How do we treat tinnitus?

Hi again, Audiology fam!

We at Andros hope you are all healthy and relatively happy, and continuing to #maskup as we all find
our way through the current landscape.

Welcome to part TWO of our tinnitus series – oh, how time flies when we’re all having fun (sincerely hope). Today we’re going to be discussing the various ways that we (your neighborhood friendly audiologists) treat and/or manage tinnitus.

First, I’m going to get this statement out of the way: you won’t find any magic bullet cure here that will immediately disappear your tinnitus. I am so sorry, but we just aren’t there yet. HOWEVER (and you see, I used the capital letters to indicate emphasis because that is a major however), there are many many many ways to manage tinnitus successfully and make life better for people who suffer from tinnitus.

The first type of management strategy we’ll discuss is the use of sound therapies. Sound therapies
involve changing a person’s perception of or reaction to their tinnitus, and they do this in a variety of ways. This can mean reducing the prominence of the tinnitus in relation to background noise by partially or completely covering your tinnitus with a sound of your own choosing, using soothing sounds to reduce the stress associated with tinnitus, using an interesting sound in order to distract yourself, or increasing the level of background sound to promote your brain’s habituation or acceptance of your tinnitus over time.

It should be noted that there is an insufficient amount of research available to fully support the use of sound therapies in the treatment of tinnitus, particularly because there are many different ways to implement sound therapy. However, many authors have seen high anecdotal rates of success with different types of sound therapy, and it is still considered a good option for patients with chronic, bothersome tinnitus, as long as realistic expectations are taken into consideration.

The devices used for sound therapy were, at one point, stand-alone devices; purely made for sound generation. Those devices still exist and are available, but at this point, most hearing aids are now what’s considered “combination” devices, and have tinnitus maskers that come standard in many, if not all of the current offerings. As stated in previous blogs regarding this subject – hearing loss is a common comorbidity (pal) of tinnitus, and if we’re treating the hearing loss with a hearing aid, it only makes sense to get a device that is also capable of sound generation. Many people find that the act of treating the hearing loss, and giving the brain something else to listen to (amplification! Birdsong! The ticking of your car turn signal!) helps to minimize their tinnitus, without having to do any other type of sound generation, but more options is better than no options. A very common type of sound therapy that many people (including the friendly neighborhood audiologist writing this article) come to on their own without having to be coached is something called sound enrichment. Sound enrichment is the use of sound in the background during the day or going to sleep to help distract from your tinnitus. Many people use music, podcasts, or even a common household box fan for this task – it is an easy and simple way to give your brain a little relief.

Next management technique is also pretty straightforward: counseling and education! Surprisingly, for some people, just knowing what exactly tinnitus is, and potentially why it is happening helps them adjust to their new normal and go from there. If you’ve been following this series from the beginning, then you already have more information about tinnitus than the general public – go you! The goal of patient education is to increase knowledge about tinnitus, which will hopefully help people to cope and manage their reactions to their tinnitus a little better. The level and type of counseling providing will vary based on individual needs – for many patients, a little education will go a long way. For others, the counseling needed may prove to be outside the scope of the audiologist, and a referral to someone who specializes in cognitive-behavioral therapy (a type of therapy that focuses on reframing thought patterns and behaviors) may be necessary. This does not mean the work you’ve done with your audiologist has failed – this means that you are continuing on the path to better quality of life with tinnitus, and just need someone else to guide you along the path for a little while.

Another subset of tinnitus management strategies include guided tinnitus protocols, where the audiologist and the patient work through a series of prescribed activities and counseling sessions. There are several currently en vogue, including, but not limited to such protocols as TRT (Tinnitus Retraining Therapy), or PTM (Progressive Tinnitus Management). The guided tinnitus protocol favored by Andros Audiology and Hearing Aid Center is a protocol called the Tinnitus Activities Therapy (TAT), which was developed by the University of Iowa. The Tinnitus Activities Therapy integrates sound therapy (see above) with counseling (also see above) and Cognitive Behavioral Therapy (also see above. Gee, I’m thorough). There are four major components or aspects to this form of tinnitus management, each with its own series of activities and counseling to move through: thoughts and emotions, hearing and communication, sleep, and concentration. While the TAT protocol has not been studied systematically, because it is a more modern protocol, there is evidence backing each component used in TAT (sound therapy, counseling, and CBT, as previously discussed).

And with that, we close out our THIRD tinnitus discussion! Next time, we’ll be discussing some tinnitus odds and ends, a few things that are important to note, but don’t really fit in the previous categories.

I hope you all are having a wonderful time taking this wild ride into tinnitus education with me!

Until next time, please stay safe, be well, and as always, remember that Andros Audiology and Hearing
Aid Center is here to help.

Tinnitus 101 – Part 1

Hi Audiology folk!

Here’s hoping that as of this writing you are all safe and continuing to social distance as the beautiful Minnesota winter descends upon us! If you remember, our last letter to the public discussed the basics of what tinnitus is, how to say it, etc. If you don’t remember – see below!

Here is a part one of four part series on Tinnitus. For this publication, we’re going to dive a little deeper, and discuss how tinnitus is assessed, or measured.

Tinnitus is a highly individualized and subjective disorder – every person experiences their tinnitus in a different way. Some people hear whistling, some hear “crickets”, this audiologist hears a high-pitched ringing (a classic) pretty much all the time. Every person will describe the sensation in a way that is specific to them – so how do we quantify the tinnitus? How do we establish how much of an issue any one person is having with it?

The initial evaluation will look very similar to the initial evaluation for a hearing loss. The reason for this is simple – 90% of people who have tinnitus also have an underlying sensorineural hearing loss. So the first steps are going to look the same.

Step One

First up is a thorough intake form, and complete case history. The intake form may include a screening questionnaire to determine your perception of your tinnitus and/or hearing loss – in order to begin assessing the tinnitus and guide a course for treating it, first we have to know where to start, and questionnaires help us along that path. A tinnitus case history should include how long the tinnitus has been present, how often it occurs, if it is in both ears or just one, if you have a history of noise exposure, and how much you feel the tinnitus is impacting your day-to-day life.

Step Two

Next up is a diagnostic audiologic evaluation, which sounds scary, but is actually pretty straightforward. It includes otoscopy (your friendly neighborhood audiologist is going to look in your ears), a hearing test (to determine if there is any underlying hearing loss accompanying the tinnitus) that includes pure-tone air conduction (under headphones), bone conduction (using a bone oscillator), and word understanding testing (repeat after us!). If indicated, your audiologist may also test the movement of your eardrums with something called a tympanogram – this is to make sure there is no fluid hanging out behind your eardrums where it certainly does not belong.

Now, if you’ve already done some research on tinnitus, or gone down the various rabbit holes about it on the internet, you may have heard of something called psychoacoustic evaluation. Psychoacoustic evaluation with regards to tinnitus can come in many different forms, all of which require some attempt to quantify the tinnitus – either by matching its pitch or loudness using the audiometer, or testing the minimum level of noise needed to mask, or cover up, the tinnitus. While these measures can be very useful for helping the patient (you!) feel heard and understood about the severity of their tinnitus, it is important to understand that there is very little hard evidence in favor of the validity of these measures, and they have very little clinical utility. They are also difficult, requiring an intense amount of focus for
an extended period of time, both for the audiologist and the patient, so it’s important that they are used in their appropriate context, when absolutely necessary.

And with that, we’ve finished another section of Tinnitus 101 by Andros Audiology!! I hope that you found this information helpful and instructive, and that you’ll join us again for our next series on tinnitus, which will cover tinnitus treatment or management techniques!

In the meantime, audiology friends, stay safe and be so well!

What is tinnitus?

Hi Audiology Friends and Fam!

Hope this message finds you well and you’re continuing to find a socially distant way to connect with people! To keep up our tradition of educating and (hopefully) entertaining our patient population, I’ve decided to embark on a grand journey – the journey of tinnitus education.

What is tinnitus? How on earth do you say it? How do we make it better? Is it indicative of a super scary
underlying diagnosis? HELP?!?!

We are going to tackle all of these questions and many more – never fear, your friendly neighborhood audiologists are here! With a five-part series on all things tinnitus! You heard me, FIVE PARTS, we have a lot to cover!! Today, we’re going simple and discussing what tinnitus is. Over the coming weeks we’ll also cover how to assess, and treat tinnitus, as well as our own Andros Protocol for tinnitus evaluation.

We’re going to start here, with the basics – what is tinnitus? You’re about to find out!

Tinnitus is defined as the perception or sensation of hearing sound when no external sound is present –
the hallmarks include perceiving/hearing the sound involuntarily, and the sound originating in the head
rather than being externally produced.

People can hear a variety of sounds, all of which are covered under the umbrella of a tinnitus diagnosis,
but the most common variations include: ringing, buzzing, roaring, chirping, or hissing.

The first step in assessing a person’s tinnitus involves placing the symptoms into a series of classifications or categories. The different types of tinnitus affect the management plan that will be put into place, or help your audiologist decide if you even need a management plan! See below for the different category types for tinnitus, and see if you can pinpoint which category you fall into.

  • Primary
    • Related to an unknown cause
    • May or may not be associated with SNHL
  • Secondary
    • Associated with an identifiable underlying cause or organic condition
  • Recent onset
    • Less than 6 months in duration
  • Persistent
    • 6 months or longer in duration
  •  Spontaneous
    • Sudden tonal tinnitus in one ear that is accompanied by a sense of fullness and hearing loss in the same ear
      • All of a sudden, everything gets very quiet, and you hear a whine come on in that ear
    • All symptoms resolve within a minute or two
      • It can be quite jarring, but is considered a natural phenomenon that
        most people will experience at least once in their lifetimes
  • Temporary
    •  Tinnitus caused by noise or some other ototoxin that may last for a few days or up to about a week
  • Occasional
    •  Occurring every few weeks or months
  •  Intermittent
    • Occurring daily or weekly
  •  Constant
    • Always present
  • Non-bothersome
    • Tinnitus does not have a significant impact on quality of life
    • You may be curious or concerned about the cause and natural progression of the tinnitus, but it hasn’t interrupted the daily flow of your life
  • Bothersome
    • Tinnitus is having a significant impact on quality of life
    • You may feel distressed and are seeking therapy/management strategies to alleviate symptoms

There are many sources of information that suggest many types of risk factors and potential underlying
contributors to tinnitus (see below for a graphic of risk factors/associated conditions for tinnitus listed

However, there is no one answer to what causes tinnitus, and how it originates in our brain and auditory
system. The brain is an intensely complex piece of machinery, and we are still theorizing about the
intricate process of tinnitus, and why it happens. Currently the predominant theories suggest that all
tinnitus – including tinnitus believed to be caused by cochlear damage (associated with hearing loss) –
originates in the central auditory system (in the brain, not the cochlea).

Here’s something to consider when thinking about your tinnitus – it really is more common than most people think. The friendly neighborhood audiologist writing this blog entry is currently experiencing her constant, non-bothersome tinnitus in both ears with some level of amusement! Per the U.S. Center for Disease Control in 2011-2012, 15% of Americans have tinnitus. For most people, tinnitus is non- bothersome (it doesn’t really get in our way), but for others, it can be quite debilitating and troublesome. There is no one way to experience tinnitus – it is a highly subjective condition, and each case is going to be unique, with its own trials and tribulations. No matter how you feel about your tinnitus – your feelings are valid! Left to its own devices, debilitating tinnitus may impact a person’s quality of life in a variety of different ways, including thoughts, emotions, sleep, concentration, socialization, physical health, and even economic well-being, so it’s important to ask for help in trying to manage tinnitus if it begins to overwhelm you. That’s what we’re here for!

Well, THAT was a LOT of information, but I believe that covers the bases as far as basics are concerned.
Oh wait! I forgot to answer the number one question I get about tinnitus on a daily basis:

it can be pronounced two different ways, TIN-ni-tus or tin-EYE-tus. Both pronunciations are technically
correct, but these audiologists were taught the TIN-ni-tus version, so that’s what we go with. That’s our answer – WE’RE ALL CORRECT!

I hope this has been instructive and (at least a little bit) fun! I’ve got a few more of these ready to go, but am also open to suggestions if you have burning questions that you’d really like answered about tinnitus – send them to the following email and we’ll try to get them covered!

Stay safe and be well, all of you, and we’ll talk soon!