As many of my domestic and international colleagues know, I have spent most of my personal and clinical life in Colorado, USA.  In our state, we have a unique and interesting culture that has, over the years, benefited from the substantial migration of population into a state that has the great outdoors, beautiful scenery and a wonderful cultural differentiation from other areas of the world.  It is the land of snow-capped mountains, great skiing, mountain climbing, hiking, great microbreweriesvast farms that coexist with  great art and science and unlimited business opportunity.

Of course, Colorado was the first in a long line of states to legalize the use of recreational marijuanaIn the old days, Coloradans and those from elsewhere would occasionally grab the munchies, close the windows, pull down the shades, watch out for the police, turn up John Denver or Aqualung by Jethro Tull …. roll a doobie, take a hit and hope for the best!

 

But, in a historic stroke of the pen….

 

Colorado governor John Hickenlooper signed two bills May 28, 2013 which made Colorado the world’s first fully regulated recreational cannabis market for adults. Hickenlooper said to the media: “Certainly, this industry will create jobs. Whether it’s good for the brand of our state is still up in the air. But the voters passed Amendment 64 by a clear majority. That’s why we’re going to implement it as effectively as we possibly can.”

In its independent analysis, the Colorado Center on Law and Policy found that the state could expect to see “$60 million in total combined savings and additional revenue for Colorado’s budget with a potential for this number to double after 2017.”  Within a few days, the state of Washington followed Colorado and became the second state to legalized marijuana for recreational and medical purposes.  Following the lead of Colorado and Washington there are now a total of eight states that legalized marijuana (Colorado, Washington, Oregon, Alaska, California, Nevada, Massachusetts, Maine and the District of Columbia (Washington D.C.)) for recreational use and over half the states now allow medical use of marijuana.   Suddenly, there is no need to watch close the window, put down the shades or watch for the cops!

 

What are the Effects of Marijuana?

Since the 1930s young people have been “warned” about the perils of “Marihuana” with a very overblown movie.  Reefer Madness, made in 1936, depicted the supposed perils of marijuana.  While movie critics call it the “worst movie ever made,” it was the attitude toward the drug in this movie and others that had marijuana classified to be as dangerous as heroin and cocaine.  As we have had more experience with the drug, many of the issues presented in this movie now make it one of the best comedies of 1936. 

Of course, neither you (nor I) have ever smoked (or at least not inhaled) or ingested marijuana but if you had…. smoked a joint or eaten a pot-laced brownie, you would hardly be alone.  Consider that Web MD (2017) estimates that more than 1 in 3 people in America have tried marijuana at one point in their lives.  Occasional use isn’t usually harmful; however, pot can affect your body and mind any time it gets into your system.  It is mostly File:Reefer Madness.webmingested by smoking the plant’s dried leaves, flowers, stems, and seeds. The drug may also be mixed into food, such as brownies, cookies, and lollipops.  It may also be brewed as a tea, or even inhaled with a vaporizer. 

No matter how it gets into the system, physicians indicate that it affects virtually every organ in the body, including the nervous system and the immune system. What really happens when you smoke pot is that the body immediately absorbs THC, or tetrahydrocannabinol, the chemical responsible for most of marijuana’s psychological effects.  If the THC is baked in a brownie or other item, it may take much longer for the body to absorb as it has to break down in the stomach before it enters the bloodstream.

Effects are noticed right after smoking and within 3-4 hours if ingested.  Specifically,  smoking pot can increase the heart rate by as much as two times for up to 3 hours and it may induce a heart attack right after use. It can also increase bleeding, lower blood pressure, and affect your blood sugar, as well.  Although it’s logical, there is not enough evidence to suggest higher odds of lung cancer for smoking marijuana, but it does tend to irritate the lungs leading to the colds and other lung related problems of heavy pot smokers.

Bradford (2015) presents that THC acts much like the natural cannabinoid chemicals made by the body.  The cannabinoid receptors are concentrated in certain areas of the brain associated with thinking, memory, pleasure, coordination and time perception. THC attaches to these receptors and activates them and affects the memory, pleasure, movements, thinking, concentration, coordination, and sensory and time perception. 

Marijuana’s medicinal uses can be traced back as early as 2737 B.C., when the emperor of China, Shen Neng, touted cannabis tea as a treatment for gout, rheumatism, malaria and even poor memory.  It was so successful that its benefits as a medicine spread throughout Asia, the Middle East and then to Africa and India, where Hindu sects used it for pain and stress relief.  

Today, Loria and Welsh (2015) indicate that there are some great medical benefits of marijuana for certain disorders such as  glaucoma, lung treatment, epilepsy, seizure disorders, cancer treatment, anxiety reduction, slowing of Alzheimer’s disease, pain reduction in Multiple Sclerosis, reduced muscle spasms, treatment for effects of hepatitis C, Crohn’s disease and other bowel disorders, arthritis, Parkinson’s disease and others.  Of course this is why over 1/2 of the United States have now approved medical marijuana use.

 

What are the Effects on Hearing?

Practicing in a state where marijuana is legal presents some interesting patients and very interesting interviews.  Many anecdotal discussions (personal and online review) about the effects of marijuana on hearing reference a 1976 study by Liedgren, Odkvist,  Davis and Fredrickson.  Although some online posts as well as patient discussions offer suggestions that the drug made their hearing better,  Liedgren et al. reported no hearing changes in virtually all auditory evaluations performed pre-and post-marijuana smoking.

There are also claims that tinnitus is benefited by marijuana as well….but….

 

What’s the REAL story?  That will be our discussion in Part II of this Hearing International discussion on Marijuana and Hearing.  If you have missed your Jethro Tull fix, click on the album above for some Aqualung!

 

 

References:

Bradford, A. (2015). What is THC? Live Science.  Retrieved January 2, 2017.

Liedgren, S., Odkvist, L., Davis, E., Fredrickson, J. (1976).  Effect of marijuana on hearing.  J Otolaryngol. 1976 Jun;5(3):233-7.  Retrieved January 2, 2017.

WebMD.com (2017).  How does marijuana affect you?  Substance Abuse and Health Center.  Retrieved January 2, 2017.

WikiAnswers (2017). What does marijuana do to hearing? Retrieved January 2, 2017.

 

Images:

The Colorado Guy (2007).  Maroon Bells.  Retrieved January 2, 2017.

Global News (2016).Campaign on marijuana’s effects on young people kicks off in Halifax.  Retrieved January 2, 2017.

 
Videos:
 
Esper, D. (1936).  Reefer  Madness, Trailer.  Public Domain. YouTube.com. Retrieved January 2, 2017.
 
Denver, J. (2013).  Rocky Mountain High.  YouTube.com.  Retrieved January 2, 2017.
 
Tull, J. (2012).  Aqualung.  Youtube.com.  Retrieved January2, 2017.
 
 
 

 

 

 

 

 

The end of the year should be a time of reflection and appreciation – for how far we have come from the dreaded days of disease that could snuff out a life before it got started and for the contributions to knowledge by those that suffered deafness through disease.  

Scarlet fever  (also known as Scarlatina), with its pandemics in both Europe and the United States in the 19th and early 20th centuries, was one of these killers, inflicting death on thousands of infants and young children.  Simply hearing the name of this dreaded disease, or knowing that it was present in the community, was enough to strike fear into the hearts of those living in Victorian-era United States and Europe. In the worst cases, all a family’s children were killed in a matter of a week or two through contagion.  Indeed, until early in the 20th century, scarlet fever was a common condition among children.  Scarlet fever, even when not deadly, caused large amounts of suffering to those infected and their families, often leaving deafness in its wake. 

To put this disease in perspective,  infant mortality rate is calculated by dividing the number of infants that die within one year of birth by the number of infants that are born. It is usually presented in the number of deaths per 1000 births.  Prior to 1900 infant mortality rates of 2-300 per 1000 were common throughout the world, fluctuating according to the weather, the harvest, war, and epidemic disease.  In difficult times, most infants would die within the first year of life, while under the best of conditions perhaps 200 per 1000 would die.  In some pre-modern countries, child mortality rates were between 300 and 500 per 1,000 live births.   In fact, in the late 19th century, every second child in Germany died before its fifth birthday.       

Smith (2011) presents historical scarlet fever death data from Krause (1992) depicting Boston, Massachusetts (USA) during the period 1840-1940 which is typical of most pre-modern cities.  These data suggest at least three epidemiologic phases during this time, not unlike the rest of the world during this pandemic.  While the first major epidemic appears to have begun in ancient times and lasted until the late eighteenth century, scarlet fever was either endemic (always present at a low level) or occurred in relatively benign outbreaks separated by long intervals. In the second phase (~1825-1885), scarlet fever suddenly began to recur in cyclic and often highly fatal urban epidemics. In the third phase (~1885 to the present), scarlet fever began to manifest as a milder disease in developed countries, with fatalities becoming quite rare by the middle of the 20th century.  This was mostly due to antibiotics and improved living conditions in these modern cities.  In both England and the United States, mortality from scarlet fever decreased beginning in the mid-1880s and by the middle of the twentieth century, the mortality rate from scarlet fever fell to around 1%. 

Those that have had children grow up in their homes will appreciate the number of times they may have become infected with a close relative to scarlet fever–“Strep Throat“.  Even in 2016, “strep” is still a relatively common disorder among infants and young children, especially in day care centers and other child care situations.  Scarlet fever and strep throat are caused by the same bacterium, Streptococcus pyogenes, or group A beta-hemolytic streptococcus. When the bacteria release toxins, scarlet fever symptoms occur.  Scarlet fever transmits from human-to-human by fluids from the mouth and nose. When an infected individual coughs or sneezes, the bacteria become airborne in droplets of water and can be inhaled. The bacteria can land on surfaces, such as drinking glasses, work surfaces, and doorknobs, and infect people who touch them with their hands and then touch their own nose or mouth. The bacteria may also be inhaled.  If someone touches the skin of an individual with a streptococcal skin infection, there is a risk of becoming infected. People who share towels, baths, clothes, or bed linen with an infected person are at risk. The early part of the Industrial Revolution probably exacerbated these conditions. At the time of the 19th and early 20th century pandemics, housing in factory cities was crowded, dirty, unheated, and unventilated.  Even in Europe and the United States, food supplies, especially milk products were unreliable, impure, and so narrowly nutrition-based that these terrible conditions probably greatly increased the incidence of this and other disorders.  At the time, diseases were generally untreatable, sometimes even unrecognized. Without a germ theory of disease, people did not know to take precautions to prevent the spread of infectious diseases.  A person with scarlet fever who is not treated may be contagious for several weeks, even after symptoms have gone. Additionally, some individuals can carry the infection and be contagious, without ever showing any symptoms and only those  who are susceptible to the toxins released by streptococcal bacteria develop symptoms.

Scarlet fever mostly affects children between ages 2 and 10 and often begins as a throat infection (strep throat), the fever (over 101 degrees) typically subsides within 3 to 5 days, and the sore throat passes soon afterward. The Scarlet Fever rash usually fades on the sixth day after sore-throat symptoms started. While there is no vaccine, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.  Today, in most first world countries, the infection usually does not progress past the “strep throat” stage.

Auditory Implications of Scarlet Fever

One of the serious results of scarlet fever was often deafness.  The deafness usually arises from complications that include sinus infections, followed by abscesses of the ear and often resulting in mastoiditis. In scarlet fever, diphtheria, measles, and influenza, the middle ear is usually affected by communication with the nasopharynx through the Eustachian tubes. The inflammation extending along the Eustachian tube is followed by suppuration and perforation of the membrane resulting in a conductive hearing loss that would not be curable until many years later, if then. Sometimes the membranous labyrinth is affected directly creating cochlear damage due to systemic poisoning by the bacteria which would then leave a sensori-neural hearing loss. Additionally, a sustained high fever of over 104 degrees which may accompany the disorder can also create a sensorineural hearing loss and require immediate medical attention. Most parents were grateful that their child’s life was spared, but the residual damage was an auditory devastation that destined many of 19th and early 20th century children to a life of deafness or being hard of hearing.  These days scarlet fever issues created within the middle ear and the resulting conductive hearing loss can usually be surgically repaired or cured in most cases, or never occur with today’s antibiotic treatment regimes. 

While deafness from scarlet fever was a devastation of the 19 and early 20th centuries a positive from this dreaded disease was the many inventions created due to its presence.  These include surgical techniques, research into bacteria, even Miller Reese Hutchinson’s first hearing aid , which was made for a friend who had suffered the disease.  Some of those deafened by scarlet fever became contributors to science, the arts and other disciplines, many of whom have been featured at Hearing International. Just a small fraction of those that were affected by the disease are remembered here:

Helen Keller – Deaf Blind Political Activist, and Lecturer

Thomas Edison – Famous Inventor

Oliver Heaviside – Famous Engineer, Mathematician, and Electric Circuit Theorist

Konstantin Tsiolkovsky – Rocket Scientist and Aeronautic Theorist

Douglas Tilden – World Famous Sculptor

Granville Redmond – Landscape Painter, occasional actor with Charlie Chaplin

For others that were famous in their chosen occupations despite their hearing impairment due to Scarlet Fever check out Disabled World.

 

References:

Kress, H. (2016). Scarlett Fever.  Henrietta’s Herbal Homepage.  Retrieved December 26, 2016. 

Roser, M. (2016) – ‘Child Mortality’. OurWorldInData.org. Retrieved December 26, 2016. 

Smith, T. (2011).  Scarlet Fever:  Past and Present.  Aeitology.  Science Blogs.com  Retrieved December 26, 2016