TINNITUSTODAY To Promote Relief, Help Prevent, and Find Cures for Tinnitus Vol. 45, No. 1, Spring 2020
Tinnitus in a Time of Chaos Calming the Mind
Finding Mental Health Support
Tinnitus Treatment Online
Creating a Caring Community
Apps for Managing Stress and Anxiety
A publication of the
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PERSONAL STORIES SPECIAL FEATURES Distinguishing 22 | Between Tinnitus Took Trudy A Variety of Therapy Hearing Loss, 11 | From Perfect Health 4 | Options Offer Tinnitus, and to Thoughts of Suicide Hope for Coping Hyperacusis: A With Tinnitus Recommended How Mindfulness Tinnitus-Evaluation 32 | Helped Me Create Launching Peace With My Tinnitus 14| Internet-based Protocol for Tinnitus Care Audiologists Hearing Aids Can Mental Well-Being 45 | Enhance Hearing, Enrich Does Tinnitus Bother Lives and Well-Being 20 | You? It Might Be Time 51 | Weighed Down to Join or Form a by Noise Support Group TINNITUS TOOLS & RESOURCES
Making Sense 8 | of Titles and Specialties of Mental Health Professionals
SCIENCE & RESEARCH NEWS Understanding Speech 43 | in Noisy Backgrounds Using Machine With Normal Hearing 19 | Learning to Predict Apps for Calming Outcomes for Better Imaging Device | the Mind Multimodal Tinnitus 47 | for Investigating Tinnitus 10 Treatment Qualifying for 40| Disability Benefits with Hearing Loss and/or Tinnitus Journalist’s Odyssey 49| Begins With YOUR HEALTH Tinnitus
Questions on Support Group 30 | Tinnitus Sound 54| Locations Management Spotlight on Patient Assessing Hyperacusis 56| Providers 35 | in Tinnitus Patients Using a Less ATA NEWS Painful Approach Christopher Cederroth The Correlation 29 | Receives Prestigious Limitations of Between Award 38 | Medications for Glaucoma 42 | Tinnitus: Things The ATA and BTA Bring and Tinnitus to Consider 29 | Together Leading Tinnitus Researchers FROM THE BOARD CHAIR Meaningful Support is Available and Can MANAGING EDITOR Change Lives Joy Onozuka American Tinnitus Association
We know our thoughts, perceptions, and behaviors PUBLISHER influence our general sense of well-being as well as our Torryn P. Brazell, CAE immune system. But when it comes to tinnitus, it’s difficult American Tinnitus Association to predict how the condition will impact someone because PODCAST PRODUCER AND WRITER each person responds differently to the intrusion of this John A. Coverstone, AuD unwanted sound. Sentient Healthcare, Inc. We don’t yet understand why 80 percent of people with EDITOR-AT-LARGE tinnitus aren’t particularly bothered by it, while 20 percent Robert Sweetow, PhD find it disruptive, even incapacitating. Among the latter group, University of California, San Francisco tinnitus typically interferes with sleep and concentration, EDITORIAL ADVISORY PANEL James A. Henry, PhD Jill Meltzer, AuD which can have a negative ripple effect on work, socializing, National Center for Rehabilitative Auditory Chair, Board of Directors and one’s mental health. Left untreated, those negative Research (NCRAR) stressors can trigger or exacerbate anxiety and depression. U.S. Department of Veterans Affairs In some cases, tinnitus is so disruptive a person may Gail M. Whitelaw, PhD question whether life with tinnitus is worth living. My Department of Speech and Hearing Science message here is don’t give up hope. I have met so many The Ohio State University
people who have gone from extreme lows brought on by DIGITAL DESIGN & PRODUCTION TEAM tinnitus to living with tinnitus without feeling particularly JML Design, LLC burdened by it. Things can and do get better with help! ADVERTISING In recent years, the tinnitus research community has Tinnitus Today is the official publication of the turned its attention to examining the effect of tinnitus American Tinnitus Association. It is published on quality of life as opposed to such things as tinnitus three times per year in April, August, and pitch and loudness. That shift is significant because the December and mailed to members and donors. The digital version is available online perception of tinnitus — even when it’s loud — may or may at www.ata.org. To grow your company’s not bother someone; hence, the impact on quality of life is brand reach, contact [email protected]. the central issue. ATA HEADQUARTERS While the percentage of people severely impacted by American Tinnitus Association tinnitus is relatively small, it is a huge and an unacceptable 8300 Boone Blvd, Suite 500 number, in my mind, because help is available. Tools Vienna, VA 22182 USA T: 800.634.8978 (Toll Free) for managing tinnitus exist and many skilled healthcare T: 202.800.6590 providers, including tinnitus-trained audiologists and mental www.ata.org health professionals, are capable of understanding the TO GIVE TO THE ATA emotional distress caused by tinnitus and helping patients American Tinnitus Association work through it. PO Box 424049 We at the ATA are also here to help, so if you or Washington, DC 20042-4049 someone you know is struggling with tinnitus, please reach The American Tinnitus Association is a non- out to us via email at [email protected] or telephone at profit corporation, tax-exempt under 501(c) (3) 1-800-634-8978. of the Internal Revenue Code, engaged in educational, charitable, and scientific activities. Tinnitus Today magazine is © copyrighted by the American Tinnitus Association.
ADVERTISEMENT Publication of any advertisement does not in any way or manner constitute or imply ATA’s approval or endorsement 2 TINNITUS TODAY SPRING 2020 of any advertised product or service. FROM THE PUBLISHER
ATA BOARD OF DIRECTORS Jill Meltzer, AuD, Chicago, IL—Chair The ATA Will Never Tell John Minnebo, MBA, Philadelphia, PA—Vice Chair Bar-Giora Goldberg, San Diego, CA—Secretary You to Just Get Used David Hadley, MBA, San Francisco—Treasurer Ron Zagel, Grand Rapids, MI—Assistant Treasurer to Tinnitus Phillip Gander, PhD, Iowa City, IA Michael E. Hoffer, MD, FACS, Miami, FL Tinnitus can be debilitating and finding people who Jeannie Karlovitz, AuD, Downington, PA grasp its negative effects can be hard. This can leave a Gordon Mountford, CPA, South Pasadena, CA person feeling alone and boxed in by constant sound. Robert Travis Scott, Baton Rouge, LA No one should feel that way. But how do you find help if LaGuinn P. Sherlock, AuD, Bethesda, MD— everyone you’ve spoken to — from your family physician, Immediate Past Chair friends, and family to your ENT doctor — has said “You’ll Robert M. Traynor, EdD, MBA, Ft. Collins, CO just have to get used to it”? Joseph Trevisani, New York, NY When the ATA says we’re here to help you that means Ted Turesky, PhD, Boston, MA we will share credible information on treatments and tools Melissa Wikoff, AuD, Atlanta, GA for tinnitus management and point you in the right direction Torryn P. Brazell, CAE Jinsheng Zhang, PhD, Detroit, MI Publisher Torryn P. Brazell, Vienna, VA—Ex-officio for utilizing healthcare resources in your local community. We will never tell you to get used to it! HONORARY DIRECTOR Tinnitus that upends your life by taking away your ability William Shatner, Los Angeles, CA to sleep well, concentrate, socialize with friends, and ATA SCIENTIFIC ADVISORY COMMITTEE relax isn’t something to “get used to.” It’s something that The opinions expressed by contributors to Tinnitus Today Michael E. Hoffer, MD, FACS—Chair affects your mental and physical health, which can further University of Miami Health System, are not necessarily those of Miami, FL USA contribute to a downward cycle in quality of life. the publisher or the American Tinnitus Association. This Carey D. Balaban, PhD In this issue, you’ll discover a growing network of mental publication provides a variety University of Pittsburgh, Pittsburgh, PA USA health professionals and tinnitus-trained audiologists who of topics related to tinnitus for Shaowen Bao, PhD are available to help you work through the anxiety, stress, informational purposes only. University of Arizona, Tucson, AZ and depression that can accompany tinnitus. ATA’s publication of any adver- Christopher R. Cederroth, PhD If an audiologist who assesses your hearing and tinnitus tisement in any kind of media Karolinska Institute, Stockholm, Sweden believes you need more support working through the does not, in any way or man- Marc Fagelson, PhD emotional turmoil of intrusive tinnitus, he/she can and ner, constitute or imply ATA’s East Tennessee State University, approval or endorsement of Johnson City, TN USA should refer you to a therapist. If your circumstances any advertised product or Fatima T. Husain, PhD prevent you from seeing a therapist, there are resources. service. ATA does not favor University of Illinois, Urbana-Champaign, You can get help online and through such tools as or endorse any commercial Champaign, IL USA product or service. teletherapy, which allow you to access help from the Mark S. Mennemeier, PhD University of Arkansas, Little Rock, AR USA comfort of your own home and on your schedule. The point Maria Rubio, PhD, MD is help is more readily available today than ever before. University of Pittsburgh, Pittsburgh, PA USA Please reach out for help today by utilizing resources Jeremy G. Turner, PhD outlined in this issue. Illinois College, Jacksonville, IL USA Tricia Scaglione, AuD University of Miami, Plantation, FL USA Roland Schaette, PhD UCL Ear Institute, London, England Grant D. Searchfield, PhD University of Auckland, Auckland, NZ Richard Tyler, PhD University of Iowa, Iowa City, IA USA Letters to the ATA Fan-Gang Zeng, PhD The ATA encourages readers to send comments and questions University of California, Irvine, about tinnitus and/or articles to [email protected] Emails selected Irvine, CA USA for publication may be edited for brevity, clarity, and grammar.
TINNITUS TODAY SPRING 2020 3 SPECIAL FEATURE
A Variety of Therapy Options Offer Hope for Coping With Tinnitus
By Joy Onozuka through another day engulfed by the that point — it was not easy — and my noise in her head. She felt a ray of therapist worked to understand more On an early August morning in hope when she learned there was a about tinnitus.” Had Lynn fixated on Massachusetts, the symphony of tinnitus specialist at Massachusetts only working with a tinnitus specialist sounds from the wetlands was General Hospital. That hope, however, in those early weeks, her journey to momentarily on pause as the crickets was quashed when she was told restore a sense of control over her and frogs fell silent, and the birds had the earliest available appointment life and the tinnitus would likely have yet to wake. In that blissful lull, Lynn was four months later. Gripped by taken longer. Had her distress been G. smiled, feeling grateful for the vast anxiety, unable to sleep, and rapidly more manageable, working with an expanse of nature right outside her losing weight, Lynn knew she needed audiologist might have been an option. door. “I never imagined that morning help immediately, so she booked an The four-month wait to see a tinnitus would be the last day I’d enjoy the appointment with a clinical social serenity of silence,” she said, recalling worker she knew socially and hoped how tinnitus upended her life just for the best. “‘Therapy cannot 24 hours later. “It raised my anxiety “Ann didn’t know about tinnitus, but through the roof,” she said, and set she understood anxiety,” Lynn said. change the level of into motion countless consultations “My weekly appointments in those with doctors and specialists in her early months [after developing tinnitus] tinnitus, but it can search for answers to why it started were the only times I felt at ease.” and how to turn it off. By the time her appointment with change the level of “All I did was focus on the tinnitus,” Massachusetts General came around, Lynn said, remembering how she she said she felt like a different person. anxiety, stress, and was unable to leave the house and “I was in a much better place,” she unable to imagine how she’d get said. “I worked really hard to get to depression.’”
4 TINNITUS TODAY SPRING 2020 www.ATA.org SPECIAL FEATURE
specialist might have even been acceptable. “…because therapy is a two-way process, Cognitive behavioral therapy (CBT) has the most research evidence for it’s important that patients feel a connection treating the functional and emotional effects of tinnitus. However, finding with their therapist and believe he/she a behavioral health therapist who specializes in CBT and who also is smart enough to help, well trained, understands tinnitus can be hard, even in large cities. Many of these therapists, authentic, and ethical.” however, have CBT training and can teach skills to cope with tinnitus. cannot change the level of tinnitus, eliminate or reduce the sound. “I According to James Henry, but it can change the level of anxiety, think the fact that there is no cure for PhD and tinnitus researcher at the stress, and depression.” tinnitus — only therapies to manage National Center for Rehabilitative Kelley also noted that while CBT is its impact — can make it particularly Auditory Research and professor at a well-validated tool for helping people challenging for people,” she noted. Oregon Health & Science University, cope with tinnitus, it isn’t always the “Our medical system, while incredible audiologists can teach some of the best therapeutic intervention for every for many acute illnesses, struggles to skills that are part of CBT, such as patient. “Where does the stress, help people with chronic conditions relaxation training, but providing CBT anxiety, and depression come from? with no known cure.” Because tinnitus per se would be outside of their scope If a person had anxiety before they can disrupt concentration, sleep, and of practice without proper training and developed tinnitus, then that particular the ability to do basic day-to-day tasks, supervision. He said, “Audiologists have person may need more [than CBT],” Hess said getting help early is critical. minimal, if any, training in counseling he says. “If anxiety is causing stress techniques, and being qualified as a that [amplifies] tinnitus, CBT will have So, how do you find the CBT provider requires basic counseling a limited effect.” In such cases, he “right” therapist? skills plus specific CBT skills.” said, analytical therapy would help a As noted in Lynn’s case, the right David Kelley, PhD and clinical person address the underlying causes therapist can make the difference psychologist in New York City, has of anxiety and/or depression. Once between making progress and living a spent nearly 40 years matching root causes have been addressed, the diminished life plagued by emotional patients with therapists best suited to emotions tied to tinnitus can be tackled. suffering. But how does one determine meet their needs through his company Elaine Hess, PhD and clinical whether a therapist is a good fit? Kenwood Psychological Services. psychologist at Baylor College of Satisfaction with a therapist is He agrees that someone struggling Medicine where she provides therapy a very personal matter, because it with tinnitus shouldn’t be overly to patients coping with a variety of entails delving into difficult emotions focused on finding a therapist who health issues, said, “Tinnitus is so while the therapist offers guidance, understands tinnitus, but rather on challenging, because it’s a sensory understanding, and tools for coping. finding a therapist who has a strong experience that you can’t escape, Kelley emphasized that because track record working with patients similar to chronic pain.” Hess has therapy is a two-way process, experiencing stress, anxiety, and worked with tinnitus patients and it’s important that patients feel a depression. “These are very common observed that the greatest challenge connection with their therapist and problems today,” he says. “And tinnitus for many people is learning to live believe he/she is smart enough to help, is not that difficult to understand,” with a new normal while recognizing well trained, authentic, and ethical. Kelley said, adding that he’s had that you can manage your response For an initial evaluation, you should tinnitus since childhood. “Therapy to tinnitus but may not be able to expect to describe:
www.ATA.org TINNITUS TODAY SPRING 2020 5 SPECIAL FEATURE
• the problems and stress in your life, patients with emotional issues show be extremely helpful. “Therapists • your feelings about those improvement after eight sessions are trained to help people who are situations, and of therapy and 75 percent show at different stages of the change • key people in your support system. improvement after six months of process. Even if you are continuing to Together with your therapist, you therapy, according to the American seek answers and treatment options should develop a treatment plan that Psychological Association. for your tinnitus, a therapist can help has clear goals and expectations Since therapy cannot change you manage the stress and distress for outcomes. “Sometimes one tinnitus, acknowledging that the that can come along with that. Also, session is all that is needed to resolve goal of therapy is to work through therapists can help you explore how something. Sometimes it takes much the emotional impact of tinnitus and you can live a meaningful life despite longer,” Kelley shared, explaining that lessen its perceived presence and living through this stressor.” timelines for improving aren’t always influence in daily life is key. Hess Basic questions to ask yourself helpful. Nonetheless, research shows said that even if someone is unable when considering therapists include: that approximately 50 percent of to “accept” tinnitus, therapy can • Do you feel a rapport with the therapist? • Does he/she have the right Professional Resources for Finding temperament for you? • Does he/she seem to understand Therapists the issues associated with tinnitus? The National Institute of Mental Health (NIMH) suggests using the following • Is the office location manageable? professional organizations’ directories or the locators on their websites for help • Can you afford it? (Check insurance finding mental healthcare practitioners. Many state psychological associations coverage and availability of lower also have referral services for individuals seeking mental health support. fees based on income) Note: This list is not comprehensive and does not constitute an endorsement by NIMH or the ATA Your primary care physician • Academy of Cognitive and Behavioral Therapies can be a good place to start when (https://www.academyofct.org/search/custom.asp?id=4410) looking for a therapist, because he/ • American Psychiatric Association (http://finder.psychiatry.org/) she can assess your symptoms • American Psychological Association (https://locator.apa.org) and make a referral to a mental • Association for Behavioral and Cognitive Therapies health professional. Other resources (http://www.findcbt.org/FAT/) include asking for a referral from your • National Register of Health Service Psychologists audiologist, family and friends, your (https://www.findapsychologist.org/) place of worship, or using internet • Society of Clinical Psychology (https://www.div12.org/therapist-search/) search tools, such as www.psychologytoday.com National advocacy organizations that have information on finding mental or professional organizations’ health professionals on their websites include the following: directories (see sidebar), to locate • Anxiety and Depression Association of America (https:// nearby therapists. members.adaa.org/page/FATMain) To sort through options, call or • Depression and Bipolar Support Alliance (https:// email to inquire about the therapist’s www.dbsalliance.org/) licensure, level of experience, • Mental Health America participation in insurance plans, (https://arc.mhanational.org/find-an-affiliate) and fees (some practitioners use a • National Alliance on Mental Illness sliding scale based on income). Many (https://www.nami.org/Find-Support/NAMI- therapists will speak with prospective HelpLine#crisis) clients over the phone, which can
6 TINNITUS TODAY SPRING 2020 www.ATA.org SPECIAL FEATURE
which included CBT.1 Results of the To locate therapists offering study provided strong support for the telehealth services, Hess suggested method, which enables therapy to be using the Psychology Today directory — provided to far more individuals than www.psychologytoday.com. “You can in traditional clinical settings. do an ‘Advanced Search’ and select Major draws of internet-based providers who do ‘online therapy’ and therapy, as noted in the research this will give you a list of individuals article on using the internet to offer who offer this service.” be helpful in making a decision to cognitive behavior therapy (iCBT) for Seeking help for coping with proceed with an appointment. If tinnitus on page 14, are convenience tinnitus can be extraordinarily hard the therapist seems like a good fit, and affordability. Online therapy can when you’re barely managing to get schedule an appointment to discuss be done from the comfort of one’s through the day. If you can’t muster therapy options and expectations. home and can be far less expensive the strength to find a therapist on your If you’re in therapy and feel you are than in-person therapy, depending on own, ask your family physician for help not improving, talk to your therapist. the subscription services. For younger or reach out to sympathetic family and You might decide to work with adults who grew up using technology friends who can make calls for you. someone else or to try a different to communicate, online options can If you’re on your own, call the type of therapy. be easier than face-to-face discussions ATA to speak with one of our tinnitus Can’t see someone about challenging topics. advisors, who offer 15-minute in person? The American Psychology consultations on managing tinnitus Association recommends that anyone and how to locate resources in Not everyone is able to access interested in pursuing teletherapy your local community. This free mental health services in person, should confirm the following: service is intended to provide because of location, work hours, or • Is it the right tool for the issue meaningful guidance to people medical/physical conditions that limit you’re trying to resolve? struggling with tinnitus by outlining mobility. Fortunately, there’s been a • Is the therapist licensed? Therapist free or inexpensive tools for tinnitus steady uptick in telepsychology, which and psychotherapist are not legally relief, what to expect when seeing is sometimes called web therapy, protected words in every state, specialists, tinnitus treatment options, phone therapy, or online therapy. meaning anyone can claim to be and tips on advocating for oneself. “Telehealth therapy has been found a therapist. Confirm the state “We know how hard it is to find to be just as effective as in-person where your therapist is licensed (a substantive help for tinnitus, so the therapy. However, telehealth is not for therapist must be licensed in your ATA wants to ensure that anyone everyone, so it’s important to discuss state to provide you with therapy), burdened by tinnitus knows that there with your therapist if telehealth is a fit the therapist’s license number, and are many options for managing it and for your specific concerns,” according his/her areas of expertise. finding relief,” Jill Meltzer, AuD and to Hess. • Is the site or app secure? Verify chair of the ATA’s board of directors Telehealth also has been shown that it is HIPAA-compliant and shared. “No one should ever feel alone to work in providing tinnitus relief, as able to verify both your identity in their tinnitus journey, and the ATA is researchers at the National Center and the identity of your therapist. here to ensure that you don’t.” for Rehabilitative Auditory Research This is to ensure that your identity found in 2018. They conducted a is protected. 1 Henry, J. A., Thielman, E. J., Zaugg, T. L., Kaelin, randomized controlled clinical trial C., McMillan, G. P., Schmidt, C. J., …Carlson, K. • How are services paid for? Many F. (2018, May 29). Telephone-based Progressive with 205 participants who had insurance plans cover treatment for Tinnitus Management for persons with and without bothersome tinnitus to test the traumatic brain injury: A randomized controlled mental health in a clinical setting, trial. Ear and Hearing, 40(2), 227–242. doi:10.1097/ efficacy of telehealth therapy using AUD.0000000000000609 but do not cover online therapy. Progressive Tinnitus Management,
www.ATA.org TINNITUS TODAY SPRING 2020 7 TINNITUS RESOURCES
Making Sense of Titles and Specialties of Mental Health Professionals
By Joy Onozuka Psychiatrists are medical doctors Training: Master of Science in who can provide medical and Nursing (MSN) or Doctor of Nursing An individual with bothersome psychiatric evaluations, diagnose (DNP) degree, with additional mental tinnitus may be best served by working psychiatric conditions, manage health education. with an audiologist trained in tinnitus medical issues, and provide Psychiatric/Mental Health Nurse management while seeing a mental psychotherapy. Many primarily oversee may be able to assess mental illness, health professional for additional help psychopharmacotherapy, which refers provide psychotherapy, or prescribe to cope with the negative emotional to the use of medications to treat medication under the supervision effects of the condition. psychiatric conditions for patients. of a psychiatrist, depending on the There are tinnitus-trained Psychiatrists often collaborate with education level of the nurse and the audiologists who provide counseling other healthcare practitioners to state he/she is located. for tinnitus distress through programs provide the best medical care. Training: Associate’s degree (RN), such as tinnitus retraining therapy, Training: MD or DO (Doctor of bachelor’s degree (BSN), master’s tinnitus activities treatment, and Osteopathy) degree, with at least four degree (MSN or APRN), or doctoral Progressive Tinnitus Management. years of special training in psychiatry. degree (DNSc, PhD). However, when emotional distress is Psychologists provide Clinical Social Workers help clients interfering with the patient’s ability to psychological evaluations and understand their own inner strengths function, an audiologist should refer a diagnostic testing as well as therapy and build upon them so that individuals patient to a mental health practitioner in various settings. They provide can successfully overcome challenges. for more in-depth and targeted psychotherapy to work through mental Clinical social workers assess, treat, counseling. health issues. They cannot prescribe and evaluate individual, interpersonal, Mental health practitioners include medications. and societal problems through the psychiatrists, psychologists, nurse Training: A doctorate (PhD, PsyD, use of social work knowledge, skills, psychotherapists, social workers, and or EdD) in clinical, educational, and strategies. They typically work in therapists/counselors. Oftentimes, counseling, or research psychology. multidisciplinary teams with health and mental health practitioners work Complete postgraduate training and a education professionals. Professional together, such as when a psychiatrist nonmedical doctoral program. social workers are the largest group of prescribes medication and another Psychiatric/Mental Health Nurse mental healthcare service providers. professional provides psychotherapy. Practitioner (PMHNP) can evaluate They cannot prescribe medication. Here’s an overview of the types of and diagnose mental health disorders, Training: A master’s degree (MA, mental health professionals and what provide psychotherapy, and, in some MS, MSW) or doctoral degree types of treatment they provide: states, prescribe medication under (DSW, PhD). supervision of a psychiatrist.
8 TINNITUS TODAY SPRING 2020 www.ATA.org TINNITUS RESOURCES
Licensed Professional Typically have two years of supervised They help clients with recovery by Counselors/Therapists can assess postgraduate experience. helping them to recognize and develop mental health conditions and provide Pastoral Counselors, such as strengths and set goals. psychotherapy or counseling to ministers, priests, rabbis, or imams, Training: Certification varies by individuals and families or in group can provide individual and group state. Peer support programs often therapy in a variety of settings and counseling. require several hours of training. specialties. They come from a variety Training: Clinical pastoral education. Other Therapists, such as art of backgrounds and are licensed by Some states require clergy members therapists and music therapists, individual states. to be licensed to provide counseling. have advanced degree training in Training: A master’s degree (MA Peer Specialists are counselors specialized forms of therapy that can or MS) in psychology, counseling, who have experienced mental health be helpful for exploring and resolving or a related mental health field. issues or substance use disorders. emotional distress.
Medical Disclaimer The content in Tinnitus Today The ATA always recommends cover all possible uses, magazine is intended to provide that you consult and work with a actions, precautions, side helpful health information for the medical, health, or other competent effects, or interactions of the general public. It is made available professional, when considering the medicines mentioned. The content with the understanding that the best course of tinnitus management. of the magazine is not intended as American Tinnitus Association (ATA) This begins with a medical examination medical advice for individual problems is not engaged in rendering medical, to rule out possible underlying medical or for making an evaluation for pursuing health, psychological, or any other causes for tinnitus. If you’re interested a particular course of action. kind of personal professional services. in adopting guidance/suggestions The ATA and authors of articles in The magazine content should not be made in the magazine, you should the magazine specifically disclaim all considered complete and, therefore, discuss this first with your medical responsibility for any liability, loss, or does not cover all physical conditions provider before doing so. risk, personal or otherwise, which is or their treatment as it relates to Any information about drugs and incurred as a consequence, directly or tinnitus and tinnitus management. supplements contained in the magazine indirectly, of the use and application of are general in nature, and does not any of the content in the magazine.
www.ATA.org TINNITUS TODAY SPRING 2020 9 TINNITUS RESOURCES Apps for Calming the Mind
Few people would argue that an app can take the place of a well-trained therapist who understands a patient’s challenges and goals. However, apps are wonderful tools to augment therapy, foster habits that promote greater awareness of mood and breathing, and reduce the negative impact of tinnitus on sleep, concentration, and anxiety. The list below represents a limited selection of apps used for mental health support and tinnitus relief. Some are free, and others have fees that vary depending upon the subscription. Normally, a trial period allows you to test an app to see whether it meets your needs and expectations.
MoodKit | ThrivePort, LLC | $4.99; iOS MoodKit draws on cognitive behavioral therapy (CBT) and provides users with more than 200 mood improvement activities. Two clinical psychologists developed it to help you learn how to change how you think, develop self-awareness, and cultivate healthy attitudes. Its journal feature enables you to practice self- care by reflecting on the day, noting any troubling thoughts and how you overcame them.
Self-Help for Anxiety Management (SAM) | University of the West of England | Free; iOS and Android Self-Help for Anxiety Management (SAM) may appeal to those who are interested in self-help but don’t like meditation. Users build their own 24-hour anxiety toolkit, which enables tracking anxious thoughts and behavior over time. The app teaches 25 different self-help techniques. You can also use SAM’s Social Cloud feature to connect confidentially with other users in an online community for peer support.
CBT Thought Record Diary | Eddie Liu | Free; iOS and Android CBT Thought Record Diary is used to document negative emotions, analyze flaws in thinking, and reevaluate thoughts more neutrally, reflecting the process of using cognitive behavioral therapy to change emotions and distorted thinking patterns. It can be used for gradually changing your approach to tinnitus and anxiety and altering thinking patterns about future situations.
iMoodJournal | Inexika Inc. | $2.99; iOS and Android iMoodJournal can be used to record everything from mood and symptoms to sleep and medications, making it part personal journal and part mood tracker. By tracking various factors, users can analyze daily feelings through summary charts that indicate where stress levels rise and fall.
Breathe2Relax | National Center for Telehealth & Technology | Free; iOS and Android The National Center for Telehealth and Technology created Breathe2Relax to help users learn to breathe and remind themselves to relax. The stress management tool teaches users a skill called diaphragmatic breathing, which can help decrease the body’s fight-or-flight stress response.
Headspace | Headspace Inc. | $12.99/Month or $9.99/Year for students; iOS and Android The Headspace app aims to help users develop mindfulness and meditation skills by using the app a few minutes per day. It has hundreds of meditations on everything from stress and anxiety to sleep and concentration. It also has a daily reminder to encourage practice, which can be helpful when getting started.
Calm | Calm Radio | $12.99/Month; iOS and Android Apple named Calm the 2017 iPhone App of the Year. Calm is well regarded by tinnitus-trained audiologists and therapists for use by their patients struggling with stress, anxiety, and difficulties sleeping. It offers guided meditations, sleep stories, breathing programs, and relaxing music, making it useful for a variety of situations and concerns.
The ATA does not endorse products or treatments. The list is intended only for informational purposes. If you are seeing a therapist and/ or audiologist for tinnitus treatment, discuss which apps they recommend and why.
10 TINNITUS TODAY SPRING 2020 www.ATA.org PERSONAL STORY
Tinnitus Took Trudy From Perfect Health to Thoughts of Suicide
By Trudy Jacobson husband would not panic in case he everything, looking up ENTs, doing saw it. I found there is no surefire way, research, because I was too frozen in Let me start off with a bang: that most of the time it fails and you fear to do anything. Tinnitus made me feel suicidal.* are in a much worse place; luckily, I I finally went to my doctor and went I have always been the happiest abandoned the idea. on Effexor ®, an antidepressant used person on Earth: no health problems, The fact that at 66 I was basically for general anxiety and panic. The first great job, lovely husband, and cute “healthy as a horse” actually couple of weeks were terrible — I got dogs. As a retired medical writer from depressed me! I felt like if I had to live every side effect there was. Slowly, it the University of Arizona College of the rest of my life with this, I simply began to improve. The doctor also had Medicine, I was involved with my could not. given me Adival™ for a couple months retirees and alumni groups. Everything After about a month of extremely as a “bridge” until the meds kicked was wonderful. bothersome tinnitus, I began having in. Those were lovely, but as you may Although I have had tinnitus for 30 terrible anxiety. I would wake up from know, benzodiazepines are harder to years, it was never a big problem; it horrible nightmares, having hot and give up than anything. would come and fade. I never sought cold sweats, with my mind racing, and Once I was off the benzos, I help for it. That was until (and I’m not even thinking nonsensical thoughts developed severe insomnia. I have sure why) it spiked a few months ago with words put together that made no always had trouble sleeping, even and began to completely devastate sense. It scared the daylights out of as a child, but it would not plague my life. me. I went to the ER a few times, only me for years at a time. Some people In the course of a couple of weeks, to be given a benzo and sent home. complain they can only sleep four I became a “sick” person. The loud If you are not seriously suicidal when hours a night; try getting no sleep unrelenting screaming in my ears they ask, or you don’t tell them you for days (although, paradoxically, I made me so anxious I actually felt are, they just don’t deal with it. I even wasn’t tired at all, but hyped up). This like I was losing my mind. It was went for an evaluation at a psychiatric may have been from the Effexor ® or like walking around with two police hospital and was told: You’re not bad withdrawal from the benzos. whistles blaring all day. I would get up enough. We can’t help you. I tried sleep medication and never at six on a beautiful Tucson morning, I had new, scary symptoms every again — it was agony. I was surprised look at the clock, and wonder how day. This was very unlike me and to find out how many common I’d get through the next five minutes, horrifying. My husband tried to do much less the next hour, and much, much less the rest of my life. I began — to my own shock — to feel suicidal and did hours of research “All of a sudden, I loved crickets, as they on the easiest and most sure way of ending it all. Then every day I would matched the ringing and calmed it a bit.” delete my browser history so my
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medications cause or worsen The hearing aids, maskers, and I’m not here to say “I’m sure tinnitus! What’s a person to do? phone apps are great, but of course a cure will come, there are many I figured out how to sleep with there are still bad days when you treatments,” and so on. I am only tinnitus with the help of soothing can’t mask it at all. I am still trying to saying: “You are not alone in the way sound: a white noise machine situated habituate. you feel; millions of people feel the next to my pillow. All of a sudden, I I looked feverishly for a support same way. Never give up.” loved crickets, as they matched the group in Tucson, but sadly, there was By being honest with ourselves ringing and calmed it a bit. not one in the state of Arizona! With and each other, we can help each After further hours of research, I all the retirees and older people here, I other cope with this terrible affliction came to find out that hearing aids with couldn’t believe it. and attempt to live our lives the way tinnitus maskers are a thing now. I was Things turned around for me the day we did before the Demon T. kicked us elated. I found a wonderful audiologist, I decided to start a support group, and good and hard. and I’m sure I drove her crazy. She ATA staff were very encouraging to was very sensitive and responsive to me. The name I came up with is TATS: *If you’re thinking me. She said she could hear the panic Tucson Arizona Tinnitus Support Group. about suicide, are worried about a in my voice the first time I called. My severe and quickly appearing friend or loved When I went to get the hearing tinnitus was terrible, but, when I one, or would like aids, we discovered I did indeed have took action for myself and others, I emotional support, the National Suicide some hearing loss. Because many felt like I had transformed something Prevention Lifeline noises hurt my ears, I thought I had devastating and horrible into a positive. (NSPL) is available 24/7 at 1-800-273-8255 or superwoman hearing, but discovered That has helped me immensely. 1-800-799-4889 to access options for the deaf instead that it is called hyperacusis. or hard of hearing.
Are You or a Loved One in Crisis? If you or a loved one are in crisis, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. Additional Resources • National Suicide Prevention Lifeline (https://suicidepreventionlifeline.org/) • Veterans Crisis Line (https://www.veteranscrisisline.net/get-help/chat) • National Action Alliance for Suicide Prevention (https://theactionalliance.org/) • National Library of Medicine - Suicide (https://medlineplus.gov/suicide.html) • National Strategy for Suicide Prevention (https://www.hhs.gov/surgeongeneral/reports- and-publications/suicide-prevention/index.html) • NIMH Multimedia on Suicide Prevention (https://www.nimh.nih.gov/news/media/ index-suicide-prevention.shtml) • NIMH Suicide Prevention (https://www.nimh.nih.gov/health/topics/suicide-prevention/ index.shtml) • Take 5 To Save Lives (https://www.take5tosavelives.org/)
12 TINNITUS TODAY SPRING 2020 www.ATA.org TINNITUS RESOURCES
Depression and the Importance of Seeking Early Treatment
Depression can emerge for someone customized for each individual. While • Loss of interest or pleasure in struggling with the various stresses some trial and error in determining hobbies and activities brought on by tinnitus, which disrupts what works best may occur, • Decreased energy or fatigue sleep, concentration, and the sense typically depression is treated with • Moving or talking more slowly of well-being, and can create anxiety psychotherapy and medications. • Feeling restless or having trouble about the future. Within that context, a As outlined by the National Institute sitting still person may experience a fundamental of Mental Health, if you’re experiencing • Difficulty concentrating, shift in mood and mindset that feels some of the following signs and remembering, or making decisions overwhelmingly negative. This might symptoms most of the day, nearly • Difficulty sleeping, early-morning include feelings of sadness, shame, every day, for at least two weeks, you awakening, or oversleeping anger, anxiety, and create the inability may be suffering from depression: • Appetite and/or weight changes to find pleasure in everyday activities. • Persistent sad, anxious, or • Thoughts of death or suicide, or Getting help for depression early “empty” mood suicide attempts* is critical to recalibrate thoughts, • Feelings of hopelessness or • Aches or pains, headaches, cramps, particularly since depression can pessimism or digestive problems without a make tinnitus treatment/management • Irritability clear physical cause and/or that do more challenging. Like tinnitus, no • Feelings of guilt, worthlessness, or not ease even with treatment two people are affected the same helplessness way by depression, so treatment is
What’s Your Story? Everyone’s tinnitus is somewhat different, which is why sharing your story is important. If your tinnitus was caused by temporomandibular joint, or TMJ, issue, we’d like to hear more about what happened. We’re also seeking stories related to diet and/or exercise and how that helps you manage your tinnitus, as well as use of personal sound amplification products. Please send your story or story idea to [email protected] by May 15 for possible publication. We’re happy to work with you on developing/polishing your story, so don’t hesitate to share how tinnitus has affected you. Suggested word length is between 500 and 1000 words.
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How can there be so many unanswered questions after so many doctor’s appointments? Launching Internet-based Tinnitus Care
By Eldré Beukes, PhD, and Vinaya Manchaiah, offered to people with tinnitus.1,2 If AuD, MBA, PhD they are provided, it’s generally much farther down the road in the patient One Patient’s Journey journey, when patients are skeptical and cynical after having already tried The journey people with tinnitus many other options.3 undertake in their search for help and More effective early interventions cures is often long and by no means could be provided for patients to straightforward. A typical tinnitus reduce the negative effects of tinnitus, patient goes to various appointments, inevitably leading to more clinically including primary care visits, referrals and cost-effective tinnitus treatments. for diagnosis-focused secondary To address this need, internet-based care, and hearing evaluations. Often, CBT (iCBT) was developed and people feel their appointments adapted for the tinnitus community with healthcare providers fail to in the United States.4 What sets this provide meaningful help, even when States. We have implemented a trial intervention apart is that a trained suggestions for management are tailored to Americans to determine tinnitus management professional made. That’s partly because research- whether internet-based tinnitus care provides individuals with personal and based evidence showing efficacy could yield positive results on par with individualized support as they work for various management options is what we found in Europe. This article their way through online modules. lacking. Because tinnitus has no cure explores one U.S. patient’s journey. Patients are, therefore, guided during at this time and is seldom linked to the intervention and encouraged along Robert’s Story an underlying medical problem, the the way with regular messages about Robert woke up one morning patient’s journey often culminates in their progress. Those undertaking the hearing a deafening ringing and frustration and disillusionment: How intervention are supported and need roaring sound, which terrified him can there be so many unanswered not work through the program alone. and upended his entire life. He was questions after so many doctor’s Testing iCBT for tinnitus in Sweden, initially prescribed medication to help appointments? Germany, and the United Kingdom him sleep despite the noise. Later, The tinnitus treatments showing revealed promising results.5,6 What he was prescribed pain medication the greatest efficacy are psychological we do not know yet is whether this for the ensuing headaches that were therapies, such as cognitive behavioral iCBT model of care suits the needs of triggered by the loud tinnitus. He was therapy (CBT), and these are often not the tinnitus community in the United then referred for diagnostic testing,
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which led to an appointment with an found himself withdrawing from family with sleeping, concentrating, and audiologist who found some hearing outings, such as school concerts, in sound sensitivity. loss. Robert declined to get hearing venues where noise exposure might A range of techniques is provided, aids, because he didn’t believe make his tinnitus worse. Hence, his including progressive relaxation, that the hearing loss was causing tinnitus was negatively impacting not thought restructuring, and CBT communication difficulties. The only him, but also the quality of his strategies such as reinterpreting the audiologist suggested that he register family life. tinnitus or using positive imagery. The for an online study investigating the intervention accommodates different usefulness of iCBT for decreasing Internet-based Self-Help learning styles. Written information is tinnitus distress. Robert registered The internet-based intervention supplemented with demonstrations, for the study reluctantly. He doubted Robert took part in was videos, and diagrams that explain that he would find it helpful, because comprehensive, consisting of techniques (Figure 1). Interactive nothing he had done in more than two approximately 20 modules provided in features, such as quizzes, are included years had helped. sets of two to three each week over to promote engagement. To help His involvement with the study eight weeks. The intervention aimed monitor progress, an online journal is began with a comprehensive online to promote his understanding and provided. Robert took notes on daily assessment, which confirmed that acceptance of tinnitus and empower practices and gauged how effective he heard a complex presentation of Robert to manage his tinnitus they were in reducing the negative different sounds. His tinnitus was independently. Because tinnitus impact of tinnitus on his daily life. causing a range of problems, including affects individuals differently, the difficulty sleeping, concentrating, intervention can be tailored specifically Robert’s Thoughts hearing conversations, and tolerating to the patient’s areas of difficulty. on iCBT sound, all of which made him irritable For instance, individuals can select Robert: The modules were well and unable to participate in activities optional modules related to difficulty structured in terms of developing that he had previously enjoyed. He techniques and understanding in
Figure 1: Example of materials used in iCBT for tinnitus intervention. What images are best to use? 1. Outline • The aim is to get one or two images that will be effective for you. 2. What is a positive image? • It is good to think of places you know well. • Select images that have a calming effect, without too much activity. 3. What Images are best to use? • There needs to be enough detail to actively explore the image. 4. Exploring images • The image should not remind you of problems, stress, work or your tinnitus. • Put yourself in the picture. Don’t have an image involving too many others. 5. Expert opinion • Images may be a beautiful waterfall, garden, or sparkling lake. They can be a 6. How forest, the seaside or a town you really like.
7. Worksheet
8. Technique guide
9. Further help
10. Key messages What positive images come to mind?
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tandem and building on each other. severity of his tinnitus over time, as doing it, to be quite honest. It was I liked going back and checking if I shown in Figure 2. certainly the most useful thing I have could find something else new there done and the best option I tried. For that I didn’t see the first time around. Robert’s Thoughts on me, the change was so positive. I found the relaxation techniques so Therapeutic Support Because clinical scores do not informative. I realized that by being Robert: The personal feedback I always relate to patient perceptions, more relaxed, the tinnitus flares received, usually once or twice a we asked Robert about his up less. The positive imagery and week, was so encouraging. When I experiences. reinterpretation provided me with felt despondent, they kept me going. I Robert: I would say that now — for excellent results. Trying to look at my liked the structure and regularity of the the majority of the time — I’m not thought patterns from a different angle weekly questionnaires. They helped conscious of my tinnitus, even though has also helped tremendously in many me focus and evaluate what I still it’s still there. It’s not controlling me aspects of my life. needed to work on. like it used to. The game-changer was cultivating a different attitude and Therapeutic Support Post-treatment emotional reaction to the tinnitus. Robert found the therapeutic Outcomes Today, I have a much more positive support greatly beneficial. Initially, he Robert’s intervention outcomes attitude, and the tinnitus doesn’t stop had a 20-minute phone consultation were carefully monitored. me from doing things anymore. I can with a tinnitus management Improvements were seen in all areas, attend events and have a wonderful professional who provided information as shown in Table 1. Critically, Robert time without constantly worrying like about how to approach the program maintained these improvements I used to. I have also formed new and the goals of the intervention. one year after finishing the program, habits that will remain part of my daily Realizing that there was an actual suggesting that he was still routine. person interested in helping him successfully using the tools he had convinced Robert to do the study. The learned. Many of the tools can be Is Internet-based Care email messaging system offered him used anywhere, which was helpful an Option in the the opportunity to ask questions and for Robert, who traveled extensively. United States? receive feedback from the healthcare For instance, when he found himself Opening clinical pathways to professional assigned to him. His becoming tense, he would draw on effectively helping the estimated 26 progress was monitored weekly relaxation strategies to recalibrate million American adults with tinnitus using tinnitus questionnaires. Robert’s his outlook. is challenging. Although CBT can be results show a gradual decline in the an effective intervention, it is difficult Robert’s Thoughts on for people with tinnitus to locate a Recommending the therapist trained in CBT and familiar with tinnitus, even in urban areas. This Figure 2: Weekly Program is why internet-based tinnitus care monitoring of Robert’s Robert: I always found appointments offers real possibility. tinnitus during the stressful, because I had to take so Results from iCBT trials in Europe program. Lower scores much time off from work. Doing the indicate that tinnitus distress and indicate less severity. iCBT program at home minimized so much stress, which was something related problems, such as problems 32 with sleeping, anxiety, and depression, 24 I hadn’t considered before starting. can be improved.5,6 Most encouraging 16 16 16 I could do it when I was traveling, at 8 10 work, or basically anywhere, which is that improvements are maintained 2 was so convenient. I actually enjoyed over an extended period, suggesting that participants continue to draw on
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the techniques for different areas of awarded the Richard May Prize following her his BSc in India, his MSc from the University their lives.7 Participants who didn’t training. She received the Shapiro prize from the of Southampton, United Kingdom, and his PhD British Tinnitus Association for three consecutive from Linköping University in Sweden. He has show much progress were generally years (2017, 2018, 2019) for her research and the worked in various clinical, research, teaching, people who were unable to commit Hallpike Research Prize (2019) from the British and administrative roles, although his current time to doing the program. Association of Audiovestibular Physicians. Her academic appointment centers predominantly research focus is the development and running on research. His research focuses on improving When results from different studies of clinical trials to assess the effectiveness of the accessibility, affordability, and outcomes of are aggregated in a meta-analysis, the internet-based interventions. hearing loss and tinnitus by promoting self- evidence indicates the potential of management and use of digital technologies. He was awarded a grant from the National Institutes iCBT to reduce tinnitus distress and Vinaya Manchaiah, of Health to develop and investigate iCBT for 8 AuD, MBA, PhD, is tinnitus-associated comorbidities. tinnitus for patients living in the United States. a Jo Mayo Endowed Most importantly, internet-based care He has published more than 100 peer-reviewed Professor of Speech manuscripts and three books. He received the was valued by individuals experiencing and Hearing Sciences Bharat Samman Award from the NRI Institute tinnitus and provided opportunities to at the Department of in India in 2017 and was named a Jerger Future Speech and Hearing deliver evidence-based care to tinnitus Leader of Audiology by the American Academy of Sciences at Lamar patients in a timely manner.9 Audiology in 2016. University, Beaumont, Because of limited access to CBT Texas. He received in the United States and the large number of people with tinnitus, iCBT could be a viable option. The Table 1: Robert’s Post-intervention Outcomes and iCBT trial here is currently ongoing One-Year Follow-up Outcomes and offered free of charge. For more Pre- Post- Outcome Range of One-year Domain intervention intervention information about iCBT for tinnitus measures scores follow-up score score studies or to register for a study, see the Tackling Tinnitus website at Tinnitus 0–100, >25 = Tinnitus Functional significant 72 9 2 https://www.tacklingtinnitus.org. Index tinnitus 0–40, >10 = Funding 50% Hearing This work was funded by the Hearing probability of Handicap 14 6 6 National Institute on Deafness and disability mild-moderate Inventory Communication Disorders (NIDCD) hearing impairment of the National Institutes of Health (NIH) under the award number Generalized Anxiety 0–21, >5 = R21DC017214. Anxiety 13 5 5 Disorder mild anxiety Questionnaire Eldré Beukes, PhD, is a postdoctoral 0–28, >5 = Patient Health researcher at the Depression mild 8 1 0 Questionnaire Department of depression Speech and Hearing Sciences at Lamar University, Beaumont, 0–28, >8 = Insomnia Texas. She received Insomnia sub-threshold 18 0 0 Severity Index her BSc in South insomnia Africa, her MSc in Audiology from the 0–42, >28 University of Manchester, and her PhD from Sound Hyperacusis = strong 28 14 11 Anglia Ruskin University, Cambridge, England. sensitivity questionnaire She is a clinical scientist in audiology and was hypersensitivity
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Launching Internet-based Care for Tinnitus Management in the United States — References
1 Hesser, H., Weise, C., Westin, V. Z., & Andersson, tinnitus for use in the United States. American 7 Beukes, E. W., Allen, P. M., Baguley, D. M., G. (2011). A systematic review and meta-analysis of Journal of Audiology. https://doi.org/10.1044/2019_ Manchaiah, V., & Andersson, G. (2018c). Long- randomized controlled trials of cognitive-behavioral AJA-19-00014. Retrieved from https://pubs.asha.org/ term efficacy of audiologist-guided internet-based therapy for tinnitus distress. Clinical Psychology doi/abs/10.1044/2019_AJA-19-00014 cognitive behavior therapy for tinnitus. American Review, 31(4), 545–553. 5 Beukes, E. W., Baguley, D. M., Allen, P. M., Journal of Audiology, 27(3S), 431–447. 2 Bhatt, J. M., Lin, H. W., & Bhattacharyya, N. (2016). Manchaiah, V., & Andersson, G. (2018a). Audiologist- 8 Beukes, E. W., Manchaiah, V., Allen, P. M., Prevalence, severity, exposures, and treatment guided Internet-based cognitive behavior therapy Baguley, D. M., & Andersson, G. (2019). Internet- patterns of tinnitus in the United States. JAMA for adults with tinnitus in the United Kingdom: A based interventions for adults with hearing loss, Otolaryngology — Head & Neck Surgery, 142(10), randomized controlled trial. Ear and Hearing, 39(3), tinnitus, and vestibular disorders: A systematic 959–965. 423–433. review and meta-analysis. Trends in Hearing, 23, 3 Marks, E., Smith, P., & McKenna, L. (2019). Living 6 Beukes, E. W., Andersson, G., Allen, P. M., 2331216519851749. with tinnitus and the health care journey: An Manchaiah, V., & Baguley, D. M. (2018b). 9 Beukes, E. W., Manchaiah, V., Davies, A. S., Allen, interpretative phenomenological analysis. British Effectiveness of guided internet-based cognitive P. M., Baguley, D. M., & Andersson, G. (2018d). Journal of Health Psychology, 24(2), 250–264. behavioral therapy vs face-to-face clinical care for Participants’ experiences of an Internet-based 4 Beukes, E. W., Fagelson, M., Arnoson E. P., treatment of tinnitus: A randomized clinical trial. cognitive behavioural therapy intervention for Munoz, M. F., Andersson, G., & Manchaiah, V. JAMA Otolaryngology — Head & Neck Surgery, tinnitus. International Journal of Audiology, 57(12), (2020). Readability following cultural and linguistic 144(12), 1126–1133. 947–954. adaptations of an Internet-based intervention for
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18 TINNITUS TODAY SPRING 2020 www.ATA.org SCIENCE & RESEARCH NEWS
Using Machine Learning to Predict Outcomes for Multimodal Tinnitus Treatment
Summary by John A. Coverstone, AuD manipulation of the head, neck, and tinnitus characteristics to level of spine), and information counseling. education, physical health, stress, and The science of treating tinnitus Approximately 32 percent of patients amount of time taken to complete continues to move forward, even if reported bothersome tinnitus — questionnaires. Notably, all of the it sometimes seems that progress called decompensated tinnitus — questionnaires contributed data comes at a snail’s pace. This is prior to treatment, and about 20 to the finalized group of predictive because the scientific process is percent of patients continued to items. Of the questionnaires, the purposefully incremental and builds have decompensated tinnitus after general depression score showed on itself. However, as we discover treatment. the strongest correlation with tinnitus new treatment approaches, one part Each patient was given 10 distress before and after treatment. of the process is still missing. That questionnaires that included This correlates well with most tinnitus missing piece is the ability to connect assessments of depression, tinnitus experts’ anecdotal observation the results of diagnostic testing — or distress, tinnitus characteristics, that mental health is a key factor in perhaps even the need for new and stress, quality of life, and bothersome tinnitus. different diagnostic tests — with the sociodemographics. From those The predictive process identified most effective treatment options. As questionnaires, the team was able by the authors is narrow in scope, new and different treatment options to add an extra 205 data points for because it was intended only to become available, it will be ever more analysis from each of the 1,416 predict tinnitus distress after a specific important for clinicians to selectively patients. Data points included single multimodal treatment process. choose the best option for each patient. items on the questionnaires, subset Further, this process resulted in a A group out of Germany may be scores, total questionnaire scores, positive change for only 12 percent of offering insight that will help this and even time necessary to complete the total population, or approximately process.1 They used machine learning each questionnaire. Data was analyzed 38 percent of those who initially had to perform an analysis of patients post-treatment and refined in multiple decompensated tinnitus. However, the undergoing multimodal tinnitus sequences of analysis. Each iteration authors have shown that prediction of therapy in a Berlin clinic, and the was intended to refine the process outcomes is possible for patients with results were published in PLOS One and weed out nonpredictive items tinnitus and further such analyses may earlier this year. while targeting the smallest group of yield better decision-making tools for Their analysis included 1,416 data points that accurately predicted clinicians. patients seen for tinnitus complaints post-treatment distress. who were enrolled in a 7-day The authors ultimately identified 1 Niemann, U., Boecking, B., Brueggemann, P., Mebus, W., Mazurek, B., & Spiliopoulou, M. (2020). multimodal plan of treatment at 26 data points that most accurately Tinnitus-related distress after multimodal treatment Charité — Universitaetsmedizin predicted tinnitus distress after can be characterized using a key subset of baseline variables. PLoS ONE, 15(1), e0228037. https://doi. Berlin. Treatment consisted of treatment. These data points varied org/10.1371/journal.pone.0228037 cognitive behavioral therapy (CBT), widely in their scope, from specific physiotherapy (a discipline involving items on the depression scale and
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Does Tinnitus Bother You? It Might Be Time to Join or Form a Support Group
By Trudy Jacobson, ATA’s Newest Support were in the same boat, who could Many of the participants relayed Group Leader completely understand what they were their frustrations about the fact that experiencing, who could relate to how nobody in their lives could relate to “It’s only a sound, just ignore it.” difficult life often is with this condition, what they were feeling. One woman, “At least you don’t have cancer.” and who understood how much life who had survived Stage 4 cancer “It’s not like it’s going to kill you.” changes when tinnitus arrives. (her doctors called her a miracle For those of us living with tinnitus, People who share distressing patient), developed tinnitus after we hear these kinds of statements conditions such as tinnitus and chemotherapy (not surprisingly). often from well-meaning people who hyperacusis — conditions that are She said she beat cancer and was advise us to just ignore it. If only it generally not understood by people “rewarded with this?” Her friends were that easy! People who do not who do not experience them — can constantly asked her to go to movies experience this chronic condition bond almost immediately. I have because they thought getting out have no idea what it is like to not bonded with people I had only emailed of the house would lift her spirits. be able to escape the constant 24/7 and who I had not even met yet! When she said she could no longer noise in our heads. Feeling understood by others who also go to movie theaters because They are sympathetic — there’s are learning to deal with an unalterable of the loudness, everyone in the no doubt about that — but they condition goes a long way toward support group nodded. All of us had just can’t imagine how stressful helping us cope. Sharing information also given up going to the movies, and debilitating it can be. This is and experiences also contributes to because even with earplugs, the one reason I decided to start a the search for well-being. noise is overwhelming. She shared local support group. I desperately Although almost everyone in with me after the meeting that she needed to interact with people who the group had tried many unproven was elated to find people she could understood how difficult life is with methods that did not help, we relate to and that it was definitely tinnitus. Just ignore it? Not possible. unanimously decided that the going to help her cope. Not being able to ignore the loud two best avenues for relief were Several participants offered tips noises in their heads brought 35 distraction and masking. None of on what helped them, including people from southern Arizona to us have been able to successfully meditation, hot baths, constant the inaugural meeting of the Tucson habituate yet. We all agreed that background sound, sound machines Arizona Tinnitus Support Group (TATS) the three worst triggers of spikes, (including white-noise machines), in February 2020. Almost everyone as most of you have discovered on hearing aids with maskers, ear muffs commented on how grateful they felt your own, were loud noises, ototoxic when vacuuming and using a blender, to finally find a group of people who drugs, and stress. dramatically cutting down on salt and sugar intake, trying to stay calm and not get angry, and, unfortunately, “I desperately needed to interact with people giving up alcohol! We all moaned and said, “Oh, yes…” who understood how difficult life is with Most of us have heard the concept of not fighting the noise tinnitus. Just ignore it? Not possible.” but accepting it. The theory is that if
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you can remove the fear and anxiety might be reluctant to go places doesn’t get that can be embarrassing brought on by tinnitus and can relax where people congregate. and deflating. about it, your brain will eventually Participating in a support group If there is no support group realize that it is not a “real” danger where you can meet and interact in your area, why don’t you start and eventually tune it out as an with other people who are trying to one? The process of creating a unimportant and uninteresting noise, cope can help in many ways. The support group has helped me like a fan or refrigerator running in camaraderie and comfort you can cope immensely because of the the background. get from others who understand can distraction, my improved mood One man said, “I read that you ease anxiety and a sense of isolation. from feeling good about myself, should make the noise your friend. You can pick up tips from people and the new friends I have made Well, when I wake up in the middle who found relief from something very quickly. Staff at the American of the night with loud screaming they tried. Tinnitus Association can provide you going on in my head, that is no friend Sharing ideas that have been with helpful tips and information, of mine!” effective for you, which could including a comprehensive support Very few people in the group help and inspire other people, is group manual. You would be making a were able to not pay attention to the a good feeling and can help you difference in your life and the lives of noise and just go on with their lives. cope, because you know you are many others! Everyone admitted, though, that contributing to others’ well-being. when they got distracted or in times Sharing your struggles and To learn more about starting a support group, of deep concentration, they didn’t emotional distress with a group that email [email protected], or contact Trudy at [email protected] to discuss how she began notice the noise. Every person there understands because they live with her group. The ATA agreed that focusing on the tinnitus the same condition can be beneficial, supplies a one- always made it worse. because it’s an authentic connection. time starter kit of materials for new A number of people with tinnitus The compassion is sincere. It’s a safe groups, a manual feel isolated and alone. As with other space to open up. For some people, it on how to start and challenges, we might feel that we might be the first time they’ve talked sustain a group, and are the only ones suffering to this openly about tinnitus or hyperacusis, email and website- listing services on degree. In addition, some people because talking about the “sounds upcoming meetings. with hearing loss and hyperacusis in your head” with someone who
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Distinguishing Between Hearing Loss, Tinnitus, and Hyperacusis: A Recommended Tinnitus-Evaluation Protocol for Audiologists
By James A. Henry, PhD
What Is an Audiologist?
Audiologists are hearing healthcare specialists who hold an Audiology Doctorate (AuD) degree, which is the current requirement, or a master’s degree in audiology, which was the previous requirement. Audiologists are distinguished from hearing Are Audiologists Trained instrument specialists (dispensers), in Tinnitus Management the basic differences being education Procedures? and scope of practice. Although Clinical management of tinnitus state requirements differ, dispensers includes two basic components: generally must have completed high assessment and intervention. school, passed a licensing exam, Performing the diagnostic evaluation in tinnitus management, but that is and completed on-the-job training. is the assessment phase of not the norm. Motivated audiologists With respect to scope of practice, management. Audiologists are typically seek tinnitus training from audiologists are trained to conduct exceptionally well trained in conference presentations, online diagnostic evaluations of the entire performing diagnostic assessments of courses, and multi-day training auditory system (outer ear to brain); the auditory system. The intervention workshops. Because tinnitus dispensers are trained to conduct phase includes fitting hearing aids management is not standardized, the evaluations for the purpose of fitting and administering any therapeutic type of training varies greatly. When (dispensing) hearing aids. procedures intended to reduce the individuals request tinnitus services Because as many as 90 percent personal impact of tinnitus. from an audiologist, it is important of people who experience chronic Unfortunately for people with for them to ask what kind of tinnitus tinnitus also have hearing loss,1 a tinnitus, most audiologists do not training the audiologist acquired diagnostic hearing evaluation by an receive comprehensive training in and what services that healthcare audiologist2 is recommended. If the tinnitus management as part of their specialist offers. person chooses to purchase hearing 3 education. This lack of training seems Regardless of whether a particular aids, both audiologists and dispensers rather inexplicable, given that 10 to audiologist specializes in tinnitus are legally qualified to dispense 15 percent of all adults have tinnitus, management, all audiologists have hearing aids. 4 but it is indeed the case. It should knowledge about tinnitus and can be acknowledged that some AuD answer many patient questions. programs provide excellent training
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Audiologists also know when a patient should be referred to an “When individuals request tinnitus services otolaryngologist (ear, nose, and throat physician — ENT) for a medical from an audiologist, it is important for them evaluation. Note that the American Academy of Otolaryngology — Head to ask what kind of tinnitus training the and Neck Surgery Foundation (AAO- HNSF) recommends that any person audiologist acquired and what services that with tinnitus receive a medical evaluation by an otolaryngologist.5 This healthcare specialist offers.” is best practice, although it may not be possible in some circumstances. with tinnitus questionnaires: Many needed to be treated for hearing loss, Is the Tinnitus Problem people who have both hearing usually with hearing aids. Therefore, difficulties and tinnitus blame the they did not qualify for the study, Actually a Hearing tinnitus for the hearing difficulties.9 and we spent many hours doing Problem? When this occurs, questions such assessments that were unnecessary It is obvious that a “hearing as “How much of a problem is your to recruit participants for our trial. problem” refers to difficulty hearing, tinnitus?” can prompt a person We remedied this conundrum by but a “tinnitus problem” is not so to respond, “It’s a huge problem, developing a questionnaire called the readily defined. It can be argued that because it affects my hearing.” Tinnitus and Hearing Survey (THS), the mere presence of tinnitus is a Such a response actually indicates a which is explained in detail below.12 problem. The distinction of a “tinnitus hearing problem. The questionnaire Our continued use of the THS, problem” warranting intervention score, however, suggests a tinnitus and its use by clinicians and other 5 is that the tinnitus is bothersome. problem. This scenario illustrates researchers, has led to this instrument Tinnitus is bothersome for about 20 why a tinnitus questionnaire is not being recommended as part of the percent of people who experience it, recommended as part of the initial audiologic assessment of patients whereas 80 percent of people are not evaluation by an audiologist.10 who complain of tinnitus.10 4,5 particularly bothered by their tinnitus. My research group has conducted How can tinnitus be bothersome? more than a dozen clinical trials to Audiologic Assessment of Sleep disturbance is the most common evaluate methods of intervention Patients With Tinnitus 6,7 effect. Tinnitus can affect any task that for tinnitus. Such trials require Our recommended protocol for the requires concentration, such as reading participants who have bothersome audiologic assessment of patients and writing. Also, ample evidence tinnitus. When we conducted our with tinnitus has been published in shows that tinnitus is associated with first trial, we screened people over detail.10 The protocol is technically 8 depression and anxiety. the telephone to determine whether the Level 2 Audiologic Evaluation An audiologist’s primary concern they had bothersome tinnitus.11 If part of the stepped-care method of when conducting a tinnitus they complained that their tinnitus Progressive Tinnitus Management. evaluation is determining whether was very bothersome, we scheduled What follows is a brief description of 5 the tinnitus is indeed bothersome. them for a full assessment in our lab. that protocol. It might seem that use of a tinnitus In many cases, the full assessment As mentioned, up to 90 percent questionnaire would enable such revealed that they were very bothered of people who experience chronic a determination. After all, tinnitus by their hearing problem and that tinnitus have some degree of hearing questionnaires are designed to they were blaming their tinnitus for loss.1 Because hearing loss tends assess the impact of tinnitus on a the hearing problem. They did not only to get worse, it is critical that person’s life. Here is the problem need to be treated for tinnitus — they a person with tinnitus receive a
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hearing evaluation. For the person attributable to tinnitus and not to movies as a “moderate problem” with tinnitus, the hearing evaluation hearing problems. Each item is rated (score = 2), understanding people with is essentially the same as it is for the as “not a problem,” “small problem,” soft voices as a “very big problem” person without tinnitus. “moderate problem,” “big problem,” (score = 4), and understanding speech A typical hearing evaluation and “very big problem” — with in group conversations as a “big includes pure-tone audiometry a respective score of 0 to 4. For problem” (score = 3). The grand total (finding the softest detectable level example, the person may rate sleeping for these four scores is 13. Clearly, — the threshold — of hearing tones as a “big problem” because of the this person has a significant hearing at different frequencies), speech tinnitus (score = 3), concentration problem. audiometry (finding the threshold as a “very big problem” (score = 4), THS Section C: Sound Tolerance. levels for detecting and understanding relaxation as a “moderate problem” This section is included because speech), and immittance audiometry (score = 2), and intrusiveness as a “big so many people with tinnitus also (determining the condition of the problem” (score = 3). The four scores report a sound tolerance problem. eardrum and the middle-ear space are added and, in this case, the total The first of the two items in this behind the eardrum). Many other score is 12. It can be safely concluded section states that “sounds were diagnostic tests can be performed, but that this person has a significant too loud or uncomfortable for me pure-tone, speech, and immittance problem with tinnitus. when they seemed normal to others audiometry are the most basic tests to THS Section B: Hearing. This around me.” As in the Tinnitus and establish a person’s hearing function. section includes four items that Hearing sections, response options If the person also has tinnitus, then describe typical hearing problems are 0 to 4 (“no problem” to “very big it is recommended they complete that would not be caused by a tinnitus problem”). Only if the response is 1 or the THS in addition to the hearing problem. The four items address: more is the second item completed, evaluation.10 The 10-item THS includes hearing in a noisy background, which asks the person to “list two three sections: A. Tinnitus; B. Hearing; understanding speech on TV and in examples of sounds that are too loud and C. Sound Tolerance. (Please see movies, understanding people with or uncomfortable to you, but seem Figure 1.) soft voices, and understanding speech normal to others.” On the basis of the THS Section A: Tinnitus. This in group conversations. The items responses to these two items, along section includes four items that are worded to ensure the person is with some follow-up questioning, the describe typical tinnitus problems that referring to effects specifically due astute audiologist will have a good would not be confused with a hearing to hearing problems and not tinnitus. idea of what kind of sound tolerance problem. The four items address sleep As in the Tinnitus section, responses problem the person is experiencing disturbance, concentration difficulties, are rated from “not a problem” to and its degree of impact on the difficulty relaxing, and intrusiveness “very big problem,” with scores of 0 person’s life. (inability to ignore tinnitus). The to 4. As an example, the person may It is beyond the scope of this article items are worded in such a way as rate hearing in a noisy background to go into detail about the different to ensure the person completing the as a “very big problem” (score = 4), kinds of sound-tolerance problems, form is referring to effects specifically understanding speech on TV and in but to summarize: Hyperacusis is
“If the individual has a significant tinnitus problem, then hearing aids or combination instruments (hearing aids with a built-in sound generator) are generally the first option.”
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physical discomfort or pain when any who complain of bothersome tinnitus for this purpose. The audiologist sound reaches a certain loudness. typically have a high score for the can explain the different features of Misophonia refers to emotional Tinnitus section and a low score for hearing aids and streaming-capable reactions only to certain sounds, the Hearing section. hearing aids to enable patients to regardless of their loudness. Noise Note that the specific scores on make informed decisions about the sensitivity refers to general discomfort the THS are less important than potential use of ear-level devices for (annoyance or feeling overwhelmed) the ensuing discussion between tinnitus management. due to a perceived noisy environment. clinician and patient to develop an If the person starts wearing ear-level These definitions are not consensual, understanding of what the scores devices, then it is suggested that the and distinguishing among them is mean and to inform decisions about tinnitus problem be reassessed after nuanced and not well understood by any future services that might be one or two months of wearing the most audiologists.13 considered. Audiologists should devices. The THS can be used again for Whereas a sound tolerance ask patients whether they desire this purpose, followed by a discussion problem is reported to commonly intervention for the types of problems with the audiologist to determine occur in people who have tinnitus, in described in the Tinnitus section. If whether further therapy is needed. If so, the experience of most audiologists, so, then tinnitus-specific intervention it is strongly suggested that the patient such a problem is usually in the mild to should be made available. learn about the various interventions moderate category, whereas very few available and the evidence that exists for patients have a severe sound tolerance Options for Tinnitus each. Some sources for this information problem. A mild to moderate sound Therapy are listed in the references below.5,20–22 tolerance problem would normally With the hearing assessment and A resource for knowing what apps are be treated with sound therapy (using THS results in hand, the audiologist available for sound therapy is provided procedures that desensitize the and individual will discuss options. by the American Tinnitus Association person to sound), which can double as If the individual has a significant (https://www.ata.org/sites/default/ sound therapy for bothersome tinnitus. tinnitus problem, then hearing aids files/SoundTherapy_Apps_Page.pdf). A severe sound tolerance problem are generally the first option. Hearing Interventions for bothersome tinnitus would normally be treated separately aids have been shown in numerous include tinnitus retraining therapy, from tinnitus.14 trials to work as a form of sound cognitive behavioral therapy, and therapy to reduce the emotional and Progressive Tinnitus Management.23–25 Tinnitus Problem? Hearing functional effects of tinnitus.15–19 Sound therapy always is an option for Problem? Or Both? Although there is no research intervention, and countless free or low- Results from the THS and hearing evidence that hearing aids that cost apps can be downloaded onto a assessment can help an audiologist include a built-in sound generator are smartphone to accomplish this purpose. determine whether the patient has a more effective than hearing aids that Before a patient receives tinnitus problem, a hearing problem, only provide amplification, a built-in intervention for bothersome tinnitus, or both problems. The above examples sound generator gives the capability they should complete a questionnaire of responses to the THS Tinnitus and of delivering constant sound to the assessing tinnitus impact. The Hearing sections illustrate a person ears in a very controlled fashion. questionnaire should be validated who has significant problems with Every major hearing aid company for “responsiveness,” that is, for both tinnitus and hearing. In contrast, offers hearing aids with built-in sound assessing changes in tinnitus impact a person who blames the tinnitus for a generators. Many hearing aids also resulting from intervention. The Tinnitus hearing problem would typically have a offer the ability to “stream” sound Functional Index (TFI) is validated for low score for the Tinnitus section and from a smartphone to the aids, responsiveness and is recommended a high score for the Hearing section. enabling sound therapy using any for this purpose.26 The patient should People with essentially normal hearing number of apps that are available complete the baseline (pre-intervention)
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TFI only after any hearing needs have been met and then complete it again Figure 1: The Tinnitus and Hearing Survey (THS) following intervention. The desired The THS is recommended for use by audiologists when conducting an evaluation of a result is a reduction in the TFI score, person who complains of tinnitus. The THS is unique, because it separates items that which would reflect a reduction in pertain specifically to tinnitus from those that pertain specifically to hearing problems. Use of the THS enables an accurate assessment of whether tinnitus is bothersome apart tinnitus impact. from any hearing problems that might otherwise be ascribed to the tinnitus. Section C It was explained above why a includes two items to screen for a sound tolerance (usually hyperacusis) problem. traditional tinnitus questionnaire, such as the TFI, is not recommended as part of the initial assessment. The
a point is that hearing problems and small moderate big very big not tinnitus problems tend to be conflated, No, problem Yes, a Yes, a Yes, a Yes, a which can artificially inflate the A. Tinnitus problem problem problem problem questionnaire score—exaggerating the Over the last week, tinnitus kept me degree to which tinnitus is a problem. from sleeping. 0 1 2 3 4 Use of such a questionnaire is, Over the last week, tinnitus kept me 0 1 2 3 4 however, an option to obtain additional from concentrating on reading. information about how tinnitus Over the last week, tinnitus kept me from relaxing. 0 1 2 3 4 impacts the individual. It can be very Over the last week, I couldn’t get my useful for this purpose provided there mind off of my tinnitus. 0 1 2 3 4 Grand Total is awareness of the potential to blame the tinnitus for any hearing problems. Total of each column
Conclusion B. Hearing A protocol is recommended for Over the last week, I couldn’t understand what others were saying 0 1 2 3 4 audiologists to address the concerns in noisy or crowded places. of people who complain of tinnitus. Over the last week, I couldn’t This protocol is based on 25 years understand what people were saying 0 1 2 3 4 on TV or in movies. of continuous research, which has Over the last week, I couldn’t included numerous clinical trials. understand people with soft voices. 0 1 2 3 4 The essence of the protocol is to Over the last week, I couldn’t conduct a routine hearing evaluation, understand what was being said in 0 1 2 3 4 Grand Total administer the THS, and fit hearing group conversations. aids or combination instruments as Total of each column needed. If tinnitus is bothersome following the assessment and use C. Sound Tolerance of ear-level devices, then various Over the last week, sounds were too loud or uncomfortable for me 0 1 2 3 4 interventions are available. A tinnitus when they seemed normal to questionnaire, such as the TFI, should others around me.* be administered both before and after If you responded 1, 2, 3, or 4 to the statement above: intervention to assess for any changes Please list two examples of sounds in the emotional and functional effects that are too loud or uncomfortable for of tinnitus. you, but seem normal to others: *If sounds are too loud for you while wearing hearing aids, please tell your audiologist. For office use only (II): M H N
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Using the Tinnitus and Hearing Survey: Guide for Audiologists
By Tara Zaugg, AuD, and James Henry, PhD relative to the specific problems the After discussing the examples, patient is experiencing. The patient can if it appears the patient does have Sections A and B then decide if any of the interventions trouble tolerating sounds that most being offered are a good match for people can tolerate well, then the The four items in the A (Tinnitus) their lifestyle and for problems they clinician will form an initial impression subscale describe common problems wish to address. about whether the sound tolerance with tinnitus that are unrelated to problem appears to be hyperacusis, hearing problems. The four items in Section C misophonia, or a combination of the the B (Hearing) subscale describe Sound tolerance problems are often two. Use the definitions below to common hearing problems that would reported by patients with tinnitus. The guide your impressions as you talk not be caused by tinnitus. Step-by- two items in the C (Sound Tolerance) through the patient’s examples. step instructions for using the THS to subscale can be used to assist Hyperacusis = physical discomfort collaboratively determine if intervention the clinician in developing an initial caused by sound at levels that for tinnitus is desirable and appropriate impression regarding the existence and are comfortable for most people. are provided below. With the patient’s type of sound tolerance problem. Item With hyperacusis, all sounds are filled-out THS in view: 1 is used to screen for the existence uncomfortable once they reach 1 Explain that intervention for of a sound tolerance problem. Any a certain loudness level, which tinnitus can help with the answer other than zero indicates some varies from person to person with problems in Section A level of difficulty with tolerating sound. hyperacusis. 2 Explain that intervention for Item 2 is intended to elicit examples Misophonia = emotional tinnitus would not help with any of from the patient (that the clinician will reactions to sound. With misophonia, the problems listed in Section B discuss with the patient) to: (1) ensure it is not the loudness of a sound that 3 Describe what would be the patient really is experiencing a causes discomfort (as is the case required to engage in the tinnitus sound tolerance problem (and not with hyperacusis), but an emotional intervention that is offered something else); and (2) inform the reaction to the sound that causes it to (logistics, cost, etc.) clinician’s opinion regarding the type of be experienced as uncomfortable. It is 4 Be available to answer questions sound tolerance problem. common for a person with misophonia or concerns about the tinnitus Examples for Item 2 that would to find particular sounds to be intervention that is offered, or suggest the patient may not have an uncomfortable at a relatively low level, about tinnitus in general abnormal reaction to sound include: but to find other sounds at the same 5 Allow the patient to decide (1) sounds that would be too loud level to be acceptable. whether or not to engage in the for anyone (e.g., gunfire, nearby “For office use only (II)” refers intervention siren); (2) references to problems to Interviewer’s Impressions as to Use of cut-off scores to determine tolerating crowds or other situations whether/not the person has a sound candidacy for an intervention for for reasons other than sound tolerance tolerance problem. tinnitus is strongly discouraged as it (e.g., hypervigilance or other PTSD M would be checked if Misophonia promotes decision making that does • symptoms, trouble understanding was suspected. not take into account all of the factors what people are saying); and (3) H would be checked if Hyperacusis in a patient’s life. The most effective • complaints from hearing aid users was suspected. use of the THS is as a tool to quickly who are only having trouble tolerating Both M and H would be checked if and efficiently separate hearing • sounds that are commonly problematic both were suspected. problems from tinnitus problems, for hearing aid users (e.g., silverware If Neither condition is suspected, which then allows the clinician to • or dishes clanking, paper rustling). then N would be checked. describe the available interventions
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Distinguishing Between Hearing Loss, Tinnitus, and Hyperacusis: A Recommended Tinnitus-Evaluation Protocol for Audiologists (continued)
James A. Henry, 8 Reavis, K. M., Henry, J. A., & Carlson, K. F. combination hearing aid and tinnitus therapy PhD, is a certified (2020). Prevalence of depression and anxiety device. Ear and Hearing, 36(1), 42–52. among community-dwelling US adults reporting 18 Shekhawat, G. S., Searchfield, G. D., & Stinear, and licensed tinnitus. Manuscript submitted for publication. C. M. (2013). Role of hearing aids in tinnitus audiologist with Perspectives of the ASHA Special Interest Groups. intervention: A scoping review. Journal of the a doctorate 9 Ratnayake, S. A., Jayarajan, V., & Bartlett, J. American Academy of Audiology, 24(8), 747–762. in behavioral (2009). Could an underlying hearing loss be 19 Dos Santos, G. M., Bento, R. F., de Medeiros, neuroscience. He a significant factor in the handicap caused by I. R., Oiticcica, J., da Silva, E. C., & Penteado, tinnitus? Noise & Health, 11(44), 156–160. S. (2014). The influence of sound generator is employed as a 10 Henry, J. A., & Manning, C. (2019). Clinical associated with conventional amplification for Veterans Affairs protocol to promote standardization of basic tinnitus control: Randomized blind clinical trial. (VA) Rehabilitation, tinnitus services by audiologists. American Journal Trends in Hearing, 18. Research & of Audiology, 28(1S), 152–161. 20 Henry, J. A. (2017). Tinnitus management based 11 Zaugg, T. L., Schechter, M. A., Fausti, S.A., & on research evidence. Tinnitus Today, 5–9. Development (RR&D) Senior Research Henry, J. A. (2002). Difficulties caused by patients’ 21 Fuller, T. E., Haider, H. F., Kikidis, D., Lapira, A., Career Scientist at the VA RR&D National misconceptions that hearing problems are due Mazurek, B., Norena, A.,...Cima, R. F. F. (2017). Center for Rehabilitative Auditory Research to tinnitus. In R. Patuzzi (Ed.), Proceedings of Different teams, same conclusions? A systematic (NCRAR) located at the VA Portland Health the Seventh International Tinnitus Seminar (pp. review of existing clinical guidelines for the Care System. He is also Research Professor 226–228). Crawley, Western Australia: University assessment and treatment of tinnitus in adults. of Western Australia Press. Frontiers in Psychology, 8, 206. in the Department of Otolaryngology — 12 Henry, J. A., Griest, S., Zaugg, T. L., Thielman, 22 Henry, J. A., Zaugg, T. L., Myers, P. M., & Kendall, Head and Neck Surgery at Oregon Health & E., Kaelin, C., Galvez, G., & Carlson, K. F. (2015). C. J. (2010). How to manage your tinnitus: A step- Science University. For the past 25 years, he Tinnitus and hearing survey: A screening tool to by-step workbook. 3rd ed. San Diego, CA: Plural. has devoted his career to tinnitus research. differentiate bothersome tinnitus from hearing 23 Jastreboff, P. J., & Hazell, J. W. P. (2004). difficulties. American Journal of Audiology, 24(1), Tinnitus retraining therapy: Implementing the His overall goals are to develop and validate 66–77. neurophysiological model. New York: Cambridge clinical methodology for effectively helping 13 Theodoroff, S. M., Reavis, K. M., Griest, S. E., University Press. individuals with bothersome tinnitus and Carlson, K. F., Hammill, T. L., & Henry, J. A. (2019). 24 Aazh, H., Landgrebe, M., Danesh, A. A., & to increase accessibility to evidence-based Decreased sound tolerance associated with blast Moore, B. C. (2019). Cognitive behavioral tinnitus care. exposure. Scientific Reports, 9(1), 10204. therapy for alleviating the distress caused by 14 Henry, J. A., Zaugg, T. L., Myers, P. M., & Kendall, tinnitus, hyperacusis and misophonia: Current C. J. (2010). Progressive tinnitus management: perspectives. Psychology Research and Behavior 1 Kim, D. K., Park, S. N., Kim, H. M., Son, H. R., Clinical handbook for audiologists. San Diego, CA: Management, 12, 991–1002. Kim, N. G., Park, K. H., & Yeo, S. W. (2011). Plural. 25 Henry, J. A., Thielman, E. J., Zaugg, T. L., Kaelin, Prevalence and significance of high-frequency 15 Searchfield, G. D., Durai, M., & Linford, T. (2017). A C., Schmidt, C. J., Griest, S.,...Carlson, K. (2017). hearing loss in subjectively normal-hearing state-of-the-art review: Personalization of tinnitus Randomized controlled trial in clinical settings to patients with tinnitus. Annals of Otology, sound therapy. Frontiers in Psychology, 8, 1599. evaluate effectiveness of coping skills education Rhinology, and Laryngology, 120(8), 523–528. 16 Henry, J. A., McMillan, G., Dann, S., Bennett, K., used with progressive tinnitus management. 2 Henry, J. A., Piskosz, M., Norena, A., & Fournier, P. Griest , S., Theodoroff, S.,...Saunders, G. (2017). Journal of Speech, Language, and Hearing (2019). Audiologists and tinnitus. American Journal Tinnitus management: Randomized controlled Research, 60(5), 1378–1397. of Audiology, 28(4), 1059–1064. trial comparing extended-wear hearing aids, 26 Meikle, M. B., Henry, J. A., Griest, S. E., Stewart, 3 Husain, F. T., Gander, P. E., Jansen, J. N., & Shen, conventional hearing aids, and combination B. J., Abrams, H. B., McArdle, R.,...Vernon, J. A. S. (2018). Expectations for tinnitus treatment and instruments. Journal of the American Academy of (2012). The Tinnitus Functional Index: Development outcomes: A survey study of audiologists and Audiology, 28(6), 546–561. of a new clinical measure for chronic, intrusive patients. Journal of the American Academy of 17 Henry, J. A., Frederick, M., Sell, S., Griest, tinnitus. Ear and Hearing, 33(2), 153–176. Audiologists, 29(4), 313–336. S., & Abrams, H. (2015). Validation of a novel 4 Hoffman, H. J., & Reed, G. W. (2004). Epidemiology of tinnitus. In J. B. Snow (Ed.), Tinnitus: Theory and management (pp. 16–41). Lewiston, NY: BC Decker. 5 Tunkel, D. E., Bauer, C. A., Sun, G. H., Rosenfeld, R. M., Chandrasekhar, S. S., Cunningham, E. R., Jr.,...Whamond, E. J. (2014). Clinical practice guideline: Tinnitus. Otolaryngology — Head and Neck Surgery, 151(2 Suppl.), S1–S40. 6 Meikle, M., & Taylor-Walsh, E. (1984). Characteristics of tinnitus and related observations in over 1800 tinnitus patients. In Proceedings of the Second International Tinnitus Seminar, New York 1983. Journal of Laryngology and Otology, Suppl. 9 (pp. 17–21). Ashford, United Kingdom: Invicta Press. 7 Erlandsson, S. (2000). Psychological profiles of tinnitus patients. In R. S. Tyler (Ed.), Tinnitus © ASHA - American Speech-Langage-Hearing Association handbook (pp. 25–57). San Diego: Singular.
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Association for Research in Otolaryngology (ARO) 43rd Annual MidWinter Meeting
Gander was also CHRISTOPHER CEDERROTH RECEIVES THE ATA AND BTA BRING TOGETHER PRESTIGIOUS AWARD LEADING TINNITUS RESEARCHERS in attendance, as was Rich Tyler, who The Association for Research in The American Tinnitus Association serves on the ATA’s Otolaryngology (ARO) announced and the British Tinnitus Association Scientific Advisory Christopher Cederroth as the recipient held their first Tinnitus & Big Data Committee. Hubert Lim, PhD, tinnitus for the Geraldine Dietz Fox Young networking dinner on January 25 The evening neuromodulation Investigator Award at its 2020 ARO during the Association for Research featured a thought- researcher. Annual MidWinter Meeting. The in Otolaryngology (ARO) 43rd Annual provoking presentation called “Tinnitus, award recognizes the impact of his MidWinter Meeting from January 25 to Big Data, and Genetics” by Christopher research on the genetic influences on 29, in San Jose, California. The annual Cederroth, PhD, from Karolinska tinnitus, the scope and achievements conference showcases cutting-edge Institute in Sweden. (Cederroth of his research, and the potential for research in the field of auditory science, was awarded the ARO’s prestigious advancing progress in the field. “This attracting close to 2,000 attendees Geraldine Dietz Fox Young Investigator award confirms that my research has from around the world. The networking Award the following evening.) had a significant impact on the auditory dinner, which was underwritten Will Sedley, MD, PhD, a leading field,” said Cederroth, PhD, in a press by Neuromod, was attended by tinnitus researcher at Newcastle release. “It also indicates that I have the approximately 50 attendees, including University, in the United Kingdom, gave support from the auditory community up-and-coming a presentation called “Tinnitus, Big Data, for my current research.” early career and Objective Measures,” highlighting He emphasized that the award was researchers and the importance of how we define important for tinnitus research, because well-established tinnitus and research and report on it. tinnitus remains ones from The closing presentation was one of the more various areas delivered by Gary Curhan, MD, from difficult disorders of of tinnitus Harvard School of Public Health: the auditory system research, as ATA CEO Torryn Brazell “Tinnitus, Epidemiology, and Big Data.” with David Stockdale, chief to understand. well as industry executive of the British Curhan had been engaged in the Cederroth is an representatives. Tinnitus Association. long-term epidemiological study called associate professor The formal portion of the evening the Nurses’ Health Study, which was at the Department began with a brief introduction of the launched in the 1970s to investigate
Photo credit: Annika af Klercker af Klercker Annika credit: Photo of Physiology and activities of the ATA and BTA. Torryn women’s health issues, including Christopher Pharmacology, Cederroth, PhD, Brazell, ATA CEO, unveiled the ATA’s smoking, contraception, and cancer. He Karolinska Institute, assistant professor commitment of $252,000 to new noted that hearing Sweden, and at the Department research and student award funding health and tinnitus of Physiology and member of the Pharmacology, for 2020 through 2022. Speaking for would benefit ATA’s Scientific Karolinska Institute, the ATA board were David Hadley, who from a similar type Sweden, and ATA Advisory Scientific Advisory addressed patient concerns and the of investigation
Committee. Committee member. desire among those without bothersome that could provide Jain Paul Aparna credit: Photo
tinnitus for a solution to eliminate the valuable data for Gary Curhan, MD, sound, and Jinsheng Zhang, who tinnitus researchers from Harvard School spoke on how ATA seed-grant funding and public health of Public Health, presenting on the early in his career helped launch him officials. importance of large- in the field. ATA board member Philip scale data.
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Questions on Tinnitus Sound Management
Answered by Grant Searchfield, PhD ears also means the overall volume option and can be very helpful, but can be lower. In our clinic, we would people often find use of earbuds Question: I have tinnitus in my certainly recommend a pair of hearing annoying after a while. Hearing- right ear only, but my audiologist aids for tinnitus when a person has aid-style maskers tend to be very suggested a pair of hearing aids with a hearing loss in both ears — even if comfortable, by contrast. It is maskers. For the ear with tinnitus, the tinnitus appears in just one ear. important to note that sometimes the masker is louder. For my other, If there is a hearing loss in just a masking sound in one ear will normal ear, the masker emits faint one ear, and that ear is where the change the tinnitus so that it is sound. Since I don’t have hearing tinnitus is located, we would try one partially covered in that ear, but loss, why should I wear hearing aids hearing aid; but if that didn’t help, tinnitus is then heard in the other with masking in both ears? we would turn on “masking” sounds ear. The solution is to add sound in and then add a second aid with both ears. Dr. Grant Searchfield: I’m frequently masking sounds to the other ear. Using an ATA grant, our research asked this question. Our auditory Generally, the use of two devices is group has been trialing different system uses information from both more successful, but there are some masking sounds. One of these uses ears to perceive and analyze our reasons why only one device might three-dimensional (3D) sounds to auditory environment. Tinnitus can be chosen: try to target from where tinnitus is be heard as if it’s coming from one 1 Hearing loss and tinnitus in only perceived. Our results have been ear, both, or somewhere in and one ear — a single hearing aid around the head. Because we hear may be enough tinnitus coming from a particular 2 No usable hearing in an ear — location and process it this way, only one hearing aid/masker can “Correcting hearing it means that part of the auditory be used system that localizes where sound Correcting hearing loss, even if loss, even if mild, comes from must be involved. mild, can make a big difference in can make a big Activation of the processes in how tinnitus is heard. normal localization of sound (both When there is normal hearing, difference in how ears) is, therefore, likely to interfere tinnitus apps and earbuds also can with tinnitus better than sound from be used and tend to play sounds tinnitus is heard.” a single ear. Sounds played in both to both ears. This is a lower-cost
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promising, and we are undertaking Question: What’s your advice on Associate Professor more work to improve the method. sounds that might promote a restful Grant D. Search- field has been an We also have found that a person’s night’s sleep? audiologist since initial response to sound is a good 1994 and obtained indicator of long-term success. If GS: Natural sounds, especially water his Doctorate in Audiology in 2004. He low-level sounds are effective when sounds, are often helpful in inducing is the clinical director first used, we believe the likelihood calm and sleep. In addition to using of the University of Auckland’s Hearing and of improvement in tinnitus related to sound for masking tinnitus at night, Tinnitus Clinic, scientific director of the tinnitus quality of life is strong. sound-based attention exercises treatment website Tinnitus Tunes, and deputy director of the Eisdell Moore Centre for hearing In summary, our hearing system for relaxing prior to bedtime can be and balance research. Searchfield is a primary relies on information from both ears, helpful. For instance, visualizing a investigator in Auckland University’s Centre for so in most cases we would play relaxing holiday, a time when it was Brain Research and Brain Research New Zea- therapy sounds in both ears. There raining, or when you were at the land, a national center of research excellence. He is an associate editor for the International are exceptions to this rule, however. ocean listening to the surf can create Journal of Audiology, Scientific Reports, and It is important that an individual feel a greater sense of calm. There are Frontiers in Neuroscience and Psychology. He comfortable with the sounds used apps for attention and relaxation, is well known internationally for his research investigating the use of sound and hearing and the volume in each ear. So, if and our clinicians use brain-training aids for tinnitus management. In addition to his the different levels in each ear are exercises from our clinic website, tinnitus research, he is the lead investigator in annoying, have the audiologist adjust www.tinnitustunes.com, with tinnitus a major multisite trial of hearing aids as a po- them so that the balance between patients. Counseling strategies also tential method to slow cognitive decline, which is funded by the Health Research Council of ears is comfortable for you. can help reduce the impact of waking New Zealand. He also is a member of the ATA’s up due to tinnitus. Scientific Advisory Committee.
Support the American Tinnitus Association by Shopping at When you’re shopping for friends and family on Amazon, the American Tinnitus Association hopes you’ll link your shopping account to , the online retailing company’s generous program that enables you to shop and contribute to your favorite nonprofit organization at the same time. Amazon pays all program expenses and donates half of a percent of the cost of your eligible purchases to your favorite earmarked charity. Won’t you choose the American Tinnitus Association to help us advance tinnitus research and treatments? https://smile.amazon.com/ch/93-0749558
www.ATA.org TINNITUS TODAY SPRING 2020 31 PERSONAL STORY
How Mindfulness Helped Me Create Peace With My Tinnitus
By Lisa Caldwell, MA tinnitus was going to be a permanent My friends and family couldn’t fixture, not just something temporary understand how tinnitus could make In 2005, I lost my hearing on one to keep me entertained. me feel the way it did. It’s not that side and gained tinnitus in its place. That news changed my relationship they didn’t try, but I’m not sure anyone Initially, I was quite fascinated with tinnitus completely. Once I knew can really “get” tinnitus until they by its varied repertoire of pings, that I could potentially have these have it. So, I became increasingly squelches, whirs, and clicks. I have a noises for the rest of my life, my isolated. I sent my husband to parties very clear memory of walking home tinnitus became invasive, annoying, alone, claimed I was too busy to join from the train station in those early distracting, frustrating, and the source girlfriends for dinner in the latest days captivated by the constantly of both anxiety and depression. I restaurants, and avoided the booming changing noise in my head. That couldn’t sleep, I couldn’t concentrate cinema like the plague. was before my ENT told me that my at work, I was addicted to Google — I lived like this for nine exhausting convinced the tinnitus was a sign of years. By then, I’d also acquired a tumor or illness the doctors hadn’t slipped disks in my neck and back and “The tinnitus was picked up. I became acutely aware of was living with chronic pain. I was every change in my tinnitus pitch and desperate for anything to make my life tiring enough volume. No longer amusing, it was better. Fate stepped in. Redundancy irritating and, frankly, scary. It felt like from a job I adored coincided with a in itself, and my my tinnitus had a life of its own and space at an eight-week mindfulness was utterly beyond my control. course in the nearest city. I signed up obsessive pursuit That didn’t stop me trying to control and changed my life. it, of course! I became an expert Mindfulness is a series of practices of the all-elusive patient in tinnitus. At every whiff of that train us to pay inquiring attention a success story, I was all over social to our thoughts and sensations, cure just made me media to find out more. The tinnitus without judging what we experience was tiring enough in itself, and my as good or bad. We learn to feel worse.” obsessive pursuit of the all-elusive distinguish between what actually cure just made me feel worse. exists in the here and now and
32 TINNITUS TODAY SPRING 2020 www.ATA.org PERSONAL STORY
what is created by our thoughts or emotions. That awareness then gives us a choice in how to respond. “Mindfulness is a series of practices that After the eight-week course, and with continued practice, I found that train us to pay inquiring attention to our I was learning to manage my life with chronic pain better. The pain was still thoughts and sensations, without judging there, but I was less aware of it, less worried by it, and I spent less time what we experience as good or bad. We harking back to the good old days before it became a permanent fixture learn to distinguish between what actually in my life. I’m embarrassed by how long it took me to realize that I could exists in the here and now and what is adapt the techniques I had learned to created by our thoughts or emotions.” managing my tinnitus! But I did. And it opened the gateway to a life where I live with tinnitus, but it doesn’t control me. And there are many But not all automatic processes rid of the thoughts and feelings, the moments I forget it’s there. are helpful. Let’s imagine that our more they persist. I knew I couldn’t keep this to myself tinnitus changes sound or gets louder. So how do we start to release when so many people are suffering Whether we’ve had months or years those automatic thoughts and with tinnitus. So, I went on to qualify of tinnitus, it won’t take us long to behaviors that aren’t helpful? By as a mindfulness meditation teacher. develop automatic thoughts about paying attention. And my job — my life’s vocation — is these changes, such as the following: teaching mindfulness to fellow tinnitus “Something must be really wrong Paying Attention travelers, so they can live with tinnitus with me.” Mindfulness encourages us to pay rather than suffer with it. “Is this going to last forever?” attention to the feelings, thoughts, and “I can’t cope with this!” sensations that we’re experiencing Living on Automatic “I can’t concentrate — I’m going to right now. We become aware, for One of the key things that I have lose my job.” example, if we are worrying about our learned from mindfulness practice is And with these thoughts come the future life with tinnitus or ruminating to be aware of the automatic thoughts, clenched teeth, panicky breathing, about what we might have done to feelings, and behavior that kick in knotted stomach, hunched shoulders, have caused this challenging condition. when certain events happen. These and headache. Why? Because our This awareness allows us to can be both helpful and unhelpful. thoughts affect how we feel, and how press pause for a moment … then If you’re driving a car, automatic we feel feeds back into our thoughts. gently refocus our attention on our processes can be really useful. You Even if we notice this cycle, experience right now and whatever likely will not be aware of the process we often employ strategies like we are doing in this present moment. of shifting gears, the movement of suppression (“mustn’t grumble”) or The result is that we disrupt the your feet, and the way you hold the putting things in perspective (“it could cycle — the ping-pong between steering wheel. Can you imagine be worse — at least it’s not…”). These thoughts and emotions — and step off having to think carefully about driving not only fail to get us out of the cycle the tinnitus roller coaster. And, believe like you did when you were learning? but also actually pull us back into it. me, that is really liberating! It would be exhausting! The more we attempt to avoid or get
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Let’s take an example. Whenever time? Some mindful breathing? accept that the situation is what it is I wake up at night, the first thing I A body scan? Play some masking — a temporary increase in my tinnitus, become aware of is my tinnitus. Before sounds? Okay, let’s pop the masking thanks to my cold. And the head and learning mindfulness, my head would sounds on and start a breathing heart understanding that no matter fill with these automatic thoughts: anchor meditation.” how challenging my tinnitus may “Urgh, there it is. I bet that’s what No drama, no catastrophizing. No seem, I actually can manage it, if I take woke me up. I can’t escape it. Why tossing and turning for hours gnashing it moment by moment. did I have to get tinnitus? It’s not fair. my teeth about the unfairness of it all. I can’t live like this. I can’t go the rest Instead, I acknowledge my tinnitus and Lisa Caldwell studied of my life getting so little sleep. I can’t accept it is there. I then decide what law at Cambridge University and was function without my seven hours. mindfulness tool I am going to use to a solicitor in London I might as well get up — I’m never get back to sleep. and Manchester going to get back to sleep.” It doesn’t work all the time. As I before losing her hearing on one side As I became increasingly wound write this, I have a full-on head cold, overnight. She is a up, my heart rate would raise, my and my tinnitus is having a party. certified Mindfulness breathing would become shallow, and Last night, even mindfulness and Meditation teacher. my body would become tense. No masking weren’t enough to help me Since 2015, she has walked alongside people who have hearing loss wonder I couldn’t get back to sleep, get straight back to sleep. So, I got or tinnitus and has used her unique combina- and my husband would find me doing up and puttered for a little while, tion of expertise and personal experience to laundry at four in the morning! playing masking sounds through my help them live their best lives, regardless of I still wake up at night, but now, hearing aids. these challenges. Like everyone with tinnitus, she wishes there were a cure. But until that thanks to regular mindfulness Whereas before I’d be stressed day arrives, her mission is to change our rela- practice, my automatic thoughts run about the sleep I was missing and tionship with tinnitus so it becomes just one pretty differently: how exhausted I’d feel the next day, part of a great life, rather than the sole focus of a hard one. You can read more at www.the- “Oh, hello again, tinnitus! What now my automatic thoughts have hearingcoach.co.uk, and contact Lisa at lisa@ shall I do to get back to sleep this changed to the extent that I can thehearingcoach.co.uk
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Assessing Hyperacusis in Tinnitus Patients Funded Research Using a Less Painful Approach
By Sarah M. Theodoroff, PhD predictor of an individual’s real- world experience of loudness Background discomfort, so the usefulness of LDL test results for Hyperacusis is defined as an hyperacusis patients is unclear.6 intolerance to sounds at low-to- In the literature, LDL testing shows moderate intensity levels that also a large degree of variability and poor may result in physical discomfort.1 sensitivity to diagnose hyperacusis.7 It is an important and under- The primary reason it has been used researched type of decreased sound a finer grading scale clinically is because an alternative tolerance that commonly co-occurs by having listeners behavioral metric is lacking. Therefore, with tinnitus. In tinnitus patients, select one of 11 there is a strong need to improve prevalence of hyperacusis has been loudness categories. The categories the clinical procedure to behaviorally estimated to be from 60 percent to represent a range of individual measure loudness perception in a 79 percent.2,3 Many forms of tinnitus categorical units (CUs), from 5 to 50 manner that minimizes the risk of management take a sound-based in 5 CU steps (see Figure 1). These exacerbating hyperacusis symptoms, approach to reduce tinnitus-related categories are displayed on a touch- which was the primary goal of this distress.4 When hyperacusis and screen computer and the listener pilot study. tinnitus coexist, it is important to assigns each sound-presentation level address the hyperacusis first, because Categorical Loudness a loudness category (“can’t hear”; patients with hyperacusis often find “very soft”; “soft”; “medium”; etc.). everyday sounds to be intense and Scaling: A New In the literature, multiple scaling overwhelming and would reject any Measurement Approach procedures are referred to as “CLS.” form of sound-based tinnitus therapy. Categorical Loudness Scaling (CLS) Our research used the specific CLS One significant barrier to studying is a cutting-edge behavioral method procedure that has documented the causes and potential therapies of measuring loudness perception. reliability and an associated ISO for hyperacusis is that the standard CLS is an automated procedure used standard (from the International measurement technique, Loudness to quantify loudness judgments by Organization for Standardization).8–10 Discomfort Level (LDL) testing, presenting various sound intensities, We modified this standard CLS can expose patients to unbearably from below an individual’s audiometric procedure to present stimuli only loud sounds that can exacerbate threshold (“can’t hear”) to a maximum at low-to-moderate intensity levels, symptoms.5 The purpose of the test is level (“too loud”), to establish minimizing the risk of presenting to identify the minimum level of sound a listener’s dynamic range. One sounds that would be uncomfortable that is found to be uncomfortable by advantage of CLS over other loudness or painful. By modifying the CLS the patient. LDL results are not a good tests or scaling methods is that it uses procedure in this way, we took the first
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step in achieving one of our long-term hyperacusis and not a different type of Figure 1: CLS Categorical goals: to have an alternative metric decreased sound-tolerance condition. Units (CU) that could provide the information LDL Preliminary data are presented in CLS response categories are used to testing attempts to capture without Figure 2 and show average loudness create the loudness growth functions distressing patients or exacerbating growth for hyperacusis participants (in displayed in Figure 2. Eleven response hyperacusis symptoms. red) compared to loudness growth in options (categorical units, or CUs) are In this study, all participants controls without hyperacusis (in gray) presented to the listener on a computer touch screen. experienced chronic tinnitus and were as a function of presentation level divided into two groups: those who (decibels of sound pressure level, or Too Loud also experienced hyperacusis and those dB SPL) standardized to the dynamic Very Loud who did not. We defined hyperacusis range for each person. On average, at as any affirmation to the screening all presentation levels, participants in question from the Tinnitus and Hearing the hyperacusis group judged sounds Loud Survey: “Over the last week, sounds to be louder than control participants were too loud or uncomfortable for did, lending support to our hypothesis me when they seemed normal to that at any given presentation level Medium others around me.” Individuals who or frequency, loudness judgments responded yes to any degree (“yes — a are greater in participants with small problem”; “yes — a moderate hyperacusis. Results show that it Soft problem”; “yes — a big problem”; or was not necessary to present high- “yes — a very big problem”) were intensity levels (e.g., 100–110 dB SPL)
Very Soft then asked to provide examples of to detect differences in loudness the sounds that were too loud or perception between individuals with Can’t Hear uncomfortable to confirm whether hyperacusis and individuals without their reports were consistent with it. On average, listeners with tinnitus who did not report hyperacusis had loudness growth functions that did Figure 2: CLS Average Judgments not reach the “loud” category (i.e., 35 CUs), whereas listeners with Thick Line (average) CLS loudness growth functions at four different tinnitus and hyperacusis had loudness frequencies (0.5, 1, 2, 4 kHz); hyperacusis group Dotted Line (individual) growth functions that usually reached judgments (thick red lines) are compared to the non- hyperacusis hyperacusis control group (thick gray lines). control between “loud” and “very loud” for judgments using the same range of 0.5 kHz 1 kHz 2 kHz 4 kHz Too Loud intensities (audiometric threshold to 45 85 dB SPL). 40 35 Conclusions 30 By modifying the CLS procedure 25 and only presenting low- and 20 moderate-intensity levels, we found 15
Categorical units (CUs) 10 it was possible to characterize 5 deviations in loudness perception Can’t Hear using levels that represent the majority of sounds individuals Presentation level standardized to subject’s dynamic range encounter in everyday life —
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intensities below the levels by the ATA, were used as the basis professor in the Department of Otolaryngology that typically result in loudness for a multi-year grant application — Head and Neck Surgery at Oregon Health & Science University. Her research focuses on discomfort. The sounds listeners recently submitted to the Veterans auditory complaints presented in the clinic that encounter throughout the day, Health Administration Office of are not adequately captured by the standard including in conversations and Research and Development. test battery nor effectively treated. Her work is informed by her clinical background and aims to complex listening environments, improve patient-centered clinical protocols and typically are at intensity levels below Acknowledgments to increase awareness of the needs of patients the threshold of hearing damage This work was supported by the with tinnitus, hyperacusis, and other decreased and pain. Therefore, it would be ideal guidance and help from Drs. Gallun, sound tolerance disorders among medical professionals and the general public. for a clinical measure to be able Jesteadt, Rasetshwane, Neely, to identify deviations from normal Konrad-Martin, and McMillan and by 1 Baguley, D. M. (2003). Hyperacusis. Journal of the loudness perception and capture grants from the American Tinnitus Royal Society of Medicine, 96, 582–585. Association (PVARF #403002) and 2 Andersson, G., Vretblad, P., Larsen, H. C., & this information using presentation Lyttkens, L. (2001). Longitudinal follow-up of levels below those that may cause National Institutes of Health (NIH R01 tinnitus complaints. Archives of Otolaryngology — DC011806). This material is the result Head & Neck Surgery, 127(2), 175–179. loudness discomfort. 3 Dauman, R., & Bouscau-Faure, F. (2005). With this study, behavioral evidence of work supported with resources Assessment and amelioration of hyperacusis in tinnitus patients. Acta Oto-Laryngologica, 125(5), now exists for an alternative approach from and the use of facilities at the 503–509. to measure loudness perception in VA Rehabilitation Research and 4 Hoare, D. J., Searchfield, G. D., El Refaie, A., & Henry, J. A. (2014). Sound therapy for tinnitus a manner that minimizes the risk Development Service National Center management: Practicable options. Journal of the of exacerbating decreased sound for Rehabilitative Auditory Research American Academy of Audiology, 25, 62–75. 5 Tidball, G. A., & Fagelson, M. (2018). Audiological tolerance symptoms. This research (Center Award #C9230C) at the assessment of decreased sound tolerance. In: M. VA Portland Health Care System in Fagelson & D. M. Baguley (Eds.), Hyperacusis and has significance for many disciplines disorders of sound intolerance (pp. 15–32). San outside of auditory research. Portland, Oregon. The content does Diego, CA: Plural Publishing. not necessarily represent the views 6 Zaugg, T. L., Thielman, E. J., Griest, S., & Henry, J. Scientists and clinicians examining A. (2016). Subjective reports of trouble tolerating similar patient complaints of sound of the U.S. Department of Veterans sound in daily life versus loudness discomfort levels. American Journal of Audiology, 25(4), intolerance associated with migraines, Affairs, Department of Defense, or the 359–363. concussions, traumatic brain injury, United States government. 7 Sheldrake, J., Diehl, P. U., & Schaette, R. (2015). Audiometric characteristics of hyperacusis patients. and post-traumatic stress disorder also Frontiers in Neurology, 6, 105. would benefit from knowledge gained Sarah M. Theodoroff, 8 Al-Salim, S. C., Kopun, J. G., Neely, S. T., Jesteadt, PhD, is a research W., Stiegemann, B., & Gorga, M. P. Reliability of categorical loudness scaling and its relation to from this research. investigator at the threshold. Ear and Hearing, 31(4), 567–578. Currently, CLS exists only in U.S. Department of 9 Rasetshwane, D. M., Trevino, A. C., Gombert, J. N, research form. Important next steps Veterans Affairs, Re- Liebig-Trehearn, L., Kopun, J. G., Jesteadt, W.,… Gorga, M. P. (2015). Categorical loudness scaling are to create a clinical version of CLS habilitation Research and Development, and equal-loudness contours in listeners with and validate its use. To continue this normal hearing and hearing loss. Journal of the National Center Acoustical Society of America, 137(4), 1899–1913. avenue of investigation, pilot data for Rehabilitative 10 International Organization for Standardization. from this study, which was funded Auditory Research (NCRAR), located at the VA (2006). Acoustics — loudness scaling by means of Portland Health Care System and an assistant categories. Geneva, Switzerland: ISO.
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The Correlation Between Glaucoma and Tinnitus
Summary by John A. Coverstone, AuD There also is a primary and secondary closed-angle glaucoma).2 Primary open- glaucoma, and about hearing and ear What could eye disease and tinnitus angle glaucoma is the most common disease. The authors used data from the have to do with each other? There may be form, and patients with this condition first available 79,866 participants in the a common underlying cause, according have a higher incidence of vascular- study for their analysis. to researchers from the University of related diseases than the general They received 209 responses from Groningen in the Netherlands. A recent population. This suggests that there patients in the clinical database and study published in the journal Hearing may be an underlying cause related to 109 responses from people with no Research details an investigation into this compromised blood flow. glaucoma. Analysis of data from the potential comorbidity.1 To study the correlation between Lifelines study yielded 390 individuals While collecting data for a previous these conditions, the researchers used identified with probable glaucoma study correlating glaucoma with hearing, both a large-scale population-based and 72,319 controls. In each study, the researchers noted that many approach and a clinical study component. more people with glaucoma reported patients also complained of tinnitus. The For the latter, 371 patients from a tinnitus symptoms either “sometimes” reports were frequent enough to lead university glaucoma study database or “always” (options were “never,” the researchers to perform a literature were sent two questionnaires: one for “rarely” [clinical study participants search. They found two studies that themselves and one to give to a friend only], “sometimes,” and “always”). mentioned poor regulation of blood or partner without glaucoma. The latter During statistical analysis, the authors flow (termed “vascular dysregulation”) served as a control group for the study. controlled for age, gender, body mass as a possible underlying cause of both Chosen subjects needed to be over 50 index, hypertension, and diabetes in both glaucoma and tinnitus. They found years of age and have a diagnosis of populations. They found from the clinical another study that specifically mentioned glaucoma. The questionnaires included study data that patients with glaucoma a relationship of glaucoma to tinnitus as identification of tinnitus (“Do you ever had an 85 percent increased chance part of Flammer syndrome, a condition hear a ringing or rushing sound in your of tinnitus compared to those without involving a complex array of disorders ear?”) and questions to qualify and glaucoma. From the Lifelines data, they caused by poor regulation of blood quantify what people reported as tinnitus, found that patients with glaucoma had a supply in the brain. After finding these which included questions regarding the 19 percent increased chance of tinnitus. studies, the researchers at University of presence of pulsatile tinnitus that often is There were no significant differences Groningen decided to launch a separate due to problems with blood flow. in prevalence of pulsatile tinnitus study focusing specifically on tinnitus. The authors also accessed a population between those with and without This study looked at a type of study called Lifelines that includes a glaucoma, indicating that a specific glaucoma called primary open-angle 30-year look at health behaviors from blood flow disorder did not contribute glaucoma (You guessed it — there is a 167,729 people in the northern part of the to the correlation between glaucoma secondary form that is characterized by Netherlands. The study included questions and tinnitus. Also, because the authors increased damage to eye structures. about various eye diseases, including controlled for age, gender, and other
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demographic factors that might be cause. They specifically discussed the as you continue reading this issue of associated with higher incidence of possibility of inhibited production of nitric Tinnitus Today! hearing loss, they concluded that a higher oxide, which has been linked to tinnitus in incidence of hearing loss in one population previous studies. It also has been shown 1 Loiselle, A., Neustaeter, A., de Kleine, E., van Dijk, P., & Jansonius, N. M. (2019). Associations could be ruled out as a cause for tinnitus. in a previous study that nitrates in the between tinnitus and glaucoma suggest a common The authors were able to show an diet can reduce risk of glaucoma by 20 mechanism: A clinical and population-base study. Hearing Research, 386, 107862. increased incidence of glaucoma and to 30 percent. So, pour yourself a glass 2 Rhee, D. (2019). Primary open-angle glaucoma. In Merck Manuals (rev. October 2019). Retrieved from tinnitus occurring together and concluded of beetroot juice (high in natural nitrates) https://www.merckmanuals.com/professional/eye- that vascular dysregulation could be the disorders/glaucoma/primary-open-angle-glaucoma.
Moving for the Mind Moderate Exercise Decreases Depression, Anxiety, and Stress
Summary by Joy Onozuka of their recreational exercise, the indicate that meeting the guideline Centre of Epidemiologic Studies recommendations has a positive Exercise triggers a biological Depression Scale (CES-D), effect on reducing symptoms of cascade of events that improve and the Generalized anxiety and depression. physical and mental health, Anxiety Disorder (GAD-7). While noting that further research which can be helpful for those Key findings included: is needed, the researchers concluded with mild to moderate depression Lowest depression and that individuals should set modest, who prefer not to take medication. 1lowest anxiety scores were achievable exercise goals based Moderate exercise, in particular, is found for indoor team athletes, on what they enjoy doing to reap effective in reducing stress, anxiety, followed by outdoor individual athletes. the rewards of improved mood and depression, which is why the World Those who did not meet and outlook. If you can’t manage Health Organization recommends 150 2 the minimum 150-minute 30 minutes of exercise five times a minutes of moderate-intensity exercise recommendation of weekly exercise week, then start with five minutes of per week. reported higher depression daily exercise and gradually increase But how much, what context, what scores, whether they exercised the duration as your body adjusts. It intensity, and what types of indoors or outdoors, and whether should be noted that exercise only is exercise are really necessary they participated in individual or not effective for helping people with to reap mental health benefits? group exercise. disorders such as bipolar, schizophrenia, A group of researchers from the Higher depression scores were or severe depression, which require University of South Australia 3 found among those individuals treatment and supervision by trained (UniSA) and MSH Medical School engaged in vigorous-intensity exercise mental health professionals. Hamburg in Germany sought to answer compared to those engaged in that question because research in this moderate-intensity exercise indoors on 1 Siefken, K., Junge, A., & Laemmle, L. (2019). 1 How does sport affect mental health? An area is limited. a team and meeting the 150-minute per investigation into the relationship of leisure- The researchers recruited 682 week guideline. time physical activity with depression and anxiety. Human Movement, 20(1), 62–74. recreational athletes who completed The findings reaffirm the doi:10.5114/hm.2019.78539 a questionnaire on the characteristics WHO exercise guidelines and
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Qualifying for Disability Benefits with Hearing Loss and/or Tinnitus
By Rachel Gaffney You also will not qualify if • You have an average air you’re able to modify your job in conduction hearing threshold If your hearing loss prevents you a way that you’re still able to earn of 90 decibels or greater in from working, you might be eligible income. For example, if a marketing the better ear AND have an for financial assistance. The Social specialist experiences hearing loss average bone conduction hearing Security Administration (SSA) offers but requires only writing skills to threshold of 60 decibels or greater monthly resources for people with maintain employment, he or she will in the better ear, OR a disability that has impacted their not qualify. • You have a word recognition lives for at least 12 months. Although score of 40 percent or less in the hearing loss does not automatically Medically Qualifying better ear, determined by using a qualify someone, many people are With Hearing Loss standardized list of phonetically able to receive aid. The SSA uses its own medical balanced monosyllable words. guide, known colloquially as the Blue Cochlear implantation is considered Considerations for Book, to evaluate Social Security a disability for one full year after Hearing Loss disability applicants and potential surgery. After the year has passed, you Before applying for disability award benefits. There are a few ways still can qualify for disability benefits, if benefits for hearing loss, it’s to qualify for disability with hearing you have a word recognition score of important to note that the SSA will loss. The Blue Book has two listings, 60 percent or less using the Hearing in need evidence proving your hearing Sections 2.10 and 2.11, for hearing Noise Test (HINT). is seriously affected in your best ear. loss. Without a cochlear implant, you The complete Blue Book listing This means that people who are deaf will qualify if you can meet either of for hearing loss can be found in one ear, but can hear well in the the following criteria: online. Review the listings with your other, will not qualify. audiologist to get a better idea of whether you’ll qualify.
40 TINNITUS TODAY SPRING 2020 www.ATA.org TINNITUS RESOURCES
What About Tinnitus? your application successfully. Be sure deserve. She lives in Boston but helps those to list every hearing specialist you’ve seeking assistance nationwide. If you have Those with tinnitus also may any questions about this article or would like qualify for disability benefits. seen to ensure the SSA can gather a little more information on how to qualify for Tinnitus doesn’t have its own listing accurate and up-to-date medical disability benefits, Gaffney can be reached at [email protected]. in the Blue Book. However, you evidence on your behalf. may be able to qualify, if you are If you prefer to apply in person Disability Benefits Center. Social Security disability experiencing another condition that with the help of a Social Security benefits for hearing loss. Retrieved from https://www. representative, you can visit your disabilitybenefitscenter.org/social-security-disabling- causes tinnitus. For example, if you conditions/hearing-loss local SSA office. You also can call have Meniere’s disease, you can Disability Benefits Center. State Social Security qualify if you have frequent tinnitus the SSA at 1-800-325-0778 TTY to disability resources. Retrieved from https://www. get the process started. It should disabilitybenefitscenter.org/state-social-security- attacks, balance disturbances, and disability take between three to five months progressive hearing loss as well as Social Security Administration. Disability evaluation a disturbed function of vestibular to hear back from the SSA regarding under Social Security: Listing of impairments — adult your claim. listings (Part A). In SSA Blue Book. Retrieved from labyrinth demonstrated by caloric https://www.ssa.gov/disability/professionals/bluebook/ or other vestibular tests and if AdultListings.htm your hearing loss is established by Rachel Gaffney Social Security Administration. Listing 2.10 and is an outreach 2.11: Disability evaluation under Social Security: audiometry. specialist at Disability 2.00 special senses and speech — adult. In SSA Blue Book. Retrieved from https://www. Benefits Center, ssa.gov/disability/professionals/bluebook/2.00- Starting Your Application an independent SpecialSensesandSpeech-Adult.htm#2_10 organization dedicated The easiest way to apply is online Social Security Administration. Online application. to helping people Retrieved from https://secure.ssa.gov/iClaim/dib on the SSA’s website. There you’ll of all ages receive find a complete list of paperwork and the Social Security materials you will need to submit disability benefits they
www.ATA.org TINNITUS TODAY SPRING 2020 41 YOUR HEALTH
Limitations of Medications for Tinnitus: Things to Consider
Question: I developed tinnitus time. Hence antianxiety medications Unfortunately, many people with recently and am struggling to cope. and antidepressants should be used tinnitus have been told “you need My doctor suggested that I take cautiously, and patients should to learn to live with it” by various medication to reduce my anxiety. work closely with their prescribing medical providers, which can be What are your thoughts? physicians. This is particularly extremely frustrating for those important when discontinuing the experiencing this debilitating sound. Sara Pastoor, AuD: Currently, there medication, if tinnitus worsens. More importantly, it’s incorrect. are no FDA-approved medications The only way to know whether a Today’s tinnitus treatments can help specifically for the treatment of medication can help alleviate issues reduce awareness of it and the level tinnitus. The antianxiety medications associated with tinnitus is through trial of emotional disruption it can cause and/or antidepressants often and error, as is often done by physicians through sound therapy, counseling, prescribed for tinnitus patients are who prescribe medication to “treat” and education. If you’re struggling intended to treat only the negative tinnitus. As such, it is often better with tinnitus, seek help early on emotional effects of tinnitus. These for patients who are not bothered from qualified professionals who medications may help relieve the significantly by tinnitus to treat their can properly diagnose and develop a stress, anxiety, and depression that tinnitus through counseling and use treatment plan that suits your unique may coexist with tinnitus; however, of sound therapy. Those with a history needs. It may or may not be the case no medications have been shown to of anxiety might find it beneficial to that medication plays a role in that actually reduce the underlying neural pursue interventions that don’t rely plan, so know your options and decide hyperactivity that researchers have on medications, such as cognitive what makes the most sense for your identified as the cause of tinnitus. behavioral therapy, deep breathing specific situation. In some cases, medications exercises, meditation and mindfulness prescribed to alleviate the negative training, exercise, and progressive Sara Pastoor, AuD, effects of tinnitus actually may worsen relaxation techniques. All of these can received her Doctor of Audiology from tinnitus in some patients. Moreover, the build self-resilience and skills that can Towson University. medications often come with undesirable be drawn on for a lifetime. She has been side effects, including dizziness and Because the underlying neural employed as a clinical audiologist at Duke nausea, drowsiness and fatigue, mechanisms associated with tinnitus University Hospital headaches, problems with concentration, are unbelievably complex, clinical since 2007. Her clinical interests include adult insomnia, and undesirable interactions implementation of drug therapies aural rehabilitation and tinnitus management. with other medications. for specifically targeting tinnitus has Some evidence suggests been largely unsuccessful. This can Henry, J. A., Zaugg, T. L., Myers, P. J., & Kendall, C. J. (2010). Progressive tinnitus management clinical that antianxiety medications and be very frustrating for a patient with handbook for audiologists. San Diego: Plural Publishing. antidepressants may impact the debilitating tinnitus, and most patients Salvi, R., Lobarinas, E., & Sun, W. (2009). Pharmacological treatments for tinnitus: New and old. neural plasticity of the brain, which would prefer a drug therapy that would Drugs of the Future, 34(5), 381–400. might affect one’s ability to habituate rapidly improve their tinnitus or even to the sound of the tinnitus over eliminate it completely.
42 TINNITUS TODAY SPRING 2020 www.ATA.org SCIENCE & RESEARCH NEWS
Understanding Speech in Noisy Backgrounds With Normal Hearing
Summary by John A. Coverstone, AuD conversation but were found to have signal-to-noise ratio where the normal hearing.1 subject correctly repeated at least 70 In recent years, it has generally The authors recognized that percent of the numbers. A signal- been accepted that hearing processing of speech in background to-noise ratio is defined as the loss is more complex than was noise may involve two different loudness (intensity, in decibels [dB]) previously presumed. Many people systems acting on the auditory of the stimulus compared to the complain of difficulty understanding signal. Bottom-up processing loudness of the background noise. conversation, even though they (starting at a lower level of The thresholds of different subjects show normal hearing during an processing) involves encoding the varied significantly. audiology exam. These complaints acoustic information as it enters The researchers first looked to often are about difficulty hearing the sensory organ of the ear and existing clinical tests to see whether in noisy environments in which is passed to the auditory nerve these might correlate well with multiple people are talking. The and farther up the hearing system. the results of the speech-in-noise traditional hearing test is not targeted Top-down processing begins at a task. They measured extended high to diagnose this kind of condition. cortical level in the brain and applies frequencies (above 8 kHz) and Wave Current tools, such as speech-in-noise increased attention and effort and I of the auditory brainstem response testing, are being used more widely linguistic information to try to make (ABR), which is generated by the but are somewhat limited in what sense of a poor signal coming from auditory nerve. Both of these showed they tell us. the ear. significant variability compared to the Researchers from Massachusetts For this study, 23 subjects speech-in-noise test results. Eye and Ear noted this trend and were recruited. Each had normal They next presented subjects wanted to see whether they could hearing on traditional tests but with a low-pitch tone with frequency identify the mechanisms that cause complained of difficulties with modulation (think of a warbling tone, these kinds of problems. They also speech understanding, particularly like a siren) of various degrees. A hoped to find a clinical test that would in noisy settings. The subjects first threshold was established at the uncover the biological conditions they completed a test during which they lowest level of modulation where the found. Their initial search of more repeated sequences of four numbers subject could accurately identify the than 100,000 records found that that were presented while a male modulated tone versus a steady tone. roughly 10 percent of patients who and a female voice talked in the The authors found that thresholds in scheduled audiological appointments background (the competing digits this test correlated well with results complained of difficulty with task). The researchers established of the speech-in-noise test. a speech threshold at the poorest
www.ATA.org TINNITUS TODAY SPRING 2020 43 SCIENCE & RESEARCH NEWS
They also wanted to test a Whereas FM detection and greatest difficulty with speech in hypothesis that loss of afferent FMFR are tasks requiring bottom- noise, measured as higher speech auditory nerve fibers might reduce up processing, the authors also thresholds in the earlier task. a listener’s ability to detect subtle wanted to look at top-down The authors performed further cues in the frequency modulation processing strategies that use statistical analysis of these results (FM) stimulus and contribute to cognitive resources. To do this, they and concluded that a combination of decreased understanding of speech measured pupil dilation in subjects the speech thresholds, FMFR, and in noise. To test this, the authors who were attempting to hear and pupil measurements provided the measured an electroencephalogram understand speech in the presence best prediction of difficulty hearing (EEG) response to an FM stimulus of other speakers. Pupil diameter speech in noise for patients with and isolated the response from correlates with the amount of effort normal hearing test results. These the auditory nerve. The measured and attention being allocated to a additional measures may be able to response, called the FM following task. It can indicate how cognitively provide a basis for identifying and response (FMFR), was found to be challenging a task is. The amount treating people with auditory damage a good predictor of performance on of change in pupil size was plotted that does not show up during a more the FM detection test and correlated on a graph against the signal-to- traditional hearing test. well with the competing digits task. noise ratio (SNR) of the speech task. This was taken to mean that the The authors found that a steeper 1 Parthasarathy, A., Hancock, K. E., Bennett, K., DeGruttola, V., & Polley, D. B. (2020). Bottom-up hypothesis about afferent auditory slope (more change in pupil size for and top-down neural signatures of disordered nerve fiber loss may be correct. a given change in SNR) correlated multi-talker speech perception in adults with normal hearing. eLife, 9, e51419. with those subjects who had the
28th Annual International Conference at the University of Iowa Management of the Tinnitus & Hyperacusis Patient
The 28th Annual International are given by leading researchers, For more Conference, Management of the practitioners, and leaders in advocacy information, visit DIAMOND Tinnitus & Hyperacusis Patient is and include the latest developments the University of SPONSOR scheduled to be held June 11–12, in the areas of medical treatments, Iowa’s website: 2020*, at the University of Iowa. neuroscience, sleep therapy, noise- https://medicine. The educational event is intended induced hearing loss, and hyperacusis. uiowa.edu/oto/ for otologists, audiologists, hearing The conference is intended to education/conferences-and-events/ aid specialists, and other healthcare increase the knowledge and skills international-conference-management- professionals providing clinical of clinicians; however, it is open to tinnitus-and-hyperacusis services for tinnitus patients. Topics patients and their families, with the include an overview of current understanding that no individual *Due to the coronavirus pandemic, check evaluation practices, management diagnosis or treatment will be offered. the organizer’s website for updates on the conference status. strategies, and research. Presentations
44 TINNITUS TODAY SPRING 2020 www.ATA.org PERSONAL STORY
Hearing Aids Can Enhance Hearing, Enrich Lives and Well-Being
By Marion Patterson and Rich Patterson Whereas Jones’s hearing challenges there could be millions of Americans began in childhood, the experiences who are struggling with workplace and A social gathering sparked a life- of Mark Ogden and Bill Desmarais are social communication and a diminished changing event for Jill Jones, a retired more typical of hearing loss progression. ability to enjoy music, nature sounds, nurse who bakes the most amazing Ogden, an attorney, gradually found and other audible messages. Poor breads. One balmy evening, she sat it harder to hear and understand his hearing also strains marriages with us and several of our friends as clients. “That’s not good for a lawyer,” he and friendships and complicates we enjoyed snacks and conversation on said. Desmarais, a high school science professional communication, which can our back deck. “Before sunset I could teacher, found it increasingly difficult lead to increased isolation and mental understand everyone fairly well, but to hear his students. “I especially had health issues. once it got dark, I couldn’t understand trouble hearing girls, who speak at a anyone’s speech,” she said. Just like higher frequency than boys,” said the Prevention that, her hearing diminished to such a veteran teacher. Jones’s hearing loss may have low point that she felt compelled to do By working with an audiologist, stemmed from childhood ear infections, something about it. Jones, Ogden, and Desmarais each but for Ogden and Desmarais, steps She had endured poor hearing for discovered that hearing aids could to reduce exposure to loud noise could much of her life and had found ways enhance their hearing, which helped have made a difference in the degree to compensate, such as using closed them in every dimension of their lives of their hearing loss, which progressed captioning on her television and always where sound and communication so gradually that it wasn’t apparent sitting with a friend who could tell her matter. Unfortunately, they are in the until they realized they weren’t hearing what the speaker was saying. But the minority of the growing population of things that others could. “Noise- sudden hearing loss she experienced Americans with hearing loss. induced hearing loss is 100 percent on our deck prompted her to get fitted According to Jennifer Reekers, preventable,’’ says Bob Ghent, AuD, for hearing aids. AuD, many people who have hearing who tests hearing protection devices in “I’m guessing I’d miss at least 30 difficulty don't seek help, which means a Honeywell lab. percent of words before I got hearing aids. I learned to read lips, and in school would always sit at the front of the room so I could clearly see the “After getting hearing aids, Jones became more teacher,” she said. conversational and felt less socially isolated. After getting hearing aids, Jones became more conversational and felt She also could enjoy conversation outdoors less socially isolated. She also could enjoy conversation outdoors after dark. after dark. The hearing aids changed her life.” The hearing aids changed her life.
www.ATA.org TINNITUS TODAY WINTER 2019 45 PERSONAL STORY
Foam earplugs that cost only with such sparse savings that they to the audiologist. “In my case, cost pennies and inexpensive ear muffs, are unable to pay for an unexpected and procrastination caused my delay, when used consistently from an early car repair. Even relatively high-wage but my wife encouraged me to find a age, can help someone save thousands earners may have no financial cushion. solution,” said Ogden. of dollars on hearing aids later in life At a cost of approximately $1,500 “One of the amazing things about and also avoid all the frustrations that and up for a pair of hearing aids, getting hearing aids was my surprise result from poor hearing. Unfortunately, cost is a barrier to better hearing for at being able to hear simple sounds, too few people use them. many folks. While it’s hard to ignore like floorboards creaking under my feet Ironies abound in the area of a toothache or serious vision problem and birds singing,” Desmarais said. hearing protection. Industries and regardless of financial standing, it “I used to be able to hear them but businesses that expose employees is possible to live with diminished hadn’t for years.” to loud noise usually provide hearing hearing by unconsciously or Ogden related having better protection and expect employees to consciously developing compensating conversations and communication with use it. But some businesses don’t techniques. his law clients, and Jones found herself provide protection, mostly because “Some people balk at the relatively less socially isolated and more able the noise to which their employees high cost of audiologist-fitted hearing to participate in conversations. Often, are exposed doesn’t seem dangerous. aids,” said Ghent, “but they should conversations with someone who has Think dentist drills, tavern and kitchen know that they get much more than been successfully treated with hearing mixers, hairdryers at salons, and aids. The cost covers the services of aids encourages someone with hearing vacuum cleaners that cleaning crews a trained, certified audiologist. During problems to call an audiologist. use for hours. Over time, such noise evaluations, these professionals often Though hearing aid technology exposure can lead to problems. are able to spot hearing issues that advances rapidly, an epidemic of A factory foreman expressed another require more than amplification.” hearing loss and tinnitus looms as irony: “Most of our workers are young. I Reekers agreed, saying, “A person today’s young and middle-aged people require them to wear hearing protection with hearing challenges is really shun hearing protection and allow their on the job. Then, when their shift ends, forming a long-term relationship with ears to funnel booming noise into their they jump in their car and turn the radio an audiologist.” auditory system. on at such high volume, I can hear it Reekers cites research that reveals “I urge teachers, coaches, work across the parking lot,” she said. that in countries where hearing aids supervisors, and anyone else who can “Preventing hearing loss and are covered by insurance, a minority influence people to join audiologists tinnitus is always best,” Reekers of people with hearing difficulties in encouraging the use of muffs and shared. “But too many people suffer seek help. This seems to indicate that earplugs to suppress loud noise,” hearing loss and don’t seek the help of denial, stigma, and procrastination are Reekers said. “I also urge people an audiologist. Sometimes they simply among the key factors keeping people with hearing problems to realize don’t realize their hearing is not good, from seeking help from an audiologist. that finding solutions is a gift to but cost and procrastination also keep Because hearing loss usually is themselves, their family, their friends, people enduring poor hearing.” gradual, it is hard to notice it as it and work colleagues.” Among the weaknesses of U.S. advances. Often a spouse identifies healthcare is that most insurance the difficulty first and recognizes how Rich Patterson is a member of the Circle plans omit or limit coverage for many it stresses the marriage. Overcoming of Conservation Chiefs and a past Outdoor Writers Association of America (OWAA) board conditions. Dentistry, hearing, vision, denial and procrastination is president. He and Marion Patterson, both and sometimes mental illness are challenging until a life-changing event OWAA members, own Winding Pathways, LLC, left partially or completely uncovered. takes place, such as what happened a business devoted to encouraging people to create wondrous yards. For more information, That’s a particular problem for the with Jill Jones. Sometimes it takes a visit www.windingpathways.com. approximately 40 percent of Americans combination of triggers to initiate a call
46 TINNITUS TODAY SPRING 2020 www.ATA.org SCIENCE & RESEARCH NEWS
Better Imaging Device for Investigating Tinnitus
Summary by John A. Coverstone, AuD
One of the difficult things about working with ears is that we can’t see most of what is going on. Researchers and doctors use imaging devices when they need to see whether structural or functional abnormalities are present. One of the biggest discoveries for neuroscience in the modern era has been functional magnetic resonance imaging, or fMRI. Instead of just taking pictures resolution in key auditory structures subjects listened to the same tones of the body’s structure, fMRI and to gain insight into possible as the patient to which they were measures blood flow. Because the causes of tinnitus. matched. After presentation of the brain increases blood flow in areas Because this was a feasibility study, tones, data was acquired while that are being used, this technology the researchers recruited just six subjects were resting. can track areas of the brain that are patients with tinnitus and six control The human auditory system is activated either while resting or in subjects without tinnitus who were highly organized by frequency. From response to external stimuli. matched in age, gender, dominant the inner ear up to the structures of the Traditional fMRI is used up to 3 Tesla hand, and hearing loss (if any). The brainstem, our sensory receptors and (a measure of magnetic field strength) patients with tinnitus each had the nerve fibers are organized according to and is somewhat limited in resolution condition only on one side and any frequency, from highest frequencies of the image. Newer machines available potential physiological causes were to lowest frequencies (depending on in the last 20 years can operate at ruled out, as were psychological which way you look). For instance, in 7 Tesla, which is called ultra-high- conditions and other auditory the cochlea — the organ of hearing field fMRI. These have been used in conditions (misophonia — fear of — sensory cells that respond to the research with animals and are now specific sounds - or phonophobia — a highest frequencies are in the outer being used in humans with the promise persistent fear of sound). Subjects part of the cochlea and sensory cells of increased resolution of imaging. listened to tones at eight frequencies that respond to the lowest frequencies A group of researchers from the from 200 Hz to 10,000 Hz (most of are in the very innermost portion. Netherlands sought to use ultra-high- the range of adult hearing) as well The auditory nerve is organized so field fMRI to study tinnitus in humans.1 as tones centered at the frequency that nerves carrying high-frequency Their primary goals were to investigate of each patient’s tinnitus. Control information are on the outside and the feasibility of improving image
www.ATA.org TINNITUS TODAY SPRING 2020 47 SCIENCE & RESEARCH NEWS
nerves carrying low-frequency does not arise from additional nerve although not specifically for the information are on the inside. This is cells responding to certain frequencies frequency region of the tinnitus. called tonotopic organization. of sound. There was some indication, It should be noted that this was a The researchers created tonotopic however, that other frequency areas very small study, given the primary maps of the structures they studied, (nontested frequencies) showed a purpose of addressing feasibility. which primarily included the inferior greater response in patients with Therefore, the results described here colliculus (a central auditory center for tinnitus in the inferior colliculus and the are suggestive only and cannot be the brain), the medial geniculate body auditory cortex. considered conclusive. Further study (a gatekeeper for auditory information The researchers also noticed that will be necessary with larger groups in the brain), and the auditory cortex. the response to sound stimuli was that include people with different types There is a popular theory of tinnitus no greater in subjects with tinnitus and degrees of tinnitus. Only then will where extra nerve cells respond to than in those without tinnitus. There we be able to develop firm conclusions certain frequencies and this causes us is another common idea that tinnitus about how the auditory system changes to hear additional sound at a certain may result from hypersensitive to either create tinnitus or in response frequency or frequencies. This idea auditory neurons (nerve cells), but this to having tinnitus. The authors do believe comes from a long-held notion that, finding refutes that concept. this study successfully demonstrated when auditory nerve cells are no longer What was different between the value of increased resolution of being used because of hearing loss, subjects with tinnitus and those ultra-high-field fMRI for studying tinnitus they may begin to synchronize with without tinnitus was the connection and encouraged others to utilize this tool adjacent nerve cells and respond to between auditory structures — for further research into the causes and other frequencies of sound. In this specifically between the medial effects of tinnitus. study, there were no observed changes geniculate body and the auditory in the tonotopic maps between those cortex. Scans showed a significant 1 Berlot, E., Arts, R., Smit, J., George, E., Gulban, O. F., Moere, M.,...De Martino, F. (2020). A 7 subjects with tinnitus and those decrease in overall strength of the Tesla fMRI investigation of human tinnitus without. This suggests that tinnitus connection between these structures, percept in cortical and subcortical auditory areas. NeuroImage, 25, 102166.
Inaugural Brain Imaging and Tinnitus Conference The University of Illinois at Urbana-Champaign is scheduled to host the first-ever Brain Imaging and Tinnitus: International Interdisciplinary Conference on May 18–19, 2020*. Renowned tinnitus researcher Jos Eggermont, PhD, is the keynote speaker at the event, which brings together neuroscientists, clinicians, psychoacousticians, and other researchers in an effort to better understand how a multidisciplinary brain imaging framework might be used to advance pathways to treatments for tinnitus patients. Topics include the latest advances in understanding the neural bases of tinnitus through a variety of techniques, including magnetic resonance imaging (MRI), functional MRI (fMRI), electroencephalogram (EEG), and electrocochleography (ECOG), as well as significant contributions from psychoacoustics, animal neuroscience, and interventional studies, such as mindfulness-based cognitive therapy and neurostimulation. Registration for the conference, which is intended for researchers, clinicians, and students, is free. Seating is limited, so register early. For more details, see https://tinncon.beckman.illinois.edu/
*Due to the coronavirus pandemic, check the organizer’s website for updates on the conference status.
48 TINNITUS TODAY SPRING 2020 www.ATA.org TINNITUS RESOURCES
Journalist’s Odyssey Begins With Tinnitus
Review by David M. Sykes
Book: Volume Control: Hearing in a Deafening World, by David Owen, 260 pp., Riverhead Books, NY
For an author, writing a book is a voyage of discovery — an odyssey — with all the threats and risks involved in any adventure. For readers, it’s an armchair guided tour. That’s why many of us like well-written nonfiction books whose authors use novelists’ techniques to artfully guide us through subjects that might be daunting on their own. A case in point is New Yorker journalist and author David Owen in his latest nonfiction book, Volume Control: Hearing in a Deafening World. “If you belong to a book group or a tinnitus Owen sails into the tiny and infinitely mysterious labyrinth of the human support group whose members enjoy artful, ear, which contains the smallest and least-understood bone in the body witty nonfiction that is shaping public — at a time when hearing disorders have suddenly become mainstream opinion, read Owen’s book…” news in the United States after years of absence. Indeed, he quotes one lured him into the ear canal? He’s one technology or solution or another researcher, who notes, “There’s of us — his personal experience with will hit the market and maybe fix the never been a better time to be alive the siren call of tinnitus led him there. author’s hearing disorder. if you suffer from hearing disorders.” Like any odyssey, this book With uncanny skill at spotting That statement sets a hopeful, even unfolds as Owen’s personal journey, the most intriguing ideas — and lighthearted, tone for the book: a a wonderfully entertaining narrative the talented researchers behind meandering search for answers and for filled with fascinating first-hand stories them — Owen coasts through 13 solutions, though these always seem as he seeks answers and explores chapters that cover everything from his to be just around the next peninsula. “cures.” That cures are so elusive and grandmother’s deafness that resulted Owen is best known for his wry, changeable is what makes the book from a boyfriend’s shotgun blast to his relaxed observations so well suited to interesting. Ultimately, it is a search own youthful absurdities that caused his the pages of the New Yorker, so what for who’s doing what and when one tinnitus and hearing loss. He discusses
www.ATA.org TINNITUS TODAY SPRING 2020 49 why the world is so noisy, how the ear the Big Six manufacturers of traditional Smithsonian and Natural History and works, the history of hearing aids, the hearing aids and high-tech companies AARP’s magazine. search for earplugs that actually work, like Bose and Apple. He delves into Owen’s book has been attracting cochlear implants, the controversy over the emerging world of apps and national media attention. In his American Sign Language, the emerging personal sound amplification products interviews with national media tech revolution, and the battle between that are advertised on the pages of outlets, Owen discusses the latest research into noise and hearing and new technology that can help turn Owen’s book is the most recent in a decade-long string of popular (non- down the volume in one’s external scholarly, highly readable) books on hearing and noise-induced hearing loss environment. This type of media that demonstrate the steady awakening of interest in hearing and hearing- exposure is a wonderful outcome related disorders that pose a burgeoning, even alarming, global public for all of us who suffer from hearing health problem recognized by the U.S. Centers for Disease Control and disorders, because media attention Prevention and the World Health Organization. helps awaken legislators and If this subject interests you, here are some other books worth reading: government regulators to the fact • In Pursuit of Silence (2010), George Prochnik’s well-reviewed book that hearing disorders really matter to became a successful documentary film with the same title in 2015. many people and that there is a need • The Unwanted Sound of Everything We Want (2010), Garrett Keizer’s for public investment in research and book got excellent reviews in 2012. development. “Noise” is not “merely • Why Noise Matters (2012), John Stewart’s book contributed to the public annoyance for a few complainers” dialogue on the issue of noise-induced hearing loss and noise control. anymore. Now it’s a burgeoning public Alongside these popular books stand: health problem. • the U.S. National Academy of Engineering report Technology for a If you belong to a book group or a Quieter America (2011), tinnitus support group whose members • the World Health Organization’s two-volume Burden of Disease From enjoy artful, witty nonfiction that is Environmental Noise (2011–2012), shaping public opinion, read Owen’s book • the U.S. President’s Council of Advisors on Science and Technology — it’s a wonderful place to dive into a report on hearing loss in America (2015) https://obamawhitehouse. subject that is clearly of personal interest archives.gov/sites/default/files/microsites/ostp/PCAST/pcast_hearing_ to anyone with tinnitus, hyperacusis, or tech_letterreport_final3.pdf, and other hearing disorders. • the National Academy of Medicine report on the same subject (2016) http:// nationalacademies.org/hmd/reports/2016/Hearing-Health-Care-for-Adults.aspx. David Sykes is lead All of these add to growing momentum that has, so far, yielded three author of the book important pieces of legislation in the United States: Sound & Vibration 2.0 • The Congressional Warren-Grassley OTC Act (passed and signed into and a contributor to the National Academy law by President Trump in August 2017) of Engineering report https://www.hearingreview.com/inside-hearing/chuck-grassley-and- Technology for a elizabeth-warren-request-update-on-otc-hearing-aid-act, Quieter America, • The FAA Re-Authorization Act (passed and signed by President Trump in the General Service Administration’s Sound Matters, and other books. He is vice chair of 2018), https://www.aviationairportdevelopmentlaw.com/2019/01/articles/ The Quiet Coalition and cofounder of LARA, the federal-aviation-administration-faa/congress-provides-numerous-noise- Laboratory for Advanced Research in Acoustics, studies-2018-faa-reauthorization-act/, and at Rensselaer Polytechnic Institute. A graduate of the University of California, Berkeley, with • The Congressional Medicare Hearing Act (passed by Congress but advanced degrees from Cornell University, he currently stuck in the queue at the Senate). https://www.hearingloss. served as a member and officer of ATA’s board org/house-passes-bill-for-medicare-coverage-of-hearing-aids/ of directors from 2014 to 2017.
50 TINNITUS TODAY SPRING 2020 www.ATA.org SPECIAL FEATURE
Mental Well-Being Weighed Down by Noise
By Arline L. Bronzaft, PhD including farmers’ markets, recycling, issue.2 Many of the respondents and school gardens, as well as believed their complaints were As an environmental psychologist, through providing information on the not taken seriously, and a large I have long been interested in negative effects of noise and how to percentage were dissatisfied with how elements in our environment protect against them. New Yorkers how their complaints were handled. impact our mental and physical often call our office for assistance Unresolved noise complaints can health. I have especially focused my with their noise problems, and, for exacerbate emotions of anger and research and writings on the effects the past 30 years, I have been the anxiety. In addition, when noise of noise. I wrote this article to call one to respond to these calls. I can complaints are not taken seriously, attention to the adverse impact of most certainly attest to how unhappy individuals may develop what has noise on mental health, but I could these callers are. been called “learned helplessness,” a not have written it without first A research study examining how condition in which a person believes noting the effects of noise on overall people react to noise intrusions nothing can be done about the health. In early discussions of how found that individuals respond problem. The individual may then noise affects people, researchers emotionally to such intrusions by give up trying to ameliorate the frequently stated that noise was becoming angry or anxious.1 The noise problem, and this, in turn, may found to be annoying and disturbing. New York State Comptroller’s Office create even greater mental stress Although these words do not fully studied how noise complaints and unhappiness. represent the scope of noise effects were handled in New York City and In a review of studies on on our physical health, they do clue found that 92 percent of people environmental noise impacts on us in to the psychological effects. who reported a noise complaint mental health published between A quick survey of any city’s 311 indicated that it was a recurring 1993 and 1998, Stansfeld et al. call-center operators, who accept noise complaints, would find operators describing callers’ voices “Anti-noise groups can pressure their as distressed and upset. I am a member of the board of GrowNYC local authorities to pass bylaws that limit in New York City (www.growNYC. org), an organization whose mission noise intrusions from construction, nearby is to improve the livability of the city through environmental programs, highways, and noisy neighbors.”
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concludes that we cannot definitively especially at high levels, is related to but they suggest that follow-up data relate noise impacts to more serious mental health symptoms.”3 are needed to definitively address mental health problems. But the Another team of researchers the causal relationship.4 Ma et al. researchers also state: “Current found noise annoyance to be examined perceived noise pollution evidence does seem to suggest associated with depression and and mental health impacts in Beijing that environmental noise exposure, anxiety in the general population, and conclude: “Higher noise-pollution
Tools and Suggestions to Advocate for a Quiet Environment You may not live in New York City, but you can learn about advocacy tools and noise standards from the city’s online resources to advocate for a quieter environment in your hometown. Here are a few suggestions: At www.growNYC.org/noise, visit both the Noise Awareness and Publications sections to learn about the 1hazards of noise to health and well-being. The Solving Noise Problems section assists people seeking solutions to noise problems in their communities. You will find information about the New York City Noise Code and suggestions on how to ask public officials about noise bylaws in your town or city. If you live somewhere that 2 has noise bylaws, familiarize yourself with them. If not, ask local public officials why such bylaws don’t exist. Ask local public officials 3 whether a community group exists that is involved in reducing noise in the environment. If a group exists, consider joining it or supporting its efforts. If no local group addresses 4 noise issues, ask people living in your neighborhood whether they, too, are bothered by noise. With a like-minded group of people, you can work to bring about change, drawing on the resources you garnered about how other communities do it and what standards/issues exist in your community. Remember, there is strength in numbers. Be prepared to work hard. Be patient and be persistent. You can reasonably expect initiatives to be introduced, if you work with officials on defining the noise problem and ways to combat it.
52 TINNITUS TODAY SPRING 2020 www.ATA.org SPECIAL FEATURE
exposures are significantly associated introduced to lower noise levels in seriously. Of course, the greatest with worse mental health of urban our environment.8 In that paper, I comfort will come when their noise residents in general.”5 criticized the EPA for abandoning its problems are truly remedied. As reported in the Winter efforts to lessen noise as directed by 2019 issue of Tinnitus Today, the Noise Control Act of 1972. Noise Arline L. Bronzaft, Rick Neitzel, PhD, conducted a reduction, for the most part, has been PhD, is a professor emerita of the City systematic review on behalf of the left to cities and states. University of New U.S. Centers for Disease Control Anti-noise groups can pressure York, member of the and Prevention (CDC) National their local authorities to pass bylaws board of GrowNYC (appointed by five Center for Environmental Health to that limit noise intrusions from mayors, nonpaid measure the adverse effects of noise construction, nearby highways, and position), and exposure on 11 categories of health. noisy neighbors. For example, the worldwide consultant on the deleterious His study found moderate evidence New York City Noise Code, updated impact of noise on health. Her groundbreaking research on the impact of transit noise on of a negative impact on mental in 2007, attempts to reduce noise classroom learning is frequently cited by health and psychological effects from in a city that has been traditionally the media and academia. As a researcher noise exposure.6 perceived as a “noisy” urban and writer on the negative impact of noise, Although the recent research environment. Agents in the city’s Bronzaft has published extensively, including chapters in books and encyclopedias, articles cited above does indicate the impact Department of Environmental in academic journals and the popular press, of noise on mental well-being, let Protection respond to many of the the children’s book Listen to the Raindrops, me add that the U.S. Environmental noise complaints in the city, and and the book Why Noise Matters (Earthscan, 2011) as co-author. Protection Agency (EPA) in its 1978 more agents were hired to deal brochure Noise: A Health Problem with city noise in response to the 1 Bronzaft, A. L., & Van Ryzin, G. (2007). stated: “When noise becomes Comptroller’s report discussed above. Neighborhood noise and its consequences. sufficiently loud or unpredictable… Is this enough to protect people’s Retrieved from http://www.noiseoff.org/document/ cenyc.noise.report.14.pdf our initial annoyance can become mental and physical well-being? 2 DiNapoli, T. P. (2018, January 29). Silencing excessive NYC noise a major challenge [press transformed into more extreme With respect to mental well- release]. Office of the New York State Comptroller emotional responses and behavior” being, I must call attention to Thomas P. DiNapoli. Retrieved from https://www. 7 osc.state.ny.us/press/releases/jan18/012918.htm (p. 18). More than 40 years ago, the how disillusioned people become 3 Stansfeld, S. A., Haines, M. M., Burr, M., Berry, United States federal government when their calls for help with noise B., & Lercher, P. (2000). A review of environmental noise and health. Noise & Health, 2(8), 1–8. http:// noted the adverse effects of noise problems are dismissed and how this www.noiseandhealth.org/article.asp?issn=1463- on mental well-being, and today increases their stress. Although public 1741;year=2000 4 Beutel, M. E., Jünger, C., Klein, E. M., Wild, P., we have even more support for this officials may not yet be able to limit Lackner, K., Blettner, M.,...Münzel, T. (2016). Noise conclusion. Yet, have we responded the effects of overhead aircraft noise annoyance is associated with depression and anxiety in the general population—the contribution adequately to these findings with on people’s well-being, they can work of aircraft noise. PLoS One, 11(5), e0155357. https:// www.ncbi.nlm.nih.gov/pubmed/27195894 actions to reduce noise? Have we on legislation to curb aircraft noise 5 Ma, J., Li, C., Kwan, M.-P., & Chai, Y. (2018). A acted sufficiently to lessen the effects and other neighborhood-level noise multilevel analysis of perceived noise pollution, geographic contexts and mental health in Beijing. of noise on hearing health and overall disturbances. International Journal of Environmental Research physical health, considering the Public officials must take noise and Public Health, 15(7), 1479. https://doi. org/10.3390/ijerph15071479 many studies linking noise to hearing complaints seriously and assist 6 Neitzel, R. (2019). Noise affects more than your deficits and poorer physical health? people who call for help. Additionally, tinnitus. Tinnitus Today, 44(3), 42–46. 7 U.S. Environmental Protection Agency. (1978). In an earlier paper, I argued that local noise bylaws should be Noise: A Health Problem. Washington, D.C.: Office there is a gap between the research reviewed and strengthened. I believe of Noise Abatement and Control. 8 Bronzaft, A. L. (2017). Impact of noise on health: on the deleterious effects of noise citizens’ mental health would be less The divide between policy and science. Open Journal of Social Sciences, 5, 108–120. https:// on mental and physical health and stressed if people knew their public www.scirp.org/journal/PaperInformation. the policies governments have officials were taking noise problems aspx?PaperID=76120
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Support Group Locations
People with tinnitus at every stage in their journey, from the first few days to many years later, can benefit from membership in a support group. Each tinnitus support group operates differently, but they all share a passion for providing meaningful discussion and a caring environment where one can be understood through shared experience. Below is a list of groups and meeting dates, current at time of print. To reconfirm dates and times, please email/call the point-of-contact person listed.
San Francisco Tinnitus Support/ Mesa County Tinnitus Support Group Arizona Education Group Community Hospital, Legacy Room 1 Tucson Tinnitus Support Group Hearing and Speech Center of Northern CA 2351 G Road ALOHA (Adult Loss of Hearing Association) Second Floor Conference Room Grand Junction, CO 81505 4001 E. Fortt. Lowell Rd. 1234 Divisadero St. Contact: Elaine Conlon Contact: Trudy Jacobson San Francisco, CA 94115 T: 970-589-0305 T: (520) 982-7813 Contact: Tracy Peck Holcomb E: [email protected] E: [email protected] T: 415.921.7658 Third Wednesday of the month from 6:00 pm. Fourth Saturday of the month from E: [email protected] 10:00–noon. Meeting dates and times TBD. Florida Limited seating so please RSVP. The Palo Alto Tinnitus Support Group Clermont Tinnitus Support Group California at Avenidas Citrus Hearing Clinic Avendias Center 835 7th St., Suite 2 Los Angeles/Orange County Tinnitus 450 Bryant Clermont, FL 34711 Support Group Palo Alto, CA 94301 Contact: Laura Pratesi, AuD La Purisma Catholic Church Contact: Ken Adler, Amy Nelson, AuD, T: 352-989-5123 11712 N. Hewes St. Brandon Cyrus, AuD E: [email protected] Orange, CA 92869 E: [email protected] Contact: Barry Goldberg Second Monday of the month from E: [email protected] E: [email protected] 1:00–2:00 pm. E: [email protected] Visit the ATA website/contact Goldberg Sarasota Tinnitus Support Group Third Thursday of the month from for times. Silverstein Institute 6:30–8:30 pm. 1901 Floyd St. San Diego Tinnitus and Hyperacusis Sarasota, FL 34239 Support Group Colorado San Diego City Library Contact: Carmen Trotta, Tom Terrenzi Denver Tinnitus Support Group North University City Branch T: 941-993-7616, 941-462-1311 Lutheran Medical Center 8820 Judicial Dr. E: [email protected] 2nd Floor Learning Center, Classroom #1 San Diego, CA 92122 Third Friday of the month from 2:00–4:00 pm. 8300 West 38th Contact: Michael J. Fischer, Loretta Marsh, Arvada, CO 80033 Dave Phaneuf, Tom Sutton Georgia Contact: Rich Marr E: [email protected] T: 303-875-5762 Atlanta Tinnitus Support Group E: [email protected], E: [email protected] Dekalb County Public Library P: 858-484-9267 Dunwoody Branch, Meeting Room Meeting dates and times TBD. E: [email protected] 5339 Chamblee Dunwoody Rd. E: [email protected] Dunwoody, GA 30338 First Wednesday of the month from Contact: Erica Caplan 6:00–7:30 pm. E: [email protected] Meeting dates and times TBD.
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Illinois Michigan The Long Island Tinnitus Group Long Island Jewish Hospital Chicago Suburban Tinnitus Holland Tinnitus Support Group 900 Franklin Ave. (Meet in the lobby before Support Group 399 E 32nd St. going down to conference room.) Contact: Margie B. Holland, MI 49423 (or TBD) Valley Stream, NY 11580 E: [email protected] T: 616-392-2222 Contact: Anthony Mennella Meeting dates and times TBD. E: [email protected] T: 516-379-2534 RSVP requested E: [email protected] Maryland Meeting dates and times TBD. Meeting dates and times TBD. DC & MD Tinnitus Support Group Potomac Audiology Missouri North Carolina 11300 Rockville Pike, Ste 105 St. Louis Tinnitus Support Group Raleigh Tinnitus Support Group Rockville, MD 20852 Grand Glaize Branch Raleigh Hearing and Tinnitus Center Contact: David Treworgy, Gerry Baill, Ann 1010 Meramec Station Rd. 10320 Durant Road, Suite 107 Ramsey Manchester, MO 63021-6943 Raleigh, NC 27614 E: [email protected] Contact: Tim Busche Contact: Saranne Barker, AuD, E: [email protected], T: 636-734-4936 Sheri Mello, AuD [email protected] E: [email protected] T: 919-790-8889 Meeting dates and times TBD. Meeting dates and times TBD. E: [email protected] University of Maryland Tinnitus and Meet the 4th Thursday of every month. Hyperacusis Support Group New Jersey Meeting times TBD. University of Maryland College Park campus Tinnitus Self-Help Group, Ewing College Park, MD First Presbyterian Church Oregon Contact: Christina Shields, AuD 100 Scotch Road VA Portland Health Care System E: [email protected] Ewing, NJ 08628 Tinnitus Education Group T: 301-405-5562 Contact: Dhyan Cassie, AuD National Center for Rehabilitative FB: https://www.facebook.com/ T: 215-984-8380 Auditory Research UMDHearingSpeechClinic E: [email protected] 3710 SW US Veterans Hosp. Rd. Meetings held quarterly. Visit the ATA website for dates and times. Portland, OR 97239 South Jersey Tinnitus Support Group Contact: Bryan Shaw Massachusetts Advanced ENT/HearMD E: [email protected] Boston Tinnitus Support Group 1020 North Kings Highway, Ste. 201 Meeting dates and times TBD. Athan’s Bakery Cherry Hill NJ 08034 407 Washington St. Contact: Beth Savitch, Erin Lustik Pennsylvania Brighton, MA 02135 E: [email protected] Lehigh Valley Tinnitus Support Group Contact: Kevin Plovanich Location of Meetings: To Be Determined E: [email protected] New York Contact: Ed Kozelnicky Meeting dates and times TBD. Bronx Tinnitus Support Group T: 610-797-7251 (H), 610-739-6675 (C) Mediator Church Meeting dates and times TBD. Conference Room If you’re interested in forming a group, 260 W. 231st St. Texas Bronx, NY 10463 please contact Kevin Willman at Dallas/Ft. Worth Tinnitus Support Group Contact: Dr. S. Karie Nabinet [email protected]. Texas Health Presbyterian Hospital Plano T: 917-797-9065 or 718-410-2301 If there isn’t a group in your area, 6200 W Parker Rd. E: [email protected] the ATA has an extensive network Plano, TX 75093 of volunteers who provide email and First Thursday of the month from 6:00 pm. Contact: John Ogrizovich telephone support and educational E: [email protected] information. To connect with a volunteer, visit https://www.ata. Meeting dates and times TBD. org/managing-your-tinnitus/support- network/telephoneemail-support-listing.
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Houston Tinnitus Support Group Washington Tinnitus Association (ATA) does not sponsor or Business Center, Village at West endorse these activities and expressly disclaims Seattle Tinnitus Support Group University Apartments any responsibility for the conduct of any Broadview Public Library 5151 Edloe St. independent support group or the information 12755 Greenwood Ave N. they may provide. The ATA is not a healthcare Houston, TX 77005 Seattle, WA 98133 provider so you should consult with your Contact: Vinaya Manchaiah Library Font Desk: 206-684-7519 primary care physician or hearing healthcare T: 409-466-0427 Contact: Keith Field professional for qualified medical advice on E: [email protected] T: 206-783-7105 tinnitus and related disorders. Meeting dates and times TBD. E: [email protected] *Some groups do not or cannot schedule San Antonio Tinnitus & Hyperacusis Meeting dates and times TBD. meetings far in advance to allow for flexibility Support Group in planning. We post support group information Contact: Matthew Randal Wisconsin on our online events calendar at www.ATA. E: [email protected]. org when we receive notifications from the Madison Tinnitus Support Group organizers. The information above was provided Meeting location, dates and times TBD. Madison Masonic Center to the ATA staff at the time the magazine went 85 S Stoughton Rd. to print; therefore, please confirm meeting Virginia Madison, WI 53714 details with the contact person prior to a Northern Virginia Tinnitus Contact: Deb Holmen meeting or visit our website at https://www.ata. Support Group T: 608-219-0277 org/news/events. Northern Virginia Resource Center for Deaf E: [email protected] This is a partial listing of support groups and & Hard of Hearing Persons (NVRC) Fourth Wednesday of the month from scheduled meetings. A complete list can be 3951 Pender Drive, Ste. 130 6:30–7:30 pm. found at https://www.ata.org/managing-your- Fairfax, VA 22030 tinnitus/support-network/support-group-listing. Contact: Elaine Wolfson, Marian Patey New groups form throughout the year so please Each support group referenced here is E: [email protected] check the website for updates periodically. independently operated and led by volunteers E: [email protected] who wish to provide education and support Meeting dates and times TBD. to the tinnitus community. The American
Spotlight on Patient Providers
Professional Members Arizona Arkansas Listing current as March 15, 2020 Lynn Callaway, BC-HIS Kelley Linton, AuD When making an appointment, please mention Affordable Hearing Solutions Center for Hearing, Ltd that you learned of the provider from the ATA, Green Valley, AZ Fort Smith, AR thereby ensuring that providers understand the Judy Huch, AuD importance of being a part of the ATA’s tinnitus Oro Valley Audiology Inc. California patient-provider network. Oro Valley, AZ Kasra Abolhosseini, AuD UNITED STATES Jonathan Ramirez-Lira, AuD Tustin Hearing Center Sound Relief Hearing Center Tustin, CA Scottsdale, AZ Melissa Alexander, AuD Alabama Neal Sorenson, BS Alexander Audiology Susan Sheehy, AuD Moore Audiology Santa Monica, CA Alabama Hearing Associates Sun City, AZ Randall Bartlett, MA Madison, AL Thea Wickey, AuD Tinnitus & Audiology Center of Southern California, Inc. Valencia, CA Alaska Sound Relief Hearing Center Scottsdale, AZ Troy Cascia, AuD Emily McMahan, AuD UCSF Health Alaska Hearing & Tinnitus Center San Francisco, CA Anchorage, AK
56 TINNITUS TODAY SPRING 2020 www.ATA.org HEALTHCARE PROVIDERS
Shahrzad Cohen, AuD Diane Markva, AuD Susan E Terry, AuD Hearing Loss Solutions Animas Valley Audiology Broadwater Hearing Care Sherman Oaks, CA Durango, CO St. Petersburg, FL Arthur Corpus, PA Abigail McMahon, AuD Liz White, AuD Sharp Rees-Stealy Medical Group Inc. Sound Relief Hearing Center Harbor City Hearing Solutions Chula Vista, CA Fort Collins, CO Melbourne, FL Jean M. Deiss, AuD Natalie Phillips, AuD Kayla Wilkins, AuD VA Northern California Health Care System Advanced Otolaryngology & Audiology Aspire Hearing and Balance Martinez, CA Fort Collins, CO Lakeland, FL David DeKriek, AuD Martin Smith, PsyD Fidelity Hearing Center Associates in Managed Care Georgia Cerritos, CA Denver, CO Brian K. Jones, MEd Jerilyn Dutton, AuD Mandi Solat, AuD Greater Atlanta Hearing Inc. Salient Sounds Audiology Audiology Services & Hearing Aid Center Cumming, GA La Jolla, CA Lakewood, CO Christin Brooke Means, AuD Gregory Frazer, AuD Hilary Wisdom, AuD North Georgia Audiology Pacific Hearing & Balance Center Inc. Columbine Audiology & Hearing Aid Center Suwanee, GA Los Angeles, CA Sterling, CO Otis Whitcomb, MA Tracy Peck Holcomb, AuD Cobb Hearing Aid Services Hearing and Speech Center of Northern California Florida Marietta, GA San Francisco, CA Anne Carter, AuD Melissa Wikoff, AuD Kent Holtorf, MD Pasadena Hearing Care Peachtree Hearing Holtorf Medical Group St Petersburg, FL Marietta, GA El Segundo, CA Maura Chippendale, AuD Idaho Malvina Levy, AuD Chippendale Audiology Hearing and Speech Center of Northern California Cape Coral, FL Christine Pickup, AuD San Francsico, CA Ali Danesh, PhD Mt. Harrison Audiology & Hearing Aids, LLC Rupert, ID Sara Mattson, AuD Labyrinth Audiology Rancho Santa Fe Audiology Boca Raton, FL Tosha Strickland, AuD Rancho Santa Fe, CA Brooke Davidson, AuD Strickland Ear Clinic Meridian, ID Marni Novick, AuD Baptist ENT Specialists Jacksonville Beach, FL Silicon Valley Hearing Inc Illinois Los Gatos, CA Ericka DeVore, AuD Nancy Congdon, AuD Bruce Piner, AuD All About Hearing/Lake Audiology & Hearing Aids Longwood, FL The Hearing Care Clinic Hearing and Balance Center Downers Grove, IL Encino, CA Wilson DuMornay, MD Broward ENT Services Phillip Elbaum, LCSW Jane Rosner, AuD Deerfield, IL West Valley Hearing Center Fort Lauderdale, FL Woodland Hills, CA Kelly J. Dyson, AuD Lori A Halvorson, AuD Suncoast Audiology, LLC Lake Forest Hearing Professionals Mimi Salamat, PhD Lake Forest, IL Dr. Mimi’s Audiology Clinic Largo, FL Walnut Creek, CA Melodi B. Fehl, MS JoAnn Harano, AuD ENT & Allergy Associates of Florida Loyola University Health System William Stubbeman, MD Chicago, IL TMS Psychiatry Boca Raton, FL Los Angeles, CA Lisa Gascay, AuD Jill Meltzer, AuD Rainbow River Hearing & Balance Inc. North Shore Audio-Vestibular Lab Christopher Sumer, NBC-HIS Highland Park, IL Coastal Hearing Aid Center Dunnellon, FL Encinitas, CA Margaret Richards, AuD James H Peck, HIS The Hearing Center Life Hearing Health Centers Katarzyna Tarnowska, PhD Rockford, IL San Jose State University Pensacola, FL San Jose, CA Sharon Rophie, AuD Jeanne Perkins, AuD Harbor Hearing PA Audiologic Services Brian Worden, MD Glen Ellyn, IL Kaiser Permanente Palm Harbor, FL Woodland Hills, CA Cindy Ann Simon, AuD Alyssa Seeman, AuD South Miami Audiology Consultants Illinois State University Colorado South Miami, FL Normal, IL Lindsay Collins, AuD Mindy Stejskal, MCD Indiana Sound Relief Hearing Center The Hearing Center Centennial, CO Pensacola, FL Laura L. Fragomeni, AuD Reid Hearing Center Kaela Fasman, AuD Anne Marie Taylor, AuD Richmond, IN Sound Relief Hearing Center ALPHA Audiology & Hearing Aids Golden, CO Panama City Beach, FL
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Erica Person, AuD Judith Bergeron, BC-HIS, CDP Jason Leyendecker, AuD Flex Audiology Beauport Hearing Care Audiology Concepts Lawrenceburg, IN Gloucester, MA Edina, MN Taylor Buotte, AuD Laura Morrison, AuD Iowa Atlantic Hearing Care Stillwater Medical Group-Health Partners Jason Aird, AuD Salem, MA Stillwater, MN Iowa Audiology and Hearing Aid Center Theresa Cullen, AuD Thomas Tedeschi, AuD Coralville, IA Cape Cod Hearing Center Amplifon Americas Jill L. Belski, AuD Hyannis, MA Minneapolis, MN Professional Hearing Solutions by Dr. Jill Peter Harakas, PhD Cedar Rapids, IA CBT Associates, LLC Missouri Diana Kain, AuD Lexington, MA Laura Flowers, AuD Heartland Hearing Center Robert Mario; AuD, BC-HIS St. Luke’s Health System Hiawatha, IA Mario Hearing & Tinnitus Clinics Lee’s Summit, MO Beki Kellogg, AuD Cambridge, MA Linda Guhe, MSW Hope Hearing & Tinnitus Center Mind Body Clinical Hypnosis Hiawatha, IA Michigan St. Louis, MO Heather Thatcher, HIS Terese Alsum, AuD Jay Piccirillo, MD Hope Hearing & Tinnitus Center Kaczmarski Hearing Services Washington University School of Medicine Hiawatha, IA Wyoming, MI Saint Louis, MO Richard Tyler, PhD Stelios Dokianakis, AuD University of Iowa, Dept. of Otolaryngology - Head & Holland Doctors of Audiology Nevada Neck Surgery Holland, MI Robyn Lofton, BC-HIS Iowa City, IA MaryRose Hecksel, AuD Hearing Associates of Las Vegas Shelley Witt, MA Audiology & Hearing Aid Center Las Vegas, NV University of Iowa Hospitals & Clinics Lansing, MI New Jersey Iowa City, IA Beckie Kaczmarski, AuD Kaczmarski Hearing Services Catherine Ahrens Berke BC-HIS Kansas Wyoming, MI Ahrens Hearing Center Fair Lawn, NJ Bryne Gonzales, AuD Angela Lederman, MS NuSound Hearing & Tinnitus Center Hear Now Audiology & Tinnitus Center Granville Y. Brady Jr., AuD Topeka, KS Clinton Township, MI East Brunswick, NJ Michael Schneller, HIS Shannon Radgens, DO Valerie Kriney, AuD Focus Hearing Red Cedar Ear Nose & Throat & Audiology Northern Jersey ENT Associates Overland Park, KS Owosso, MI Glen Rock, NJ Susan Smittkamp, AuD Michelle Rankin, AuD Beth Savitch, MA Associated Audiologists Inc. Ascent Audiology & Hearing Advanced ENT/Hear MD Shawnee Mission, KS Chelsea, MI Voorhees, NJ Donna Szabo, AuD Kentucky Karrie Slominski, AuD Henry Ford Health System Innovative Hearing Solutions Ann Rhoten, AuD West Bloomfield, MI Westwood, NJ Kentucky Audiology & Tinnitus Services Lexington, KY Benjamin Wightman, AuD New York Sound Advice Audiology Livonia, MI Nicole Ball, AuD Louisiana Hearing Evaluation Services of Buffalo, Inc Mary Miller, PhD Minnesota Tonawanda, NY Premier Hearing and Balance Carol Bass. MS Hammond, LA Sara Downs, AuD Hearing Wellness Center All Ears Audiology Tinnitus & Hyperacusis Audiological Duluth, MN Consulting Maryland Ithaca, NY John Ehlen Chelsea Carter, AuD Alyssa Beaton, AuD University of Maryland Medical Center Hear Central Victoria, MN Hearing Evaluation Services of Buffalo, Inc. Baltimore, MD Orchard Park, NY Christina Shields, AuD University of Maryland College Park College Park, MD Please note that the American Tinnitus Association does not verify providers’ certifications Massachusetts and expertise in tinnitus treatment. The list is meant expressly for informational purposes Eugene Antonell, BC-HIS and should not be construed as the ATA’s endorsement of the providers listed. The ATA Hear Better Now Tinnitus & Hearing Center strongly advises anyone using the list to check practitioners’ websites and tinnitus services N. Dartmouth, MA before scheduling appointments. Please note that the list includes hearing aid dispensers because hearing aids can be helpful to some people in the management of their tinnitus.
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Diana Callesano, AuD Nancy McKenna, AuD Kristen Furseth, AuD Hearing and Tinnitus Center University of North Carolina Hearing and Willamette ENT Woodbury, NY Communication Center Salem, OR Lois Cohen, LCSW, ACSW, BCD Chapel Hill, NC James Henry, PhD Tinnitus Counseling Melissa Palmer, AuD National Center for Rehabilitative Auditory Research Northport, NY High Point Audiology (NCRAR) Collin Campbell, L.ac Clayton, NC Portland, OR Campbell Acupuncture Sandra Royle-Tabak, MA Ha-Sheng Li-Korotky, AuD New York, NY CarolinaEast Ear, Nose & Throat Pacific Northwest Audiology LLC Anthony Durante, MD Morehead City, NC Bend, OR Mineola ENT Christina Seaborg, AuD Mineola, NY Hearing & Balance Center Pennsylvania Craig Kasper, AuD Charlotte, NC Lisa A. Blackman, MA New York Institute for Hearing and Balance Gina Whritenour, FNP A Hearing Healthcare Center New York, NY Robeson Family Health Philadelphia, PA Tracey Lynch, AuD Lumberton, NC Gail Brenner, AuD Island Better Hearing Inc. Hearing Technology Associates LLC Melville, NY Ohio Bala Cynwyd, PA Katherine Maffetone, AuD Samantha Bayless, AuD Mindy Brudereck, AuD ENT & Allergy Associates The Hill Hear Better Clinic Berks Hearing Professionals Manhasset, NY Cincinnati, OH Birdsboro, PA Deanna Ross AuD Neil Cherian, MD Jeannie Karlovitz, AuD Albany ENT & Allergy Services PC Cleveland Clinic Advanced Hearing Solutions Albany, NY Cleveland, OH Exton, PA Amy Sapodin, AuD Sarah Crow, AuD Edward Keels, MA Advanced Hearing Center Modern Hearing Solutions/ Choice Hearing Center Hear Now Hearing Aid Center Albertson, NY Canton, OH Philadelphia, PA Leigh A. Sauerbier, AuD Sarah E. Curtis, AuD Melissa Reitnour, MA The Advanced Hearing Center Sounds of Life Hearing Center, LLC Valley Forge ENT Brooklyn, NY Concord Twp, OH Phoenixville, PA Cathy Kooser, MSW, LISW Rivka Strom AuD Rhode Island Advanced Hearing NY Inc. Hillcrest Hearing & Balance Center Brooklyn, NY Centerville, OH Holly Puleo, AuD Eric Mounts, HIS Gateway Hearing Solutions Jennifer Sutton, AuD Warwick, RI Hearing Evaluation Services of Buffalo, Inc. Modern Hearing Solutions/ Choice Hearing Center Canton, OH Williamsville, NY South Carolina Joseph Pietrolungo, DO Lori Trentacoste, AuD Todd Gibson, AuD Island Better Hearing Inc. Summa Health Akron, OH Lake Murray Hearing Melville, NY Lexington, SC Babette Verbsky, PhD Carolyn Yates, AuD L. Margaret Kalady, AuD Hearing Evaluation Services of Buffalo, Inc. Hearing Connections Audiology Lebanon, OH Kalady Audiology Amherst, NY Beaufort, SC Kyle Woods, MA Alexandra Zweig, AuD Alexandra Tarvin, AuD New York Institute for Hearing and Balance Modern Hearing Solutions/ Choice Hearing Center Canton, OH Elevate Audiology Hearing and Tinnitus Center New York, NY Easley, SC North Carolina Oklahoma Jennifer Waddell, HIS Suzanne Kimball, AuD Sound Hearing Care Jennifer Auer, AuD Simpsonville, SC Audiology Attention & Tinnitus Care PLLC University of Oklahoma Health Sciences Center Oklahoma City, OK Concord, NC South Dakota Teresa M. Mazza, AuD Saranne Barker, AuD Melissa E. Baker, MA Raleigh Hearing & Tinnitus Center Landrum ENT Ada, OK Baker Audiology and Hearing Aids Raleigh, NC Sioux Falls, SD Christy Mitchell, AuD Susan Bergquist, MS Stephanie Wubben, AuD Heritage Audiology Talihina Hearing Clinic Talihina, OK Stanford Hearing Aids Wake Forest, NC Sioux Falls, SD Lisa Fox-Thomas, PhD Oregon UNCG Speech and Hearing Center Tennessee Greensboro, NC Anna Forsline, AuD VA Portland Healthcare System Tiffany Ahlberg, AuD Kelly Knolhoff, AuD Portland, OR Ahlberg Audiology & Hearing Aid Services Birkdale Audiology Cleveland, TN Huntersville, NC
www.ATA.org TINNITUS TODAY SPRING 2020 59 HEALTHCARE PROVIDERS
Cynthia Ellison, AuD Vermont Andrew Campbell, MA Franklin Hearing Center Neuaudio Franklin, TN Elizabeth Adams, AuD Chermside, QLD TINNITUSTODAY Univ. of Vermont-E.M. Luse Center Briana Hester, AuD Michael Segal, MA Burlington, VT Vanderbilt University Medical Center Pristine Hearing Nashville, TN Stephanie Hollop, AuD Nollamara Univ. of Vermont-E.M. Luse Center Andrea Plotkowski, AuD Burlington, VT Ear, Nose and Throat Consultants of East Tennessee Belgium Peter Van Ostaeyen, MPsych(Clin) Knoxville, TN Virginia Paul Shea, MD Resilence Psychepolis Ana Anzola, AuD Shea Ear Clinic Schoten, AN Ascent Hearing Memphis, TN McLean, VA Canada Texas Theresa Bartlett, AuD Nashlea Brogan AuD Virginia Hearing Consultants S. Diane Allen, PhD Bluewater Hearing Virginia Beach, VA The Grove Counseling & Wellness Center Sarnia, ON Dallas, TX Ann DePaolo AuD Patrick DeWarle, AuD The Audiology Offices LLC Theodore Benke, MD Winnipeg Hearing Centres Kilmarnock, VA Benke Ear Nose & Throat Clinic Winnipeg, MB Cleburne, TX Margaret Cooper Evans, AuD Kimberly Eskritt, AuD Evolution Hearing Christie Cahill, AuD Lambton Audiology Associates Richmond, VA Family Hearing & Sensory Neural Center Sarnia, ON Huntsville, TX Julie Farrar-Hersch, PhD Deborah Lain, MSc. Augusta Audiology Associates, P.C. Mary Sue Harrison, AuD Hope For Tinnitus Fishersville, VA Today’s Hearing Calgary, AB Carol A. Lau, HIS Katy, TX Washington Jamie Hawkins, AuD Soundid Ears Inc. Dustin Spillman, AuD Clarity Hearing Vancouver, BC Audiologists Northwest Conroe, TX Bremerton, WA Malaysia Kristen Keener, AuD Wan Syafira Ishak, PhD IlluminEar Tinnitus & Audiology Center Wisconsin Austin, TX Program Audiologi, Fakulti Sains Kesihatan Hugo Guerrero, AuD Kuala Lumpur, KL Christina Lobarinas, AuD Mayo Clinic Health System UT Southwestern Childrens Health Specialty Onalaska, WI Norway Frisco, TX Veronica H. Heide, AuD Sandra Michele Ochoa, MA Cynthia Lockhart, HIS Audible Difference, LLC Oslo Carrollton, TX Fitchburg, WI Pedro Montano, MD Dan Malcore South Korea McAllen, TX The Hyperacusis Network Taewoo Kim Rene Pedroza, AuD Green Bay, WI St. Mary’s Hearing Aid United States Department of Defense Samantha Sikorski, HIS, ACA Seoul El Paso, TX Sikorski Hearing Aid Center, Inc. Elly Pourasef, AuD Spooner, WI United Kingdom Memorial Hearing Inc. Hashir Aazh, PhD Houston, TX West Virginia Hashir Tinnitus Clinic Lydia Ramanovich, AuD Erin Wells, AuD London Dallas Ear Institute Mountain Ears Hearing Clinic, LLC Lisa Caldwell, MA Frisco, TX Parkersburg, WV The Hearing Coach Bradley Stewart, AuD Glossop ClearLife Hearing Care INTERNATIONAL Alan Hopkirk Allen, TX The Invisible Hearing Clinic Argentina Bethany Tsui-Brum, AuD Glasgow UT Southwestern Medical Center Susana Dominguez Fonoaudióloga Dallas, TX Hospital Italiano de Bs.As, Argentina Capital Federal, BA Crystal D. Wiggins, AuD Bay Area Audiology Australia Webster, TX Lynne Blackford, BSc Utah MQ Health Speech and Hearing Clinic Macquarie University, NS Ashley Penrod, PA-C Intermountain Healthcare Sandy, UT
60 TINNITUS TODAY SPRING 2020 www.ATA.org TINNITUSTODAY Editorial Calendar
Tinnitus Today magazine is a print and electronic media magazine published in April, August, and December, and circulated to 25,000+ ATA contributors, donors, 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 issues, questions and answers, self-help suggestions, and letters to the editor from others with tinnitus. 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 Digital Issue Issue Theme Copy Due Photos Due Ad Close Launch Mailed
Summer—Aug 2020 Diet and Dentistry 4/15 5/1 5/1 8/1 August
Winter—Dec 2020 Annual Research Issue 9/15 10/1 10/1 12/1 December
Spring—Apr 2021 Causes of Tinnitus 1/15 2/1 2/1 4/1 April
Editorial Calendar is subject to change.
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MISSION AND CORE PURPOSE The mission and core purpose of the ATA are to promote relief, help prevent, and find cures for tinnitus evidenced by its core values of compassion, credibility, and responsibility.
CORE VALUES AND GUIDING PRINCIPLES Compassion: Evidenced in a spirit of hope reflected in the commitment to finding a cure, preventing the condition, and supporting those affected by the condition. Credibility: Evidenced in accurate information from reliable sources, transparency in decision- making, and an earned reputation for trustworthiness. Responsibility: Evidenced in patient-centered advocacy by a collaborative community of forward thinking leaders accountable to its mission and members.
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Open Access
ATA’s Conversations in Tinnitus, with John A. Coverstone, AuD, and Dean Flyger, AuD Tune In to Conversations in Tinnitus to Stay Abreast of Tinnitus Research and News The American Tinnitus Association’s podcasts are available 24/7 to help you stay abreast of tinnitus research and other tinnitus topics. Just like listening to music on your smartphone or computer, you can tune in to Conversations in Tinnitus podcasts, cohosted by John A. Cover- stone, AuD, and Dean Flyger, AuD, while you work out, take a walk, relax at home, or commute to work. To access and learn more about this unique and compelling series, visit our website at www.ata.org. To enhance listening comprehension and accommodate those with noise sensitivity, transcripts are available with each podcast.
ALL PODCASTS ARE FREE AND OPEN ACCESS
Podcast 14: Does Tinnitus Retraining Therapy Podcast 16: Understanding the Problem of Painful Improve Quality of Life? Hyperacusis SUBJECT MATTER EXPERTS: Roberta Scherer, PhD, and Craig Formby, PhD SUBJECT MATTER EXPERT: Bryan Pollard, BA TOPIC: Drs. Scherer and Formby guide us through the decades-long journey TOPIC: Bryan Pollard, founder of the nonprofit Hyperacusis Research, to conduct the first and only phase III trial of tinnitus retraining therapy, an explains what it is like to live with noise-induced pain and what is known influential habituation-based treatment protocol for alleviating the negative about this often overlooked condition. As someone who lives with painful reactions to tinnitus. The researchers explore findings that highlight the hyperacusis and tinnitus, Pollard provides unique insight into the struggles, importance of sound enrichment and working with a caring and qualified his mission to increase research on the condition, and the importance of healthcare provider. developing tools to enable sufferers to return to a more normal life, without fear of setbacks. Podcast 15: Exploring Noninvasive Neurosensory Tinnitus Treatment Podcast 17: Talking About Tinnitus With Children SUBJECT MATTER EXPERT: Hubert Lim, PhD SUBJECT MATTER EXPERTS: David Baguley, PhD, and Claire Benton, MSc TOPIC: Dr. Lim, a leading scientist and thought leader in auditory TOPIC: Dr. Baguley and Claire Benton discuss their efforts to educate neuroscience, discusses the research and development of non-invasive parents, teachers, and healthcare providers on talking to children about bimodal neuromodulation for treatment of tinnitus. He explains the scientific tinnitus. The widespread misconception that children don’t have tinnitus concept and the research being conducted, which is aimed at developing has meant children suffer alone and miss critical opportunities for early a treatment that decreases the perception of the tinnitus sound and the intervention. They also discuss their research findings on the topic and tools negative emotional reactions caused by it. to help children manage tinnitus.
To subscribe to the print or digital issue of Tinnitus Today, which is published three times a year, visit www.ata.org or email [email protected]