($20 and up)? Extra reading glasses to place in favorite nooks ($15 and up)? If none of these ideas is right, consider giving a healthy treat. A great choice right now is fresh citrus (send a box for $30 and up). "Avoid grapefruit, which can interfere with certain medications," Dr. Salamon advises, "but oranges or tangerines are sweet and rich in vitamin C, which supports a healthy immune system. And that’s a great gift."

How well are you protecting yourself against heart disease, the nation’s leading cause of death? A check of five important numbers can give you a good idea.

“For my patients, I typically look at their blood pressure, blood sugar, LDL cholesterol and triglycerides values, and their waist circumference,” says Harvard Heart Letter editor-in-chief Dr. Deepak L. Bhatt, who directs interventional cardiovascular programs at Harvard-affiliated Brigham and Women’s Hospital. Those values provide a picture of a person’s overall health and, more specifically, what factors they may need to address to lower their chance of a heart attack or stroke, he says.

Below are the ideal values for each measurement, along with why they’re important and targeted advice for improving them. Universal suggestions for improving all five measurements appear at the very end.

How do your heart health numbers stack up?

While the ideal values are good goals for most people, your doctor may recommend different targets based on your age or other health conditions.

Blood pressure

Less than 120/80 mm Hg

Blood pressure readings tell you the force of blood pushing against your arteries when your heart contracts (systolic blood pressure, the first number) and relaxes (diastolic blood pressure, the second number). Your blood pressure reflects how hard your heart is working (when you’re resting or exercising, for example) and the condition of your blood vessels. Narrowed, inflexible arteries cause blood pressure to rise.

Why it matters to heart health: High blood pressure accelerates damage to blood vessels, encouraging a buildup of fatty plaque (atherosclerosis). This sets the stage for a heart attack. High blood pressure forces the heart’s main pumping chamber to enlarge, which can lead to heart failure. Finally, high blood pressure raises the risk of strokes due to a blocked or burst blood vessel in the brain.

What helps: A diet rich in potassium (found in many vegetables, fruits, and beans) and low in sodium (found in excess in many processed and restaurant foods); minimizing alcohol.

LDL cholesterol

Less than 100 mg/dL

A cholesterol test (or lipid profile) shows many numbers. Doctors are usually most concerned about low-density lipoprotein (LDL) cholesterol, particles that makes up about two-thirds of the cholesterol in the blood.

Why it matters to heart health: Excess LDL particles lodge inside artery walls. Once there, they are engulfed by white blood cells, forming fat-laden foam cells that make up atherosclerosis.

What helps: Limiting saturated fat (found in meat, dairy, and eggs) and replacing those lost calories with unsaturated fat (found in nuts, seeds, and vegetable oils).

Triglycerides

Less than 150 mg/dL

Perhaps less well-known than cholesterol, triglycerides are the most common form of fat in the bloodstream. Derived from food, these molecules provide energy for your body. But excess calories, alcohol, and sugar the body can’t use are turned into triglycerides and stored in fat cells.

Why it matters to heart health: Like high LDL cholesterol, elevated triglyceride values have been linked to a higher risk of heart attack and stroke.

What helps: Limiting foods that are high in unhealthy fats, sugar, or both; eating foods rich in omega-3 fatty acids (such as fish); avoiding alcohol.

Blood sugar

Less than 100 mg/dL

High blood sugar defines the diagnosis of diabetes. Type 2 diabetes is most common. It occurs when the body develops insulin resistance (insulin enables cells to take in sugar) and does not produce enough insulin to overcome the resistance.

Why it matters to heart health: High blood sugar levels damage blood vessel walls and cause sugar (glucose) to attach to LDL. This makes LDL more likely to oxidize — another factor that promotes atherosclerosis. Excess sugar in the blood also makes cell fragments called platelets stickier so they’re more likely to form clots, which can trigger a heart attack or stroke.

What helps: Avoiding sugary beverages and foods high in sugar; eating whole, unprocessed grains instead of foods made with refined grains (white flour, white rice).

Waist circumference

Whichever number is lower:

Less than half your height in inches

OR

Women: Less than 35 inches

Men: Less than 40 inches

Measure your waist around your bare abdomen just above your navel (belly button). A big belly — what doctors call abdominal or visceral obesity — usually means fat surrounding internal organs.

Why it matters to heart health: Visceral fat secretes hormones and other factors that encourage inflammation, which triggers the release of white blood cells involved in atherosclerosis.

What helps: Consuming fewer calories, especially those from highly processed foods full of sugar, salt, and unhealthy types of fat.

Universal advice to improve all five measures of heart health

If one or more of your numbers is above ideal levels, you’re far from alone. Most Americans are overweight or obese and have bigger-than-healthy bellies. Excess weight and waist circumference affect blood pressure, LDL cholesterol, triglycerides, and blood sugar. Eating a healthy, plant-based diet can help. Regular exercise also helps: aim for at least 30 minutes of moderate-intensity exercise like brisk walking most days. Other lifestyle habits that can lower your heart disease risk include getting seven to eight hours of sleep nightly and managing your stress level.