TINNITUSTODAY To Promote Relief, Help Prevent, and Find Cures for Vol. 44, No. 2, Summer 2019

The Beauty and Dangers of

Understanding Why People Are Drawn to

Famous Musicians with Tinnitus

Tinnitus Retraining Therapy Findings

Tinnitus Tools • Internet Music and Radio for Tuning Out Tinnitus • High-Fidelity that Maintain Quality

A publication of the

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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 Vol. 44, No. 2, Summer 2019

PERSONAL STORIES SPECIAL FEATURES The Dangers of Loud 14| Music: Let’s Turn the Music Was Magic Until Why Do We Like Volume Down 6 | the Ringing Began 4 | Listening to Loud Music? Michael Santucci, 11 | Conservationist for America’s Music Legends

Dangerous : 26 | The Drive to Educate One Loud Night and Change Listening 22 | Too Many Behavior How Tinnitus Musicians Should Changed My Life Music Therapy to 33 | 13 | Invest In Custom-Fit 38 | Heal the Mind and High-Fidelity Earplugs Emotions YOUR HEALTH

A Musician’s Exposure to SCIENCE & RESEARCH NEWS Does Tinnitus 9 | 36 | Retraining Therapy Loud Music: Most People Prefer Improve Quality of Life? A Case Study 17 | Music at Lower Volumes Gender Association of 41 | Tinnitus and Suicide Neurofeedback to Alter Attempts 24 | Brain Waves Associated With Negative Tinnitus

TINNITUS TOOLS & RESOURCES

Be Ear-Responsible: 21 | High-Fidelity Auditory Injury Earplugs for 19 | is Permanent, Safer Quality so Wear Sound Earplugs An Endless Variety What 42 | of Music and 31 | Noise Level Is Safe? Tinnitus Retraining 34 | Therapy Trial Support Group Demonstrates 44 | Locations TRIBUTE the Importance of Spotlight on Patient Counseling and Sound ATA Board of Directors Enrichment 46 | Providers 43 | Tribute  FROM THE BOARD CHAIR Music to My Ears

MANAGING EDITOR In my youth, my friends and I attended rock concerts Joy Onozuka American Tinnitus Association and afterward laughed about the ringing in our ears that was so bad we could hardly hear one another—a concert PUBLISHER souvenir we thought was a normal part of the experience. Torryn P. Brazell, CAE American Tinnitus Association We always assumed our hearing would return to normal by morning. Little did we know that we were laying the PRODUCER AND WRITER groundwork for possible future hearing difficulties and John A. Coverstone, AuD Sentient Healthcare, Inc. tinnitus, which are permanent, not transient, conditions. Back then, we thought we were invincible. Sadly, we EDITOR-AT-LARGE were simply uninformed about the danger loud sound Robert Sweetow, PhD University of California, San Francisco posed to our hearing health. Exposure to loud sound— even when we love the sound—can cause tinnitus, EDITORIAL ADVISORY PANEL Jill Meltzer, AuD , and hypersensitivity to sound. But how James A. Henry, PhD Chair, Board of Directors National Center for Rehabilitative Auditory loud is too loud? Is it bad to wear ? As an Research (NCRAR) audiologist, my answer is generally, “No, it’s not inherently U.S. Department of Veterans Affairs dangerous to wear earphones. It depends on how loud Gail M. Whitelaw, PhD and how long.” Department of Speech and Hearing Science Today, more student musicians and adults are using The Ohio State University hearing protection, such as high-fidelity earplugs, which DIGITAL DESIGN & PRODUCTION TEAM offer different levels of noise protection depending on JML Design, LLC the filters used. Famous musicians who have spoken ADVERTISING publicly about their struggles with tinnitus and hearing Tinnitus Today is the official publication of the loss have raised awareness. American Tinnitus Association. It is published Researchers continue to study species, such as fish three times per year in April, August, and December and mailed to members and and birds, that regenerate damaged hair cells in hopes donors. The digital version is available online of discovering how this can be done in humans—a at www.ata.org. To grow your company’s complicated objective. Our best strategy is to protect our brand reach, contact [email protected].

hearing by using earplugs and limiting our time around ATA HEADQUARTERS loud noise. American Tinnitus Association 8300 Boone Blvd, Suite 500 Vienna, VA 22182 USA T: 800.634.8978 (Toll Free) T: 202.800.6590 www.ata.org

TO GIVE TO THE ATA American Tinnitus Association PO Box 424209 Support the American Tinnitus Association by Washington, DC 20042-4049

Shopping at The American Tinnitus Association is a non- When you’re shopping for yourself, friends and family on Amazon, the American Tinnitus profit corporation, tax-exempt under 501(c) (3) of the Internal Revenue Code, engaged in Association hopes you’ll link your shopping account to , the online retailing educational, charitable, and scientific activities. company’s generous program that enables you to shop and contribute to your favorite nonprofit organization at the same time. Amazon pays all program expenses and donates half Tinnitus Today magazine is © copyrighted by of a percent of the cost of your eligible purchases to your favorite earmarked charity. Won’t you the American Tinnitus Association. choose the American Tinnitus Association to help us advance tinnitus research and treatments? ADVERTISEMENT Publication of any https://smile.amazon.com/ch/93-0749558 advertisement does not in any way or manner constitute or imply ATA’s approval or endorsement 2 TINNITUS TODAY SUMMER 2019 of any advertised product or service. FROM THE PUBLISHER 

ATA BOARD OF DIRECTORS Jill Meltzer, AuD, Chicago, IL—Chair My Music Therapy for John Minnebo, MBA, Philadelphia, PA—Vice Chair Thomas Lobl, PhD, Valencia, CA—Secretary Tinnitus and Life David Hadley, MBA, San Francisco—Treasurer Ron Zagel, Grand Rapids, MI—Assistant Treasurer When you have tinnitus, self-care strategies for Phillip Gander, PhD, Iowa City, IA staying mentally and physically healthy are essential. On Bar-Giora Goldberg, San Diego, CA the basis of research and testimonials, I know yoga and Michael E. Hoffer, MD, FACS, Miami, FL meditation are great practices for cultivating a sense of Jeannie Karlovitz, AuD, Downington, PA control over tinnitus. But, for me, music is my therapy and Gordon Mountford, CPA, South Pasadena, CA personal passion. Every day that I am swept away by the Robert Travis Scott, Baton Rouge, LA world of music is a good one. LaGuinn P. Sherlock, AuD, Bethesda, MD— Wherever I go and whenever I can, I attend live Immediate Past Chair music performances. And, yes, every handbag, glove Robert M. Traynor, EdD, MBA, Ft. Collins, CO Joseph Trevisani, New York, NY compartment, and set of keychains has a pair of earplugs, Ted Turesky, PhD, Boston, MA or ear defenders, ready for me so I can make the most of Torryn P. Brazell, CAE an evening surrounded by loud sound without amping up Melissa Wikoff, AuD, Atlanta, GA Publisher Jinsheng Zhang, PhD, Detroit, MI my tinnitus or further damaging my hearing. Torryn P. Brazell, Vienna, VA—Ex-officio Like some of the people described in this issue, I am drawn to loud music for the sense of community it HONORARY DIRECTOR engenders, the excitement, the opportunity to talk to William Shatner, Los Angeles, CA The opinions expressed by strangers, and the power of music to silence personal contributors to Tinnitus Today ATA SCIENTIFIC ADVISORY COMMITTEE concerns. But it’s not exactly an escape, because I am are not necessarily those of Michael E. Hoffer, MD, FACS—Chair the publisher or the American University of Miami Health System, never really off-duty in my mission to raise awareness of Tinnitus Association. This Miami, FL USA tinnitus and prevent others from developing it. publication provides a variety Carey D. Balaban, PhD I arrive at every concert with spare earplugs to pass of topics related to tinnitus for University of Pittsburgh, Pittsburgh, PA USA out to others in my midst. And although the American informational purposes only. Shaowen Bao, PhD Tinnitus Association doesn’t endorse products because ATA’s publication of any adver- Helen Wills Neuroscience Institute, tisement in any kind of media Berkeley, CA USA what works for me may not work for you, I have lots of personal favorites that I share because they’re affordable does not, in any way or man- Christopher R. Cederroth, PhD ner, constitute or imply ATA’s Karolinska Institute, Stockholm, Sweden and don’t interfere with the quality of the sound that I paid approval or endorsement of Marc Fagelson, PhD good money to hear. So, I hope you too enjoy live music any advertised product or East Tennessee State University, and have an array of high-fidelity earplugs to make that service. ATA does not favor Johnson City, TN USA experience ear healthy and safe! or endorse any commercial Fatima T. Husain, PhD product or service. University of Illinois, Urbana-Champaign, Champaign, IL USA Mark S. Mennemeier, PhD University of Arkansas, Little Rock, AR USA Maria Rubio, PhD, MD University of Pittsburgh, Pittsburgh, PA USA Jeremy G. Turner, PhD Illinois College, Jacksonville, IL USA Tricia Scaglione, AuD University of Miami, Plantation, FL USA Roland Schaette, PhD Letters to the ATA UCL Ear Institute, London, England The ATA encourages readers to send comments and questions about  Grant D. Searchfield, PhD tinnitus and/or articles to [email protected]. Emails selected for publication University of Auckland, Auckland, NZ may be edited for brevity, clarity, and grammar. Richard Tyler, PhD University of Iowa, Iowa City, IA USA Fan-Gang Zeng, PhD University of California, Irvine, Irvine, CA USA TINNITUS TODAY SUMMER 2019 3  SPECIAL FEATURE

Why Do We Like Listening to Loud Music?

By David Welch, PhD, and Guy Fremaux, MAuD physiological, social, psychological, together, and we know that others and for personal identity. around us, be they strangers or Our ears are extremely delicate On a physiological level, loud music friends, feel the same. People structures designed to respond to arouses and excites us. Presumably, reported liking the sense of oneness tiny fluctuations in air pressure; their our auditory systems have evolved with others that they experienced exquisite sensitivity also renders to warn us about our environments in loud-music environments. On the them vulnerable when sound levels and our ears are deeply connected other hand, being in an environment become too great. Despite the danger to the parts of the brain that evoke with loud music fosters intimacy. For of injury, some loud sounds seem to arousal (the hypothalamus) and one thing, our barriers about personal attract people. This can be illustrated wakefulness (the reticular activating space are shattered by the practical by the fact that many people enjoy system) and that mediate emotions need to shelter conversations behind listening to very loud music, and it is (the amygdala). These systems can hands with mouths close to ears in often present in our lives. It is played be thought of as reflecting the deeper order to be heard. This unusual and at sports events, parties, bars, and animal parts of our natures that forced physical proximity feels good other places where people want to evolved for our survival. The loudness for people in societies where we are have fun. We seem to associate loud of music might activate the systems often rather isolated and where we music with fun. To understand better that kept our ancestors ahead of the demand our personal space. It also why this is the case, we conducted predators and that influence is very provides a socially acceptable excuse research interviewing people who strong: we feel thrilled; we want to for those with more amorous intent. identified themselves as keen night- move and dance; we feel alive! And once intimate contact is made, clubbers or who work in the nightclub On a social level, loud music the loud music provides a blanket sector.1 The answers that people gave seems to bring us together in two of privacy over the words that are were in line with our earlier theoretical ways. On one hand, people get a shared, allowing confidences and work and provided additional insight feeling of fellowship when in a loud- perhaps questionable things to be into how loud music is perceived sound environment. Maybe that is said without fear of judgment from as beneficial on several levels: because we feel the excitement others listening in. Conversely, loud sound also provides a way for people to "People reported liking the sense of separate themselves, providing an almost magical sense of altered oneness with others that they experienced environmental perception. For a in loud-music environments." start, the sounds of the outer world can be masked by music, so those

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distractions or irritants are removed, ways. The findings were broadly though, and our interviews suggested and the world beyond the enjoyable consistent with a theoretical model we that some nightclub patrons may not environment can be forgotten for developed: the CAALM (Conditioning, feel the same way. a while. This leads to a sense of Adaptation and Acculturation to Loud These findings give us ideas about peacefulness. What’s more, people Music) Model.2 The findings from our why the enjoyment of dangerously reported that the music seems interviews allowed us to observe how loud music is so difficult to remove. to drown out their own thoughts. the CAALM Model plays out in real As we develop our thinking, we hope Normally, our worries and anxieties life and extended it to give us deeper this will lead to more effective ways can gnaw at our inner beings even understanding. to convince people to protect their when we are apparently relaxed, The CAALM Model seeks to explain ears and to avoid the hearing loss but in the pounding of loud music, the process that leads people to desire and tinnitus that often occur after they too are masked, and the mind loud music. It postulates that there exposure to loud music. is empty and calm. And it may go are three main features: conditioning, beyond this, because the music adaptation, and acculturation. Classical David Welch, PhD, brings its own meaning. In following conditioning is the process explained has backgrounds in psychology, its patterns and imagining the with the example of a dog that hears physiology, and concepts it generates in our minds, it a bell ring every time food is delivered hearing health provides a new and wonderful world eventually starting to salivate at the promotion. His research includes the in which to be. So, loud music masks sound of the bell. We believe that influence of sound and the real world and our worries and people essentially become conditioned noise on people, and the subsequent effects transports us to a new carefree place. to enjoy loud music because it is so of hearing loss and tinnitus on other health and Fourth, people felt that loud music often present when they are having cognitive effects. Particular interests are the impact of noise-induced hearing loss and the could give them a stronger identity, fun. It is a paired association. influence of environmental noise on health and particularly one of personal power and The four levels of benefit from wellbeing. He is currently head of at toughness. This is a very interesting loud music suggest that loud music the University of Auckland, New Zealand. phenomenon and might be why may also bring benefits in its own loud music is often associated with right, and these would only add to Guy Fremaux, MAuD, masculinity: think of hard rock and the conditioning effect of the other is a senior audiologist at Northland District rap music; think of the anger and enjoyable activities that are paired Health Board. He has power in heavy metal. An explanation with it. The process of adaptation worked in both the for this may rest in the physiological is automatic and pre-conscious: private and public sectors in New arousal described above. Loud sounds when we enter a loud environment, Zealand. Along with an activate pathways in our brains that we can initially feel shocked by the emerging interest in balance system disorders mediate deep emotive responses: sound, but gradually, that passes; our and vestibular testing, he maintains interest warnings of danger. And one response auditory systems adapt, and we learn in research pertaining to recreational noise exposure and its effects. Often described as to danger is aggression and a fearless to tolerate the sound. Acculturation an urban renaissance man, he spends his free willingness to face down the threat. is a social process. It is the group time studying project management, learning If we can feel that we are brave and expectation of loud music when we languages, and playing guitar. invulnerable without actually putting are doing fun things. According to the ourselves at a perceived risk, then we nightclub managers we interviewed, 1 Welch, D., & Fremaux, G. (2017). Why do people like loud sound? A qualitative study. International might indeed enjoy the sensation. when people go to nightclubs, Journal of Environmental Research and , 14(8), E908. Put together, these four features of they expect loud music. Whether 2 Welch, D., & Fremaux, G. (2017). Understanding loud music exert a powerful influence this acculturation is as strong and why people enjoy loud sound. Seminars in Hearing, 38(4), 348–358. on us, making an environment filled complete as the nightclub managers with loud music appealing in many believe is an interesting question,

www.ATA.org TINNITUS TODAY SUMMER 2019 5  PERSONAL STORY

Music Was Magic Until the Ringing Began

By Gabriel Heredia all comes back together as a whole and I enjoy the song even more. As a musician and songwriter, I That sonic breakdown would help listen to music a bit differently from me write my own songs, and for the way people do if they don’t play me there was nothing better than music or compose. I hear the song plugging in my instrument, turning Late 2008, after a typical day of as a whole, then tune in to a certain it up, and strumming a chord. It studio work and rehearsal, I came instrument and follow that sound would be so loud that the room home with the usual ringing in my to the next one. I home in on the would shake. Add in the bass guitar, ears, confident that by the morning beat, single out the snare drum, kick then drums; my songs would it would be gone. The next day it drum and how they blend with the begin to roar from the speakers. was still there, but I didn’t worry be- synth sounds. I pick up the echo on You literally feel the music in your cause sometimes it took a few days the voice, the harmonies, then it bones. Everyone is in sync and to fade away. By the third day, not you’re in your element, nothing only was it ringing but it was also else matters. There is a sense of getting louder to the point that I joy, freedom, lightness as you play couldn’t think or concentrate. That’s your music almost in a trance. Two when I really started to worry, but I or three hours later, rehearsal is still had a job to do. over and there it is—the inevitable While I was on the mix stage, ringing in your ears—but you fine-tuning the sound for a feature, don’t mind because you know by the client asked me to stop and tomorrow it will be gone. I couldn’t listen for a hissing sound in the have been more wrong. dialogue. I played back the scene Ten years ago, my life consisted and heard nothing, so I figured he of waking up and heading to the was mistaken and continued. He recording studio. During the day, interjected, “Hey, Gabe, stop for a I would edit dialogue for TV or second. Are you sure you don’t hear features, record ADR (automated that? It’s pretty loud and it’s in the dialogue replacement) with actors, whole scene. Can we remove it?” or mix on an incredible mix stage I couldn’t hear the sound because for a few days at time or tune and the ringing in my ears was so loud tweak someone’s movie and bring it it was drowning it. I needed to to life sonically. I’d wrap up my day hear to be able to do my work and and head to rehearsal. To me, I was I couldn’t; that moment was the Gabriel Heredia playing guitar prior to living the dream. beginning of the end. developing tinnitus.

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I went home that night began What struck me the most during a thing, but no one on that platform researching online and discovered this period was I couldn’t find better talked about tinnitus. It took another “tinnitus.” In the first paragraph, information online about tinnitus. eight or nine years for me to discover I read, “There is no cure and it’s Facebook was still in its infancy and the American Tinnitus Association. permanent but treatable.” I felt a cold the internet was 1.0. Myspace was chill run down my spine and couldn’t breathe. The further I read, the more I realized that I had made a colossal mistake by not protecting my ears all those years. The next six months would be the most difficult of my life. Doctor visits were dead ends and the only “remedy” was antidepressants and advice that I learn to live with it. I found myself in the emergency room about twice a month suffering from massive panic attacks caused by the ringing as it got louder. I could only sleep in 30-minute to 1-hour spurts, waking panicked as the ringing blared. It was awful. I left the studio to my partner. And although I continued to write and play music (with ear protection this time), it would never be the same because I was now afraid of the thing that I loved the most. I thought about suicide because if the ringing got any louder, I knew I wouldn’t be able to handle it. I was depressed and anxious. My emotions seesawed back and forth constantly. In the following months, my sister, who was my roommate at the time, helped me get out of the house. I started eating healthier, cut out alcohol, exercised, practiced yoga, discovered meditation, and took vitamins. It made a difference. The ringing wasn’t as loud and I was a little more comfortable with it. Nights, however, were still terrible. And I now sleep with the TV on to mask it. Gabriel Heredia and his band Kill the Complex.

www.ATA.org TINNITUS TODAY SUMMER 2019 7  PERSONAL STORY

For me, that was a multifaceted part of mainstream conversation. you is when you’re at a concert or problem because I had seen at They, too, are vulnerable to sporting event or any place you know least seven different doctors and developing tinnitus from the work is going to be loud, bring earplugs, or audiologists and no one told me they do. Think of William Shatner, at least give your ears a break every about the ATA. When searching will.i.am, Eric Clapton, and so many 30 to 40 minutes by stepping away online, I was inundated with snake- others. If I had known then what I to take a break from the sound. It oil treatments. Nobody in my know now about the risks of loud can make a world of difference. circle of friends had ever suffered sound, I would’ve always worn from tinnitus, so it was extremely hearing protection. It would have Gabriel Heredia, 38, isolating. been a $2 solution to something that is a former sound re-recording mixer In the years before finding the will dog me for the rest of my life. and music producer, ATA, I just winged it, staying healthy Any person blasting their living in Sherman and wearing ear protection. My band headphones, standing in front of the Oaks, California. After developing tinnitus, disbanded because it just wasn’t the speakers at a show, or taking their he changed careers same. During the ensuing years, I children to a loud concert should be and now edits and would try to keep my finger on the aware of the risk and either turn the produces unscripted pulse of all things tinnitus—be it on volume down on the music or wear content for networks, including Bravo, Food social media platforms or forums— earplugs at the concert; it’s so worth Network, ESPN, and started to notice an increase in it. SO WORTH IT. If you’re in doubt, CNN, Discovery, and young adults suffering from tinnitus. ask the thousands of people on many more. In his 10th year with tinnitus, That’s when I knew I had to try to do Facebook or Reddit who talk about he considers himself habituated. He uses $10 earplugs available on Amazon whenever something because there was a void their struggles with tinnitus; how he’s in a loud environment. He began using in the media on the issue. Tinnitus they wish they could go back and hearing aids three years ago and found they is a complicated topic, it’s scary, it’s protect their hearing. helped with hearing in frequencies affected by hearing loss, which reduced the perception permanent, and there isn’t a quick-fix I feel like we’re just at the of tinnitus. Heredia produced the American cure. All of that is scary to people, beginning of getting the word Tinnitus Association’s first tinnitus awareness especially young adults who feel out on the importance of hearing clip last year as part of his commitment to invincible. protection and tinnitus awareness. making a difference and raising awareness Instead of turning a blind eye— That’s okay in some sense because online among teens or a deaf ear—I think well-known it is now easier than ever to have and young adults. musicians, athletes, movie stars, and a voice online that—with the right anyone else in the spotlight need message—will cut through the noise to embrace the topic so it becomes of the internet. My message to

"If I had known then what I know now about the risks of loud sound, I would’ve always worn hearing protection. It would have been a $2 solution to something that will dog me for the rest of my life."

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A Musician’s Exposure to Loud Music: A Case Study

By Robert M. Traynor, EdD, AuD carries a 17 percent chance of causing The issue the musician describes greater hearing loss and/or tinnitus.1 here does sound like a case of Gunderson (2018) indicates that temporary threshold shift. It is well Case Study many of the Rock n’ Roll era musicians known that when the human ear is A tinnitus patient was concerned have significant hearing loss and exposed to high levels of music or that his tinnitus had recently become tinnitus.2 As much as we all love noise, such as at a rock concert or constant. As a musician, he worried music, especially when it’s loud for band practice and around the roar of that in the future he wouldn’t be able those best songs, it places all of us in an airplane engine or a chainsaw, it to play his instrument and that the danger of hearing loss and tinnitus. undergoes a phenomenon termed tinnitus might get worse over time. Musicians, though, are exposed temporary threshold shift (TTS), which Additionally, he was concerned that to higher levels of intensity than their causes acute changes in hearing he might be more susceptible to audience is because they are generally sensitivity and is often accompanied by hearing loss because he already had right next to the sound source. Shrink tinnitus that will recover over time. If a tinnitus, but he had heard from others et. al. indicates that a musician’s that his issues could be caused by a proximity to the sound source temporary threshold shift. creates a higher intensity exposure and a higher incidence of hearing "…many of the Analysis loss than in the general population.3 First, evidence shows that existing Pragmatically, many professional Rock n’ Roll era hearing loss and/or tinnitus may musicians all over the world, no increase with continued exposure to matter the type of music (classical, musicians have high-intensity noise over time. And rock n’ roll, heavy metal, etc.), present a noise categorized as an acoustic with hearing loss and tinnitus that has significant hearing trauma—a one-time, high-intensity resulted from many years of practice loss and tinnitus." blast, such as an explosion or airbag sessions and stage performances.4 deployment in an auto accident—

www.ATA.org TINNITUS TODAY SUMMER 2019 9  YOUR HEALTH

person exposed to noise experiences subtle neural pathologies that may is a frequent lecturer in the United States and a TTS often enough, the TTS becomes result in future degradation. abroad, with speaking engagements in more than 40 countries. As an academic, Traynor a permanent threshold shift (PTS), or So, what does our musician friend has been an instructor, assistant professor, a hearing loss that does not recover to do for his episode of tinnitus and and associate professor of audiology as well preexposure threshold levels. hearing loss? First, he can refrain from as an audiology program director. He currently teaches as an adjunct professor in three The high-frequency regions of practicing his instrument for a couple university programs. the are most sensitive to of weeks to see whether the tinnitus As the founder of Robert Traynor Audiology, damage from loud noise because subsides and his hearing improves. LLC www.roberttraynor.com, he provides of the acoustic resonance of the Even if the impairment and the tinnitus expert witness services and audiology ear canal, which (because of its size subside, they indicate this person is consulting to the hearing industry. He also and shape) adds to the intensity of sensitive to noise exposure. He may serves on the ATA’s Board of Directors. the exposure, especially in the high- then obtain high-fidelity earplugs and 1 Price, R. (2007, February 16). Intense impulse frequency region, between 4 and 6 monitor his sessions for intensity and noise: Hearing conservation’s poison gas. Paper kHz. Thus, hearing loss that begins duration. Another option is to use in- presented at the Annual Conference of the National Hearing Conservation Association, Tampa Florida. as a temporary threshold shift will, ear monitors, which are available from 2 Gunderson, E. (2018). List of rockers with hearing loss grows. AARP, Health Conditions and with continued exposure, turn into a a number of vendors. Treatments, retrieved from https://www.aarp.org/ permanent threshold shift, with more health/conditions-treatments/info-2018/musicians- hearing-loss.html. For 45 years, Robert impairment of the high frequencies. 3 Shrink, T., Kruetz, G., Busch, V., Pigeot, I., & Ahrens, Chasin (2017) states that M. Traynor, EdD, W. (2014). Incidence and relative risk of hearing AuD, practiced disorders in professional musicians. Occupational temporary hearing loss can no longer audiology at Audiology and Environmental Medicine, 71(2), 472–476. be considered a benign, transient Associates, Inc., in 4 MaxiAids.com. (2019, March 7). Rock n’ roll musicians make a lot of loud noise on hearing loss 5 audiometric characteristic. Although Greeley, Colorado, and tinnitus. Retrieved from https://www.maxiaids. providing diagnostic it has not been established that TTS com/rock-n-roll-musicians-make-a-lot-of-loud-noise- and rehabilitative on-hearing-loss-and-tinnitus. is a predictor of future hearing loss, treatment for hearing 5 Chasin M. (2017). Temporary threshold shift (TTS) is NOT so temporary. Hearing Review. 24(2):22. its presence does point to sometimes loss and tinnitus. He

Famous Musicians with Tinnitus and/or Hearing Loss • Beethoven • Huey Lewis • Bono of U2 • of • Eric Clapton • Ozzy Osbourne • Phil Collins • Neal Schon of Journey • John Densmore of The Doors • Barbra Streisand • Bob Dylan • Sting • Anthony Kiedis of the Red Hot • Pete Townsend of The Who Chili Peppers • Lars Ulrich of Metallica • James Hetfield of Metallica • will.i.am of The Black Eyed Peas • Mick Fleetwood • Brian Wilson of the Beach Boys • Liam Gallagher of Oasis • Neil Young

10 TINNITUS TODAY SUMMER 2019 www.ATA.org SPECIAL FEATURE 

Michael Santucci, Hearing Conservationist for America’s Music Legends

By Joy Onozuka “I get the music mindset,” he says. the instruments because musicians “In the 1980s, having hearing loss and typically take great care to protect Scanning the blockbuster lineup tinnitus was like a badge of honor for them. Earphones and in-ear monitors of performers at the 52nd annual a rocker....It was a statement of being are used during rehearsal and on stage GRAMMY Awards® in 2010, Michael successful.” Today, he says musicians to eliminate unwanted ambient sound Santucci, AuD, counted nine out of are afraid of tinnitus. “If it weren’t for and allow musicians to hear with 16 of them wearing his custom-fit tinnitus, people wouldn’t show up.” greater accuracy at lower volumes. Sensaphonics earphones. His clientele With a long line of well-known For each musician, Santucci is a “who’s who” in the music world, musicians struggling with hearing develops a hearing conservation with approximately 1,800 musicians loss and tinnitus, public and program that entails a detailed seeing him annually. But it didn’t start music-industry awareness of the assessment of the musician’s hearing out that way. importance of hearing protection has health, education on the auditory In 1985, when Santucci opened improved markedly. Santucci noted system, periodic assessments of his audiology practice in Chicago, he a significant shift in attitudes about hearing depending on exposure to saw only five musicians his first year. five years ago when earplugs were loud sound, measurement of sound Despite that, he knew business would given away at the GRAMMY Awards. levels in the workplace, and use of grow, partly because he came from “Musicians with [severe] hearing protective devices while performing a family of musicians and therefore loss aren’t playing. [They] don’t come or rehearsing. It’s a patient-care understood the hearing issues that out and talk about that because no system that mirrors other types musicians face with ongoing exposure one wants to be the poster child.” of preventive healthcare, such as to loud sound, such as distortion And no musician wants his or her dentistry and dermatology, where of sound, diplacusis (when a pitch career cut short by something that patients return for regular visits to sounds different in each ear), tinnitus, is avoidable, so Santucci says his job ensure nothing has changed. sound sensitivity, and, of course, has become easier. Whereas sound can be measured, hearing loss. When Santucci encounters loudness, or what’s termed sound musicians reluctant to use in-ear pressure level, varies at every monitors or custom-fit earplugs, he concert venue, depending on its tries to frame the conversation in a size and architecture, stage, and way that is meaningful to the players. speakers. Santucci notes that He never lectures them on what recreational work spaces, such they should do. “I ask, ‘How often as concert halls and other music do you injure yourself?’ and that gets venues, fitness classes, restaurants, attention.…You injure your hearing. and outdoor entertainment events, Damage is something you do to a car.” do not fall under Occupational Safety Sometimes conversations focus on and Health Administration (OSHA)

www.ATA.org TINNITUS TODAY SUMMER 2019 11  SPECIAL FEATURE

guidelines limiting upper-level noise time soon, he says a global shift in • Public health campaigns to change exposure, so hearing protection falls emphasis on hearing health and its listening behavior on the individual. preservation is underway. • Development of a regulatory Over the years, Santucci branched framework for recreational noise into design and product development Increased Focus on Public Santucci notes that some to be sure that the instruments he Hearing Health European Union nations already have provided to musicians worked as In 2015, Santucci was invited to regulations for recreational noise. He intended. A recently released tool is join the World Health Organization’s thinks the United States will likely the dB Check Pro, which measures Make Listening Safe initiative, aimed adopt voluntary recommendations. levels a person at reducing the global risk of hearing “Personal responsibility matters. It’s wearing earphones or headphones loss among young people resulting like sunscreen,” he says. “Are you is exposed to, thereby answering from unsafe listening behavior. going to police beaches to make sure the question “How loud is it?” WHO estimates 1.1 billion teenagers people are wearing it?” Hi-fidelity Santucci programmed the dB Check and young adults are at risk. WHO earplugs, education on hearing health, Pro to work with the most popular partnered with the International and better technology to measure in-ear monitors and headphones Telecommunication Union, which is exposure to recreational sound will so musicians and sound engineers a specialized agency of the United change people’s behavior, in his view, could measure sound levels in real Nations, to help with the initiative, echoing his experience working with time. The device shows safe sound which also includes corporate giants musicians the last three decades. exposure based on the National like Apple and Sony. Make it personal and meaningful, Institute for Occupational Safety Santucci attends the annual then behavior will change. and Health (NIOSH) and OSHA conference in Geneva, which brings guidelines, which are used to protect together experts in audiology, public Michael Santucci, AuD, is president of the hearing of workers while on health, sound engineering, and Sensaphonics, Inc., the job. (NIOSH is governed by the communication; representatives which develops and Centers for Disease Control and of standardization organizations; manufactures custom Prevention, while OSHA is an office musicians; professional associations; in-ear products for the music industry that are within the U.S. Department of Labor.) and consumer groups to discuss designed to preserve Although Santucci doesn’t envision how exposure to loud sound in hearing while providing public recreational places in the recreational settings can be reduced award-winning sound. United States falling under federal and regulated realistically. He is the chair of the Music Induced Hearing Loss Task Force for the National Hearing regulations for sound limits any Targeted goals include: Conservation Association, vice chair of the • Development and implementation Technical Committee for the Audio Engineering Society, lecturer and consultant to Musicares, of global standards for safe part of the GRAMMY foundation, and member listening devices of the World Health Organization’s Make Listening Safe initiative.

“WHO estimates 1.1 billion teenagers and young adults are at risk [of hearing loss from unsafe listening behavior].”

12 TINNITUS TODAY SUMMER 2019 www.ATA.org SPECIAL FEATURE  Musicians Should Invest In Custom-Fit High-Fidelity Earplugs

By Robert M. Traynor, EdD, AuD Musicians have options for higher- monitor mix with an adjustable level quality hearing protection: custom- of on-stage ambient sound mixed in, fit high-fidelity earplugs or in-ear all while keeping the ears acoustically Question monitors. Many laboratories offer sealed when both earpieces are I’m a fairly serious musician and custom-made high-fidelity earplugs safely and comfortably in place. also attend loud concerts and that differ by the amount of intensity Miniature embedded microphones dance clubs. Should I invest in reduction they supply. The best pick up ambient sounds with natural custom-fit high-fidelity earplugs? way to obtain these is by visiting an directionality and sound quality. audiologist, who will work with the IEMs are the only way professional Answer laboratory to custom-fit the earplugs musicians can have great hearing Top priority is to use some sort of to your ears. Tell your audiologist what protection that simultaneously hearing protection for situations when you will use the earplugs for and then preserves the integrity of the music. you are part of an audience in a loud decide together which laboratory and Audiology clinics that specialize in atmosphere. For dance clubs and which type of to order. musicians and their particular needs loud concerts, you can choose from a The audiologist will take deep sell these systems, which range in number of inexpensive earplugs that impressions of your ears and send price from around $400 to $6,000. For allow you to hear the musical aspects the order to the laboratory for professionals exposed to high-intensity of the performance and still prevent manufacture. It usually takes about a music daily, IEMs are as essential hearing damage. They are available week to get the custom high-fidelity a tool as the high-quality musical online, and many cost less than $25— earplugs back for fitting. Depending on instruments they play. not much money to preserve your the clinic, the audiologist may assess hearing for the future. One website, the actual amount of sound reduction For 45 years, Robert Best Reviews Guide, reviews over- the custom plugs offer while fitted in M. Traynor, EdD, the-counter earplugs to help you in AuD, practiced your ears. choosing the most suitable type. audiology at Audiology Fees for high-fidelity earplugs vary Associates, Inc., in by area but generally cost around Greeley, Colorado, providing diagnostic Sound $200–$250. For musicians who Level and rehabilitative practice routinely and have stage treatment for hearing performances occasionally, these will loss and tinnitus. He is a frequent lecturer in do a nice job of protecting hearing the United States and abroad, with speaking engagements in more than 40 countries. As Hearing while not affecting the quality of the an academic, Traynor has been an instructor, Loss sound of the music. assistant professor, and associate professor Time Distance Professional musicians who of audiology as well as an audiology program practice daily and perform frequently director. He currently teaches as an adjunct professor in three university programs. need more serious hearing protection. As the founder of Robert Traynor Audiology, The best solution for professional Adapted from the National Institutes of LLC www.roberttraynor.com, he provides Health’s It’s a Noisy Planet. Protect Their musicians is in-ear monitors (IEMs). expert witness services and audiology ® Hearing public awareness campaign IEMs allow musicians to hear the consulting to the hearing industry. He also (http://www.noisyplanet.nidcd.nih.gov) serves on the ATA’s Board of Directors.

www.ATA.org TINNITUS TODAY SUMMER 2019 13  SPECIAL FEATURE

The Dangers of Loud Music: Let’s Turn the Volume Down

The American Tinnitus Association percent of respondents agreed with to them? And once we’ve increased had the pleasure of interviewing the statement: “You can damage your their motivation, how do we remove Elizabeth Beach, PhD, a leading hearing when exposed to loud noise roadblocks to change? researcher investigating exposure at events like concerts and night JO: Your most recent study found to recreational noise, with clubs.”1 Even though this widespread that the majority of people prefer emphasis on the music and awareness is encouraging, we know lower volumes, so why are music entertainment industries, and the that knowledge alone is not enough venues louder than what most effect on hearing acuity. to change behavior. people like? Health behavior theories tell us Joy Onozuka (JO): Based on your that people need to feel personally EB: Whenever people are asked research, do you feel most people are susceptible to hearing damage before to speculate about why music is aware of the dangers of loud music? they will change their behavior; and played at loud volumes, a number If yes, why are so few people taking they also need to feel that hearing of common themes emerge: loud steps to protect their hearing? damage is a severe condition before music evokes pleasurable sensations; they take steps to avoid it. This it helps us feel part of a cohesive Elizabeth Beach (EB): I think it’s is exactly what the Gilliver study social group; it makes it hard to hold probably true that most people are showed: the 40 percent of people a conversation so that (a) people drink aware that loud music is not the who actively took steps to protect more, which means venues make best thing for your hearing. The their hearing were those with higher more money; and (b) people stand edict which states “all things in levels of concern about personal closer to one another, which leads to moderation” is a truth that we know susceptibility to hearing loss and they feelings of intimacy.2 instinctively, and it applies to were more likely to regard hearing Though all of these reasons help loud music as much as it does loss as a severe and important issue. explain the attractions of loud music, to food, alcohol, and other The challenge for us is to find they don’t explain why we find pleasurable stimulants. innovative ways to engage with the ourselves in situations where music Certainly, our earlier young risk-takers—approximately 36 is played more loudly than most of us research suggests that percent of young adults—who are not would like. I think the main reason we young adults are aware taking steps to protect their hearing. have reached this point has to do with of the potential damage How can we make real the idea that cultural expectations. associated with loud hearing loss can happen to them? In the past few decades, the music—Gilliver et al.’s 2013 How can we convey the severity immense power of modern sound survey of 1,000 18- to of hearing loss and the potential systems and the trend toward 35-year-olds showed that 85 impacts of tinnitus without preaching soundproofing venues (to ensure

14 TINNITUS TODAY SUMMER 2019 www.ATA.org SPECIAL FEATURE 

that external sound-level limits are not exceeded) have resulted in venues that can produce very loud music without fear of breaching environmental sound regulations. After repeated exposure to these sound levels, patrons become used to them and begin to associate loud music with the positive aspects outlined previously. According to Welch and Fremaux,3 this is a form of conditioning, which leads people to enjoy music at high volumes (because they enjoy the intimacy, effective ways that we can transmit EB: Regulating music volume at arousal, and other associated benefits our message, and one that hasn’t recreational venues is certainly that co-occur with loud music). Over really been tried before. Right now challenging, not least because of time, a process of acculturation in Sydney, Australia, there is a lot of the many different types of indoor occurs—loud music becomes a talk about the difficulties of attracting and outdoor venues that play music. cultural norm, resulting in a pervasive live music audiences, so if we can A one-size-fits-all approach is very expectation that loud music is an highlight the potential for volume unlikely to be effective, and I think essential component of a good night reduction to improve audience we can learn a lot from the various out, and therefore music venues numbers, it could get people to sit up countries in Europe where regulations provide high volumes to meet patron and take notice. have been implemented. expectations. When expectations Of course, we’re not naive enough Several of these jurisdictions become entrenched cultural norms, to think that for change to occur, we (e.g., Switzerland, Germany, and no one stops to think: Maybe we simply need to go around showing parts of Belgium) have adopted a should check and ask if this is actually our charts to nightclub operators. We multifaceted approach that specifies what people want? know that change, when it happens, an upper sound-level limit, while also will be gradual, and it will need buy-in taking into account different venue JO: Using your findings, how do you from a few forward-thinking venue types and imposing increasingly hope to effect change? managers, who are willing to take stringent regulatory requirements as a risk, turn the volume dial anti- sound level increases. Venues may EB: On days when I’m feeling clockwise, and see what happens. be required to warn patrons of the optimistic, I like to believe that potential risk and provide earplugs or we could use our research to JO: Is it realistic to regulate music quiet rest areas. demonstrate to venues that most volume at recreational venues, which In the Netherlands, there are no patrons prefer lower volumes, and would include stadiums, fitness regulations, per se, but there is a that if venues were to reduce their classes, and music and dance clubs “covenant”—an industry-driven volumes, even by a few decibels, that vary immensely in size, audience, agreement that brings together there is a good chance that they and the type of music played? Are stakeholders from the music industry would also increase their patronage, there lessons to be learned from the and the Ministry for Health, Welfare appeal to a wider audience, and Swiss, who do regulate recreational and Sport. Now in its third edition, ultimately improve their bottom line. noise in public spaces? the covenant details the practical I think appealing to the economic commitments of each party in bottom line is one of the most relation to restricting sound levels,

www.ATA.org TINNITUS TODAY SUMMER 2019 15  SPECIAL FEATURE

providing hearing protection, and who are unaware or unwilling to significantly in terms of severity. raising awareness. This model holds change their individual behavior, Cancer can cause death—a negative particular appeal because it involves noise reduction at the organizational outcome that is very real and the music industry taking proactive level will act as a protective safety significant to the public. Hearing steps to devise safer listening net that limits the maximum level to loss, on the other hand, is much less practices that are practical and which they can be exposed. well understood; the public does not feasible for venues to achieve. In the long run, taking action at appreciate its potential impacts, and both an organizational and individual everyone knows that hearing loss JO: Given the difficulty of level should also lead to a sustained doesn’t kill you. enforcement, doesn’t the cultural shift sooner than if we Knowing that the perceived responsibility for protecting hearing were to simply to take action at severity of a condition is a key factor belong to the individual? only one of these levels. As people in motivating change in behavior, we begin to notice that more people need public health campaigns that EB: I think the responsibility for around them are adopting protective help people better appreciate that hearing health belongs to all of us. behaviors, and as lower sound levels tinnitus and hearing loss can have far- Music venues and policymakers in venues become normalized, new reaching implications in your life, and know the risk from loud music and social norms and expectations will that your hearing is worth preserving. therefore have a duty of care to form, gradually displacing old notions I think this is perhaps one of the lower the risk. On the other hand, and outdated expectations related to biggest challenges we face. one could argue that patrons should loud music. take responsibility for their own Elizabeth Beach, hearing health. JO: It took decades for the public PhD, is head of the Behavioural Sciences We know from our research that to embrace sunscreen to prevent Department at the many regular patrons share this view, skin cancer, and to give up smoking National Acoustic with more than half agreeing that cigarettes because of the risk of lung Laboratories, Australia. Her current research “it’s up to the individual.”2 Ideally, we cancer and the dangers of second- covers a range of need to approach the problem from hand smoke. What needs to be done issues relevant to both angles, simultaneously seeking at a public health level to encourage hearing and hearing- to effect change “upstream”—at the behavioral change regarding related behaviors, including leisure noise exposure and its impact systemic or organizational level, as protecting hearing and the right to on hearing health; noise exposure in the music well as further “downstream” at the quiet space in public settings? and entertainment industry; development level of the individual. of strategies for encouraging Given what we know about the EB: The examples of skin cancer for staff and patrons; and motivating young adults to protect their hearing. She also works varying levels of motivation in the and cigarette smoking are often on projects related to the delivery of hearing young adult population, a dual- raised in relation to hearing health, health services and explores the factors that pronged approach is needed and it’s worth keeping in mind influence speech-in-noise deficits in adults. to ensure that the majority the many years of sustained 1 Gilliver, M., Beach, E. F., & Williams, W. (2013). of people are protected effort that were required Noise with attitude: Influences on young people’s from excessively loud sound before awareness increased and decisions to protect their hearing. International Journal of Audiology, 52, S26–S32. exposure. By encouraging behaviors changed sufficiently to 2 Beach, E. F., & Gilliver, M. (2019). Time to listen: protective behavior at the improve health outcomes in these Most regular patrons of music venues prefer lower volumes. Frontiers in Psychology, 10, 607. individual level, those who areas. We are in the early stages of doi:10.3389/fpsyg.2019.00607 choose to wear earplugs, for a long journey! 3 Welch, D., & Fremaux, G. (2017). Understanding why people enjoy loud sound. Seminars in Hearing, example, will be personally It’s also worth remembering 38, 348–358. doi:10.1055/s-0037-1606328 protected, whereas for those that hearing loss and cancer differ

16 TINNITUS TODAY SUMMER 2019 www.ATA.org SCIENCE & RESEARCH NEWS 

Most People Prefer Music at Lower Volumes

Summary by John A. Coverstone, AuD held as part of Australia’s National 24 years old, and the average age of Science Week. Results were those attending live music venues Exposure to loud sound is one published in the March 2019 issue of was 29 years old. More than 75 of the most common causes of Frontiers in Psychology. The general percent of respondents described hearing loss among adults. Sources survey included questions regarding their hearing as good to perfect. of dangerous noise include power behaviors and beliefs regarding Over 95 percent of respondents also tools, firearms, and loud music. Loud hearing health, noise exposure, indicated that music at these venues music at nightclubs and live music and hearing loss. Those participants posed a risk for hearing loss. events, however, is something many who indicated frequently attending Answers to most questions were people tend to tolerate, even though nightclubs or live music events were similar between the group answering they might prefer music played at directed to a more specific survey questions about nightclubs and those lower volumes. Recent research containing detailed questions about answering questions about live music. sheds light on why people put listening preferences in one of those However, more survey takers rated themselves at risk for hearing loss two settings. nightclub sound levels as “louder than from music played at recreational Of the 9,904 people completing you’d like them to be” than they did venues. Elizabeth Beach and Megan the general survey, 955 were for live music. Overall, though, most Gilliver from the National Acoustic redirected to and completed the respondents indicated levels in each Laboratories in Sydney, Australia (a specialized survey about music venue as “loud but tolerable.” member of the HEARing Cooperative listening preferences. Twenty-two When rating sound levels for each Research Centre) performed a were ultimately excluded. In this type of venue, responses were again national survey to determine survey, participants were asked to similar between groups. Those taking listening preferences among perform such tasks as estimating the survey rated the actual level of people who frequented venues the level of music in the venues they music at venues higher than they with music.1 (See related article on frequented (scale of 0 to 100), the rated their own preference for sound page 14.) According to the authors, level of loudness they thought other levels. Respondents also estimated previous research has shown that people preferred, their preferred other people’s preferences for music people drink more when loud music sound volume, their impression of levels to be lower than their rating is playing, which is perhaps an perceived risk for hearing loss and for actual levels, but rated others’ incentive for venues to keep music whether they perceived themselves preferences as being higher than loud. They also described research to have hearing loss. their own preference for sound showing that loud music can have an Participants were almost evenly levels. These ratings correlate with effect on listeners that is similar to split between males and females, well-established observations in recreational drugs. and the age range was 19 to 99 social science in which people Their data was collected through years old. The average age of those consistently rate others’ behavior an online “citizen science” survey frequently attending nightclubs was as different from their own and

www.ATA.org TINNITUS TODAY SPRING 2019 17  SCIENCE & RESEARCH NEWS

frequently poorer or, in this case, more tolerant than their own. The authors point out that our own perceptions are frequently influenced by mistaken ideas regarding social norms. In a previous study conducted by Megan Gilliver, listeners were shown to consistently rate others’ listening volume with headphones as being higher than the rater’s own listening volume. These kinds of perceptions, which the authors ascribe to social comparison theory, can ultimately lead to perpetuation of risky behavior. If individuals believe that others are more tolerant or prefer risky behaviors, they will be less likely to speak up about their listening to music. Male respondents also indicates that people tolerate own concerns and go along with were also less likely to indicate higher sound exposure at these the crowd. This can lead to people preference for music at lower levels. types of recreational venues, even putting themselves at risk of hearing Those who had never experienced in the face of their own preferences damage based on the incorrect belief tinnitus or temporary hearing loss for lower volumes, because they that others in the group find the after listening to music were similarly believe the sound level is acceptable loudness level acceptable. less likely to indicate a preference for to others. This may indicate a need The authors were also able to lower levels. This appears to indicate for a greater national or worldwide determine that self-perceived risk a lack of education on the part of conversation about the hazard of of hearing loss correlated highly those who have not personally loud music and more education on with people’s preferences for music experienced hearing loss or tinnitus. this subject. sound levels. Those who indicated This study demonstrates that both nightclubs and live music 1 Beach, E. F., & Gilliver, M. (2019). Time to listen: low perceived risk of hearing loss Most regular patrons of music venues prefer were significantly less likely to venues play music at levels that lower volumes. Frontiers in Psychology, 10, 607. indicate a lower preferred level for exceed individual preferences. It

“Exposure to loud sound is one of the most common causes of hearing loss among adults.”

18 TINNITUS TODAY SUMMER 2019 www.ATA.org YOUR HEALTH 

Auditory Injury Is Permanent, so Wear Earplugs

By Daniel Fink, MD involuntarily at the gym, where the worthwhile spending a little more instructor refuses to turn down the money—from $2 to $25 a pair—to Loud noise, such as at a rock music, hearing protection is your buy better reusable ones. concert or dance club, can cause responsibility. For those concerned about sound temporary tinnitus and muffling of You can prevent hearing damage distortion, high-fidelity earplugs sound, which both typically resolve by avoiding noise exposure or offer a flatter sound reduction. after a period of quiet. However, wearing earplugs. Earplugs are Custom earplugs offer the best recent research has found that there small enough to fit in a pocket or protection, and many musicians is no temporary auditory damage, purse, and many different kinds now wear these when performing. and any temporary symptoms are available. Hearing protection is The Earplug Superstore (https:// indicate permanent damage. This measured by the Noise Reduction www.earplugstore.com) offers is called “hidden hearing loss” Rating (NRR), which can range from both convenient one-stop earplug because it is not detected by 11 decibels to 33 decibels. In actual shopping and standard hearing tests. use, the effective NRR is about half inexpensive Noise damages hearing, just as the rated NRR. “assortment sun damages skin. We have learned There is no “best” earplug for packs” with many to wear sunscreen, hats, and long everybody. The best earplugs are different earplugs sleeves, and we need to learn to ones that fit your ears comfortably so you can find wear earplugs. and reduce noise effectively. Many what works best Whether you’re exposed to loud people can’t get a good fit with for you. Daniel Fink, MD noise voluntarily at a rock concert or disposable foam earplugs, so it’s

Wonderful, accurate information for patients and hearing professionals alike! Thanks for providing a quality Tinnitus Today Magazine publication for all of us! — B. Verbsky

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Be Ear-Responsible: High-Fidelity Earplugs for Safer Quality Sound

What’s the point of wearing earplugs High-Fidelity Earplugs at concerts when the purpose of Noise Reduction attending is to hear live music? Brand Price Materials Rating Because high-fidelity earplugs reduce sound while maintaining good sound Alpine Hearing Protection (3 filters) 16, 19, 22 $29.95 Thermoplastic DownBeats High Fidelity quality. Below is a list of staff and 18 $13.95 Silicone magazine contributors’ favorite high- Hearing Protection fidelity earplugs.* Note that improper Eargasm High Fidelity Earplugs 16 $34.88 Silicone fit reduces their effectiveness. EarPeace HD Concert Earplugs 11-19 $24.95 Silicone ER•20®XS (Etymotic) High- Silicone and 20 $24.95 *The American Tinnitus Association does not Fidelity Earplugs Universal Fit Foam endorse products or guarantee their effectiveness. HEAROS High Fidelity Earplugs 20 $9.18 Silicone The products listed here are intended for informational purposes only. With any over-the- LiveMus!c HearSafe Earplugs (2 filters) 29 and 23 $28.95 Silicone counter hearing protection, it is recommended that Vibes High Fidelity Concert you read the packaging instructions before using 15 $23.98 Silicone and understand that the effectiveness depends on Earplugs fit and the environment in which they are worn.

What’s a Noise Reduction Rating?

The U.S. Environmental Protection • Subtract 7 from the NRR number, Agency requires a Noise Reduction which is given in decibels. Occupational Safety Rating (NRR) on hearing protection • Divide the result by 2. and Health (NIOSH) packaging, including all non-custom • Subtract the result from the developed a sound meter app earplugs. The NRR is based on the original noise exposure level in exclusively for the iPhone. The app minimum amount of noise reduction decibels. can be used by researchers to collect achieved by 98 percent of people For example, NRR 30 – 7 = 23 / 2 = data about noise exposure. tested in a laboratory setting. 11.5, then 100 dB – 11.5 = 88.5 dB. X: dB, dBA Noise Meter The NRR does not reduce the For more information on NRR Sound Spectrum Analyzer & FFT decibel level in a given environment calculations, see SkyPaw Co. Ltd by the precise decibel number https://www.osha.gov/

indicated in the NRR, which is to say laws-regs/regulations/ NIOSH Sound Level Meter an NRR of 30 in a noisy environment standardnumber/1910/1910.95AppB EA LAB at 100 decibels does not reduce the Dozens of decibel meter apps loudness to 70 decibels. Instead, quickly measure sound levels. noise is lowered to 88.5 decibels. One free app that works on both Note that measurements using smartphones can be imprecise and only reflect sound levels at a To determine the level of noise Android and iOS smart phones is given moment near you. If the mic isn’t working exposure, Decibel X. The National Institute for correctly, then the reading will be inaccurate.

www.ATA.org TINNITUS TODAY SUMMER 2019 21  PERSONAL STORY

One Loud Night Too Many

By Daniel Fox constant tug—especially in the interim between events—to push your On the advice of friends who creative envelope, incorporate new noticed I loved hogging the music at sounds, reach new audiences, and get parties, I first took up DJing in late booked at different venues. In contrast 2014 after moving to Washington, to my day-to-day job, which isn’t DC. I was 25. With the popular always as colorful, DJing has provided explosion of electronic music, festival me an outlet for accomplishment, culture, and companies producing engagement, and affiliation with a simple, inexpensive DJ equipment, whole new subculture of club goers, DJing today is an easily accessible promoters, fellow DJs, and others that pursuit, and I became one of its many make up “the scene.” acolytes. Soon after purchasing my Despite my immersion in this own equipment, I found my mentors community, I was only marginally Daniel Fox DJing as a side job. in the DC scene who schooled me aware of the risks associated with in the technical and promotional constantly being around loud music. high-fidelity earplugs could cost up to skill sets needed to make the jump My only wake-up call came in 2017 $250, it only added to the perception between playing in my own bedroom when I had persistent ear soreness that earplugs were an extra burden. and playing in front of live audiences. for a few days following a gig. It Subsequently, when the aching With their help, the past four years wasn’t awful, but bad enough for me subsided and eventually went away, I have seen me, once a month or so, to ask in a DJ community Facebook procrastinated over the next two years DJing at bars, clubs, weddings, and group about wearing earplugs. I in purchasing plugs. That hesitance, private events. was motivated to ask, in tandem however, caught up with me in Though I’ve always thought of with the ear soreness, because of February this year following the gig it more as a peripheral pursuit, the my perception that club-level noise that left me with tinnitus. standard millennial “side hustle,” could gradually cause me to lose my I don’t think tinnitus is the result DJing has still managed to become hearing—something I thought was of one stupid mistake I made that a part of my life that carries a lot the worst-case scenario. While two night. Rather, I believe it resulted as of weight. There’s an addiction to responses critically urged me to wear a culmination of many bad DJ habits being behind the decks creating plugs, the majority of responses I developed, stemming from my lack soundscapes, making people move, were fairly tame and blasé. Moreover, of knowledge and respect for the risk watching their reactions, and being none mentioned the risk of tinnitus, a of noise-induced ear damage. The in control of where you and your condition at the time I knew nothing venue was a small space and had a audience are headed next. There’s a about. When I learned that custom low-quality sound system, and yet, despite this, I left my listening ear exposed to the large speaker closely "…when the aching subsided and adjacent to the DJ booth. I turned the volume higher to accommodate for eventually went away, I procrastinated over lower-quality songs, and as a result, I caught myself “redlining” (playing the next two years in purchasing plugs." music loud enough that it pushes the color display on the mixer past

22 TINNITUS TODAY SUMMER 2019 www.ATA.org PERSONAL STORY 

green and yellow into the red, which After about a month of consistent Although I look back and recognize degrades the quality of the sound). ringing, my nervous system how I could have avoided tinnitus, I Moreover, whether DJing or not, I was descended into a state of full-time don’t dwell on what I could have or going out several weekends a month anxiety. Although I’ve dealt with should have done differently because to bars and clubs that played music at anxiety before, tinnitus has been what’s done is done. There’s no way a high volume without wearing any ear uniquely constant, and inescapable, as of yet to cure tinnitus, so I have protection. These were all habits that I making it all the more challenging. to learn to live with it. Nor do I find it knew to be poor but were boundaries I couldn’t focus on basic tasks for constructive blaming myself or others. that I didn’t mind crossing because I more than a few minutes at a time, Rather, I recognize that, generally, did not fully understand the damage I often felt nauseous, experienced despite the enormous popularity was doing to my ears. In other words, depth perception problems, dramatic of high-volume nightlife, there’s a it didn’t happen overnight until it fatigue, and tension headaches. I disproportionate lack of knowledge happened overnight. had to take time off from work and, about tinnitus and accordingly a lack The week following my gig, I at my worst, genuinely feared that I of respect for it as a very real risk. I do noticed soreness in my ears, felt couldn’t possibly live with the ringing, my best to serve as a cautionary tale extremely sensitive to light, and soon precipitating thoughts of hurting by telling my story and urging music began to notice a persistent high- myself. As an otherwise healthy and enthusiasts to take precautions by pitched ringing of about 15 kHz in happy 30-year-old enjoying life in DC, purchasing earplugs (even if it means my left ear. Although I at first chalked tinnitus started to make my life feel shelling out a little cash), taking 5- to this up to a bad hangover, as the desperately grim. 10-minute breaks at concerts, and week wore on and my symptoms Four months later and I’m grateful not standing directly under loud persisted, I decided to visit an urgent to say that my nervous system has speakers. For DJs and promoters, I care. It was there that I first heard of backed off from such a critical state urge the same but also emphasize tinnitus, ringing in the ears, and was and has given me a little room for the seriousness of watching volume told that it would hopefully subside relief. Certain coping mechanisms levels and the imperative of providing given more time to heal. After another such as masking techniques, quality sound (even if it means letting week with the ringing still insufferable craniosacral massages, and cognitive go of that favorite 24/7, I visited an ear, nose, and throat behavioral therapy have helped me bootleg). Tinnitus doctor, who confirmed the tinnitus deal with tinnitus. However, I still have isn’t inevitable and provided a little more detail. The a long way to go and I would be lying and can easily be consensus was that I’d suffered an if I didn’t admit to my ongoing battle avoided. It just acute auditory trauma and that the with anger, frustration, fatigue, and, at requires taking ringing and soreness were the result. times, depression. It’s difficult waking the risk seriously Worse, the ringing, I was also told, up every day feeling incapacitated by and exercising could only go away on its own, over something so seemingly innocuous as the right amount time, and possibly not at all. a high-pitched noise in one ear. Daniel Fox of caution.

Share Your Story What’s your story? The American Tinnitus Association invites readers to submit stories about living with tinnitus for possible publication in the magazine. Complete or partial stories, with a  word length of 300 to 800 words, should be sent by email to [email protected], or by mail to The ATA, 8300 Boone Blvd, Ste. 500, Vienna, VA 22182. Please include email and telephone contact information so Tinnitus Today staff can work with you on story development. The ATA reserves the right to edit for clarity, brevity, and grammar.

www.ATA.org TINNITUS TODAY SUMMER 2019 23  SCIENCE & RESEARCH NEWS

Neurofeedback to Alter Brain Waves Associated With Negative Tinnitus Distress

Summary by John A. Coverstone, AuD

Neurofeedback is a therapeutic tool used by mental health professionals to treat a variety of conditions, including attention deficit disorder, traumatic brain injury, post-traumatic stress disorder, autism, and even insomnia. In neurofeedback, brain waves measured by electroencephalography (EEG) create auditory or visual signals that are presented to the patient as either sound (often music) or visual displays sometimes similar to a . The goal is for patients to use the feedback to change their brain activity to achieve desired outcomes. What outcomes are desired depends on the condition being treated. For example, when treating PTSD, the patient may need to become A group of researchers in Potential participants were more relaxed or focused to change Switzerland and Germany screened to ensure they had the feedback on the screen to the looked at the possibility of using experienced tinnitus for at least desired state. As the patient works neurofeedback for treatment of six months and had no psychiatric toward the treatment objectives, tinnitus.1 They specifically targeted disorders or other potentially positive reinforcement is provided. improvement in tinnitus loudness confounding conditions. A total of The idea is that individuals can and tinnitus distress using a protocol 24 individuals were recruited and change their brain patterns, with the that was tailored to individual ultimately completed 15 weeks of eventual goal of creating long-lasting subjects. The researchers used the treatment with EEG measurement. changes in behavior. Tinnitus Handicap Inventory (THI) Follow-ups were conducted with There is a fair degree of criticism and Tinnitus Questionnaire (TQ) questionnaires at three and six of neurofeedback, with most critics to track tinnitus severity. Subjects months after treatment. pointing out the lack of solid and indicated tinnitus loudness using a Brain waves measured through consistent evidence supporting its use. scale of 0 to 100. EEG recording were classified

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according to their frequency. To and lower frequency brain waves lower than before treatment but envision this, think of waves washing at inappropriate times may be increased to pretreatment levels up on a beach. Waves occurring at a associated with depression or by three and six months after the lower frequency result in a broader, inattentiveness/daydreaming and treatment stopped. seemingly slower movement. Higher may contribute to insomnia. This suggests that neurofeedback frequency waves hit the beach more In prior neurofeedback research, may provide a short-term effect on rapidly, and the waves occur closer tinnitus symptoms were reported tinnitus loudness. However, this together. Frequency is measured to improve when a protocol that protocol does not result in persistent in Hertz (Hz), which is how many targeted increasing alpha-range reduction in loudness after treatment times the waves hit the beach each activity and inhibiting delta-range concludes. The authors reported that second. Brain waves are categorized activity was used. In those studies, tinnitus loudness was decreased by frequency range, although some specific fixed frequencies within the more permanently in previous researchers and clinicians have alpha band (8–12 Hz) and delta band studies that used more aggressive slightly different frequency ranges (3–4 Hz) were measured and used to and longer treatment schedules for their working definitions. Delta provide feedback/rewards. (2–3 times per week for 20 to 30 waves are generally considered The authors of the current study minutes rather than once weekly for to be measured in the 0.5 Hz to 4 recognized that alpha-range brain 15 minutes in this study). Subjects’ Hz frequency range., Theta waves activity may vary significantly from rating of tinnitus distress, measured occur in the range of 3 or 4 Hz up to one person to another and sought to with questionnaires, improved after 8 Hz. Alpha waves are considered customize the alpha measurement. treatment and remained at post- to be somewhere in the 8–14 They accomplished this by treatment levels for six months, Hz range. Beta waves are higher measuring only the specific alpha although improvements have not frequency than alpha waves, up to frequency containing the greatest been related to other therapies or to approximately 38 Hz and gamma amount of—or peak—power. placebo, which have a large effect waves are measured around 38–42 After 15 sessions of in tinnitus treatment. A study with a Hz. Higher frequency brain waves neurofeedback with this customized larger sample size is needed to look at are correlated with alert, conscious protocol, the authors found effects of neuromodulation across a activity, and lower frequency brain that scores on both the THI and broader range of subjects and to allow waves are associated with deep TQ improved, indicating lower analysis of additional factors. sleep or can indicate negative brain tinnitus distress. After six months patterns. Higher frequency brain of treatment, scores on each 1 Gütensperger, D., Thüring, C., Kleinjung, T., Neff, P., & Meyer, M. (2019). Investigating the efficacy waves that occur at inappropriate questionnaire remained stable. of an individualized alpha/delta neurofeedback times may indicate nightmares, Tinnitus loudness ratings one week protocol in the treatment of chronic tinnitus. Neural Plasticity, 19, article 3540898. hypervigilance, or impulsivity, after treatment were significantly

“The idea is that individuals can change their brain patterns, with the eventual goal of creating long-lasting changes in behavior.”

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Dangerous Decibels®: The Drive to Educate and Change Listening Behavior

The World Health Organization Deanna Meinke (DM): Dangerous Research has demonstrated how estimates that 1.1 billion young Decibels materials are in use in at least difficult it is to promote safe-listening people (ages 12–35 years old) are 41 countries, and we have trained behaviors in high schoolers through at risk of hearing loss due to noise and certified nearly 2,000 Dangerous direct targeting of those teens.1 We in recreational settings. To learn Decibels educators who are qualified developed an alternative approach of more about efforts to change the to deliver the program globally in an enlisting high school students to teach listening behavior of young people, effective manner. the Dangerous Decibels program the American Tinnitus Association As part of our original planning, we to younger (fourth-grade) students, interviewed Deanna Meinke, designed a longitudinal study to track which results in positive changes in PhD, who serves as co-director of the long-term impact of the Dangerous knowledge, attitudes, beliefs, and Dangerous Decibels, an international Decibels program on knowledge, behaviors in both groups.2 So, in program that conducts educational attitudes, and behaviors related this approach we get “two for one” workshops to raise awareness of the to exposures to dangerous sound in our effort. Significant, sustained risks of noise-induced hearing loss. levels and appropriate use of hearing- improvement for the high school protective strategies, which included students was reported in studies Joy Onozuka (JO): How many hearing evaluations at each interval conducted in the United States by children have participated in the up through joining the workforce researchers at the Oregon Health and program since its inception in after high school. Unfortunately, the Science University and again in New 1999? Was an early cohort tracked vast majority of grants fund projects Zealand by the University of Auckland to determine whether those initial for relatively short time periods (3 group. We currently have research participants were more careful in years), making the planned study funding through Creare, Inc. (Odile protecting their hearing as they impossible to do. We certainly have Clavier is the principal investigator) to entered their teens, adopting use of anecdotal evidence, but no concrete develop an online training program earbuds for music entertainment? numbers. We would love to do this for high school students and a STEM type of research, but research funding (science, technology, engineering, in this arena is lacking and not as and math) game based on Dangerous high of a priority as research on hair Decibels to be delivered to fourth- cell regeneration, otoprotectant grade students in the next two years. development, and the genetics of hearing loss. Certainly, these are JO: Do we have reliable statistics worthwhile research endeavors, about the hearing health of the iPhone but hearing and generation (2007 to present) of teens prevention tends to be low priority for and young adults? Is there evidence funding initiatives. of increased auditory damage due to listening to music at high volume?

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DM: There are ongoing epidemiological Su and Chan, in 2017, evaluated prevention efforts must cross all noise studies comparing hearing status of 212- to 19-year-olds: “Prevalence sources encountered over a lifetime. youth and adults over the years. of Hearing Loss in US Children and I would like to avoid putting so Adolescents: Findings from NHANES much emphasis on music player Noise-Induced Hearing Loss 1988–2010”:3 listening. It gets lots of attention Three recent studies are worth a Noise-induced hearing loss because everyone does it, but it noting in this regard: one for youth, increased from 15.8 percent in doesn’t mean that everyone listens at ages 12 to 17 years old; one for youth, 1988–1994 to 17.5 percent in dangerous sound levels. Somewhere ages 12 to 19 years old; and one for 2007–2008, then dropped to around 15 to 20 percent of listeners adults, ages 20 to 69 years old. These 12.8 percent by 2009–2010. will listen at a dangerous level, and it studies all suggest we hear better b There was no association is usually driven by the background now than we did 40 to 50 years ago. between exposure to loud noise noise levels where they are listening. Percentages across studies vary or music through headphones For instance, you will listen at a higher depending on the definition of hearing 24 hours prior to testing. volume sitting on a plane, in a subway, loss and the age group being analyzed. It is difficult to study noise-induced or on a school bus if you don’t utilize Hoffman et al.’s study from 2018: hearing loss in youth because the noise-cancelation or noise-isolating 1“Kids Nowadays Hear Better Than effects of hazardous noise exposures earphones. The majority of us listen We Did: Declining Prevalence of Hearing are cumulative over time and noise- safely in quiet settings and there is Loss in US Youth, 1966–2010.”2 induced hearing loss has a gradual technology available to help individuals a High-frequency (3,000, 4,000, onset that may take years to become listen safely in noisy environments. and 6,000 Hz) hearing thresholds measurable. Listening to music on (softest sound you can hear) your smartphone isn’t going to cause JO: As a country, are things improved between 1966 and instantaneous hearing loss for an improving in terms of hearing health 2010 for 12- to 17-year-olds. The adolescent. In addition, you can’t education and changes in recreational prevalence of high-frequency take a hearing loss and divide up the listening behavior? hearing loss (suggestive of contributions of different sources noise-induced hearing loss) was from years past. Hearing loss from DM: There is no means of tracking long- • 32% in 1966–1970 high-level music listening doesn’t look term outcomes related to hearing health • 7.3% in 1988–1994 any different on an audiogram from education in the United States. Perhaps • 7.9% in 2005–2010 high-level noise exposure at work, most telling is that hearing health • More recent data have not from sporting events, or participation education is not a part of K–12 education been analyzed and published. in other noisy activities. And our ears and there are no national public health b Loud music exposure may have are not susceptible to just one type policies to promote hearing health increased over the years, but of loud sound—all hazardous sound initiatives in schools or communities. it does not account for hearing levels combine to damage our ears. So, Since the inception of Dangerous impairment differences. Decibels, there has been an increase

“It is difficult to study noise-induced hearing loss in youth because the effects of hazardous noise exposures are cumulative over time and noise-induced hearing loss has a gradual onset that may take years to become measurable.”

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in “awareness” campaigns to bring attention to the risk of hearing loss from hazardous noise exposure. “For instance, high-fidelity musician The U.S. Centers for Disease Control and Prevention have expanded earplugs help preserve the sound quality their efforts beyond the occupational setting (administered by NIOSH: while protecting ears from high-level National Institute of Occupational Safety and Health: www.cdc.gov/ sounds when attending concerts or live niosh/topics/noise/) to include other audiences. See: music performances.” • www.cdc.gov/nceh/hearing_loss/ additional_resources.html • www.cdc.gov/features/hear- to protect themselves. Awareness It’s important for the public not to ing-damage/index.html does not equal behavioral change. get a false sense of security if sound • And for parents: www.cdc.gov/ This is why evidence-based programs levels are not measured accurately by ncbddd/hearingloss/noise.html like Dangerous Decibels are needed. an app on a smartphone or tablet. • The National Institute of Deafness The program is based on health and Other Communication Disor- communication science that translates Earplug Usage ders has adapted materials from into positive changes in knowledge, Using earplugs is only one strategy Dangerous Decibels to use in their attitudes, beliefs, and behaviors that are for hearing loss prevention and should Noisy Planet campaigns at www. critical to actually being successful in be the last resort. Efforts should noisyplanet.nidcd.nih.gov. preventing noise-induced hearing loss. first focus on eliminating the noise So, overall, I have a sense of the hazard, or “turning it down,” so that general public recognizing noise it does not produced a hazard in the exposure as a health risk, but that Recreational Listening first place. “Walk away” is another doesn’t necessarily translate into In regard to changes in recreational strategy that enables someone to an actual change in hearing health listening levels, it isn’t just about the reduce their sound exposure by behavior. For instance, if you ask most level of sound, but the combination increasing the distance between adults (and even kids) if loud (high- of level and time spent listening. the hazardous sound source and level) sound can damage your ears, Overall, I have observed a greater their ears, and the final strategy is they will answer yes. But most do awareness regarding the need for “protect your ears,” which is the use not use hearing protective strategies safe-listening practices. The new Apple of hearing-protective devices, such as watch has noise level monitoring earplugs and . capabilities and the World Health There is no way to track the use of Organization has made strides in earplugs on a national level; however, promoting safe listening: https:// general observations suggest that www.who.int/pbd/deafness/activities/ hearing protection is being used MLS/en/. Individuals can use a sound more often now than 10 to 20 years level meter app on their smartphone, ago. Parents are becoming aware but these need to be calibrated to of helping protect their children’s work properly and will only measure ears, but they still don’t set a good a limited range of sound levels. The example and protect their own ears. microphones are unable to capture the Many types of workers are still noise- softest sounds or the loudest sounds.

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exposed on the job. So, there is still We really don’t know how much much work to be done in this area. noise our ears can tolerate for a Encouraging and From our work with Dangerous lifetime of exposure, so we only Discouraging Trends Decibels, we know that it is critical have recommended guidelines to JO: What hearing health trends to create a sense of self-efficacy and go by that may vary depending on do you find encouraging or help individuals not only know how how conservative you want to be in discouraging? to use an earplug/earmuff correctly preventing hearing loss. but also when to wear them. Many DM: Encouraging: Parents are specialized hearing protectors on JO: How important is getting a making efforts to protect the the market can help an individual hearing test? hearing of their children. overcome barriers to use of earplugs. For instance, high-fidelity musician DM: A hearing test is really your Discouraging: Parents don’t earplugs help preserve the sound only way to know whether you have model good hearing health quality while protecting ears from hearing loss. Most adults do not get behavior by wearing ear high-level sounds when attending a hearing test once they leave K–12 protection themselves. concerts or live music performances. schooling unless they are employed Encouraging: Greater public Last, we do not see widespread in a noisy job that requires testing for health initiatives to generate availability of hearing-protective regulatory compliance. We don’t have awareness around the issue of devices in retail stores, and this a good consensus regarding how often hazardous noise. suggests to me that there has not hearing should be tested, although Discouraging: No efforts to been enough consumer demand annual testing is recommended if you reduce the hazards in the first for such products. If we want to are exposed to hazardous levels of place. Many high-level sounds encourage the use of hearing sound in your activities. can be reduced with engineering protection, then the individual needs Noise-induced hearing loss will controls, by using quieter tools, or to know where to obtain a variety not be detected by the individual just by turning it down slightly. of hearing protection devices. It is until it has progressed and negatively difficult to tell people where to access influences communication, so Discouraging: A misconception them beyond online merchants. audiometry is helpful for early that simply raising awareness detection. Otoacoustic emissions are results in actual behavior change. JO: How loud is too loud? also useful in monitoring the inner ear Behavior change is a difficult status for early detection of noise- thing to accomplish: it takes early DM: I think the focus is often just on induced hearing loss. We get our eyes education, consistent public health “how loud,” when the reality is that and teeth checked as adults, but we messaging, and “booster” efforts listening to one of your favorite songs tend to ignore our ears until a problem over time to keep the focus on the with the volume turned up is just fine; presents. The bottom line is that if a health hazard and strategies to you just can’t listen at high volumes hearing loss shows up on the hearing protect yourself. for hours in a day over many days and test, the damage is already done! Encouraging: More health years. It is the level and the duration of Ideally, an individual would be getting professionals becoming engaged the sound exposure that matter. a hearing test to make sure their in hearing loss prevention efforts. A simple rule of “ear” is that if you protective measures are working and Discouraging: More could be have to raise your voice above the their hearing remains undamaged, sort engaged, and the ones who are ambient noise level to talk to someone of like having no cavities at the dental engaged are not necessarily using at arm’s length away, then the sound checkup, which reinforces the person evidenced-based strategies and level is likely hazardous to your ears to continue brushing their teeth. information to address the issues. over extended periods of time.

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JO: What role, if any, do electronics JO: If a state or school wishes to and the use of wireless automated hearing test manufacturers, restaurants, clubs, include Dangerous Decibels in its systems for use outside of a sound booth. She has served as past president of the National and concert venues play in including curriculum, how do they go about Hearing Conservation Association. As co- warnings on their products or in their doing that? director of the Dangerous Decibels® program, venues about the impact of prolonged her passion for changing knowledge, attitudes, beliefs and behaviors related to the prevention exposure to loud sound? DM: Currently, Dangerous Decibels is of noise-induced hearing loss and tinnitus is disseminated on a grassroots basis. highlighted by her international collaborations DM: There is no evidence that We offer two-day educator training with colleagues in the delivery of Dangerous warnings would work in this context. workshops that equip an attendee to Decibels educator training workshops in the U.S., Australia, Brazil, Canada, New Zealand Sound levels fluctuate and may have the materials and skills needed and Singapore (www.dangerousdecibels.org). be safe at one point in time and to deliver the program to K–12 dangerous at another; the risk students, adults in the workplace, and Acknowledgement depends on the level and the time military and special populations, such Meinke would like to acknowledge the co- (duration) of exposure, so it would as musicians and recreational firearm director of Dangerous Decibels, Dr. William differ for each individual in a room or users (e.g., hunters, target shooters). Hal Martin, and numerous other colleagues in listening to earphones/headphones. Workshops are publicized on the the U.S. and abroad who have contributed to the development, growth, and dissemination Warnings are too generic to be of Dangerous Decibels Facebook page of Dangerous Decibels. She looks forward much use. It goes back to education and on the website. Currently, we to sustaining the current partnerships and and behavioral change: the public has only provide the in-person workshop fostering new ones in the years to come. to be educated to know how loud is since each attendee practices 1 Weichbold, V., & Zorowka, P., 2007. Can a too loud and assess their own risk, delivering the program on the second hearing education campaign for adolescents and then be motivated and capable of day of the training and engaging with change their music listening behavior? International Journal of Audiology, 46 (3), 128–33. protecting themselves. Perhaps then the teaching materials and other doi:10.1080/14992020601126849 venue owners would begin to consider attendees is important. We have not Welch, D., Reddy, R., Hand, J., & Devine, I. M. (2016). Educating teenagers about hearing health the hazard and take steps to avoid had funding to create and validate an by training them to educate children. International putting individuals at risk, including online training program that might journal of audiology, 55(9), 499-506. 2 Hoffman, H. J., Dobie, R. A., Losonczy, K. G., themselves, if they understood their provide the same outcomes as our Themann, C. L., & Flamme, G. A. (2018). Kids own vulnerability. in-person current training model. If a nowadays hear better than we did: declining prevalence of hearing loss in US youth, 1966–2010. The World Health Organization school is interested in the program for The Laryngoscope. 3 Su, B., & Chan, D. (2017). Prevalence of hearing is working with manufacturers to its students, it can contact Dangerous loss in US children and adolescents: Findings from incorporate safe-listening standards Decibels and we can try to match NHANES 1988-2010. JAMA Otolaryngology—Head Neck & Surgery, 1;143(9): 920–927. doi: 10.1001/ into devices that would provide the a trained educator to the school’s jamaoto.2017.0953 listener with feedback related to how location. (Please send email to loud and how long they listened (a [email protected] to inquire.) noise dose). This is not an easy feat because each earphone/headphone Deanna Meinke, PhD, is a that you attach to a device will have Winchester Distinguished Professor in the a different sound level output even department of Audiology if the song and volume control are and Speech-Language not changed. So, there are efforts Sciences at the University of Northern Colorado to address the technical capabilities where her research and calculations that are needed to focus is early detection establish voluntary standards to guide and prevention of noise-induced hearing loss. manufacturers. Current research includes investigations on the auditory risk of impulse noise, educational gaming to promote hearing loss prevention,

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What Noise Level Is Considered Safe?

By Daniel Fink, MD exposure level is lower, because the You don’t need a sound meter to EPA didn’t adjust for lifetime noise know whether noise is too loud. If Auditory health includes the ability exposure. The difference between noise is hurting your ears, even if to hear well, free from tinnitus and occupational and public noise it isn’t bothering others, you need . There is a large overlap exposures was discussed in a National to leave the noisy environment or between hearing loss and tinnitus, Institute for Occupational Safety and use earplugs. If you have temporary 5 with about half of those with hearing Health science blog post in 2016. tinnitus or muffling of sounds after loss also having some tinnitus, and The equal energy hypothesis states loud noise exposure, your hearing is most of those with tinnitus also having that the effects of noise are caused by at risk. some hearing loss. the cumulative sound energy reaching And if you can’t carry on a What is a safe noise level to the ear, or the average sound level for conversation without straining to 6 prevent hearing damage? The National a time period. The safety of various speak or to be heard, the ambient Institute on Deafness and Other noise exposures cannot be discussed sound is above 75 decibels, and that’s Communication Disorders (NIDCD) without also describing the exposure the auditory injury threshold. states, “Long or repeated exposure time. Other than blast injuries to sound at or above 85 decibels can strong enough to cause disruption cause hearing loss.”1 This statement is of auditory structures in the ear, the Safe Exposure Times for true, but misleading. exact mechanisms of injury from Different Noise Levels Eighty-five decibels is not a safe intermittent and impulsive noise are not well understood. The exposure- Noise Level noise exposure level to prevent (average Exposure Time 2 effect relationship is understood auditory damage. The 85-decibel decibels, LAeq) only for hearing loss, not for tinnitus standard is derived from an 90 15 minutes occupational recommended exposure or hyperacusis. This is described in 87 30 minutes level.3 Noise is different from other the table. 84 1 hour occupational exposures, such as Most Americans are exposed to 7, 8 ionizing radiation and toxic solvents, too much noise in everyday life. 81 2 hours because exposure continues outside Perhaps because of this, researchers 78 4 hours the workplace. at the Centers for Disease Control 75 8 hours and Prevention found that about 25 The Environmental Protection 70 24 hours Agency (EPA) adjusted the percent of adults ages 20–69 had Note: L is the equivalent continuous occupational standard for additional noise-induced hearing loss, with Aeq 53 percent of them having had noise level. exposure time—24 hours a day Sources: World Health Organization (Europe). (2011). Burden of disease instead of 8 hours at work, and 365 no significant from environmental noise. WHO Regional Office for Europe. Retrieved 9 from http://wwweurowho.int/data/assets/pdf_file/0008/383921/noise- exposure. Noise-induced hearing guidelines-engpdf?ua=1; World Health Organization (Europe). (2018). days a year instead of 240 days—to Environmental noise guidelines for the European region. WHO Regional loss and many, if not most, cases of Office for Europe. Retrieved from http://www.euro.who.int/__data/assets/ calculate that a daily time-weighted pdf_file/0008/383921/noise-guidelines-eng.pdf?ua=1 average of only 70 decibels prevents tinnitus are entirely preventable: avoid hearing loss.4 The actual safe noise noise exposure.

www.ATA.org TINNITUS TODAY SUMMER 2019 31  YOUR HEALTH

The safe listening rule is very meetings and published it in peer-reviewed on levels of environmental noise requisite to protect scientific journals. public health and welfare with an adequate margin simple: If it sounds too loud, it is too of safety. Washington, DC: U.S. Government loud! Avoid loud noise or wear hearing Fink served on the Board of the American Printing Office. Retrieved from http://www.nonoise. Tinnitus Association from 2015 to 2018. He is org/library/levels74/levels74.htm protection if you can’t. 5 Kardous, C., Themann, C. L., Morata, T. C., & currently Board Chair of the Quiet Coalition Lotz, W. G. (February 8, 2017). Understanding (https://thequietcoalition.org/). He serves as an noise exposure limits: Occupational vs. general Daniel Fink is a expert consultant to the World Health Organiza- environmental noise. NIOSH Science Blog. retired internist who tion on its Make Listening Safe program and as Retrieved from https://blogs.cdc.gov/niosh-science- developed tinnitus a subject matter expert for the National Center blog/2016/02/08/noise/ 6 Berglund, B., Lindvall, T., & Schwela, D. H. (Eds.). for Environmental Health at the Centers for Dis- and hyperacusis after (1999). Guidelines for community noise. Geneva, a one-time exposure ease Control and Prevention. Switzerland: World Health Organization. Retrieved to loud music at a from https://apps.who.int/iris/handle/10665/66217 New Year’s Eve party 7 Flamme, G. A., Stephenson, M. R., Deiters, K., Tatro, A., van Gessel, D., Geda, K.,...McGregor, K. (2012). in 2007. In 2014, after 1 National Institute on Deafness and Other Communication Disorders. (2017). Noise-induced Typical noise exposure in everyday life. International reading an article about hyperacusis in the New hearing loss. Retrieved from https://www.nidcd.nih. Journal of Audiology 51(Suppl. 1), S3–11. doi:10.3109 York Times science section, he decided to try gov/health/noise-induced-hearing-loss /14992027.2011.635316 to make the world a quieter place. 2 Fink, D. J. (2017). What is a safe noise level for the 8 Neitzel, R. L., Gershon, R. R., McAlexander, T. P., public? American Journal of Public Health, 107, Magda, L. A., & Pearson, J.M. (2012). Exposures His research led to three main insights into 44–45. Retrieved from https://ajph.aphapublications. to transit and other sources of noise among New noise and hearing: (1) 85 decibels is not a safe org/doi/pdf/10.2105/AJPH.2016.303527 York City residents. Environmental Science and noise level for auditory health, (2) significant 3 National Institute for Occupational Safety and Technology, 46(1), 500–508. doi:10.1021/es2025406 9 Carroll, Y. I., Eichwald, J., Scinicariello, F., Hoffman, hearing loss is not part of normal aging, and Health. (June 1998). Occupational noise exposure: Criteria for a recommended standard. Cincinnati, H. J., Deitchman, S., Radke, M. S.,...Breysse, P. (3) ambient noise, especially in restaurants, OH: Author. Retrieved from https://www.cdc.gov/ (2017). Vital Signs: Noise-induced hearing loss is a disability rights issue. He has presented niosh/docs/98-126/pdfs/98-126.pdf among adults – United States 2011–2012. Morbidity this information at national and international 4 Environmental Protection Agency, Office of Noise and Mortality Weekly Report, 66, 139–144. doi:http:// Abatement and Control. (March 1974). Information dx.doi.org/10.15585/mmwr.mm6605e3External

Decibel Exposure Time Guidelines How loud is too loud? rocket launch Accepted standards for recommended permissible exposure time for continuous time weighted average noise, according to the National Institute for Occupational 165 12-gauge shotgun 155 fireworks Safety and Health and Centers for Disease Control and Prevention, 2002. For every gunshot 3 dBAs over 85dBA, the permissible exposure time before possible damage can 145 jet plane (from 100ft.) 135 ambulance occur is cut in half. jack hammer 125 leaf blower rock concert The Noise Continuous dB Permissible Exposure Time 115 chainsaw ® 105 walkman Navigator : a 85 dB 8 Hours tractor 95 database of over 88 dB 4 Hours gas mower hair dryer 1700 noise sources. 85 91 dB 2 Hours busy city Developed by Elliott 75 traffic 94 dB 1 Hour 65 Berger, MS, Senior typical speech 97 dB 30 minutes 55 Scientist with 3M rainfall Occupational Health 100 dB 15 minutes 45 35 and Environmental 103 dB 7.5 minutes 25 Safety Division. 106 dB 3.75 minutes (< 4 min.) whisper 15 109 dB 1.875 minutes (< 2 min.) Published with 5 softest sound permission from 112 dB 0.9375 min. (~ 1 min.) 0 you can hear Dangerous Decibels®. 115 dB 0.46875 min. (~ 30 sec.)

32 TINNITUS TODAY SUMMER 2019 www.ATA.org PERSONAL STORY 

How Tinnitus Changed My Life

By Tommy Scott entire life figured out. This new listening constantly to music without medical condition affected my hearing protection or understanding For me, tinnitus has been one big ability to concentrate, which caused of the cumulative effect of damaging roller coaster. A roller coaster that I my thoughts to be consumed with sounds. didn’t agree to ride on and certainly doubts. Luckily for me, my parents Tinnitus has changed my life did not expect to find myself on were extremely supportive and in many ways—I am never found at the age of 23. At the time of my talked through all of my options for without earplugs when I am out diagnosis, I was a senior in college both treatment and career choices. and about—but most of all my tin- and was on top of the world. Given Through many twists and turns, nitus has given me a new sense of that I had been a commercial DJ for I moved to Washington, DC, to purpose and determination. several years, my time spent around pursue healthcare consulting and Tommy Scott is an speakers is most likely the cause of complete the tinnitus retraining therapy program at the University incoming medical my tinnitus. Doctors were confused student at Northeast about my condition because no of Maryland Medical Center. Ohio University. He obvious signs of hearing loss were This coming fall, I’m enrolling is a graduate from at Northeast Ohio University in the the University of detected and there was no other Alabama and holds medical school class of 2023. Due logical cause for the sounds that I a Bachelor of Science in Biology. Tommy was was hearing in my head. to my battle with tinnitus, I now a commercial DJ for several years and has a When I heard that there was no have a passion for helping others passion for music (and now hearing protection). avoid needless hearing loss. Every His professional experience includes pediatric cure for my condition, my carefully cancer research, biopharmaceutical business day Americans use personal listen- planned life came to a screeching development and advocacy, and healthcare halt. I was planning to begin med- ing devices at alarming volumes. consulting. He is considering a career as an ear, nose and throat doctor to help others ical school after graduation and I Through my medical training, I hope to be able to provide guidance to affected with hearing conditions. Tommy enjoys was fully convinced that I had my hiking, traveling, and cooking in his free time. young musicians and others who are

www.ATA.org TINNITUS TODAY SUMMER 2019 33  SCIENCE & RESEARCH NEWS

Tinnitus Retraining Therapy Trial Demonstrates the Importance of Counseling and Sound Enrichment

The Tinnitus Retraining Therapy phase III trial, which was the primary on surveys of ongoing military care Trial (TRTT), conducted at multiple purpose of the TRTT. for tinnitus together with elements sites between August 2011 and June The TRTT was a multisite of current recommended best 2017, is the first and only phase III randomized placebo-controlled phase practice professional care guidelines. trial of tinnitus retraining therapy III trial that was designed to assess The secondary objectives of (TRT) or of any tinnitus treatment the efficacy of TRT versus standard the trial were to establish the to date. The American Tinnitus of care (SoC) over 18 months of contributions of TRT counseling and Association had the opportunity treatment and follow-up. The SoC sound therapy components. The to ask Craig Formby, PhD, one control was a patient-centered latter, with the aid of a short-acting of the principal researchers and counseling protocol. SoC was based sound generator placebo control, Study Chair for the TRTT, about this groundbreaking research on the efficacy of one of the leading “Our findings suggest that if a tinnitus patient treatments for bothersome tinnitus. is treated by a clinician providing quality Joy Onozuka (JO): Why was the TRTT important? care of the kind administered in our trial by

Craig Formby (CF): Since the 1990s, a professional who demonstrates empathy tinnitus retraining therapy (TRT) has been a prominent and influential— for the patient and his or her condition, then but controversial—habituation-based the patient’s quality of life with respect to the treatment protocol for alleviating the negative emotional reactions to tinnitus problem can be expected to improve and the awareness of debilitating tinnitus. TRT had not previously been meaningfully with treatment.” vetted adequately in a definitive

34 TINNITUS TODAY SUMMER 2019 www.ATA.org SCIENCE & RESEARCH NEWS  also allowed for a comparison indices, including the Tinnitus dynamics achieved when patients of the efficacy of the sound Functional Index and the Tinnitus used sound generators in TRT were generators versus that of enriched Handicap Inventory. expedited when compared with the environmental sound. Enriched Our findings suggest that if treatment dynamics for either SoC environmental sound was routinely a tinnitus patient is treated by a or partial TRT using placebo sound encouraged for use across all clinician providing quality care of generators. That is, TRT achieved its participants in the study. the kind administered in our trial by full treatment effect within slightly Findings (see summary on page 39 a professional who demonstrates fewer than six months, whereas for greater detail) empathy for the patient and his or either of the other treatments The main findings, after 18 months her condition, then the patient’s required 10 to 12 months to achieve of follow-up, consistently revealed quality of life with respect to the their full treatment effects. Future that all three treatment groups tinnitus problem can be expected research should explore this finding improved significantly. Specifically, to improve meaningfully with in greater detail, the distressing effects of the tinnitus treatment. The use of sound which if it holds were reduced significantly relative generators in TRT for tinnitus true suggests to baseline pretreatment measures, patients with unaided functionally that the use of with no meaningful differences in the adequate hearing sensitivity may sound generators treatment effects across the three not be necessary if enriched may be important groups of participants as assessed environmental sound is used for expediting by the primary outcome measure, routinely by these patients. treatment the Tinnitus Questionnaire, or by [However,] some of our analyses Craig Formby, PhD by TRT. any of the key secondary outcome suggest the treatment response

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Does Tinnitus Retraining Therapy Improve Quality of Life?

Summary by John A. Coverstone, AuD called an enriched sound environment. of tinnitus treatment in the military The purpose of sound therapy and and professional best practices.1 Tinnitus retraining therapy (TRT) enriched sound environments is to All groups were encouraged to was developed in the late 1980s reduce the perception of the tinnitus use enriched environmental sound by Pawel Jastreboff, who was sound and prevent tinnitus from ever throughout the day. By comparing the studying tinnitus in animal models, being the only sound heard by the treatment results among the groups, and Jonathan Hazell, who pioneered patient. Since its origin, TRT has been the researchers’ study design made the use of low-level broadband a fundamental tool of many providers possible the separation of the effects sound therapy for treatment of of tinnitus care, and the underlying of sound therapy versus directive tinnitus. Jastreboff created the principles have been the basis for counseling, while comparing the neurophysiological model of tinnitus, other treatment models developed efficacy of TRT with the standard-of- which describes the role of the over the years. care treatment. limbic system (involved in emotional For the past decade, a group of Baseline and treatment data were responses) and autonomic nervous academic civilian researchers has collected from August 4, 2011, to June system (responsible for many bodily partnered with colleagues in military 20, 2017, at six U.S. military hospitals. functions) in the negative reactions hospitals to create the Tinnitus Participants had to have had tinnitus to hearing tinnitus. To this model, Retraining Therapy Trial Research for at least one year, with medically Jastreboff and Hazell added principles Group. They are investigating the or surgically treatable causes ruled of sound therapy to create TRT, which efficacy of TRT and are assessing out. None of the study participants is a treatment protocol that includes the separate contributions of sound had significant hearing loss, which counseling and sound therapy. TRT therapy and counseling to TRT. In otherwise might have confounded prescribes a specific method of the most recent study, participants the utility of the sound generators. counseling called directive counseling, were randomly assigned to one of They also could not have had prior in which the therapist provides three treatment groups: TRT including treatment within the past year and advice and guidance to the patient’s counseling and sound therapy were required to have a baseline decisions. Sound therapy is often achieved with bilateral ear-level sound score of at least 40 on the Tinnitus achieved with ear-level devices, usually generators; partial TRT including Questionnaire, showing that tinnitus in the form of sound generators, counseling combined with short- was having at least a moderately hearing aids, or a combination of the acting “placebo” sound generators; severe effect on their quality of life. two instruments. Patients are also and what the authors termed Participants enrolled in the standard encouraged to keep some sort of “standard of care,” a patient-centered and partial TRT groups were assigned sound in their environment at all times, counseling approach based on surveys to use bilateral sound generators

36 TINNITUS TODAY SUMMER 2019 www.ATA.org SCIENCE & RESEARCH NEWS 

that were identical in appearance and implemented to provide as close to standard of care, or partial TRT and initial operation. Those in the partial identical treatment experiences as standard of care. TRT group used sound generators possible within and across hospitals. There was no difference in that produced a constant low-level The study included 151 participants. treatment effects for sound therapy broadband output for the initial 40 The Tinnitus Questionnaire was as prescribed by TRT versus partial minutes of operation, after which used as the primary outcome TRT implemented with placebo sound the output decreased by 1 dB every measure, and participants were therapy. This finding indicates that minute until becoming silent. Both assessed prior to treatment and at sound therapy from sound generators researchers and participants were follow-up visits at three, six, 12, and 18 may not be necessary when TRT blinded as to whether participants months after the initial treatment visit. directive counseling is combined with had received standard sound therapy Other assessments used included an enriched sound environment, at or placebo devices (called double- the Tinnitus Functional Index, Tinnitus least when treating tinnitus patients blinding). If the devices were checked Handicap Inventory, measures of who have no greater than a mild by audiologists, the placebo sound depression, anxiety, and hearing hearing loss. This conclusion is generator output was restored handicap and a visual scale of tinnitus further supported by the fact that the to the initial volume level setting severity (similar to visual pain scales standard-of-care counseling approach within approximately 3 seconds after with faces depicting various states of had a similar effectiveness to the removal from the ears. Counseling distress, called a visual analog scale). standard and partial TRT treatments. also reinforced the expectation that The overall results were similar This study highlights the importance output from the sound generators across groups. Most importantly, of counseling in tinnitus treatment and would appear to decrease over time all groups experienced significant suggests that enriched environmental for both the standard and placebo TRT improvement in rating their quality of sound therapy in combination treatment groups. life outcomes with tinnitus over the with counseling may be sufficient All participants were counseled 18-month follow-up period. Change for achieving treatment success. to maintain a sound-enriched in questionnaire scores from baseline Sound generators may be of lesser environment throughout the day, to 18-month follow-up revealed no importance in the TRT treatment meaning they were to avoid very meaningful differences among the process for these individuals. quiet environments. This is a current treatment groups. That is, there strategy used in many treatment was no meaningful difference in the 1 Scherer, R. W., & Formby, C., for the Tinnitus Retraining Therapy Trial Research Group. (2019, approaches to reduce the relative changes in the quality of life measures May 23). Effect of tinnitus retraining therapy loudness of a patient’s tinnitus. when comparisons were made vs. standard of care on tinnitus-related quality of life. JAMA Otolaryngology—Head & Neck Audiologists were formally trained in between groups receiving standard Surgery. Advance online publication. doi:10.1001/ TRT, and standardized protocols were TRT and partial TRT, standard TRT and jamaoto.2019.0821

“Most importantly, all groups experienced significant improvement in rating their quality of life outcomes with tinnitus over the 18-month follow-up period.”

www.ATA.org TINNITUS TODAY SUMMER 2019 37  SPECIAL FEATURE

Let the Beat Go On… Music Therapy to Heal the Mind and Emotions

Many years ago, back when Barbara to perform as a woodwind player in in acute care and nonacute care Else was in college, she was thrilled several ensembles, and is pleased to settings and in the community in to receive a scholarship. As a student note that hearing protection is standard private clinics, schools, or a whole minoring in music, the award provided operating procedure. host of agencies. In short, music tuition assistance in exchange therapy is the clinical and evidence- for playing piccolo in at least two Joy Onozuka (JO): What is music based use of music interventions to ensembles each semester, including therapy and how might it help mitigate accomplish individualized goals within marching band in season. Back then, the negative effects of tinnitus? a therapeutic relationship.1 the practice rooms were essentially Interestingly, in clinical music closet-sized rooms with minimal sound Barbara Else (BE): Music therapy therapy practice, tinnitus tends to be insulation and there were no advisories refers to the profession comprising a secondary finding and not usually to protect hearing in rehearsals. more than 8,000 credentialed the primary reason for seeking Her path to tinnitus began in those clinical professionals who are Board- consultation with a therapist. As an practice rooms and in marching band. Certified Music Therapists (MT-BC) invisible injury, tinnitus may be easily Today, Else, who is a senior research in the United States and beyond. overlooked, tolerated or ignored for and policy advisor with the American Music therapy consists of a wide long periods of time, despite the Music Therapy Associates, continues array of interventions taking place stress it can trigger.

38 TINNITUS TODAY SUMMER 2019 www.ATA.org SPECIAL FEATURE 

There may be times when simply BE: In considering the overall level BE: In some instances, music “tolerating” the symptoms of tinnitus is of evidence, it can be very helpful to therapists co-treat with audiologists unacceptable and bothersome. Working look to the peer-reviewed published and other health providers. In those with a music therapist, individuals may research in aggregate as a systematic instances, the MT-BC is often choose to concentrate a portion of their review or meta-analysis pooling supportive to the process as an treatment plan on the psychological and findings across multiple studies. adjunct provider to the sound therapy emotional aspects of tinnitus. Aalbers et al. examined the question treatment; however, the scope of One approach that may be used of the effectiveness of music therapy music therapy practice extends to draws upon principles of mindfulness. interventions for depression and the psychosocial and mental health In a mindfulness context, the target related comorbid symptoms.5 side also. skill is acceptance and not ignoring These investigators concluded In the context of a wellness or or passive tolerance. Ignoring implies several findings. First, music therapy mindfulness approach, music therapy effort expended to resist or ignore protocols provide short-term positive can provide a “productive distraction,” the irritating stimulus and sound effects for people with depression. or a supportive stimulus, to focus on perceptions of tinnitus. Acceptance, When added to treatment as usual, and can assist an individual in shifting on the other hand, implies a state of music therapy helps to improve cognitive focus from the irritating ease with acknowledgment of the depressive symptoms compared with stimulus, or unproductive thought stimulus without resistance. usual treatment alone. The addition of pattern, to a more productive stimulus Part of the individual or group music therapy to usual treatment is not or thought pattern. process when using a mindfulness associated with a change in adverse Music, particularly preferred music, approach involves music-based events compared to usual care. The is a pleasant and enjoyable stimulus to exercises to practice acknowledgment evidence also points to the efficacy of assist the shift to a more productive and acceptance of the symptoms. music therapy for decreasing anxiety cognitive focus. Participating in In short order, acknowledgment levels and improving functioning in music making can be an even more and acceptance help reduce anger, persons with depression. powerful activity because it engages frustration, resentment, anxiety, and An area of future research in this more of the senses, is active and emotional and physical tension. realm is expected to concentrate on fully engaging. This active process Music therapist and counselor Anne better understanding the mechanisms of making music can be immensely Parker of Tucson, Arizona, notes via that underpin these favorable findings. helpful when the condition triggers email, “The paradox is that the more changes in affect or depression. The we resist or ignore a stimulus, the JO: Sound therapy for tinnitus refers Heidelberg Model, noted below, is a more tension we create. Our attention to the use of sound to mask tinnitus protocol that combines sound therapy is now focused on what we don’t and to enhance one’s ability to sleep, with counseling and psychological want and we amplify the distress.” concentrate, and relax, as well as approaches. Mindfulness training, in the context of treatment under the supervision of an a multipronged plan in music therapy, audiologist to reduce the perception JO: Do you need a music background does not reduce the irritating stimulus. of the tinnitus sound through rewiring to benefit from music therapy? It reduces the distress surrounding, or of the brain (Levo system, Desyncra in response to, the irritating stimulus nueromodulation). Does music therapy BE: No music background is by intentionally training acceptance fall under the umbrella of sound needed to benefit from music and acknowledgment. therapy, or is it more of a psychological therapy. MT-BCs have many approach to reducing the negative music-based tools at their JO: What does the research say comorbid effects of tinnitus? disposal to support the client about music therapy’s effectiveness and their needs without the in reducing depression, anxiety, and client having to know how stress? to play an instrument, tune

www.ATA.org TINNITUS TODAY SUMMER 2019 39  SPECIAL FEATURE

hearing; or it could be a focus on Barbara Else is intensity (loudness), melody, and senior research and policy advisor with pitch to facilitate relaxation, dampen the American Music an instrument, or read music. If the general anxiety, and/or help with sleep Therapy Association. disturbances. In this second example, She coordinates AMTA’s individual has interest in using previous research initiatives and this may sometimes involve filtering or or current music interests, the clinician is managing editor of the can certainly fold that into the plan. masking certain sound frequencies. Journal of Music Therapy. Else practiced as a hospital-based music JO: The Heidelberg Model, therapist and as a researcher in health policy JO: What should someone expect and economics. She maintains a part-time sometimes referred to as Neuro- when trying music therapy? How are music therapy practice. Music Therapy, has also been studied goals defined? What kind of things do Else was recipient of a postgraduate fellowship you do during therapy? for tinnitus patients with hearing with the U.S. House of Representatives and loss. If someone can’t find a therapist for the U.S.P.H.S., Agency for Healthcare Policy familiar with tinnitus, is it easier to and Research (renamed to AHRQ) in medical BE: Music therapy takes place in effectiveness research, policy analysis, and find someone trained to help people sessions for either individuals or small grants management. She provides training and groups. The therapist conducts an with auditory issues? presentations on the use of music therapy to mitigate the effects of trauma. Her publication initial assessment to understand the BE: Not all MT-BCs practice in this credits focus on health policy, research individual’s needs and aims related methods, trauma and music therapy, and health clinical area or have experience to their health and well-being. In economics. in the Heidelberg Model. This other words, we explore each client’s Else volunteers with the American Red Cross individualized goals to tailor the use model combines both acoustic and in disaster services/mental health and training. She serves in an advisory role for disaster of music-based interventions. In psychotherapeutic techniques. As a multipronged protocol, it involves response for AMTA and the World Federation that process, we set priorities with of Music Therapy. As a musician, Barb is active counseling with resonance training, the client to tackle the most salient in the jazz scene and is a studio recording artist outcomes and goals. neuroauditive cortex reprogramming, specializing in concert and ethnic flutes. 2–4 The process also includes a review and tinnitus desensitization. As a model and protocol developed 1 American Music Therapy Association. (2019). What of musical preferences, likes, and is music therapy? Retrieved from https://www. dislikes because musical preferences in Europe, it is less known in the United musictherapy.org States. There are, however, many 2 Argstatter, H., Grapp, M., Hutter, E., Plinkert, matter and can influence motivation, P. K., & Bolay, H. V. (2015). The effectiveness of energy, and emotional responses. more music therapists with training in neuro-music therapy according to the Heidelberg (a) general neurologic music therapy model compared to a single session of educational The good news is that music is for counseling as treatment for tinnitus: A controlled everyone, and anyone experiencing (NMT) and (b) the psychological aspects trial. Journal of Psychosomatic Research, 78(3), of coping with a clinical condition. 285–292. doi:10.1016/j.jpsychores.2014.08.012 tinnitus may choose to engage in 3 Grapp, M., Hutter, E., Argstatter, H., Plinkert, P. K., the intentional use of music to help There is also a small cohort of & Bolay, H. V. (2013). Music therapy as an early music therapists with advanced intervention to prevent chronification of tinnitus. manage and cope with tinnitus! International Journal of Clinical and Experimental education and training who Medicine, 6(7), 589–593. In music therapy, interventions 4 Krick, C. M., Argstatter, H., Grapp, M., Plinkert, P. may include active music making, or concentrate on research in music K., & Reith, W. (2017). Heidelberg Neuro-Music therapy for hearing disorders. Therapy restores attention-related activity in “musicking,” and/or listening to music. the angular gyrus in chronic tinnitus patients. Sometimes individuals may elect to To locate a music therapist, the Frontiers in Neuroscience, 11, 418. doi:10.3389/ American Music Therapy Association fnins.2017.00418 emphasize one element of music to 5 Aalbers, S., Fusar-Poli, L., Freeman, R. E., support their plan. For example, this (AMTA) is happy to assist with Spreen, M., Ket, J. C., Vink, A. C.,…Gold, C. referrals for a consultation. Individuals (2017). Music therapy for depression. Cochrane could be rhythm or tempo to support Database of Systematic Reviews, 11, CD004517. balance and movement exercises may contact AMTA via email at info@ doi:10.1002/14651858.CD004517.pub3 for individuals with alterations in musictherapy.org or by calling the proprioception around changes in association at 301-589-3300.

40 TINNITUS TODAY SUMMER 2019 www.ATA.org SCIENCE & RESEARCH NEWS 

Gender Association of Tinnitus and Suicide Attempts

Summary by John A. Coverstone, AuD tinnitus. Of that group, 1,995 (2.8%) measure the association between reported severe tinnitus, but only two variables (in this case, tinnitus and Tinnitus is known to have a high 1,484 (2.1%) had been diagnosed by suicide attempts) according to another correlation with mental health a specialist. All told, only 395 of 1,995 variable, such as age group or gender. disorders in people who are more people—just under 20 percent— In this case, the authors found that a severely bothered by it. This is a reporting severe tinnitus were statistically meaningful link between primary concern when considering diagnosed. This is a concerning statistic increased suicide attempts and severe clinical treatment for tinnitus and because it indicates the vast majority tinnitus existed only for women. There is likely why cognitive behavioral of people with tinnitus have not been was no statistical increase in attempts therapy has been identified as the only clinically diagnosed. It may be tempting at suicide for men with severe tinnitus. evidence-based treatment proven in to dismiss these data as representing These data indicate that there is research to decrease tinnitus distress. the large proportion of people with psychological benefit (at least as far A group of researchers and non-bothersome tinnitus. However, as decreasing suicide attempts) to physicians from Sweden, Italy, and more than 80 percent of people with seeking clinical care for tinnitus. An England published a review of survey self-described severe tinnitus have association was also made for suicide data addressing the effects of tinnitus.1 not been clinically diagnosed. This attempts by women with severe Data came from the Stockholm may be because clinical resources are tinnitus. Given that only 20 percent Public Health Cohort, a 2010 survey unavailable, a primary care physician of people with severe tinnitus were of Stockholm County residents. gave negative advice (“nothing can found to have a clinical diagnosis, The researchers specifically sought be done”), or a belief that care will be greater effort needs to be made to get information regarding the incidence ineffective or inappropriate (“they will people with tinnitus to a specialist so and characteristics of people with just want to sell me a hearing aid”). Out they can receive help when needed. tinnitus who attempted suicide. Their of the 71,542 individuals completing This is shown to be particularly true findings were published in JAMA the survey, 2,404 (3.4%) reported a for women. Women with tinnitus have Otolaryngology—Head & Neck Surgery suicide attempt. historically been perceived as a much in May 2019. The authors found a higher smaller population than men with As part of the survey, participants incidence of suicide attempts among tinnitus because men engage in more were asked to indicate whether they the population who reported any occupational and recreational activities experienced moderate tinnitus, severe kind of tinnitus and also the subset that have risk for tinnitus. This survey tinnitus, or no tinnitus. Researchers of people reporting severe tinnitus. shows only a slightly smaller number were able to correlate these answers This was not the case for the group of women reporting tinnitus—as well with data from the National Patient of people with clinically diagnosed as those reporting severe tinnitus. Register when residents were tinnitus. In other words, data revealed Yet, a significantly greater number of diagnosed prior to 2010. Participants that people who had visited a women are affected to the point of were also asked to indicate whether specialist and received a diagnosis— attempting suicide. they had attempted suicide: more than and hopefully a treatment plan as well—were no more likely to attempt 1 Lugo, A., Trpchevska, N., Liu, X., Biswas, R., a year ago; in the past year; in the past Magnusson, C., Gallus, S., & Cederroth, C. R. month; or never. suicide than the general population. (2019, May 2). Sex-specific association of tinnitus The researchers next performed with suicide attempts. JAMA Otolaryngology— Among all 71,542 participants, more Head & Neck Surgery. Advance online publication. than 16,000 (about 22%) reported a stratified analysis. This is a way to doi:10.1001/jamaoto.2019.0566

www.ATA.org TINNITUS TODAY SUMMER 2019 41  TINNITUS RESOURCES

An Endless Variety of Music and Sounds to Tune Out Tinnitus

For many people with tinnitus, music literally plays a pivotal role in offering an easy escape from the annoyance of listening to tinnitus. In the last few years, listening options have expanded and prices have equalized among most large streaming services that grant access to a vast selection of songs and sounds for approximately $10 per month. Which streaming service is best depends on the music and benefits that appeal to you. Fortunately, most services offer a free option or free trial period, which allows you to explore the services and quality of sound before subscribing.

Well-known streaming services include:

Amazon Unlimited Music Apple Music Deezer Offers songs, playlists, and 50 million song catalog 53 million-plus song catalog radio Apple DEEZER SA AMZN Mobile LLC

SiriusXM Google Play Music Pandora Stream music, comedy, news, Stream songs & curate playlists Music & podcast platform and sports Google LLC Pandora Media LLC SIRIUS XM Holdings Inc

Spotify TIDAL YouTube Music 35 million-plus song catalog High-fidelity music and video Stream songs and music videos and TIDAL Music AS Google LLC Spotify Ltd.

There are thousands of internet radio stations playing genre-specific music for free. Tiered subscriptions are often available, which eliminate ads. Explore more than 30,000 options by visiting www.internet-radio.com

Examples of genre-specific options include:

Calm Radio Relaxing music to work, meditate & sleep Provides access to more than 350 channels of relaxing music, nature sounds, classical music, and sounds and music to help promote concentration and sleep.

Sleep Radio Nobex Technologies Provides ambient music for free 24/7, without ads or DJs. The station is based in New Zealand and is run by its founder, who suffered from insomnia and depression.

42 TINNITUS TODAY SUMMER 2019 www.ATA.org TRIBUTE 

Remarkable Service to Tinnitus Community

The American Tinnitus Association wishes to express its sincere gratitude to Scott Mitchell and Gary Reul for their many years of service on the organization’s Board of Directors. We will miss working with them, but know that they will stay in touch for years to come. Departing remarks from Scott C. Mitchell—17 years as an ATA Board Member Why should you United States, you could count the 1870 poem “Ten Times One Is Ten,” volunteer time number of researchers on one hand; Edward Everett said it best: and contribute now there are hundreds. At this point, “I am only one. your money to it is only a question of resources to But still I am one. an organization commit to the quest. As to the second I cannot do everything. like the American point about making a difference, we But still I can do something; Tinnitus Association? I think you have can’t wait around for somebody else to And because I cannot do everything to believe two things: First, that a cure donate money or make that phone call I will not refuse to do the something for tinnitus is not only possible but also to help the ATA. It’s up to us. In the that I can do.” likely. And, second, that you personally can make a difference in making that Scott has been a tireless advocate for the ATA and its mission happen. As to the first, I have seen to raise tinnitus awareness, educate policy makers about the pace and breadth of scientific tinnitus research accelerate since I’ve tinnitus, advocate for granting agencies to prioritize tinnitus been involved in the ATA. Jack Vernon, grants, and improve the interface that patients have with one of the principal founders of the healthcare and retail professionals. ATA, once told me that when he first — Tom Lobl, PhD, entrepreneur and ATA board member pioneered tinnitus research in the

Departing remarks from Gary Reul—18 years as an ATA Board Member

It was a balmy become progressively worse. During board chair. This journey brought me in morning in the the last five years, I have become touch with caring staff, dedicated board Florida Everglades basically housebound. members, thousands of generous when my wife and Twenty-two years ago, a friend at donors, members of the ATA’s Scientific I came across an work told me he was a member of the Advisory Committee, and many airboat company American Tinnitus Association and that I scientists who received seed grants for offering 30-minute rides. We bought should consider joining. I did, which was tinnitus research from the ATA. tickets for a ride that changed my life the beginning of a journey that I started I owe the ATA a tremendous thanks forever: When I got off that very noisy as a committee member and that led for the support it has given to me boat, I had tinnitus and hyperacusis. to membership on the board, where I along the way. Tinnitus comes in many That was 25 years ago. Over the years, served in various capacities, including varieties, which doesn’t help scientists my tinnitus and hyperacusis have treasurer, chief executive officer, and around the world who are trying to develop cures. Until we have cures, we Gary Reul has devoted much of his life to helping the ATA in must support research. their mission of helping those with tinnitus. Thank you, Gary! Thanks to everyone who has crossed — Rich Tyler, PhD, leading researcher and tinnitus my path during my tinnitus journey and who has given me support, especially patient advocate at the University of Iowa my wife and daughter.

www.ATA.org TINNITUS TODAY SUMMER 2019 43  TINNITUS RESOURCES

Support Group Locations People with tinnitus at every stage in their journey, from the first few days to many years later, can benefit from membership in a support group. Every tinnitus support group operates somewhat differently; but they all share a passion for providing meaningful discussion and a caring environment where one can be understood through shared experience. The list of groups below can be found on our website at www.ATA.org with additional information on upcoming meetings and locations. It is highly recommended to confirm meeting times and place with the point-of-contact person listed prior to attending a meeting.

California Colorado Tinnitus Self-Help Group of Palm Beach County Los Angeles/Orange County Tinnitus Denver Tinnitus Support Group South County Civic Center Support Group Lutheran Medical Center 16700 Jog Road La Purisma Catholic Church 2nd Floor Learning Center Delray Beach, Florida 33446 11712 N. Hewes St. 8300 West 38th Contact: Ellen Gartner Orange, CA 92869 Arvada, CO 80033 T: 800-732-9217 Contact: Barry Goldberg Contact: Rich Marr E: [email protected] T: 303-875-5762 Georgia San Diego Tinnitus and Hyperacusis E: [email protected] Atlanta Tinnitus Support Group Support Group Mesa County Tinnitus Support Group Dekalb County Public Library San Diego City Library Community Hospital, Legacy Room 1 Dunwoody Branch, Meeting Room North University City Branch 2351 G Road 5339 Chamblee Dunwoody Rd. 8820 Judicial Dr. Grand Junction, CO 81505 Dunwoody, GA 30338 San Diego, CA 92122 Contact: Elaine Conlon Contact: Erica Caplan Contact: Michael J. Fischer, Loretta Marsh, T: 970-589-0305 E: [email protected] Dave Phaneuf E: [email protected] E: [email protected] Illinois E: [email protected], P: 858-395- Florida Chicago Suburban Tinnitus Support Group 1787 Clermont Tinnitus Support Group Glenview Public Library E: [email protected] Citrus Hearing Clinic 1930 Glenview Rd. San Francisco Tinnitus Support/ 835 7th St. Glenview, IL 60025 Education Group Suite 2 Contact: Margie B Hearing and Speech Center of Northern CA Clermont, FL 34711 E: [email protected] Second Floor Conference Room Contact: Laura Pratesi, AuD 1234 Divisadero St. T: 352-989-5123 Maryland San Francisco, CA 94115 E: [email protected] Washington DC Tinnitus Support Group Contact: Malvina Levy, AuD Sarasota Tinnitus Support Group Potomac Audiology T: 415.921.7658 Silverstein Institute 11300 Rockville Pike, Ste. 105 E: [email protected] 1901 Floyd St. Rockville, MD 20852 Palo Alto Support Group Sarasota, FL 34239 Contact: David Treworgy, Gerry Baill Avendias Center Contact: Carmen Trotta, Tom Terrenzi E: [email protected] and 4000 Middlefield Road T: 941-993-7616, 941-462-1311 [email protected] Building One, Second floor E: [email protected] University of Maryland Tinnitus & Palo Alto, CA 94303 The Villages Tinnitus Support Group Hyperacusis Support Group Contact: Ken Adler, Amy Nelson, AuD, Churchill Recreation Center University of Maryland College Park Campus Brandon Cyrus, AuD 2375 Churchill Downs College Park, MD E: [email protected] Lady Lake, FL 32162 Contact: Christina Shields E: [email protected] Contact: Sal Gentile E: [email protected] E: [email protected] E: [email protected] P: 301-405-5562

If you’re interested in forming a group, please email [email protected]. If there isn’t a group in your area, the ATA has an extensive network of volunteers who provide email and telephone support and educational information. To connect with a volunteer in your time zone, see: https://www.ata.org/managing-your-tinnitus/support-network/telephoneemail-support-listing.

44 TINNITUS TODAY SUMMER 2019 www.ATA.org TINNITUS RESOURCES 

Massachusetts HearMD Tinnitus Support Group Texas 1020 North Kings Highway Boston Tinnitus Support Group Dallas/Ft. Worth Tinnitus Support Group Ste. 201 Athan’s Bakery Texas Health Presbyterian Hospital Plano Cherry Hill NJ 08034 407 Washington St. 6200 W Parker Rd. Contact: Beth Savitch, Erin Lustik Brighton, MA 02135 Plano, TX 75093 E: [email protected] Contact: Kevin Plovanich E: [email protected] or E: [email protected] Callier Center for Communication Disorders New York 1966 Inwood Road Michigan Bronx Tinnitus Support Group Dallas, TX 75235 Holland Tinnitus Support Group 260 W. 231st St. Contact: John Ogrizovich Bigby Coffee Bronx, NY 10463 E: [email protected] 660 Chicago Dr. Contact: Dr. S. Karie Nabinet Holland, MI 49423 T: 917-797-9065 or 718-410-2301 Virginia *Limited space available, so confirm E: [email protected] Northern Virginia Tinnitus Support Group attendance in advance Northern Virginia Resource Center for Deaf Contact: Stelios Dokianakis, AuD The Long Island Tinnitus Group & Hard of Hearing Persons (NVRC) T: 616-392-2222 Long Island Jewish Hospital 3951 Pender Drive, Ste. 130 E: [email protected] 2nd Floor Conference Room Fairfax, VA 22030 www.facebook.com/HOLAUD 900 Franklin Ave. Valley Stream, New York 11580 Contact: Elaine Wolfson, Marian Patey E: [email protected] Missouri Contact: Anthony Mennella, E: [email protected] St. Louis Tinnitus Support Group T: 516-379-2534 E: [email protected] St. Louis County Library Oak Bend Branch Washington 1640 S. Lindbergh Blvd. Seattle Tinnitus Support Group St. Louis, MO 63131-3598 North Carolina Raleigh Tinnitus Support Group Broadview Public Library or Raleigh Hearing and Tinnitus Center 12755 Greenwood Ave N. Grand Glaize Branch—Meeting Room 1 10010 Falls of Neuse Rd., Ste. 12 Seattle, WA 98133 1010 Meramec Station Rd., Raleigh, NC 27614 Library Font Desk: 206-684-7519 Manchester, MO 63021-6943 Contact: Saranne Barker, AuD, Sheri Mello, AuD Contact: Keith Field Contact: Tim Busche T: 919-790-8889 T: 206-783-7105 T: 636-734-4936 E: [email protected] E: [email protected] E: [email protected] Oregon Wisconsin Nevada VA Portland Health Care System Madison Tinnitus Support Group Reno/Sparks Nevada Tinnitus Support Tinnitus Education Group Madison Masonic Center Group National Center for Rehabilitative 85 S Stoughton Rd. Modern Audiology of Sparks Auditory Research Madison, WI 53714 634 Pyramid Way 3710 SW US Veterans Hosp. Rd. Contact: Deb Holmen Sparks, NV 89431 Portland, OR 97239 T: 608 219 0277 Contact: Scott Sumrall Contact: Bryan Shaw E: [email protected] E: [email protected] E: [email protected] T: 775-336-0211 Each support group referenced here is Pennsylvania independently operated and led by volunteers New Jersey who wish to provide education and support to Lehigh Valley Tinnitus Support Group Tinnitus Self-Help Group, Ewing the tinnitus community. The American Tinnitus St. James Lutheran Church First Presbyterian Church Association (ATA) does not sponsor or endorse 333 Oxford St. 100 Scotch Road, Ewing, NJ 08628 these activities and expressly disclaims any Coopersburg, PA 18036 Contact: Dhyan Cassie, AuD responsibility for the conduct of any independent Contact: Ed Kozelnicky support group or the information they may T: 215-984-8380 T: 610-797-7251 provide. The ATA is not a healthcare provider and E: [email protected] E: [email protected] you should consult with a primary care physician or hearing healthcare professional for qualified medical advice on tinnitus and related disorders.

www.ATA.org TINNITUS TODAY SUMMER 2019 45 HEALTHCARE PROVIDERS

Spotlight on Patient Providers Update on Patient Provider Listings: In an effort to expand the American Tinnitus Association’s listing of healthcare providers engaged in tinnitus treatment and management, a new application was instituted that asks for more information on the types of services provided. Such information will be added to our website in upcoming months. The first section of the list below includes members who joined recently under the new membership program. Gold and Silver lists, which reflect paid memberships at different rates, will be phased out.

When making an appointment, please mention that you learned of the provider from the ATA, thereby ensuring that providers understand the importance of being a part of the ATA’s tinnitus patient-provider network.

Arthur Corpus, PA Deborah Lain, MSc PROFESSIONAL Sharp Rees-Stealy Medical Group Inc. Hope for Tinnitus HEALTHCARE PROVIDERS Chula Vista, CA Calgary, AB, CANADA Sarah Crow, AuD Malvina Levy, AuD Professional Members Modern Hearing Solutions/ Choice Hearing Center Hearing and Speech Center Listing current as of July 10, 2019 Canton, OH San Francisco, CA David DeKriek, AuD Hashir Aazh, BSc, MSc, PhD Katherine Maffetone, AuD Fidelity Hearing Center Hashir Tinnitus Clinic DC Audiology, DBA Hearing & Tinnitus Center Cerritos, CA London, UK, ENGLAND Woodbury, NY Ericka DeVore, AuD Elizabeth Adams, AuD Diane Markva, AuD All About Hearing Univ. of Vermont-E.M. Luse Center Animas Valley Audiology Longwood, FL Burlington, VT Durango, CO Sara Downs, AuD Nicole Ball, AuD Teresa M. Mazza, AuD Hearing Wellness Center Hearing Evaluation Services of Buffalo, Inc Landrum ENT Duluth, MN Tonawanda, NY Ada, OK Anthony Durante, MD Alyssa Beaton, AuD Abigail McMahon, AuD Mineola ENT Hearing Evaluation Services of Buffalo, Inc. Sound Relief Hearing Center Mineola, NY Orchard Park, NY Fort Collins, CO Phillip Elbaum, LCSW Theodore Benke, MD Brooke Means, AuD Loyola University Benke Ear Nose & Throat Clinic North Georgia Audiology Deerfield, IL Cleburne, TX Gainesville, GA Kaela Fasman, AuD Nashlea Brogan, AuD Laura Morrison Sound Relief Hearing Center Bluewater Hearing Stillwater Medical Group Golden, CO Sarnia, ON, CANADA White Bear Lake, MN Lisa Fox-Thomas, PhD Taylor Buotte, AuD Eric Mounts, HIS UNCG Speech & Hearing Center Atlantic Hearing Care Modern Hearing Solutions Greensboro, NC Salem, MA Canton, OH Todd Gibson, AuD Lisa Caldwell, MA Melissa Palmer, AuD Lake Murray Hearing The Hearing Coach High Point Audiological Lexington, SC Glossop, UK, ENGLAND Clayton, NC Lori Halvorson, AuD Lynn Callaway, BC-HIS Tracy Peck, AuD Lake Forest Hearing Professionals Affordable Hearing Solutions Hearing and Speech Center Lake Forest, IL Green Valley, AZ San Francisco, CA Veronica Heide, AuD Diana Callesano, AuD Andrea Plotkowski, AuD Audible Difference, LLC Hearing and Tinnitus Center ENT Consultants of East Tennessee Madison, WI Woodbury, NY Knoxville, TN Stephanie Hollop, AuD Andrew Campbell, MA Holly Puleo, AuD Univ. of Vermont-E.M. Luse Center NeuAudio Gateway Hearing Solutions Burlington, VT Chermside, Queensland, Australia Warwick, RI Diana Kain, AuD Collin Campbell, LAc Jonathan Ramirez-Lira, AuD Heartland Hearing Center Campbell Acupuncture & Herbal Medicine Clinic Sound Relief Hearing Center Hiawatha, IA New York, NY Scottsdale, AZ Craig Kasper, AuD Maura Chippendale, AuD Deanna Ross, AuD New York Institute for Hearing and Balance Chippendale Audiology Albany ENT & Allergy Services, PC New York, NY Cape Coral, FL Albany, NY Taewoo Kim Shahrzad Cohen, AuD Mimi Salamat, AuD St. Mary’s Hearing Aid Auditory Processing Centers: Dr. Mimi’s Audiology Clinic Seoul, SOUTH KOREA Hearing Solutions Walnut Creek, CA Sherman Oaks, CA

46 TINNITUS TODAY SUMMER 2019 www.ATA.org HEALTHCARE PROVIDERS

Christina Shields, AuD Lindsay Collins, AuD Richard Reikowski, AuD University of Maryland, College Park Sound Relief Hearing Center Family Hearing and Balance Center College Park, MD Centennial, CO Akron, OH Martin Smith, PsyD Nancy Congdon Jennifer Reynolds, AuD Associates in Managed Care The Hearing Care Clinic Reynolds Audiology & Tinnitus Center Denver, CO Downers Grove, IL Woodbury, MN Dustin Spillman, AuD Theresa Cullen, AuD Ann Rhoten, AuD Audiologists Northwest Cape Cod Hearing Center Kentucky Audiology & Tinnitus Services Bremerton, WA Hyannis, MA Lexington, KY Katarzyna Tarnowska, PhD Ali Danesh, PhD Christine Russell, AuD San Jose State University Labyrinth Audiology Sound Relief Hearing Center San Jose, CA Florida Atlantic University Fort Collins, CO Susan Terry, AuD Boca Raton, FL Allison Sayer, AuD Broadwater Hearing Care Nikki DeGeorge, AuD Sound Relief Hearing Center St. Petersburg, FL Fayette Hearing Clinic Scottsdale, AZ Babette Verbsky, PhD Newnan, GA Cindy Ann Simon, AuD Hearing Connections Audiology Kristen DesErmia, AuD South Miami Audiology Consultants Lebanon, OH Ascent Audiology & Hearing South Miami, FL Jennifer Waddell, HIS Bradenton, FL Jacqueline Smith, AuD Sound Hearing Care Patrick DeWarle, AuD Sound Relief Hearing Center Simpsonville, SC Winnipeg Hearing Centres Highlands Ranch, CO Thea Wickey, AuD Winnipeg, MB, CANADA Susan Smittkamp, AuD, PhD Sound Relief Hearing Center Stelios Dokianakis, AuD Associated Audiologists Scottsdale, AZ Holland Doctors of Audiology Shawnee Mission, KS Kayla Wilkins, AuD Holland, MI Randall Solomon, MD Aspire Hearing & Balance MaryRose Hecksel, AuD Island Psychiatry Lakeland, FL Audiology & Hearing Aid Center Port Jefferson Station, NY Hilary Wisdom, AuD Lansing, MI Christopher Sumer, NBC-HIS Columbine Audiology & Hearing Aid Center James Henry, PhD Coastal Hearing Aid Center Sterling, CO VA Portland Health Care System Encinitas, CA Kyle Woods, MA Portland, OR Alexandra Tarvin, AuD Modern Hearing Solutions Jeannie Karlovitz, AuD Elevate Audiology—Hearing and Tinnitus Center Canton, OH Advanced Hearing Solutions Easley, SC Carolyn Yates, AuD Exton, PA Gail Whitelaw, PhD Hearing Evaluation Services of Buffalo, Inc. Kate Landowski AuD OSU Speech-Language-Hearing Clinic Amherst, NY Sound Relief Hearing Center Columbus, OH Alexandra Zweig, AuD Denver, CO Benjamin Wightman, AuD New York Institute for Hearing and Balance Ha-Sheng Li-Korotky, AuD, PhD Sound Advice Audiology New York, NY Pacific Northwest Audiology Livonia, Michigan 48150 Bend, OR Melissa Wikoff, AuD GOLD LEVEL Terence Limb, AuD Peachtree Hearing Evergreen Speech & Hearing Clinic, Inc Marietta, GA Professional Members Kirkland, WA Listing current as of July 10, 2019 Robert Mario, BC-HIS, PhD SILVER LEVEL Melissa Alexander, AuD Mario Hearing & Tinnitus Clinics Alexander Audiology, Inc. Canton, MA Professional Members Santa Monica, CA Sara Mattson, AuD Listing current as of July 10, 2019 Eugene Antonell, BC-HIS Rancho Santa Fe Audiology Catherine Ahrens-Berke, BC-HIS Hear Better Now, LLC Rancho Santa Fe, CA Ahrens Hearing Center N. Dartmouth, MA Stephanie McGuire, AuD Fair Lawn, NJ Judith Bergeron, BC-HIS, CDP McGuire Hearing & Tinnitus Center Jason Aird, AuD Beauport Hearing Care Dayton, OH Iowa Audiology Gloucester, MA Jill Meltzer, AuD Coralville, IA Granville Brady, Jr., AuD North Shore Audio-Vestibular Lab Saranne Barker, AuD Dr. Granville Brady, Jr. Highland Park, IL Raleigh Hearing and Tinnitus Center East Brunswick, NJ Christine Peacock, AuD Raleigh, NC Gail Brenner, AuD Naples Audiology & Hearing Center Randall Bartlett, MA Tinnitus & Sound Sensitivity Treatment Center of Naples, FL Tinnitus & Audiology Center of Southern CA Philadelphia, PC Jeanne Perkins, AuD Los Angeles, CA Bala Cynwyd, PA Audiologic Services Carol Bass, AuD Lois N. Cohen, LCSW, ACSW, BCD Glen Ellyn, IL All Ears Audiology Tinnitus Counseling Julie Prutsman, AuD Ithaca, NY Northport, NY Sound Relief Hearing Center Highlands Ranch, CO

www.ATA.org TINNITUS TODAY SUMMER 2019 47 HEALTHCARE PROVIDERS

Samantha Bayless, AuD Peter Harakas, PhD Marni Novick, AuD The Hill Hear Better Clinic Cognitive Behavioral Therapy Associates, LLC Silicon Valley Hearing Clinic, Inc. Cincinnati, OH Lexington, MA Los Gatos, CA TINNITUSTODAY Linda Beach Dana Heath, MS James Orban, BC-HIS Voorhees, NJ Advanced Hearing LLC Miracle-Ear Hearing Aid Center Lisa Blackman Alpharetta, GA Columbia, MD A Hearing Healthcare Center Hannah Heet, AuD Ashley Penrod, PA-C Philadelphia, PA Duke Otolaryngology of Raleigh Alta View Specialty Clinic Mindy Brudereck, AuD Raleigh, NC Sandy, UT Berks Hearing Professionals Sherry Hodge, AuD Ann Perreau, PhD Reading, PA Advanced Hearing Care Augustana College Anne Carter, MA, PhD Anderson, IN Rock Island, IL Pasadena Hearing Care Alan Hopkirk Jay Piccirillo, MD, FACS St. Petersburg, FL Invisible Hearing Clinic Washington University School of Medicine Chelsea Carter, AuD Glasgow, UK St. Louis, MO University of Maryland Medical Center Wan Syafira Ishak, PhD Bruce Piner, AuD Baltimore, MD Universiti Kebangsaan Malaysia Hearing and Balance Center Troy Cascia, AuD Kuala Lumpur, KL, MALAYSIA Encino, CA University of California, San Francisco Audiology Edward Keels, MA Sandra Royle-Tabak, AuD San Francisco, CA Hear Now Hearing Aid Center Carolina East Ear, Nose, & Throat Patrick Coughlin, AuD Philadelphia, PA Morehead City, NC Hearing Care Professionals Suzanne Kimball, AuD Christina Seaborg, AuD Aberdeen, SD Univ. of Oklahoma Sciences Center Hearing and Balance Center Terry Cummings, AuD Oklahoma City, OK Charlotte, NC Columbine Audiology and Hearing Aid Center Jason Leyendecker, AuD Alyssa Seeman, AuD Sterling, CO Tinnitus and Hyperacusis Clinic of Minnesota Illinois State University Ann DePaolo, AuD Edina, MN Normal, IL The Audiology Offices, LLC Brandon Lichtman, AuD Paul Shea, MD Kilmarnock, VA Wheeling Hospital Shea Ear Clinic Susana Dominguez, AuD Wheeling, WV Memphis, TN Hospital Italiano de Bs, AS, Argentina Virginia Lindahl, PhD Susan Sheehy, AuD Capital Federal, BA, ARGENTINA Psychologist Alabama Hearing Associates Cynthia Ellison, AuD Alexandria, VA Madison, AL Franklin Hearing Center Robyn Lofton, BC-HIS Rivka Strom, AuD Franklin, TN Hearing Associates of Las Vegas Advanced Hearing NY, Inc. Kimberly Eskritt, AuD Las Vegas, NV Brooklyn, NY Lambton Audiology Associates Dan R. Malcore Jennifer Sutton, AuD Sarnia, ON, CANADA Hyperacusis Network Hearing Evaluation Services of Buffalo, Inc. Julie Farrar-Hersch, PhD Green Bay, WI Williamsville, NY Augusta Audiology Associates Nancy McKenna, AuD, PhD Robert Traynor, EdD, MBA Fisherville, VA University of North Carolina, Chapel Hill Audiology Associates of Greeley, Inc Brittany Fauble, AuD Chapel Hill, NC Greeley, CO The American Institute of Balance Brian Melzian, PhD West Valley Hearing Center Largo, FL US Environmental Protection Agency Woodland Hills, CA Leon Flores, MD Jamestown, RI Peter Van Ostaeyen Monterey, Mexico Mary Miller, PhD Antwerp, Belgium, EU Anna Forsline, AuD Premier Hearing and Balance Brian Worden, MD National Center for Rehabilitative Auditory Research Hammond, LA Kaiser Permanente Portland, OR Deanna Nickerson, AuD Woodland Hills, CA Laura Flowers, AuD CarolinaEast ENT Angela Zuendt, AuD Hearing and Balance Specialists of Kansas City New Bern, NC Greenville Health System Lees Summit, MO Greenville, SC Kristen Furseth, AuD Willamette ENT Salem, OR Please note that the American Tinnitus Association does not verify providers’ certifications and Amy Greer, AuD expertise in tinnitus treatment. The list is meant expressly for informational purposes and should ENT Associates of Johnstown not be construed as the ATA’s endorsement of the providers listed. The ATA strongly advises Johnstown, PA anyone using the list to check practitioners’ websites and tinnitus services before scheduling Kathleen Hadsell, AuD appointments. Please note that the list includes hearing aid dispensers because hearing aids can North Shore Audio-Vestibular Lab Highland Park, IL be helpful to some people in the management of their tinnitus.

48 TINNITUS TODAY SUMMER 2019 www.ATA.org TINNITUSTODAY Editorial Calendar

Tinnitus Today magazine is a print and electronic media magazine published in April, August, and December, and circulated to 25,000+ ATA contributors, donors, patients, supporters, researchers, and healthcare professionals.

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

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

Winter—Dec 2019 Annual Research Issue 9/15 10/1 10/1 12/1 December

Spring—Apr 2020 Causes of Tinnitus 1/15 2/1 2/1 4/1 April

Summer—Aug 2020 Tinnitus and the Mind 4/15 5/1 5/1 8/1 August

Editorial Calendar is subject to change.

To advertise, contact: [email protected]

MISSION AND CORE PURPOSE The mission and core purpose of the ATA are to promote relief, help prevent, and find cures for tinnitus evidenced by its core values of compassion, credibility, and responsibility.

CORE VALUES AND GUIDING PRINCIPLES Compassion: Evidenced in a spirit of hope reflected in the commitment to finding a cure, preventing the condition, and supporting those affected by the condition. Credibility: Evidenced in accurate information from reliable sources, transparency in decision- making, and an earned reputation for trustworthiness. Responsibility: Evidenced in patient-centered advocacy by a collaborative community of forward thinking leaders accountable to its mission and members.

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Open Access ATA’s Conversations in Tinnitus, with John A. Coverstone, AuD, and Dean Flyger, AuD Tune In to Conversations in Tinnitus to Stay Abreast of Tinnitus Research and News The American Tinnitus Association’s podcasts are available 24/7 to help you stay abreast of tinnitus research and other tinnitus topics. Just like listening to music on your smartphone or computer, you can tune in to Conversations in Tinnitus podcasts, cohosted by John A. Coverstone, AuD, and Dean Flyger, AuD, while you work out, take a walk, relax at home, or commute to work. To access and learn more about this unique and compelling series, visit our website at www.ata.org. To enhance listening comprehension and accommo- date those with noise sensitivity, transcripts are available with each podcast.

ALL PODCASTS ARE FREE AND OPEN ACCESS Podcast 13: Unraveling the Power of Loud Music Podcast 15: Exploring Noninvasive Neurosensory SUBJECT MATTER EXPERT: Elizabeth Beach, PhD Tinnitus Treatment TOPIC: Dr. Elizabeth Beach discusses research that explores why people SUBJECT MATTER EXPERT: Hubert Lim, PhD are drawn to loud music and the obstacles that impede behavioral changes TOPIC: Dr. Lim, a leading scientist and thought leader in auditory that would encourage safe listening practices. As head of the Behavioural neuroscience, discusses the research and development of non-invasive Sciences Department at the National Laboratory in Australia, bimodal neuromodulation for treatment of tinnitus. He explains the scientific she studies recreational noise in the music and entertainment industry, concept and the research being conducted, which is aimed at developing strategies for encouraging safe listening for staff and patrons, and how to a treatment that decreases the perception of the tinnitus sound and the motivate young adults to protect their hearing. negative emotional reactions caused by it. Podcast 14: Does Tinnitus Retraining Therapy Podcast 16: Understanding the Problem of Painful Improve Quality of Life? Hyperacusis SUBJECT MATTER EXPERTS: Roberta Scherer, PhD, and Craig Formby, PhD SUBJECT MATTER EXPERT: Bryan Pollard, BA TOPIC: Drs. Scherer and Formby guide us through the decades-long journey TOPIC: Bryan Pollard, founder of the nonprofit Hyperacusis Research, explains to conduct the first and only phase III trial of tinnitus retraining therapy, an what it is like to live with noise-induced pain and what is known about this influential habituation-based treatment protocol for alleviating the negative often, overlooked condition. As someone who lives with painful hyperacusis reactions to tinnitus. The researchers explore findings that highlight the and tinnitus, Pollard provides unique insight into the struggles, his mission to importance of sound enrichment and working with a caring and qualified increase research on the condition, and the importance of developing tools to healthcare provider. enable sufferers to return to a more normal life, without fear of setbacks. Podcast 17: Talking About Tinnitus with Children To subscribe to the print or digital issue SUBJECT MATTER EXPERTS: David Baguley, PhD, and Claire Benton, MSc of Tinnitus Today, which is TOPIC: Dr. Baguley and Claire Benton discuss their efforts to educate parents, teachers, and healthcare providers on talking to children about tinnitus. The published three times a year, visit widespread misconception that children don’t have tinnitus has meant children www.ata.org or email [email protected] suffer alone and miss critical opportunities for early intervention. They also discuss their research findings on the topic and tools to help children manage tinnitus.