Answer the following questions, circling Y for yes and N for no.

Y         N          Do I have a problem hearing on the telephone?

Y         N          Do I have trouble hearing when there is noise in the background?

Y         N          Is it hard for me to follow a conversation when two or more people talk at once?

Y         N          Do I have to strain to understand a conversation?

Y         N          Do many people I talk to seem to mumble (or not speak clearly)?

Y         N          Do I misunderstand what others are saying and respond inappropriately?

Y         N          Do I often ask people to repeat themselves?

Y         N          Do I have trouble understanding the speech of women and children?

Y         N          Do people complain that I turn the TV volume up too high?

Y         N          Do I hear a ringing, roaring, or hissing sound a lot?

Y         N          Do some sounds seem too loud?

If you answer"Yes" to 3 or more of these questions, you may have significant hearing loss. Ask your primary care doctor whether you should see aspecialist.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What is a hearing aid?

A hearing aid is an electronic, battery-operated device that amplifies and changes sound to help you hear better.

How do I know if I need a hearing aid?

The best way to find out if you need a hearing aid is to see a specialist called an audiologist. An audiologist is a licensed professional who will perform tests to find out what kind of hearing loss you have and whether hearing aids can help you. Your doctor can recommend an audiologist and help set up an appointment for you.

Because some hearing loss develops from medical problems, your doctor may also refer you to an otolaryngologist (an ear, nose and throat doctor). If you have ear pain, drainage, sudden hearing loss or dizziness, it is especially important that you see an otolaryngologist.

How do hearing aids work?

Every hearing aid contains a microphone to pick up sound around you, an amplifier to make sound louder, and a receiver to deliver the sound to your ear. All hearing aids run on batteries. Some have extra features. Among the most popular features are adapters that make it easier to hear on the telephone, directional microphones that help you separate sounds coming from in front of you from sounds coming from behind you or beside you, and feedback cancellation that prevents the aid from squeaking.

What are the different kinds of hearing aids? 

There are five basic styles of hearing aids:

•       Completely-in-the-canal hearing aids

These aids fit completely into the ear canal. They are the smallest aids available and therefore the least noticeable. However, because they are so small, the parts of these hearing aids (such as the volume control and batteries) can be hard to see and adjust.

•       In the canal hearing aids

These hearing aids fit partly in the ear canal, but not as deeply as the completely-in­the-canal aid. They include features that won't fit on completely-in-the-canal aids such as feedback cancellation and volume control.

•       Half-shell hearing aids

A smaller version of the in-the-canal hearing aid, the half shell fills the lower portion of the bowl-shaped part of your outer ear. It fits better in smaller ears and has the cosmetic advantage of being small.

•       In-the-ear hearing aids

Also called full shell, these hearing aids fill most of the bowl-shaped area of your outer ear. They are more visible than in the-canal aids and may pick up wind noise, but are generally easier to insert in the ear. Batteries last longer and these hearing aids are easier to handle than smaller aids. Although they are more visible, they still have the cosmetic advantage of fitting inside the ear.

•       Behind-the-ear hearing aids

All parts are contained in a plastic case that hooks over the top and rests behind the ear. The case is connected to an ear mold, which fits into the ear. These are the bulkiest hearing aids but many people find them easiest to use. Behind-the-ear hearing aids are less bulky and more comfortable than they were even a few years ago. Because they can amplify sound more than other hearing aid styles, they are often the best choice for people with severe hearing loss.

What does digital technology mean?

Most hearing aids today contain a computer chip that can be programmed for different listening environments such as quiet conversation in your home, noisy situations like a restaurant, or large areas like a theater. Many aids now use ‘digitized sound processing’ to convert sound waves into a computerized code. With this technology, the hearing aid can analyze sounds and make automatic adjustments to help you hear better as you move from one environment to another.

What are directional microphones?

Though no hearing aid can completely ‘remove’ background noise, directional microphones are the best technology available to help sort out speech from background noise. These microphones are designed to amplify sounds directly in front of the user more than the sounds to the back and sides of the user. So, in a crowded restaurant, the hearing aid will amplify the voice of the person you are looking at more than the voices at tables behind and around you.

How much do hearing aids cost?

Hearing aid costs vary according to styles and electronic features. Prices range starts from thousands to ten thousands of Chinese currency. Itis important to shop carefully. You can purchase them at pharmacy or medical equipment stores, discounts may apply.

Here are a few tips:

•       Buy from a professional audiologist or hearing aid specialist

•       Bring a friend along to help you make the decision

•       Ask about add-on features. Don’t be pressured into buying extras you don’t need

•       Get a contract in writing that includes a trial period and follow-up visits

Price is an important factor, of course, but it should not be the only thing you think about when you are choosing a hearing aid. Buying a reliable product can save repair costs and the frustration of a hearing aid that doesn’t work well.

Will my health insurance pay any of the costs of acquiring a hearing aid?

Some health insurers cover the costs of hearing tests, a hearing aid evaluation, and partial or even full coverage of a hearing aid. Check with your health insurance plan to find out exactly what your policy covers. 

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What is a ruptured eardrum?

A ruptured eardrum is a tear or a hole in your eardrum (also called the tympanic membrane). The eardrum is a thin membrane that separates your ear canal from your middle ear. This membrane vibrates when sound waves strike it, starting the process of converting sound waves into nerve impulses that travel to your brain. The membrane also acts as a shield, protecting your inner ear from bacteria and debris.

What causes a ruptured eardrum?

Causes include:

•   Middle ear infection(otitis media). The pressure of fluid in your middle ear can cause your eardrum to rupture

•   Changes in air pressure (barotraumas). Flying in an airplane or diving can cause a build up of pressure on your ear, resulting in a ruptured eardrum

•   Foreign objects in your ear. Small objects such as a cotton swab or a bobby pin pushed too far into your ear canal can rupture your eardrum

•   Loud, sudden noise. A sudden, extremely loud noise, such as from an explosion or a firearm, can rupture your eardrum.

How will the doctor treat this problem?

In most cases, a ruptured eardrum heals on its own within a few weeks to a few months. Your doctor will want to see you regularly while your eardrum is healing to make sure everything is going well. The most important thing you can do is to keep your ear dry during the healing process. Here are some things you can do at home to help your eardrum heal and to stay comfortable while it is healing:

•   Keep your ear dry. Place a cotton ball with Vaseline in your ear when showering, bathing or washing your hair

•   Do not clean your ears while the eardrum is healing

•   Do not go swimming until the doctor tells you that the ruptured eardrum has healed completely

•   Avoid blowing your nose. The pressure created when blowing your nose can damage a healing eardrum

•   Use over-the-counter pain relievers to ease ear pain. Some choices are aspirin, Advil, Motrin or Aleve. Ask your doctor what’s best for you. Antibiotics are generally used to treat a ruptured eardrum only when an ear infection caused the problem

Will my hearing return to normal?

Any hearing loss you suffer should go away once the tear or hole in your eardrum has healed. To be sure your hearing has returned to normal, your doctor may recommend that you make an appointment for a hearing evaluation once the rupture has completely healed.

What if my eardrum doesn't heal?

In most cases, a ruptured eardrum will heal without any special treatment. If your eardrum doesn't heal within three months, your doctor may refer you to a specialist to talk about treatment, including surgery.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What is an abrasion?

An abrasion is a scrape on your skin. It happens when your skin rubs against a rough surface. Some examples of an abrasion include rug burn, a skinned elbow, or road rash. Abrasions can be many shapes and sizes. The wound may hurt, bleed, bruise, or swell. 

How can I care for my abrasion?

•  Wash your hands and dry them with a clean towel

•  Press a clean cloth against your wound to stop any bleeding

•  Rinse your wound with a lot of clean water. Do not use harsh soap, alcohol, or iodine solutions

•  Use a clean, wet cloth to remove any objects, such as small pieces of rocks or dirt

•  Rub antibiotic ointment on your wound. This may help prevent infection and help your wound heal

•  Cover the wound with a non-stick bandage. Change the bandage daily, and if gets wet or dirty

When should I seek immediate care? 

•  The bleeding does not stop after 10 minutes of firm pressure

•  You cannot rinse one or more foreign objects out of your wound

•  You have red streaks on your skin coming from your wound

When should I contact my doctor? 

•  You have a fever or chills

•  Your abrasion is red, warm, swollen, or draining pus

•  You have questions or concerns about your condition or care

What causes chest pain? 

Chest pain can be caused by a range of conditions, from not serious to life-threatening. Chest pain can be a symptom of a digestive problem, such as acid reflux or a stomach ulcer. An anxiety attack or a strong emotion, such as anger, can also cause chest pain. Infection, inflammation, or a fracture in the bones or cartilage in your chest can cause pain or discomfort. Sometimes chest pain or pressure is caused by poor blood flow to your heart (angina). Chest pain may also be caused by life-threatening conditions such as a heart attack or blood clot in your lungs. 

What other symptoms might I have with chest pain? 

•      A burning feeling behind your breastbone

•      A racing or slow heartbeat 

•      Fever or sweating 

•      Nausea or vomiting 

•      Shortness of breath 

•      Discomfort or pressure that spreads from your chest to your back, jaw, or arm 

•      Feeling weak, tired, or faint 

How is the cause of chest pain diagnosed?

 Your doctor will examine you. Describe your chest pain in as much detail as possible. Tell him or her where your pain is and when it began. Tell the provider if you notice anything that makes the pain worse or better. Tell him or her if it is constant or comes and goes. Your doctor will ask about any medicines you use and medical conditions you have. He or she will also examine you. You may also need any of the following tests: 

•      An EKG is a test that records your heart's electrical activity

•      Blood tests check for heart damage and signs of a heart attack

•      An echocardiogram uses sound waves to see if blood is flowing normally through your heart

What is diverticulos is and how does it happen?

Diverticulosis is the presence of weak areas or pouches in the wall of the large intestine. The pouches are usually in the part of the intestine called the colon. The pouches, called diverticula, look somewhat like small thumbs poking out of the side of the colon. Diverticula occur when the pressure inside the colon is too high. The main cause of high pressure appears to be too little fiber in the diet. Fiber helps keep digested food bulky and soft as it passes through the colon. This makes it easier for the food to move through the intestine without too much pressure.

What is a diverticulos is diet?

A diverticulosis diet is basically a high-fiber diet. Fiber is the part of fruits, vegetables, and grains that the body cannot digest.

Foods to eat more of:

The simplest way to increase the fiber in your diet is to eat more fresh fruits, fresh vegetables, and whole grain foods. This means eating at least 5 servings of fruits and vegetables every day. Whole grains are easiest to eat as cereals, such as 100% bran or shredded wheat cereals. Bran, oats, or whole wheat flour may be baked into breads or muffins. You can also sprinkle bran flakes on to other foods, such as salads, yogurt, or cereal.

Foods to avoid:

Some physicians recommend avoiding foods that may get stuck in the diverticula, such as popcorn, raisins, whole kernel corn, and peanuts. However, there is no proof that seeds and nuts increase risk for diverticulitis.

What is Diverticulitis?

Diverticulitis happens when one or more of the diverticula becomes inflamed. Inflammation occurs when diverticula become blocked with stool. Symptoms of diverticulitis may include: alternating diarrhea and constipation; severe, intermittent cramps in the lower left side of the abdomen; tenderness in the lower left side of the abdomen; chills or fever; or rectal bleeding. If you experience these symptoms, you should contact your physician. While you are recovering from a bout of diverticulitis, your physician will recommend that you follow a low fiber diet, also called a low residue diet.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What is core needle biopsy?

Core needle biopsy is an imaging procedure used in the diagnosis of a lump or other breast abnormality. The clinician inserts a needle with a special cutting edge into the questionable area of the breast. Very thin slivers of tissue are removed. The pathologist can then look at the tissue under a microscope to determine the cause of the problem. The needle is usually positioned using ultrasound, or a special x-ray called a stereotactic device.

What can I expect to happen during this procedure?

Your breast will be cleaned with iodine and alcohol to produce a sterile area through which the needle can be inserted. Xylocaine (like novocaine) is used to numb the area before the core needle device is introduced. You will feel pressure and movement of the needle, but you should not feel any pain. If there is any discomfort, more xylocaine can be used.

How long does the procedure take?

You can expect your appointment to last about an hour. The period of time in which the needle is inserted is usually not longer than ten minutes. In most cases, between 3 and 5 tissue slivers are removed to increase the likelihood of getting a good sample.

Is core needle biopsy safe?

This procedure is extremely safe. Most women do experience some bruising around the place in the breast where the needle is inserted. A little bleeding may occur but vigorous bleeding is very uncommon. An infection is a potential complication, but this is extremely uncommon.

What should I do to prepare for my appointment?

Since a core needle biopsy may cause some temporary bruising, please do not take any medication that may make you more likely to bleed. Aspirin, ibuprofen and any drugs containing either of these ingredients should be avoided for five days before the biopsy is scheduled since they may cause bleeding. If you have any unusual bleeding tendency, please talk to your doctor about this before you come in for your appointment.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2018 The General Hospital Corporation.

Primary Care Office InSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

Constipation is typically classified as having fewer than 3 bowel movements per week. Symptoms of constipation include painful, hard, or incomplete bowel movements and/orstraining.

Things you can do to help reduce constipation:

Check Your Fluid Intake

If you don’t consume enough fluid it may make your symptoms worse. You may also want to cut down on liquids that can be dehydrating, like alcohol.

 Note: If you are taking fiber supplements, you will also need additional fluid. Fiber absorbs water and can swell, potentially causing a blockage in your digestive tract.

Tip: Check the color of your urine. If it is dark yellow, you are probably not drinking enough fluid

Increase the Fiber in Your Diet (found in whole grains, fruits, vegetables, nuts and beans)

Fiber adds bulk and can soften bowel movements, making them easier to pass. Most people need between 25-35 grams of fiber per day.

Switching to whole grains is an easy way to increase your fiber intake, e.g. eating whole wheat pasta instead of white pasta.

Tip: Look for foods with 3 grams of fiber or more per serving

 ▶Soluble fiber(found naturally in apples, bananas, pears, plums, artichokes, carrots, peas, potatoes, squash, barley, oats and beans)

Soluble fiber acts like a gel and can help regulate bowel movements, especially if you alternate between constipation and diarrhea (this is common with irritable bowel syndrome).

Try to include a source of soluble fiber in your diet every day.

Tip: In addition to containing soluble fiber, prunes (dried plums) are a natural source of sorbitol, which can act like a laxative. Apples, cherries, dates, pears and peaches also contain sorbitol

▶Insoluble fiber (found naturally in whole grains, e.g. whole wheat bread and brown rice, bran, and the edible skins of fruits andvegetables)

 Insoluble fiber helps to move food through your digestive tract, thus increasing your bowel movements. It also adds bulk to movements, making them easier to pass.

Tip: If you normally peel the edible skins of vegetables, e.g. cucumbers and potatoes, leave them on to increase your intake of insoluble fiber

Get Active

Exercise may increase muscular contractions in your intestines, thus aiding bowel movements.

Most healthy adults need at least 150 minutes of moderate physical activity per week, such as brisk walking or riding a bike.

Tip: Try to spread your activity throughout the week. If you need to increase your activity, aim for small increases (i.e. 10 minutes at a time). Consult your doctor if you are unsure if you should increase your activity

Limit/Avoid the Use of Laxatives

Long-term use of certain laxatives can reduce your body's natural ability to have regular bowel movements and can cause laxative dependence.

    •  Fiber is nature's natural laxative. If you simply aren’t able to consume enough fiber through food, you could try taking a fiber-containing laxative, like Metamucil or Citracel. However, be aware that fiber supplements can interfere with the absorption of certain medications

    •  Your doctor may also suggest taking a stimulant laxative (such as Senokot or Dulcolax), an osmotic laxative (such as Miralax), or a stool softener (such as Colace). Be sure to check with your doctor before buying over-the-counter versions of these laxatives, as they can affect electrolyte levels (such as potassium) in the body

Check Your Supplements and Medications

Calcium and iron supplements can contribute to constipation. Antacids can also cause constipation, as can long-term use of certain pain medications, like opiates. Certain antidepressants (such as amytriptline), diuretics (such as furosemide), and blood pressure medications may also affect bowel regularity.

   •  A dietitian can review your diet to see if a nutrition supplement is necessary. A dietitian may also advise you on how to reduce heartburn to decrease reliance on antacids

   •  If you are concerned that medication may be contributing to your constipation, talk to your doctor

Note: While research does not support taking probiotic supplements to relieve constipation, consuming healthy probiotic-containing foods (like yogurt, kefir, miso and kimchi) may offer benefits and should not worsen constipation if consumed as part of a regular diet.

Practice Regularity

Do not resist the urge to have a bowel movement, as this may worsen constipation symptoms. You may even want to set aside time each day to have a bowel movement, such as after breakfast.

Eating regular meals also helps your colon work properly. Try to avoid skipping meals and be sure you are consuming adequate calories to support normal bowel function.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine