Connecting with Nature to Find Relief & Rejuvenation

TinnitusToday To Promote Relief, Prevent, and Eventually Cure Tinnitus Vol. 42, No. 2, Summer 2017

Insights on Rethinking Tinnitus from a Cognitive Behavioral Therapist

Knowing When to Refer Tinnitus Patients to a Specialist

ATA’s 2017 Research Grant Recipients

A publication of the

Visit & Learn More About Tinnitus at ATA.org ATA thrives through the dedication of a vast number of people, all of whom make a difference. Join the Jack Vernon Legacy Society

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

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

We hope you’ll be a part of the legacy of securing silence for those with tinnitus through a variety of treatments, as well as finding a cure for the millions who endure incessant noise and anxiety.

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

EDITOR Letters to the Editor...... 4 John A. Coverstone, AuD Sentient Healthcare, Inc. Technology & Nature at Our Fingertips...... 5 Consulting Editor and Writer Joy Onozuka, MA Hearing Aids Restore Nature’s Joyful Sounds...... 6 American Tinnitus Association Better Health with Nature Soundscapes...... 8 copy Editor Margaret L. Brown Cognitive Behavioral Therapy: MLB Communications A Proven Tool for Managing Tinnitus...... 10 PUBLISHER 6 Torryn P. Brazell, MS, CAE Three Emerging Trends in American Tinnitus Association Cognitive Behavioral Therapy...... 12 EDITORIAL ADVISORY PANEL James W. Hall III, PhD Creating a Multidimensional University of Hawaii, Manoa Salus University & University of Pretoria Tinnitus Personality Profile...... 15 James A. Henry, PhD The Intake Process for People with Tinnitus...... 16 National Center for Rehabilitative Auditory Research (NCRAR) An Advancement in Replacing U.S. Department of Veterans Affairs Damaged Hair Cells...... 20 Gail M. Whitelaw, PhD 10 Department of Speech and Hearing Science ATA Funds Innovative Research...... 22 The Ohio State University

DIGITAL DESIGN & PRODUCTION TEAM The Search for the Elusive Cure for JML Design, LLC Both Lyme & Tinnitus...... 24 ADVERTISING Tinnitus Today is the official publication of the The Possible Hereditary Nature of American Tinnitus Association. It is published Bilateral Tinnitus...... 26 three times per year in April, August, and December and mailed to members and Q and A: Strategies for Living with Tinnitus...... 28 donors. The digital version is available online at: www.ata.org. To advertise, contact Giving Time, Money and Hope...... 30 16 Kathleen Turner, Donor Relations Specialist, at: [email protected] Quiet Understanding, Depth of Headquarters Knowledge, and Empathy Can 522 SW. 5th St., Ste. 825 Portland, OR 97204 USA Equal Great Leadership...... 31 Editorial Office ATA Support Network Calendar...... 32 American Tinnitus Association P.O. Box 5, Portland, OR 97207 Would You Consider Buying a +1-503-248-9985 800-634-8978 PSAP at a Store Near You?...... 34 [email protected] The Spectrum of Hearing Loss, www.ata.org 24 The American Tinnitus Association is a non- Tinnitus, and Constant Fatigue...... 36 profit corporation, tax-exempt under 501(c) (3) of the Internal Revenue Code, engaged in Spotlight on Patient Providers...... 38 educational, charitable, and scientific activities. Tinnitus Treatment with Repetitive Tinnitus Today magazine is © copyrighted by the American Tinnitus Association. Transcranial Magnetic Stimulation...... 41 Advertisement Publication of any Sound Therapy Poetic Reflection...... 42 advertisement does not in any way or manner constitute or imply ATA’s Neuromodulation as a Tool for approval or endorsement of any Changing Neural Pathways...... 43 advertised product or service. 31  From the editor and publisher Reconnecting with the World

Tinnitus, hyperacusis and related disorders, joyment of the world. People with tinnitus often such as misophonia, often are unique in that they miss the quality of life they had prior to its on- include a very strong psychoemotional aspect. set. When you have tinnitus that is bothersome, While not completely unique in this respect, you can still throw a ball, take a walk in the most health conditions do not affect us in the forest, and run through the park; but, your ability profound and personal way these conditions do. to enjoy those activities and connect with other The auditory system is connected to the lim- people while doing them may be diminished. bic system, which supports emotions, behavior, In this issue, we focus on connecting with and long-term memory, among others. Some the world around us and finding ways to regain would say this strong relationship between some of the enjoyment that may have been lost. hearing and emotions exists as a protective I hope the strategies, experiences, and research response — the fight or flight response. If we share in this issue will help you to venture John A. Coverstone, AuD Editor, Tinnitus Today ancient man heard rustling in the bushes, for back out into your world and enjoy some of the example, he became afraid it might be a lion experiences you may have left behind. and ran away (and those who didn’t run weren’t around to become our ancestors). It should not be surprising that bothersome tinnitus has the potential to severely disrupt en- Unexpected Tinnitus Relief Often Found in Nature Photo courtesy of John Lack Photography We can thank serendipity and the melodic and a sense of tranquility. flow of a water fountain for the first tinnitus To find studies confirming treatment. It was 1971 when Charles Unice, a that the sound and view of doctor suffering from tinnitus, came to Portland, ocean waves brings a multi- Oregon, to see Jack Vernon and learn about tude of health benefits is his tinnitus research. As he and Jack walked hardly surprising. It makes to lunch, they passed the Lovejoy Fountain. me wonder what it is about Noting that Charles had lagged behind, Jack human nature that we approached him at the fountain. There was a require proof for something look of shock on Charles’ face, as he conveyed that we intuitively know to that his tinnitus had ceased with the sound of be true. Torryn P. Brazell, MS, CAE babbling water. It was an “ah-ha” moment that As we come to the end Executive Director & Chief gave us our first masking device, as well as the of summer, I hope you find Operating Officer formation of a bond between two men who moments of calm and relief Publisher, Tinnitus Today went on to found the ATA. in the magic of nature, be it Such chance encounters — putting us in touch from a water fountain in an with the sounds of nature and nature itself — urban jungle, alongside the ocean, or in the thick Old Bahia Honda Bridge, often bring unexpected surprises. I was raised of the woods. Bahia Honda State Park, Florida Keys, Florida in Montana, and my love for the great outdoors runs deep. But, it’s the warm ocean of the Florida Keys that draws my spirit, providing comfort

2 Tinnitus Today Summer 2017 From the board chair  Passing the Torch

Every organization needs change in lead- She currently works for the U.S. Army Public ership, if it expects to grow. The bylaws and Health Center / Army Hearing Division in the other operating policies of the American Tinnitus Scientific and Clinical Studies Section at Walter Association recognize this by requiring elections Reed National Military Medical Center. She of new officers and a turnover of directors on a is conducting research on hearing protection regular basis. devices and extended-wear hearing aids, as well When my term ended on June 30, I never as tinnitus evaluation and management for the felt more optimistic and excited about the military and — eventually — others. future of ATA. With her training and clinical experience, A big reason for that is the newly elected LaGuinn understands tinnitus and related hear- Chair of the Board: LaGuinn Sherlock, AuD. ing disorders and has committed her career to LaGuinn has been a clinical and research au- treating patients and researching treatments. Scott C. Mitchell, JD diologist for more than 25 years. She trained at She has served the ATA in leadership roles and Immediate Past Chair the University of Maryland, Johns Hopkins Hos- will bring that experience to her work as Chair ATA Board of Directors pital, University of Florida, and spent 19 years of the Board. We are very fortunate to have her at the University of Maryland Medical Center. in this position, so it gives me great pleasure, In the latter part of her time there, she focused with a (quiet) roll of drums, to pass the torch on tinnitus and hyperacusis in collaboration with to … LaGuinn Sherlock! some of the top researchers and clinicians in the field, eventually serving as Clinical Director of Audiology.

Thank you, Scott! What a wonderful oppor- that help reduce the impact of tinnitus on tunity this is for me to help the many individuals sleep, concentration, emotional well-being, and who are struggling with the effects of tinnitus. hearing. Over the past 10 years specializing in For the past 46 years, the ATA Board has the evaluation and management of tinnitus and done great work to help people with tinnitus. hyperacusis, I have witnessed relief achieved From providing valuable information, education, by hundreds of patients who feel “cured” of compassionate support, research funding, and tinnitus. even help finding a local provider, ATA has long I look forward to working with the ATA Board, been an organization that advocates. Through Staff, and Executive Director to help those the ATA’s arduous work, improved treatments with tinnitus improve the quality of their lives are available TODAY and more will be available in by increasing awareness and raising funds for Torryn P. Brazell, MS, CAE the future! I am looking forward to being a part research in the evaluation and treatment of Executive Director & Chief of this history of helping. tinnitus. LaGuinn P. Sherlock, AuD Operating Officer One of the goals of the ATA is to find a Chair Publisher, Tinnitus Today ATA Board of Directors cure for tinnitus. While many assume that a “cure” means complete absence, “cure” also is defined as providing relief. Considering this definition, a cure already exists in the form of behavioral and sound-therapy-based treatments

Tinnitus Today Summer 2017 3  letters to the editor

1 ATA Board of Directors Letter see that ‘jet plane’ is almost the very Col. John T. Dillard USA (Ret.), Carmel, CA Under Fact or Fiction (Fall, 2016), item worst. I used to take wonderful trips Daniel J. Fink, MD, Beverly Hills, CA three indicates that there are possi- with my husband, flying overseas a Michael E. Hoffer, MD, Miami, FL Jeannie Karlovitz, AuD, Downington, PA ble cures for pulsatile tinnitus with a lot. Now, the thought of that noise Thomas Lobl, PhD, Valencia, CA cochlear implant. I would appreciate terrifies me, and I no longer do so. Scott C. Mitchell, JD, Houston, TX more information on who and where Please write an article about flying. Randy Phillips, Great Falls, VA this is being done. — D. Hendrix, Dallas, TX Bryan Pollard, Marlboro, MA Gary P. Reul, EdD, Issaquah, WA — T. Cavalieri, Bedminster, NJ LaGuinn P. Sherlock, AuD, Bethesda, MD I sympathize with your sudden onset Joseph Trevisani, New York, NY The Fact or Fiction segment you refer- of tinnitus and hyperacusis and am Ted Turesky, PhD, Washington, DC enced was referring to two different glad you found help in your area. The Jinsheng Zhang, PhD, Detroit, MI things. Pulsatile tinnitus is often airplane noise described in Tinnitus Honorary Director caused by a condition affecting blood Today in the Spring 2017 issue is a rat- William Shatner, Los Angeles, CA flow. This can be treated medically ing of airplane engines as measured ATA Scientific Advisory Committee in many cases. When someone has from the outside of the airplane. It Shaowen Bao, PhD pulsatile tinnitus, we almost always represents an average jet engine at Helen Wills Neuroscience Institute make a medical referral for further di- full throttle as someone would mea- Berkeley, CA USA agnostic examination to see whether sure it standing next to the airplane. Susan M. Bowyer, PhD Henry Ford Health Systems, Detroit, MI USA medical treatment is appropriate. There may be options that could al- Dirk De Ridder, PhD When someone has severe hearing low you to enjoy air travel again — or University of Otago, Dunedin, NZ loss and is a candidate for a cochlear certainly to tolerate it well enough to Marc Fagelson, PhD implant, we have found that the co- enjoy the rest of the travelling expe- East Tennessee State University chlear implant may result in cessation rience. For example, if changes in air Johnson City, TN USA of tinnitus. The answer to the Fact or pressure are troublesome for you, Michael E. Hoffer, MD, FACS Fiction question was referring to this there are products to help with that. University of Miami Health System Miami, FL USA result specifically and was not intend- You may want to speak with your Fatima T. Husain, PhD ed to indicate that cochlear implants audiologist about custom earplugs or University of Illinois, Urbana-Champaign may cure pulsatile tinnitus. My apol- noise-cancelling headphones to wear Champaign, IL USA ogies for the confusion on this, but during a flight. An audiologist may Elisabeth Maria Knipper-Breer, PhD thank you for contacting us to clarify. be able to duplicate airplane noise to University of Tubingen, Tubingen, Germany help you decide what solutions work Mark S. Mennemeier, PhD University of Arkansas, Little Rock, AR USA 2 best. Choosing seats away from the Letter engines may also help. Also, con- Larry E. Roberts, PhD I have been dealing with tinnitus and sider starting with a short trip. If the McMaster University, Hamilton, ON, Canada hyperacusis (roaring sound) for the anxiety of the trip is too much, you Maria Rubio, PhD, MD University of Pittsburgh, Pittsburgh, PA USA past 5 years. It was sudden onset may want to speak with your audiolo- Jeremy G. Turner, PhD and very traumatic. In the Spring gist about a referral to a psychologist, Illinois College, Jacksonville, IL USA 2017 issue you have a chart of the many of whom have wonderful strat- Roland Schaette, PhD “noise dose exposure level” (p. 15). I egies for dealing with anxiety. UCL Ear Institute, London, England Grant D. Searchfield, PhD University of Auckland, Auckland, NZ Letters to the Editor Athanasios Tzounopoulos, PhD University of Pittsburgh, Pittsburgh, PA USA The ATA encourages readers to write to the editor, Dr. John Coverstone, with comments on articles, podcast topics, items of Pim Van Dijk, PhD University Medical Center Groningen interest, and general concerns. Letters selected for publication may Groningen, Netherlands be edited for brevity, clarity, and grammar. Letters should be sent to: Fan-Gang Zeng, PhD [email protected] University of California, Irvine Irvine, CA USA Jinsheng Zhang, PhD Wayne State University 4 Tinnitus Today Summer 20 Detroit, MI tinnitus Technology 

Technology and Nature are Both Now at Our Fingertips

By Joy Onozuka The ATA doesn’t endorse or recom- of nature, creating your own orchestra mend specific apps or sound thera- of forest birds, frogs, whale cries, While technology will never be a pies, but it is widely recognized that and tropical rain — something that in replacement for time spent in nature, masking devices can help relieve the the end could sound highly unnatural. it enables us to surround ourselves negative effects of tinnitus or at least Such experimentation can allow you with the calming sounds of nature provide a palatable pause. However, to better gauge the impact of sound while indoors. as with “one man’s junk is another on your mood and awareness of Our readers have shared their man’s treasure,” what one person tinnitus. favorite apps — including Rain Rain, enjoys, another may find annoying. Some contend that simulated and websites, such as www.rainy- Finding the right sounds that bring sound is less effective in reducing mood.com — that they use to help relief and lower stress is an individual stress than recordings of real nature. them cancel out the cacophony that endeavor of trial and error. Set aside The Macaulay Library, which is part comes with tinnitus. If you search an hour to experiment with apps and of the Cornell Lab of Ornithology and “nature sounds” on Apple’s iTunes websites, and give yourself time to found at https://www.macaulaylibrary. App Store, you will find almost 500 find your preferred sound. For in- org/, provides upwards of 200,000 free options intended to help listeners stance, White Noise provides an array bird calls and millions of bird photos. relax, sleep, meditate, focus, or learn of rain storms, ocean waves crash- With such resources, we truly have more effectively. ing, and crickets chirping. With Relax nature at our fingertips, and it is Oriental, you can become a conductor inspiring.

Tinnitus Today Summer 2017 5  My Tinnitus Journey

Hearing Aids Restore Nature’s Joyful Sounds

By Rich Patterson tinnitus and pursue life normally. “I can hear better However, as the constant ringing Sometimes change happens as increased in volume, it diminished quickly as flipping a light switch. with the aids, ear my ability to hear. This impacted One moment it’s dark. A second my relationships with others, as I later, brightness fills the room. ringing is less could not accurately hear what was Other changes creep up so subtly being said and would often re- that it’s hard to notice them at all. intense, and I am spond incorrectly in a conversation That’s what happened to my or not at all. hearing acuity. It probably start- more engaged with I am a professional naturalist ed years ago, when machine gun conversations.” with 39 years’ experience as the noise assaulted my ears during executive director of nonprofit Army training. But running chain- nature centers. Being able to hear saws, lawnmowers, and other By age 60, my left ear buzzed nature’s gentle delicious sounds machines didn’t help. Gradually, constantly, with my right ear some- was professionally and personally slowly, and pretty much unnoticed, times adding its own chorus of important to me. I lost the ability to hear many of distracting noise. For several years, Early last May, a tiny bird and nature’s delightful sounds. I could mentally disregard the my wife, Marion, convinced

6 Tinnitus Today Summer 2017 My Tinnitus Journey 

me it was time to get my hearing A year has passed since Reek- homeowners create wondrous checked. I was sitting on my back ers fitted me with hearing aids. yards that provide beauty, solitude, deck when a warbler landed on an She had predicted that they might education, and inspiration. We have oak branch about 20 feet in front lessen the impact of tinnitus by transformed our yard from a sterile of me. My wife commented on amplifying sounds. My tinnitus mowed lawn to a haven of bloom- how sweet the song was. I could remains, but her prediction proved ing plants that attract a stream of clearly see the bird singing, but I true. I can hear better with the aids, wildlife. Where a lawnmower once couldn’t hear it! A few days later, I ear ringing is less intense, and I am roared, birdsong now greets our was at Heartland Hearing Center in more engaged with conversations. mornings. Cedar Rapids. Audiologist Jennifer An event happened on the one- My experience with the hear- Reekers, AuD, positioned me in a year anniversary of my purchase of ing aids has been positive, and, small booth and tested my ability to hearing aids. We were sitting in our although they were expensive, it hear sounds of varied intensity and living room reading with the win- was money well spent. Through wavelength. The test proved what I dows open when my wife, Marion, our website and in our speaking already knew: I could not hear many remarked, “Rich, listen!” Wafting engagements, we now encourage sounds well, especially high pitches. into our home from a nearby tree people to protect their hearing from “Hearing aids will help improve was one of nature’s most delightful loud noises and to seek the help of a your ability to hear many sounds,” sounds — the call of a wood thrush. professional audiologist to improve she promised. She fitted me with a For the first time in years, I could their ability to enjoy sounds. few trial pairs until I found one that hear its melody clearly. did the trick. Some long-for- Following my long A graduate fishery biologist, Rich Patterson gotten sounds, like nature-center ca- served as executive director of the hearing my own reer, Marion and I Indian Creek Nature Center in Cedar footsteps and my founded a busi- Rapids, IA, for 36 years. He and his wife, Marion, a professional edu- pant legs swoosh- ness designed cator, founded Winding Pathways ing together as I to encourage in 2014. walked, were odd. and help To learn more visit: www.windingpathways.com

Tinnitus Today summer 2017 7  Research news

Better Health with Nature Soundscapes

us, but because of how it makes us National Park Service in Ft. Collins,

Photo courtesy of Lisa Greany Photography feel,” said David Strayer, a cognitive CO, has been measuring sound with psychologist specializing in attention hidden microphones in parks around at the University of Utah.2 Strayer is the country for the last decade. The among a group of scientists around study is measuring how man-made the world drawing on psychology noise drowns out the sounds of birds, and neuroscience to try to quantify insects, and rain.5 how nature mitigates common health Kurt Fristrup, a senior scientist with problems, such as obesity, heart dis- the research project said, “I’d like to ease, anxiety, and depression. think that we can reach out through By Joy Onozuka Since being in nature would not be this effort — not just to park visitors complete without the sound of wind or backpackers — to help everyone Tinnitus is aberrant sound that can rustling leaves, birds singing, or waves realize that their lives could be better taint the process of hearing, as well breaking onto shore, efforts are being and their communities could be more as the ability to enjoy silence or be made to protect the great outdoors vibrant places, if we take some time alone with one’s thoughts. For many, from noise pollution that negatively to make them quieter.” nature provides a temporary reprieve effects both people and wildlife. Fristrup envisions new technolo- from the buzzing, ringing, whooshing, “Today, the din of modern life gy being applied to make pavement hissing, or any other sound one might extends into protected areas,” said quieter, electric airplanes prevalent, experience with tinnitus. And study acoustic biologist Megan McKenna, and to encourage the use of roadside after study confirms what we know a scientist with the Natural Sounds noise gauges to raise awareness intuitively: Nature is good for the and Night Skies Division of the U.S. of man-made noise. In parks with mind, body, and soul. National Park Service in Ft. Collins, designated quiet zones, noise levels In fact, studies in the Netherlands, CO, who participated in research, drop, suggesting people are willing to Scotland, and Canada have shown analyzing noise levels at 492 federal, reduce noise when asked. that proximity to green space, even state, and local parks.3 The quietest That is good for everyone who when people don’t use it, translates parks have a background noise level wants to enjoy the sight, sound, and into better health.1 Researchers still below 20 decibels. City sound levels smell of nature and the health bene- are trying to pinpoint what exactly it often exceed 65 decibels, which is fits they offer. is about time outdoors — air, smell, the equivalent of listening to an air color, sound — that improves health. conditioner running. 1 Williams, F. (2016, January). This is your brain on It is clear, however, that living near a The Noise Control Act of 1972 nature. National Geographic. Retrieved from http:// www.nationalgeographic. tree-lined street in the center of a city, gave the Environmental Protection 2 Williams. visiting a park — be it a tiny one or a Agency (EPA) the ability to impose 3 Hotz, R.L. (2017, May 5). Noise pollution invades park lands. The Wall Street Journal, p. A3. famed national one — or sitting by the limits on noise from motor vehicles 4 Chrobak, U. (2017, May 4). Noise pollution ocean benefits the mind and body. and machinery. However, noise levels invading even the most protected natural areas. Science Magazine. Retrieved from http://www. “At the end of the day, we get in parks, wilderness, and protected sciencemag.org out into nature not because the areas have largely been ignored.4 5 Klein, K. (2016, December 23). In a noisy world, our brains still need the sounds of nature. http://www. science says it does something to Another research team with the U.S. alleghenyfront.org

8 Tinnitus Today Summer 2017 My Tinnitus Journey  Taking a Stand for Tinnitus Research & Awareness

Anne Medbery has had tinnitus physician by training. Her letter The ATA thanks Medbery for her since 1990. She recently shared advocated for increased funding advocacy and longtime support of a letter she wrote to Health and of tinnitus research and greater our organization. Human Services secretary Tom awareness of the condition among Price, a former congressman and doctors and the public.

May 31, 2017

Dear Secretary Price,

We are most anxious to have funding for tinnitus, or ringing in the ears. Our service men and women are exposed to explosive sounds while on duty. When they return home, they are having to cope with loud and varying sounds constantly.

Please make sure: • All audiologists are made aware of this condition and have the necessary equipment to diagnose it. • All Ear, Nose, Throat (ENT) doctors have the same access for treatment and knowledge of tinnitus. • ENT+T (tinnitus) should become a household name.

Of course, our service men and woman are not the only people with tinnitus. No cure is yet available, but there are many disciplines that can be helpful.

The American Tinnitus Association, located in Portland, Oregon, can be most helpful for information. Their telephone number is (800) 634-8978, and their website is www.ata.org. They can be reached via email at [email protected]. The American Tinnitus Association also publishes Tinnitus Today magazine.

I am living with tinnitus myself and so is my son-in-law.

Sincerely,

Anne B. Medbery Foley, AL

Tinnitus Today Summer 2017 9  Research news

Cognitive Behavioral Therapy: A Proven Tool for Managing Tinnitus

By Joy Onozuka social withdrawal). Pa- tients with tinnitus and Cognitive Behavioral Therapy (CBT) hyperacusis who seek is a treatment, backed by evidence- treatment typically based research, that has been shown experience anxiety and to alleviate the negative psychological depression, along with effects of bothersome tinnitus. While insomnia, which have it is not a cure for the condition, it can significantly impaired their help one develop stress tolerance and ability to function at work and home. tools to reclaim a sense of control Unlike traditional “talk therapy,” over one’s life. CBT is a treatment requiring active To learn more about CBT and its ap- participation on the part of the patient patients return to more fulfilling lives. plication with tinnitus and hyperacusis and considerable practice at home The auditory perception of sound patients, I interviewed Dr. Lynne Gots, between sessions. To be successful, (loudness and persistence) may or a clinical psychologist with 35 years of a patient must be motivated and able may not change. experience in cognitive-behavioral ther- to carry out assignments. For people apy and behavioral medicine. Dr. Gots who are severely depressed, the JO: When did you begin working with has a private practice in the Wash- depression often needs to be treated tinnitus and hyperacusis patients? ington, DC area, and is an assistant with pharmacotherapy before CBT for clinical professor in the Department tinnitus can be initiated. LG: I began working with tinnitus of Psychiatry and Behavioral Sciences and hyperacusis patients about 10 at The George Washington University JO: Why is CBT an effective tool for years ago. Though I’d previously seen School of Medicine. She is also an helping those with tinnitus and/or people with hyperacusis, that wasn’t ADAA (Anxiety and Depression Asso- hyperacusis? the primary focus of treatment. My ciation of America) Clinical Fellow. specialty is anxiety and, specifical- LG: CBT and related, so-called “third- ly, Obsessive Compulsive Disorder Joy Onozuka (JO): How and why wave” cognitive therapies, such as (OCD), which frequently co-occurs does CBT work? mindfulness and Acceptance and with hyperacusis. I also used to work Commitment Therapy (ACT), are in a rehab hospital with patients who Dr. Lynne Gots (LG): CBT is a struc- evidence-based treatments for the dis- suffer from chronic pain. The CBT tured, relatively short-term therapy tress that can result from experiencing approach to treating tinnitus distress (typically 8-24 sessions, but that can tinnitus, not for the condition itself. developed from the model used to vary) designed to modify unrealistic Research has shown these ap- treat chronic pain, so it was very thoughts and beliefs (cognitions) and proaches to be effective in modifying familiar to me. maladaptive behaviors (e.g., avoid- negative emotional and behavioral ance of environmental triggers and responses to tinnitus and helping

10 Tinnitus Today Summer 2017 Research news  Photo courtesy of S teven M arks JO: Are there therapies you would suggest in combination with CBT? LG: The primary obstacle to treatment is an overinvestment in elim- LG: There is greater research ev- inating the tinnitus entirely. Many idence for CBT than any other people are reluctant to engage in non-psychological interventions, such CBT when they learn it isn’t going to as maskers, hearing aids, electrical eliminate their tinnitus. stimulations, or surgical approaches, in reducing the psychological impact JO: How do you approach treatment? of tinnitus. However, a combination approach that uses CBT with mask- LG: I set goals collaboratively with ers may be more effective than CBT patients at the beginning of treatment alone. to help them develop realistic expecta- tions for treatment outcome. We talk JO: Do you have a distinct protocol about the importance of focusing on Dr. Lynne Gots when working with tinnitus patients? values rather than symptom reduction. My role is to help them identify what’s LG: The length of treatment is LG: I use roughly the same protocol meaningful to them, what they’ve lost, highly variable. I’ve seen successful for all tinnitus patients, but adapt it and how they can get back to living outcomes in as few as five sessions, to fit individual needs. The standard their fullest lives. Tinnitus reduction is but a more typical course of treat- components are: not the goal of CBT, rather, the focus ment would be from 8-20 sessions. • mindfulness meditation (to im- is on living the best life possible. This prove stress tolerance); will help the patient in every circum- JO: Have you successfully treated • identification of thought patterns stance that may affect quality of life. patients with hyperacusis? contributing to negative emotional If patients are using tinnitus reduction reactions; and to measure their progress, either I ha- LG: There is no evidence-based proto- • behavior modification (refraining ven’t explained the agenda adequately col for hyperacusis, but I’ve had some from obsessive or negative repet- or they’re not willing to accept it. success with using the same type of itive behaviors and returning to gradual exposure-based approach that previously enjoyed activities.) JO: What length of time do you typi- is the treatment for OCD. Reducing so- cally work with tinnitus and hyperacu- cial isolation is very important, because JO: What obstacles to progress are sis patients? social withdrawal is both a risk factor typical of tinnitus patients? for and a symptom of depression.

JO: What advice would you offer to someone who is in the first stages of “Research has shown these approaches bothersome tinnitus?

to be effective in modifying negative LG: I would discourage any tinnitus patient I’m working with from pursu- emotional and behavioral responses to ing scientifically unproven remedies. tinnitus and helping patients return to more There are a lot of snake oil sales people out there, so it is important fulfilling lives.” to consult a health professional with experience in treating tinnitus.

Tinnitus Today Summer 2017 11  Research news

Three Emerging Trends in Cognitive Behavioral Therapy

Summary by John A. Coverstone, AuD Impression — Improvement Scale sion Inventory to indicate symptoms Cognitive behavioral therapy (CBT) and Amsterdam Misophonia Scale of depression, and the World Health is a leading psychological tool used to determine improvement in each Organization Well-Being Index for for treating tinnitus by addressing patient’s condition. The latter scale is a subjective measure of overall the way in which people react to and noted as not validated, but was used well-being. Following the prescribed perceive tinnitus. The Clinical Prac- as a relative scale to determine se- treatment, the patient improved tice Guidelines for Tinnitus published verity of misophonia. After counsel- from a tinnitus severity of severe to in 2014 by the American Academy ing with CBT, the authors found that clinically negligible. He also improved of Otolaryngology — Head and 48 percent of patients demonstrated from a depression score of minimal Neck Surgery Foundation, describe a significant reduction of misopho- to a score of no depressive symp- CBT as the only tinnitus treatment nia. This suggests that CBT may have toms and from a borderline critical with solid evidence to support its usefulness in treating misophonia. well-being score (52nd percentile) effectiveness. Even though CBT is However, because half the patients to above average (84th percentile). established as a treatment method were not helped by CBT, it also indi- The conclusions from this paper for people with troublesome tinnitus, cates that more research is needed are limited, because there was only there are numerous studies continu- to determine when it is appropriate one patient and no control subjects. ing to look for more effective uses to use and to compare against other However, it does suggest that com- for CBT or new ways to use CBT in methods for a measure of relative bination treatment approaches may tinnitus treatment. Here is a summa- effectiveness. have promise for managing tinnitus. ry of some of the emerging research in this area. Managing Chronic Tinnitus Is CBT Being Discussed 2 and Insomnia with rTMS 3 with Patients? CBT Effectiveness in and CBT Following publication in 2014 of 1Misophonia A case study published in Fron- the American Academy of Otolaryn- A group of researchers in Amster- tiers in Psychology by clinicians in gology — Head and Neck Surgery dam sought to determine whether Germany and Switzerland presented Foundation (AAO-HNSF) Clinical CBT would be an effective method a 53-year-old patient who had tinnitus Guidelines for Tinnitus, a group from for treating people with misopho- since age 49 and more recently had Harvard Medical School and Univer- nia, a condition that makes specific developed insomnia. The authors sity of California, Irvine sought to as- sounds intolerable to an individual. It developed a treatment approach that sess tinnitus management patterns is distinct from hyperacusis, which included 10 sessions of repetitive in the United States, compared to is a lowered tolerance for all (usually transcranial magnetic stimulation AAO-HNSF recommendations. They loud) sounds. The authors recruited (rTMS) followed by 10 sessions of gathered data from the 2007 Nation- 90 patients with misophonia and CBT. The authors used the Tinni- al Health Interview Survey, a large- provided eight biweekly group CBT tus-Fregebogen instrument to assess scale questionnaire that contained sessions, using the Clinical Global tinnitus severity, the Beck Depres- a significant number of questions

12 Tinnitus Today Summer 2017 Research news 

regarding tinnitus (see Tinnitus by the Numbers, pp. 8-9, Spring 2017 issue of Tinnitus Today). The authors analyzed patient reports for the type of therapy that was discussed as treatment options for their tinnitus. The authors found that CBT was discussed 0.2 percent of the time with patients, which was the lowest of all described treatment options and less often than options that were not even included in the guidelines document. In fact, surgical transection (severing) of the auditory nerve was discussed six times more frequently than CBT. Medication, which AAO-HNSF recommended against in the guidelines, was discussed most at 45.4 percent. That equates to discussion of a non-recommended procedure 227 times more frequently than the most recommended procedure. The next most frequently discussed options were: • hearing aids (9.2 percent), • nutritional supplements (7.8 percent), about the latest developments in effective, and how — or how often • stress reduction methods (6.7 tinnitus management. It also may — CBT is used to treat tinnitus. As percent), and include many people who have less tinnitus research continues to ex- • music treatment (4.0 percent). bothersome or even non-bother- pand and we learn more about what some tinnitus and would not neces- tinnitus is and how we might treat it, It should be noted that these sarily be good candidates for CBT. we should expect CBT to be an im- data represent discussed options Nonetheless, the very low percent- portant part of those discussions. as reported by patients. This may be age of discussions that included CBT biased due to the impact on the pa- indicates that more education likely tient, who might more readily recall 1 CBT Effectiveness in Misophonia: http:// needs to be provided to the medical www.sciencedirect.com/science/article/pii/ a discussion about nerve transection community. S0165032716321681 than one about counseling sessions. 2 managing Chronic Tinnitus and Insomnia with CBT has proven to be one of the rTMS and CBT: https://www.ncbi.nlm.nih.gov/ It also represents all discussions, pubmed/28484405 most effective treatment approaches including those by physicians who 3 epidemiology study of treatment discussions for people with troublesome tinnitus. with physicians: http://jamanetwork.com/journals/ were faced with a patient’s com- jamaotolaryngology/fullarticle/2533660 Therefore, it is not surprising that plaint of tinnitus but had no experi- research continues into new uses ence treating it or were uneducated for CBT, ways to make CBT more

Tinnitus Today Summer 2017 13 According to 2016 statistics from the Department of Veterans Affairs, tinnitus remains the #1 service-connected disability for veterans from all periods of service, accounting for 1,610,911 Veterans. (www.benefits.va.gov)

14 Tinnitus Today Summer 2017 Research news 

Creating a Multidimensional Tinnitus Personality Profile

Summary by John A. Coverstone, AuD Tinnitus Functional Index, and Tinnitus treatment of those people whose tin- Case History Questionnaire. Partici- nitus is interfering with daily activities. Clinicians and scientists working pants were adults of all ages, although The authors also found that a greater with tinnitus have known for years only three respondents were in the 21 stress reaction and alienation from that psychological factors may have to 30-year-age range (1 with tinnitus, others correlated strongly with a ten- significant bearing on its effects on 2 without), well over half were over dency to experience hyperacusis. any individual person. Tinnitus re- 60 years old. Participants had hearing These results correlate well with search has documented the influence loss of varying severity — slight to studies investigating individual traits of social and emotional traits, as well profound. Those indicating they did and tendencies in people with tinnitus. as personality type, locus of control, not have hearing loss were excluded. However, the authors of this study anxiety sensitivity, feeling of self-con- Analysis of scores showed that sought to compare multiple personality trol, and other factors. Some tinnitus tinnitus sufferers reported greater traits, demographic data, and percep- questionnaires, such as the Tinnitus reaction to stress, higher degrees of tual characteristics to uncover the com- Functional Index and Tinnitus Hand- alienation, significantly lower levels of binations of factors that may lead to a icap Questionnaire seek to identify self-control, and lower social closeness decreased ability to adapt to tinnitus. some of those traits so a clinician than the control group of participants For instance, many individuals have may quantify the level of disturbance without tinnitus. Many interactions been observed to live with “benign” tinnitus is causing in a person’s life. between parameters also were tinnitus until a significant life event or A group of researchers is expand- examined. For instance, participants environmental influence causes it to ing on that research and is attempting with slight hearing loss showed lower worsen and become bothersome. to create a multidimensional person- reaction to stress in the 41 to 50-year- We do not yet have the science ality profile for tinnitus sufferers. The old age group, compared to those from to determine whether tinnitus truly researchers, from the Department 51 to 60-year-old age group. In addition, changes in the brain, but we now may of Audiology at the University of the control group showed significantly have information that describes the Auckland (New Zealand) and led by higher social closeness for females risk factors leading to troublesome Dr. Grant Searchfield, recruited 154 than the group with tinnitus. No differ- tinnitus — e.g., tinnitus that requires participants with tinnitus (81 male, ences in personality traits were found treatment. Clinicians also may be able 73 female), along with 61 control for those participants whose tinnitus to develop more specific treatment participants. Participants took a web- changed in the presence of environ- regimens based on the personality based personality survey consisting mental noise, versus those whose traits of the individual patient, so that of questions about self-control, stress tinnitus did not. habituation is enhanced and appropri- reaction, alienation, and social close- Findings also indicated that in- ate therapeutic methods are chosen ness. The questions were particularly dividuals who had sought several earlier in the treatment process. relevant, as they were taken from treatments for tinnitus were more subtests of the Multidimensional likely to react strongly to stress than Searchfield, G., O’Keeffe, M., & Durai, M. (2017). Personality Questionnaire, Hearing those who had not sought treatment. The Personality Profile of Tinnitus Sufferers and a Handicap Inventory-Screening Version, This may reflect the greater need for Nontinnitus Control Group. JAAA 28:271–282.

Tinnitus Today Summer 2017 15 patient providers

The Intake Process for People with Tinnitus Simple tools can help make you a better clinician for patients with tinnitus

By John A. Coverstone, AuD and initial intake, even though there are One excellent source for basic tin- Gail M. Whitelaw, PhD numerous options available to help nitus education is the British Tinnitus people with tinnitus and associated Association’s Guidance for General Patients and providers alike know conditions. As one would surmise, Practitioners, which was reprinted that one of the most important en- this response — rather than provid- in the Spring 2017 issue of Tinnitus counters for someone experiencing ing help — may actually contribute Today. This guidance serves as a tinnitus is the first time he or she men- to a patient reacting to tinnitus with starting point to quickly educate pri- tions it to a health care provider. The depression, anxiety, or even despair. mary care physicians about the nature intake professional could be a primary Providers can change that scenario of tinnitus and helps them understand care physician, ENT, audiologist, psy- and turn it into a positive experience that there are many things that can chologist, or other provider. Regardless simply by asking a few basic ques- help tinnitus patients. of the type, it is the way a provider tions. In addition to making a better In this article, we outline ways to receives and acknowledges a patient’s experience for the patient, these assess a patient’s condition quickly first report of tinnitus that is crucial to questions allow the provider to deter- and determine the most appropriate the process of directing treatment and mine the most appropriate referrals referrals based on those findings. addressing the other conditions that and ensure that all individuals with These tools may be used by any often are associated with it. tinnitus receive the help they need in physician, audiologist, psychologist, Far too many patients hear, “There an efficient, effective, and empathetic or other provider who encounters is nothing that can be done,” at this manner. patients with acute tinnitus.

16 Tinnitus Today Summer 2017 patient providers

tinnitus has a history of recent dental immediately referred to a mental health Tinnitus presents itself in work or complains of jaw pain or professional. Tinnitus is known to exac- several common ways across other conditions that suggest possible erbate or possibly even cause onset of the population of those who TMJ disorder/dysfunction, a provider clinical-level depression and anxiety dis- experience it. Understanding should refer him or her to a dental or orders. Therefore, providers should have these symptoms will help you orthodontic specialist for evaluation. all patients who report severe tinnitus offer better care and ensure you complete a tinnitus questionnaire, such make appropriate referrals to Traumatic Brain Injury as the Tinnitus Reaction Questionnaire professionals who can diag- Tinnitus frequently occurs with (TRQ) or Tinnitus Handicap Inventory nose and treat tinnitus or the traumatic brain injury (TBI) and may be (THI). A patient with tinnitus who exhib- conditions that cause it. an indication of a more severe injury its clinical-level mental health disorders than initially reported. Patients who should be referred to a mental health Pulsatile Tinnitus have experienced a recent head injury specialist knowledgeable in cognitive Many patients report that they and report tinnitus should receive a behavioral therapy. hear a pulsing tinnitus, which may be full TBI exam by an appropriate physi- described as rhythmic, pulsing, thump- cian. In these cases, tinnitus may per- Unilateral Tinnitus or ing, whooshing, or following their heart- sist regardless of other treatments, so Tinnitus Ipsilateral to beat. This is referred to as pulsatile tin- additional referrals listed in this guide Head/Neck Mass nitus, and its rhythm frequently is timed may be necessary. Patients diagnosed Many otologic and neuro-otologic to the patient’s heartbeat. This condition with TBI, who report tinnitus, should conditions have the potential to cause results from abnormalities with blood be referred to an audiologist who can tinnitus. Many of these result in flow resulting from atherosclerosis, hy- perform a tinnitus evaluation and/or unilateral tinnitus, rather than bilateral perthyroidism, increased localized blood auditory processing assessment. tinnitus that often is associated with flow resulting from tumors of the head hearing loss, noise exposure, ototox- or neck, or even conductive hearing Post-Traumatic Stress icity, head trauma, and other causes. loss. Pulsatile tinnitus also may result Disorder Unilateral tinnitus may be caused from idiopathic intracranial hyperten- PTSD may occur in concert with trau- by a more benign condition, such as sion, which additionally includes visual matic injury or may result from distinct unilateral hearing loss. On the other disturbances and headaches. Providers events. In either case, patients with tin- hand, it also could result from a more whose patients report pulsatile tinnitus nitus who also show signs of — or have serious and acute condition, such as a should refer the patient to a primary been diagnosed with — PTSD are at vestibular schwannoma, a labyrinthine care physician or otologist for evaluation high risk for psychological disorders, in- condition, such as Meniere’s disease, of blood flow. cluding depression or anxiety disorders. or a condition of the middle ear, such These patients should be referred to a as otosclerosis or otitis media. When Temporomandibular Joint psychologist or a psychiatrist, as appro- a patient presents with unilateral tin- Disorder priate, for cognitive behavioral therapy nitus, providers should make a referral Some patients experiencing what is and other intervention as necessary. for examination by an ENT. commonly referred to as “TMJ,” also will report tinnitus. These patients of- Depression and Other Tinnitus Onset Following ten report clicking, roaring, hissing, or Mental Health Issues Flying/Diving buzzing, although other sounds may Some patients with tinnitus also may Patients reporting tinnitus onset close- be experienced. These sounds may be report depression, intentions of harming ly following an episode of flying, div- accompanied by jaw pain, worsening themselves, or other related signs of ing, or other activity with rapid chang- or relief with jaw movement, or recur- depression or mental health problems. es in air pressure may be experiencing rent headaches. If a patient reporting Obviously, such patients should be the effects of middle ear pathology,

Tinnitus Today Summer 2017 17 patient providers

sinus problems, or ear barotrauma. In medication (on a short-term basis) for may be performed. Hearing loss may all cases, referral to an otologist and sleep, refer the patient for a sleep study, be present, but not mentioned or audiologist is recommended for com- or refer him or her to a mental health perceived. Another potential cause plete evaluation of these symptoms. specialist for cognitive behavioral ther- may be uncovered by the audiologist. apy. If these referrals do not help the If other intervention is not indicated, Tinnitus Related Hearing patient manage sleep issues, a combi- the audiologist will advise the patient Loss nation of treatments may be in order. about effective methods for treating The most common etiology for tinnitus tinnitus in everyday life. is believed to be hearing loss. Therefore, Tinnitus with Sound Given the fact that more than 50 patients reporting tinnitus should be Tolerance Problems million Americans experience tinnitus screened for hearing loss. This screen- Some people with tinnitus and a larger at some point in their lifetimes, it is ing may be as simple as asking whether number with bothersome tinnitus also likely that nearly every primary care patients have difficulty understanding may have sound tolerance problems. physician, ENT, audiologist, psycholo- conversation with background noise This occurs when someone has an gist, psychiatrist, physician assistant, present, whether they turn up the tele- adverse reaction (sometimes severe) and nurse practitioner will encounter vision (spouses are more than happy to to sounds at levels typically consid- one or more patients with tinnitus. report this), notice that they are strain- ered very tolerable. It is important to Knowing the information provided — ing to hear what is being said, or do not identify this condition and avoid probes along with the accompanying flow- understand everything being said in a that create loud sounds (for audiolo- chart and a questionnaire, such as the conversation. Pure tone hearing screen- gists, in particular). Materials such as Tinnitus Reaction Questionnaire (TRQ) ings or screening questionnaires, such the Tinnitus Reaction Questionnaire or the Tinnitus Handicap Inventory as the Hearing Handicap Inventory for help determine whether a patient has (THI) — will be invaluable in helping Adults (HHIA), also can be employed. sound tolerance problems. Referral respond appropriately and effectively Any tinnitus patient identified as having to an audiologist who specializes in to those patients who are seeking possible hearing loss should be referred tinnitus and related disorders is indicat- help with tinnitus. Keep these tools for a comprehensive audiologic evalua- ed in these instances. Referral to a close by for quick reference. tion performed by an audiologist. psychologist also may be necessary With a basic understanding of tinni- and may be done in consultation with tus, as well as these simple guidelines Sleep Disorders/Lack of the audiologist. It is critical that those and tools, any primary care provider Sleep from Tinnitus working with patients who have sound can help patients with tinnitus. Instead Most providers who serve patients with sensitivity issues, sometimes referred of “Nothing can be done,” your answer tinnitus agree that sleep is a funda- to as hyperacusis, have knowledge can and should be “Something can be mental component of overcoming its and experience with this population. done — let me help you.” effects. If a patient with tinnitus is not getting sufficient sleep, tinnitus may Tinnitus Without Evident John A. Coverstone, AuD, is a clinical audiolo- worsen, and its effects may be per- Etiology or Comorbidity gist, Audiology Ear Care, New Brighton, MN ceived as more severe. If a patient is Some people experience tinnitus Gail M. Whitelaw, PhD, is an audiologist and having mild difficulty sleeping due only without other conditions present, so clinic director, The Ohio State University Speech-Language-Hearing Clinic, Columbus, OH to the tinnitus, an audiologist typically the need to refer often is based on can provide help through sound therapy. the patient’s perceived need for help. 1 Baracca, G., delBo, L., and Amborsetti,U. (2011). If sleep problems involve non-tinnitus However, it is recommended that Tinnitus and Hearing Loss. In Møller, A.G., Langguth, B., DeRidder, D., and Keliniung. T. (Eds)., causes or the patient is suffering from any patient who experiences tinnitus Textbook of Hearing Loss. New York: Springer. severe sleep deprivation and sound and is seeking help be referred to an 2 Goodey, R. (2007). Tinnitus Treatment–State of the Art. Progress in Brain Research, 166, 237-246. therapy is insufficient to allow normal audiologist specializing in tinnitus so 3 nagler, S.M. (2003). Tinnitus. A Patient’s sleep, it may be appropriate to prescribe that examination and consultation Perspective. Otolaryngology Clinics of North America. 36(2):235-8.

18 Tinnitus Today Summer 2017 Tinnitus may be associated with one or more of the following conditions. It is recommended that all providers check all Intake Process conditions in this chart, even if a positive answer leads to a specific referral. Redirection to subsequent decisions is provided for those conditions that have common comorbidities. This process chart for Tinnitus may require updates as new information becomes available.

Patient presents with tinnitus

YES Medical referral for Is tinnitus pulsatile? YES evaluation of blood flow abnormalities in the head NO and neck. Refer to dentist/ orthodontist for further YES Recent dental work or jaw pain? evaluation and treatment of possible TMJ disorder. NO Refer to specialist for head injury. Refer for History of head injury/TBI diagnosis? YES psychological/psychiatric management Refer for mental health NO or YES as indicated. counseling and treatment, as necessary, Signs of PTSD, depression, YES with provider offering anxiety, or other MHD? Cognitive Behavioral Therapy (CBT). NO Refer to neuro-otology for evaluation Is tinnitus unilateral? YES of central lesion, labyrinthine disease, or NO other otologic condition. Refer to otology, audiology for assessment YES Recent flying or diving? of middle ear, sinus, If negative ear barotrauma. NO

Refer to audiologist No evident etiology or comorbidity? YES specializing in tinnitus.

NO or YES

Is sleep disorder due YES Sleep disorder noted? to non-tinnitus factors, severe in nature, or sound NO or YES therapy ineffective? Refer to audiologist Sound tolerance problems? YES for assessment and NO YES treatment, if indicated.

Consider medication for sleep, Refer to audiologist for sound a sleep study, or referral to therapy consultation. psychology for CBT as indicated.

An Advancement in Replacing Damaged Hair Cells

Summary by John A. Coverstone, AuD If those hair cells lose their func- capability has long been considered tion, whether from drugs toxic to the the “holy grail” for hearing loss re- Most of the heavy lifting in the ear, repeated loud sounds, or certain search, as it may render hearing aids human ear is done by structures in infectious diseases, their ability to and cochlear implants unnecessary the cochlea called hair cells. These respond to sound is gone forever. for many people with hearing loss. tiny cells and the filaments (called When people lose hair cells in the Luckily, there is headway being “cilia”) that protrude from the top of high-frequency region of the cochlea, made in this area. Along the mem- the cells are responsible for sens- for example, they can no longer hear brane that contains hair cells in the co- ing specific wavelengths of sound high-frequency sounds (high-frequen- chlea, there are many supporting cells entering the cochlea and stimulating cy hearing loss). that fit under and around them. In re- the auditory nerve. The cochlea is Hair cells cannot regenerate — at cent years, researchers have identified organized by frequency, which is least not in mammals. Other animals cells in the cochlea containing Lgr5, an called tonotopic organization. Higher have long been known to regenerate epithelial cell protein that was previous- frequency sounds are sensed in the hair cells in their ears. Birds, for ex- ly known to be a marker for intestinal earlier portion, called the basal end of ample, were identified first as having stem cells. It has more recently been the cochlea. Lower frequency sounds this capability, and some amphibians found to be critical to the function of are sensed at the end, or apical por- and fish also have been found to renewing cells in the intestinal lining, tion, of the cochlea. regenerate damaged hair cells. This which have a high turnover rate. Cells expressing Lgr5 have been found to proliferate when stimu- lated by Wnt, which is a protein that regulates the proliferation of cells in many contexts, including playing a critical role in the early growth and development of tissues in newborns. In the cochlea, it has been found that cells expressing Lgr5 may divide in response to Wnt signaling and may differentiate into hair cells. Cells not expressing Lgr5 do not create new hair cells. An increase of Lgr5 within a cell, called upregulation, has been shown to cause greater differentiation of hair cells as well — particularly when combined with inhibition of another signaling protein called Notch.

20 Tinnitus Today Summer 2017 Research news 

These and other studies have led greatest number of viable hair cells. human cells, resulting in differentiation scientists to believe that cells contain- By combining the most successful into hair cells. ing Lgr5 are progenitor cells for the techniques, the researchers were The authors also tested their epithelium in the cochlea — meaning able to produce many times more vi- ability to grow hair cells in explanted that Lgr5 cells are able to replicate able hair cells than had resulted from cochleae of mice. They used both and replace other cells within the co- previous methods. healthy cochleae and those treated chlea. Research has shown that cells To this point, though, the authors with gentamycin to damage the hair containing Lgr5 spontaneously regen- had successfully refined methods for cells. In this case, cell expansion was erate in newborns when the cells are expansion (growth) and differentiation encouraged through use of the same damaged. However, this regenerative of progenitor cells only in neonates. conditions. However, the authors process only occurs in the first week They next sought to study expansion hoped for spontaneous differentiation of life. After that time, spontaneous and differentiation of adult progenitor in the intact cochlea. regeneration is lost in the cochlea. cells into hair cells. First attempts used After treatment, they reported The authors sought to use tech- cochlear epithelial cells from adult regeneration of hair cells close to niques developed to grow intesti- rhesus macaques. This failed due to re- normal numbers and seven times the nal stem cells for the purposes of peated contamination from non-sterile number counted in control cochleae. growing neonatal cochlear hair cells. conditions during isolation of tissues. Using these techniques, the authors After testing several growth factors in The authors then obtained access demonstrated a potentially viable isolation and in varying combinations, to healthy human ear tissue from a method for regeneration of damaged they identified the treatment that led patient undergoing a labyrinthectomy hair cells in human ears. to the greatest amount of cell growth. (removal of the end organs in the ear) They next treated the cells with dif- to access a tumor. Applying the same McLean, Will J. et al. Clonal Expansion of Lgr5- ferent compounds that were intend- procedures found to be most suc- Positive Cells from Mammalian Cochlea and High- ed to encourage differentiation into cessful for neonatal cells, the authors Purity Generation of Sensory Hair Cells. Cell Reports, Volume 18, Issue 8, 2017. pp. 1917-1929. hair cells. They studied the results to encouraged expansion of the adult identify which compound yielded the

Tinnitus Today Summer 2017 21  Research news

ATA Funds Innovative Research

By Jennifer Born were included in the review process that are awarded to academic re- to add an important perspective. searchers, who are eligible to receive The ATA Board of Directors “What makes our grant process so up to $50,000 per year, and student announced funding of new grants compelling is that funding dollars are grants, which have a maximum award for four research projects aimed at almost entirely from individuals who of $10,000. These grants are typically increasing scientific understanding of have experienced tinnitus and want seed grants that enable researchers tinnitus and accelerating progress to- to help find a cure for it,” according to obtain data that then becomes the ward effective treatments and a cure. to Torryn P. Brazell, executive director basis for applying for larger funding This is the third decade in which of the American Tinnitus Association. from such entities as the National the ATA has funded innovative re- “Since 1980, ATA has given more than Institutes for Health and the U.S. search based on recommendations $6 million in seed grants for over 100 Department of Defense. from its Scientific Advisory Commit- projects, and we have done so without tee (SAC), which represents an inter- large grant resources or government Jennifer Born is ATA’s Scientific Research national panel of researchers engaged funding. It’s all from individual support.” Coordinator and Programmatic Advisor. in cutting-edge tinnitus research. This The two categories of research year, for the first time ever, patients funded by ATA include regular grants

Keeping the Focus on Patient Interests

For the first time, patients participated as reviewers in the how well those tests reflect key aspects of the patient’s ATA Scientific Advisory Committee’s evaluation of grant condition (e.g., pain from new sounds with hyperacusis). requests for 2017. Among the patient reviewers was Bryan TT: What did you take away from being a part of the Pollard, ATA Board of Directors member, who has hypera- process? cusis. Here is what he had to say about the experience: BP: There were many great proposals to choose from TinnitusToday (TT): What’s the value of having the (I wish we could fund them all!). The rigorous ranking patient perspective in the grant review process? model that we used helped to assess the strength of a Bryan Pollard (BP): Including patients is a great step wide variety of proposals, from clinical-focused to basic toward ensuring that researchers comprehend the actual neuroscience. The broad experience of the SAC team lives of patients — their symptoms and experiences. For helped provide a balanced perspective with the collective example, if a new clinical test is proposed, a patient can wisdom of more than a dozen researchers. This rigorous provide feedback on how the test may be perceived by methodology takes some time, but the outcome drives that important constituency. If additional animal model the best of the best to the top and helps to ensure ATA tests are proposed, patient participants can offer input on funds the most promising research on the path to a cure.

22 Tinnitus Today Summer 2017 Research news 

2017 ATA Research Grant Recipients

The Role of Cochlear Synaptopathy Informational Masking and Tinnitus in Tinnitus Adaptation

Principal Investigator: Principal Investigator: Gabriel Corfas, PhD Grant Searchfield, PhD The Regents of the University of University of Auckland Michigan Dr. Searchfield and his team will Noise-induced hidden hearing loss explore the effects of Informational (HHL) can result from loss of inner hair Masking (IM) on tinnitus. IM is a form cell synapses — known as synaptop- of sound masking that is thought to athy — and some speculate that reversing synaptopathy be a result of central auditory processes. It occurs due could serve as a tinnitus therapy. To date, all studies to stimulus similarity (e.g., spatial location, timing, and linking HHL and synaptopathy to tinnitus are based on meaning), attention, and demand on cognitive resources. noise exposure, making the connection between synapse They propose that tinnitus masking occurs through an loss and tinnitus indirect. Dr. Corfas and his team have IM mechanism. Through analysis of the IM mechanism generated mouse models in which they induce and repair and how it relates to tinnitus perception, it is expected synaptopathy independent of noise. They propose to use that improved and customized sound therapies can be these mice and well established behavioral assays to developed. determine if loss of synapses cause tinnitus; if increased synaptic connectivity alters the tinnitus percept; and “This grant makes such a huge difference if restoring synapses after noise exposure prevents or to our ability to do research.” reduces noise-induced tinnitus. —Grant Searchfield, PhD

A New Approach to Diagnosing Cross-Validation of Two Tinnitus Hyperacusis in Tinnitus Patients Screening Approaches in Mice Principal Investigator: Principal Investigator: Sarah Theodoroff, PhD Inga Kristaponyte (student grant) National Center for Rehabilitative Mentor: Alex Galazyuk, PhD Auditory Research (NCRAR), Veterans Northeast Ohio Medical University Affairs Portland Health Care System The research objective is to screen To help people with tinnitus who also mice for tinnitus-like behavior us- have hyperacusis, a sound tolerance ing both operant conditioning and disorder that commonly co-occurs with gap-induced inhibition of the acoustic tinnitus, it is crucial to correctly diagnose the condition. startle reflex. To induce tinnitus, mice are exposed to loud However, no such metric exists. The long-term research sound. It is hypothesized that two conceptually different goal is to develop an effective paradigm to diagnose and tinnitus paradigms will identify the mice as tinnitus posi- assess hyperacusis in tinnitus patients and distinguish it tive. This will help prove the efficacy of existing diagnos- from other sound tolerance disorders. This area of research tics for tinnitus. is necessary to aid in directing the clinical management of those who suffer from tinnitus and hyperacusis.

Tinnitus Today Summer 2017 23  My Tinnitus Journey The Search for the Elusive Cure for Both Lyme and Tinnitus

By Joy Onozuka

Long before Lyme disease became a household word and increasingly important public health problem, Kathy Olson knew its ravages first hand. “I’ve had chronic pain since I was 16 years old, but nothing ever pointed to a reason in test results,” she explained. That changed in 1995, when a blood test came back positive for Borrelia burgdorferi, the bacteria that causes the infection known as Lyme disease.

24 Tinnitus Today Summer 2017 my tinnitus journey 

With a name attached to her volves using hearing aids with mask- illness, Olson expected to be cured. ing to measure the effect of white That was not to be, as other infec- noise at two different levels. “So far, tions unleashed from that initial tick it hasn’t helped,” she said, noting that bite proved to be stronger than the every therapy requires time, which drugs prescribed to beat them. has aggravated her fears. “The pain is ongoing and nothing To quell the anxiety, she is seeing a explains it,” she said. Despite that, she cognitive behavioral therapist and psy- remained upbeat. Today, more than 20 chiatrist. Cognitive behavioral therapy years since her diagnosis, Olson is part Mark and Kathy Olson (CBT) has been shown to help miti- of a small clinical trial using stem-cell With the support of her husband, gate tinnitus, so Olson is determined infusion to boost her immune system’s Mark, she began searching for more to make that work. “You can’t inter- ability to combat infections. As part of comprehensive help and is participat- rupt training once you begin, so I’m the treatment protocol, she stopped ing in the Tinnitus Retraining Therapy starting when I return from vacation,” taking all medications, most of which (TRT) program at the University of she said, explaining that the trip was were holistic. Right before starting Maryland Tinnitus & Hyperacusis planned prior to the onset of tinnitus. treatment, tinnitus entered her life. Center in Baltimore, MD, as a com- To help her enjoy the holiday, her “It was February (2017). I was in plement to the stem-cell infusion trial, therapist suggested that she use the car with my husband, when I which is being conducted separately the Headspace app, which features asked him, ‘Do you hear that high- at a private practice. The center runs guided meditations for all levels and pitched noise?’ I thought it must be a three-stage program that starts can be found at www.headspace. the air-conditioning. He turned it off, with an overview session with an com. “It’s a British guy talking you but the noise never stopped,” she said. audiologist who outlines the nature of through meditation. It’s a good place Her family doctor thought it was water tinnitus and hyperacusis. to start,” she said. Stop, Breathe & in her ears, so she was referred to an “We were instructed to bring Think, which can be found at www. ear, nose and throat (ENT) specialist. support people. Out of five (people stopbreathethink.com, is the other Deciding inflammation was behind the attending), I was the only one who had app recommended to help her feel high-pitched buzz, the ENT scribbled a a support person with them,” she said. at peace. “The CBT is eight-to-10 three-week prescription for prednisone The second stage is a comprehen- weeks,” Olson explained, adding that and assured her it would go away. sive hearing exam, which measures she hopes the therapy will enable her When the prescription ran out and such things as the severity of tinnitus, to stop taking antidepressants. “Right the buzzing continued, Olson made which then determines the direction now, that’s a safety net.” an appointment with a well-regarded of the third stage of TRT. When that Though Olson is at the beginning ENT, who specialized in tinnitus treat- exam is complete, Olson will receive stages of learning to cope with tinni- ment, in Bethesda, MD. “He was the a treatment plan. tus, she has done everything doctors least sympathetic,” she said, recalling The TRT model is based on the suggest to habituate, from being seen how stunned she was by his com- premise that various parts of the brain by qualified medical specialists and ment that she “learn to live with it.” are involved in the tinnitus signal, with exploring a variety of therapies to “There was no compassion,” she said. the cochlea and auditory systems play- attending tinnitus support groups. She Within weeks, she was overcome ing a secondary role. The treatment credits her husband for helping her with anxiety. “I thought the tinnitus aims to facilitate habituation through stay focused on finding answers and would go away. Now I’m afraid it counseling and sound therapy. getting better. And, once the tinnitus is won’t,” Olson said, explaining that she In addition, Olson is working with less bothersome, she hopes to finally had never experienced anxiety or de- her audiologist, who also is new to rid herself of the vestiges of Lyme. pression prior to the onset of tinnitus. TRT, in a one-year clinical trial that in-

Tinnitus Today Summer 2017 25  Research news

The Possible Hereditary Nature of Bilateral Tinnitus

Summary by John A. Coverstone, AuD monozygotic (maternal or identical) The researchers from Karolinska twins and dizygotic (fraternal) twins. Institutet looked at data from adults Tinnitus often is thought to occur Monozygotic twins are derived born between 1900 and 1985 who exclusively from environmental from a single ova (egg) and share participated in either the Screening factors. Among common causes are all their alleles, an “alternate” form Across the Lifespan Twin (SALT) study noise exposure, head trauma, med- of a gene — i.e., a mutation — that or the Study of Twin Adults: Genes ications toxic to the ear, tumors of is found at a specific location in a and Environment (STAGE). SALT was the head and neck, and hearing loss. person’s DNA. Dizygotic twins, on a computer-assisted telephone inter- However, recent research is investi- average, only share half their alleles. view of twins born before 1959, and gating the possibility that there may Therefore, if a greater correlation STAGE was a web-based survey of be a genetic component to tinnitus. of tinnitus is found in monozygot- twins born in Sweden between 1959 Scientists at the Karolinska Insti- ic twins, this implies that genetic and 1985. tutet in Sweden recently studied her- factors are influencing tinnitus. By In total, 70,186 individuals were itability of tinnitus by sifting through studying twins of opposite gender, asked the question, “Do you have data from the Swedish Twin Registry. researchers also can study whether buzzing in the ears?” They were asked Twins are compelling for studies, be- there is a difference based on gender to answer Yes/No/Don’t know (or cause researchers can compare differ- and whether the difference is the refuse to answer). Of those, 10,464 ences in large populations between result of environment or genetics. people were one of a pair of twins reporting tinnitus, while twins not

26 Tinnitus Today Summer 2017 Research news 

Following analysis of responses, a greater correlation was found for bilateral tinnitus in monozygotic twins, compared to dizygotic twins. No correlation was noted for unilateral tinnitus. This suggests that a genetic factor is present for bilateral tinnitus, while unilateral tinnitus may result from environmental exposure. Furthermore, men displayed a greater effect of inheritance for bilateral tinnitus over unilateral tinnitus, while women did not show this effect. While data showed that men ease (0.34), and Alzheimer’s disease are more prone to developing tinnitus (0.48). They also noted that heritability (either unilateral or bilateral), heritabil- of bilateral tinnitus in men (score ity scores of men and women were of 0.68) was similar to other brain similar overall. The authors noted that disorders, including attention deficit tinnitus prevalence overall increases hyperactivity disorders (0.76), autism with age and some effects of herita- (0.71), and schizophrenia (0.81). (This bility are greater for younger individ- is a comparison of incidence between uals. This is consistent with greater various disorders and does not indi- environmental effects for older adults. cate any relationship between tinnitus It also was noted that tinnitus inci- and these other disorders.) dence peaks in the seventh decade of This information sets the stage for life for men and the eighth decade for a new view of tinnitus as an inherited reporting tinnitus in either person women. Incidence of tinnitus in the condition. As has been found with were excluded. Pairs of twins were studied population (14.9 percent) also many other conditions, it may be that considered to be concordant only if was similar to other published tinnitus we simply inherit susceptibility for they each reported bilateral tinnitus. incidence data. tinnitus with the final determining If one twin reported bilateral tinnitus Finally, the authors noted that factor linked to environmental factors, and the other reported no or unilateral heritability of tinnitus (0.43 heritability such as lifestyle choices and work en- tinnitus, they were considered to be score overall) compares well to herita- vironment. More research is needed discordant. bility of other conditions, such as ma- to confirm this data and more fully jor depression (0.37), Parkinson’s dis- explore the effects of gender and environment — possibly even to locate genetic markers for tinnitus susceptibility. Until then, the best solution is to minimize noise exposure and “It also was noted that tinnitus incidence educate those around us on how to prevent or limit environmental noise peaks in the seventh decade of life for men hazards that may lead to tinnitus. and the eighth decade for women.”

Maas et al. Genetic Susceptibility to Bilateral Tinnitus in a Swedish Twin Cohort. Genetics in Medicine, 2017.

Tinnitus Today Summer 2017 27  consultation corner

Q and A: Strategies for Living with Tinnitus

Photo courtesy of Dr. Stephen Nagler, Briksdal Glacier, Norway

I have had tinnitus for two will be one of the “lucky ones” and column because you have tinnitus. You Q months. I was evaluated by an that at some point your tinnitus will are reading this column because you ENT specialist, who said there is no vanish, or you can assume that you have tinnitus, and it makes you feel cure. Does tinnitus ever go away on could hear your tinnitus for the rest bad. If your tinnitus did not in some its own? I keep hoping mine will. I of your life. With the first approach, way or other make you feel bad, then don’t see how I can conduct my life each morning when you wake, you — while you would still have tinnitus otherwise. may well discover that you still have — you really wouldn’t have a problem. tinnitus, and you could, therefore, Moreover, if your tinnitus made you Yes, sometimes tinnitus does start out your day disappointed. With feel less bad, then — while you would A go away on its own. There is the second approach, your day starts still have tinnitus — you would have no hard data, but it happens more out exactly as expected, and if one less of a problem. With daily disap- frequently than you might imagine. It day you notice that your tinnitus is pointment, adopting the second ap- is more likely to occur within the first gone, then you can be absolutely proach can be very powerful indeed. year or two, but even after a decade, thrilled to have been wrong in your Any strategies that serve to lessen tinnitus can spontaneously resolve for initial assumption. the impact of tinnitus on your life — no apparent reason. In terms of how Early on in my own tinnitus odys- and there are many such strategies — to conduct your life, there is really no sey, I decided that it made no sense are worthy of serious consideration. “one size fits all” answer. at all for me to start out each day It’s just that I honestly do not think As I have come to see it, now disappointed if I didn’t absolutely have that spending any appreciable amount that you have had tinnitus for several to because I knew it would not affect of time hoping it will go away is one weeks and have been evaluated by my tinnitus itself in the least. So, I per- of them. Far better to assume it could an ENT, you have two choices from a sonally chose the second approach. In never go away and be overjoyed if you purely practical standpoint: you can my opinion, this is not a decision to be discover one day that you have been hope each and every day that you taken lightly. You are not reading this wrong all along.

28 Tinnitus Today Summer 2017 consultation corner 

What is the difference between present every time you purposely neomycin in a shingles vaccine is Q habituation and learning to live seek it. But with habituation you just on the order of 25 μg (or 0.025 mg), with tinnitus? don’t care. And if, as a result, you go which is not even remotely enough from being aware of your tinnitus 90 to cause auditory damage. From a When I think of learning to live percent of the time to being aware of tinnitus standpoint, I consider the A with tinnitus, I think of devel- your tinnitus 10 percent of the time, shingles vaccine to be completely oping effective strategies for coping in my opinion, that’s not learning to safe. If it is at all reassuring to you, with it or dealing with it. I think in live with your tinnitus. Rather, that’s I myself took the vaccine without particular of figuring out how to get learning to live without your tinnitus. giving it a second thought. through those “bad ear days.” Habitu- ation is something entirely different. I have heard that the shingles Q Stephen Nagler, MD, is a licensed physician Habituation is a process whereby vaccine contains neomycin, whose practice is devoted to the evaluation you react to your tinnitus less and which is ototoxic. Is it safe for a per- and treatment of individuals with severe less over time — and, consequently, son with tinnitus to take the vaccine? intrusive tinnitus and hyperacusis. He is a former chairman of the Board of Directors of become less and less aware of it. the American Tinnitus Association. He lives in With habituation, as with learning A Neomycin ototoxicity is Atlanta, Georgia, and runs a Q & A tinnitus site to live with it, your tinnitus is still dose-related. The amount of at: www.tinn.com

Tinnitus Today Summer 2017 29  it’s all about support

Giving Time, Money, and Hope Photo by Ajae González of R

By Joy Onozuka

“Fundraising is a part of me,” said Sal Gentile, ATA’s new National Support eel Wicked Group Liaison, after his most recent fundraiser for the American Tinnitus Association. “I like the challenge, (and) want to give back and help others,” said Gentile, who held the fundraiser in the spring at The Villages in Florida. Gentile devotes significant time and energy to fundraising and helping From left to right, Mattie and Sal Gentile, Robert Mladinich, Michael and Betty Domino people with tinnitus, because he be- lieves greater support and awareness His tinnitus has four different sounds participated in a Q&A session. For Gen- are crucial for everyone — from those at 83 decibels, which is as loud as the tile, it took weeks of preparation and with the condition to researchers human voice in normal conversation. one night of fun to raise $700, which trying to find a cure. The noise continues, so he draws on included cash contributions and money He supports the ATA, because it Spankovich’s techniques daily to man- from an auction. The money will go was the organization’s patient pro- age it. “I feel so good about my life,” toward ATA’s Research Program. vider network that brought him to a he said. “My job is to educate and “I run on compassion,” he said. He tinnitus-savvy doctor who helped him promote (tinnitus awareness).” also knows from the many people he regain control over his life. Gentile was Gentile also wants to have fun while encounters that he provides an exam- struck with the sudden onset of tinni- raising awareness, which is the im- ple of what is possible when effective tus in the summer of 2011, and before petus behind his ATA fundraisers. The treatments and broad-based support he found the provider through the ATA, most recent was billed as “The Villages converge. he had spent a frustrating year visiting Meets Hollywood” and included the “When people see what I do, more than a dozen doctors, none of premiere of the indie film, The Expedi- knowing I hear four different sounds, whom had provided meaningful care. tor. Directed and co-written by Michael they want to be like me,” he said. “I needed help and hope,” said Domino, the red-carpet buzz of the If you are interested in learning Gentile, recalling his first encounter evening drew a crowd of 125 viewers. more about fundraising for the ATA, with Dr. Christopher Spankovich, who Domino even attended the premier or locating a tinnitus support group, was a tinnitus professor at the Univer- with co-writer Robert Mladinich, both email: [email protected] sity of Florida. (Spankovich is currently of whom are from New York City, and an associate professor at the Univer- sity of Mississippi Medical Center.) “Spankovich gave me my life back.” “I run on compassion,” Gentile said. He also knows Through Spankovich’s approach to from the many people he encounters that he provides treatment, including sound therapy, meditation, and cognitive behavior- an example of what is possible when effective al therapy, Gentile learned how to treatments and broad-based support converge. disengage from the incessant noise.

30 Tinnitus Today Summer 2017 it’s all about support 

Quiet Understanding, Depth of Knowledge, and Empathy Can Equal Great Leadership

By Joy Onozuka

When one hears the word “leader,” there’s an assumption of strength and responsibility. Leaders are thought of as larger than life and bold. Sal Gen- tile would argue otherwise. He might posit that quiet understanding, depth of knowledge, and empathy can make a great leader too. That is why he has partnered with the American Tinnitus Association to serve as a liaison to support group leaders and those interested in becoming more proactive in tinnitus support and awareness around the country. Gentile is himself a tinnitus sup- “Many people don’t have support stress and isolation that tinnitus often port group leader, who enjoys pulling groups, so they call for help,” Gentile triggers. together large groups. As such, he said. It is those calls for help and the “A leader has to get things started knows firsthand that many of those resulting conversations that keep him and step back. I’ve learned so much who have tinnitus can be pathfinders, going, no matter what the challenge. from my audience,” Gentile said. a term he prefers over leader. He remembers all too well how hard “You can use your weaknesses as an “Sometimes we think because we it was living with tinnitus on his own. advantage to overcome things.” have so many personal or medical His goal now is to help others find, The real challenge in Gentile’s view challenges that we are just followers and in some cases launch, support is that tinnitus is invisible. A support who let others lead, because we are groups, because the demand for face- group, therefore, provides a vital not strong enough to help ourselves. to-face discussion is urgent. connection and opportunity to find Not true,” said Gentile. “If we use the Because tinnitus is different for strength through shared experience. condition as a positive tool to help each person, no one person can To learn more about starting a others, we learn that leading mends understand all the challenges that an support group, contact Gentile at: the heart and soul. It makes us feel individual is experiencing. However, in [email protected] stronger, creates a happier lifestyle, a group setting, there is the power of Email ATA: [email protected] and gives us personal insight into our compassion, sharing, and real con- The ATA Support Group Leader own problems. nection, all of which can alleviate the Guide is available on our website: www.ata.org

Tinnitus Today Summer 2017 31  it’s all about support

ATA Support Network Calendar Patients can support one another by sharing personal experiences and providing a sympathetic ear. Attend a local support group and discover how fellow patients manage their tinnitus. To view all ATA support group locations, visit: www.ata.org/managing-your-tinnitus/support-network/support-group-listing

California E: [email protected], Colorado [email protected] North San Diego County Denver Tinnitus Support Tinnitus Support Group August 2—6:00 pm Group Rancho Bernardo Library September 6—6:00 pm Lutheran Medical Center 17110 Bernardo Center Dr. October 4—6:00 pm Second Floor Learning Center San Diego, CA 92128 November 1—6:00 pm 8300 West 38th Contact: Eli Tyler December 6—6:00 pm Arvada, CO 80033 T: 951-505-9200 Contact: Rich Marr August 24—3:30 pm E: [email protected] San Francisco Tinnitus T: 303-875-5762 Sept 28—3:30 pm Support/Education Group E: [email protected] August 15—6:30 pm October 26—3:30 pm Hearing and Speech Center of September 19—6:30 pm August 14—7:00 pm November Date and Time TBD Northern CA October 17—6:30 pm September 11—7:00 pm Dec 28—3:30 pm Conference Room November 21—6:30 pm October 9—7:00 pm 1234 Divisadero St. December 19—6:30 pm November 13—7:00 pm Tinnitus Self-Help Group of San Francisco, CA December 11—7:00 pm Palm Beach County Contact: Malvina Levy, AuD, or Orange County Tinnitus South County Civic Center Tracy Peck, AuD Self Help Group Florida 16700 Jog Road T: 415-921-7658 Mariposa Women and Family Sarasota Tinnitus Support Delray Beach, FL 33446 E: [email protected] Center Group Contact: Ellen Gartner 812 Town and Country Road August 22—5:30 pm Silverstein Institute T: 800-732-9217 Orange, CA 92868 September 19—5:30 pm 1901 Floyd St. Meetings resume in October. BUILDING C October 24—5:30 pm Sarasota, FL Contact Mari Quigley-Miller December 5—5:30 pm Contact: Carmen Trotta Michigan T: 714-317-9420 T: 941-993-7616 Holland Tinnitus Support E: [email protected] Los Altos Hills Tinnitus E: [email protected] Group Support Group August 5—12:30 pm October 20, Time TBD Holland Doctors of Audiology 2670 Arastradero Road October 7—12:30 pm November 17, Time TBD 399 E 32nd St. Classroom 16 November 4—12:30 pm December 15, Time TBD Holland, MI 49423 Los Altos Hills, CA 94022 Contact: Stelios Dokianakis, AuD Contact: Ken Adler, Amy San Diego Tinnitus Support The Villages Tinnitus T: 616-392-2222 Nelson, AuD Group Support Group E: [email protected] T: 650-839-1770 San Diego City Library Churchill Street Recreation E: [email protected], Aug 1—6:00 pm North University City Branch Center [email protected] Sept 11—6:00 pm 8820 Judicial Dr. 2375 Churchill Downs Oct 30—6:00 pm San Diego, CA 92122 August 10—6:45 pm The Villages, FL Nov 27—6:00 pm Contact: Jack Innis, Loretta September 14—6:45 pm Contact: Sal Gentile Dec 18—6:00 pm Marsh October 12—6:45 pm T: 813-503-1421 T: 858-484-9267 November 9—6:45 pm E: [email protected] December 14—6:45 pm

32 Tinnitus Today Summer 2017 it’s all about support 

Missouri South Jersey Tinnitus Oregon Washington Support Group St. Louis Tinnitus Support VA Portland Health Care Seattle Tinnitus Support 1020 North Kings Highway Group System Tinnitus Education Group Suite 201 St. Louis County Library Group Greenwood Public Library Cherry Hill, NJ 08034 Headquarters National Center for 8016 Greenwood Ave. N Contact: Linda Beach, East Room Rehabilitative Auditory Research Seattle, WA 98103 MaryAnn Halladay, Barbara 1640 S. Lindbergh Blvd. 3710 SW US Veterans Hosp. Rd. Contact: Keith Field Kennedy St. Louis, MO 63131-3598 Portland, OR 97239 T: 206-783-7105 E: [email protected], Contact: Tim Busche Contact: Bryan Shaw E: [email protected] [email protected], T: 636-734-4936 T: 503-220-8262 x55568 [email protected] Meetings typically held on the E: [email protected] E: [email protected] 3rd Thursday of each month. September 7—7:00 pm August 09—7:00 pm Meeting dates and times TBD. October 5—7:00 pm October 04—7:00 pm Washington, D.C. November 2—7:00 pm December 06—7:00 pm Texas DC Tinnitus Group December 7—7:00 pm Dallas/Ft. Worth Tinnitus Georgetown University New Jersey Support Group Medical Center New York Jersey Shore Tinnitus Texas Health Presbyterian Medical and Dental Building The Long Island Tinnitus Support Group Hospital Plano Room SW107 Group 302 Hawthorne Ave 6200 W Parker Rd. 3900 Reservoir Rd. NW Long Island Jewish Hospital Point Pleasant Beach, NJ 08742 Plano, TX 75093 Washington, DC 20007 Second Floor Conference Contact: James Malone or Contact: Ted Turesky, PhD Room T: 732-714-7040 Callier Center for T: 207-807-0962 900 Franklin Avenue E: [email protected] Communication Disorders E: [email protected] Valley Stream, NY 11580 1966 Inwood Road September 9—11:00 am Contact: Lisa Kennedy, Meeting dates and times TBD. Dallas, TX 75235 November 11—11:00 am Anthony Mennella Contact: John Ogrizovich T: 516-313-8061, 516-379-2534 E: [email protected] Tinnitus Self-Help Group, E: [email protected] Ewing Meeting dates and times TBD. September 25—7:30 pm 100 Scotch Road October 30—7:30 pm Ewing, NJ November 27—7:30 pm Contact: Dhyan Cassie, AuD December 11—7:30 pm T: 215-984-8380 E: [email protected] September 16—10:00 am

n Some groups do not schedule their meetings far in advance due to leader availability and/or to allow for flexibility when sched- uling speakers or for other reasons. These meetings were provided to ATA staff at the time of publishing. It is important to double-check the ATA Events calendar at ATA.org for the most up-to-date information on Support Group/Self-Help meetings. n This is only a partial listing of support groups and scheduled meetings. A full listing can be found at ATA.org/managing-your-tinnitus/support-network/support-group-listing. Also, new groups form all the time, so be sure to check back frequently if you don’t see one in your area. n Interested in starting a support group in your area? Please contact Sal Gentile, National Support Group Liaison, at: [email protected]. n If you don’t see a group in your area, but want to connect with a support system, ATA also has Help Network volunteers who provide one-on-one email and phone support and education. You can view that listing at: ATA.org/managing-your-tinnitus/support-network/help-network-listing

Tinnitus Today Summer 2017 33  technology Would You Consider Buying Personal Sound Amplification Products at a Store Near You?

By Joy Onozuka Not everyone agrees that cost is a driving factor behind low usage Not everyone with tinnitus expe- of hearing aids. In countries where riences hearing loss, but many do. hearing aids are covered by insurance, Unfortunately, many with mild tinni- adoption remains well below 50 per- tus don’t get a hearing exam, which cent, with the highest usage found in might uncover undetected hearing Norway at 42.5 percent, followed by loss. In fact, skipping hearing exams the United Kingdom at 41.1 percent, is common across the general and Switzerland at 38.8 percent. population, which reflects The creation of an FDA-approved a lack of understanding category for over-the-counter wearable of how even mild hearing hearing aids is expected to attract loss can impact quality makers of what are now known as of life and overall general personal sound amplification products well-being. However, with the hearing-aid options, reduce cost, (PSAPs) into the hearing-aid market. unprecedented shift in demograph- increase market transparency, PSAPs have been on the market for ics, as the population of older Ameri- spur innovation, and increase market years, with cutting-edge devices oper- cans increases, hearing healthcare and competition. ating much the same way as hearing increased access to hearing aids have The most prominent example of aids. However, because they aren’t become topics of national concern. this was the unveiling of the Over-the- FDA approved, such devices are mar- Recent studies show that hearing Counter Hearing Act of 2017 in the keted as consumer electronic devices loss can contribute to a host of debili- spring, which was greeted with much to non-hearing-impaired consumers to tating health issues, including demen- fanfare. Senator Elizabeth Warren amplify such things as music, conver- tia, depression, and balance problems. (D-Mass) said, “Allowing hearing aids sations, and animals rustling in the However, only one in five of those to be sold over the counter will help woods. with hearing loss uses hearing aids. bring down costs and expand con- Advanced PSAPs are sophisticated Moreover, as many as 67 to 86 per- sumer choices so that millions more earbuds equipped with a computer cent of those age 50 years and older Americans can find affordable hearing device that can control environmental who would benefit from using hearing aids.” sound. Accompanying smartphone aids opt not to use them. Reasons cit- This legislation reflects, among oth- apps for some devices can be pro- ed for not wearing hearing aids include er things, recommendations made in a grammed so that the earbuds auto- cost, denial of hearing-loss severity, 2016 report by the National Academies matically adjust volume in identifiable vanity, and the perceived social stigma of Sciences, Engineering, and Medi- settings, like an office or bustling café. of wearing them. cine to create a new Food and Drug Current drawbacks for such devices, With a greater understanding of Administration (FDA) device category as noted in a recent Business Insider the ramifications of leaving hearing for over-the-counter (OTC) wearable review include the low life of batter- loss untreated, changes in the dynam- hearing devices for individuals with ies, which make them impractical and ics of hearing healthcare for adults mild to moderate hearing loss. unreliable for lengthy events. Quick are underway and aim to increase improvements and reduced glitches

34 Tinnitus Today Summer 2017 technology  are expected as consumer demand missing underlying medical conditions, devices to meet the specific hearing increases. Moreover, one company as well as injury from inserting buds in needs of an individual. Less expensive is designing products that aim to be their ears, as can happen with earwax and sometimes less sophisticated fashionable and fun to help destigma- buildup. While the OTC devices would hearing aids can be purchased online tize hearing loss. not be intended for those with more and through retailers like Costco and While amplification technology has severe hearing loss, a lobbying effort is Sam’s Club. However, since Medicare been around for decades, the required underway to change the legislation to and private insurance companies don’t circuitry only recently has become limit the functionality of OTC hearing normally cover the cost of the hearing inexpensive enough to manufacture products so they only address mild aids or the visits, many opt not to be products en masse, according to hearing loss. fitted for them. Mead Killion, who invented analog hi-fi Until this year, there have been no To find out if PSAPs can help people amplification technology in 1988 and studies in the United States exam- diagnosed with mild to moderate hear- co-founded Etymotic Research, Inc., ining the effect of price and delivery ing loss, Consumer Reports conducted maker of The Bean Quiet Sound Ampli- model (consulting an audiologist using a very limited study on devices priced fier. Companies like Etymotic produce best practices versus self-selection from $20 to $350 and had the devices products to measure, enhance, and of an OTC hearing aid) to determine if assessed by a hearing-aid researcher protect hearing and, hence, would like- either or both factors would result in to check such things as amplification, ly benefit from changes in legislation. more people with mild to moderate battery life, and sound distortion. The legislation, if passed, could hearing loss using hearing aids. The Participants wore the devices sever- shake up the lucrative U.S. hearing-aid study, which was conducted using the al days in their offices, at home, in industry, which is dominated by six same hearing aids for a placebo group restaurants, and in an audio lab to de- companies — GN ReSound, Siemens, (with no amplification), an OTC group termine how well the devices helped Sonova, Starkey Hearing Technologies, that used instructional videos and their hearing in noisy environments. Oticon, and Widex. Together, these written materials for understanding They concluded that, like hearing aids, companies produce 98 percent of all their devices, and a group that worked the effectiveness varies between devices sold in the United States. with audiologists, found that price products. Some of the PSAPs, when The hearing-aid industry is send- didn’t influence the decision to buy the properly fitted and adjusted, did help ing mixed messages about the bill. hearing aids. people with mild to moderate hearing Opponents argue that hearing loss According to Consumer Reports, impairment. is complex and, therefore, difficult prescription hearing aids start at While the study was limited, it for consumers to self-evaluate. By about $1,650, which includes fees for illustrated the value of consulting an bypassing audiologists and medical working with an audiologist or hear- audiologist or other hearing specialist exams, they argue that people risk ing-aid specialist who fits and adjusts to determine which PSAP would be most suitable for one’s hearing needs. The debate over hearing healthcare and the proposed legislation With a greater understanding of the ramifications will continue as the bills work their way through Congress. Whatever of leaving hearing loss untreated, changes in the outcome, options for PSAPs and the dynamics of hearing healthcare for adults other assisted hearing devices will continue to grow, because interest are underway, and aim to increase hearing- in controlling environmental sound aid options, reduce cost, increase market remains high among a broad spectrum of consumers and the number of older transparency, spur innovation, and increase Americans with hearing loss continues to grow. market competition.

Tinnitus Today Summer 2017 35  my tinnitus journey The Spectrum of Hearing Loss, Tinnitus, and Constant Fatigue

By Joy Onozuka So, almost five months after going Those who use hearing aids and/ deaf, Rosen had out-patient cochlear or cochlear implants know that it is For 25 years, Janet Rosen compen- implant surgery and hoped for the recommended that they be removed sated for hearing loss through hearing best. She anticipated being unable and placed in a drying kit at night to aids. That all changed one morning in to hear clear sound when the device eliminate moisture absorbed while June 2013, when she woke up com- was activated three weeks later. “I being worn during the day. This helps pletely deaf and trapped by raging had read a lot of research and … avoid damaging or compromising the tinnitus in her home in West Bloom- knew that when you are first given longevity of the devices. field, MI. your processor you do not hear well.” About a year ago, when Rosen “It was horrific,” said Rosen, who She did, however, hear her audiologist took off the cochlear processor as sought immediate medical advice from clearly from the start. This represent- she prepared for bed, the tinnitus her audiologist and an ear, nose and ed a highly successful outcome. resumed. “The moment I take off my throat (ENT) specialist, both of whom “From that point on, it was a pro- processor, the tinnitus begins raging couldn’t provide a conclusive reason cess of rehabbing and programming again,” Rosen said. When she puts for the sudden onset of deafness. the processor with frequent map- the processor back in, the tinnitus She was put on a 28-day course ping,” Rosen said. With her hearing stops immediately. That continues of prednisone to see if the steroid restored and the tinnitus gone, Rosen today, so, as a result, Rosen struggles would restore her hearing. The stress was ecstatic! to find balance between allowing the of inexplicable deafness and high- For her right ear, Rosen was fitted processor to dry at night and getting pitched tinnitus was heightened by with a leading-edge hearing aid, which adequate sleep. what Rosen described as insensitive in combination with her cochlear Given the choice between taking medical care at the ENT office, rang- implant, enabled her to hear more antidepressants, Benadryl, or pre- ing from nonsensical advice to listen than 90 percent of sound. “High- and scription sleep medication to induce to an iPod to block out the tinnitus to soft-pitch voices are hard to hear,” she sleep, Rosen opted for Benadryl, the refusal of an audiologist to write said, and shared that sound direc- which enables her to sleep about five down answers to her questions about tionality remains a problem since the hours without the processor. She her deafness and treatment options. hearing aid and processor are different would prefer to take nothing, but has “I (was) totally deaf,” said Rosen, still modes of hearing. found the fatigue is too grueling. baffled by the senseless suggestion To ensure optimal hearing and op- Despite the various challenges, to listen to an iPod. eration of the cochlear implant, Rosen Rosen feels blessed by the gift of When the steroid treatment did not is examined biannually by her audi- restored hearing through her cochlear work, Rosen’s next step was evaluation ologist, who adjusts the processor’s implant, the ability to switch tinnitus for a cochlear implant. “After many electrodes. It’s a 90-minute mapping off by reconnecting her processor, tests, including an MRI, a brain scan, process, which demonstrates the and the proximity of her cochlear and evaluation by a neurologist, it was complexity of the technology, the need support group. determined that I qualified for and for regular care, and ongoing changes needed a cochlear implant,” she said. in the auditory processing system.

36 Tinnitus Today Summer 2017 giving 

Have You Considered Making a Charitable Gift to the ATA in your Estate Planning?

If the ATA has helped you or the ATA where the need is great- a loved one in the past, est. Another option is a resid- you can join us in uary bequest, which would helping others in the be the amount left in your future with a gracious estate after all specific act of generosity gifts are made, and all through an estate gift. debts, taxes, administra- Charitable gifts tive fees, probate costs, enable the ATA to fulfill and court costs are paid. its mission to find a cure Another option would be for tinnitus, as well as help to give a percentage of your those who currently strug- estate, rather than leaving a gle with it. The easiest planned specific sum, or give property to gift to implement is an estate gift. the ATA that could then be sold to All you have to do is name the ATA as a generate funds. beneficiary of your estate, according to the laws As you consult your attorney on the se- of the state in which you live. You can even name the lection of appropriate wording and your goals bequest in honor or memory of anyone you choose. regarding the ATA, be sure the organization’s legal Most donors leave their gifts to the ATA without name appears in all final documents as the “American restriction. However, the ATA will honor every donor’s Tinnitus Association.” It also is helpful to provide a stated request for how the gift is to be used, whether copy of the paperwork to the ATA once a bequest has made during their life or through their estate. All one been completed. has to do is ensure that specific bequest provisions are The ATA is honored to receive gifts from those who included in the estate documents, such as your will. feel that a cure for tinnitus is an important goal. If you Whether you choose a gift for a certain activity or would like to include the ATA in your estate planning, for the ATA to use as it sees fit, there are several types we would be glad to discuss your ideas. Please feel of estate gifts you can make. These include an unre- free to email ATA’s Executive Director Torryn P. Brazell stricted gift of a specific amount that can be used by at: [email protected]

Tinnitus Today Summer 2017 37  donors

Spotlight on Patient Providers

Stelios Dokianakis, AuD Deborah Lain, MSc, RPsych Gold Level Holland Doctors of Audiology Hope for Tinnitus Professional Members Holland, MI Calgary, AB, CANADA Listing current as of June 30, 2017 Sara Downs AuD Joanne LaPorta, MA When making an appointment, please say you Hearing Wellness Center Accent on Hearing learned about patient providers through the ATA Duluth, MN Denver, CO website or Tinnitus Today magazine. With this Kaela Fasman, AuD Malvina Levy, AuD information, providers understand the value of Sound Relief Hearing Center Hearing and Speech Center of Northern California being a part of the ATA network of patient support. Golden, CO San Francisco, CA Eugene Antonell, BC-HIS Michael Flores, AuD Ha-Sheng Li-Korotky, AuD, PhD, MD Hear Better Now, LLC University of New Mexico Speech and Hearing Sciences Pacific Northwest Audiology N. Dartmouth, MA Albuquerque, NM Bend, OR Jennifer Auer, AuD Lisa Fox-Thomas, PhD Matthew Lyon, MA Audiology by the Sound UNCG Speech & Hearing Center El Paso Hearing Aid & Audiology Center Ridge, NY Greensboro, NC El Paso, TX Carol Bass, MS Amanda Frazier, HIS Suzanne MacLaren, MA, RPsych All Ears Audiology ASI Audiology & Hearing Calgary Ear Centre Ithaca, NY Council Bluffs, IA Calgary, AB, CANADA Lisa Blackman, MS Belinda Gonzales, HIS Robert Mario, BC-HIS, PhD A Hearing Healthcare Center NuSound Hearing Center Mario Hearing & Tinnitus Clinics Philadelphia, PA Topeka, KS Canton, MA Granville Brady Jr., AuD MaryRose Hecksel, AuD Michael Messina, HIS Dr. Granville Brady, Jr. Audiology & Hearing Aid Center Clarity Hearing Aid Solutions East Brunswick, NJ Lansing, MI Summerfield, FL Gail B. Brenner, AuD James Henry, PhD Leah Mitchell, AuD Tinnitus & Sound Sensitivity Treatment Center of VA Portland Health Care System Sound Relief Hearing Center Philadelphia Portland, OR Westminster, CO Bala Cynwyd, PA Melanie Herzfeld, AuD Elizabeth Patterson, AuD Mindy Brudereck, AuD Hearing and Tinnitus Center REM Audiology Associates Berks Hearing Professionals Woodbury, NY Voorhees, NJ Reading, PA Bruce Hubbard, PhD Jeanne Perkins, AuD Bonita Chow, MSc, RAuD Cognitive Health Group Audiologic Services Calgary, AB, CANADA New York, NY Glen Ellyn, IL Carol Clifford, AuD David Illich, AuD Julie Prutsman, AuD Albuquerque Hearing & Balance Professional Hearing Associates, Inc. Sound Relief Hearing Center Albuquerque, NM Escondido, CA Highlands Ranch, CO Lois N. Cohen, LCSW, ACSW, BCD Marsha Johnson, AuD Stephen Reinshuttle, BC-HIS Northport, NY Oregon Tinnitus & Hyperacusis Treatment Center Florida Best Hearing LLC Lindsay Collins, AuD Portland, OR Sebring, FL Sound Relief Hearing Center Jeannie Karlovitz, AuD Jennifer Reynolds, AuD Centennial, CO Advanced Hearing Solutions Reynolds Audiology & Tinnitus Center John Coverstone, AuD Exton, PA Woodbury, MN Sentient Healthcare, Inc. Jason Kaufman, DC Ann Rhoten, AuD New Brighton, MN Scottsdale Neurology Kentucky Audiology & Tinnitus Services David Cuthbertson, AuD Scottsdale, AZ Lexington, KY Acadia Hearing Center Edward Keels, MA Christine Russell, AuD Ellsworth, ME Hear Now Hearing Aid Center Sound Relief Hearing Center Ali Danesh, PhD Philadelphia, PA Fort Collins, CO Labyrinth Audiology Beki Kellogg, AuD Mimi T. Salamat, PhD Boca Raton, FL Sound Relief Hearing Center Dr. Mimi’s Audiology Clinic Nikki DeGeorge, AuD Golden, CO Walnut Creek, CA Fayette Hearing Clinic Jennifer Klimczak, AuD Tiffany Sexton, AuD Newnan, GA Avalon Hearing Aid Centers Lifestyle Hearing Patrick DeWarle, AuD Sacramento, CA Rochester Hills, MI Winnipeg Hearing Centres Winnipeg, MB, CANADA

38 Tinnitus Today Summer 2017 donors 

Cindy Ann Simon, AuD Melissa Alexander, AuD Melissa Clark, AuD South Miami Audiology Consultants Alexander Audiology, Inc. Suncoast Hearing Services Plus South Miami, FL Santa Monica, CA Bradenton, FL Patrick Slater, MD Nicole Ball, AuD Shahrzad Cohen, AuD Austin Ear Clinic Hearing Evaluation Services of Buffalo, Inc. Auditory Processing Centers Austin, TX Tonawanda, NY Sherman Oaks, CA Randall Solomon, MD Saranne Barker, AuD Patrick Coughlin, AuD Island Psychiatry Raleigh Hearing and Tinnitus Center Hearing Care Professionals Port Jefferson Station, NY Raleigh, NC Aberdeen, SD Murray Steinfeld, BC-HIS, ACA Simon Barriga, PhD Ross Cushing, AuD Hearing Solutions of the Palm Beaches VisionQuest Biomedical, LLC A&A Hearing Group Jupiter, FL Albuquerque, NM Elkridge, MD Meg Stout, AuD Carol Bass, AuD Ann DePaolo, AuD Tinnitus Treatment Solutions (TTS) All Ears Audiology The Audiology Offices, LLC Campbell, CA Ithaca, NY Kilmarnock, VA William Stubbeman, MD Alyssa Beaton, AuD Patrick DeWarle, AuD TMS Psychiatry Hearing Evaluation Services of Buffalo, Inc. Winnipeg Hearing Centres Los Angeles, CA Orchard Park, NY Winnipeg, MB, CANADA Alicja Tobola Pamela Best Linda DiLiberto, AuD Metro Hearing and Tinnitus Treatment Clinic Best Hearing San Diego Northern Jersey ENT Associates Mississauga, ON, CANADA Vista, CA Midland Park, NJ Janusz Tobola Denise Bickley, AuD Cynthia Ellison, AuD Metro Hearing and Tinnitus Treatment Clinic Indiana Ear Franklin Hearing Center Mississauga, ON, CANADA Fort Wayne, IN Franklin, TN Jennifer Waddell, HIS Lisa Blackman Julie Farrar-Hersch, PhD Sound Hearing Care A Hearing Healthcare Center Augusta Audiology Associates Simpsonville, SC Philadelphia, PA Fishersville, VA Therese Walden, AuD Shelly Boelter, AuD Debby Feinberg, OD Potomac Audiology OHSU Sound Source Vision Specialists of Michigan Rockville, MD Portland, OR Bloomfield Hills, MI Thea Wickey, AuD Susan Boggia, AuD Michael Franklin, MD, DDS Highlands Ranch, CO Center for Better Hearing Buckland Ear, Nose and Throat, LLC Glens Falls, NY Manchester, CT Melissa Wikoff, AuD Peachtree Hearing Mary Bohr, AuD Myron Goldberg, MD Marietta, GA McGuire’s Hearing Services New York, NY Riverhead, NY Carolyn Yates, AuD Amy Greer, AuD Hearing Evaluation Services of Buffalo, Inc. Rebecca Boyce, AuD ENT Associates of Johnstown Amherst, NY Nyce Hearing Center, P.C. Johnstown, PA Plainfield, IL, Peter Harakas, PhD Rose Brakke, AuD Cognitive Behavioral Therapy Associates, LLC Silver Level Heartland Hearing Professionals PLLC Lexington, MA West Fargo, ND, Professional Members Robin B. Hardin, MA Listing current as of June 30, 2017 Chelsea Carter, AuD Athens Oconee Audiology UM Medical Center, Dept. of Otorhinolaryngology Watkinsville, GA When making an appointment, please say you Baltimore, MD learned about patient providers through the ATA Donna Hill, AuD website or Tinnitus Today magazine. With this Anne Carter, PhD, AuD Audiology Professionals information, providers understand the value of Pasadena Hearing Care Eugene, OR being a part of the ATA network of patient support. Saint Petersburg, FL Sharon Hirstein, MA Debbie Abel, AuD Linda Centore, PhD, NP Elkhart Audiology Rehab Audigy Group University of California School of Dentistry Elkhart, IN Vancouver, WA San Francisco, CA Sherry Hodge, AuD Catherine Ahrens-Berke, BC-HIS Maura Chippendale, AuD Advanced Hearing Care Ahrens Hearing Center Chippendale Audiology Anderson, IN Fair Lawn, NJ Cape Coral, FL Kara Houston AuD Jason Aird, AuD Jeffrey Clark, AuD Rush Oak Park Audiology Iowa Audiology and Hearing Aid Center Physician’s Choice Hearing & Dizziness Center Oak Park, IL Coralville, IA Tampa, FL Margaret Hutchison, PhD Austin Hearing Services Austin, TX

Tinnitus Today Summer 2017 39  donors

Wan Syafira Ishak, PhD Lauren Mann, AuD Richard Salvi, PhD Universiti Kebangsaan Malaysia UK Dept. of Hearing & Speech SUNY Buffalo/Center for Hearing and Deafness Kuala Lumpur, KL, MALAYSIA Kansas City, KS Buffalo, NY Coral Jud, AuD Randa Mansour-Shousher, AuD Lindsay Satchell, HIS Berry Hearing Aid & Audiology Center Northwest Ohio Hearing Clinic Woodland Tinnitus & Hearing Clinic Fort Dodge, IA Toledo, OH Williams Lake, BC, CANADA Casie Keaton, AuD Brooke Means, AuD Christina Seaborg, AuD Thrive Hearing and Tinnitus Solutions North Georgia Audiology Hearing and Balance Center Collierville, TN Gainesville, GA Charlotte, NC Edward Keels, MA Mary Miller, PhD Alyssa Seeman, AuD Hear Now Hearing Aid Center Premier Hearing and Balance Illinois State University Philadelphia, PA Hammond, LA Normal, IL Kristen Keener, AuD Pamela Montgomery-Earl, AuD Susan Sheehy, AuD IlluminEar Audiology Intermountain Audiology Alabama Hearing Associates Austin, TX St George, UT Madison, AL Suzanne Kimball, AuD Cristi Moore, AuD LaGuinn Sherlock, AuD University of Oklahoma Health Sciences Center Sonora Hearing Care, LLC Walter Reed Oklahoma City, OK Tucson, AZ Bethesda, MD Lyn Kirsch, AuD Amy Nelson, AuD Christina Shields, AuD Kirsch Audiology Landmark Hearing Services University of Maryland Medical Center Santa Monica, CA Sunnyvale, CA Baltimore, MD Philip Kolba, MA Northern Jersey ENT Associates Susan Shore, PhD Philip Kolba Psychotherapy Midland Park, NJ UM Medical School Portland, OR Ann Arbor, MI Marni Novick, AuD Kristen Kostkowski, AuD Silicon Valley Hearing Clinic, Inc. Abraham Shulman, MD Hearing Center Silver Spring Los Gatos, CA Martha Entenmann Tinnitus Research Center Silver Spring, MD Brooklyn, NY Ayo Ogunlusi, AuD Valerie Kriney, AuD Northern Jersey ENT Associates David Siegman, PsyD Northern Jersey ENT Associates Midland Park, NJ Highland Park, NJ Midland Park, NJ Ashley Penrod, PA-C Scott Sims, AuD Lindsay Lad, AuD Alta View Specialty Clinic Physician’s Choice Hearing & Dizziness Center University of Kansas Medical Center Sandy, UT Tampa, FL Kansas City, KS Andrea Pernick, AuD Martin Smith, PsyD Joanne LaPorta, MA South Miami Audiology Consultants Associates in Managed Care Accent on Hearing South Miami, FL Denver, CO Castle Rock, CO Jay Piccirillo, MD, FACS Judith Sonner, LICSW Vanessa Lee, MA Washington University School of Medicine Newton Biofeedback Auglaize Audiology Saint Louis, MO Newton, MA Wapakoneta, OH Bruce Piner, AuD Christina Stocking, AuD Beverly Lew, AuD Hearing and Balance Center University of Buffalo Speech and Hearing Clinic Sound Advice Encino, CA Buffalo, NY Burbank, CA Michelle Rankin, AuD Jennifer Sutton, AuD Terence Limb, AuD Ascent Audiology & Hearing Hearing Evaluation Services of Buffalo, Inc. Evergreen Speech & Hearing Clinic Chelsea, MI Williamsville, NY Kirkland, WA Stephen P. Ratner, BC-HIS Anne Marie Taylor, AuD Andrea Livingston, AuD Hearing Aid Discount Centers & Tinnitus Retraining Therapy ALPHA Audiology Hearing Health Services Central Florida Hearing Services Boynton Beach, FL Panama City Beach, FL Sebring, FL Jennifer Reekers, AuD Christine Wilson, MS Nancy Lucas, AuD Heartland Hearing Center Conejo Hearing Center Chisholm Trail Hearing Cedar Rapids, IA Westlake Village, CA Cleburne, TX Maria Rosa-Laycock, BC-HIS Deborah Woodward, AuD Dan R. Malcore Atlantic Hearing Aid Center Johns Creek Audiology Hyperacusis Network Fort Lauderdale, FL Johns Creek, GA Green Bay, WI Deanna Ross, AuD Michael Mallahan, AuD Albany ENT & Allergy Services PC Hearing and Balance Lab Albany, NY Mill Creek, WA Bonnie Rubin, AuD Rye Brook, NY

40 Tinnitus Today Summer 2017 Research news 

Tinnitus Treatment with Repetitive Transcranial Magnetic Stimulation

Summary by John A. Coverstone, AuD with nine days of a more standard protocol of rTMS stimulation. Subjects As tinnitus is redefined as a prob- were then brought back for follow-up lem of the brain and not just the ear, visits two weeks and 10 weeks after new technologies are being consid- treatment was concluded. ered for its treatment. Repetitive Fifty percent of the subjects transcranial magnetic stimulation reported immediate changes — or (rTMS) is one such technology. rTMS modulation — of tinnitus after the uses magnetic pulses directed at the initial treatment. There were no noted brain to stimulate target cortical areas temporal lobe of the brain contains differences in clinical or demographic in the hope of correcting maladapted the auditory cortex itself, which has characteristics of the group assigned (malfunctioning) neural pathways. shown promising results when stimu- to individualized treatment and those rTMS has been used as treatment for lated with rTMS. assigned to standard treatment proto- depression with varying results, and it The researchers at University of cols. Over the measurement period, is currently being studied for use with Regensburg applied stimulation to from baseline (before initial stimula- anxiety disorders, auditory hallucina- each of these areas — the dorsolater- tion) to 10 weeks post-stimulation, tions, and tinnitus. al prefrontal cortex and temporo-pa- scores on a tinnitus questionnaire In studies using rTMS for treat- rietal junction, to be specific — on showed a larger decline in tinnitus ment of patients with chronic tinnitus, each side of the brain. In addition, at severity for those receiving individual- procedures have largely been the each of these four stimulation sites, ized treatment than for those receiv- same for each subject and results patients received stimulation at five ing the standard treatment protocols. have varied widely from one individ- different frequencies, providing a total This study included a small num- ual to the next. However, a group of 20 different treatment protocols. ber of subjects and is viewed as a from the University of Regensburg After initial stimulation, researchers pilot study. It also lacked some of the in Germany has begun study of a asked patients to rate changes in their controls of a larger study, such as ran- more personalized approach that may tinnitus according to percentage of domly assigning patients to individual- improve outcomes. loudness. The most effective protocol ized and standard protocol groups and Previous studies revealed positive for each patient was then repeated including a control group that receives outcomes from rTMS stimulation of to ensure retest validity. The protocol only sham stimulation. However, the the prefrontal and temporal areas of also was repeated in a sham stimula- researchers demonstrated potential the brain. Some research has sug- tion to provide a control. for an individualized protocol with gested that areas of the prefrontal Patients who reported changes in rTMS, which may lead to more target- cortex, which modulate sensory infor- tinnitus were treated with stimulation ed treatment and better predictions of mation, may act as a gating system to the most effective prefrontal site outcomes. for tinnitus. Basically, it has been the- (right or left) and the most effective orized that the gate may be broken, temporo-parietal site for nine consec- http://journal.frontiersin.org/article/10.3389/ and, therefore, it cannot stop tinnitus utive (working) days. Patients who fneur.2017.00126/full signals from reaching the auditory did not experience immediate tinnitus cortex where sound is perceived. The changes on the first day were treated

Tinnitus Today Summer 2017 41  my tinnitus journey: poetic reflection

Sound Therapy (to Snoqualmie Falls, WA)

By Ann Ramsey

Worn and tired I was that day, Something happened in that place; A worker bee gone lost. My ringing seemed to cease. With GPS to make my way No one saw my teary face A shady park I crossed. As splendor lent me peace. I felt you before I heard you Did you see me by your side Like a freight-train on the line. Worshipping your waves? I heard you before I saw you, Distressed that I could not abide, Unexpected anodyne. Or take home the gift you gave. There your waters hurtled out, Even now recalling you, Your surface foam flowed down. I wish I could return, Rivulets threw themselves about To see your sparkling spray anew, As I stood in Sensaround. And hear your healing churn. I heard your deep and rumbling roar, A fulsome, luscious din Ann Ramsey lives with her husband and Maine Coon cat in Washington, That through my own tinnitus tore D.C. An avid photographer and occasional poet, she joined ATA in 2008. In December 2007, she developed severe tinnitus and hyperacusis from To let some respite in. unknown causes. By 2010, she became habituated. She attributes her improvement to a combination of medications, mindfulness based stress reduction (MBSR), cognitive behavior therapy (CBT), tinnitus retraining therapy (TRT), and hearing aids. To experience the sound and beauty of Snoqualmie Falls from the comfort of your home, please view the 2-hour relaxation video of the falls at: https://youtu.be/89opmzpKHls

42 Tinnitus Today Summer 2017 podcast summary 

Neuromodulation as a Tool for Changing Neural Pathways

Summary by John A. Coverstone, AuD neuromodulation strategies from which evolution of neuromodulation research. to choose. An important question that However, once the neuromodulation ATA had the pleasure of talking with researchers will need to answer is how treatments are refined and widely avail- Dr. Jinsheng Zhang about neuromod- your doctor will be able to determine able for use, further research will be ulation for tinnitus in our June Conver- which method of treatment will be needed to determine how and when sations in Tinnitus podcast. Zhang is appropriate for your tinnitus. and how much they should be used. immediate past chair of the ATA Scien- Does your tinnitus require transcra- Listening to Zhang speak about re- tific Advisory Committee, a member nial magnetic stimulation, or will elec- search in neuromodulation, it becomes of the ATA Board of Directors, and a trical stimulation or auditory stimulation evident that there is still much to be researcher at Wayne State University. be most appropriate? Perhaps a com- done in this important area of tinnitus In a nutshell, neuromodulation is bination of one stimulation type with treatment. However, we can also be any stimulation of nerve pathways a specific regimen of medications? excited about the advances being in the brain intended to change the Zhang said that research combining made in this field and the promise behavior or function of those nerves. treatment methods with pharma- neuromodulation holds for everyone According to Zhang, some forms of ceuticals may be the next step in the with tinnitus. tinnitus occur due to changes in the brain following acoustic trauma. This is a negative form of brain plasticity called maladaptive plasticity. Neuro- Everyone has a Story! modulation also relies on plasticity of ATA Wants to Hear from You the brain and is intended to disrupt the The ATA invites readers to submit their stories — short or long — about pathways creating the phantom sound living with tinnitus for possible publication. We’d like to hear from pain the hopes that they will recover nor- tients, healthcare providers, and loved ones. Topics include recapping how mally — meaning without tinnitus. it was triggered; how you cope; what challenges you face; how it changed Currently, neuromodulation may be your life; or how you were able to habituate. Suggested word length is accomplished in a number of ways, between 500 and 800 words. Please include contact information, so staff including electrical, magnetic, or acous- can reach you for permission to publish, as well as for additional details, tic stimulation. Zhang also described if needed. ATA reserves the right to edit for brevity, clarity and grammar. pharmaceutical treatment as neuro- Stories can be sent by email to [email protected] or by mail to ATA, 522 S.W. modulation for tinnitus. In the future, Fifth Avenue, Ste. 825, Portland, OR 97204 as a result, clinicians may have multiple

Tinnitus Today Summer 2017 43 Corporate Sponsor TinnitusToday

Silver

Hearing loss is the third most common chronic health problem in the United States, with almost twice as many people reporting it than those reporting diabetes or cancer, according to a 2017 report by the Centers for Disease Control and Prevention. Of the estimated 40 million adults, aged 20-69 years old, who have noise-induced hearing loss, about 1 in 4 who report “excellent to good” hearing already have hearing damage. (www.cdc.gov)

44 Tinnitus Today Summer 2017 TinnitusToday Editorial Calendar 2017

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

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

Editorial Digital Issue Issue Theme Copy Due Photos Due Ad Close Launch Mailed

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

Spring Apr 2018 Habituation 2/1 2/1 2/1 4/15 April

Summer Aug 2018 Pharmacology 5/1 5/1 5/1 7/15 August

Editorial Calendar is subject to change.

To advertise, or to request a customized corporate sponsorship, contact: Kathleen Turner, Donor Relations Specialist, at: [email protected]

MISSION The American Tinnitus Association improves the lives of people with tinnitus and related conditions by providing education, support, advocacy, and funding research for a cure.

CORE PURPOSE To promote relief, prevent, and eventually cure tinnitus.

CORE VALUES & 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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Podcast 1: Clinical Aspects of Tinnitus Podcast 4: Ringing Ears and the Neuroscience of ReleaseD: February 2017 Tinnitus Subject Matter Expert: David Baguley, PhD, MBA Release: August 2017 Topic: Dr. Baguley discusses the journey of a person with tinnitus, from the Subject Matter Expert: Larry E. Roberts, PhD moment a problem is registered to the point he/she recognizes there may be Topic: Listeners learn from Dr. Roberts how specific features of sounds and no quick fix. The conversation touches on the patient and healthcare provider their corresponding significance differ from person to person. Due to that relationship, current research, the importance of support groups, and hope for uniqueness, sounds — and the way the brain responds to them — are not future advancements in treatments and a cure. something that can be deciphered through genetic coding. Dr. Roberts will Podcast 2: Sound Therapy address this challenge of uniqueness and how the brain contains mechanisms for neural plasticity that tune auditory neurons to represent the sounds that ReleaseD: April 2017 are meaningful to us. Subject Matter Expert: Richard Tyler, PhD Topic: Listeners learn about research and treatment through Sound Therapy, Podcast 5: The Latest Research on Tinnitus which can reduce stress and enable tinnitus and hyperacusis sufferers to Management engage more effectively in dynamic environments. Thoughts on obstacles Release: October 2017 toward cures and treatment are also shared. Dr. Tyler also spoke about the Subject Matter Expert: James Henry, PhD University of Iowa’s “Management of the Tinnitus & Hyperacusis Patient” Topic: Dr. Henry’s goal is to develop and validate clinical methodology for practitioner conference, which ran June 15-16. Having founded the annual effectively helping individuals who are afflicted with bothersome tinnitus. In conference 25 years ago, Dr. Tyler discussed how it has evolved to serve this podcast, listeners will learn about the latest research and studies related the needs and interests of patients, researchers, clinicians, audiologists, and to tinnitus clinical management. Listeners also will hear about the Veterans other healthcare providers. Administration’s tinnitus management program. Podcast 3: Neuromodulation to Suppress Tinnitus Podcast 6: How the ATA Helps Improve the Lives of ReleaseD: June 2017 People with Tinnitus Subject Matter Expert: Jinsheng Zhang, PhD Release: December 2017 Topic: Dr. Zhang discusses his research in neuromodulation, which involves Subject Matter Expert: Torryn P. Brazell, MS, CAE stimulation of a variety of peripheral and brain structures, through direct TOPIC: ATA is the nation’s foremost trusted organization committed to finding and indirect approaches. This groundbreaking research, involving animal treatments and a cure for tinnitus and associated disorders. ATA’s commitment and human subjects, shows promising results toward providing potential demands focus, determination, strategy, and resources. Brazell, marking her relief for tinnitus sufferers. Listeners hear Dr. Zhang discuss the research, first anniversary as ATA’s Executive Director, will discuss how ATA fulfills its its underlying mechanisms, and how it might translate into treatments for mission by funding targeted research projects; providing education, hope, and suppressing tinnitus. support for the tinnitus community; advocating for effective public policies focused on advancing science toward cures for tinnitus and related conditions; To ensure that podcast content is available to the broadest and collaborating with others to promote awareness, encourage prevention, audience possible, particularly those with impaired hearing and ultimately silence tinnitus. or noise sensitivity, transcripts are available on our website: To listen to ATA podcasts, visit www.ata.org www.ata.org/podcasts