Mostrando entradas con la etiqueta The New York Times. Mostrar todas las entradas
Mostrando entradas con la etiqueta The New York Times. Mostrar todas las entradas

domingo, 7 de julio de 2013

Acúfenos: Sección Acúfenos en las Artes: Música Clásica: Los 3 meses de acúfenos del pianista Till Fellner



Hearing Things. The Wrong Kind of Things.

Published: January 28, 2007
 
 Till Fellner. Image from: www.bach-cantatas.com
IT happens all the time. In 2005 Till Fellner, an Austrian pianist then rising quickly, canceled an appearance in the Mostly Mozart Festival at Lincoln Center because of illness. A cold? The flu? A sprained finger?

This time the matter was not so simple. Mr. Fellner had developed tinnitus, an ear affliction that rendered him extremely uncomfortable.

“I couldn’t play because everything — traffic, people talking — seemed much too loud to me,” Mr. Fellner said recently from his home in Vienna. “I couldn’t bear listening to anything, so even teaching wasn’t possible.”

Neil Cherian MD. 
Tinnitus can be caused by exposure to sounds that damage the delicate hair cells in the inner ear, said Dr. Neil Cherian, a neurologist and the director of the Center for Performance Medicine at the Cleveland Clinic. One result can be a persistent ringing, hissing or buzzing.

What causes the condition is not always obvious, nor is it necessarily clear what allows normal ear function to return. “There is no consistent method to help this,” Dr. Cherian said, noting that many tinnitus sufferers recover simply by avoiding reinjury and allowing their ears time to heal.

Ear ailments are well known in classical music.


The most famous sufferer was Beethoven, whose decline into deafness has been recounted not only in books and monographs but also in plays and movies — recently, “Copying Beethoven,” with Ed Harris.
Imagen: es.wikipedia.org

Schumann too endured an ear affliction at least for a time. In the book “Schumann: The Inner Voices of a Musical Genius,” Peter Ostwald quotes Schumann’s wife, Clara, describing her husband’s troubles as a “constant singing and rushing in his ears.”

Dr. Peter F. Ostwald, an author, professor of psychiatry and the founding director of the Health Program for Performing Artists at the University of California at San Francisco, died on Saturday 05-30-1996 at his home. He was 68 and lived in San Francisco.
Dr. Ostwald was recognized internationally for his work on the interaction between music and psychiatry. 
He was the author of a pioneering biography on Robert Schumann, "Schumann: The Inner Voices of a Musical Genius" (1985), the first work to attempt an exact diagnosis of Schumann's severe mental disorders as they related to his compositions and creative life.


As for Mr. Fellner, the ailment disappeared with treatment after an agonizing three months, and he resumed his career without making the matter public.

“Normally I don’t talk about it,” he said. “In Europe nobody knows about it.”

Now after an absence of more than two years from New York, Mr. Fellner is set to return, playing a program of Bach, Beethoven and Schubert at the Metropolitan Museum on Feb. 8.

“I enjoy playing even more than before,” Mr. Fellner said. “There was a lot of thinking going on, but I realized how important it is to me, playing the piano. So I’m very happy I could continue.”

Mr. Fellner, 34 and a native of Vienna, first performed in the United States in 1995, then appeared regularly in New York and with major orchestras like the Chicago Symphony and the Los Angeles Philharmonic.

Still he has yet to achieve the fame of other pianists of his generation like Leif Ove Andsnes and Hélène Grimaud.

Part of the reason may be his self-effacing manner.

He has been compared to Tobey Maguire, the star of the Spider-Man films, though he does not so much resemble Mr. Maguire as embody his typical on-screen persona: the awkward boy next door, lanky, a bit goofy and unfailingly earnest.

Still there is nothing tentative about Mr. Fellner’s playing. It is assured, fluid and musical.

“To my mind he has all the ingredients to be on the top,” Alfred Brendel, the elder statesman among Austrian pianists and Mr. Fellner’s best-known teacher, said from his home in London.

“It has impressed me how ambitiously he has developed his repertory from Bach to the present, being equally at home in solo and concerto repertoire, chamber music and lieder.”

The conductor Kent Nagano, who has worked with Mr. Fellner steadily since 1997, is also an admirer. “When you perform with him, you share the feeling of music as a language beyond technical expression,” Mr. Nagano wrote in an e-mail message. “For me, his music-making has a special kind of truth and natural character.”

Mr. Fellner’s big break, if the term applies, came three years ago, with the release of his recording of Book 1 of Bach’s “Well-Tempered Clavier” by ECM.

The praise from critics was almost universal. Anthony Tommasini, in The New York Times, called the album “a major achievement” and later listed it among the best classical CDs of 2004: “one of the most substantive and rewarding recordings of the year.” (Mr. Fellner has yet to follow up that success, though he is scheduled to record Bach’s Two- and Three-Part Inventions for ECM in July.)

In addition to Bach, Mr. Fellner performs many Classical and Romantic standards, Mozart’s concertos prominently among them, and continues to expand his range.

He recently performed Chopin’s F minor Concerto for the first time, and Beethoven will soon fill his days. He plans to present complete cycles of the Beethoven sonatas in Vienna and London over two seasons, beginning next year.

He also plays less familiar music, including Schoenberg’s solo pieces and the demanding sonata of Julius Reubke, a talented pupil of Liszt who died young.

He is especially fond of the music of Gyorgy Kurtag, the contemporary Hungarian composer. “Except for Anton Webern, he is the only composer who can express himself in so few notes,” Mr. Fellner said.


Mr. Fellner has played other contemporary music as well. In 2002 he and the cellist Heinrich Schiff gave the first performance of “Mumien” by the Austrian composer Thomas Larcher. And last summer Mr. Fellner and Adrian Brendel, a cellist and Alfred Brendel’s son, performed “Lied,” a short work by the British composer Harrison Birtwistle written in honor of the elder Mr. Brendel’s 75th birthday. Mr. Fellner is scheduled for premieres by both composers this year.

“His choice of repertory will seem highbrow to some people,” Mr. Brendel said, “but I applaud him for it. And don’t mistake him for a predominantly intellectual player. I heard him do the best live performance of Liszt’s ‘Années de Pèlerinage.’ ”

Mr. Brendel and Mr. Fellner met in 1990, when Mr. Fellner, then 20, was studying at the Vienna Conservatory.

“I listened to Till, and he sounded promising,” Mr. Brendel said. “It was evident that he was very intelligent.” They have since met two or three times a year, discussing repertory and playing on two pianos.

“He’s a wonderful teacher,” Mr. Fellner said. “Normally he demonstrates a lot. On one hand, he’s looking for all the details. But on the other, he gives you a view over the whole piece. What he says is always very precise, very concrete.”

For his part Mr. Brendel said: “It is really a matter of a very valuable friendship. I like to share my experience with young concert pianists who are able to help themselves, and to check them out once in a while, to see whether they remain on course.”

Mr. Fellner, having overcome a physical setback, seems to have done just that.

Fuente: The New York times
 http://www.nytimes.com/2007/01/28/arts/music/28merm.html

sábado, 6 de octubre de 2012

Tinnitus



Tinnitus is the medical term for "hearing" noises in your ears when there is no outside source of the sounds.

The noises you hear can be soft or loud. 
They may sound like ringing, blowing, roaring, buzzing, hissing, humming, whistling, or sizzling. 
You may even think you are hearing air escaping, water running, the inside of a seashell, or musical notes.

TopAlternative Names
 
 

Ringing in the ears; 
Noises or buzzing in the ears; 
Ear buzzing

Considerations

Tinnitus is common. Almost everyone experiences a mild form of tinnitus once in awhile that only lasts a few minutes. 
However, constant or recurring tinnitus is stressful and can interfere with your ability to concentrate or sleep.

Causes

It is not known exactly what causes a person to "hear" sounds with no outside source of the noise. 
However, tinnitus can be a symptom of almost any ear problem, including:

    Ear infections
    Foreign objects or wax in the ear
    Injury from loud noises
 
    Meniere's disease -- an inner ear disorder that involves hearing loss and dizziness.
   Alcohol, caffeine, antibiotics, aspirin, or other drugs can also cause ear noises.

Tinnitus may occur with hearing loss. 
Occasionally, it is a sign of high blood pressure, an allergy, or anemia. 
Rarely, tinnitus is a sign of a serious problem like a tumor or aneurysm.

Home Care

Tinnitus can be masked by competing sounds:

    Low-level music, ticking clocks, or other noises may help you not notice the tinnitus.
    Tinnitus is often more noticeable when you go to bed at night because your surroundings are quieter. 
Any noise in the room, like a humidifier, white noise machine, or dishwasher, can help mask tinnitus and make it less irritating.

Learn ways to relax. Stress does not cause tinnitus, but feeling stressed or anxious can worsen it.

Avoid caffeine, alcohol, and smoking.

Get enough rest. 
Try sleeping with your head propped up in an elevated position. This lessens head congestion and noises may become less noticeable.

Protect your ears and hearing from further damage. 
Avoid loud places and sounds. 
Use earplugs if you need them.

When to Contact a Medical Professional
Call your doctor if:

    Ear noises start after a head injury.
    The noises are associated with other unexplained symptoms like dizziness, feeling off balance, nausea, or vomiting.
    You have unexplained ear noises that bother you even after self-help measures.

What to Expect at Your Office Visit

The health care provider will perform a physical examination, which will include looking in your ears. 
You may be asked questions, such as:

    What does the noise sound like?
    Is the sound throbbing or rhythmic?
    Is it in one or both ears?
    What other symptoms do you have?

The following tests may be done:

    Audiology/audiometry to test hearing loss
    Head CT scan
    Head MRI scan
    Blood vessel studies (angiography)
    X-rays of the head

TREATMENTS

If your doctor can determine the cause, fixing the problem (for example, removing ear wax) may make your symptoms go away.

Review all of your current medicines, including over-the-counter drugs, vitamins, and supplements with your health care provider. Do not stop taking any medications without first talking to your provider.

Many medicines have been used to relieve symptoms of tinnitus, but no drug works for everyone. 
Medications may include anti-arrhythmics (usually used for irregular heart rhythms), antidepressants, vasodilators, tranquilizers, anticonvulsants, and antihistamines.

A tinnitus masker is a device worn like a hearing aid. 
This helps some people.
It delivers low-level sound directly into the ear to cover or disguise the ear noise that is bothering you.

A hearing aid may help reduce ear noise and make outside sounds louder.

Sometimes, counseling may help you learn to live with tinnitus.

Your doctor may recommend biofeedback training. 
This method helps you learn to control body functions by monitoring specific responses (such as tightness of a muscle group) and altering this response through relaxation.

Some people have tried alternative therapies to treat tinnitus. 
These includes:

    Acupuncture
    Craniosacral therapy
    Hypnosis
    Vitamins or herbal supplements, including zinc, magnesium, ginkgo, melatonin, or B vitamins

However, such methods have not been entirely proven. 
Talk to your doctor before trying any of these alternative therapies.

The American Tinnitus Association offers a good resource center and support group.

Prevention

Wear ear protection in any situations where ear damage is possible (such as loud concerts or jackhammers). 
 
If you have hearing loss, avoid further damage to your hearing by avoiding excessive noise.

Make sure your blood pressure is normal by maintaining proper body weight, exercising regularly, and seeing your doctor for yearly check-ups.

References

Heller AJ. Classification and epidemiology of tinnitus. Otolaryngol Clin North Am . 2003; 36(2): 239-248.

Sismanis A. Tinnitus. Advances in evaluation and management. Otolaryngol Clin North Am . 2003; 36(2): xi-xii.

Bauer CA. Tinnitus and hyperacusis. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery . 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 150.

 
Fuente: The New York Times
 http://health.nytimes.com/health/guides/symptoms/tinnitus/overview.html

Advice for Dealing With Multiple Ailments

A new brochure offers tips for managing medical care of multiple chronic conditions. 
Philippe Huguen/Agence France-Presse — Getty Images  
A new brochure offers tips for managing medical care of multiple chronic conditions.
Here’s the problem: A majority of older adults, the medical literature shows, are coping with at least three chronic conditions. Diabetes, heart disease, arthritis, osteoporosis, hypertension, kidney failure — the list goes on and on.

Medical groups have developed separate clinical guidelines for most of these diseases, but when doctors simply follow those recommendations, treating one disease can worsen another. 

Drugs interact in unpredictable ways. 

Side effects make patients miserable, even if their lab results look better.

The drugs an endocrinologist might prescribe to strictly control a diabetic patient’s blood sugar (and very low blood sugar doesn’t benefit the older patient) can cause problems for people who also have kidney disease, for example. 

Opioids to control arthritis pain can impair cognition. 

The examples are probably infinite.

“There’s not a good understanding of how to manage all these problems simultaneously,” said Dr. Matthew McNabney, a Johns Hopkins geriatrician and the American Geriatrics Society’s chairman of clinical practice. “Not only is it difficult and complicated, but it’s often harmful.”

Dr. McNabney led a panel of 11 geriatrics experts — including an ethicist, a nurse practitioner and a pharmacologist — who began meeting more than a year ago to come up with a better approach to treating “multimorbidity” (medspeak for having several chronic illnesses) in older adults.


Initially, the group focused on reorienting other doctors, who often have “a single-disease focus,” Dr. McNabney said. 

The resulting 25-page document, “Guiding Principles for the Care of Older Adults With Multimorbidity,” appeared in The Journal of the American Geriatrics Society last week, and panel members have been presenting their findings at professional meetings around the country.

But not long into their discussions, the group also recognized the need to bring older adults themselves — their experiences, values and priorities — into these decisions. 

They’re the ones living with all these conditions, after all, and trying to follow all of the sometimes competing advice about what to do, what to test for, what to take.

“You can sense, talking with your patients, how overwhelming and confusing it all is,” Dr. McNabney said.

So the group also drafted a tip sheet for patients and caregivers, “Living With Multiple Health Problems: What Older Adults Should Know.” 

You can find it on the Web site of the society’s Foundation for Health in Aging; you may also spot it at doctors’ offices and clinics in coming months.

It takes a very patient-centered approach, to adopt the current jargon. “The health care approach has historically been to tell patients what to do, what benefits them,” Dr. McNabney said. 

“We need to ask, ‘What do they want? How can they tell me what they want?’ Not just tell them, ‘This is what the guidelines say.’”

The tip sheet’s suggestions sound common-sensical: Patients and family members need to get as much information as they can about treatments, understand the inevitable trade-offs between benefits and risks, make sure health professionals understand their priorities.

The guide even acknowledges what many patients don’t realize: There’s scant research on how older people respond to certain treatments, in part because they have often been excluded from clinical trials.

Maybe being able to walk without dizziness is more important to an older patient than somewhat prolonged survival. 

Maybe less frequent blood testing is worth the greater freedom, untethering an older person from constant clinic visits, even if that means less stringent monitoring.

“A patient may need to honestly tell their health care provider, ‘I can’t do this,’” Dr. McNabney said. “’I can’t take 18 medications. I’m not doing it.’” Eighteen meds? “It’s not an extreme example,” he said.

Questioning treatments and prescriptions, knowing and expressing one’s own needs, becoming a partner in decisions — these won’t come easily to some older people. 

Their boomer children, the ones who grew up with “Question Authority” bumper stickers, will often need to serve as record-keepers, questioners, interpreters — as many of us already do.

Plus, how many doctors have, or can develop, the communicative and collaborative personality to operate this way? You hope they are reading the panel’s full report, about “assessing the complexity and feasibility of treatment options,” among other things, as their patients are reading the tip sheet.

Still, this approach represents a potential step toward rethinking the way older people and their doctors reach medical decisions.

“It feels right,” said Dr. McNabney. 

Since he began work on the project, “I’ve had different conversations with patients,” he said. “I feel a pretty dramatic turn.”

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
Fuente: The New York Times
http://newoldage.blogs.nytimes.com/2012/10/01/tips-for-dealing-with-multiple-chronic-ailments/?ref=health