Feeling exhausted?  Struggling to juggle the demands of each day?  Rest and relaxation doesn’t revive you?  

On a daily basis we see people who are just so tired and fatigued that they can hardly drag themselves out of bed.  With stressful busy lives, most people experience tiredness at some time but usually this resolves with rest and relaxation.   

Fatigue occurs if the mechanisms providing the body with the energy to function are not working effectively.  Have you ever heard anyone say “all their tests are normal” and wonder why they still feel wretched?  When we use Bio-Impedance Cellular Analysis or energy screening with the VegaTest Expert, we often see very low energy.  

 

Students struggle with the demands of assignments and exams.  Young men at the peak of their careers become so exhausted they find decision making a challenge.  Career women and Mums struggle to juggle each day, and this often compounds following childbirth until they just “want to self destruct”. 

More mature men and women are now being encouraged to work longer.  Finding and maintaining energy and drive to continue achieving starts to take a toll on their weight and wellness.      

There are three aspects to fatigue.  First, there are functional disorders which can include cellular energy deficiencies.  Second is metabolism and energy production.  Third is the ability of the body to detoxify and eliminate toxins efficiently.   

Symptoms of functional disorders may include anaemia, shortness of breath, dizziness, muscle weakness and decreased gastrointestinal function. These are not diseases, rather a sign that something has interfered with the red blood cell transport system that carries oxygen to all bodily tissues.  In

Australia, 40% of females aged 12 – 50 years consume less than the RDA of iron.  Absorption may also be impaired by the effects of stress hormones on the digestive system. 

A drop in energy levels with a cold or flu is due to the underlying inflammation that is created by the immune system in response to the ‘bad bugs’.  There are various other triggers that cause both short and long term inflammation and cause fatigue.   

Hormones are vital chemical messengers within the body.  The thyroid hormones play an important part in the running of the metabolism and sub-clinical low levels frequently see the whole body slow down.  If the fatigue is post natal, or accompanied by difficulty losing weight, low (or no) libido, mood changes, irritability, constipation, thinning or loss of hair, low thyroid hormones may a factor. 

Metabolism and energy production involves the digestion and transport of nutrients into the mitochondria, “the power house of the cell” where a process takes place to produce cellular energy.  Alcohol, air pollution (worse in mining or industrial environments), cigarette smoke, car exhaust fumes, pesticide and exposure to drugs can damage the delicate mitochondria.   

This “energy powerhouse” needs a balance of vital nutrients to support healthy energy production.  Any deficiencies of these nutrients may result in muscle pains, cramps and spasms, mood changes, irritability, mental or physical stress, tension headaches, restlessness and anxiety, insomnia, tremors and vertigo.    

The ability of the body to detoxify and eliminate toxins is important to prevent fatigue.  Toxic load may be a major ‘driver’ of fatigue and needs to be managed to achieve a long-term resolution.

 

An increased toxic load may be suspected if fatigue is accompanied by recurrent headaches, muscle aching and weakness, poor short-term memory and concentration, infertility, adverse reactions to environmental chemicals and mood swings.  

To regain energy it is vital to assist the body to clear these toxins.  This must be done in a definite sequence to ensure clearance of the toxic accumulations. 

Colon hydrotherapy and lymphatic drainage massage may be incorporated into the detoxification program to speed up the process and ensure a better outcome.   

Are you fatigued?  Ask for a free questionnaire at Nurtura Health.   

Working closely with your Naturopath or Practitioner may help ascertain what the core issues are with “your fatigue” and individually determine a comprehensive plan to regain your energy.  Each and every step you make, no matter how small it may feel, will be setting you up to reach that goal of jumping our of bed with a smile and excitement about your day.

I was chewing and suddenly there was something hard… 

It is always a bit of thrill when you discover something hard in your food that shouldn’t be there.  You have a few seconds of suspense while your tongue does a full inventory of all the teeth to find out which one is broken.  All of a sudden you come across one that feels like the

Grand Canyon.

 

A broken tooth is one of the most common reasons for a dental visit.  Surprisingly, there are a lot of much more urgent concerns people should be worried about with their teeth, such as tooth decay, which they can’t feel so, often, don’t do anything about. 

However a broken tooth feels so horrendous your tongue will permanently be finding and testing it, probably resulting in a sore tongue, until you get the tooth fixed.  So, why do teeth break? 

Teeth themselves are incredibly hard to break in their natural state.  Only people who clench or grind with extreme force, and who have teeth with extremely deep grooves, crack teeth all on their own.  My wife is one of these people and now must wear a little appliance at night to prevent clenching.  However, most people need a bit of help to break their teeth. 

Usually teeth break because at some stage previously there has been tooth decay which has been fixed with a filling.  When the tooth decay is removed from the tooth quite a bit of the enamel must also be removed.  This usually reduces the strength of the tooth to about half of the original.  Now that the tooth is weakened, all you need to do is chew on it a couple of hundred thousand times and do some clenching in your sleep and voila, twenty years later it cracks. 

So, can you prevent it?  Well sort of.  It has been shown that if you place a ceramic restoration in the tooth rather than just a filling the tooth is usually just as strong as a natural tooth and sometimes stronger.  A ceramic restoration is not the same as a white filling, which is made of plastic.  The other prevention strategy is prevent clenching or grinding, which are done during sleep and generally cause more damage to the teeth than chewing does (your teeth don’t generally touch during chewing).  This can be done with a small plastic device called an NTI. 

What about fillings that are already in place?  During a thorough examination, your dentist will usually make note of any cracks that are starting in the teeth and advise you of them.  While you can sometimes tell how close a tooth is to fracturing, it is hard to be entirely accurate.  You can tell when a tire needs replacing, but it is hard to know how long you can drive it until you have a blowout.  So that’s the tricky part.  We can tell you that you have a crack and that your tooth will break, but we can’t tell you when.  Most of the time if the tooth does break, it can be easily fixed.  Occasionally the tooth will fracture in half and need to be extracted. 

So what to do?  Well, I find it best to ask the patient.  Some people prefer to have a cracked tooth fixed early so that it won’t break.  Others prefer to wait until it breaks and then fix it.  Some people prefer to be able schedule their maintenance and others are happy to put up with the surprise of unexpected fractures. However, I find that, generally, patients who travel to countries like, say,

Morocco prefer to sample the local culture rather than the local dentistry. 

While you can’t guarantee anything with teeth, you can reduce your risk of tooth fracture if you want. 

Cerebral Palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affects body movement and muscle coordination, but does not worsen progressively over time.  

It mainly affects muscle movement, but isn’t caused by problems in the muscles or nerves. Cerebral Palsy is caused by abnormalities in the brain that disrupt the brain’s ability to control movement and posture. 

There are three main types of cerebral palsy and each of these involves the way a person moves. Movements can be unpredictable, muscles can be stiff and tight and, in some cases, people can have shaky movements or tremors. 

Cerebral palsy can generally be seen in the first 12-18 months of life. It presents when children fail to reach movement milestones. Children with cerebral palsy exhibit a wide range of symptoms including: 

·          lack of muscle coordination when performing voluntary movement·          stiff or tight muscles and exaggerated reflexes·          walking with one foot or leg dragging·          walking on the toes, a crouched gait or a “scissored” gait·          variations in muscle tone, either too stiff or too floppy·          excessive drooling or difficulties swallowing or speaking·          shaking (tremor) or random involuntary movements·          difficulty with precise motions, such as writing or buttoning a shirt. 

The symptoms of cerebral palsy differ in type and severity from one person to the next, and may even change in an individual over time.  

Some people with cerebral palsy also have other medical disorders as well. The signs may appear usually before a child reaches 3 years of age.  

Parents are often the first to notice that their child’s motor skills are not developing properly. Children with Cerebral palsy frequently have developmental delay, that is, they are slow to reach milestones such as rolling over, sitting or walking. Some children may also have abnormal muscle tone which makes them appear relaxed, even floppy. 

Cerebral palsy is not a disease, isn’t contagious and can’t be passed from generation to generation. There is no cure; however, supportive treatments, medications and surgery may help many to improve their motor skills and ability to communicate with others. 

It does not always cause profound disabilities. While one child with severe cerebral palsy might be unable to walk and need extensive care another with mild symptoms might only be slightly awkward, require no special assistance and enjoy activities that most would enjoy. 

Many people with cerebral palsy are healthy and live to a ripe old age. Those with severe forms of the condition may have many health problems and shortened lifespan. They may also show signs of early ageing and experience problems usually associated with older people. 

If you are concerned about your child’s development or mobility for any reason, please contact your GP.  

For further information, please contact the Cerebral Palsy League of Queensland. 

National Diabetes Week, 13 to 19 July, is a time to raise awareness about diabetes and help prevent diabetes and its complications.  

Diabetes is a serious health condition. There is no cure. If left untreated it can cause heart attack, stroke, kidney failure, blindness, amputation, and erectile dysfunction. If diagnosed early, diabetes can be effectively managed and the risk of serious health problems greatly reduced.  

Diabetes Australia–Queensland provides support to over 150,000 people with diabetes and their families in

Queensland through education, information, advice and care.   

Seminars and Expos held throughout the state are designed to share information and to motivate individuals and families to “Live Well with Diabetes”. 

National Diabetes Week is also a great time to organise a community fundraising activity.  Help raise awareness of diabetes and support people with diabetes by holding a fundraising event in your area.  Proceeds can be sent to Diabetes Australia–Queensland to continue our mission.  

Follow the 10 Steps below to Live Well with Diabetes·          Eat Well. Enjoy a variety of healthy foods which are low in saturated fat, sugar and salt. High fibre foods are also recommended e.g. wholegrain breads and cereals, legumes, fruit and vegetables. Monitor your portion sizes so that you do not eat more food (energy) than you can use (burn) if trying to prevent weight gain.·          Be active. Stay as physically active in as many ways and as often as you can. Aim for a minimum of 30 minutes every day.·          If you smoke, Stop. Consult your GP, call Quitline on 13 78 48 and get help (if necessary).·          Test your blood glucose levels regularly. By keeping your levels in the target range you will dramatically lower the risks of many complications. Discuss your targets with your doctor and/ or your diabetes educator. Take your medications as directed by your doctor.·          If you drink alcohol, do so in moderation.·          Keep track of your weight (and waist). If overweight, even small amounts of weight loss can make a difference to your general health and diabetes management.·          Have your doctor arrange the recommended management and complication checks (Annual Cycle of Care).·          Take care of your feet and look at them daily. Wear well-fitting socks and supportive shoes or sandals.  Cut nails carefully and be aware of injuries.·          Have your eyes checked by an optometrist annually, unless recommended more frequently.·          Maintain a positive attitude - this is probably the most important tip. 

If you have diabetes or may be at risk of developing diabetes, contact Diabetes Australia–Queensland to receive an information pack outlining our range of member benefits from education, advice, support and advocacy to exclusive discounts on lifestyle products and services. Alternatively you can log on to www.diabetesqld.org.au for more information.  

Diabetes Australia –

Queensland, GPO

Box 9824, Brisbane

Qld 4001Phone: 1300 136 588Web: www.diabetesqld.org.au

St Stephens has a highly skilled group of specialists and surgeons performing state of the art procedures in their hospitals both in Maryborough and

Hervey Bay. 

Recently, Surgeons performed major Bowel Surgery in Maryborough utilising Laparoscopic or “key hole” surgery.  

This surgery was carried out for the first time and involved the resection and removal of a segment of diseased colon affected by bowel cancer. The team of surgeons and nurses who performed the surgery used this advanced technique which provided significant positive outcomes for the patient. 

Ian McGeachin was recently diagnosed with Bowel Cancer following a routine blood test. He had to have part of his bowel removed and this was performed using Laparoscopic Surgery.  

Mr McGeachin was very impressed with the technique and the ease of his recovery from this major surgery. “Having the surgery this way certainly made my recovery easier. I was walking around 12 hours after surgery and was discharged in 5 days,” Mr McGeachin said.  

Previously, this type of bowel surgery was carried out using traditional open methods.  

Open surgery is more invasive and requires longer recovery times for the patient. Laparoscopic Surgery is also commonly known as “telescopic surgery” or “minimally invasive surgery”.  

With the advent of microchip technology and fibreoptics, modern telescopes (called laparoscopes) allow a small camera to be introduced into the abdominal cavity. The view from the camera is transmitted to a TV screen, so everyone can see, and the surgeon has free hands. This allows narrow instruments to be passed through tiny nicks into the abdominal cavity, and the surgeon is thus able to operate from the outside by viewing the TV image.  

Laparoscopic surgery has been used for many years, commonly for more minor procedures such as hernia repairs, appendectomies, removal of gall bladder and adhesions and minor gynaecological procedures.  

Tissue and even internal organs also can be removed through tiny incisions, or very small incisions if the organ is larger. This type of surgery is also used to examine the interior of the abdominal or pelvic cavity for diagnosis of different diseases and conditions.  

While this surgery has many benefits to patients it doesn’t compromise positive outcomes. These benefits include less invasive surgery, minimal incisions that reduce pain, shortened length of stay in hospital and quicker recovery times. It also results in fewer complications and less blood loss. Most patients can return to their normal activities within one week of surgery. 

Being able to access this more advanced laparoscopic surgery locally means that many patients will be able to have their surgery closer to home, where family and friends are able to support their recovery. 

While we hope none of our readers require this type of surgery, it is important to know of its availability locally and to recognise the skills and achievements of our specialists in this region.

When we look at the masterpiece of engineering of the foot we see 28 bones and a multitude of soft tissues designed to go, in a fraction of a second, from being a shock absorber, and taking the impact of the ground, to becoming a rigid lever to propel us forward. 

This complete and sudden turn about is paramount in our ability to successfully stay on our feet. Do we aid or hinder this engineering feat with our choices of footwear? Or other forces like excessive weight, sudden changes in direction and speed? 

Some buy a certain brand or style of shoe. Others stand on platforms that indicate how our foot acts;  however, this measurement is taken without shoes on the feet. 

As soon as a shoe is on the foot, of course the shoe has an influence on the foot. 

We realise the problem is more complex, and why it is important to make an appointment with someone who not only looks at the end result of pressure in the foot, but also takes into consideration the injuries, the limitations, the need for support versus cushioning,  and how the limb and body are connected. 

Injuries happen. Often this is attributed to the way the foot has developed, combined with the amount  of range of motion the joints allow and with how we treat our feet. Podiatry helps to answer these important questions. 

Recurrent heel spurs are a common example of this. 

Podiatry has become more evidence based. Computerised gait analysis shows the effects movement have on the spine, the legs and the foot, indicating the effect one has on the other. 

At present we are conducting a study on the average

Hervey Bay foot. Contact Wide Bay Podiatry to find out more.  

Next month we will be looking at Diabetes and Podiatry.

Abdominal contouring has become a frequently heard catch phrase in the realm of plastic surgeons and refers to many surgical procedures aimed to target and improve the appearance of a patient’s stomach area. Procedures such as an abdominoplasty and liposculpture are the most common solutions to add length to the female torso, define waist curvature and to enhance and balance a woman’s hourglass shape. Alternatively these procedures can assist in defining a male chest, toning and sculpting the abdomen and creating a more masculine physique. 

Today, the traditional abdominoplasty, often referred to as a tummy tuck, is frequently combined with liposculpture to target areas of fatty tissue harboured at the midriff line, upper tummy, hips and love handles. Overall, the combination of techniques will provide an individualized outcome where specific characteristics of a patient’s body are meticulously assessed and specifically treated to improve their particular body contour.  

So let’s define an abdominoplasty or ‘tummy tuck’…. 

An abdominoplasty is the term to describe the procedure of removing excess skin and fat from an individual’s abdominal region. First, a slight ‘smile’ shaped incision is made across the lower abdomen, usually right along the bikini line and extending to varying lengths toward a patient’s hip bones, depending on the amount of skin to be removed. The shape and healing of this incision will depend on the tone, severity of stretch marks and overall health of the abdominal skin. 

From this incision the skin and fatty tissue can be lifted from the underlying musculature, usually as high as the rib cage, and weak abdominal muscles tightened if needed. The excess skin and fatty tissue is then drawn down, removed and precisely sutured to create a new firmer, smoother and flatter abdomen. If needed, a new position for the navel will be made. Liposculpture is often used throughout the abdominoplasty to target and tailor those areas that are visibly disproportionate to the overall shape of the patient and the result. 

What is liposculpture…. 

Liposculpture is a method of fat removal by way of small incisions in the skin, usually about 3-5mm wide, by which a fine blunt suction cannula can pass in and out to remove fat cells. To assist in this process an infusion of saline (to mobilize and swell the fat cells) and local anaesthetic (to provide pain relief and adrenaline) is introduced prior to the suction being applied to minimize bleeding in the areas to be treated. 

The end result after abdominoplasty with liposculpture is a firmer and more defined abdominal area with little or no excess skin, which improves the overall appearance of a patient’s torso. 

While these techniques are effective in treating excess abdominal skin and tissue and localized areas of fatty bulk they are not to be considered an independent weight loss solution. Abdominoplasty and liposculpture are fantastic options for you if:· You are physically healthy and at a stable weight · You have realistic expectations · You are a non-smoker · You are bothered by the feeling that your tummy/torso is too large or out of proportion with the rest of your body. 

To find out more about these procedures or to make an appointment with Dr James Gaffield FACS FRACS please call Pacific Plastic Surgery or visit www.pacificplasticsurgery.com.au. 

Most of the extensive dentistry that we do is for patients aged between 60 and 75, so a common question we hear is “should I do this at my age”.   

On the one hand it makes me sad as it reflects the devaluing by society of our most experienced citizens; however, it is a complex and serious question that deserves some consideration and, like all such judgements, is a balance of many different factors. 

I read an article a while back that said 70 is the new 50.  In other words, many 70 year olds now are more fit, active and healthy than a 50 year old in 1975. I know that most of my patients in this age bracket run rings around me. Seriously, however, it means that if you have made it to 65 or 70 without serious illness, there is something like a 85% chance that you will live into your nineties. So the teeth you have need to do a lot more work yet. 

Of course, there is the option of removing teeth and making dentures. The advantage to this is that cost is often less and the long term maintenance cost is much lower.   

The price you pay of course is uncertainty about comfort and function. Some people can handle dentures without any problems, but for most, there are usually function problems. While people adapt after a while, they usually avoid certain foods, often without thinking about it, cut food into tiny pieces or overcook food to make it soft.  

A study done in Canada showed that people with full dentures get less vitamins out of their food than with dentures anchored to implants. So dentures are to teeth like an artificial leg is to a real one. 

Sometimes we make dentures for patients with the proviso that if they have problems, we can place implant anchors.  These are very low maintenance and make a huge difference to comfort and function. I have a patient who had implant anchors to hold her lower denture in place around twenty years ago. Besides having the denture remade a few times, she has had virtually no maintenance (your denture does wear out a bit quicker when you can chew properly). 

A lot of people don’t want dentures of any sort and want to maintain their own teeth. On the one hand, if you have your teeth restored sooner, they will eventually wear out again. On the other hand, the fitter and healthier you are, the less risky and uncomfortable long and complex procedures are.  

It is also easier to restore teeth for someone who has teeth that are reasonably solid to start with. Waiting until your teeth are completely worn out creates all sorts of headaches for the restoring dentist.  It’s easier to restore a Queenslander which is basically straight and solid than one tilting over and with the roof falling in. Same goes for teeth. 

Generally, teeth are less at risk from tooth decay when you are older rather than younger as your diet generally continues to improve throughout your life, so with regular maintenance, there is no age where all your teeth will suddenly fall out. 

Obviously cost does need to be considered as if you are retired, you will be on a fixed budget.  Often dental work can be staged to fit your budget.

 

So yes, if you want your teeth restored and enjoy eating and socialising with comfort and confidence, it is worth getting your teeth restored at any age as long as the dentistry will fit around the other things in your life.

PMS - stands for –

Pardon My Sobbing … Perpetual Munching

Spree … Pimples May Surface … 

PMS is the term used to describe a number of symptoms that collectively occur during the latter phase of the menstrual cycle and abate with the onset of the period or very soon afterwards.  

For many women who cope with enormous family and workloads, this is the time when they literally feel “the world is falling apart”, or when just a minor stress seems to “tip the scales”. 

PMS jokes are everywhere. It is probably the most common female hormonal disorder, very misunderstood, and certainly one that no woman would choose. Many women accept monthly changes to their mood, appetite, energy and sleep patterns as an annoying, but inescapable part of life. 

In

Australia it is estimated that up to 75% of women experience PMS at some time in their lives, with 18% of women suffering the more severe form – Premenstrual Dysphoric Disorder (PMDD). These conditions can have a severely detrimental effect on the quality of lives, but generally PMS is a treatable condition. 

What causes Premenstrual Syndrome?   

Although the cluster of physical PMS symptoms is well recognized, the combination of neurological and endocrine factors that cause these symptoms is not necessarily well understood. 

Comparative studies are suggesting women with PMS have greater hormonal fluctuations during their cycle with an elevated level of oestrogen in the premenstrual phase. The hormone Prolactin naturally elevates during this phase and is associated with cyclic breast tenderness, fluid retention and irritability.  

Increased oestrogen, stress and low blood sugar can exacerbate these symptoms. Hormonal activity can also contribute to symptoms of fluid retention, contributing to weight gain and bloating. Associated neurological factors are thought to trigger food cravings, binge eating and fatigue. 

Collectively these factors contribute to the wide variability of symptoms experienced by each woman during her cycle. 

There are possibly three different categories of PMS, and consequently the need to address each of these with a different approach. 

In the first category, women suffer predominantly from mood changes and psychological stress due to the hormonal imbalance. They become easily frustrated, short tempered and irritable. The tension reflects in shoulder and neck pain, often with migraines and headaches. They often suffer from lower back pain, a tendency to comfort eat, breast tenderness, bloating and irritable bowel. 

Managing this category of PMS would require regulating the excessive oestrogen stimulation with phyto (plant) -oestrogens combined with anti-anxiety herbal formulas to encourage calmness. The psychologically soothing effects of this approach are reflected systemically as shoulders relax and bowel irritability is calmed during stress and PMS. 

The second category would embrace women who suffer increased physical discomfort and pain. These women complain of pain, fatigue, coldness and menstrual irregularities. Often there would be continual lower abdominal pain (relieved by heat) and frequent urination. 

Various studies have demonstrated that specific herbal and nutrient supplementation may significantly improve this spectrum of premenstrual symptoms over a period of three months. One study showed that symptoms of irritability, breast fullness and bloating were improved by 50%, whilst another study found that 93% of 1634 participants reported an improvement or complete remission of symptoms monitored, including depression, anxiety, food cravings and fluid retention. 

The third category is where there may be associated gynaecological disorders contributing to congested, painful and heavy menstruation. In these cases a blend of herbs may be used to effectively treat menstrual irregularity, oestrogen excess and dysfunctional uterine bleeding related to congestive female disorders such as endometriosis, uterine fibroids and Polycystic Ovary Syndrome (PCOS). 

The specialized formulations incorporated into treatment for these three categories are based on traditional Chinese formulas that have been scientifically proven to give significant improvements in the treatment of uterine fibroids, with heavy and painful periods, over 12 weeks in the study subjects. 

We are extremely fortunate today that so much research is being focused on female hormones, and improving female health. The multi-factorial model to treat PMS now incorporates hormonal, dietary, lifestyle and emotional support as a treatment model. Combined with utilizing the latest researched hormonal balancing formulas there is no longer need for women to suffer this often debilitating condition. We are excited that it can now be Natural Medicine to the rescue… “Poor Me” solved.

One or two hearing aids 

It has been mentioned a few times that hearing with both ears is important for both localising sounds and for communicating in noisy environments.  

One would think, therefore, that a binaural fitting – the use of two aids – would always be optimal, but this would be similar to claiming that most people using glasses would need to have their eyesight corrected for both eyes. 

 When the expert responsible for fitting of the hearing aids suggests that two hearing aids might be the best solution, it often happens that the hearing impaired says: “I am not that deaf”, thereby indicating a certain reservation towards testing the possibilities offered by modern hearing aids. 

In addition to improving the ability to localise sounds and to communicate in difficult listening situations, the fitting of two hearing aids also makes it possible to create the correct sound balance, so that the hearing impaired will have a feeling of balance between the sounds coming from the right and left side. 

There are, however, a number of circumstances that may contribute to the fact that not all hearing-impaired people – including those with considerable hearing losses on both ears – will benefit from using two hearing aids.  

It is not always possible to make a binaural fitting because some hearing losses develop in such a way that one of the ears no longer contributes effectively to the understanding of speech. Before a binaural fitting is attempted, it is therefore important to test whether both ears are in fact able to transmit speech information to the brain, and thereby avoid making a decision to fit two hearing aids on the basis of the audiogram alone.  

To attempt a binaural fitting in cases where one of the ears does not function may ruin the possibility of a good result, because the hearing aid on the bad ear will often contribute with distorted sounds and noise instead of additional information.  

In some cases, however, it is possible to create a good sound balance despite the fact that one of the ears contributes very little to the understanding of speech. 

The final decision to fit one or two hearing aids depends, therefore, on whether or not the user can benefit. If a binaural fitting is not selected, the hearing expert must concentrate on finding the optimal adjustment of the hearing aid for the better ear. 

In a case of a long-lasting, asymmetrical hearing impairment, the brain may have become accustomed to utilising the information coming from the better ear, in which case the worst ear is ‘forgotten’.  

If the worst ear is not used, its ability to transmit speech information to the brain may deteriorate and, finally, it may no longer be brought to function again, even after long-lasting training with a hearing aid – and in spite of the fact that the audiogram may tell a different story.  

In contrast, in the event that the worst ear is still functioning, it is important to keep it stimulated, and in such cases the worst ear should also be fitted with a hearing aid. This all depends in the cortical plasticity of the brain.