TinniTusToday Providing Hope for a Quieter Future Through Education, Advocacy, and Research Toward a Cure Vol. 42, No. 1, Spring 2017

w ATA’s Ne s Podcast Serie & Information First Aid Tools

A publication of the

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Jack Vernon founded ATA in 1971 to lead the way in researching a cure, developing effective treatments, and creating broad-based support and awareness of tinnitus.

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Monthly or annual financial Gifts of stock contributions Gifts of real estate Name ATA in your trust or estate Deferred gift annuities Ask ATA to create a Tribute Page in Donations to ATA in lieu of flowers in memory of a loved one memory of a loved one Convert stock and/or real estate into a unitrust

We hope you’ll be a part of the legacy of securing silence for sufferers through a variety of cures, as well as finding treatments and sustained support for the millions who endure incessant noise and anxiety.

For more information about adding ATA as a beneficiary or ways to reduce your taxes through charitable contributions, please contact Torryn Brazell, ATA’s Executive Director, via email at: [email protected]. Table of Contents

EDITOR From the Editor ...... 2 John A. Coverstone, AuD Sentient Healthcare, Inc. From the Board Chair ...... 3 CONSULTING EDITOR AND WRITER Joy Onozuka, MA From the Publisher ...... 4 American Tinnitus Association Letters to the Editor ...... 5 COPY EDITOR Margaret L. Brown An Emergency Left Behind ...... 6 MLB Communications Tinnitus by the Numbers ...... 8 PUBLISHER Torryn P. Brazell, MS, CAE The Sudden Loss of Silence ...... 10 American Tinnitus Association 6 EDITORIAL ADVISORY PANEL An Optimized Tool for Tinnitus Research ...... 12 James W. Hall III, PhD University of Hawaii, Manoa ATA Support Network Calendar ...... 13 Salus University & University of Pretoria Quieting Our Neighborhoods ...... James A. Henry, PhD 14 National Center for Rehabilitative Auditory Research (NCRAR) Tinnitus You Will Want to Hear ...... 16 U.S. Department of Veterans Affairs Poetic Reflection: About My Tinnitus ...... 17 Stephen M. Nagler, MD, FACS Atlanta Tinnitus Consultants, LLC An Objective Measure of Misophonia ...... 19 Gail M. Whitelaw, PhD Conversations in Tinnitus Department of Speech and Hearing Science 10 The Ohio State University with Dr. David Baguley ...... 20 DIGITAL DESIGN & PRODUCTION TEAM Synaptopathy—A Cause of JML Design, LLC Potomac, MD Hidden Hearing Loss ...... 22

ADVERTISING Living With Tinnitus: Tinnitus Today is the official publication of the American Tinnitus Association. It Sudden Onset Hearing Loss ...... 24 is published three times per year in April, August, and December and is mailed to Tinnitus Guidance for GPs ...... 28 members and donors. To advertise, contact us at: [email protected] Demyelination—Another Cause

HEADQUARTERS of Hidden Hearing Loss ...... 30 522 SW. 5th St., Ste. 825 Portland, OR 97204 USA Why Do Some Professionals Hesitate to 14 Provide Tinnitus Care? ...... 31 EDITORIAL OFFICE American Tinnitus Association P.O. Box 5, Portland, OR 97207 Special Donors & Tributes ...... 32 +1-503-248-9985 800-634-8978 Treating Patients with Severe Tinnitus ...... 36 [email protected] www.ata.org ATA Funded Research:

The American Tinnitus Association is a Including the Patient Perspective ...... 38 non-profit human health and welfare agency under 26 USC 501(c)(3). Don’t Make the Journey Alone ...... 39

ADVERTISEMENT Publication of any advertisement 15 Things You Might Want to does not in any way or manner constitute or imply ATA’s approval or endorsement of any advertised Know About Somatosounds ...... 40 product or service. 24 FROM THE EDITOR Change is in the Air

One of the most frequent phrases heard by We are also extending Tinnitus Today by add- ATA staff is, “when will they find a cure???” It ing an ATA podcast series on tinnitus, hosted by is usually spoken with all three question marks, myself and my close friend and colleague, denoting both anticipation and some degree of Dr. Dean Flyger. The first episode was an exasperation. The mission of the American Tin- exciting conversation with Dr. David Baguley, nitus Association reflects our members’ hopeful researcher, clinician, and current President of support. Nothing is more prominent on the the British Tinnitus Association. More podcasts website than the Research Toward a Cure Road will be available every other month and may be Map. The ATA’s mission statement specifically accessed via the ATA website at www.ata.org. includes research, education, advocacy, and You can read more about the podcast series collaboration. This is not only to find a cure, but later in this issue. also to ensure that we have all the necessary I realize that some of our readers do not John A. Coverstone, AuD Editor components to support the search for a cure. use the internet and some others may be a bit Tinnitus Today Magazine In the meantime, ATA and its members exist to daunted by accessing a podcast. However, this help us all live with tinnitus until a cure is found. is essentially a radio program delivered online. We are currently in one of the most exciting If you have a relative or friend who can help periods of tinnitus care ever. We have more you download or subscribe to the podcast, or tools and more knowledge to assist in man- can possibly bring it to you, I think you will be aging tinnitus than ever before. Even more glad you did. There is nothing quite like listening exciting is the current research in tinnitus and to people talking about a subject. It becomes tinnitus-related disorders. The British Tinnitus much more personal and relatable. Association recently published the first edition One of the most important functions of of their Annual Tinnitus Research Review, edited Tinnitus Today is to communicate. ATA has a by Dr. David Baguley and Nic Wray. In this publi- long-standing history of bi-directional commu- cation, Dr. Baguley cites the increasing number nication through its magazine. Not only do we of research publications in recent years: twice prepare articles of interest to our readers, but as many in 2015 as in 2006 and four times as our readers participate strongly in the creation of many articles as in 1995. While we can’t project content for this magazine. I truly hope you will a date for a cure simply from increased publica- share your experiences and thoughts with us as tions or even comment about the quality of the well. If you have a story to tell or have questions research being conducted, this area has undeni- about tinnitus, tinnitus resources, or about any ably experienced increased interest and funding of our stories, I hope you will contact me at: in recent years. [email protected]. With all this in mind, Tinnitus Today will Be well and thank you for reading Tinnitus continue to bring you the latest research news Today. I can’t wait to hear from you. and helpful strategies for living with tinnitus. In becoming editor, it is my goal to ensure that Sincerely, the information in Tinnitus Today is the highest possible quality, is meaningful to all our read- ers, and is free from bias or influence from any outside sources. The importance of this is par- amount, as ATA must be a reliable and trusted resource for everyone living with and caring for those with tinnitus and related conditions.

2 TINNITUS TODAY SPRING 2017 FROM THE BOARD CHAIR A Life Without Tinnitus

Can you remember what your life was like applied the lessons he learned in coping with before tinnitus? For those of us who remem- extreme suffering in a Nazi concentration camp ber the occasion when our ears first began to to a person’s experience in general. Each of our ring (or hiss, or shriek or whistle, or whatever lives has meaning, he said. It is up to each of us wretched sound most applies in your case), we to discover that meaning even while suffering. suspect we know the cause—and rue that day You can discover this meaning in life in three like no other. “If only I had used earplugs when different ways, wrote Dr. Frankl: (1) by creating I started up that chainsaw,” we might say. “If a work or doing a deed; (2) by experiencing only I hadn’t been stopped at that intersection something or encountering someone; and (3) when that car rear-ended me, and along with by the attitude we take in unavoidable suffering. the whiplash came tinnitus.” If we don’t know All these expressions of meaning look to the the cause of our tinnitus, we moan, “What did I present and the future, not the past of “if only Scott C. Mitchell, JD ever do to deserve this? My life before tinnitus this had not happened that caused my tinnitus.” Chair was good and now tinnitus makes me so miser- In the present, you can examine your situation ATA Board of Directors able. If only I had my own life back!” without the weight of all accumulated negative This “if only” thinking can drive you nuts. It emotions. Looking to the future, you can accept has the effect of directing your thoughts into the the challenge of insisting that your life still has past, with all the might-have-beens and should- meaning, no matter the suffering you happen to have-dones that could have avoided tinnitus. So be experiencing now. Just what that meaning is, along with the undeniable physical suffering that of course, is a discovery that is up to you. That comes with your tinnitus, you burden yourself meaning will have nothing to do with tinnitus— with the guilt of having brought it on yourself. making a life in the future without tinnitus. But another reason exists why “if only” That is what I like about the American Tin- thinking just makes things worse: It drives your nitus Association. It is all about what we are thinking into the past. Every time you feel sorry doing now, in the present, to have an impact on for yourself, or blame yourself and go back in our future. It’s looking forward, not back. New your mind to the day when you first got blind- research, new therapies, new information you sided by this affliction, you never get past today, can use, new friends to offer each other mutual when you still have it. So back again you go: “If support—all of these are facets of the ATA that only this had not happened…” You have just validate the premise that your life has meaning. trapped yourself in an endless loop—not just in Your future is worth fighting for and that future is your thinking, but in the emotions that go along a life without tinnitus. with that thinking: Despair, hopelessness, self- pity, forever kicking yourself. Is there a way out of this trap? The book Man’s Search for Meaning by Viktor Frankl offers an answer. Dr. Frankl was a psychiatrist who

New ATA Executive Director After an extensive search, as Chair of the American Tinnitus Association Board of Directors, I welcome Torryn P. Brazell, MS, CAE, as its new Executive Director and Chief Operating Officer. Brazell, former Managing Director of the American Board of Audiology, is a noted leader in the field of advocacy for audiology and credentialing, which ensures that all professionals—those licensed as well as those in training—have shared diagnostic skills and knowledge of standard treatment methods so patients receive the highest level of care.

TINNITUS TODAY SPRING 2017 3 FROM THE PUBLISHER Tinnitus Health

It is ironic to call tinnitus a silent epidemic It’s critical for the ATA to expand the number because silence is what many sufferers of the of skilled health-care providers to help tinni- condition no longer enjoy. However, it is a silent tus sufferers. There are many providers who epidemic in the sense that at this moment in can diagnose tinnitus, but not nearly enough time, millions struggle on their own, wonder- who understand the multitude of treatments ing if their condition will or even importance of remain manageable or the referral process remain so debilitating for their patients to that they will never have psychologists, otolaryn- a reasonable quality of gologists, audiologists, life again. This is a reality psychiatrists, pharma- that the American Tinni- cologists, and so on. Torryn P. Brazell, MS, CAE Executive Director & Chief tus Association is chang- Through my atten- Operating Officer ing through increased dance at ATA tinnitus research funding, global support group meet- alliances, and the sup- ings, I’ve identified port of professionals and three areas of critical sufferers. need where we can I am both proud and play a role. First, provid- humbled to be a part of ing updates on current the ATA, which has been research and findings. a publicly supported 501(c)(3) organization since Second, sharing information on self-manage- 1971. In my former position at the American ment techniques and products that might Board of Audiology, I was exposed to what I mitigate symptoms. Third, creating a forum for considered a crisis in tinnitus care, which is why sharing personal stories and struggles of suffer- I was drawn to the ATA. I observed that the ers. By sharing our stories, we can find solace public was unaware that there were resources through support and access to information that like ATA that could help. I feel driven to dramat- might help us reconfigure our lives. ically raise ATA’s public profile so that anyone In my ongoing effort to stay informed and who hears about or suffers from tinnitus will involved, I’d like to invite you to share your turn to us for information and support. thoughts and stories at: [email protected]. The artwork of the tic-tac-toe suggests my desire to think creatively, strategically, and move outside of regular boundaries to be- come more innovative. I envision ATA being at the forefront of research funding, identifying endeavors that offer potential insight into more Brazell holds an MS in Business and Organizational Man- effective treatments and cures, as well as agement and a BS in Political Science from Oregon State providing the most comprehensive source of University. She also holds Certified Meeting Professional patient support information. and Certified Association Executive certifications. She is an active speaker on non-profit management issues, and serves as a member of the Assessment-based Certificate Accreditation Council, Institute for Credentialing Excellence.

4 TINNITUS TODAY SPRING 2017 LETTERS TO THE EDITOR

ATA BOARD OF DIRECTORS Chair—Scott C. Mitchell, JD, Houston, TX Ringing Getting Worse, What the first step toward managing Gabriel Corfas, PhD, Ann Arbor, MI Should I Do? your tinnitus would typically be to Col. John T. Dillard USA (Ret.), Carmel, CA Some years ago I went to OHSU, locate an audiologist in your area Daniel J. Fink, MD, Beverly Hills, CA Portland, Oregon, to have the ringing who specializes in tinnitus. They Norma R. Mraz, AuD, Alpharetta, GA Randy Phillips, Great Falls, VA in my ears diagnosed. I gained no di- will be able to perform the neces- Bryan Pollard, Marlboro, MA rect benefit from the visit, as I recall. sary examination of your ears and Gary P. Reul, EdD, Issaquah, WA As the years have passed, my ringing auditory function and discuss with LaGuinn Sherlock, AuD, Severn, MD David M. Sykes, Lincoln, MA is now constant and louder. I do not you the appropriate options for Joseph Trevisani, New York, NY wear hearing aids. addressing your needs. Ted Turesky, Washington, DC I am hoping that with the passing Everyone here at the American Bradley Vite, Elkhart, IN of years that there have now been Tinnitus Association wishes you Jinsheng Zhang, PhD, Detroit, MI advances that will help my condition. the best as you work to regain HONORARY DIRECTOR William Shatner, Los Angeles, CA Please let me know how I should control over your tinnitus. We sin- proceed. Thank you for your time and cerely hope that the content of the ATA SCIENTIFIC ADVISORY COMMITTEE Chair—Jinsheng Zhang, PhD consideration. articles in this magazine, the infor- Wayne State University, Detroit, MI USA — William L. Stroh mation provided on our website, Shaowen Bao, PhD and the conversations in our new Helen Wills Neuroscience Institute, Thank you for sharing your expe- podcast will be of some help and Berkeley, CA USA rience with us. While I obviously comfort as you make this journey. Susan M. Bowyer, PhD cannot provide specific treatment — Editor Henry Ford Health Systems, Detroit, MI USA advice through a magazine col- Dirk De Ridder, PhD umn, I know that your experience Great Article University of Otago, Dunedin, NZ resonates with many of our read- The article by Dr. Michael Robb about Marc Fagelson, PhD ers. Many people develop tinnitus “Bayesian Informed Prior Probabili- East Tennessee State University, Johnson City, TN USA at a more benign level and then ties” is, despite its off-putting title, Michael E. Hoffer, MD, FACS have tinnitus progress to the point one of the most useful articles that I University of Miami Health System, where intervention is necessary. I have ever seen in “Tinnitus Today.” I Miami, FL USA highly recommend that you con- have been looking for years for a com- Fatima T. Husain, PhD tact one of the many wonderful parison of treatments like this, and University of Illinois, Urbana-Champaign, tinnitus professionals in the Port- now I have it. This issue goes on my Champaign, IL USA land area, some of whom are ATA permanent reference shelf. Elisabeth Maria Knipper-Breer, PhD members and listed in this maga- — Frederick Nobury University of Tubingen, Tubingen, Germany zine. As with any person who has Mark S. Mennemeier, PhD University of Arkansas, Little Rock, AR USA bothersome tinnitus, you may wish While the title may have been to first speak with your primary daunting, I am thrilled that you Larry E. Roberts, PhD McMaster University, Hamilton, ON, Canada care physician and/or Ear, Nose, & found the article so valuable! Dr. Maria Rubio, PhD, M.D. Throat physician to rule out any Robb is a highly respected phy- University of Pittsburgh, Pittsburgh, PA USA conditions that require medical sician amongst tinnitus profes- Jeremy G. Turner, PhD treatment. Barring such conditions, Continued on page 37 Illinois College, Jacksonville, IL USA Roland Schaette, PhD UCL Ear Institute, London, England Letters to the Editor Grant D. Searchfield, PhD University of Auckland, Auckland, NZ The ATA encourages readers to write to editor Dr. John Coverstone, Athanasios Tzounopoulos, PhD with comments on articles, podcast topics, items of interest, and University of Pittsburgh, Pittsburgh, PA USA general concerns. Letters selected for publication may be edited for Pim Van Dijk, PhD brevity, clarity, and grammar. Letters should be sent to: [email protected] University Medical Center Groningen, Groningen, Netherlands Fan-Gang Zeng, PhD University of California, Irvine TINNITUS TODAY SPRING 2017 5 Irvine, CA USA MY TINNITUS JOURNEY

An Emergency Left Behind

By Joy Onozuka after recently leaving a highly “You have tinnitus,” Tina relayed, demanding job was gone in a thinking back on the appointment, Sirens blared in the background, flash, and she was suddenly filled which felt like a declaration of causing Tina Powis-Dow to lose with angst and trepidation. Tina diminished living capacity. “What her train of thought as she sat in immediately called her sister, who was I supposed to do? My first her kitchen thinking about the day insisted that she see an audiologist choice was trying medication that ahead. “All of a sudden, I realized as soon as possible. That first wasn’t really effective,” she ex- it was coming from me,” she said, encounter with a health-care plained. “Live with it” was the mes- describing the moment in the fall provider set in motion an isolated sage she took away. “They knew of 2014 as a terrifying epiphany. and challenging journey. better than I did, and I wasn’t advo- The calm she had embraced cating for myself in that moment.”

6 TINNITUS TODAY SPRING 2017 MY TINNITUS JOURNEY

That journey became far easier tice of non-attachment. “Because when her family relocated to Mem- the noise sounds like an alarm, it phis, TN, where she met Dr. Casie would trigger fear. Non-attachment Keaton, an audiologist who special- lets me think of it as an OK sound.” izes in tinnitus. “I fell in love with By attaching no meaning to it, Tina her,” Tina exclaimed. “She walked began to make peace with it. “I was me through my hearing loss and feeling fear from this noise. I was explained what it looked like.” assigning a meaning to (it),” she Through Keaton, Tina learned that said. “I have the answers,” she said, her tinnitus was like a phantom explaining how she now listens to limb, with the tinnitus expressing the noise and assigns a different the loss of hearing. meaning to it. “Tinnitus is more “She gave me a bunch of op- like my buddy,” she says, laughing. tions,” Tina said. One suggestion Reflecting on the last few years, that had an immediate and pos- Tina describes it as a spiritual jour- itive impact was Sound Therapy. ney that has taken her from a place Utilizing the Rain Rain app, Tina replete with fear to a state of calm slept through the night, something control. “It’s important for people that had evaded her since that first to understand what’s happen- siren sounded over a year prior. For ing in their bodies and with their meditation, she settled on the Calm hearing,” she emphasized. “You’re One of Tina’s favorite distractions from app, which she draws on through- going to create a story (about it), tinnitus is playing the flute with her 10-year-old son. out the week, meditating anywhere and you’re going to change it.” To from three to 30 minutes. “They are help others take control and rede- free apps and give me quiet head fine the context of tinnitus in their space,” she said. lives, Tina and Dr. Keaton are in the Without support or effective By reframing the context of first steps of establishing a support medical advice, Tina delved into tinnitus, Tina began the daily prac- group in Memphis. finding ways to contain the si- ren blaring in her left ear, which masked the tinnitus in her right. “It’s two different tones that fight with each other,” she said. She found a degree of equilibrium through playing the flute, singing ATA Wants to Hear from You in choir, exercising, and meditation. The ATA invites readers to submit their statements or stories—short or “I had to figure out how to deal long—about living with tinnitus and/or hyperacusis for possible publi- with the chatter,” she said. “I felt cation. We’d like to hear from patients, healthcare providers, and loved like I had a lot of academics, a lot ones. Topics can include recapping how it was triggered; how you cope; of work, but not much useful (ex- what challenges you face; how it changed your life; how your loved perience) to get me through this,” ones manage; and so on. Suggested word length is between 50 and she said, as she elaborated on how 600 words. Please include contact information, so staff can reach you writing and meditation developed for permission to publish, as well as for additional details. ATA reserves into effective tools. “I started study- the right to edit for brevity, clarity, and grammar. Statements and stories ing Buddhism and took a mindful- can be sent by email to [email protected] or by mail to ATA, P.O. Box 5, ness course. I was trying to figure Portland, OR 97207. out how I was going to relate to the world,” she recalled.

TINNITUS TODAY SPRING 2017 7 the tinnitus data and performed a Tinnitus by the cross-sectional analysis of those Cognitive Behavior Therapy 0.2% reporting tinnitus on the survey. The Other* 29.5% extrapolated data indicated that 21.4 Psychiatric Therapy* 0.3% million people in 2007 had tinnitus Surgical Tr ansection within the preceding 12 months. of Auditory Nerve* 1. 2% NUMBERS A correlation was found between Medications 45.4% A study of tinnitus data from the for Disease Control and Prevention. tinnitus and hearing loss, with risk Nonwearable Masking Device 2.3% 2007 Integrated Health Interview Survey respondents were carefully of tinnitus increasing as hearing loss Series was recently published in the chosen to reflect the demographics severity increases. An elevated risk Wearable Masking Device 2.6% Treatment Journal of the American Medical of the U.S. adult population (18 of tinnitus was found for people with Biofeedback Therapy 2.8% Options Association Otolaryngology-Head years or older), including gender, head injury, depressive symptoms, & Neck Surgery. The Integrated race, income, geographic area of target shooting, arthritis, and use of Tinnitus Retraining Therapy 3.0% Discussed with Health Interview Series is conducted residence, and other factors. The non-steroid anti-inflammatory drugs. Physicians Alternative Medicine* 3.9% periodically by the National Institutes 2007 survey is the only to date Troublesome tinnitus was correlated of Health to supplement the National which included extensive tinnitus with higher rates of anxiety, Music Treatment 4.0% Health Interview Series, a personal- questions. Authors Jay M. Bhatt, depression, low self-esteem, and interview survey administered by MD, Harrison W. Lin, MD, and poor quality of life, when compared Stress Reduction Methods 6.7% the U.S. Census Bureau and Centers Neil Battacharyya, MD, extracted to people without tinnitus. Nutritional Supplements 7.8% Hearing Aids 9.2%

*Treatment not included in Academy of Otolaryngology-Head & Neck Surgery Guidelines for tinnitus management. 21.4 Million Frequency of Tinnitus (9.6%) of people in the Nearly constant 36.0% United States reported tinnitus in the preceding At least once/day 15.0% Occupational 12 months, or roughly 1 in 10 people. At least once/week 14.6% Noise Exposure 56.1% None 75% had symptoms for longer than 0-2 years 6.8% 10.5% 5 years Big/very big problem

of men reported tinnitus alence 7.2% 3-14 years 9.4% in the preceding year No problem ev Pr 52.8% 31% > 15 years 8.5% of men discussed tinnitus Moderate None 6.8% with their physician problem Extent 20.2% 0-2 years 12.9% of the 27% alence 8.8% Problem had symptoms ev of women reported tinnitus 3-14 years 18% for longer than in the preceding year us Pr 15 years > 15 years 25.7%

48.0% Tinnit of women discussed Small problem tinnitus with their physician 41.6%

8 TINNITUS TODAY SPRING 2017 Cognitive Behavior Therapy 0.2% Other* 29.5% Psychiatric Therapy* 0.3% Surgical Tr ansection of Auditory Nerve* 1. 2% Medications 45.4% Nonwearable Masking Device 2.3% Wearable Masking Device 2.6% Treatment Biofeedback Therapy 2.8% Options Tinnitus Retraining Therapy 3.0% Discussed with Physicians Alternative Medicine* 3.9%

Music Treatment 4.0%

Stress Reduction Methods 6.7%

Nutritional Supplements 7.8% Hearing Aids 9.2%

*Treatment not included in Academy of Otolaryngology-Head & Neck Surgery Guidelines for tinnitus management. 21.4 Million Frequency of Tinnitus (9.6%) of people in the Nearly constant 36.0% United States reported tinnitus in the preceding At least once/day 15.0% Occupational 12 months, or roughly 1 in 10 people. At least once/week 14.6% Noise Exposure 56.1% None 75% had symptoms for longer than 0-2 years 6.8% 10.5% 5 years Big/very big problem of men reported tinnitus alence 7.2% 3-14 years 9.4% in the preceding year No problem ev Pr 52.8% 31% > 15 years 8.5% of men discussed tinnitus Moderate None 6.8% with their physician problem Extent 20.2% 0-2 years 12.9% of the 27% alence 8.8% Problem had symptoms ev of women reported tinnitus 3-14 years 18% for longer than in the preceding year us Pr 15 years > 15 years 25.7%

48.0% Tinnit of women discussed Small problem tinnitus with their physician 41.6%

TINNITUS TODAY SPRING 2017 9 Sudden The Loss of SilenceBY DA V E ZEGER

I’m a professional cellist who has spent over 30 years teaching and playing in Houston, TX, without much worry about my hearing. Like other musicians, my primary concern has been overuse syndrome—in my case, my arms—due to the long hours of rehearsal and performances. That all changed July 29, 2015, as I stood in my brother’s garage shell shocked by the deafening explosion of his misfired gun. I was visiting him in Arizona, and we were having a great time until that moment. Despite my confidence that the loud ringing would stop in a few hours, that wasn’t to be the case. Oddly, my brother’s hearing is fine. As my wife and I continued our summer travels, I kept hoping for the best. Days, weeks, months, and now years have passed with no respite from the loud ringing. It’s a strange injury, because there are no wounds to see. People just don’t understand it.

10 TINNITUS TODAY SPRING 2017 Photo by Michael Duke, Houston, TX That September, when I returned Last summer, I hiked up a moun- to play in the orchestra pit of the I’ll never be the tain in California and didn’t think Houston Ballet Orchestra, I was about the tinnitus, from morning thunderstruck by a new problem, same, but I get till afternoon, because of the high which I would later learn was called winds. The wind blotted it out. hyperacusis. by. I love silence. The noise, which I liken to the Despite the loud ringing, I could high-pitch buzz of cicadas, is so play in tune. Things seemed OK un- I love music. I unsettling. When I wake up, I relive til the brass section came in loudly, the trauma of that day and wonder causing distortion in my ears that love nature. I run what I could have done differently. prevented me from hearing my I have sort of forgiven my brother instrument and the others in my for that gross misjudgment that section. It was very distressing. listening to music. day. But, there’s nothing I can do at The hyperacusis has changed this point, which is the problem. other things as well. I love to talk I love hiking. My treatment is staying active to people, but it’s difficult to carry and busy. I can’t be still. My wife, on a conversation in a loud envi- mined to find a cure, I asked for a who’s a violinist, had hoped we’d ronment like a party or restaurant referral. She gave me the name of be slowing down as we move because of it. another doctor who evidently had toward retirement. I can’t—I have That fall, I went to an ENT for a 50-percent success rate in treat- to keep going to do something with help. He checked my hearing and ing tinnitus patients by injecting my ears to take my mind off the found it within normal range, steroids directly into the inner ear. constant ringing. Silence despite the fact that I was now After hearing my story, he said the I decided to share my story with constantly asking people to repeat treatment wouldn’t work because ATA because the patient stories in themselves. my tinnitus was sudden onset, not Tinnitus Today have given me hope He was a young doctor work- gradual. “Besides,” he said, “in- and make me feel like I am not ing for a well-known physician, jecting steroids into your inner ear alone. I hope my story helps some- so I trusted his competence. I left hurts like hell.” one cope with what they’re going with a one-week prescription for I tried hearing aids with masking through. the steroid prednisone, which was features but couldn’t get used to intended to stimulate the little hairs them. Nothing helped. Photo by Michael Duke, Houston, TX in my inner ear. I came to the realiza- After a few days I felt great, tion that I would never then the prescription ran out. I was enjoy just silence. Silence in the middle of a performance can be almost as beauti- when I felt so bad that I had to run ful as the music itself— out of the pit. I later learned I was the rest between notes is experiencing 12 out of 13 of the just as important as the side effects for withdrawal from music. The tinnitus also prednisone. The doctor had called interferes with hearing my treatment a “burst” because of the softer sounds, so I its short duration, and had never can’t enjoy that either. heard of a reaction like mine. I That’s the maddening found that dubious, and moved on. part. My stand partner gave me the I’ll never be the same, name of another doctor who had but I get by. I love si- helped her friend with tinnitus. That lence. I love music. I love doctor basically said, “You’ll just nature. I run listening to have to learn to live with it.” Deter- music. I love hiking.

TINNITUS TODAY SPRING 2017 11 RESEARCH NEWS An Optimized Tool for Tinnitus Research

Summary by John A. Coverstone, AuD Animals that develop tinnitus can no same behavior seven weeks following longer detect the silent gap before exposure. The authors also tested Reliable and efficient methods are the loud sound and do not decrease this behavioral method using sodium critical to any desired outcome in- their acoustic startle reflex. salicylate to induce tinnitus. Rats that volving research. As scientists search The gap detection method has were injected with sodium salicylate for effective treatments for tinnitus, made significant contributions to also increased their licking during si- the methods they use can make the tinnitus research. Some recent clinical lent trials, but recovered to normal be- difference between finding a cure studies prompted caution in inter- havior after five days. The authors also or not. A group of researchers that pretation of results, because other showed that sham noise exposure includes the Chair of the ATA Scien- variables may affect their data. In gap (performing the same procedures tific Advisory Committee, Jinsheng detection, it is known that the startle but without the actual loud noise) Zhang, decided to take a step back reflex can naturally change during resulted in no tinnitus-like behavior. In and look at improving the methods testing. Additionally, tinnitus percep- tests where reinforcements with foot- used by tinnitus researchers. tion, which can be quite complex, shocks were omitted, noise-exposed The Food and Drug Administration may not affect gap detection during and sham-exposed rats did not show requires that all drugs given to hu- every tested scenario. While further a fundamental change in tinnitus (or mans first must be tested on animals. validation work is being conducted, it lack of tinnitus) behavior. In sum, the Tests are conducted to determine is beneficial to develop new behavior- authors demonstrated that their new safety, effectiveness, and possible al tests to determine whether animals method can assess both onset and interactions. However, testing au- experience tinnitus. In their paper, the long-lasting tinnitus in individual rats. ditory phenomena poses a special authors, from Wayne State University This will significantly aid research into difficulty in animal models: How do and the University of Windsor (Ontar- the precise causes of tinnitus and you determine whether an animal io, Canada), focused on an optimized drug development. has the condition? Researchers have method for detecting tinnitus that Pace, E., Luo, H., Bobian, M., Panekkad, A., Zhang, developed methods for determining involves conditioned licking behavior X., Zhang, H., et al. (2016). A Conditioned Behavioral whether an animal has hearing loss, of rats. Paradigm for Assessing Onset and Lasting Tinnitus in Rats. PLoS ONE, 11(11): e0166346. doi:10.1371/ tinnitus, or other conditions they wish In their method, rats were trained journal.pone.0166346 to test. to lick a spout for water during the http://journals.plos.org/plosone/article?id=10.1371/ journal.pone.0166346#ack One method researchers com- presentation of sound. They also were monly use is called “gap detection,” trained to limit their licking during which takes advantage of a phe- silence via occasion- nomenon known as the acoustic al footshocks. After startle reflex. This reflex consists of noise exposure rats muscular contractions. All mammals increased licking be- have this in response to loud sounds. havior during silent In healthy animals, a silent gap in periods. This sug- background noise before a loud gested that they still sound results in a decreased acoustic heard sound, which startle reflex. Animals can undergo a was assumed to be procedure that causes tinnitus, such tinnitus. Half of the as administration of certain drugs noise-exposed rats or being exposed to loud sounds. demonstrated the

12 TINNITUS TODAY SPRING 2017 IT’S ALL ABOUT SUPPORT ATA Support Network Calendar

Patients can support one another Missouri by sharing personal experiences and St. Louis Tinnitus Support Group providing a sympathetic ear. Attend a St. Louis County Library Headquarters, local support group and discover how East Room fellow patients manage their tinni- 1640 S. Lindbergh Blvd. tus. To view all of ATA support group St. Louis, MO 63131 locations visit: www.ata.org/manag- Contact: Tim Busche T: 636-734-4936 ing-your-tinnitus/support-network/sup- E: [email protected] port-group-listing May 10—7:00 pm California North San Diego County New Jersey Tinnitus Support Group Tinnitus Self-Help Group Rancho Bernardo Library in Ewing, NJ 17110 Bernardo Center Dr. Ewing Presbyterian Church San Diego, CA 92128 Florida 100 Scotch Rd, Ewing, NJ 08628 Contact: Eli Tyler Contact: Dhyan Cassie Tinnitus Self-Help Group T: 951-505-9200 E: [email protected] of Palm Beach County E: [email protected] South County Civic Center May 6—10:00 am May 16—6:30 pm 16700 Jog Road June 17—10:00 am June 20—6:30 pm Delray Beach, Florida 33446 July 18—6:30 pm Contact: Tracy Clark New York August 15—6:30 pm T: 800-732-9217 Long Island Tinnitus Support Group September 19—6:30 pm E: [email protected] Franklin General Hospital Medical Center October 17—6:30 pm 900 Franklin Ave. May 11—7:30 pm November 21—6:30 pm 2nd FLR Conference Room Summer Recess: June through September December 19—6:30 pm Valley Stream, NY 11580 Schedule TBD: October through May 2018 Contact: Anthony Mennella and San Diego Tinnitus Support Group Lisa Kennedy The Villages Tinnitus Support Group San Diego City Library T: 516-379-2534 Churchill Recreation Center North University City Branch E: [email protected] 2375 Churchill Downs 8820 Judicial Dr. The Villages, FL 32162 April 24—7:30 pm San Diego, CA 92122 Contact: Sal Gentile May 29—7:30 pm Contact: Loretta Marsh / Jack Innis E: [email protected] June 26—7:30 pm T: 858-581-9637 July 31—7:30 pm E: [email protected] April 27—3:30 pm August 28—7:30 pm E: [email protected] May 25—3:30 pm September 25—7:30 pm June 22—3:30 pm May 3—6:30 pm October 30—7:30 pm July 27—3:30 pm June 7—6:30 pm November 27—7:30 pm August 24—3:30 pm July 5—6:30 pm September 28—3:30 pm August 2—6:30 pm October 26—3:30 pm If you’re looking to start your own support September 6—6:30 pm group or you have a group you would like listed, November—TBD October 4—6:30 pm please email us at: [email protected] December 28—3:30 pm November 1—6:30 pm The ATA Tinnitus Support Group Manual is December 6—6:30 pm available online at www.ata.org to help you establish a group or plan your meetings.

TINNITUS TODAY SPRING 2017 13 By John A. Coverstone, AuD, and Joy Onozuka against devices that exceed specified to consumers from organizations like noise limits and the requirement of Consumer Reports, which makes Fall will be much quieter this year noise-level labeling for power tools, recommendations on its website to in Sonoma, CA, due to Measure V, as well as ordinances limiting noise check community noise restrictions which took effect in December 2016. levels in public places. Public interest and noise labels before buying devic- The measure made Sonoma the 25th in reducing noise pollution and expo- es like a leaf blower. city in California to ban gas-powered sure, as well as the increase in noise The Occupational Safety and leaf blowers and reflects a nationwide restrictions, is reflected in guidance Health Administration (OSHA) has trend toward banning the devices to reduce noise pollution and unwanted gas emissions. It also coincides with recent improvements in electric leaf Noise ordinances are becoming more blowers and stronger, longer-lasting lithium batteries for battery-powered common; there is growing public leaf blowers. Nonetheless, some cit- awareness of the need to protect ies are banning those devices as well, even though they are typically quieter hearing while engaged in yardwork and and do not pollute. Other noise-related laws around woodworking projects. the country include prohibitions

14 TINNITUS TODAY SPRING 2017 established 80 decibels (dB) as the threshold for hearing safety. Any Gunshot noise above that level poses a risk Time to Reach to the listener for hearing loss. The 140 projected time in which hearing dam- 100% Noise Dose age occurs decreases as the noise Jet plane level increases. For instance, OSHA Exposure Level 130 standards state that hearing loss can per NIOSH REL occur after eight hours of exposure to 120 Ambulance noise at 90 dB. However, if the noise is 95 dB, then the risk of hearing 15 minutes at 100 dB(A) 110 damage increases after four hours. Leaf blower The National Institute of Occupational 100 Safety & Health (NIOSH) recom- 2 hours at 91 dB(A) Gas mower mends a 3 dB exchange, meaning a 93 dB noise, such as a hair dryer or 90 gas-powered lawn mower, is safe for 8 hours at 85 dB(A) City traffic four hours. A 96 dB noise (a tractor, 80 for example) is safe for two hours. While improvements in reducing 70 the noise emission of gas-powered leaf blowers have been made, some 60 Typical speech still top 100 dB, making hearing pro- tection mandatory when using them. Rainfall It is common to see groundskeep- 50 ers wearing hearing protection, but bystanders are not protected from 40 the same blast of noise. Noise limits for leaf blowers are typically set at 65 dB at a distance of 50 feet, which is still loud enough to annoy people and make conversation difficult to hear. The trend toward using quieter tools is not limited to leaf blowers. Noise level (dB) Most of us are familiar with the sound of a neighbor’s circular saw or router reverberating throughout the nificant risk for employers, who can Noise ordinances are becoming neighborhood. Circular saws, routers, save hundreds of thousands or even more common and there is grow- grinders and many other tools reach millions of dollars by investing in qui- ing public awareness of the need noise levels ranging between 104- eter tools and machines or by modify- to protect hearing while engaged in 110 dB. This equates to only about 10 ing work environments to be quieter. construction work or woodworking minutes of safe use before hearing If factory workers, for instance, projects. As a result, there is increas- damage can occur. Quieter versions develop hearing loss after years of ex- ing pressure on manufacturers to are readily available. posure to hazardous levels of noise, produce tools with lower noise levels. Financial concerns are also fueling employers may be liable and forced to Some products are already packaged the trend toward quieter power tools, compensate them. Employers failing with noise levels clearly labeled, even both commercial and residential. to meet OSHA safety standards for though are no mandates or standards Commercial noise exposure is a sig- noise controls may also be fined. in the United States. In contrast,

Continued on page 37

TINNITUS TODAY SPRING 2017 15 PODCAST ANNOUNCEMENT Tinnitus You Will Want to Hear

Conversations in Tinnitus will contin- ue to make many of the same experts available and cover many of the same topics as the webinars, but in a way which can be downloaded to your computer or mobile device and even This year the American Tinnitus “While some enjoyed the more accessed via free subscription for au- Association joins most major and technical nature of the webinars, rela- tomatic downloading each time a new minor media outlets by offering addi- tively few people watched them. After episode is released. Members can find tional content to extend the news and listening to our members, we believe more information about this exciting information provided in Tinnitus Today. that a podcast format will reach many new media offering, listen to the first Most print and radio news outlets more people because of the accessi- episodes, and even subscribe today by have podcasts, an audio program bility and flexibility this format offers,” visiting: www.ata.org/podcasts designed to be accessible over the Brazell said. internet. A podcast is an audio file that you may access from a web serv- er—either by listening directly from a webpage or downloading to your How to Access computer or mobile device. In January, ATA launched Conver- Conversations in Tinnitus sations in Tinnitus, an audio podcast exclusively about tinnitus research, A podcast is simply an audio file that you can access from a website. tinnitus methodologies, and strategies Podcasts usually can be downloaded from a website and played on your for living with tinnitus. The program is computer or sometimes played right on the podcaster’s website. hosted by Tinnitus Today editor, John Podcasts also can be downloaded directly to your laptop, phone, or A. Coverstone, AuD, and fellow audiol- music player. The latter two enable you to take the podcast on the go and ogist, Dr. Dean Flyger, AuD. listen whenever and wherever you want. Each episode features a conver- sation about various tinnitus topics Subscribing—A Two-Step Process between the hosts and a guest or To enable automatic downloads, you need to subscribe to the podcast. guests. Conversations in Tinnitus is 1iTunes will allow you to subscribe to most podcasts and synchronize designed to be oriented toward peo- them to your mobile device. Non iPod/iPhone users will need a podcatcher, ple with tinnitus. According to ATA Ex- which is an app you can download from the Apple Store, Google Play Store ecutive Director Torryn P. Brazell, “In or Windows Store. Podcatchers are often free, although better apps with the past we offered webinars which more intuitive designs frequently cost $3.00 or $4.00. were on a very high level, often very Once you have a podcatcher, use the Subscribe feature in the app to technical, and needed to be viewed 2search for Conversations in Tinnitus or type in the following URL: http:// on the ATA website. Podcasts offer feeds.feedburner.com/tinnituspodcast us the ability to provide our members with a concise, casual conversation Your podcatcher app usually will check for new episodes and download between expert professionals or an them for you. Every two months or so, you will have new and exciting con- experienced individual with tinnitus versations about tinnitus waiting on your mobile device! and may be downloaded for listening anywhere, at any time.

16 TINNITUS TODAY SPRING 2017 MY TINNITUS JOURNEY

Poetic Reflection: About My Tinnitus

By Olivia Morgan

In the serenity of the spring moonlight I trudge my beach. Wild geese serenade the creaming waves And shrieks of plummeting gulls Are triumphant calls to a late night supper.

On the shore two bickering dogs tangle together I want so badly to really hear. And yelp their grievances. In the gale, even a banshee’s clear shriek I try to savor the sounds of sand-filled sanctuary Could become to me music But my roaring ears out-yell all in nature But my own noises desecrate the moment Mental warfare—and a bomb explodes in my And I talk to my God again. skull again “Please Lord, just one silent hour.” I weep and talk to my God, “Please Lord, just one silent day.” By day the schoolroom Which used to shower me with delights In bed that night No longer works its magic. The sounds of wilderness The children’s singing Rattle the walls of my tiny cottage. Is lovely as angels’ harps. The wind sucks greedily beneath the door Yet my ears defile them. And my slumbering cat turns and sighs undis- turbed. In the playground The clanging bells Call for My Journey Battle to out-din the youngsters’ shouts. My noises deform and shatter all. with Tinnitus Symphony, slaughtered by strident cacophony The ATA invites readers to sub- I pray to my universe, in pain mit their stories about living with tinnitus and/or hyperacusis for possible publication. “Please, anybody, just one quiet minute!” Suggested word length is between

50 and 600 words. Please include contact infor- Olivia has had tinnitus in both ears as long as she can remember. Often mation, so staff can contact you for permission to finding it unbearable, the 79-year-old grandmother of five and substitute publish, as well as for additional details, if needed. teacher for children with special needs, stays as busy as possible. Olivia is looking for a support group in Monterey, CA, to make connections with ATA reserves the right to edit for brevity, clarity, people who understand her challenges. and grammar. Stories can be sent by email to [email protected] or by mail to ATA, P.O. Box 5, Portland, OR 97207.

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18 TINNITUS TODAY SPRING 2017 RESEARCH NEWS An Objective Measure of Misophonia

Summary by John A. Coverstone, AuD

Some people experience emotional or visceral (“fight or flight”) reactions to certain types of sound—a condi- tion known as misophonia. Misopho- nia is distinct from hyperacusis, which is physical discomfort caused by sound reaching a level that is tolerat- ed by most people. Severe hyperacu- sis, however, will frequently result in some degree of misophonia. Miso- phonia can be severe and has been associated with sleep disturbance, reduced cognitive performance, and cardiovascular disease. The authors of a recent study from the University of are measured and indicate how the misophonia, response size became Helsinki in Finland and Aarhus Univer- oddball sound is processed. smaller. The MEG recordings addition- sity in Denmark investigated ways to Currently, misophonia can be as- ally showed a correlation between detect misophonia. They hypothesized sessed through clinical discussion and other oddballs and misophonia. that this condition may be related to questionnaires only. There is no meth- The authors concluded that objec- how sound is processed in the brain. od to detect it without relying on the tive measures may be able to detect The authors recorded brain activity patient’s subjective report (that is, it the presence of misophonia. Possible in 71 healthy volunteers using elec- cannot be detected “objectively”). The reasons for these results are that troencephalography (EEG), which re- present study used an oddball proce- neural “gating” may be impaired in cords electric potentials on the scalp, dure to attempt to develop an objec- the part of the brain that processes and magnetoencephalography (MEG), tive test for misophonia. The primary sound. Gating refers to the brain’s which records magnetic fields to map sequence of sounds used for this ability to inhibit repetitive or ongoing brain activity. A mismatch-negativity study included piano tones. A variety sounds and enhance novel or new (MMN) test was used to determine of oddball sounds was used so that sounds. This inhibition leads to an how the brain responds to certain the researchers could measure the impairment in the brain’s ability to sounds. The MMN test presents a response of the brain to each differ- filter out unwanted sensory stimuli. series of sounds and occasionally ent sound. In addition to the oddball As research in this area proceeds, inserts a distinctly different sound, sounds, the researchers created tones scientists may move from detecting called an “oddball.” The change in differing in pitch, intensity, rhythm, and measuring misophonia to finding sounds can be observed as changes location, and a “pitch slide” (a sound ways to treat the underlying cause. in the brainwaves. Observing these changing in pitch as it is presented). Kliuchko, M. et al. A window into the brain changes can help to determine how Comparing the responses from EEG mechanisms associated with noise sensitivity. Sci. the oddball stimulus is processed in and MEG recordings, a negative cor- Rep. 6, 39236; doi: 10.1038/srep39236 (2016). http://www.nature.com/articles/srep39236 the brain. Specifically, the size and relation was found between response latency (how long after the oddball size for the oddball sounds and the re- sound is presented) of the response ported misophonia; with more severe

TINNITUS TODAY SPRING 2017 19 PODCAST SUMMARY Conversations in Tinnitus with Dr. David Baguley

By Joy Onozuka the first few hours and days of their diagnosis, because some patients Conversations about tinnitus leave a doctor’s office with the and hyperacusis often begin with devastating and incorrect news that stories about patients, which there is no cure, no hope and no are shared within small circles support. “I’ve been really listening of professionals, caregivers, to my patients over the years. Once or sufferers. To broaden the people realize they’re in trouble, dialogue and offer insights into they’re in a very challenging situa- efforts being made to improve tion,” he said, referring to the many patient care, provider education, sufferers who experience disrupted and ongoing research, the sleep, difficulty concentrating, and ATA invited Dr. David Baguley, anxiety over what the future holds. an internationally renowned “Most of the information you can audiologist and professor of get in a hurry off the internet is hearing at the University of really negative,” he said, explaining Nottingham, as its featured the impetus behind writing Living guest speaker for the launch of with Tinnitus and Hyperacusis, with its podcast series, Conversations psychologist Dr. Laurence McKenna in Tinnitus. Baguley, a gifted and ENT specialist Dr. Don McFer- communicator who advocates for ran. “We wrote the book to pour such as sound and relaxation, also greater collaboration on all fronts, into it the wisdom that we have will be a useful tool for medical offered an upbeat message in the about how you get some traction providers and caregivers. 30-minute recording that explored on the situation,” he explained to In helping patients come to the patient’s journey of living with the co-hosts. terms with a condition that will tinnitus and hyperacusis. “I’ve had some wonderful most likely never be reversed, To create a better framework for communication with people who Baguley is trying to provide better tinnitus or hyperacusis sufferers, have used the book, and it’s been a information and resources to gen- Baguley spoke emphatically about lifeline for some of them,” he said. eral practitioners [Editor note: see the need of what he termed “first Baguley hopes the self-help book, our reprint of the British Tinnitus aid” tools and information. These which includes strategies for cop- Association’s “Tinnitus Guidance would be given to patients within ing and suggestions for therapies, for GPs,” on pp. 28-29.] These physi- cians are typically the first to see patients who come to them com- In February, we launched our first podcast, Conversations in Tinnitus, plaining of ringing in their ears. featuring the internationally renowned researcher and patient & doctor “I have a very real compassion advocate, Dr. David Baguley. In its first month, over 5,000 listeners tuned for both of those groups,” he said, into this extraordinary interview. If you haven’t listened to it yet, please explaining that most general prac- visit our website at www.ata.org. The full transcript is also available on- titioners receive limited training in line for reference and listening support. audiology and perhaps one lecture on tinnitus. “I think these early clin-

20 TINNITUS TODAY SPRING 2017 PODCAST SUMMARY ical conversations that people have Do you have an Echo and want to listen with patients are really formative in how the patient manages,” he said. to the new ATA podcasts? Just say To reach and give that audience “Alexa, play podcast Conversations in relevant and sound advice, Bagu- Tinnitus“ and start listening. ley publishes in journals aimed at general practitioners and seeks out avenues to promote greater dialogue. “I think that those of us than competition, in the research the tinnitus,” he said. One was the who have knowledge about tinnitus community and this bodes well actual signal itself that was being and hyperacusis have to share with for progress and potential break- driven through the man’s brain; that community so that we can throughs. He mentioned that there another was an attentional net- empower them to do better with are several drug programs that are work, involving parts of the brain their patients and have some tools being revisited and reworked, as an paying attention and monitoring; themselves that they can use,” he example of that trend. and the third was a tinnitus mem- said. Recent international research ory network that remembered and Reflecting on the rise of support that excites him came from a col- expected to hear it. “That last one groups in the United States and laborative effort between a group is very interesting, because I have a Great Britain, he believes they play in New Castle, U.K., and a neuro- number of patients who say to me, a critical part in helping sufferers surgeon in Iowa, which involved a ‘I don’t have tinnitus when I wake adapt to living with tinnitus or patient suffering from intractable up, and then I listen, and it comes hyperacusis. “I think at their best, epilepsy and severe tinnitus. In a back,’” he said. “It’s as if the brain they can be an invaluable system last-ditch effort to control the epi- remembered it.” While Baguley of support and care,” said Baguley, lepsy, neurosurgeons performed a clarified that the discovery of the who suffers from mild tinnitus. “I craniotomy and recorded from the memory network is a proposal and think it’s really powerful to meet surface of the brain to locate the not a full theory, it represents an somebody who’s been on a tinnitus ignition focus of the epilepsy and important breakthrough in under- journey and is living with (it), is remove it. “While they were doing standing what is physically and managing it,” he said. He’s ob- these surface of the brain record- physiologically happening in a pa- served that British support groups ings, they recorded the gentleman’s tient’s brain when they have severe are doing such things as screen- brain activity with and without tin- and troublesome tinnitus. ing potential tools and therapies nitus,” Baguley explained. Those re- No one expects a quick fix for by inviting guests who provide cordings allowed them to interpret tinnitus and hyperacusis, but Ba- services, such as relaxation tech- what was happening deep inside guley believes the path for finding niques, yoga, and aromatherapy to the brain, which Baguley likened to a cure and enabling sufferers to demonstrate their effectiveness at how an oceanographer uses ocean reclaim a higher quality of life will mitigating symptoms, so members stenography to tell from the sur- be found through more active and can explore options before putting face of the ocean what’s happening ongoing collaboration across all money into something. It’s a form on the ocean floor. Direct record- fronts, with careful consideration of of empowerment. ings are significant because of their what works and why. Toward that Realizing that patients are often clarity, which cannot be replicated end, the ATA hopes its podcasts stricken with anxiety, Baguley by fMRI scans. Critically, they allow will be a powerful tool in dissem- stressed that he hopes they’ll find for recording with and without inating information that supports comfort in the knowledge that re- tinnitus, which reveals what is hap- that journey, because it is indeed a searchers are trying to find answers pening deep within the brain. journey being traveled by many. right now. He noted there has been “They found three different, a shift toward cooperation, rather new brain networks that dealt with

TINNITUS TODAY SPRING 2017 21 RESEARCH NEWS Synaptopathy—A Cause of Hidden Hearing Loss

Summary by John A. Coverstone, AuD

For decades, it has been assumed that the mechanism for sensorineural hearing loss was damage to hair cells in the cochlea, the sensory organ for hearing. Research in recent years has identified a new culprit: The synapse between the hair cells of the cochlea and the auditory nerve. This degener- ation of the neural synapse is called synaptopathy. Research has indicated that synaptopathy may be the cause of presbycusis (age-related hearing loss), noise-induced hearing loss, and reduced speech understanding before hearing loss is even detected. The last condition has been called “hidden hearing loss” because it occurs when levels were similar between low and the cochlea or the auditory nerve. In hearing is normal when measured by high risk groups. They also had normal this study, the SP/AP ratio was almost audiologists. otoacoustic emissions (OAEs), which twice as large in the high-risk group In a study published recently in measure function of the outer rows as it was in the low-risk group. PLoS ONE, researchers from Harvard of hair cells in the cochlear. However, The results of this study indicate and Massachusetts Eye & Ear Infir- the high-risk group had poorer hearing that standard clinical tools may be mary recruited 71 normal hearing and for frequencies above 8000 Hz, which able to diagnose synaptopathy in the healthy subjects, 18-41 years of age, is not routinely tested during audiolo- cochlea, although neither high fre- and used a survey tool to identify risk gy exams. Subjects also were tested quency hearing tests nor ECoG are of noise exposure. Participants were using electrocochleography (ECoG), typically used in this fashion. People identified as having high or low risk, which uses rapid click stimuli to with normal hearing who express according to the amount of noise ex- measure electrical potentials that are increased sensitivity to everyday posure they reported and the consis- generated by hair cells stimulating the sounds or who complain of difficulty tency with which they used hearing auditory nerve endings in the cochlea. understanding speech may be iden- protection. They also were asked ECoG looks at two potentials in the tified with cochlear synaptopathy, if to rate their level of annoyance to cochlear: The Summating Potential these tests are used when standard different everyday sounds. A variety (SP), which is the result of electrical hearing test results are normal. of clinical tests were conducted and potentials generated by the hair cells; Liberman, M.C., Epstein, M.J., Cleveland, S.S., Wang, statistical analyses performed to de- and the Action Potential (AP), which H., Maison, S.F. (2016). Toward a Differential Diagnosis termine which tests predicted hidden is generated by activity from the of Hidden Hearing Loss in Humans. PLoS ONE, 11(9): e0162726. doi:10.1371/journal.pone.0162726 hearing loss. auditory nerve. Clinicians typically http://journals.plos.org/plosone/article?id=10.1371/ All participants had normal hearing measure the ratio of the SP and AP to journal.pone.0162726 when tested in the standard frequen- diagnose disease in the ear or deter- cy range (250-8000 Hz), and hearing mine whether hearing loss occurs in

22 TINNITUS TODAY SPRING 2017 May is Better Hearing and Speech Month

Inaugurated in 1927, Better Hearing and message with friends and family, and encour- Speech Month is designed to raise aware- age them to have their hearing checked. Early ness about communication disorders and the detection can ensure that treatable problems importance of early intervention. Share this are resolved quickly.

Listen to ATA’s New Tinnitus Podcasts— Anywhere @ Anytime

In February, ATA launched Conversations in Conversations in Tinnitus, an audio podcast exclusively about Tinnitus,” and the tinnitus research, tinnitus methodologies, and latest podcast episode will start to play. iTunes will strategies for living with tinnitus. allow you to subscribe to the podcasts and synchro- Each episode features a 20-30 minute conver- nize them to your mobile device. sation about various tinnitus topics based on the A podcatcher app can be downloaded from the area of expertise of the guest. Conversations in Apple Store, Google Play Store, or Windows Store. Tinnitus is designed to be oriented toward people Podcatchers are often free. Once you have a pod- with tinnitus, and is delivered in a concise, casual catcher, use the subscribe feature in the app to conversation between expert professionals or an search for Conversations in Tinnitus or type in the experienced individual with tinnitus. following URL: http://feeds.feedburner.com/tinni- Podcasts can be downloaded from a website di- tuspodcast. Every two months or so, you will have rectly to your computer, smartphone, or music play- new conversations about tinnitus waiting on your er. Have an Amazon Echo? Say “Alexa, play podcast mobile device!

TINNITUS TODAY SPRING 2017 23 24 TINNITUS TODAY SPRING 2017 Living With Tinnitus Sudden Onset Hearing Loss

By Margaret L. Brown

Imagine losing almost all of your hearing suddenly and irrevocably. Now add tinnitus into the equation at a nonstop, high-pitched 9,000 Hertz and 80 decibels. The tumult that would cause in your life is unimag- inable for most of us. However, it is a reality for Randy Phillips, the Vice Chair of ATA’s board of directors. Photo by M3 Studios

TINNITUS TODAY SPRING 2017 25 Randy Phillips lost his hearing in 2008. “It was autumn in New York City, and I was taking some time off work between assignments,” he shared. “As my wife and daughter and I walked into a theater one evening, instantly—I mean instantly—I lost all the hearing in my right ear and a significant amount of my hearing in the other ear. “I thought I had earwax—that something was plugging up my ear. I went to my physician the next morn- ing and after 15 minutes, he said, ‘You need to go see this ENT, and after that go to this audiologist. If they tell you to go to an otolaryngologist, then see this one. You can do that fairly easy in New York City.” “It was a whirlwind,” he continued. Photo by M3 Studios “All I remember is telling my doctor, ‘I’ve got tickets to the Lincoln Center jazz orchestra tonight, so can you just fix this and make it work again?’” Phillips ended up at an otolaryn- hearing back. So, let’s figure out what “I was looking around for solutions, gologist that same day for a series of we can do.’” and I was shocked how little clinicians, unpleasant medical procedures, trying Phillips said that the focus on his physicians, and specialists—otolaryn- to find a way to restore hearing in his deaf right ear was so concentrated gologists, audiologists—knew about right ear. At the same time, he devel- that he didn’t realize the full scope of tinnitus or, perhaps, what they could oped acute tinnitus in that ear. his problem until he visited the Univer- do to help fix it,” Phillips said. “I see The ensuing pursuit of a solution sity of Maryland—well-known for its tinnitus like any other major disease, left Phillips—a successful corpo- work in audiology. At Maryland, he such as heart disease or cancer; we rate executive with a background in met LaGuinn Sherlock, AuD. need to invest now for the future, for software and engineering—and his Dr. Sherlock asked me, “Has the next generation.” doctors stymied. During the years of anyone ever told you that you have Tinnitus in general is poorly under- surgical procedures and visits to spe- lost a lot of hearing in your left ear, stood. Most people will experience cialists for his hearing loss, he discov- your good ear?” I said, “No.” She said, ringing in their ears at some point ered that there is currently no cure for “I think if we can help your hearing in their lives. This is most common- tinnitus, even though it affects millions there, that will give you some way to ly after loud events, like concerts. of Americans. get through life. Otherwise, you are However, about 50 million Americans “We looked at it and tried to fight just going to be struggling.” Dr. Sher- experience acute tinnitus. About 16 through it all,” he said. “We could not lock’s help was significant. million experience chronic tinnitus figure out what happened and final- As he processed this diagnosis and and, of those, 2 million have severe ly, my otolaryngologist said, ‘Look, I began to explore solutions, he dis- and debilitating tinnitus.1 think it is from a virus you picked up in covered how little the broad medical Phillips says, “That is a reasonable China [after living there for two years], community knows about tinnitus. percentage of our country with this and you are never going to get your problem, but I can’t count on one full

1 As cited on www.ata.org/understanding-the-facts, taken from data derived from the 2011-2012 National Health and Nutrition Examination Survey, conducted by the U.S. Centers for Disease Control and Prevention.

26 TINNITUS TODAY SPRING 2017 hand the number of research centers golf course helps. When he is outside, or research hospitals that are doing “I call tinnitus a sound doesn’t bounce, and when he anything significant to try to help solve is focused on playing golf, the tinnitus or manage this problem. I told my hidden condition, is less noticeable. On the other hand, wife once that I wish that there was being in a noisy environment, like a something sticking out of my ear so because when you restaurant or in an airport, is difficult people would realize there is some- for him. thing wrong.” look at someone, “I call tinnitus a hidden condition, The psychological effects of tinnitus you have no idea because when you look at someone, can be devastating. Phillips compares you have no idea they have this mon- it to living in constant pain, which can they have this strous ringing going on in their head be debilitating at a psychological level. 24/7,” Phillips said. “My wife and I have talked about monstrous ringing “Hopefully, we will be able to find this, because she has suffered a cure for it, a way to remediate it or through it with me,” he said. “I call it going on in their a way to train people to cope with it a phantom pain. Like someone who more effectively,” he said. “I hope to loses a limb, but can still feel it. For head 24/7.” help the ATA continue with the solid me, this ear is deaf, but it is trying to work they have been doing and to hear. It is pinging all the time… trying help find a way to ratchet up aware- to hear. My brain is manufacturing this a senior otolaryngologist at a well- ness and education for both sufferers sound—this tinnitus.” known research center.” and audiologists.” Phillips sensed he had a responsi- For Phillips, who started with a Phillip’s story mirrors the stories bility to be an advocate because of an bone-anchored hearing aid, known as of millions of others living with this encounter he had during his search for BAHA, and moved to a cochlear im- condition, who often experience a help. “Deep down I am an engineer plant, these aids have helped with his series of steps forward and back as (and) scientist, even though I am a tinnitus. With the cochlear implant, he they seek treatments and continually corporate executive now. I want to now has spatial separation of sound, tweak techniques for ameliorating help find the root cause and what can which he didn’t have for seven years. the incessant sound. His experience, be done about it.” He cited a shocking While medical treatment has enthusiasm, and business acumen are encounter as spurring his desire to enabled him to manage his condition a valuable addition to the ATA leader- help find a cure or treatment. better, he also finds that being out- ship in our mission to find a cure for “I went to one of the best-known doors playing with his dog or on the tinnitus. hospitals on the East Coast, because Photo by M3 Studios I heard there was a physician there who was really good at tinnitus retraining therapy. The doctor I went to see wasn’t in, so they passed me off to another,” Phillips recalled. “I told him the problem. I kid you not, the doctor—an otolaryngologist—said, ‘Look, one of three things is going to happen to you: 1. It is just going to go away; 2. It’s going to be nasty for the rest of your life, and you will end up being disabled; or 3. It’s going to be so bad that you are going to kill yourself.’” “I said, ‘Two of those three don’t work for me.’ I was shocked—this was

TINNITUS TODAY SPRING 2017 27 Tinnitus Guidance for GPs

This document was Most Tinnitus Is Mild constructive statements that can be created by the British In fact it is relatively rare for it to made about tinnitus, such as “Most develop into a chronic problem of tinnitus lessens or disappears with Tinnitus Association (BTA) life-altering severity. The natural his- time;” “most tinnitus is mild;” “tinni- to support GPs who see tory of tinnitus in most patients is of tus is not a precursor of hearing loss.” an acute phase of distress when the patients with tinnitus. problem begins, followed by improve- There Is No Direct Role For ment over time. But for a minority of Drugs Tinnitus Red Flags patients, the distress is ongoing and Although they can be used to treat Firm indications that a patient with very significant, and they will require associated symptoms such as verti- tinnitus should be referred onwards specialist support. go, insomnia, anxiety or depression, include: there are no conventional or comple- sPulsatile tinnitus Underlying Pathology Is Rare, mentary medications shown to have sTinnitus in association with But Be Vigilant specific tinnitus ameliorating qualities. significant vertigo In many cases, tinnitus is due to In addition, there is anecdotal sugges- sUnilateral tinnitus heightened awareness of sponta- tion that repeatedly trying unsuccess- sTinnitus in association with neous electrical activity in the au- ful therapies worsens tinnitus. asymmetric hearing loss ditory system that is normally not sTinnitus causing psychological perceived. It can, however, be a Referral Routes For Tinnitus distress symptom of treatable and significant Patients sTinnitus in association with sig- otological pathology, such as a vestib- Referral routes vary and depend on lo- nificant neurological symptoms ular schwannoma or otosclerosis. cal protocols and commissioning, but and/or signs in the majority of cases referrals are Although many tinnitus patients do Tinnitus Can Be Associated With directed to ENT or audiology services. not fit into any of these imperative A Blocked Sensation Common sense dictates that when categories, clinicians involved in tinni- For reasons that are not clear, tinnitus there are possibilities of self-harm or tus care are firmly of the opinion that and sensorineural hearing loss can of psychological crisis, then urgent all patients with the symptom should give rise to a blocked feeling in the mental health support is indicated. at the very least receive an audiolog- ears despite normal middle ear pres- ical assessment. Local factors will sure and eardrum mobility. Otoscopy Tinnitus Is More Common In determine whether this is undertaken and, if available, tympanometry can People With Hearing Loss in primary or secondary care. exclude Eustachian tube dysfunction. Tinnitus prevalence is greater Decongestants and antibiotics are amongst people with hearing impair- At Any Point In Time Around rarely helpful. ment, but the severity of the tinnitus 10 Percent of the Population correlates poorly with the degree of Experience Tinnitus Giving a Negative Prognosis Is hearing loss. It also is quite possible Both sexes are equally affected and Actively Harmful to have tinnitus with a completely although tinnitus is more common in It is all too common to hear that normal pure tone audiogram. the elderly, it can occur at any age, patients have been told nothing can including childhood. The perceived be done about tinnitus. Such negative Hearing Aids Are Helpful If There sound can have virtually any quality— statements are not only unhelpful, Is Associated Hearing Loss ringing, whistling, and buzzing are but also tend to focus the patient’s Straining to listen can allow tinnitus common—but more complex sounds attention on their tinnitus and exac- to emerge or, if already present, to also can be described. erbate distress. A positive attitude is worsen. Correcting any hearing loss generally helpful, and there are many reduces listening effort and general-

28 TINNITUS TODAY SPRING 2017 ly reduces the level of the tinnitus. audiological assessment. Decisions Self-Help Is Often Effective Hearing aids are useful even if the on when to start using a hearing aid The BTA provides comprehensive hearing loss is relatively mild and at a and what sort to use are up to the information on tinnitus and common level where aids would not normally individual patient and audiologist. sense advice on managing symptoms. be considered. Some modern hear- It also has a network of tinnitus sup- ing aids have sound therapy devices Avoiding Silence Is Helpful port groups around the country. incorporated within the aid specifical- Having continuous, low level, un- The BTA also has produced a new ly for tinnitus patients. Department of obtrusive sound in the background online resource aimed specifically Health guidelines have emphasized can reduce the starkness of tinnitus. at patients who have recently devel- the value of audiometry in a tinnitus Sounds can be quiet, uneventful mu- oped tinnitus and want some simple, consultation, and this is the definitive sic, a fan, or an indoor water feature. clear information and advice: Take on basis for decisions about hearing aid Alternatively, there are inexpensive Tinnitus, takeontinnitus.co.uk includes candidacy. If in doubt, refer for an au- devices that produce environmental facts, tips, exercises, and videos that diological opinion. In our view, all peo- sounds and these are particularly give patients ideas for self-manage- ple who describe tinnitus deserve an useful at bedtime. ment. Please do pass on the details of the Take on Tinnitus website to your tinni- General Practitioners Urged to Become tus patients, so that we can help you provide the support they need in the Tinnitus-Aware early stages of tinnitus management. Almost every person with troublesome tinnitus knows the story first- We know from the calls we receive, hand. You develop a new sound in your ears. You think it will go away af- that when early help is given by GPs ter a short while and, when it doesn’t, you consider talking to your family and secondary services, patients man- physician about it. You may or may not have done extensive research on- age their tinnitus more effectively. line, much of which is misleading (as is most health care advice online) and even downright frightening. When you finally make the appointment Further Information and mention that you have this annoying sound that just-won’t-stop, you If you would like further copies of this hear the phrase that is almost a rally cry for those with tinnitus: “I’m document or any other of the BTA’s sorry, there’s nothing that can be done. You will just have to live with it.” leaflets please contact us: For millions of people with tinnitus around the world, this story is far too familiar. Organizations such as the American Tinnitus Association, British Tinnitus Association the British Tinnitus Association, and other national and local associations Ground Floor, Unit 5 and support groups work tirelessly to raise awareness of tinnitus among Acorn Business Park healthcare providers. In February 2017, the British Tinnitus Association Woodseats Close, Sheffield S8 0TB released advice for general practitioners, including a two-page handout Website: tinnitus.org.uk that may be downloaded via PDF or requested in print from BTA online

at www.tinnitus.org.uk. The handout is specifically targeted to GPs, who British Tinnitus Association see hundreds of different conditions each week and need guidance that Registered charity no: 1011145 is concise, easy to reference, and provides specific advice for patients Company limited by guarantee no: 2709302 and options for treatment. Registered in England The guidance document is reprinted with permission from the British This document has been written by: Tinnitus Association. It includes advice for recognizing tinnitus, what to Professor David Baguley NIHR Biomedical Re- communicate to patients—including the dangers of negative counseling, search Unit in Hearing, University of Nottingham what can be done by patients themselves, and when to refer for treat- Mr. Don McFerran Consultant ENT Surgeon, Essex County Hospital, Colchester ment. BTA invites readers to distribute the article to GPs in their area and spread the word about tinnitus to family physicians who are fre- David and Don are co-authors, with Laurence McKenna, of the self-help book “Living with quently the first to encounter patients experiencing troublesome sounds tinnitus and hyperacusis” (Sheldon Press, 2010) associated with tinnitus. Reprinted with permission.

TINNITUS TODAY SPRING 2017 29 RESEARCH NEWS Demyelination—Another Cause of Hidden Hearing Loss

Summary by John A. Coverstone, AuD cells, which has previous- ly been described as the A recent article describes a new origin for hidden hearing pathophysiology for hidden hearing loss and tinnitus. In fact, loss: Demyelination of the auditory these two mechanisms— nerve. As a child grows, his or her loss of synaptic function nervous system develops a coating and damage to the auditory of proteins and phospholipids, called nerve—are distinct but may myelin, around many nerve cells. This have an additive effect if insulating material leads to increased each are present. speeds of nerve conduction and is The authors theorized essential for a normal-functioning that mice subjected to this adult nervous system, including for procedure would lose sig- sensory nerves such as those locat- nificant hearing immediate- ed in the ear. This myelin sheath in ly after the Schwann cells peripheral nerves is created by cells were ablated, but would named Schwann cells, after Theodor regain hearing as the cells Schwann, the German physiologist regrew and remyelinated who first described them. the auditory nerve cells. The authors, from the Kresge Tests of outer and inner hair cell func- Clinicians may be able to use the Hearing Research Institute at the tion showed they were not affected information and tools described by University of Michigan, investigated by the lack of myelin around the audi- this study to determine the exact type the effects of Schwann cell loss within tory nerve cells. However, measure- of hidden hearing loss a person has the cochlea of mice. They noted that ments of the electrical potential of and recommend the most appropriate it caused a rapid demyelination of the the auditory nerve (ABR, peak 1) was treatment options. This is primarily de- auditory nerve, which was followed by permanently and significantly reduced termined by the significant change in regrowth of the Schwann cells and a and slower. Clinicians frequently use latency of sound transmission in the period of remyelination. However, this a measure called electrocochleogra- case of demyelination, whereas syn- temporary loss of Schwann cells and phy (ECoG) to indicate function of the aptopathy does not show this change. the resulting loss of myelin around the inner hair cells of the cochlea. ECoG While there are currently no treat- auditory nerve caused permanent dis- can be used to measure the ratio of ments to heal either type of damage, ruptions in the first heminode of the the summating potential (generated audiologists may be able to provide auditory nerve cells. Heminodes are by inner hair cells in the cochlea) counseling and direct patients toward the site where the electrical impuls- and action potential (generated by options that help to overcome hidden es of the auditory nerve begin after auditory nerve signaling) to diagnose hearing loss and improve communi- sound stimulation. The first heminode cochlear disease. The researchers in cation. Future research may lead to a is closest to where the nerve termi- this study identified no effect on the cure for either type of hidden hearing nates on the inner hair cells of the summating potential, but a prolonged, loss and associated tinnitus. cochlea (the sensory cells which are possibly permanent, effect on the Wan, G. & Corfas, G. Transient auditory nerve responsible for hearing). This mech- action potential. This resulted in a demyelination as a new mechanism for hidden anism did not affect that synapse decreased SP/AP ratio. hearing loss. Nat. Commun. 8, 14487 doi: 10.1038/ ncomms14487 (2017). between the auditory nerve and hair http://www.nature.com/articles/ncomms14487

30 TINNITUS TODAY SPRING 2017 PODCAST SUMMARY Why Do Some Professionals Hesitate to Provide Tinnitus Care?

By Joy Onozuka “The help is there, but not the reim- When money is involved it bursement,” he emphasized. naturally spurs change. Tyler noted Doctors spend their lives dedicated The result is the wealthy are get- that when the state of Iowa began to helping patients, so why are ting treatment, while the poor are compensating for noise-induced so many tinnitus and hyperacusis not. With tinnitus and hyperacusis tinnitus, independent of hearing patients told that nothing can be listed as top complaints among vet- loss, factory conditions improved. done to help them? According to erans, Tyler feels concerted action “The technology has been around Dr. Richard Tyler, a professor at is required to put this issue on the for decades, but it’s only in the last the Department of Otolaryngology radar. “Professionals involved in four or five years that factories are Head and Neck Surgery and the helping tinnitus patients should try taking action. Now it costs them Department of Communication and help society appreciate the im- money to reimburse their work- Sciences and Disorders at Iowa portance of tinnitus and how it can ers, because they have not just State University, the basic problem have a major impact on someone’s noise-induced hearing loss but also is the lack of reimbursement life,” he said. “The AMA (American noise-induced tinnitus.” for treatment. Since there is no Medical Association) guidelines This conversation on tinnitus pill or surgery that can solve are ludicrous and underplay the represents a call for action at the either condition, coupled with no significance.” Current AMA guide- grass-root level, because far great- insurance coverage, doctors hesitate lines, he says, allow for tinnitus er resources—in reimbursement, to focus on the field or provide care. compensation if a patient has training or research—are required This perpetuates a fundamental hearing loss, which doesn’t always if widespread treatment and lack of understanding on available happen. The maximum support is awareness of tinnitus and hypera- treatment options, according to 5 percent, which grossly under- cusis are to be achieved. What are Tyler in his March Conversations in estimates the degree of suffering your thoughts on this issue? Please Tinnitus podcast interview. of millions. “People may commit email: [email protected] Dr. Tyler’s conference, now in suicide because they have tinnitus,” its 25th year, has gone a long way Tyler stressed. toward the training of clinicians. He is adamant that support groups, patients and organizations like the Management of the Tinnitus & Hyperacusis Patient ATA need to advocate for reim- The 25th Annual International Conference, Management of the Tinnitus & Hyperacusis bursement for clinicians in addition Patient, will be held June 15-16, 2017, at the University of Iowa. The event is intended to advocating for better training and for otologists, audiologists, hearing-aid specialists, psychologists, and other healthcare research. “If there’s no reimburse- professionals providing clinical services for patients. Topics will include an overview ment for clinicians working with of current evaluation and management strategies and research, as well as an array of their patients, then it’s not so likely presentations on such topics as sleep therapy, vestibular links to tinnitus, and an NIH trial they’ll take up on it,” Tyler said. on tinnitus retraining therapy. Since its inception, the conference has been designed to Moreover, since there are so many increase knowledge and skills of clinicians. Patients with tinnitus and/or hyperacusis and subsets within tinnitus and hypera- their families and friends are welcome to attend, with the understanding that no individ- ual diagnosis or treatment will be offered. Further information can be accessed online by cusis, it requires considerable time visiting the University of Iowa’s website, https://medicine.uiowa.edu/oto/education/con- and dedication to be able to work ferences-and-events/international-conference-management-tinnitus-and-hyperacusis effectively with patients, as well as The ATA is a Diamond Sponsor of the conference. understand the steps for referrals.

TINNITUS TODAY SPRING 2017 31 DONORS NEW! Spotlight on Patient Providers

GOLD LEVEL Sara K. Downs, AuD Deborah R. Lain, MSc, RPsych Hearing Wellness Center Private Practice Professional Members Duluth, MN Calgary, Alberta, CAN Listing is current as of February 15, 2017. Janice Dungan, AuD Joanne LaPorta, MA When making an appointment, please say you Appalachian Audiology Accent on Hearing learned about patient providers through the ATA Knoxville, TN Denver, CO website or Tinnitus Today magazine. With this Robyn Edgson, BC-HIS Malvina Levy, AuD information, providers understand the value of Hearing Associates of Las Vegas Hearing and Speech Center being a part of the ATA network of patient support. Las Vegas, NV San Francisco, CA Eugene Antonell, BC-HIS Michael Flores, AuD Ha-Sheng Li-Korotky, PhD, AuD, MD Hear Better Now, LLC University of New Mexico Pacific Northwest Audiology North Dartmouth, MA Albuquerque, NM Bend, OR Jennifer Auer, AuD Amanda Frazier, HIS Matthew Lyon, MA Audiology by the Sound ASI Audiology & Hearing Instruments El Paso Hearing Aid & Audiology Center Ridge, NY Council Bluffs, IA El Paso, TX Carol Bass, MS Belinda Gonzales, HIS Suzanne MacLaren, MA, RPsych All Ears Audiology NuSound Hearing Center Calgary Ear Centre Ithaca, NY Topeka, KS Calgary, Alberta, CAN Randall Bartlett, MA MaryRose Hecksel, AuD Robert Mario, PhD Tinnitus & Audiology Center of Southern California, Inc. Audiology and Hearing Aid Center Mario Hearing and Tinnitus Clinics Santa Clarita, CA Lansing, MI Canton, MA Lisa Blackman, MS James Henry, PhD Michael Messina, HIS A Hearing Healthcare Center VA Portland Healthcare System Clarity Hearing Aid Solutions Philadelphia, PA Portland, OR Summerfield, FL Granville Y. Brady, Jr., AuD Melanie Herzfeld, AuD Leah Mitchell, AuD Tinnitus Center at Williamsburg Commons Hearing and Tinnitus Center Sound Relief Hearing Center East Brunswick, NY Woodbury, NY Westminster, CO Mindy Brudereck, AuD Bruce Hubbard, PhD John P. Molina, AuD Berks Hearing Professionals Cognitive Health Group Colorado Hearing Specialists Reading, PA New York, NY Parker, CO Carol Clifford, AuD David Illich, AuD Stephen M. Nagler, MD, FACS Albuquerque Hearing and Balance Professional Hearing Associates Atlanta Tinnitus Consultants, LLC Albuquerque, NM Escondido, CA Atlanta, GA Lois Cohen, LCSW, ACSE, BCD Kent Jarratt, LCSW Elizabeth Protti-Patterson, AuD Tinnitus Counseling Private Practice REM Audiology Associates, PC Northport, NY Bradley Beach, NJ Vorhees, NJ Lindsay Collins, AuD Marsha Johnson, AuD Jeanne Perkins, AuD Sound Relief Hearing Center Oregon Tinnitus & Hyperacusis Clinic Audiologic Associates Centennial, CO Portland, OR Glen Ellyn, IL John A. Coverstone, AuD Jeannie Karlovitz, AuD Julie Prutsman, AuD Sentient Healthcare, Inc. Advanced Hearing Solutions Sound Relief Hearing Center New Brighton, MN Exton, PA Highlands Ranch, CO David Cuthbertson, AuD Jason Kaufman, DC Jennifer Reynolds, AuD Acadia Hearing Center Scottsdale Neurology Reynolds Audiology & Tinnitus Center Ellsworth and Bangor, ME Scottsdale, AZ Woodbury, MN Ali Danesh, PhD Edward Keels, MA Ann Rhoten, AuD Florida Atlantic University Hear Now Hearing Aid Center Kentucky Audiology & Tinnitus Services Boca Raton, FL Philadelphia, PA Lexington, KY Nikki DeGeorge Weaver, AuD Jennifer Klimczak, AuD Christine Russell, AuD Fayette Hearing Clinic and Coweta Hearing Clinic Avalon Hearing Aid Centers Sound Relief Hearing Center Peachtree City and Newnan, GA Sacramento, CA Fort Collins, CO Stelios Dokianakis, AuD Nichole Kovel, AuD Mimi Salamat, PhD Holland Doctors of Audiology Elite Hearing of Colorado Springs Dr. Mimi’s Audiology Clinic Holland, MI Colorado Springs, CO Walnut Creek, CA

32 TINNITUS TODAY SPRING 2017 DONORS

Tiffany Sexton, AuD SILVER LEVEL Lifestyle Hearing Rochester Hills, MI Professional Members Cindy Simon, AuD Listing is current as of February 15, 2017 South Miami Audiology Consultants When making an appointment, please say you South Miami, FL learned about patient providers through the ATA Randall Solomon, MD website or Tinnitus Today magazine. With this Long Island Mental Health information, providers understand the value of Port Jefferson Station, NY being a part of the ATA network of patient support.

Murray Steinfeld, HAS, BC-HIS, ACA Debbie Abel, AuD Hearing Solutions of the Palm Beaches AudigyCare Jupiter, FL Vancouver, WA

Megan Stout, AuD Catherine Ahrens Berke, BC-HIS Member Survey Tinnitus Treatment Solutions Ahrens Hearing Center Campbell, CA Fair Lawn, NJ

Results Jennifer Waddell, HIS Jason Aird, AuD Iowa Audiology and Hearing Aid Centers The ATA would like to thank the Sound Hearing Care Simponsville, SC Coralville, IA 250+ readers who returned our Thea Wickey, AuD Melissa Alexander, AuD Member Survey, which was in Sound Relief Center Alexander Audiology, Inc. our Winter 2016 publication. Highlands Ranch, CO Santa Monica, CA Results are being reviewed to Melissa Wikoff, AuD Saranne Barker, AuD Raleigh Hearing and Tinnitus Center determine which issues and Peachtree Hearing Marietta, GA Raleigh, NC research endeavors are of great- Diane E. Williams, AuD Simon Barriga, PhD est concern to our readership. Better Sound Audiology VisionQuest Biomedical, LLC Yucca Valley, CA Albuquerque, NM

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TINNITUS TODAY SPRING 2017 33 DONORS

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Anne Carter, PhD, AuD Cynthia Ellison, AuD Sherry Hodge, AuD Pasadena Hearing Care Franklin Hearing Center Advanced Hearing Care St. Petersburg, FL Franklin, TN Anderson, IN

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Andrea Livingston, AuD Jennifer Reekers, AuD Patricia Wightman, CBT, LCMHC Central FL Hearing Services Heartland Hearing Center Labyrinth Audiology Sebring, FL Cedar Rapids, IA Boca Raton, FL

Nancy Lucas, AuD Rebecca Rich, AuD Christine Wilson, MS Chisholm Trail Hearing Tinnitus Treatment Center Conejo Hearing Center Cleburne, TX Aberdeen, SD Westlake Village, CA

Dan Malcore Deanna Ross, AuD Deborah Woodward, AuD The Hyperacusis Network Albany ENT & Allergy Services, PC North Georgia Audiology Green Bay, WI Albany, NY Johns Creek, GA

Michael Mallahan, AuD Richard Salvi, PhD Hearing and Balance Lab, PC University at Buffalo Mill Creek, WA Buffalo, NY We appreciate the generosity of those Randa Mansour-Shousher, AuD Lindsay Satchell, HIS who have made donations to the ATA in Northwest Ohio Hearing Clinic Woodland Tinnitus & Hearing Clinic memory and honor of their loved ones. Toledo, OH Williams Lake, BC, CAN

Brooke Means, AuD Christina Seaborg, AuD Donations Made in Memory North Georgia Audiology Hearing and Balance Center, LLC Listing is current as of February 15, 2017 Gainesville, GA Charlotte, NC Geneieve Anna Butts Mary Miller, PhD Paul Shea, MD Irwin Larry Goldman Premier Hearing and Balance Shea Ear Clinic Hammond, LA Memphis, TN Michael F. Haar

Pamela Montgomery-Earl, AuD Susan Sheehy, AuD Dr. Mary Meikle & Dr. Jack Vernon Intermountain Audiology Alabama Hearing Associates Karol Wolf Niederfringer St. George, UT Madison, AL Michael Ratajczak Cristi Moore, AuD LaGuinn Sherlock, AuD Leonard Schaffel Sonora Hearing Care, LLC Walter Reed Army Medical Center Silence Tucson, AZ Bethesda, MD Daniel E. Teune Amy Nelson, AuD Susan Shore, PhD Martha Usatine Landmark Hearing Services University of Michigan Medical School Sunnyvale, CA Ann Arbor, MI Dr. Jack Vernon

Marni Novick, AuD Abraham Shulman, MD, FACS David Waldon Silicon Valley Hearing, Inc. Martha Entenmann Tinnitus Research Center Mr. Donald Wayne Webb Los Gatos, CA Brooklyn, NY Ruth H. Weikert Ayo Ogunlusi, AuD David Siegman, PsyD Northern Jersey ENT Associates Dr. David Siegman Donations Made in Honor of: Midland Park, NJ Highland Park, NJ Listing is current as of February 15, 2017 Ashley Penrod, PA-C Scott Sims, AuD Dawn Epstein Alta View Specialty Clinic Physician’s Choice Hearing & Dizziness Center Davis Donald Hohn Sandy, UT Tampa, FL Linda J. Hall Andrea Pernick, AuD Martin Smith, PsyD Marjorie Kobe South Miami Audiology Consultants Associates in Managed Care South Miami, FL Denver, CO The Levy Family

Jay Piccirillo, MD, FACS Judith Sonner, LICSW Thomas Mauskopf Washington University School of Medicine Newton Biofeedback Scott Mitchell, J.D. Saint Louis, MO Newton, MA Dr. Stephen M. Nagler Bruce Piner, AuD Christina Stocking, AuD Norman Roberts Hearing and Balance Center University at Buffalo Jeff Sullivan Encino, CA Buffalo, NY

TINNITUS TODAY SPRING 2017 35 PODCAST SUMMARY The Journey: Treating Patients with Severe Tinnitus

By Joy Onozuka matized, you have to have some the signs of depression and when supervision,” Dr. Baguley said, to make the appropriate referrals… During the Conversations in noting that it is considered good you’re doing a real disservice to Tinnitus discussion between Dr. practice around the world. “When I your patient and you may even be David Baguley and co-hosts Dr. tell psychologists that audiologists endangering his or her life,” said John Coverstone and Dr. Dean don’t generally do this, they say, Dr. Coverstone. “This is a very Flyger, there was discourse on the ‘What? You’re crazy.’” Dr. Baguley specialized area for audiologists challenges that audiologists face felt compelled to act. and we’re not necessarily used to as they try to help patients who To provide support and peer being well-versed in those areas of have more severe tinnitus and networking opportunities for tinni- psychology, depression, and such hyperacusis. To give voice to that tus clinicians in the U.K., he began things, so it’s a little difficult for us.” seldom discussed topic, we’ve establishing regional chapters that Dr. Baguley, being determined to included a short synopsis here. meet twice a year, to give doctors a find as many avenues as possible forum to discuss research, journal for disseminating relevant informa- There is a concerted effort to articles, and patients. “(Doctors) tion, began focusing on how other create broader public awareness ask all sorts of questions and share professionals learn about illness re- of tinnitus and hyperacusis and to good practices in a really open and lated to their fields through sources better prepare general practitioners honest way,” he said. “The groups other than medical. For instance, for working with tinnitus and have plugged them into a commu- he noted that psychiatrists and hyperacusis patients. General nity.” Because of the frustration that neurologists readily turn to depic- practitioners are typically the first often comes with being unable to tions portrayed in literature, drama, ones to meet patients seeking provide a cure or significant relief and film. This spurred him recently help for problems with their for patients, a burden is alleviated to write a chapter on tinnitus as it is hearing. However, the challenges through talking with other clini- characterized in literature, film and that the individual audiologist cians facing the same challenges, music. “There’s quite a lot … peo- face are not typically considered. he said. Today, every region of the ple sometimes in crisis, sometimes Without peer support, Dr. Baguley U.K. has such a network. dealing with it, sometimes men- argued audiologists are setting It was noted that there also is a tioning it off-hand,” he said, refer- themselves up for problems. The trend in the United States toward encing Woody Allen’s film “Hannah podcast co-hosts, both of whom greater awareness of the complex- and Her Sisters” and music by Bob are audiologists, agreed. When ity of treating patients with more Dylan. “It’s very interesting and working with the estimated 10 severe tinnitus and hyperacusis. An made me think quite deeply about percent of patients with more acute audiologist can specialize in adults, the situation,” Dr. Baguley said. tinnitus and hyperacusis, more pediatrics, geriatrics, hearing and The opportunity to listen, observe, comprehensive training and care hearing aids, cochlear implants, be heard, and learn from others—be it are needed, because those patients or balance disorders but only be within the context of popular culture, often struggle with the complicating exposed to a small number of a doctor-patient relationship, thera- factors of sleep deprivation, patients with tinnitus and/or hy- peutic support setting, or through a anxiety, and depression. peracusis. As a result, they may be professional gathering—is critical for “If you’re a psychologist who unaware of the personal struggles gaining perspective, diffusing stress, works with people who are anxious that patients are experiencing. “Un- and fueling motivation to keep mov- or upset, or who have been trau- less you have been educated on ing forward and improving.

36 TINNITUS TODAY SPRING 2017 Continued from page 5 information), Dr. Robb did an excel- highly encourage readers who may sionals, and he packed a wealth lent job of aggregating a significant have balked at the title to return to of information into a rather brief amount of data which is critical to the Winter 2016 issue in print or on article. The information he present- the proper care of patients with the ATA website and read again Dr. ed is very much what those of us tinnitus. Dr. Robb provided excel- Robb’s informative and thought- in clinical practice assimilate from lent summaries of the difficulty of ful article. I also hope he will be research and personal experiences studying tinnitus and treatments encouraged by your comments and to make the best choices for pa- for tinnitus, the placebo effect in re- agree to write for us again! tient care. In the Bayesian Informed search (which is incidentally a sig- — Editor Prior Probabilities table (which is a nificant effect in tinnitus treatment fancy way of describing how past also), and the effects of negative theories are updated with current counseling for those with tinnitus. I

Continued from page 15 “Public interest in reducing noise the European Union requires that all devices bearing the CE mark that ex- pollution and exposure, as well as ceed 70 dB output, include the sound the increase in noise restrictions, level for usage at a workstation (rath- er than in a lab or treated room) in the is reflected in guidance to user manual. As standards by the In- consumers from organizations ternational Organization for Standard- ization and, to a lesser extent, the like Consumer Reports…” International Engineering Consortium are increasingly adopted by countries, ratings for many power tools from a Legal actions to reduce noise in U.S. consumers are reaping benefits. variety of manufacturers. However, it neighborhoods, along with engineer- Many U.S. companies manufacturer does not yet include leaf blowers and ing improvements that reduce noise power tools for sale both domestically similar yard equipment devices. The emissions from power tools and yard and abroad. In order to complete—or database includes filters for tool type, equipment, have produced better possibly even to sell—in other mar- manufacturer, and technical specifi- choices for the consumer and worker. kets, companies are already re-en- cations, like a 10-inch blade versus a As individuals, we can ask that land- gineering tools to be quieter. If new 12-inch blade. scapers use quieter and more envi- products do not comply with other Over the years, NIOSH has made ronmentally friendly equipment. As countries’ regulations for labeling or it easier for consumers to understand consumers, we can replace old tools sale of power tools and equipment, it actual noise levels and safe limits of with new ones that are less noisy. As will not be profitable to produce tools exposure by testing tools in loaded, workers, we can push for implemen- for sale in those markets. meaning engaged in operation, and tation of Buy Quiet policies. Through When purchasing new tools, con- unloaded, meaning turned on, condi- such steps, we will move steadily sumers are encouraged to research tions. toward a noticeable reduction in noise noise levels to guard against hearing To strengthen the drive to reduce levels in our environments. Please be damage and noise pollution. NIOSH work-related noise-induced hearing sure that your new-found quiet is the has made this process easier by loss, NIOSH encourages businesses result of a deliberate move to utilize maintaining a database on power tool to adopt its Buy Quiet programs by newer equipment with lower noise noise levels, which can be viewed at replacing old tools with quieter ones levels and not due to noise-induced https://wwwn.cdc.gov/niosh-sound-vi- and maintaining accurate information hearing loss. bration. It contains verified noise on equipment noise levels.

TINNITUS TODAY SPRING 2017 37 RESEARCH NEWS

ATA Funded Research Reviewing Research Grants: Including the Patient Perspective

By Jennifer A. Born ATA grant. Viewed in this context, better understanding and treatment ATA Scientific Research Coordinator you can see how ATA’s investment outcomes for patients. and your donations contribute to a Recognizing the significance of As an ATA member, you are directly clear path toward scientific progress patients, ATA introduced a provisional supporting cutting-edge scientific and breakthroughs. patient review panel to join the pro- research with your donation. One Every March, ATA’s Scientific cess this year. Patient reviewers will of the most important things that Advisory Committee (SAC), which is focus on the impact that a proposal ATA does as an organization is fund made up of researchers and medical may have on the patient community grants for researchers who are professionals who volunteer their and present their conclusions to SAC investigating the conditions, causes, time and expertise to review grant during the March meeting. treatments, and potential cures for proposals, meets to discuss their It is anticipated that the patient tinnitus and hyperacusis. Over the review results. Based on that, they review panel will further enhance past four decades, ATA has provid- make funding recommendations to the dynamics of the research grant ed more than $6 million in research the ATA Board of Directors, which program. In future review cycles, we aimed at solving the tinnitus and meets in the spring to review and hope to draw on ATA members to (more recently) hyperacusis puzzles. award grants. serve as patient reviewers. ATA grants allow researchers to As the understanding of tinnitus To learn more about the Scientific gather pilot data or continue work and hyperacusis has evolved, so Advisory Committee and the Board that ATA has previously funded. In has ATA’s grant program. In 2005, of Directors, visit: ATA.org/about-us/ many cases, scientists go on to re- ATA’s SAC developed and adopted its leadership ceive much larger grants from federal Roadmap to a Cure. The Roadmap To learn more about research agencies, such as the National Insti- outlines four paths of research—two funded by ATA, visit: ATA.org/ tutes of Health (NIH) and the Depart- basic and two clinical—to ensure research-toward-cure. ment of Defense (DoD), to continue that your grant dollars are following the work they started with their initial a research trajectory likely to yield

“Hearing loss is the third most common chronic health condition in the U.S., surpassing diabetes and cancer,” according to Anne Schuchat, Acting Director for the Centers for Disease Control and Prevention, in an article published March 1, 2017, on Fox News.

38 TINNITUS TODAY SPRING 2017 IT’S ALL ABOUT SUPPORT Don’t Make the Journey Alone

Become a group leader in your area related expertise in the field, we and lead the way in learning about the provide resources to help and sustain latest research, learning from health a group. professionals, and being part of a larg- To learn more, visit our website at er community committed to sharing www.ata.org, where you will find our and understanding the challenge of ATA Support Group Leader Guide. living with and adapting to tinnitus This is a comprehensive outline of and/or hyperacusis. all the steps for creating and sustain- The ATA, in an ongoing effort to in- ing a support group, from defining a crease the number of support groups mission statement, finding a meeting across the United States, is calling on place, developing an agenda, and those who feel a desire to connect creating a network of volunteers, to with others to turn the journey of liv- tips on finding speakers, and finding ing with tinnitus and hyperacusis into care professional. You don’t have to counselors capable of providing more a team effort by becoming a support understand all the layers of what it is comprehensive support. We antic- group leader in your area. like to have either or both conditions. ipate that you’ll have questions, so Don’t feel qualified? Don’t worry. Being part of a team means that the please don’t hesitate to email us at You don’t have to have all the an- ATA is here to help you. Whether [email protected] swers. You don’t need to be a health- you are a layperson or someone with

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TINNITUS TODAY SPRING 2017 39 15 Things You Might Want To Know About… Somatosounds By John A. Coverstone, AuD physician. It can be life-threatening the movement of the eardrum. The in rare cases. Fortunately, pulsatile eardrum will move in sync with the Somatosounds are noises that tinnitus can also be treated in most person’s breathing. It may be enhanced 1originate within your body, cases. for forceful breathing, particularly if the usually from bodily functions. They Another somatosound that is opposite nostril is pressed closed. After are NOT tinnitus. Somatosounds can 7often mistaken for tinnitus comes showing all your friends, you should be traced back to a specific origin from temporomandibular joint (TMJ) see an ENT, who may be able to treat within the body. Tinnitus arises problems. People who clench their the condition. from, or is directly connected to, the jaw frequently may develop a clicking A patulous eustachian tube auditory nervous system—as far as or other sound. Your orthodontist can 12 may occur after rapid weight we know. Research is still being done probably help with that (see the Winter loss, so if you’ve been contemplating to determine exactly what causes 2016 issue of Tinnitus Today for a the newest fad diet, be forewarned. tinnitus. patient story about TMJ problems). When the ear is stimulated with In the past, somatosounds Some people experience a 13 certain sounds, hair cells of the 2sometimes were called objective 8condition where one of the middle inner ear respond and create additional tinnitus. This is because some ear muscles moves abnormally— sounds. In a healthy ear, these somatosounds may be heard by a often rhythmically—and vibrates the responses may be measured and are physician or audiologist listening close bones of the middle ear. Those bones called otoacoustic emissions (OAEs). to a patient’s ear. transmit sound passed through the Audiologists use them to measure If a somatosound cannot be eardrum. Sound is vibration. So when whether certain hair cells—called 3heard by another person, it is they vibrate, we hear sounds. outer hair cells—are working normally. not technically objective tinnitus. This condition is called myoclonus There have been cases reported However, somatosounds are not 9of the middle ear. It is usually where otoacoustic emissions occur technically tinnitus at all. So it benign, but should also be checked spontaneously and are loud enough to technically shouldn’t matter. out. In rare cases, it also may also be heard by an outside person. Because somatosounds do indicate a serious condition. The outside person would 4not originate from the auditory The eustachian (“yu-stay- 14 need to have pretty good system, the term objective tinnitus 10 shun”) tube is an opening hair cell function of their own. is usually frowned upon by traveling from the nasopharynx— Spontaneous OAEs are very soft— professionals. It really isn’t considered between your throat and nose—to even the louder ones. tinnitus at all. the middle ear, which is filled with Just about everybody Pulsatile tinnitus is usually a air. It allows air to move into or out 15 experiences somatosounds. 5somatosound. In many cases, it of the middle ear cavity so the air Have you ever had a moment when has a vascular origin. It may be caused pressure equalizes with the outside your hearing decreased and you by conditions, including arteriosclerosis world. Guess what? It can cause heard an intense ringing for few of the carotid artery, ideopathic somatosounds, too! When the tissues seconds? You may have even felt intracranial hypertension (high blood around the eustachian tube atrophy some pressure in your ear. It was pressure around your brain), vascular or a muscular problem causes the probably due to a spasm of the malformations or tumors, or the higher eustachian tube to be abnormally stapedius muscle in the middle ear. incidence of blood vessels associated open, a person may hear his or her If it happens frequently you should with Piaget’s disease. own breathing as a “blowing” sound. check with your physician, but if it If the last paragraph didn’t scare This condition called a “patulous” only happens every now and then 6you enough, pulsatile tinnitus 11 or “patent” eustachian tube, you are probably fine. should always be checked out by a can be seen by an examiner watching

40 TINNITUS TODAY SPRING 2017 TinniTusToday Editorial Calendar 2017

Tinnitus Today magazine is a print and electronic media magazine published in April, August, and December, and circu- lated to 10,000+ ATA members, patients, supporters, researchers, and healthcare professionals.

The magazine editorial team empowers readers with information, including up-to-date medical and research news, feature articles on urgent tinnitus and hyperacusis issues, questions and answers, self-help suggestions, and letters to the editor from others with tinnitus and/or hyperacusis. Strong service journalism, compelling storytelling, first-person narrative, and profiles are presented in a warm, vibrant and inviting format to encourage readers to reflect, engage, and better understand a medical condition that affects millions.

Editorial Photographer Online Issue Issue Theme Copy Due Photos Due Ad Close Launch Mailed

Summer Aug 2017 Nature Issue 6/1 6/1 6/1 8/1 August

Special Insert: ATA Strategic Plan

Winter Dec 2017 Research Issue 10/1 10/1 10/1 12/1 December

ATA Research Grants Update

Spring Apr 2018 Leadership Issue 2/1 2/1 2/1 4/15 April

Editorial Calendar is subject to change.

To Advertise: Contact Torryn Brazell at [email protected]

ATA is the nation’s foremost and trusted organization committed to finding cures for tinnitus and hyperacusis. Our commitment demands focus, determination, strategy and resources. ATA promotes synergistic alliances between dedicated medical professionals and researchers who work with and within the tinnitus community. The battle for a cure is real, and will be won through advances in technology and medicine, areas in which we have often served as a conduit for new discoveries.

We fulfill our mission by: 1. Funding targeted research projects 2. Providing education, hope, and support for the tinnitus community 3. Advocating for effective public policies focused on advancing science toward cures for tinnitus and hyperacusis, and 4. Collaborating with others to promote awareness, encourage prevention, and ultimately to silence tinnitus.

www.ata.org P.O. Box 5 Portland, OR 97207-0005

CALENDAR

Podcast 1: Clinical Aspects of Tinnitus Podcast 4: Ringing Ears and the Neuroscience of RELEASE DATE: February 2017 Tinnitus SUBJECT MATTER EXPERT: David Baguley, PhD, MBA RELEASE DATE: August 2017 TOPIC: Dr. Baguley discusses the journey of a person with tinnitus, from the SUBJECT MATTER EXPERT: Larry E. Roberts, PhD moment a problem is registered to the point he/she recognizes there may be TOPIC: Listeners will learn from Dr. Roberts how specific features of sounds no quick fix. The conversation touches on the patient and healthcare provider and their corresponding significance differ from person to person. Due to relationship, current research, the importance of support groups, and hope for that uniqueness, sounds—and the way the brain responds to them—are not future advancements in treatments and a cure. something that can be deciphered through genetic coding. Dr. Roberts will Podcast 2: Sound Therapy address this challenge of uniqueness and how the brain contains mechanisms for neural plasticity that tune auditory neurons to represent the sounds that RELEASE DATE: April 2017 are meaningful to us. SUBJECT MATTER EXPERT: Richard Tyler, PhD TOPIC: Listeners learn about research and treatment through Sound Therapy, Podcast 5: The Latest Research on Tinnitus which can reduce stress and enable tinnitus and hyperacusis sufferers to Management engage more effectively in dynamic environments. Thoughts on obstacles RELEASE DATE: October 2017 toward cures and treatment are also shared. Tyler also spoke about the SUBJECT MATTER EXPERT: James Henry, PhD University of Iowa’s “Management of the Tinnitus & Hyperacusis Patient” TOPIC: Dr. Henry’s goal is to develop and validate clinical methodology for practitioner conference, which runs June 15-16. Having founded the annual effectively helping individuals who are afflicted with bothersome tinnitus. In conference 25 years ago, Tyler discussed how it has evolved to serve the this podcast, listeners will learn about the latest research and studies related needs and interests of patients, researchers, clinicians, audiologists, and to tinnitus clinical management. Listeners also will hear about the Veterans other healthcare providers. Administration’s tinnitus management program. Podcast 3: Neuromodulation to Suppress Tinnitus Podcast 6: ATA Leading the Drive for Patient RELEASE DATE: June 2017 Support, Treatments, and a Cure SUBJECT MATTER EXPERT: Jinsheng Zhang, PhD RELEASE DATE: December 2017 TOPIC: Dr. Zhang will discuss his research in neuromodulation, which SUBJECT MATTER EXPERT: Torryn P. Brazell, MS, CAE involves stimulation of a variety of peripheral and brain structures, through di- TOPIC: Brazell, marking her first year as ATA’s Executive Director and Chief rect and indirect approaches. This groundbreaking research, involving animal Operating Officer, will discuss the mission of ATA and its drive to lead the and human subjects, shows promising results toward providing potential re- charge in finding a cure for tinnitus. Due to the complexity of the condition, lief for tinnitus sufferers. Listeners will hear Dr. Zhang discuss the research, Brazell will share the multifaceted approach that the ATA pursues, including its underlying mechanisms, and how it might translate into treatments for research funding, development of effective treatments, broad-based support suppressing tinnitus. for sufferers and healthcare providers, education, and coordination with other national and international players in the quest to spread global awareness and To ensure that podcast content is available to the broadest find a cure. audience possible, particularly those with impaired hearing To listen to ATA podcasts, visit or noise sensitivity, transcripts are available on our website www.ata.org/podcasts www.ata.org at the time of release.