Medicine.com

Urinary Tract Infections

2008-08-09T05:47:00.000-07:00

Urinary tract infection introduction

Urinary tract infections are a serious health problem affecting millions of people each year.

Infections of the urinary tract are the second most common type of infection in the body. Urinary tract infections (UTIs) account for about 8.3 million doctor visits each year. Women are especially prone to UTIs for reasons that are not yet well understood. One woman in five develops a UTI during her lifetime. UTIs in men are not as common as in women but can be very serious when they do occur.

The urinary system consists of the kidneys, ureters, bladder, and urethra. The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The kidneys remove excess liquid and wastes from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce a hormone that aids the formation of red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder, a sack-like organ in the lower abdomen. Urine is stored in the bladder and emptied through the urethra.

The average adult passes about a quart and a half of urine each day. The amount of urine varies, depending on the fluids and foods a person consumes. The volume formed at night is about half that formed in the daytime.

What are the causes of UTI?

Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi but does contain fluids, salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. The urethra is the tube that carries urine from the bladder to outside the body. Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon.

In many cases, bacteria first travel to the urethra. When bacteria multiply, an infection can occur. An infection limited to the urethra is called urethritis. If bacteria move to the bladder and multiply, a bladder infection, called cystitis, results. If the infection is not treated promptly, bacteria may then travel further up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis.

Microorganisms called Chlamydia and Mycoplasma may also cause UTIs in both men and women, but these infections tend to remain limited to the urethra and reproductive system. Unlike E. coli, Chlamydia and Mycoplasma may be sexually transmitted, and infections require treatment of both partners.

The urinary system is structured in a way that helps ward off infection. The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur.

Who is at risk?

Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone, for example) sets the stage for an infection. An enlarged prostate gland also can slow the flow of urine, thus raising the risk of infection.

A common source of infection is catheters, or tubes, placed in the urethra and bladder. A person who cannot void or who is unconscious or critically ill often needs a catheter that stays in place for a long time. Some people, especially the elderly or those with nervous system disorders who lose bladder control, may need a catheter for life. Bacteria on the catheter can infect the bladder, so hospital staff take special care to keep the catheter clean and remove it as soon as possible.

People with diabetes have a higher risk of a UTI because of changes in the immune system. Any other disorder that suppresses the immune system raises the risk of a urinary infection.

UTIs may occur in infants, both boys and girls, who are born with abnormalities of the urinary tract, which sometimes need to be corrected with surgery. UTIs are more rare in boys and young men. In adult women, though, the rate of UTIs gradually increases with age. Scientists are not sure why women have more urinary infections than men. One factor may be that a woman's urethra is short, allowing bacteria quick access to the bladder. Also, a woman's urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear.

According to several studies, women who use a diaphragm are more likely to develop a UTI than women who use other forms of birth control. Recently, researchers found that women whose partners use a condom with spermicidal foam also tend to have growth of E. coli bacteria in the vagina.

Recurrent infections

Many women suffer from frequent UTIs. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another. Of the last group, 80 percent will have recurrences.

Usually, the latest infection stems from a strain or type of bacteria that is different from the infection before it, indicating a separate infection. Even when several UTIs in a row are due to E. coli, slight differences in the bacteria indicate distinct infections.

Research funded by the National Institutes of Health (NIH) suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach to cells lining the urinary tract. A recent NIH-funded study found that bacteria formed a protective film on the inner lining of the bladder in mice. If a similar process can be demonstrated in humans, the discovery may lead to new treatments to prevent recurrent UTIs. Another line of research has indicated that women who are "non-secretors" of certain blood group antigens may be more prone to recurrent UTIs because the cells lining the vagina and urethra may allow bacteria to attach more easily. Further research will show whether this association is sound and proves useful in identifying women at high risk for UTIs.

Infections in pregnancy

Pregnant women seem no more prone to UTIs than other women. However, when a UTI does occur in a pregnant woman, it is more likely to travel to the kidneys. According to some reports, about 2 to 4 percent of pregnant women develop a urinary infection. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many doctors recommend periodic testing of urine during pregnancy.

What are the symptoms of UTI?

Not everyone with a UTI has symptoms, but most people get at least some symptoms. These may include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination. It is not unusual to feel bad all over -- tired, shaky, washed out -- and to feel pain even when not urinating. Often women feel an uncomfortable pressure above the pubic bone, and some men experience a fullness in the rectum. It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if blood is present. Normally, a UTI does not cause fever if it is in the bladder or urethra. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting.

In children, symptoms of a urinary infection may be overlooked or attributed to another disorder. A UTI should be considered when a child or infant seems irritable, is not eating normally, has an unexplained fever that does not go away, has incontinence or loose bowels, or is not thriving. Unlike adults, children are more likely to have fever and no other symptoms. This can happen to both boys and girls. The child should be seen by a doctor if there are any questions about these symptoms, especially a change in the child's urinary pattern.

How is a UTI diagnosed?

To find out whether you have a UTI, your doctor will test a sample of urine for pus and bacteria. You will be asked to give a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample of urine in a sterile container. This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results. Usually, the sample is sent to a laboratory, although some doctors' offices are equipped to do the testing.

In the urinalysis test, the urine is examined for white and red blood cells and bacteria. Then the bacteria are grown in a culture and tested against different antibiotics to see which drug best destroys the bacteria. This last step is called a sensitivity test.

Some microbes, like Chlamydia and Mycoplasma, can be detected only with special bacterial cultures. A doctor suspects one of these infections when a person has symptoms of a UTI and pus in the urine, but a standard culture fails to grow any bacteria.

When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor may order some tests to determine if your system is normal. One of these tests is an intravenous pyelogram, which gives x-ray images of the bladder, kidneys, and ureters. An opaque dye visible on x-ray film is injected into a vein, and a series of x-rays is taken. The film shows an outline of the urinary tract, revealing even small changes in the structure of the tract.

If you have recurrent infections, your doctor also may recommend an ultrasound exam, which gives pictures from the echo patterns of soundwaves bounced back from internal organs. Another useful test is cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see inside the bladder from the urethra.

How is UTI treated?

UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin). A class of drugs called quinolones includes four drugs approved in recent years for treating UTI. These drugs include ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan).

Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or other disorder. Still, many doctors ask their patients to take antibiotics for a week or two to ensure that the infection has been cured. Single-dose treatment is not recommended for some groups of patients, for example, those who have delayed treatment or have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate infections. Longer treatment is also needed by patients with infections caused by Mycoplasma or Chlamydia, which are usually treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. A followup urinalysis helps to confirm that the urinary tract is infection-free. It is important to take the full course of treatment because symptoms may disappear before the infection is fully cleared.

Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own. Kidney infections generally require several weeks of antibiotic treatment. Researchers at the University of Washington found that 2-week therapy with TMP/SMZ was as effective as 6 weeks of treatment with the same drug in women with kidney infections that did not involve an obstruction or nervous system disorder. In such cases, kidney infections rarely lead to kidney damage or kidney failure unless they go untreated.

Various drugs are available to relieve the pain of a UTI. A heating pad may also help. Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria. During treatment, it is best to avoid coffee, alcohol, and spicy foods. And one of the best things a smoker can do for his or her bladder is to quit smoking. Smoking is the major known cause of bladder cancer.

Recurrent infections in women

Women who have had three UTIs are likely to continue having them. Four out of five such women get another within 18 months of the last UTI. Many women have them even more often. A woman who has frequent recurrences (three or more a year) can ask her doctor about one of the following treatment options:

Take low doses of an antibiotic such as TMP/SMZ or nitrofurantoin daily for 6 months or longer. If taken at bedtime, the drug remains in the bladder longer and may be more effective. NIH-supported research at the University of Washington has shown this therapy to be effective without causing serious side effects.

Take a single dose of an antibiotic after sexual intercourse.

Take a short course (1 or 2 days) of antibiotics when symptoms appear.

Dipsticks that change color when an infection is present are now available without a prescription. The strips detect nitrite, which is formed when bacteria change nitrate in the urine to nitrite. The test can detect about 90 percent of UTIs when used with the first morning urine specimen and may be useful for women who have recurrent infections.

Doctors suggest some additional steps that a woman can take on her own to avoid an infection:

Drink plenty of water every day.

Urinate when you feel the need; don't resist the urge to urinate.

Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.

Take showers instead of tub baths.

Cleanse the genital area before sexual intercourse.

Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.

Some doctors suggest drinking cranberry juice.

Infections in pregnancy

A pregnant woman who develops a UTI should be treated promptly to avoid premature delivery of her baby and other risks such as high blood pressure. Some antibiotics are not safe to take during pregnancy. In selecting the best treatments, doctors consider various factors such as the drug's effectiveness, the stage of pregnancy, the mother's health, and potential effects on the fetus.

Complicated infections

Curing infections that stem from a urinary obstruction or other systemic disorders depends on finding and correcting the underlying problem, sometimes with surgery. If the root cause goes untreated, this group of patients is at risk of kidney damage. Also, such infections tend to arise from a wider range of bacteria, and sometimes from more than one type of bacteria at a time.

Infections in men

UTIs in men are often a result of an obstruction -- for example, a urinary stone or enlarged prostate -- or from a medical procedure involving a catheter. The first step is to identify the infecting organism and the drugs to which it is sensitive. Usually, doctors recommend lengthier therapy in men than in women, in part to prevent infections of the prostate gland.

Prostate infections (chronic bacterial prostatitis) are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. For this reason, men with prostatitis often need long-term treatment with a carefully selected antibiotic. UTIs in older men are frequently associated with acute bacterial prostatitis, which can have serious consequences if not treated urgently.

Is there a vaccine to prevent recurrent UTIs?

In the future, scientists may develop a vaccine that can prevent UTIs from coming back. Researchers in different studies have found that children and women who tend to get UTIs repeatedly are likely to lack proteins called immunoglobulins, which fight infection. Children and women who do not get UTIs are more likely to have normal levels of immunoglobulins in their genital and urinary tracts.

Early tests indicate that a vaccine helps patients build up their own natural infection-fighting powers. The dead bacteria in the vaccine do not spread like an infection; instead, they prompt the body to produce antibodies that can later fight against live organisms. Researchers are testing injected and oral vaccines to see which works best. Another method being considered for women is to apply the vaccine directly as a suppository in the vagina.

For more information

American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 1-866-RING–AUA (746-4282) or 410-689-3700
Fax: 410-689-3800
Email: aua@auanet.org
Internet: www.urologyhealth.org

The Prostatitis Foundation
1063 30th Street, Box 8
Smithshire, IL 61478
Phone: 1-888-891-4200
Fax: 309-325-7184
Email: mcapston@aol.com
Internet: www.prostatitis.org

Urinary Tract Infection in Adults At A Glance

The urinary tract consists of the kidneys, ureters, bladder, and urethra.
Some people are at more risk for urinary tract infections (UTIs) than others.
One woman in five develops a UTI during her lifetime.
Not everyone with a UTI has symptoms. Common symptoms include a frequent urge to urinate and a painful, burning when urinating.
Underlying conditions that impair the normal urinary flow can lead to more complicated UTIs.
What is a urinalysis?

A urinalysis is simply an analysis of the urine. It is a very common test that can be performed in many healthcare settings including doctors' offices, urgent care facilities, laboratories, and hospitals.
It is performed by collecting a urine sample from the patient in a specimen cup. Usually only small amounts (10-15 ml's) may be required for urinalysis testing.

What can a urinalysis show?

Urinalysis can disclose evidence of diseases, even some that have not caused significant signs or symptoms. Therefore, a urinalysis is commonly a part of routine health screening.
Urinalysis is also a very useful test that may be ordered by your physician for particular reasons. Urinalysis is commonly used to diagnose a urinary tract or kidney infection, to evaluate causes of kidney failure, to screen for progression of some chronic conditions such as diabetes mellitus and high blood pressure (hypertension).
It also may be used in combination with other tests to diagnose some diseases. Examples of this include kidney stones, inflammation of the kidneys (glomerulonephritis), or muscle break breakdown (rhabdomyolysis).
Interpretation of urinalysis is generally based on reviewing all the components of the test as well as the clinical symptoms and signs of the patient.
What does urinalysis involve?

Urinalysis is done by collecting a urine sample from a patient. The optimal sample tends to be an early morning urine sample because it is frequently the most concentrated urine produced in the day.
Methods of collection are slightly different for female and male patient.
For females, the patient is asked to clean the area around the urethra with a special cleansing wipe, by spreading the labia of the external genitals and cleaning from front to back (toward the anus).
For men, the tip of the penis may be wiped with a cleansing pad prior to collection.
The urine is then collected in a clean urine specimen cup while the patient is urinating. It is best to avoid collecting the initial stream of urine. After the initial part of urine is disposed of in the toilet, then the urine is collected in the urine container provided. Once about 10-15 ml (roughly 3-4 tablespoons) are collected in the container for testing, the remainder of the urine may be voided in the toilet again. This is called the clean catch or the midstream urine collection.

The collected urine sample should be taken to the laboratory for analysis, typically within one hour of collection. If transportation to the lab could take more than one hour, then the sample may be refrigerated.

In some patients who are unable to void spontaneously or those who are not able to follow instructions other methods may be used, such as placing a catheter (a small rubber tube) through the outside opening to the bladder (urethra) to collect the sample directly from the bladder.

What is macroscopic urinalysis?

Macroscopic urinalysis is the direct visual observation of the urine, noting its quantity, color, clarity or cloudiness, etc.

Normal urine is typically light yellow and clear without any cloudiness. Obvious abnormalities in the color, clarity, and cloudiness may suggest possibility of an infection, dehydration, blood in the urine (hematuria), liver disease, breakdown of muscle or red blood cells in the body. Certain medications may also change the color of urine. Very foamy urine may represent large amounts of protein in the urine (proteinuria).

What is urine dipstick chemical analysis?

Urine dipstick is a narrow plastic strip which has several squares of different colors attached to it. Each small square represents a component of the test used to interpret urinalysis. The entire strip is dipped in the urine sample and color changes in each square are noted. The color change takes place after several seconds to a few minutes from dipping the strip. If read too early or too long after the strip is dipped, the results may not be accurate.

The squares on the dipstick represent the following components in the urine:

specific gravity (concentration of urine),
acidity of the urine (pH),
protein in the urine (mainly albumin),
glucose (sugar),
ketones (products of fat metabolism),
blood, leukocyte esterase (produced by white blood cells in urine),
nitrite (produced by bacteria in urine),
bilirubin (possible liver disease or red blood cell breakdown), and
urobilinogen (possible liver disease).

Presence or absence of each of these color changes on the strip provides important clues for your doctor to make clinical decisions based on the urinalysis results.

What are the pros and cons of dip sticks?

The main advantage of dipsticks is that they are convenient, easy to interpret, and cost-effective for urinalysis testing. They can be analyzed within minutes of urine collection in the doctor's office or in the emergency room to provide valuable information.

However, what can be learned from a dipstick is limited by the design of the dipstick. The main disadvantage is that the information may not be very accurate as the test is time-sensitive. It also provides limited information about the urine as it is qualitative test and not a quantitative test (for example, it does not give a precise measure of the quantity of abnormality).

What is microscopic urinalysis?

The microscopic urinalysis is the study of the urine under the microscope. It requires only a relatively inexpensive light microscope. Cells and cellular debris, bacteria, and crystals in the urine can detected by this examination to provide further clinical clues.

How is microscopic urinalysis done?

Microscopic urinalysis is done simply pouring the urine sample into a test tube and centrifuging it (spinning it down in a machine) for a few minutes. The top liquid part (the supernatant) is discarded. The solid part left in the bottom of the test tube (the urine sediment) is mixed with the remaining drop of urine in the test tube and one drop is analyzed under a microscope.

First, the sediment is examined through the microscope under low-power to identify what are called casts, crystals, squamous (flat) cells, and other large objects.

Examination is then performed through the microscope at high power to further identify any cells, bacteria and clumps of cells or debris called casts.

What kind of cells can be detected?

Epithelial (flat cells) and red and white blood cells may be seen in the urine.

Sometimes cells, cellular debris, and casts are seen in the microscopic urinalysis. Epithelial cells (cells in the lining of the bladder or urethra) may suggest inflammation within the bladder, but they also may originate form the skin and could be contamination.

Casts and cellular debris originate from higher up in the urinary tract, such as in the kidneys. These are material shed from kidney cell lining and travel down through the urinary tubes. These usually suggest an injury to the kidney from an inflammation or lack of blood flow to the kidneys. Rarely, tumor cells can be in the urine suggesting a urinary tract cancer.

What can the presence of red blood cells in the urine mean?

Red blood cells can enter the urine from the vagina in menstruation or from the trauma of bladder catherization.

A high count of red blood cells in the urine can indicate infection, trauma, tumors, kidney stones. If red blood cells seen under microscopy look distorted, they suggest kidney as the possible source and may arise due to kidney inflammation (glomerulonephritis). Small amounts of red blood cells in the urine are sometimes seen young healthy people and not indicative of any disease.

What can the presence of white blood cells in the urine mean?

Urine is a generally thought of as a sterile body fluid, therefore, evidence of white blood cells or bacteria in the urine is considered abnormal and may suggest a urinary tract infection such as, bladder infection (cystitis), infection of kidney (pyelonephritis). White blood cells may be detected in the urine through a microscopic examination (pyuria or leukocytes in the blood). They can be seen under high power field and the number of cells are recorded (quantitative).

White cells from the vagina or the opening of the urethra (in males, too) can contaminate a urine sample. Such contamination aside, the presence of abnormal numbers of white blood cells in the urine is significant.

Hearing Loss,Deafness andCommunications Disorder

2008-08-05T09:42:00.000-07:00

Ten Ways to Recognize Hearing Loss:

More than 28 million Americans are deaf or hard of hearing and 30 million more are exposed to dangerous levels of noise. Levels of hearing impairment vary from a mild but important loss of sensitivity, to a total loss of hearing. The largest group of Americans suffering from hearing loss is the elderly. Age-related hearing loss affects 30 to 35 percent of the U.S. population between the ages of 65 and 75 years, and 40 percent of the population over the age of 75. The most common cause of hearing loss in children is otitis media, a disorder that affects predominantly infants and young children. A substantial number of hearing impairments are caused by environmental factors such as noise, drugs, and toxins. Many acquired sensorineural hearing losses may result from a genetic predisposition. Important progress has been made during the last decade in understanding the auditory system.

The following questions will help you determine if you need to have your hearing evaluated by a medical professional:

1. Do you have a problem hearing over the telephone? Yes or No

2. Do you have trouble following the conversation when two or more people are talking at the same time? Yes or No

3. Do people complain that you turn the TV volume up too high? Yes or No

4. Do you have to strain to understand conversation? Yes or No

5. Do you have trouble hearing in a noisy background? Yes or No

6. Do you find yourself asking people to repeat themselves? Yes or No

7. Do many people you talk to see to mumble (or not speak clearly)?

8. Do you misunderstand what others are saying and respond inappropriately? Yes or No

9. Do you have trouble understanding the speech of women and children?

10. Do people get annoyed because you misunderstand what they say? Yes or No

If you answered "yes" to three or more of these questions, you may want to see an otolaryngologist (an ear, nose, and throat specialist) or an audiologist for a hearing evaluation.
What is the importance of noise induced hearing loss?

The industrial and technological revolution may have propelled society to higher levels of achievement. At the same time, however, this progress has also made the world a noisier place in which to live. In fact, noise pollution is a growing health hazard and is everywhere. Car alarms, leaf blowers, gunshots, boom boxes, and traffic congestion fill our cities with decibels (the measure of sound intensity). Even escaping to the country may not provide a quiet refuge. Thus, farmers are at high risk for exposure to noise from their farm machinery.

What's more, potentially harmful noise is not necessarily unpleasant or unwanted. For example, the music at a concert or the pounding of a jackhammer on the street can be equally damaging to the inner ear. The reason for this is that any sounds (acoustic energies) delivered with equal intensity, regardless of their source, are equally dangerous. Eventually, continued or repeated exposures to high intensity sound can cause acoustic trauma to the ear. This trauma can result in hearing loss, ringing in the ears (tinnitus), and occasional dizziness (vertigo), and nonauditory effects, such as increases in heart rate and blood pressure.

One-third of the 30 million Americans with hearing loss have an impairment that is at least partially attributed to excessive noise exposure. Noise remains the most common preventable cause of irreversible sensorineural (involving the ear's sensory nerve) hearing loss.

What are acoustic trauma and noise induced hearing loss?

Acoustic trauma occurs when any excessive sound energy strikes the inner ear. If it is brief, the noise may cause a reversible, temporary auditory fatigue, technically known as a temporary threshold shift. For example, after a loud rock concert, it is common to experience hearing dullness and ringing for several hours. In this situation, if symptoms persist beyond several days, oral steroids (cortisone-type medications) may help the inner ear recover. If the noise is loud enough and the duration of exposure long enough, however, it may cause a permanent threshold shift. This condition is called noise induced hearing loss, and has no cure and is irreversible.

Hearing loss produced by a sudden and very loud noise (blast injury) is called acute acoustic trauma. If the sound is loud enough, it can cause the eardrum to rupture or the person to have a complete loss of hearing. Sometimes, particularly if the sudden loss is total and combined with dizziness, immediate surgical exploration of the ear may be necessary. In this circumstance, the ear surgeon may need to locate and patch a hole (perilymphatic fistula) between the inner ear fluid space and the middle ear space.

How can a person tell if a noisy situation is dangerous to their hearing?

People may differ in their sensitivity to noise. Nevertheless, as a general rule, noise is probably damaging to the hearing if the noise:

Makes it necessary to shout to be heard over the background noise
Causes ear pain
Makes the ears ring
Causes a loss of hearing for several hours or more after exposure to the noise

In contrast to popular belief, there is no truth to the idea that a person is able to "toughen up" the ears by frequent exposure to loud noise. In reality, cumulative noise in the past has probably damaged the ears to such a degree that a person doesn't hear the noise as much. Unfortunately, no treatment is available for noise induced hearing loss once the damage has occurred.

How loud can a sound get before it affects hearing?

Many experts agree that continual exposure to more than 85 decibels (dB) may be dangerous to the ears. As already mentioned, the decibel is a measure of the intensity of sound. The faintest sound the human ear can detect is labeled 0 dB, whereas the noise at a rocket pad during launch approaches 180 dB. A quite whisper is approximately 30 dB, normal conversation is 60 dB, and a lawnmower is 90 dB. Decibels are measured logarithmically, which means that the sound energy of noise increases by units of 10. Therefore, a dB increase of a sound from 20 to 30 dB is an increase of 10 times, and a db increase of a sound from 20 to 40 dB is an increase of 100 times (10 times 10).

Do the duration and closeness of exposure to loud noise relate to hearing damage?

There is a direct correlation between the duration of exposure to a loud noise and the damage to hearing. This means that the longer the exposure, the more the damage. Furthermore, the closer one is to the source of the intense noise, the more damaging it is. For example, a gunshot produces a noise that could damage the ears of anyone in close hearing range. Large bore guns and artillery are the worst because they are the loudest. But even a cap gun or a firecracker can damage the hearing if the explosion is close to the ears. Accordingly, anyone who uses firearms must wear hearing protection.

Studies have shown an alarming increase in hearing loss in children and young adults. Evidence suggests that loud music along with increased use of portable CD players with earphones may be responsible for this increase. Here, the problem is the long duration and close exposure to the loud music.

What factors increase a person's susceptibility to noise induced hearing loss?

The following factors have been associated with an increased susceptibility to noise induced hearing loss:

Blue eyes
Light skin
Family history of hearing loss
Diabetes mellitus
Meniere disease
Iron deficiency
Vitamin A deficiency
Older age
Atherosclerosis (hardening of the arteries)
Smoking tobacco

How else can noise affect a person?

After exposure to noise, tinnitus, which is a ringing or another sound in the ears, occurs commonly. The tinnitus is a sign that inner ear damage or nerve destruction has occurred. Initially the tinnitus will just be temporary, lasting only several hours. As more cumulative exposure and damage occur, the tinnitus will last longer until eventually it will become permanent.

· Loud noise will also cause some people to have anxiety and irritability, an increase in heart rate and blood pressure, or an increase in stomach acid. In addition, very loud noise can reduce efficiency in performing difficult tasks by diverting attention from the job.

What are the regulations regarding on-the-job exposure to noise?

Habitual exposure to noise above 85dB will cause a gradual hearing loss in a significant number of individuals. Moreover, noise greater than 85dB will accelerate this damage. Accordingly, the Occupational Safety and Health Administration (OSHA) has imposed regulations nationwide regarding on-the-job exposure to noise. For unprotected ears, the allowed exposure time decreases by one half for each 5 dB increase in the average noise level. For instance, exposure is limited to 8 hours at 90 dB, 4 hr at 95 dB, and 2 hr at 100 dB. The highest permissible noise exposure for the unprotected ear is 115 dB for 15 minutes per day. Any noise above 140 dB is not permitted.

· OSHA, in its Hearing Conservation Amendment of 1983, required the institution of a hearing conservation program in noisy workplaces. Such a program must include a yearly hearing test for workers exposed to an average of 85 dB or more of noise during their 8-hour workday. It turns out that approximately 25% of the American industrial workforce is exposed to this much noise.

· Ideally, noisy machinery and work places should be designed to be quieter and/or the workers' time in the noise should be reduced. The cost of reducing noise exposure in these ways, however, is often prohibitive. As an alternative, individual hearing protectors are required when noise averages more than 90 dB during an 8-hour day.

· When noise measurements indicate that hearing protectors are needed, the employer must offer at least one type of earplug and one type of earmuff without cost to employees. If the yearly hearing test reveals a hearing loss of 10 dB or more in the higher sound frequencies (pitch) in either ear, the worker must be informed. (The higher frequencies of sound are the most sensitive to noise damage.) Also, the worker must wear hearing protectors when noise averages more then 85 dB for an 8-hour day. Greater losses of hearing or the possibility of ear disease necessitates referral to an ear doctor (otolaryngologist).

How effective are hearing protection devices?

Hearing protection devices decrease the intensity of sound that reaches the eardrum. They come in two forms: earplugs and earmuffs.

Earplugs: Earplugs are small inserts that fit into the outer ear canal. To be effective they must totally block the ear canal with an airtight seal. They are available in a variety of shapes and sizes to fit individual ear canals and can be custom made. For people who have trouble keeping them in their ears, they can be fitted to a headband.

Earmuffs: Earmuffs fit over the entire outer ear to form an air seal. They are held in place by an adjustable band. Earmuffs must be snugly sealed so the entire circumference of the ear canal is blocked.

· Properly fitted earplugs or muffs reduce noise by 15 to 30 dB of sound. The better earplugs and earmuffs are approximately equally effective in sound reduction. However, earplugs are better protection against low frequency noise (such as noise from a jackhammer), and earmuffs are better protection against high frequency noise, (such as noise from an airplane taking off). For high frequency sounds, think of the high-pitched treble keys of the piano, whereas for low frequency sounds, think of the low- or deep-pitched bass keys of the piano.

· Simultaneous use of earplugs and muffs usually adds 10 to 15 dB more protection than either used along. Combined use should be considered when the noise exceeds 105 dB. It is important to understand that ordinary cotton balls or tissue paper wads stuffed into the ear canals are very poor protectors since they only reduce noise by approximately 7 dB.

· Excessive noise exposure may occur at live rock concerts as well as in more intimate venues for music whenever amplification is utilized. The damage to hearing from music is every bit as permanent as that incurred by other means. As a matter of fact, special high-fidelity earplugs have been developed specifically for such situations and are being utilized by musicians and professional sound engineers. These earplugs are specially designed to eliminate the so-called plugged (occluded) ear effect and to maintain an even reduction of sound across the frequency range. Otherwise, when the ear is plugged, the plugged ear effect makes one's voice sound more bass, or deeper, and louder. Try it by occluding your ear(s) (gently) with your finger, and speak. You'll hear the plugged ear effect.

How Do I Choose the Hearing Aid that’s Right for Me?

Choosing a hearing aid is an important decision, but it doesn’t have to be a difficult decision. Look for the highest quality aid available, and don’t forget to ask about the service, which is so important to being satisfied with your product.

Styles of Hearing Aids

Wide selection of sizes available

These six sizes are divided into three styles: Behind-the-Ear, Comfort and Cosmetic.

Many Styles – All Advanced Technology

Behind-The-Ear (BTE)

BTE aids offer a secure fit, with wide fitting flexibility. If other hearing aids have left you with a less than perfect fit, Behind-the-Ear may be the most satisfying style for you.

Open Fit Behind-The-Ear (BTE)/Receiver in the Canal (RIC) BTE

Combining a virtually invisible behind-the-ear design with all the modern advances of high-end digital technology, Open Fit and RIC BTE’s offers a discrete look with first class performance; providing some of the most natural sound available today.

Comfort Styles

Also referred to as "semi-contour" or "contour," these hearing aids typically offer more features and options than smaller instruments.

Cosmetic Styles

Virtually invisible to other people, these tiny hearing aids are placed in the ear canal.

What are the common problems with hearing protectors?

Studies have shown that one-half of the workers wearing hearing protectors receive only one-half or less of the noise reduction potential of their protectors. This diminished protection occurs because these devices either are not worn continuously while exposed to noise or they do not fit properly.

· As previously mentioned, a hearing protector can give an average of 30 dB noise reduction if worn continuously during an 8-hour workday. If taken off for just one hour while exposed to noise, however, such a protector would provide only an average of 9 dB of protection during the 8 hours. This substantial reduction in protection occurs because with the logarithmic scale used to measure decibels, a 10-times increase in noise energy occurs for each 10 dB increase in sound. Thus, during the hour with unprotected ears, the worker is exposed to 1,000 times more sound energy than if earplugs or muffs had been worn. (For the 30 dB, 10 x 10 x 10 = 1000 times more noise.)

· In addition, noise exposure is cumulative. So, the noise at home or at play must be counted in the total exposure during any one day. A maximum allowable on-the-job exposure followed by further exposure at home to a noisy lawnmower or loud music will definitely exceed the safe daily limit.

· Even if earplugs and/or earmuffs are worn continuously while exposed to noise, they do little good if there is an incomplete air seal between the hearing protector and the skin. As mentioned above, when using ordinary hearing protectors, it is common to hear one's voice as louder and deeper. This plugged ear effect can actually be taken as a useful sign that the hearing protectors are properly positioned.

Do hearing protectors prevent a person from communicating with others?

The answer is no, at least for people with normal hearing. In fact, just as sunglasses help vision in very bright light, hearing protectors enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.

· Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. Nevertheless, it is essential that persons with impaired hearing wear earplugs or earmuffs to prevent further inner ear damage from noise.

· It has been argued that hearing protectors might reduce a worker's ability to hear the noises that signify an improperly functioning machine. Most workers, however, readily adjust to the quieter sounds and can still detect such problems.

How can someone tell if their hearing is already damaged, and what can be done about it?

Hearing loss usually develops over a period of several years. Since the hearing loss is painless and gradual, many people may not notice it. What someone may notice is tinnitus, which is a ringing or another sound in the ear. The tinnitus could be the result of long-term exposure to noise that has damaged the hearing nerve. Or, a person may have trouble understanding what people are saying or may hear everyone as mumbling. Such hearing difficulties are especially apt to occur when one is trying to hear in a noisy place such as in a crowd or at a party. These difficulties could be the beginning of high-frequency hearing loss.

· A typical hearing test (audiogram) of a person with noise induced hearing loss will initially show only a high frequency loss at 4000 Hz. (Hertz or Hz is the measure of sound frequency or pitch. Four thousand Hz is high frequency, while 250 or 500 Hz would be low frequency). With continued noise exposure and hearing loss, the audiogram will show a broader loss to include lower (deeper) frequencies.

· Noise induced hearing loss will almost always affect both ears equally, but in some situations, especially with firearm usage, it may be worse in one ear than in the other. For example, firing a rifle tends to injure the ear opposite the side of the trigger finger due to the shadow (blocking the sound) effect of the shooter's head.

· If a person has any of these symptoms that suggest hearing loss, he or she should consult a physician with special training in ear and hearing disorders (an otolaryngologist or otologist). This type of doctor can diagnose hearing problems and recommend the best way to manage them.

Portions of the above information has been adapted from the American Academy of Otolaryngology-Head and Neck Surgery, Inc, Alexandria, VA leaflet on noise induced hearing loss.

Hearing Loss Prevention Tips:

Every day we experience sound in our environment such as the television, radio, washing machine, automobiles, buses and trucks. But when an individual is exposed to harmful sounds-sounds that are too loud or loud sounds over a long time-sensitive structures of the inner ear can be damaged causing Noise-Induced Hearing Loss (NIHL).

NIHL is serious. Some 30 million people are at risk in the workplace, in recreational settings, and at home. In fact, it is the most common work-related disease. Already, 10 million Americans have permanently damaged their hearing.

Riddle: What is painless, odorless, tasteless, invisible, and toxic?

The following tips may help save you or your childs hearing. Share these tips with your family so they too will be aware of the dangers of NIHL.

Noise-induced hearing loss is preventable.
There are three things to consider about noise: How loud. How long. How close.
Workplace noises contribute to noise-induced hearing loss.
An extreme noise like a firecracker, experienced at close range, can damage hearing permanently in an instant.
Repeated exposure to engines and machines like motorcycles or chain saws can erode hearing more slowly. The result is the same: irreversible hearing loss.
Be aware of damaging noise.
Be prepared to protect your hearing. Carry earplugs or other protection.
Help your kids understand how hearing works and how it can be damaged.
If you are standing next to a person wearing a personal radio with earphones . . . and you can hear the lyrics to the song . . . damage.
If your kids are watching you cut wood with a power saw to build a bookshelf in your basement and you're not wearing protection . . . you are all experiencing damage.
If your teenager is doing lawn work for the summer, using a gasoline engine and not wearing hearing protection, hour after hour, it's doing damage.
If anyone in your family uses a firearm for recreational shooting, and does not use hearing protection . . . damage.

Know which noises can cause damage and wear ear plugs when you are involved in a loud activity:

NIHL (Noise-Induced Hearing Loss) can be caused by a one-time exposure to loud sound as well as by repeated exposure to sounds at various loudness levels over an extended period of time. The loudness of sound is measured in units called decibels.

Regular exposure of 110 decibels (and higher) for more than one minute risks permanent hearing loss.
No more than 15 minutes of unprotected exposure of 100 decibels is recommended.
Prolonged exposure to any noise above 90 decibels can cause gradual hearing loss!

Rock concerts and firecrackers are 140 decibels!
Loud bass in cars (when other cars can feel the vibration and hear the noise) and snowmobiles are 120 decibels!
A chainsaw is 110 decibels
Wood shop is 100 decibels
Lawn mowers and motorcycles are 90 decibels
City traffic noise is 80 decibels
Normal conversation is 60 decibels
Refrigerator humming is 40 decibels

Answer to riddle: What is painless, odorless, tasteless, invisible, and toxic? Noise-induced hearing loss.

For additional information, please visit the MedicineNet.com Hearing Center.

Source: National Institute on Deafness and Other Communication Disorders (www.nidcd.nih.gov)

Health Tip: Protect Your Hearing

(HealthDay News) — Ears are very sensitive to loud noises, and too much noise or prolonged exposure to loud noise can damage your hearing.

Before you crank up the mp3 player, read these suggestions to prevent hearing loss, provided by the American Academy of Family Physicians:

Wear protective ear coverings when working in a noisy area, such as around traffic or loud machinery.
Wear earplugs when you know you'll be around loud noise for prolonged periods, especially when operating noisy tools and equipment.
Use rubber mats under noisy electronics and appliances.
Avoid too much noise at once, such as the TV and noisy appliances going at the same time.
Don't use more noise to block out another noise. For example, don't turn up the music to drown out the sound of traffic or the vacuum cleane

How to Choose a Doctor:

Medical Author: Melissa Stoppler, M.D.
Medical Editor: Barbara K. Hecht, Ph.D.

Choosing a new physician can be a difficult task, especially if you have moved and are living in a new community. Asking for recommendations from coworkers, neighbors, and friends is a good way to start, but ultimately you will have to decide which physician is best suited to your individual needs and situation.

Your insurance plan may restrict your choices to a group of plan-approved physicians or offer financial incentives to use plan-affiliated doctors. Always check the terms of your insurance coverage to find out whether your plan will cover visits to the physician you are considering. If he or she does not participate in your health plan, how much will you pay out-of-pocket for visits to this provider? If you have changed jobs and must decide among different health plans offered by your employer, you may want to make your choice of doctor first and then choose the health plan that covers visits to this physician.

You will also need to decide what type of physician you are looking for. Do you need a primary health care provider (a doctor who will manage your overall care and refer you to specialists when necessary)? Or do you need a specialist in a particular area?

Most practicing physicians in the U.S. both primary care physicians physicians (a doctor you would see for routine ailments such as a cold, the flu, and regular checkups) and specialists (doctors who focus on one area whom you would see, for example, for a colonoscopy, rheumatoid arthritis, IBS , multiple sclerosis, cancer, or other specific conditions) are board certified, meaning that they have completed residency training in a specific field following graduation from medical school and have passed a competency examination in that field. Primary care providers may be board certified in different areas such as, for instance, Family Medicine or Internal Medicine.

It is also possible to find out whether a physician is in good standing with state licensing agencies through a Web site run by administrators of several state medical licensure boards. The Web site Administrators In Medicine can provide information about disciplinary actions taken or criminal charges filed against physicians in many states.

Finally, you may have additional concerns when choosing a physician. These concerns should reflect your own needs and priorities The following questions can help you to define further what is most important for you:

1. Where is the practice located? Will it be easy for you to get there? Is it accessible by public transportation? Is there ample parking?

2. Which hospital(s) does the doctor use? Are you comfortable with the possibility of being treated at one of these institutions should the need arise?

3. Where are routine x-rays and laboratory studies performed? Can these be done in-office, or will you have to go to an outside laboratory?

4. How long must you wait for an appointment after you call? Can you be seen on the same day if you have an urgent need?

5. Is the office staff friendly and courteous?

6. If you call with a question about your care, does a doctor or nurse return your call promptly?

7. Who covers for the physician when he/she is away? Whom should you call if you have a problem after-hours? If the doctor works in a group, are you comfortable with being seen by one of the practice partners?

8. Does the physician frequently refer patients to specialists or does he/she prefer to manage the majority of your care themselves?

9. Does the office process insurance claims, or must you pay up-front for services and file the claims yourself?

If you still aren't sure about your choice, ask if you can make an “interview” appointment to speak with the physician about your concerns. You may have to pay a co-payment or other fee for this service, but it can be a valuable way to gather information when making your decision.

Getting the Most from Your Doctor's Appointment

Medical Author: Melissa Stoppler, M.D.
Medical Editor: William C. Shiel, Jr, MD, FACP, FACR

Doctors spend on average only a few minutes with each patient they see for routine examinations. (Of course, there is often time out of the exam room that is spent reviewing the chart and records.) The experience can be both confusing and frustrating when communication on one or both sides is lacking, particularly if you're presented with new information to process or new instructions to follow.

While a visit to the clinic can be intimidating for anyone, you can lessen the stress and worry associated with doctor's appointments by taking steps to be sure that you're provided with all the information you need at the appointment. There are also ways you can improve the quality of your care by helping your doctor develop the best understanding possible of your symptoms and condition.

Before the appointment, write down a list of things you need to tell the doctor. Note any concerns or questions you may have. Also write down the names and dosages of any prescription, over-the-counter medications, or supplements you are taking. It is very important to take this list with you to the appointment – don't count on remembering every single item. Before you leave the office, go over the list to be sure you've covered everything. This simple step benefits both you and your doctor by keeping the discussion focused and ensuring that all your concerns are addressed.

Don't hesitate to use the words “I don't understand.” Doctors are only human and may not always know when they haven't explained something well or in terms you can understand. Never feel embarrassed or shy about asking for clarification about something your doctor says. When in doubt, repeat back what your doctor has told you and ask if you've got it right. You can also ask if he or she recommends any specific reading materials about your condition.

If your doctor asks questions that sound embarrassing or overly personal, remember that the information you provide enables him or her to better establish a diagnosis, or to determine which treatment is most appropriate for you. Never fib in response to questions about alcohol or drug use, sexual history, or other lifestyle matters. Be honest about the extent to which you are taking your prescriptions or following a treatment plan. Withholding the truth can affect the quality of your care and can even lead to a wrong diagnosis.

Finally, the office medical assistants and nurses can be an additional resource of information. Do not hesitate to ask them questions about your concerns as well.

Advance preparation for your doctor's visit is a vital step toward becoming a partner in your own health care and an advocate for your health and well-being. A good doctor will always encourage your desire to understand as much as possible about your condition and will welcome your active participation in your care.

Checklist to Take To Your Doctor's Appointment

Print this out and take it with you to your next doctor's visit.

1. Make the most of your doctor's visit. Take five minutes, right now or in the waiting room, to jot down everything you'd like to ask your physician- and what he or she needs to know about you:

(Any changes in your sex life? Appetite? Mood? Body?)

2. Write down every medication you are currently taking: (Including prescription and non-prescription drugs such as aspirin, antihistamines, vitamins or supplements)

3. Follow-up notes from your doctor's visit: (Follow-up visits? Side effects? Terms to research?)

Never ignore the following symptoms:	Always Tell your doctor about the following changes:
Severe headaches or a change in the way you have experienced headaches in the past	Diet: Has your appetite increased/decreased? Going "low-carb" or "low-sugar"? Are you hungry frequently? Do you get headaches?
Extreme weight loss without trying to lose weight	Stress: Having financial trouble? Marital problems? Do you feel overwhelmed by work or parenthood?
Pain while swallowing, fullness after eating small meals or a decrease in appetite	Mood: Do you feel "down" for longer than a day or two at a time?
Abdominal pain or change in bowel movements	Sleep: Do you have trouble falling asleep? Do you feel tired all day?
Slurred speech, vertigo, lack of physical coordination or limb weakness	Alcohol: Are you drinking more than 1-2 drinks each day or bingeing during the weekends?
Memory loss or loss for words during speech	Libido: Have you lost desire for sex? Is there any pain during sex?

Medicine.com

Urinary Tract Infections

Urinary tract infection introduction

What are the causes of UTI?

Who is at risk?

Recurrent infections

Infections in pregnancy

What are the symptoms of UTI?

How is a UTI diagnosed?

How is UTI treated?

Recurrent infections in women

Infections in pregnancy

Complicated infections

Infections in men

Is there a vaccine to prevent recurrent UTIs?

For more information

Urinary Tract Infection in Adults At A Glance

What is a urinalysis?

What can a urinalysis show?

What does urinalysis involve?

What is macroscopic urinalysis?

What is urine dipstick chemical analysis?

What are the pros and cons of dip sticks?

What is microscopic urinalysis?

How is microscopic urinalysis done?

What kind of cells can be detected?

What can the presence of red blood cells in the urine mean?

What can the presence of white blood cells in the urine mean?

Hearing Loss,Deafness andCommunications Disorder

Ten Ways to Recognize Hearing Loss:

Hearing Loss Prevention Tips:

Health Tip: Protect Your Hearing

How to Choose a Doctor:

Getting the Most from Your Doctor's Appointment

Checklist to Take To Your Doctor's Appointment