Monthly Archives: October 2012

Progesterone – Interesting new research.

Maturitas. 2012 Oct 3. pii: S0378-5122(12)00277-0. doi: 10.1016/j.maturitas.2012.09.003. [Epub ahead of print]

Compounded progesterone: Why is it acceptable to Australian women?


School of Pharmacy and Applied Science, LaTrobe Institute of Molecular Science, Bendigo, Victoria, Australia. Electronic address:



To determine factors influencing compounded progesterone products’ acceptability amongst Australian women who use them.


A cross-sectional survey of 366 women from all states of Australia who had been dispensed a compounded progesterone product, using the ‘Perspectives on Progesterone’ questionnaire.


Descriptive statistics and a logistic regression model of acceptability. Acceptability was measured by respondents’ willingness to recommend progesterone therapy to other women with a similar condition to their own and whether they had talked about their experience to other women.


Australian women who use compounded progesterone tend to be highly educated. They were treating symptoms associated with menopause transition or hormone deficiency. The most common dosage form being used was transdermal cream. More than half the respondents reported improvement for mood swings or irritability (73%), foggy thinking (58%), hot flushes (56%), sleeping problems (55%), and anxiety (54%). Side effects were minimal with the weight gain being the most frequently reported (10%). There was no difference in symptom improvement between those who use progesterone alone or in combination with other hormones. The compounded progesterone acceptability model contains symptom improvement (very large effect size) perception that progesterone is natural and safe (large effect size), number of unexpected benefits (medium effect size) and treatment tailored to suit them (medium effect size). Concerns about other treatments or other treatments being ineffective did not contribute to acceptability.


Acceptance of compounded progesterone therapy depends on symptom improvement, perception of safety and naturalness and tailored therapy.

Detox Diets

22 October 2012, 2.30pm AEST

Monday’s medical myth: detox diets cleanse your body

Detox diets make amazing promises of dramatic weight loss and more energy – all achieved by flushing toxins from the body. Toxins have very little to do with it; detox diets “work” because of the very severe dietary and energy restrictions they require someone to follow. Detox or liver-cleansing diets…

Detox diets make amazing promises of dramatic weight loss and more energy – all achieved by flushing toxins from the body. Toxins have very little to do with it; detox diets “work” because of the very severe dietary and energy restrictions they require someone to follow.

Detox or liver-cleansing diets have been around for many years. With amazing claims of rapid and easy weight loss and improved health, together with a heavy dose of Hollywood celebrity endorsement, it is no wonder these diets are in the public spotlight.

Toxin build up from our environment and poor diet and lifestyle habits is claimed to be the main culprit for weight gain, constipation, bloating, flatulence, poor digestion, heartburn, diarrhoea, lack of energy and fatigue. “Detoxing” is a way for the body to eliminate these toxins and as a result, a person will feel healthier and lose weight.

Detox diets can vary from a simple plan of raw vegetables and unprocessed foods and the elimination of caffeine, alcohol and refined sugars to a much stricter diet bordering on starvation with only juices consumed.

Some detox programs may also recommend vitamins, minerals, and herbal supplements. Detox diet programs can last anywhere from a day or two to several months.

Do detox diets work?

There is no shortage of glowing testimonials from people who have gone on a detox diet, claiming to feel cleansed, energised and healthier. Promoters of detox diets have never put forward any evidence to show that such diets help remove toxins from the body any faster than our body normally eliminates them.

The idea that we need to follow a special diet to help our body eliminate toxins is not supported by medical science. Healthy adults have a wonderful system for removal of waste products and toxins from the body. Our lungs, kidneys, liver, gastrointestinal tract and immune system are all primed to remove or neutralise toxic substances within hours of eating them.

As for the dramatic weight loss typically seen, this is easily explained by the very restrictive nature of detox diets, which can cut kilojoules dramatically.

Claims made that the typical physical side effects such as bad breath, fatigue and various aches and pains are evidence that the body is getting rid of toxins just do not stand up to scientific scrutiny. Bad breath and fatigue are simply symptoms of the body having gone into starvation mode.

The many downsides of detox diets

Apart from the false claim that a detox diet is actually “detoxifying” the body, these diets have many well-documented downsides including:

  • Feelings of tiredness and lack of energy
  • Cost of the detox kit if a commercial program is followed
  • Expense of buying organic food if required
  • Purchasing of supplements if recommended by the diet
  • Stomach and bowel upsets
  • Difficulties eating out and socialising, as most restaurants and social occasions do not involve detox-friendly meals.

The biggest downside of detox diets, especially the more extreme ones, is that any weight loss achieved is usually temporary and is more the result of a loss of water and glycogen (the body’s store of carbohydrate) instead of body fat. This means that the weight lost is easily and rapidly regained once the person reverts back to a more normal eating plan. These dramatic weight fluctuations can be demoralising and lead to yo-yo dieting.

Following a typical detox diet for a few days has few real health risks in otherwise healthy individuals. Very restrictive detox diets, such as water or juice only fasting, can be an unsafe form of weight loss and should not be used for more than a few days.

The verdict of Choice

In 2005, Choice carried out a survey and expert review of popular detox diets sold in supermarkets and chemists.

Choice found no sound evidence that we need to “detox”, or that following a detox program will increase the elimination of toxins from your body. Some of the popular detox kits have diet plans that are far too restrictive, and give dietary advice with either poor or no rationale.

Detox diets may do little harm to most people, except perhaps for their bank balance, but neither do they do a lot of good just on their own. Concerted changes to diet and lifestyle habits are far more valuable than detox diets and supplements.

Six O’Clock News

On channel 9 this evening at 6, there is a report on using troches and Mens health. May be worth watching.

Testosterone and memory

Testosterone and brain function link

It is already known that testosterone plays an important role in cardiovascular health as well as its function as the male sex hormone. Now Australian researchers are testing the links between testosterone and brain function in women.

Researchers believe it could unlock the secrets of treating dementia and even improve the libido of people on anti-depressants.

But despite this, they say Australian pharmaceutical regulators have set the bar too high for testosterone therapy.

Professor Susan Davis from Monash University said the researchers were undertaking studies to look at the role of testosterone on memory and concentration. The study was conducted on women aged 55 to 70 years.

Professor Davis said testosterone has an effect on the brain for many known reasons.

“Women make oestrogen from testosterone so oestrogen in the brain is produced from testosterone as well as from circulating blood levels. Secondly testosterone acts on blood vessels and is what we call a vasodilator so it increases blood flow to tissues including possibly the brain,” she said.

“And thirdly we know that one factor in the development and progression of dementia is the deposition of a protein called amyloid within the brain. And there is evidence to suggest that testosterone may reduce the amount of amyloid protein that is deposited in the brain.”

According to Professor Davis, as people live longer and healthier, the “goal posts” have been moved and women want to be healthier for longer.

“And there is no question if we can delay the onset of memory decline, even by a couple of years, that will have a huge socioeconomic impact,” she said.

The drug testosterone is not broadly available in Australia which has caused some implications in the study.

“There are two products available for women in Australia, neither of which have Therapeutic Goods Administration approval. So, the real block has been this terror engendered from the findings from the Women’s Health Initiative study back in 2002 that hormones are bad for women,” Professor Davis said.

However, the TGA is not alone in its view as authorities in other countries have also resisted testosterone therapies for women.

“America has changed its direction somewhat. They said yes we agree testosterone works, but we just want more safety data; and I don’t have a problem with that,” Professor Davis said.

“The TGA on the other hand has said we don’t believe this works. You need to give us data that shows how it compares to the best approved current standard treatment for women with low sexual function.”

The problem, according to Professor Davis, is that there is no standard treatment approved for low sexual function.

Testosterone May Improve Mental Function

ScienceDaily (Jan. 14, 2008) — When we think about the powers of testosterone, we usually do not consider mental processes. However, research suggests that testosterone levels may affect men’s cognitive performance, reports the January 2008 issue of Harvard Men’s Health Watch.

All the body’s attributes change with age, and mental functions are no exception. Memory is the most fragile mental function. With age, new learning is slower, new information is processed less carefully, and details often slip. These changes give rise to the “senior moment” in healthy elders and to cognitive impairment and dementia in others.

Testosterone levels decline with age, just when memory begins to slow. Might falling hormone levels account for some of the problem? Perhaps, says Harvard Men’s Health Watch. The data are far from conclusive, but studies have found some connections. For instance, higher testosterone levels in midlife have been linked to better preservation of tissue in some parts of the brain. And in older men, higher testosterone levels have been associated with better performance on cognitive tests.

If higher testosterone levels are associated with better mental function, do treatments that reduce testosterone lead to cognitive decline? Three studies linked impaired performance on cognitive tests with androgen deprivation therapy, which is sometimes used in treating prostate cancer. However, the effects were modest and certainly should not deter men from receiving this treatment if needed.

This research also raises the question of whether testosterone therapy might improve mental function in healthy older men, or even in those with cognitive impairment. Only a few small, short-term studies have examined this, and some have reported subtle improvements on cognitive tests. However, high testosterone levels may have harmful effects as well. Harvard Men’s Health Watch suggests that until more research findings are available, men should not use testosterone or any other androgen to improve mental function.


When I was a medical student, I discovered that I had most of the illnesses we were learning about!  I was convinced I had Rheumaticus Abnormalaria- Timpatica because I had the same symptoms as that disease. Funny however, my colleagues all had the same very rare disease! So I realized we couldn’t all have it, so I had discovered the power of suggestion. Mention an itch on my big toe, and immediately I would have one. This article below is interesting as we will be hearing about this condition more often. Doctors are already dealing with patients who are sure they have some rare disease they read about on the internet.

Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search

Ryen White and Eric Horvitz
November 2008

The World Wide Web provides an abundant source of medical information. This information can assist people who are not healthcare professionals to better understand health and disease, and to provide them with feasible explanations for symptoms. However, the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure. We use the term cyberchondria to refer to the unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web. We performed a large-scale, longitudinal, log-based study of how people search for medical information online, supported by a large-scale survey of 515 individuals’ health-related search experiences. We focused on the extent to which common, likely innocuous symptoms can escalate into the review of content on serious, rare conditions that are linked to the common symptoms. Our results show that Web search engines have the potential to escalate medical concerns. We show that escalation is influenced by the amount and distribution of medical content viewed by users, the presence of escalatory terminology in pages visited, and a user’s predisposition to escalate versus to seek more reasonable explanations for ailments. We also demonstrate the persistence of post-session anxiety following escalations and the effect that such anxieties can have on interrupting user’s activities across multiple sessions. Our findings underscore the potential costs and challenges of cyberchondria and suggest actionable design implications that hold opportunity for improving the search and navigation experience for people turning to the Web to interpret common symptoms.

Avoiding Alzheimers.

Can you sidestep Alzheimer’s disease?

A recent international survey identified Alzheimer’s as the second most feared disease, behind cancer. It’s no wonder.

Alzheimer’s disease is characterized by progressive damage to nerve cells and their connections. The result is devastating and includes memory loss, impaired thinking, difficulties with verbal communication, and even personality changes. A person with Alzheimer’s disease may live anywhere from two to 20 years after diagnosis. Those years are spent in an increasingly dependent state that exacts a staggering emotional, physical, and economic toll on families.

A number of factors influence the likelihood that you will develop Alzheimer’s disease. Some of these you can’t control, such as age, gender, and family history. But there are things you can do to help lower your risk. As it turns out, the mainstays of a healthy lifestyle — exercise, watching your weight, and eating right — appear to lower Alzheimer’s risk.

5 steps to lower Alzheimer’s risk

While there are no surefire ways to prevent Alzheimer’s, by following the five steps below you may lower your risk for this disease — and enhance your overall health as well.

1. Maintain a healthy weight. Cut back on calories and increase physical activity if you need to shed some pounds.
2. Check your waistline. To accurately measure your waistline, use a tape measure around the narrowest portion of your waist (usually at the height of the navel and lowest rib). A National Institutes of Health panel recommends waist measurements of no more than 35 inches for women and 40 inches for men.
3. Eat mindfully. Emphasize colorful, vitamin-packed vegetables and fruits; whole grains; fish, lean poultry, tofu, and beans and other legumes as protein sources; plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too.
4. Exercise regularly. This simple step does great things for your body. Regular physical activity helps control weight, blood pressure, blood sugar, and cholesterol. Moderate to vigorous aerobic exercise (walking, swimming, biking, rowing), can also help chip away total body fat and abdominal fat over time. Aim for 2 1/2 to 5 hours weekly of brisk walking (at 4 mph). Or try a vigorous exercise like jogging (at 6 mph) for half that time.
5. Keep an eye on important health numbers. In addition to watching your weight and waistline, ask your doctor whether your cholesterol, triglycerides, blood pressure, and blood sugar are within healthy ranges. Exercise, weight loss if needed, and medications (if necessary) can help keep these numbers on target.


Caregiving: Take away the keys?

Caring for a person with dementia or Alzheimer’s disease presents a range of challenges. Spouses, family members, and friends must deal with feelings of loss as the person they know seems to slip away. Supporting a loved one with basic activities of daily living can be time consuming and exhausting. And it is difficult to balance protecting the person you’re caring for and preserving what independence remains.

One of the trickiest problems to negotiate is driving. The consequences of a misstep behind the wheel can be deadly.

Decisions about driving

Whether or not it is safe to drive can be complicated, particularly when the person is only mildly impaired. Some believe that driving privileges should not be taken away until a person is clearly an unsafe driver.

But can you identify an unsafe driver before an accident occurs?

Driving requires amazing coordination — the eyes, brain, and muscles must process information and respond to it quickly. Driving skills may seem sufficient until an unexpected situation occurs when a person with dementia can panic or freeze with indecision. A University of California study found that the driving skills of people with mild Alzheimer’s were significantly poorer than those of other elderly people, including those with some other forms of dementia.

One way to gauge the risk is to observe the person’s general behavior. If friends and family see their loved one exhibit poor judgment, inattentiveness to what’s going on around him or her, clumsiness, and slow or inappropriate reactions, then that person should not get behind the wheel.

Taking away the keys

Ideally, a tactful and respectful approach will preserve the person’s self-esteem while getting them off the road. Some people may agree to stop driving for other reasons — for instance, the car needs repair or the license or registration has expired. You can also opt for a road test with a driver’s rehabilitation specialist, who can offer an independent assessment of safety. People with Alzheimer’s disease sometimes take seriously a written prescription from a physician that says, “Do not drive.”

In some states, doctors have a legal duty to report unsafe drivers and drivers with certain medical problems to the state department of motor vehicles. If all else fails, you may need to seek advice from a lawyer or an official with the Department of Public Safety in your state. Procedures vary, but generally a driver’s license can be suspended on the basis of a physician’s written statement.

From Healthbeat – Harvard University Medical School.

Here comes the Sun

A leading neurologist says that the pendulum has swung too far towards restricting sun exposure. I have been saying this for ages to both my family and my patients. I have unfortunately been ignored by both most of the time. You know the quote: “no prophet is accepted in his hometown.”  Everybody is so scared of skin cancer that they have become obsessed about avoiding any sunshine. I test most of my patients for Vit D and over 70% show up with low levels. Over 30% show up with moderate to severe deficiencies. Even after showing them the error of their ways, they continue to show low on the next 6 monthly visit. See what low vitamin D can do to you (serious harm) under the Heading “Bit and Pieces” Vit D.  The Cancer Council Aust says 6-7 minutes a day when the UV index is above 3. Many people and kids are not even getting that.  Autoimmune diseases like MS are now being linked to Vit D deficiency.

Taking Vit D in the various formulations does not seem to work very well. I have noticed that on retesting after 6 months, many of my patients on Vit D supplements have not improved much. It just goes to show, you cannot put the sun in a pill.

Good news for bowel sufferers

The future of personalised medicine … for your gut

The emerging field of personalised medicine seeks to tailor therapies to suit an individual’s metabolism or genetic make-up. This strategy has worked well with medication for specific forms of breast cancer and more generally with drugs which are metabolised by liver enzymes, such as the immunosuppressant…

Patients struggling with unpleasant and debilitating gastrointestinal diseases may benefit from some of these advances. KayVee INC

The emerging field of personalised medicine seeks to tailor therapies to suit an individual’s metabolism or genetic make-up. This strategy has worked well with medication for specific forms of breast cancer and more generally with drugs which are metabolised by liver enzymes, such as the immunosuppressant thiopurines for inflammatory bowel disease.

We’re now beginning to realise that a personalised approach to medicine can help improve the health of your gut in many ways.

Good vs bad bacteria

Your lower gut is home to a phenomenal number of bacteria made up of so-called good strains and bad strains. The good bacteria help your immune system develop, salvage nutrients and keep the bad bacteria in check. For their part, the bad strains are associated with bowel cancer, inflammatory bowel disease and a host of other conditions such as obesity.

Eating live cultures of the good strains may help with common gut complaints such as bloating. But live cultures don’t survive long in the upper intestine – most are gone within 48 hours. Even those bacteria protected within a pill are unlikely to gain a foothold in the already thriving ecology of your lower intestine.

Until recently, it wasn’t even clear what kinds of bacteria were present in your lower bowel, much less the relative numbers of each.

Now, new genetic testing in mice has shown we may be able to identify thousands of different strains of bacteria in the human gut – work that is now underway. This would allow us to map our individual bacterial community and better understand the role particular bacteria play in producing (or reducing) common gastrointestinal complaints.


The best way to find out what’s happening inside your gut is to have a look. And there’s nothing more personal than taking a few pictures along the way. This generally involves an endoscope – a camera attached to several metres of fibre optics – which is gently fed down your oesophagus and to regions below.

Endoscopy (or colonoscopy) is the most common (and unfortunately priciest) outpatient procedure at most hospitals. One reason for the expense is that it takes a highly skilled clinician to safely perform these procedures. A slip while taking pictures can tear the gut wall which, if left untreated, can cause the bacterial community to move into your abdomen’s peritoneal cavity.

With the advent of cheap digital cameras, many companies have tried to place a tiny camera inside a pill. This development is important, as colonoscopy-based bowel cancer screening programs dramatically increase the number of expensive procedures. Thus a cheaper and more efficient alternative is needed.

Once swallowed, the pill-cam travels down the entire gastrointestinal tract along with any other food. Until recently, a special harness was needed to help communicate with the camera and track its position in the gut. Even then, only a few pictures could be taken on the way through – often missing important but small features that can lead to incorrect diagnoses.

Imagine driving a car and looking for a particular small lane way. Traffic is busy and it’s impossible to get more than a glimpse out of the window. Now imagine you are using the Google street view camera – you have a continuous, wide angle shot of the whole street that you can review at home. This is what the recently released CapsoVision does. The capsule makes a scrapbook of images from your entire gastrointestinal tract which reduces the guesswork in diagnosing problems.

Researchers are hoping that in future, these capsules will be paired with computerised diagnoses systems to analyse all these images and help the clinician plan your personalised treatment.

Next steps for therapies

While bowel cancer can potentially shorten your life expectancy, many other diseases of the gastrointestinal tract are life-long and come with a variety of unpleasant symptoms. Common gastrointestinal diseases – such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) or even obesity (which is associated with pain, reflux and diarrhoea) – are ripe for a personalised approach.

For IBD, the front-line class of drug called thiopurines is metabolised by several families of liver enzymes. For some people, genetic variation in these enzymes can greatly affect the levels of thiopurines that are available to help reduce the inflammation in the gut.

There are many important hormones in the gut which regulate gastrointestinal function as well as alter how you feel, such as being satisfied after a meal. Serotonin, a gut hormone that helps keep your meal moving, is particularly important in this process and has been the target of several classes of drug designed to reduce the symptoms of IBS, constipation, slowed gastric emptying and reflux.

Given that the levels of serotonin in your gut can determine whether some therapies are effective or not suggests another area that could benefit from a personalised approach, perhaps by characterising the levels of all gastrointestinal hormones and their receptors.

Technology is driving many of the advances in personalised medicine and is allowing for the variation in individuals to be taken into account during treatment.

Patients struggling with unpleasant and debilitating gastrointestinal diseases may benefit from some of these advances today such as the pill-cam or your drug metabolism profile; while cataloguing your microbial community or your gut’s hormonal control system will take five to ten years before applications appear in the clinic.

Good News about HRT

This study from the British Medical Journal (BMJ), one of the most prestigious medical journals, is very reassuring about the safety of all forms of  HRT.

What is already known on this topic

  • Observational studies consistently indicate that hormone replacement therapy (HRT) reduces the risk of coronary heart disease (CHD

  • Randomised trials of HRT and meta-analyses indicate that CHD and total mortality are reduced when HRT is initiated in women aged less than 60 or within 10 years of menopause

What this study adds

  • HRT started early in postmenopausal women significantly reduces the risk of the combined endpoint of mortality, myocardial infarction, or heart failure

  • Postmenopausal women who started HRT early and used it for more than 10 years were not at significantly increased risk of breast cancer or stroke


Objective To investigate the long term effect of hormone replacement therapy on cardiovascular outcomes in recently postmenopausal women.

Design Open label, randomised controlled trial.

Setting Denmark, 1990-93.

Participants 1006 healthy women aged 45-58 who were recently postmenopausal or had perimenopausal symptoms in combination with recorded postmenopausal serum follicle stimulating hormone values. 502 women were randomly allocated to receive hormone replacement therapy and 504 to receive no treatment (control). Women who had undergone hysterectomy were included if they were aged 45-52 and had recorded values for postmenopausal serum follicle stimulating hormone.

Interventions In the treatment group, women with an intact uterus were treated with triphasic estradiol and norethisterone acetate and women who had undergone hysterectomy received 2 mg estradiol a day. Intervention was stopped after about 11 years owing to adverse reports from other trials, but participants were followed for death, cardiovascular disease, and cancer for up to 16 years. Sensitivity analyses were carried out on women who took more than 80% of the prescribed treatment for five years.

Main outcome measure The primary endpoint was a composite of death, admission to hospital for heart failure, and myocardial infarction.

Results At inclusion the women on average were aged 50 and had been postmenopausal for seven months. After 10 years of intervention, 16 women in the treatment group experienced the primary composite endpoint compared with 33 in the control group (hazard ratio 0.48, 95% confidence interval 0.26 to 0.87; P=0.015) and 15 died compared with 26 (0.57, 0.30 to 1.08; P=0.084). The reduction in cardiovascular events was not associated with an increase in any cancer (36 in treated group v 39 in control group, 0.92, 0.58 to 1.45; P=0.71) or in breast cancer (10 in treated group v 17 in control group, 0.58, 0.27 to 1.27; P=0.17). The hazard ratio for deep vein thrombosis (2 in treated group v 1 in control group) was 2.01 (0.18 to 22.16) and for stroke (11 in treated group v 14 in control group) was 0.77 (0.35 to 1.70). After 16 years the reduction in the primary composite outcome was still present and not associated with an increase in any cancer.

Conclusions After 10 years of randomised treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke

Hearing Loss.

Testing for hearing loss

The human ear is the envy of even the most sophisticated acoustic engineer. Without a moment’s thought or the slightest pause, you can hear the difference between a violin and a clarinet, you can tell if a sound is coming from your left or right, and if it’s distant or near. And you can discriminate between words as similar as hear and near, sound and pound.

Nearly everyone experiences trouble hearing from time to time. Common causes include a buildup of ear wax or fluid in the ear, ear infections, or the change in air pressure when taking off in an airplane. And a mild degree of permanent hearing loss is an inevitable part of the aging process. Unfortunately, major hearing loss that makes communication difficult becomes more common with increasing age, particularly after age 65.

Testing, 1, 2, 3

How do you know if you need a hearing test? If you answer yes to the questions below, talk with your doctor about having your hearing tested:

  • Are you always turning up the volume on your TV or radio?
  • Do you shy away from social situations or meeting new people because you’re worried about understanding them?
  • Do you get confused or feel “out of it” at restaurants or dinner parties?
  • Do you ask people to repeat themselves?
  • Do you miss telephone calls — or have trouble hearing on the phone when you do pick up the receiver?
  • Do the people in your world complain that you never listen to them (even when you’re really trying)?

You can also ask a friend to test you by whispering a series of words or numbers. After all this, if you think you have a hearing problem, you should have a test.

What does a hearing test involve?

Thorough hearing evaluations start with a medical history and examination of your ears, nose, and throat, followed by a few simple office hearing tests. An audiogram is the next step.

For an audiogram, you sit in a soundproof booth wearing earphones that allow each ear to be tested separately. A series of tones at various frequencies are piped to your ear. The audiologist will ask you to indicate the softest tone you can hear in the low-, mid-, and high-frequency ranges. People with excellent hearing can generally hear tones as soft as 20 decibels (dB) or less. If you can’t hear sounds softer than 45 to 60 dB, you have moderate hearing loss, and if you don’t hear sound until it’s ramped up to 76 to 90 dB, you have severe hearing loss.

Hearing tones is nice, but hearing and understanding words is crucial. The audiologist plays tape-recorded words at various volumes to find your speech reception threshold, the lowest dB level at which you can hear and repeat half the words. Finally, you’ll be tested with a series of similar sounding words to evaluate your speech discrimination. (From Harvard Healthbeat)

If you want more information, go to On this site you will see my son, Dr Clive Holloway, discussing various aspects of hearing problems.