What Causes Ringing in My Ears?

If you have tinnitus, you will hear a sound that’s not coming from the environment. People with tinnitus frequently describe it as ringing, buzzing, cricket sounds, humming and whooshing.

Verywell Health’s recent article entitled “Causes of Tinnitus or Ringing in the Ears” explains that tinnitus can be linked to anything that causes hearing loss, such as ear wax or fluid in the middle ear. However, most commonly, tinnitus is associated with inner ear hearing loss. It’s thought to be caused by inner ear cell damage. Cilia in your inner ear move in relation to the pressure of sound waves. This triggers the inner ear cells to release an electrical signal through the auditory nerve—a nerve that sends messages from your ear to your brain. Your brain interprets these signals as sound. The common causes of tinnitus are also often associated with hearing loss.

  • Noise Exposure. This can damage the outer hair cells, which are part of the inner ear. These hair cells don’t grow back if they’re damaged. Even short exposure to very loud sounds, like gunfire, can be damaging to the ears and cause permanent hearing loss. Long periods of exposure to moderately loud sounds, such as factory noise or music played through earphones, can also result in just as much damage to the inner ear, with permanent hearing loss and tinnitus. Listening to moderately loud sounds for hours at a young age carries a high risk of developing hearing loss and tinnitus later in life.
  • Some meds can be ototoxic (toxic to the ears or structures of hearing), and some medications list tinnitus as a side effect. If you want to know if a medication you’re taking could cause tinnitus, talk to your pharmacist, or look at your medication label. Don’t stop a medication without consulting with your physician, even if you think it may be contributing to your tinnitus.
  • Age-related hearing loss. Hearing loss is common with advancing age. It happens because of nerve damage.
  • When too much earwax accumulates, it becomes too hard to wash away naturally. This may cause hearing loss or irritation of the eardrum and can lead to tinnitus. If earwax is removed, tinnitus will usually resolve.

Many other medical issues can contribute to tinnitus. Some can take a while to identify because they aren’t common and because the signs and symptoms are not always consistent. Tinnitus is also often one of the less common symptoms.

  • Meniere’s Disease. This is an inner ear disorder that may be caused by abnormal inner ear fluid pressure. A feeling of ear fullness, vertigo and hearing loss are other symptoms of Meniere’s disease.
  • Ear Bone Changes. Otosclerosis is the stiffening of the bones in your middle ear, which may impact your hearing and cause tinnitus.
  • Temporomandibular Joint Disorders. Issues with the temporomandibular joint (TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull) can cause tinnitus.
  • Head injuries or neck injuries. These can affect the inner ear, auditory nerves, or the brain functions connected to hearing. These types of injuries generally cause tinnitus in only one ear.
  • Acoustic Neuroma. This is a benign (noncancerous) tumor that develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. It’s also called vestibular schwannoma, and generally causes tinnitus in only one ear.

If you’re experiencing tinnitus, it’s important to have a complete hearing evaluation. Your audiologist and ear, nose, and throat specialist will look at underlying medical conditions that require treatment before discussing treatment options with you.

Reference: Verywell Health (March 3, 2022) “Causes of Tinnitus or Ringing in the Ears”

Suggested Key Terms: Senior Health, Tinnitus

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What Should I Know about Graves’ Disease?

Graves’ disease is diagnosed from its symptoms, a physical exam and blood tests. Imaging tests may also be required.

Verywell Health’s recent article entitled What Is Graves’ Disease?” explains that treatment, including anti-thyroid medications, radioactive iodine therapy (RAI) and (rarely) surgery, can alleviate symptoms. If you have Graves’ disease, you may also need treatment for symptoms of hyperthyroidism.

Graves’ disease is connected to several symptoms that are the same as symptoms of any type of hyperthyroidism. There are a number of symptoms specific to Graves’ disease. The symptoms of hyperthyroidism (due to any cause) include:

  • Weight loss
  • Heart palpitations
  • Fatigue
  • Shortness of breath
  • Dizziness
  • Muscle weakness
  • Agitation
  • Irritability
  • Insomnia
  • Increased sweating/heat intolerance
  • Shaking hands
  • Diarrhea or frequent bowel movements
  • Increased appetite (sometimes decreased appetite)
  • Thinning hair
  • Fertility problems
  • Menstrual-cycle changes; and
  • Hypertension (high blood pressure).

Graves’ disease and other causes of hyperthyroidism are frequently linked to a goiter (enlargement of the thyroid gland). Here are some additional symptoms that commonly occur with Graves’ disease but not other types of hyperthyroidism:

  • Graves’ ophthalmopathy: Also called Graves’ orbitopathy, this can result in “bulging eyes,” and can cause pressure around the eyes, sensitive eyes and decreased vision. This impacts about a third of those with Graves’. It’s caused by swelling due to the autoimmune process behind the disease.
  • Skin lesions: Thyroid dermopathy, also known as Graves’ dermopathy, can cause a thickening of the skin, swelling and severe itching. In some instances, thyroid dermopathy can progress to a condition called acropachy, which is characterized by deformities of the fingers and toes.

If your Graves’ disease is not adequately treated, osteoporosis (thinning of the bones) and heart disease can develop.

Reference: Verywell Health (Aug. 29, 2022) What Is Graves’ Disease?”

Suggested Key Terms: Senior Health, Graves’ Disease

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How Should I Handle Memorabilia in My Estate Planning?

Kiplinger’s recent article entitled “Estate Planning for Memorabilia Collectors: Don’t Leave Your Family in the Lurch” says the first step is to know what you have. Make a thorough and updated inventory to help your family understand the scale of the collection and where the items are located. Make sure the inventory is current and has detailed information about the items, like if a piece of memorabilia is signed or if it was game-used.

It’s also wise to log valuations along with the items’ description. You can try to stay on top of when comparable items sell at auction and follow industry publications to keep your valuations as current as possible. Every sector of collectible is different. Some items see their valuations fluctuate more than others. Even so, it’s helpful to have a ballpark idea of the total value of the collection. At some point, it might be worth hiring an appraiser to give you a formal valuation of the collection.

As far as authentication, many items need supporting paperwork to verify they’re legitimate. As you plan for your family to handle the sale of your items, they’ll need to know that those documents are an essential part of the collection and where they are.

When you’re walking them through your inventory, note where the items are identified as having separate certificates of authenticity and make sure they know where to find them. This can be as simple as using file folders.

When it comes time to sell, where does your family go Whether it’s sports memorabilia, coins, stamps, or just about anything else, there are dealers who are willing to purchase the collection. If you go into a collectibles shop that’s only buying items they plan to resell, you can expect to get about half of a collection’s actual value.

You can help your loved ones by making connections with auction houses that would be interested in bringing your collection up for sale. This can be a highly specialized area, so you’ll be saving your beneficiaries a big pain if you give them information about where they will get a fair price.

Reference: Kiplinger (Feb. 26, 2023) “Estate Planning for Memorabilia Collectors: Don’t Leave Your Family in the Lurch”

Suggested Key Terms: Estate Planning Lawyer, Memorabilia, Inheritance, Asset Protection, Probate Attorney

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Do Family Secrets Hurt Estate Planning?

A study by the financial services research firm reveals just how big a problem family secrets can be, as reported in Financial Advisor’s recent article “Family Wealth Transfers Undermined by Secrecy.” Most asset holders plan to share their wishes and intentions with family members before they die. However, the research reveals only about half actually do so.

The survey looked at two demographics: affluent investors with more than $250,000 in investable assets and near affluent, investors under age 45 with earnings more than $125,000. Responses were weighted to reflect the distribution of households within these segments, which are wealthier and older than the average U.S. population.

Estate planning attorneys understand the complexity of multi-generational families and are experienced with nuances in family dynamics and the hesitancy of families to share their financial details. After a lifetime of not discussing wealth, it can be difficult to know where to begin.

When asked how well informed heirs are about their parent’s desires and plans for bequests, only 26% saiAdvanced Directives, Power of Attorney, Health Care, Long-Term Care, Assets, Wealth, Incapacity, Estate Planning Attorney, Heirs, Bequests, Trusts, Will, Affluent Investorsd their heirs were very well informed. The greater the wealth, the more likely conversations had taken place. About a third of respondents with more than $1 million in investable assets said heirs knew of their plans.

Those with less than $250,000 to pass on were not sure if heirs knew their wishes or, worse, admitted their heirs had absolutely no idea.

Although skipping generations offers tax advantages, most heirs receive inheritances directly from a parent upon their death. Having an estate plan in order, including wills and trusts agreements, ensures an orderly transfer of wealth.

A key component of successful wealth transfer is communication. However, this survey found a full 25% of respondents never intend to share information about their assets while they are living. This prevents comprehensive planning from taking place, since a number of aspects of wealth planning require active planning and other people to be involved during the parent’s lifetime.

Planning for incapacity requires the involvement of siblings, spouses, and heirs. Advanced directives, power of attorney, health care power of attorney and related documents need to be shared with family members, so they can act on the parent’s behalf. Lacking these documents creates emotional and financial burdens on loved ones.

Because healthcare costs later in life can quickly erode assets, talk with your estate planning attorney about health care and Medicaid planning for long term care to help manage expenses and preserve as much wealth as possible.

Reference: Financial Advisor (Feb. 22, 2023) “Family Wealth Transfers Undermined by Secrecy”


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Three Ways to Making Trusts Millennial Friendly

If your named beneficiaries are Millennials—born between 1981-1996—you may want to consider three essential points about your trusts, as explained in the recent article “Trusts For Your Millennial Beneficiaries” from The Street. They’re different from their parents and grandparents, and disregarding these differences is a missed opportunity.

This generation’s distinguishing characteristics and traits include:

  • Valuing relations with superiors with a passion for learning and growth.
  • Desire to live a life with meaning and make a positive impact on the world and causes.
  • Creative and free thinking, looking for outside-the-box solutions and opportunities.

If your estate plan benefits Gen Y, some trust features recommended for Millennials may not be optimal for them. They’re different than their older Millennial counterparts.

Have your beneficiary serve as a co-trustee of their trust alongside an experienced advisor. Millennials appreciate the opportunity to ask for advice from a trusted advisor, secure positive reinforcement and get constructive feedback. Many heirs set to come into money are likely to work with an advisor once they inherit. For them, a co-trustee arrangement could be perfect. Consider naming a family member or friend with a background in finance as their co-trustee or naming a corporate trustee.

Consider giving your beneficiary a limited testamentary power of appointment to support their favorite charity. Millennials want to make a positive impact on the world, and there’s a trust feature you can build into a trust to support this goal: a limited testamentary power of appointment. In broad strokes, this gives the trust beneficiary the power to redirect where assets go upon their death. If the scope of power permits, they could redirect assets to charitable organizations of their choice.

Most people design trusts to last for the beneficiary’s lifetime and then structure the trust so assets remaining at their death will pass in trust to their children in equal shares. Trusts can also be created to change the distribution percentages between recipients. For instance, instead of a 50-50 split, the trust can redirect shares of 70-30 to better accomplish their personal objectives. You can also provide for new beneficiaries, like charities, if they weren’t part of the original trust.

Powers of appointment can be complicated and making them overly broad can have serious and adverse tax consequences. Therefore, speak with your estate planning attorney to make sure the scope of power is clear and properly designed.

Broadly define the standards for which distributions can be made to your beneficiary. Millennials think differently, so the commonly used trust distribution standards of health, education, maintenance and support (“HEMS”) may stop them from being able to tap into trust funds for philanthropic or entrepreneurial efforts. The HEMS standard only allows for distributions generally for purposes to align with the beneficiary’s current standard of living. If you want beneficiaries to be able to do more, they need to be given the ability to do so.

Another way to accomplish this is to allow a disinterested trustee (someone who is not a beneficiary) an expansive distribution authority. Having the ability to make a distribution of trust funds to your beneficiary for any purpose can be a little unsettling. However, naming a disinterested trustee you trust will ensure that funds are distributed responsibly.

Leaving assets in trust for beneficiaries can be part of an effective estate plan supporting planning goals and your loved one’s future. However, if the trust’s structure doesn’t meet their unique needs and talents, then their potential may be dimmed.

Reference: The Street (Feb. 24, 2023) “Trusts For Your Millennial Beneficiaries”


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What are Warning Signs of Macular Degeneration ?

The American Optometric Association recommends annual eye exams for people over 60, says AARP’s recent article entitled “3 Warning Signs of Macular Degeneration.”

During an eye exam, your doctor will examine the macula for what’s known as drusen—yellow deposits of fats and proteins. Some small drusen are to be expected with age and don’t cause vision loss.

However, medium-sized or larger ones are a classic sign of AMD.

Regular visits with an ophthalmologist can detect AMD years before patients notice anything is a miss.  Early detection of changes can lead to treatments that can slow progression or reverse vision loss in some AMD cases.

Research says taking certain high-dose vitamins and minerals slows progression of the disease in people with intermediate AMD and those with late-stage AMD in one eye. These include:

  • Vitamin C;
  • Vitamin E;
  • Zinc;
  • Lutein;
  • Zeaxanthin; and

However, don’t go loading up on these vitamins and minerals with reckless abandon.

Supplements known as AREDS2 are sold over the counter in specific quantities. Ask your eye doctor about whether such high-dose supplements are a good choice for you.

“Wet AMD is treated with the same AREDS2 vitamins as dry AMD, but also with injections of medications into the eye to treat the leaking blood vessels,” says Akrit Sodhi, M.D., professor of ophthalmology at the Wilmer Eye Institute at Johns Hopkins Medicine. These medications help reduce the number of abnormal blood vessels in your retina. They also slow leakage. “Currently, these treatments are focused on stopping progression of disease, but good treatments that reverse damage are still in the works.”

Lifestyle also plays a role in treating macular degeneration, and reducing exposure to sunlight by wearing sunglasses, avoiding cigarette smoke, eating a healthy diet and getting annual eye exams can help lower the risk that you develop vision loss from AMD as you age.

Reference: AARP (Oct. 27, 2022) “3 Warning Signs of Macular Degeneration”


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Can I Enroll in Medicare While I’m Still Working?

As inflation and a rocky stock market continue to eat away at the nest eggs of older workers approaching retirement, working longer than expected is increasingly being considered. However, a recent Allsup survey showed that one-third of those nearing retirement age (62-64) who plan to keep working past 65 don’t understand they can sign up for what is often more affordable Medicare coverage, even while they’re still employed.

Kiplinger’s recent article entitled “Yes, You Can Sign Up for Medicare While You’re Still Working” says with retirement perhaps further away for many, some people need help understanding their options. The article gives answers to some common questions concerning retirement postponement and Medicare coverage, including common misperceptions.

When should I plan to retire? Your retirement decision is personal and depends on your situation. Most employees now expect to retire around age 71. Workers in their 60s have been making the decision to work longer. Although some are relatively positive about working past 65, about 50% of those people have continued working primarily to maintain their health insurance. Access to health coverage is one of the primary reasons why the average age when people retire is going up. In a survey of more than 1,000 American older workers, 31% of those with employer insurance say health care is their main reason for working, and 53% say it’s one factor. In any event, having a plan in place for how you’ll handle your Medicare decisions before you turn 65 can streamline the transition off your employer-sponsored health insurance.

Do I have to enroll in Medicare? For most working seniors, the answer is no. While enrolling in Medicare is often a good alternative to their company’s coverage, it’s not required that all seniors make the jump as soon as they turn 65. However, in some cases, it’s mandatory, and it’s important to understand these exceptions to be sure there are no gaps in your coverage.

Is Medicare better than my employer-sponsored coverage? Employees who are approaching retirement, and those who have reached retirement age, say they’re mostly content with their employer health benefit packages. However, hesitation and misconceptions about Medicare prevents workers from shopping for potentially better plans. If Original Medicare is unaccompanied by a prescription drug plan (Part D) or a Medigap supplement, it may not match your current employer-sponsored level coverage. It’s recommended to pair your Original Medicare plan with a prescription drug plan and a Medigap plan. Each Medigap plan (plans A to N) offers a different level of coverage. You should carefully consider which plan best fits your needs.

Reference: Kiplinger (Oct. 11, 2022) “Yes, You Can Sign Up for Medicare While You’re Still Working”


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What to Ask a Prospective Elder Law Attorney

Seasons recent article entitled “Finding an elder care lawyer” provides some sample questions to ask yourself as you consider an elder law attorney, including:

  • Is my senior capable of speaking out for themselves, or do they need an advocate to represent their voice?
  • Is my senior the type of person to accept abuse without complaining?
  • Have there been any other instances of abuse at my senior’s nursing home?
  • Is my senior more vulnerable to scams and frauds?
  • What services do elder care lawyers provide?

If your senior has suffered legitimate abuse at the hands of their caregivers, you have the right to file a lawsuit against the guilty party. Your elder law attorney can help to assess whether a lawsuit is possible during a consultation. That is an initial meeting with a lawyer. During this meeting, you can discuss your unique situation and your concerns. Based on this information, your lawyer can recommend various paths of action. If a lawsuit is possible, they will guide you forward and help you initiate this legal process.

A lawsuit may be filed against a nursing home, a long-term-care facility, or any other organization responsible for caring for your senior. Once you’ve initiated the action, you’ll have the chance to negotiate with the at-fault party for a settlement. However, if a settlement can’t be reached, your elder law attorney will likely represent your senior in court and fight for their rights in front of a judge and jury. The court will then decide on the penalties and financial awards.

It’s a good idea to ask a few questions during your initial consultation. These questions can help you get a better idea of your lawyer’s personality, their overall philosophy toward elder law and whether they can develop a working relationship with you.

Here are some examples:

  • How much experience do you have with elder law?
  • How long has your practice been in operation?
  • Where did you attend law school?
  • Have you taken any additional courses from the bar association or NAELA specific to elder law?
  • What is your philosophy toward elder law?
  • Have you won any settlements for elder victims in the past?
  • How much do you charge?

Reference: Seasons (Aug. 30, 2022) “Finding an elder care lawyer”


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Does Divorce Have an Impact on Estate Planning?

Even the most amicable divorce requires a review and update of your estate plan, as explained in a recent article from yahoo! finance, “I’m Divorcing. Will That Impact My Estate Planning?” This includes your will, power of attorney and other documents. Not getting this part of divorce right can have long-term repercussions, even after your death.

Last will and testament. If you don’t have a will, you should get this started. Why? If anything unexpected occurs, like dying while your divorce is in process, the people you want to receive your worldly goods will actually receive them, and the people you don’t want to receive your property won’t. If you do have a will and an estate plan and if your will leaves all of your property to your soon-to-be ex-spouse, then you may want to change it. Just a suggestion.

State laws handle assets in a will differently. Therefore, talk with your estate planning attorney and be sure your will is updated to reflect your new status, even before your divorce is finalized.

Trusts. The first change is to remove your someday-to-be ex-spouse as a trustee, if this is how you set up the trust. If you don’t have a trust and have children or others you would want to inherit assets, now might be the time to create a trust.

A Domestic Asset Protection Trust (DAPT) could be used to transfer assets to a trustee on behalf of minor children. The assets would not be considered marital property, so your spouse would not be entitled to them. However, a DAPT is an irrevocable trust, so once it’s created and funded, you would not be able to access these assets.

Review insurance policies. You’ll want to remove your spouse from insurance policies, especially life insurance. If you have young children with your spouse and you are sharing custody, you may want to keep your ex as a beneficiary, especially if that was ordered by the court. If you received your health insurance through your spouse’s plan, you’ll need to look into getting your own coverage after the divorce.

Power of Attorney. If your spouse is listed as your financial power of attorney and your healthcare power of attorney, there are steps you’ll need to take to make this change. First, you have to notify the person in writing to tell them a change is being made. This is especially urgent if you are reducing or eliminating their authority over your financial and legal affairs. You may only change or revoke a power of attorney in writing. Most states have specific language required to do this, and a local estate planning attorney can help do this properly.

You also have to notify all interested parties. This includes anyone who might regularly work with your power of attorney, or who should know this change is being made.

Divide Retirement Accounts. How these assets are divided depends on what kind of accounts they are and when the earnings were received. The court must issue a Qualified Domestic Relations Order (QDRO) before defined contribution plans can be split. The judge must sign this document, which allows plan administrators to enforce it. This applies to 401(k) plans, 403(b) plans and any plans governed under ERISA (Employment Retirement Income Security Act of 1974).

Divorce is stressful enough, and it may feel overwhelming to add estate planning into the mix. However, doing so will prevent many future problems and unwanted surprises.

Reference: yahoo! finance (Feb. 3, 2023) “I’m Divorcing. Will That Impact My Estate Planning?”


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Beneficiary Battle over Presley Estate Reveals Possible Problems in Estate Planning

This is the situation facing the estate of Lisa Marie Presley, whose estate is being challenged by her mother, Priscilla Presley, as described in a recent article, “Presley beneficiary battle sets example of poor estate planning practices” from Insurance NewsNet. These situations are not uncommon, especially when there’s a lot of money involved. They serve as a teachable moment of things to avoid and things to absolutely insist upon in estate planning.

Lisa Marie’s estate is being challenged because of an amendment to the trust, which surfaced after she died. The amendment cut out two trustees and named Lisa Marie’s children as executors and trustees.

At stake is as much as $35 million from three life insurance policies, with at least $4 million needed to settle Lisa Marie’s debts, including $2.5 million owed to the IRS.

When this type of wealth is involved, it makes sense to have professional trustees hired, rather than appointing family members who may not have the skills needed to navigate family dynamics or manage significant assets.

A request to change a will by codicil or a trust by amendment happens fairly often. However, some estate planning attorneys reject their use and insist clients sign a new will or restate a trust to make sure their interests are protected. In the case of Lisa Marie, the amendment might be the result of someone trying to make changes without benefit of an estate planning attorney to make the change correctly.

The origins of the estate issues here may go back to Elvis Presley ’s estate plan. His estate was worth $5 million at the time of this death, $20 million if adjusted for inflation. His father was appointed as the executor and a trustee of the estate. His grandmother, father and Lisa Marie were beneficiaries of the trust. Lisa Marie was just nine when her famous father died, and her inheritance was held until she turned 25.

When his father died, Priscilla was named as one of three trustees. When his grandmother died, Lisa Marie was the only surviving beneficiary. She inherited the entire amount on her 25th birthday—worth about $100 million largely at the time because of Priscilla’s skilled management.

Terminating such a large trust and handing $100 million to a 25 year old is seen by many estate planning attorneys as a big mistake. Distribution at an older age or over the course of the beneficiary’s lifetime could have been a smarter move. Lisa Marie reportedly blew through $100 million as an adult and was millions of dollars in debt, despite the estate having plenty of cash because of two large life insurance policies.

In 1993, Lisa Marie established a trust naming her mother and former business manager as trustees. The amendment in question seems to have been written in 2016, removing Priscilla and business manager Siegel as trustees, appointing Lisa Marie’s daughter and son as trustees, and naming her son and her fourteen year old twin sons as beneficiaries.

Priscilla’s attorneys say they had no prior knowledge of the change. Certain changes in estate plans require written notification of people with interest in the estate, which did not occur. They are also challenging the amendment’s authenticity, saying it was neither witnessed nor notarized. Priscilla’s name is misspelled and Lisa Marie’s signature is not consistent with other signatures of hers.

The estate is being contested, with a preliminary hearing on the matter scheduled for April 13.

Any changes to an estate plan, particularly those involving changes to the will, trusts or beneficiaries, should be done with the help of an experienced estate planning attorney. When large changes are made, or large assets are involved, a simple codicil or amendment could lead to complicated problems.

Reference: Insurance NewsNet (Feb. 17, 2023) “Presley beneficiary battle sets example of poor estate planning practices”


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