Acúfenos: Sección tratamientos: "Long-term complications after cochlear implantation"

• Jun Ikeya^, ,
• Atsushi Kawano,
• Nobuhiro Nishiyama,
• Sachie Kawaguchi,
• Akira Hagiwara,
• Mamoru Suzuki

• Department of Otorhinolaryngology, Tokyo Medical University Hospital, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, Japan

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Abstract

Objective

Cochlear implantation has become an effective treatment for many profoundly deaf patients. 

As with any surgical procedure, a proportion of patients suffer postoperative complications. 

The aim of this study was to analyze long-term postoperative complications in patients with cochlear implants with a view to improve clinical interventions and propose a consensus for reporting complications.

Methods

A total of 406 cases received cochlear implants between December 1985 and April 2007 at Tokyo Medical University (TMU) Hospital. 

We retrospectively reviewed case notes from 366 patients who had undergone cochlear implantation (215 adults and 151 children) after excluding 40 patients of re-implantation including 13 cases implanted initially at other hospitals.

Life-threatening, major and minor complications were examined retrospectively.

Results

Major complications occurred following cochlear implantation in 32 patients (8.7%) who had received their initial implant at TMU Hospital. Revision surgery was required for 30 patients. 

The mean age at implantation was 33 years 6 months (range, 1 year 9 months to 83 years; median, 37 years). 

The main etiology of deafness was unknown or progressive (113, 52.6%) in adults and congenital (132, 87.4%) in children. 

The cause of deafness was meningitis in 41 cases (11.2%), and 26 cases (7.1%) were diagnosed with idiopathic sudden deafness.

• Flap-related problems (including middle ear infection and/or flap necrosis) developed in 13 cases (3.6%), with 12 cases (7 adults, 5 children) requiring re-implantation. 

• Electrode slip-out occurred in 8 patients (7 adults, 1 child). All adult cases in whom electrodes slipped out underwent implantation before 1994, while the child (1 pediatric case) was operated in 2003. 
• All cases required re-implantation and most cochlear implantations were performed using the modified split-bridge technique after 1997. 
• Six patients (4 adults, 2 children) experienced device failure. 
• Four patients experienced electrode problems. 
• Non-surgical major complications included 1 patient with permanent facial nerve paralysis as a result of thermal injury in 1995.

The total number of minor medical and surgical complications was 27, representing 7.4% of all operations.

Conclusion

Many cases of major complications, including:

1.  electrode problems and 
2.  facial paralysis, 

excluding traumatic device failure were considered avoidable by strict operative and postoperative procedures.

 Some cases of flap infection and traumatic device failure may not be able to be avoided completely, and every possible care should be taken by implant patients and others involved.

Keywords

• Cochlear implant;
• Complication;
• Flap-related problem;
• Electrode slip-out;
• Device failure

Fuente: Auris Nasus Larynx

Available online 2 July 2013

Acúfenos: Sección etiología: Electrosensibilidad (una entidad en estudio)

Electrosensitivity:is technology killing us?

Is modern life making us ill? Yes, say those who suffer from electrosensitivity. Are they cranks, or should we all be throwing away our mobile phones?

• • Nicholas Blincoe
  • The Guardian, Friday 29 March 2013 19.00 GMT

Tim Hallam, 36, sleeps in a custom-made silver-coated sleeping bag that helps block out electromagnetic fields. Photograph: Thomas Ball

Tim Hallam is just tall enough to seem gangly.
His height makes the bedroom feel even smaller than it is.
Muddy sunlight filters through the grey gauze hung over his window. His narrow bed appears to be covered with a glistening silver mosquito net.
The door and the ceiling are lined with tinfoil. Tim tells me there is also a layer of foil beneath the wallpaper and under the wood-effect flooring.
He says, "The room is completely insulated; the edges are sealed with aluminium tape and connected with conducting tape so I could ground the whole room.

It's a Faraday cage, effectively. Grounding helps with the low frequencies radiation, apparently. The high frequencies just bounce off the outside."
Tim is trying to escape atmospheric manmade radiation caused by Wi-Fi, phone signals, radio, even TV screens and fluorescent bulbs.

It's a hopeless task, he admits: "It's so hard to get away from, and it's taken a toll on my life." I offer to put my phone outside the room and he happily accepts, firmly closing the door.

He explains the phone would have kept searching for a signal. "And because it wouldn't find one, it would keep ramping up." With the tinfoil inside his cage, the signal would hurtle around the room like a panicked bird.
Tim estimates he spent £1,000 on the insulation, taking photographs at every stage to share with others via ElectroSensitivity UK, the society for sufferers.

He found the whole process stressful, especially after a summer sleeping in the garden of his shared house in Leamington Spa to escape a new flatmate's powerful Wi-Fi router.

How did he feel about the flatmate at the time? "Oh, I hated him. It wasn't really him, of course. But I was so angry."

Among the symptoms Tim experiences – headaches, muscular pain, dry eyes – there are memory lapses and irritability.

 He now says his bed is the single most important thing he owns. "I climb in and zip it up so I'm completely sealed. Inside, I sleep extremely well. Without it, my sleep is fragmented, and without sleep, then lots of other things go wrong."
Tim demonstrates the effectiveness of the tinfoil using a radiation detector called Elektrosmog, manufactured in Germany.

It is blocky and white, which makes it look both retro and futuristic. On the front of the box, a picture of an electricity pylon is surrounded by jagged black lightning flashes. The machine gives a reading close to zero: Tim's room is radiation-free.

As a child in the 70s, I watched a BBC science-fiction serial called The Changes, which imagined a future after humans became allergic to electricity.

 Pylons were the greatest danger, making people violently sick. On cross-country runs, I would speed up when I had to pass beneath a power cable, feeling the weight of the buzzing electricity above me.

The idea that electromagnetic fields affect our health took root in the 1960s.

A US doctor named Robert O Becker became the face of the campaign against pylons after appearing on the US TV show 60 Minutes. Professor Andrew Marino, now of Louisiana State University, was Becker's lab partner. Marino says, "He's the reason nobody wants to live near power lines."

If electromagnetic radiation is dangerous to humans, there are far more risks now than 40 years ago, thanks to the telecommunications industry. More than a billion people worldwide own mobile phones. In the UK, there are more mobile contracts than people. The new 4G spectrum will cover 98% of the country, erasing all but the most remote "not spots".

Dr Mireille Toledano runs Cosmos, a 30-year, five-nation study into the effects of telecoms radiation on humans.

 She knows how rapidly things are changing. In 2000, a 10-year study into mobile phones and brain tumours pegged heavy use at 30 minutes a day.

The study found the 90th percentile had spent 1,640 hours of their lives on their phones. In the UK, Toledano says, "heavy use is now defined at 86 minutes a day; 30 minutes is in the median range. Across the whole [international Cosmos study], the top 10% of users have now clocked up 4,160 or more hours."

The earlier study found no evidence linking phone use and cancer in the short term, yet as our love affair with technology keeps deepening, anxieties grow. Two years ago, the European Assembly passed Resolution 1815, which, among other things, calls for restrictions on Wi-Fi in schools and the use of mobile phones by children.

The World Health Organisation has classified electromagnetic fields of the kind used in mobile telephony as Group 2b carcinogens – that is, as possibly cancerous.

The issue of electromagnetic sensitivity is immediately political. It places sufferers on the other side from both industry and the governments that profit from leasing wavelengths.

Over and over, I hear the phrase, "We are the canaries in the coal mine": sufferers believe we are approaching a tipping point.

 Tim Hallam worries about the effects of electromagnetic fields on the most vulnerable: on his sister's young family; on children in schools bathed in Wi-Fi rays; or old people in sheltered accommodation, each with their own internet router.

 "I think it's affecting everyone's cells. There are test-tube experiments which show it damages DNA and affects the blood-brain barrier. I do think there's going to be a surge in the people who are sensitive in years to come. But my sister's not fully taken that on board."

Yet electro hypersensitivity syndrome is controversial. Sweden recognises EHS as a "functional impairment", or disability, but it is the patients, not doctors, who make the diagnosis. The fact is, everyone who suffers from EHS is self-diagnosed – and each has their own story to explain the cause of their problems.

Tim was 16 years old, at a gig by the industrial band Sheep on Drugs, when the singer produced a pistol and fired blanks into the ceiling.

Tim, who is now 36, says, "It was the loudest thing I had ever heard." His ears began ringing but he continued going to gigs without using ear plugs and the problem grew worse.

He played clarinet in two orchestras but had to stop: "Immediately, my musical life and my social life ended." Today, his sister is a professional classical musician.

Tim, a Cambridge graduate, is a van driver for Asda. He works shifts that allow him time alone when his flatmates are out and the house is free of Wi-Fi and phones. It was the arrival of Wi-Fi in his house, just 10 months ago, that led Tim to identify the cause of his problems, but it was the tinnitus that started it all.
 

Michelle Berriedale-Johnson, 65, is wearing a jacket made from a silver-coated material that reduces the strength of electromagnetic fields. Photograph: Thomas Ball 

  Michelle Berriedale-Johnson has worked in the field of food intolerances and allergies for more than 20 years. She runs the industry awards for "Free From" foods from her home in north-west London, as well as foodsmatter.com, a website that raises awareness around food intolerances.

 Five years ago, at the age of 60, she began to feel unwell.

She was sitting at her desk when she identified the cause. "I looked up and there was the Royal Free Hospital with the phone masts on the top, beaming straight through my window, and it just clicked." Michelle is bright and lively, happy to dive beneath her desk to show the precautions she has taken to shield herself from the spaghetti of wires.

Her walls are painted with carbon paint, lined with foil and papered over.

 The windows have the same netting as Tim's, though when she uses her Elektrosmog meter she discovers to her consternation that the netting is old and no longer works.

 Her front rooms buzz with electromagnetic radiation, though her office – now at the back of the house – shows far better readings.

She says, "I'm lucky to work from home, but I often feel like a prisoner." When she leaves the house, she wears hats lined with material similar to Tim's mosquito netting and even has blouses made of the same material. "The important thing is to protect your head and upper torso," she says.

Michelle precisely identifies the moment she became sensitised to radiation. She was an early user of mobile phones.

 "Do you remember the type with the little aerial? I had one where the antenna had broken off, but I continued to use it pressed to my ear, which people who know tell me meant that I was using my entire head as an aerial."
In her view, we are all sensitive to electromagnetic fields, but events can tip us over into hypersensitivity, like a kitchen sink filling so fast that the overflow becomes overwhelmed and water cascades to the floor.

The problem, in clinical terms, is that "hypersensitivity" refers either to allergies or to auto-immune conditions. EHS may be like hay fever or, in extreme cases, like rheumatoid arthritis but only via analogy.

If we speak of "hypersensitivity" we are using a metaphor – or we are talking about something entirely new. Does this "new" condition exist?

Long-time researcher Dr Olle Johansson, from Sweden's Karolinska Institute, coined the term "screen dermatitis" to explain why computer users in the depths of the Stockholm winter could complain of sunburn-like symptoms.

Johansson has a theory that could explain how extremely high levels of radiation could affect histamine levels in cells.

Yet telecoms radiation is low and becoming lower as gadgets become more efficient. Johansson acknowledges that if anyone is found to be truly allergic to their phone it would be an entirely new kind of allergy, but he hopes that an awareness of EHS will lead to revolutionary changes. "In Sweden, we take accessibility measures seriously for disabilities.

You think of changes to sidewalks, or wheelchair access, or ramps on buses. These are also helpful to mothers with prams, people with shopping or to rollerskaters.

The big winner is everyone." Similarly, he believes that cutting off the telecoms signals would not only help EHS sufferers, it would benefit all of us, returning us to a society based on face-to-face human interaction.


Dr James Rubin of King's College Institute of Psychiatry is adamant EHS is not a genuine syndrome.

 "With most conditions, patients don't necessarily know what's going on.

But with electrosensitivity there's an absolute certainty about the cause.

Self-diagnosis is at the core of it." He prefers the term "idiopathic environmental intolerances", or IEI, which covers conditions with no obvious cause, like multiple chemical sensitivity, sick building syndrome, food intolerances – even a physical reaction to wind turbines. "The problem is, if you look for a coherent set of symptoms, you are not going to find it. You even find that people's symptoms change over time. Many have other intolerances in addition to the electrical sensitivity."


Tim is intolerant to milk and gluten. He is also allergic to wool, and cannot sleep in a room with a carpet. Michelle has no intolerances but admits she is unusual in the community: "Most people do."

She made her diagnosis because she was familiar with EHS through her work. She is familiar with Rubin's research and has written blogs condemning his methods: "These stupid so-called provocation studies where they place a mobile in your hand and ask if you feel unwell. And if you say yes, they go, ho-ho, the phone wasn't switched on."

These tests pay no attention to the way that people are sensitised, or react to their sensitivity in different ways, she believes.
Rubin is a bogeyman in the electrosensitive community thanks to a 2008 paper that suggested the condition was psychosomatic.

Yet he has also undertaken a review of all the research – more than 50 provocation studies – and found no evidence of sensitivity to telecoms radiation.
He says, "The suffering is very real – I don't doubt that – and I take it very seriously.

But we've spent millions on the research and the time comes when you have to say, in the future the money would be better spent on looking for effective treatments, rather than chasing a cause."

Professor Andrew Marino is less sceptical. "When people say they feel unwell and trace that to a Wi-Fi signal or a phone, that is a kind of experiment.

 It may not be well designed, they may not understand blinds and double blinds, but if they are reasonable people, carefully noting what they are suffering, we should take a look at that."
Marino was a first-year postgraduate in 1964 when he began working with Dr Robert Becker.

Once he and Becker began campaigning against electricity pylons, their funding disappeared. Becker retired at the relatively young age of 56.

Today, Andrew Marino will not look to industry for research funds. He has reviewed many of the same 50 papers on EHS as Rubin, concluding, "It's easy to find nothing."

The common denominator he identified in the papers casting doubt on EHS is that they were funded by the telecommunications industry.

EHS sufferers have criticised Rubin's research because it is funded jointly by mobile phone companies and government.

They believe this shows direct bias. Marino's criticism is different. He recognises Rubin's money was placed in a fund and administered by scientists separate from the industry.

Yet, he argues, the industry approves funding because statistical modelling of large-scale studies averages out experiences and produces no clear-cut results.

 Big business is happy to back risk studies, but they favour projects that minimise risk: "You look at the statistics and see the way they design the experiments and they have no ability to find anything."
Rubin's research is statistic-driven. If Rubin is a pollster, then Marino is a canvasser.

He believes vast overviews hide the way people really feel. Marino chose to focus on a single sufferer, a female doctor.

His two-week study began by first discovering which wavelengths affected her.

Once her symptoms had subsided, Marino and his team began again, using provocation studies of real and fake signals.

Their results were published as Electromagnetic Hypersensitivity: Evidence For A Novel Neurological Syndrome.
Marino and Rubin have exchanged a series of letters about the study in the Journal Of Neuroscience.

If the research stands up, Marino's syndrome is novel because it is unlike other kinds of hypersensitivity. In truth, it depends upon singularity.

Marino speaks urgently: "I'm not interested in measuring the prevalence of the syndrome. I want to establish its existence." In his view, humans – complex living organisms – are all different. In the economy of our bodies, Marino says, "causes becomes effects and effects becomes causes which become effects, and so on". It is an endless and unpredictable cycle.

So should we all make radical lifestyle changes, like cutting down our mobile phone use or getting rid of our Wi-Fi?
"Why?" Marino sounds perplexed.
"Because we might get sick."
Marino dismisses the idea.

He may disagree vehemently with Rubin, but he views EHS sufferers as outliers, far removed from the average human experience and with few lessons for the rest of us.

"Listen, I use an ear bud with my phone, and I minimise use.
I don't know if you'd call it radical but I don't have acute reactions to anything.

So there's nothing for me to worry about."

• This article was corrected on 2 April 2013 because Tim Hallam was 16 years old when he went to a concert by Sheep on Drugs, not 15 as the original said.

Fuente: The Guardian, UK
http://www.guardian.co.uk/society/2013/mar/29/electrosensitivity-is-technology-killing-us?INTCMP=SRCH

Words.
Electrosensitivity, Nicholas Blincoe, Tim Hallam, The Guardian, Faraday Cage, Frecuencies, phones; Robert O Becker,  Prof. Andrew Marino; Dr. Mireille Toledano, Cosmos; WHO, Michelle Berriedale-Johnson, Royal Free hospital;  Dr. Olle Johansson; Karolinska Institute; histamine; Dr. James Rubin, Kings College Institute of Psychiatry

Acúfenos,Sección Experiencias personales: La música intensa en los casamientos

 

In my own write: Let the music play

By JUDY MONTAGU

    03/12/2013

I hate loud bands at weddings. Does that make me a killjoy?

Israeli metal band Photo: Courtesy

I was climbing the stairs leading to my apartment when I met my next door neighbors, a French couple in their late sixties, coming down, dressed in their best. “We’re going to a wedding,” smiled the wife wryly, “and another one tomorrow. It’s too much.”

“Much too loud,” explained her husband. Mimicking a walking movement with two fingers, he added that this meant they would be leaving early – filer à l’anglaise was his humorous choice of phrase.

Not to be outdone, I remarked that our English equivalent for an illicit absence was “to take French leave.”

Amiably disposed as they are, we parted on good terms – me to enjoy a quiet evening, they to undergo what would almost certainly be an ear-crushing, almost physically painful experience they would grin and bear until they could make their escape. Then it would all be repeated the next day.

The prevailing trend in Israel, and other places, to hire wedding bands that assault hapless guests’ eardrums as relentlessly as battering rams leads me to pose this question to families who make weddings, often at exorbitant cost: After all the planning, and all the time and money invested, is grim resignation followed by a speedy and relieved exit really the response you desire from a significant proportion of your invitees? Along with the lavish food on offer, did you think about providing “the greatest good for the greatest number”?

NOW THE majority of couples who marry are young, and young people – and their friends – naturally want music that expresses their exuberance and reflects their energy, joy of life and happiness at attending a joyful event.

In contrast, my French neighbors – and I myself – might well be dismissed as grumblers and killjoys on the path to old fogeyhood who’ve simply forgotten what it means to have a good time.

I was thus intrigued by the conversation during a car journey back to Jerusalem from a wedding held in the south of the country just a few days earlier.

Judy Montagu

My daughter and I had been given a ride to the event by a lively young couple in their late twenties; and on the way home, I raised the subject of the music, provided by a DJ, which had, true to form, been uninterrupted and earsplitting.

While some guests who looked to be 50 or over had danced with every appearance of enjoyment, others had sat at their tables wearing fixedly resigned expressions.

Conversation, beyond a word or two, was out.

“The volume is one of the reasons we left earlier than planned,” the young woman explained. “I’m giving a presentation at work tomorrow, and my throat was seriously hurting from all the shouting I had to do to be heard over the music.”

Did they prefer their music so very loud? It emerged that they didn’t. So does it really have to be like that? I wondered. Couldn’t people dance and celebrate just as happily with music at half the volume? “It’s the trend,” she shrugged.

“But who set the trend?” her husband persisted.

They tossed the point back and forth for a while, but clearly neither of them thought anything would change.

Weddings, while undeniably happy occasions, would for many guests continue to be an endurance test.

WHAT DO band players say about the decibel issue? Contrary to what you might think, it’s a topic that engages them.

The managing director of an acoustic music company posted this comment on a musicians website: “I did concert sound for over 20 years and the levels asked for kept increasing... We had one concert that was so loud I had three sets of ear protection on, and could still hear the music.”

Added “GuitarMax99”: “DJs and live bands are both guilty of turning up the volume to levels approaching (and exceeding) the threshold of pain. Personally, I hate it. I understand wanting to hear loud music, but I don’t understand pushing it to the point where you’re going to cause tympanic membrane damage and tinnitus.

“When I go to a movie, I don’t want the projectionist to turn up the brightness to the point where I’m squinting. So why do sound-guys think I want them to turn up the volume until my ears bleed?” Wrote another band player: “Often musicians don’t get the distinction between when they should be in the foreground and when they shouldn’t... Unfortunately, instead of talent being the focal point, volume often is.”

A guitarist had no doubt about who was ultimately responsible for the pervasive high volume: “One problem you run into when playing in a band is that while the guitars, bass and microphones are all amplified, the drums are not (unless you’re using electric drums). It’s pretty tough to play a set of acoustic drums quietly and have them sound uniform and good. [So] we tended to play to the volume of our drummer...

“It’s the damn drummer,” he stressed. “I’ve played with a few great drummers, and they all could play just as intensely at normal volumes. Unfortunately, most of them seem to equate emotion with volume. So everyone else plays louder. The volume is controlled by the naturally loudest instrument, which is the drums.”

“Personally,” countered a drummer, “I enjoy trying to maintain energy and interest at low volume – it’s challenging and fun, if frustratingly tricky.”

If this drummer plays at weddings here in Israel, I’ve yet to hear him. He belongs to an endangered species, and so I hope he’s taking good care of himself.

There’s always one poster who likes to be contrary, and in this case it was someone calling himself, perhaps understandably, SingleDad: “Most people have nothing to say to each other. The loudness the band provides relieves them of the embarrassment of exposing the shallowness of their personalities.”

TAKING A broader look at Israeli life, let’s agree that it tolerates a lot of noise, fitting well into the surrounding Mediterranean culture.

People talk loudly. Drivers sound their horns frequently, most irritatingly when they’re right behind you and the traffic light turns green, as if your dawdling is a foregone conclusion.

Unintelligible tinny piped ads in malls assail you when you’re trying to have coffee and quiet conversation with a friend. Stores and cafes play music that cannot, by any stretch of the imagination, be called “background,” more for the benefit of the staff, it often seems, than the customers.

When my husband and I went to pick up our gas masks at a local mall, there was a children’s show going on next to the collection point. Several rows of tots sat transfixed before a couple of costumed performers dancing to canned music amplified to a point of near-pain. We could barely stand the few minutes it took to reach the head of the distribution line, and I don’t know how the soldiers manning the station could function. It seemed criminal to expose young children’s ears to such a distorted notion of entertainment.

WITH ALL the above, it seems that over-loud music at weddings and other celebrations will, with some welcome exceptions, continue to be the rule here in Israel. For things to change, more and more people – specifically those who hire the bands and DJs – will have to be extremely firm about what they are prepared to put up with. For now, they are putting up with a great deal.

But just in case anyone planning a wedding is listening, I have a good interim solution that will keep everyone happy, and no one deprived or in pain. Here it is: Stage 1: Request good background music for the wedding reception – there’s an amazing musical array out there to choose from. Many people already do this.

Stage 2: Any music played during the actual ceremony will, by definition, be tolerable as to volume and short in duration. At religious weddings, decide on 10-15 minutes of joyful (loud) “mitzva dancing” immediately after the huppa – and no more at that time.

Stage 3 is where we depart from hallowed custom: Continue with background music during the entire meal, enabling guests to relax, enjoy the food and music and talk to friends and relatives they may not have seen in years. Serve all courses of the meal – except possibly dessert – one after the other, with no significant breaks. (The rabbis don’t forbid it, and it’s healthier to finish dinner earlier rather than later.) Stage 4: Let the band or DJ finally turn up the volume to their hearts’ content for those guests who adore loud music and want to dance until they drop. The rest of us can leave quite happily at this point, knowing we have participated in all the important parts of the celebration – and suffered not at all.

How’s that for an idea?

 

Fuente: The jerusalem post, Israel

http://www.jpost.com/Opinion/Columnists/In-my-own-write-Let-the-music-play

Acúfenos: Sección experiencias personales: Comprendiendo el sufrimiento de la gente: la perspectiva de un otorrinolaringólogo

Understanding people’s suffering: A doctor’s perspective

By JAY WOHLGELERNTER

06/23/2013

I will always try to remember that no matter how minor I think the patient’s condition is, to the person who is suffering it is frightening, depressing and very, very real.

Scheinder Children’s Hospital in Petah Tikva, Israel
 

The literature is full of moving, inspirational accounts of doctors’ experience as patients living through and sometimes dying from life-threatening illnesses. 

What about doctors who experience somewhat less serious conditions? I am an Ear-Nose-and-Throat specialist.

Unfortunately, I recently lost some hearing in my right ear.

Kind of funny, no? I spend most of my time trying to help people regain hearing, whether by removing earwax in the clinic or by performing cochlear implant surgery to give hearing to a deaf child.

 
 JAY WOHLGELERNTER MD.

I realize that my hearing loss is unilateral and mild. I realize that most of my patients have it much worse than me. My colleagues have reminded me of that as well. Surprisingly, none of that is particularly comforting.

Two weeks ago, I traveled to Jerusalem for a rehearsal in a TV pilot I was recently cast for the lead role in. Acting has always been my passion, but I haven’t given up medicine, yet. 

After making a quick stop at the famous Mahane Yehuda market and picking up some super-gooey and delicious rugalach, I started my trip back home to Ra’anana.

While descending from Jerusalem toward the coastal plain, my right ear plugged and I was unable to pop it open.

I was getting over a pretty bad cold at the time which is why my Eustachian tube didn’t function properly, and I couldn’t equalize the pressure in my ear. 

Okay, it happens. 

It usually takes a few minutes, a couple of swallows and maybe a good nose blow and everything goes back to normal.

Except this time it didn’t work.

Over the next few hours my ear became progressively plugged and I developed severe pain.

Over the weekend, the pain gradually resolved but my hearing didn’t return.

I wasn’t too concerned because I’ve seen this hundreds of times.

I dutifully followed the recommendations I have given every patient in the same situation. I started taking nasal steroids, antihistamines and decongestants. 

The negative pressure in my ear caused fluid to accumulate, interfering with the natural motion of the tympanic membrane and the three tiny ossicles or bones of the middle ear.

There are two types of hearing loss. Conductive hearing loss, which can be caused by common problems like earwax or fluid in the middle ear, is not a big deal. 

A little bit of cleaning or very minor surgery (tubes or grommets) generally cures it. Often no treatment is needed at all and the problem resolves spontaneously.

The other type of hearing loss, sensorineural hearing loss, is the bad kind. 

That is the type of hearing loss that comes with age, after excessive noise exposure, or when you take drugs that kill the cells in your cochlea. It is usually irreversible.

I knew that I had a conductive hearing loss. No biggie. Within a few days, at most a couple of weeks, the congestion resolves, the fluid drains, and my ear goes back to normal. 

I found it annoying having only one good ear but I really couldn’t complain. 

That same day, while I was at rehearsal, my brother-in-law sustained an injury during a basketball game and was rushed to the hospital where he underwent emergency surgery to try to save his eye.

 I wasn’t going to get too worked up about my temporary, minor problem.

The problem was, it didn’t seem to be getting better. If anything, my hearing was getting worse. On the second day I developed deafening ringing in my right ear, known as tinnitus.

 By the time I got back to work after the weekend I was beginning to get nervous. I had my ear checked by my colleagues.

(Actually, I checked it myself as well by attaching an endoscope to a screen and snaking it into my own ear. I won’t be doing that again for awhile!) My eardrum was significantly inflamed and my middle ear, normally an air-filled cavity, was halfway filled with blood.

Although it might come as a surprise to some, that was actually reassuring because it was consistent with conductive hearing loss.

By the next day, things weren’t improving, so I finally arranged for a formal hearing test. I couldn’t believe the results! I was in shock. I had actually sustained some sensorineural hearing loss in my right ear.

That’s when everything changed.

I realized that my ear might never get better. I had already been through denial, and now I started going through the other stages of Kubler-Ross grieving.

I was angry that I had driven to Jerusalem for that ill-fated rehearsal. Bargaining came in the form of megadoses of steroids to somehow try to stem the damage to my cochlea or auditory nerve, and possibly even reverse it.

By no means was I clinically depressed but I often felt sad about what I might miss should my hearing fail to return; The sound of my children laughing, the baby crying, localizing noise, understanding speech in a crowded room to name a few. 

Dammit, I know too much about hearing loss! Since then I have been inching closer to acceptance.

Through all this, however, the most eye-opening experience was hearing the remarks of my colleagues, including audiologists, nurses and physicians. 

They all made well-intentioned comments of a type I myself have made countless times to patients in similar situations: “Oh, that’s not so bad!” “You probably had it before and didn’t notice.”

No, I’m pretty sure I only stopped hearing the same day my ear popped! “I don’t believe the hearing test.”

Except for the fact that I have screaming tinnitus.

“Why are you upset? It’s so minor you are not even going to notice it.”

Newsflash: it’s driving me CRAZY! “It’s so mild it doesn’t even fulfill the criteria for treatment.”

I refer you to my earlier comment on bargaining and megadose steroids.

It’s a little bit ironic. I pride myself on communication skills and empathy. 

I’m a graduate of McMaster University Medical School, probably the world leader at training doctors in communicating with patients.

 My father is a psychiatrist and my mother is a social worker. I was pretty much born communicating. 

And here I am, on the other end of the otoscope, being schooled on what it means to have a “minor” condition.

One of the doctors was able to make me feel bit better by pointing out that I hadn’t even suffered this barotrauma due to one of the sexy causes, such as sky diving or scuba diving. 

I got it driving down a hill with a stuffy nose. Sometimes laughter is the best medicine.

A few days later, when I was feeling the full effects of the steroids in my mood swings, extreme fatigue, disturbed sleep patterns and ravenous appetite, 

I was bemoaning my condition over lunch to a friend of mine who is a pediatric lung specialist at Schneider Children’s Medical Center in Petah Tikva. 

He asked me very specific questions, demonstrating a rare and keen knowledge of hearing loss. He then proceeded to tell me about his own severe unilateral conductive hearing loss.

He has no idea what caused it, despite various attempts at diagnostic surgery and imaging. Hearing that his situation was much worse than mine didn’t make me feel any better. 

But instead of just rattling off how he really only needs one ear, how a hearing aid might be helpful and how we can try new diagnostic modalities, I was able to really feel his frustration and despair.

I still plan on doing everything I can to help, but I think a little bit of empathy probably helps as well.

If nothing else, I will always try to remember that no matter how minor I think the patient’s condition is, to the person who is suffering it is frightening, depressing and very, very real.

Since then I’ve been monitoring my hearing by asking my kids to whisper things in my right ear.

They almost always whisper “I love you, Daddy.”

(I have gotten “Can I play with your iPhone, Daddy” a few times as well.) My most recent audiogram shows my hearing has started to improve. The tinnitus is also almost gone. 

Turns out my prognosis may not be so bad in the end! Thankfully, my brother-in-law’s surgery was a success and his vision has been steadily improving.

We are taking it one day at a time.

The TV pilot was a flop. I guess I’ll have to keep my day job.

Becoming a Hollywood star is temporarily on hold.

The author, formerly from Toronto, Canada, is a pediatric ear nose and throat surgeon practicing at Scheinder Children’s Hospital in Petah Tikva.

He lives with his wife and four boys in Ra’anana.

Fuente: The Jerusalem Post. Israel

http://www.jpost.com/Opinion/Op-Ed-Contributors/Understanding-peoples-suffering-A-doctors-perspective-317484 

Acúfenos: Síntomas auditivos en los baby boomers; Audifonos, Sonido ambiental, Acúfenos, presbiacusia, sonidos que hacen doler

What Should Be Done About Hearing Loss?

By THE NEW YORK TIMES

Published: February 27, 2013 

Judging purely by the responses to Ask an Expert, hearing problems are an enormous concern for baby boomers, rivaled only by worries about memory. More than 200 people wrote to this week’s expert on hearing, Neil J. DiSarno. 

Dr. DiSarno is chief staff officer for audiology at the American Speech-Language-Hearing Association, and from 1998 to 2012 was chairman of the department of communication sciences and disorders at Missouri State University.

 

Neil J. DiSarno of the American Speech-Language-Hearing Association.

Because of the large response, not all questions can be answered individually. Dr. DiSarno is selecting representative questions on similar topics, and a second set of answers will appear on Booming next Wednesday. This feature is now closed to new questions.

 

Dr. DiSarno’s first set of answers follows.

As is quite evident from the number of comments readers sent in, hearing loss affects large numbers of baby boomers. 

Although I would like to have the time to answer each question individually, that is not possible. 

Those of you who have read the comments, however, see that they fall pretty neatly into seven or eight categories. I will address the questions by topic area.

First I would like to point out that although the effects of hearing loss differ as a result of type and degree of impairment, one important aspect to be mindful of is that the use of hearing aids is only part of a plan of treatment. 

Although it is a prime component, amplification in the form of hearing aids only brings sounds closer to the individual. 

How the individual’s auditory system processes that information differs considerably among those with impaired hearing.

This is one reason some individuals benefit greatly from the use of hearing aids and others somewhat less.

The treatment following the fitting of hearing aids includes extensive counseling that is tailored to the degree of impairment as well as the lifestyle of the individual user. 

Hearing aid users must establish realistic expectations with regard to the benefit they can expect. 

Although hearing aids have become more technologically advanced in recent years, it must be kept in mind that the auditory system is the most complex organ in the human body. 

When it becomes altered, either through the process of normal aging, or other health-related factors, it can leave the individual with limitations ranging from an inability to hear soft speech which is easily addressed by hearing aids, to complete inability to understand any speech information, even when using very powerful hearing aids.

Another factor to consider is the change that occurs in how the brain processes speech. 

Consider this example. A twenty-something and a sixty-something both have their hearing checked and learn that hearing is within normal limits. 

Each individual receives a cellphone call while dining in a very noisy restaurant. 

If you are me, you are amazed that the twenty-something appears to have no difficulty at all understanding the conversation. 

The sixty-something on the other hand can barely understand who they are speaking with, much less what is being said. Remember, each had quite good hearing on a hearing test.

The brain’s ability to understand speech in background noise undergoes changes and this imposes limitations on how the aging auditory system processes speech under those circumstances. 

Now, add a bit of hearing loss or a foreign accent to the cell phone situation and you can imagine, or probably already live with that frustration. 

Help can be found for many of the limitations impaired hearing imposes on an individual; however, appropriate counseling and realistic expectations are key to successful rehabilitation. 

Please understand that any advice in this section is provided without the benefit of seeing you as a patient.

 It is only with the knowledge of a complete medical history and a thorough audiological evaluation that accurate information can be provided. 

Please allow this to serve as a stepping-off point to allow you to research your condition further and to seek professional consultation

.

BACKGROUND NOISE

Q. After thorough testing, the Mayo Clinic told me that I had a slight hearing loss, but my difficulty separating sounds (as in a noisy restaurant) is caused by a brain function that can’t be alleviated by audiology modifications.

 What is the name of this disability, and are people being sold hearing aids that can’t deal with it very successfully? — George B., Creve Coeur, Mo. 

 

Q. I only have hearing problems in certain situations, e.g., at movies, crowded restaurants. If I got a hearing aid, would there be any problem wearing it in just those situations? — John Fisher, Winston-Salem, N.C.

 

A. Without seeing audiological test results from either George B. or John Fisher it is difficult to provide consultation as to whether hearing aids would help. 

An important fact to keep in mind is that most hearing loss occurs in the high-frequency range. 

This is the part of the hearing organ that typically produces awareness of sounds such as “s”, “f”, “th”, “p”, and “t”.

 An inability to hear these consonant sounds can cause considerable confusion when listening to speech. When listening in the presence of background noise, the damaged high-frequency portion of your hearing organ cannot provide you with accurate high-frequency speech information. 

You may easily confuse the word shoot with shoe, or hit with hip. 

Your inability to hear these high-frequency consonant sounds can certainly send your brain an inaccurate message.

The fortunate part of this condition is that these high-frequency sounds are some of the most visible sounds on a person’s lips. 

So, if you are able to see the speaker’s face, your brain can often fill in what your ears may have misunderstood. 

Positioning yourself in restaurants, at family dinners, or group settings where you are able to see the speaker’s face can improve your ability to follow conversation. 

Can hearing aids help as well? A properly fit hearing aid may boost up the damaged region of your hearing, in most cases this is the high-frequency portion. 

Depending on the degree of the damage, the boosted high-frequency sounds can fill in where your damaged hearing organ is lacking. 

The extent of the benefit you may receive is dependent upon several factors. 

Certainly you must give your brain a chance to get used to utilizing this new amplified information.

 A trial period of at least one month of consistent hearing aid use often times will provide you with the answer.

TINNITUS

Q. I’ve had tinnitus on my left ear since August 2011 but it was not annoying at first. Hearing tests show mild to moderate hearing loss on my left ear; however, for some inexplicable reason my tinnitus got very loud in October 2012. I suspect it was emotional stress.

 I have tried many things to lessen the sound and its effects on my mood and reaction including a hearing aid but nothing seems to help. I am only 25 and the hissing continues. 

The sound is destroying my life day by day! It is not life anymore it is torture. 

Can you please recommend something a college student like me can do to improve this unfortunate situation? And do you have any further knowledge on acoustic neuromodulation treatment offered in the U.K.? Thank you. — Henry, Sacramento

 

Q. Following surgery to repair a ruptured eardrum about five years ago, I experienced a catastrophic loss of high-frequency hearing in one ear.

 I wear a hearing aid in that ear and can get by except in the presence of high background noise (cocktail party effect). 

However, I’ve never completely adjusted to the tinnitus, which is not only intrusive and distracting but wakes me up at night. 

What are the latest developments in overcoming tinnitus? And is there anything on the horizon as far as hair cell regeneration? — Liza, Connecticut

 

Tinnitus refers to “ringing in the ears” or “head noises” when no other sound is present. 

Tinnitus can sound like hissing, roaring, pulsing, whooshing, chirping, whistling or clicking. Tinnitus can occur in one ear or both ears. 

It is a symptom common to many problems.

While the exact cause of tinnitus is unknown, it may be a symptom of other problems like hearing loss, exposure to loud noise, ototoxic medications, allergies or even too much wax in the ear canal. 

If you have tinnitus, chances are the cause will remain a mystery. 

The American Speech-Language-Hearing Association has more about commonly asked questions about tinnitus.

Both Henry and Liza as well as many others who have written are experiencing the effects of tinnitus to the point where it is disruptive to their lives, and both asked about the latest treatments.

 An advocacy group for tinnitus suffers is the American Tinnitus Association, and this link provides information about the latest research on tinnitus treatment, including neuromodulation treatment. 

With regard to hair cell regeneration to replenish the damaged sensory hair cells, a critical component to the hearing process, the National Institutes of Health provides information regarding recent advances in this area. Successes dealing with hair cell regeneration have so far been limited to animal studies. 

Some facts regarding tinnitus are:

¶One-third of all adults report experiencing tinnitus at some time in their lives. Ten to 15 percent of adults have prolonged tinnitus requiring medical/audiologic evaluation. 

¶Up to 18 percent of the general population of industrialized countries is mildly affected by chronic tinnitus, and 0.5 percent report tinnitus having a severe effect on the ability to lead a normal life. 

Tinnitus and hearing loss often go hand in hand. Contact an audiologist to find out if your tinnitus symptoms also include hearing loss. For a provider check here. If you have hearing loss as well as tinnitus, in some cases hearing aids can help.

Q. What is the latest research on tinnitus and treatments/cure? Congress is looking at this issue because so many of our returning military have tinnitus so hopefully that will mean more research dollars to benefit them as well as the rest of us who have tinnitus. — Anne Royal Oak, MI

 

A. New brain imaging techniques have led to insights about the connections between structures and function within the ear and in the cognitive process of the brain. 

These new imaging techniques suggest the possibility of more effective treatments for tinnitus and hyperacusis (oversensitivity to normal sounds; see question below). 

Imaging advances will also increase the knowledge about the plasticity of the brain and its ability to compensate for hearing dysfunction.

Q. Following surgery to repair a ruptured eardrum about five years ago, I experienced a catastrophic loss of high-frequency hearing in one ear (complicated story). I wear a hearing aid in that ear and can get by except in the presence of high background noise (cocktail party effect). However, I’ve never completely adjusted to the tinnitus, which is not only intrusive and distracting but wakes me up at night. What are the latest developments in overcoming tinnitus? And is there anything on the horizon as far as hair cell regeneration? – Liza, Connecticut

 

A. One area of exciting research involves inner ear hair cell regeneration with the use of stem cells. The discovery of both adult and embryonic stem cells in the inner ear and scientific evidence that they can be converted into hair cells raises hope for the development of stem-cell based treatments to regrow damaged hair cells. 

Researchers are studying precisely how hearing may have been damaged from exposure to loud noise or ear-damaging medications, known as ototoxic medications. 

This research is looking at the biology of the ear structures and chemistry to understand the role of free radicals, highly reactive molecules in the body. 

Free radicals are a result of stress (oxidation) on the inner ear tissues and can lead to cell death. Several pharmaceutical interventions based on natural and synthetic antioxidants are being studied. 

AGE-RELATED HEARING LOSS

 

Q. I am 63 years old. I blame my “hearing loss” on cell phones and poor audio quality of DVDs and inconsiderate people who talk from distant rooms, but my wife is not buying it. I can hear fine if someone speaks to me face to face, but . . . Is it me? — John, Memphis

 

Q. After thorough testing, Mayo Clinic told me I had slight hearing loss, but my difficulty separating sounds (as in a noisy restaurant) is caused by a brain function that can’t be alleviated by audiology modifications. What is the name of this disability, and are people being sold hearing “aids” that can’t deal with it very successfully? — George B., Creve Coeur, Missouri

 

A. Age-related hearing loss, or presbycusis, is increasing as the baby-boom generation grows older. Scientists are still trying to determine whether the age-related deficit is mostly due to loss of sensitivity in the inner ear. Increasingly, research suggests that other areas within the hearing system may be affected.

For example, it has been found that the brain processes sound less quickly with advancing age. 

This suggests that a major contributor to poor speech understanding in older people is poor processing of sound in the brain. 

Thus, simple hearing aid strategies that only address damage in the inner ear by amplifying sound may not solve the communication problems often expressed by older hearing aid users. 

An emerging area of research is looking at a link between noise exposure and the degree and rate of development of presbycusis. 

What we know now is that exposure to loud levels of noise over time will increase the ear’s vulnerability to the aging process.

PAINFULLY LOUD SOUNDS

 

Q. Would like to learn more about “recruitment.” Although I have a moderate to severe hearing loss, I notice that sounds that others can tolerate are painfully loud to me. This seem paradoxical; can you explain to me how and why this happens? — Jerry M., Little Rock, Ark.

 

Q. What is the latest information on helping people who have tinnitus and hyperacusis caused by having a bad case of the flu or a virus. 

This happened to me in 1991 and actually the hyperacusis is harder to deal with than the tinnitus, which never stops hissing and screaming. 

Have you seen any success with acupuncture treatment? — Chadds Ford, Pa.

 

A. Recruitment is a condition sometimes observed in people with known damage to the hair cells of the inner ear and/or the damaged auditory nerve cells to which they are connected. 

Although it seems paradoxical, consider this situation. An individual without hearing loss has a tone presented to one ear just barely above the level he can hear (his hearing threshold) and he responds that yes, he hears a very soft tone. 

An individual with impaired hearing is also presented with a tone that is just above his threshold of impaired hearing and he reports that yes, he hears a very soft tone. 

The level of the tone is brought up the same amount (e.g., 20 dB additional) for the normal hearing individual and he reports that the tone is a little louder. 

The same additional 20 dB of loudness is presented to the individual with impaired hearing and he reports that the new tone is much louder than the original tone and may be approaching a painfully loud level.

The impaired ear is experiencing an abnormal growth of loudness. 

Recruitment is defined as an abnormal perception of loudness and is seen in some people with sensory and/or neural hearing loss. 

Hyperacusis is a rare hearing disorder that causes sounds which would otherwise seem normal to most people to sound unbearably loud. 

People who suffer from hyperacusis may even find normal environmental sounds to be too loud.

Hyperacusis is not discomfort around loud sounds. Individuals with hyperacusis may find a car engine, dishes clanking, rustling of paper or even loud conversation uncomfortable enough to avoid such situations.

Many people with hyperacusis have normal hearing.

The disorder can occur in one or both ears and is often accompanied by tinnitus (ringing or buzzing in the ear). It is reported that 1 in 50,000 people has hyperacusis and that 1 in 1,000 people who have tinnitus will also have hyperacusis.

There are some diseases or disorders that are linked to hyperacusis, like Bell’s palsy, chronic fatigue syndrome, Lyme disease, Ménière's disease, post-traumatic stress disorder, depression and autism.

Additionally, hyperacusis is seen in patients who have experienced a head trauma, such as an air bag deployment, surgery to the jaw or face, or a viral infection of the inner ear. 

One major cause of hyperacusis is loud noise exposure. It may be triggered by a single intense noise such as a gunshot, or it may develop gradually from listening to loud noise without hearing protection. 

People exposed to loud levels of noise through their occupation, whether as a machinist or a musician, should be protective of their hearing to avoid noise-induced hearing loss and other changes in their hearing such as tinnitus or hyperacusis. 

Depending on the cause, hyperacusis may get better with time. 

Specifically, in cases of trauma to the brain or hearing system, there is a chance that the sensitivity to sounds will become more tolerable. 

In cases where the cause is not clear, however, relief may not come on its own. 

I do not have any personal experience with acupuncture as a successful treatment for hyperacusis.

Many people who suffer from hyperacusis get by in their everyday life by wearing earplugs or earmuffs to reduce incoming sound levels that may be bothersome or by withdrawing from social situations that may have uncomfortable sounds present. This is a logical response.

But these strategies may not work — hyperacusis sufferers may be furthering their poor tolerance to relatively soft sounds. 

Wearing earplugs or earmuffs may provide immediate relief from an environment that seems uncomfortably loud, but when the individual eventually removes the earplugs or earmuffs, that environment will seem even louder than it might have otherwise.

Additional resource: http://www.hyperacusis.org/

On March 6, Booming will post Dr. DiSarno’s answers about hearing aids, cochlear implants, genetic causes of hearing loss, ear wax and other hearing issues.

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at booming@nytimes.com.

Fuente: The New York Times
http://www.nytimes.com/2013/02/27/booming/what-should-be-done-about-hearing-loss.html?pagewanted=all

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

Hearing Things. The Wrong Kind of Things.

By DAVID MERMELSTEIN

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