Spotlight on the American Tinnitus Association

Hi, I’m Jim Cuddy, and this is Ask the Hearing Doctors, and I’m joined today by Dr. Ana Anzola, doctor of audiology and principal of Hearing Doctors, the Washington, D. C. area’s highest rated audiology practice with over 2,500 5-star reviews. Also joining us today via Zoom is Dr. Rebecca Lewis, a clinician scientist who currently serves as chief of audiology at the University of California, San Francisco and also serves as the scientific grants project officer for the American Tinnitus Association. Dr. Rebecca Lewis, Dr. Anna Anzola, thank you both for your time.

Thank you.

Thanks. Nice to be here.

We have talked about Rebecca on this program. We’ve talked about tinnitus a lot, but we always have new viewers. We always have are finding people that really don’t know a whole lot about tinnitus, some of them even walking around with tinnitus looking for solutions. Can you tell us a little bit about just what tinnitus is?

Yeah, absolutely. So, essentially, tinnitus is when someone has the perception of sound, but there’s no external sound source. So, they’re hearing something in their head, in their ears, in one ear, and there’s really no particular place that this is coming from. Oftentimes, it’s described as ringing in the ears, but honestly, there’s so many different descriptors that folks use, like buzzing, hissing, whistling, the list goes on and on. It can be quite short term and it could also last for a long time depending on different individuals. So, this is something that can definitely affect a lot of people, and as you touched on, some people don’t even know that they’re experiencing this, and others can be extremely bothered by it. So, it’s something that for those who find particularly tended to be particularly bothersome, this is something that we, as audiologists, are really interested in making sure that they get good guidance with.

And, Anna, you have tinnitus yourself? I mean you have to deal with this on a personal level.

Yeah and so that is my own personal connection with our patients because I can relate to them and they can relate to me, and I have the consideration of saying, “Yes, I have the buzzing,” or the ringing or whatever other terminology they use, and so they feel a little bit more open to share their stories, and in fact, we feature quite a few of their patrons in our podcast for our viewers to really look into those and try to find out there’s so much help out there, luckily. I get to wear my devices when I need them the most and I think that that’s something that they can look forward to.

Now, Rebecca, I mentioned your position with the American Tinnitus Association. Tell us a little bit about the American Tinnitus Association, what sort of a resource that is for folks that are suffering from tinnitus?

Yeah, the American Tinnitus Association or ATA is a place that offers a wide variety of resources, both for patients and researchers, but we’ll focus on patients here. So, we have a tool where you can find a healthcare provider who has indicated that they are comfortable working with people who have tinnitus. It is something that is important because I think some folks who say that they’re maybe not as comfortable working with people who have tinnitus, and especially bothersome tinnitus, might take away from some of their experiences that there isn’t anything that you could do to help with this perception in the head, and it turns out, and I think we’re going to get into this later, that there’s a lot of different things you can do, but you might need to talk to the right person, so making sure that you can find an appropriate healthcare provider is really important and the ATA can certainly help with that. The other thing is that we can connect individuals with different support groups, so I think it can be helpful just for folks with bothersome tinnitus to connect with people who are having a similar experience. It’s something that’s invisible to others. You wouldn’t know that Dr. Anzola had tinnitus just by looking at her, and if she’s having a hard time with it, then maybe she would like to go to a group and talk to someone about it and kind of connect on that level, and then we also have a helpline. It’s a tinnitus advisors program and that is a helpline that’s staffed by trained audiologists who can provide information and support to people who really are looking for assistance with that next step.

And tinnitus is something that there isn’t necessarily a singular known cause, correct? Or is there something that’s typical that may trigger tinnitus?

Well, I think that as audiologists, we’ve seen a lot that typically people with tinnitus present with some degree of hearing loss, whether that is a very mild, high frequency hearing loss, whether it appears as a normal hearing status but has just a little bit of decreased hearing relative to what we would assume to be baseline. I believe the stats are that over 90% of people with tinnitus present with some form of hearing loss so that is something we tend to see quite often. But you’re right that there really isn’t one particular mode that can be guaranteed as the etiology or the cause of that tinnitus. Other things can be clenching of the teeth, whiplash, traumatic brain injury, the list kind of goes on there but, of course, as audiologists, we definitely see a lot of folks with hearing loss too.

Do you then look at it, is treatment then different based on like let’s say for instance, it’s a traumatic brain injury that you figured out the cause of it, is treatment different for one person with tinnitus than somebody else that has tinnitus? This question could actually go to both of you.

Yeah, it’s a great question.

Yeah, it is a great question, so I would recommend for us audiologists, I like to get to the bottom of the cause of the tinnitus. Is it happening in the outer ear? It could be wax, it could be an ear infection, it could be due to an eardrum, a perforation, TMJ, the ossicle, the bones in the middle ear are not working properly, so a list of host things that could be happening, so we want to rule out before we get to the actual brain.

Rebecca, is there a path to curing something like tinnitus?

There certainly is a path. It is not a path that is available to patients today, but this is exactly what researchers are working hard to kind of develop that path right now across the world, and in fact, the American Tinnitus Association has really created we call it our roadmap to a cure because this is something that at the end of the day, people with tinnitus really just don’t want that sound in their ears or head. They don’t want to necessarily work with different management strategies to try to just kind of keep it at bay. I think if anyone could take that magic pill that would make it go away, they would certainly do that if there was no poor side effects, but we really are still in the stages of understanding how best to get to that cure. I think at this point, we’re also very interested in making sure that folks are aware that this is an issue and trying to prevent it when possible, and that’s where audiologists can be a really great partner in that for people who are kind of earlier on in their life and their stage.

It’s also important to point out that for most people, this is manageable. This isn’t something that has to debilitate you day in and day out, right?

Well, it can be very debilitating and then finding out where you are in the spectrum like we have. We use questionnaires that gives us a little bit more information as to how they feel or they’re reacting towards it. One of them is the tinnitus reaction questionnaire we often use, and it’s a scale from zero to 100, and it can be very debilitating, and we do work with professional help, and then we start with that, and then we measure the actual hearing abilities, and then we then recommend a certain treatment plan.

Rebecca, is something else that I’ve read about recently and this goes towards the research, of course, that the American Tinnitus Association supports, and that is regenerative therapy. What is it? How can that possibly help folks with tinnitus?

Yeah. Well, so one thing we’ve noticed as audiologists, and of course, researchers have as well, is that if you restore audibility or if you give someone who has hearing loss and tinnitus hearing aids or amplification devices, if you bring some of that volume back, oftentimes the tinnitus isn’t as much of a problem. Now, it’s certainly not a cure on its own, but you could imagine that if you were to address the underlying cause of the hearing loss by perhaps regenerating some sensory cells in the inner ear that you could potentially increase that audibility, and then this could potentially also lead to reduced tinnitus. However, the limitation with that is that one of the prevailing thoughts of how tinnitus is actually working in the mind is that it is a result of a change in how the brain is processing that sound, so basically there’s something called like a central amplifier where it will start to boost a signal if there’s really not a lot of information to work from. So, you could imagine that if someone has hearing loss in the higher pitches and you give them a regenerative therapy to restore that audibility to bring that hearing back, it might still take some time for the brain to actually understand that it doesn’t need to provide that area, those higher pitches, as much of a boost anymore. So, I think it has a lot of potential, but I don’t know if right away it would stand on its own. I think that there would certainly need to be time involved and potentially some more steps to try to address that as well.

One thing that I’ve learned since we’ve been doing these podcasts is that there’s a lot we don’t know or a lot that most folks don’t know about hearing loss and all the different effects of hearing loss and that kind of thing, so with something like tinnitus, is that something that if I recognize that I have tinnitus, but I don’t do anything about it, does it get worse?

That’s a great question. I think at sometimes if you are not doing anything about it, you might think if you’re not doing anything, maybe it’s not bothersome for you, and if you’re not paying attention to it, the line of thinking could be that your brain isn’t assigning importance to it and therefore it won’t necessarily kind of feed into this cycle of making it more important and creating kind of more of a problem, but it could be that there’s an underlying etiology or kind of disease or disorder that really does need to be addressed. If it’s hearing loss, and hearing loss can be progressive, then potentially we need to work with that hearing loss so that the brain doesn’t just continue to amplify the sound that you’re missing out on. It could be a whole host of different medical issues that I won’t go into here because some of these things can be very rare, but it could be something that you want to have addressed. Anna, did you want to add to that potentially?

Yeah, so it goes back to your perception, and I think all those who suffer from tinnitus. I had a really bad relationship with my own tinnitus because I perceived it, I couldn’t do anything about it. I didn’t know what it was. I can’t cure it and there are certain things that can exacerbate it. More noise, so being exposed to loud levels of noise, caffeine, so I cut down my caffeine to one cup a day, nicotine, alcohol, sodium. Sodium was my trigger, so I was very mindful of what I was eating or drinking and I started plotting it because it might have gotten louder. My perception was louder or it was longer duration. I tied it back to “Oh, I must have eaten something, I’ve done something,” and so I kind of went back and tied it to the sodium intake, so there are certain things that we can learn how to manage it. Certainly with my devices, I’m able to manage it and not have my brain pay too much attention to it.

It’s funny, we’ve talked about tinnitus all these different times. I didn’t remember that a food could be a trigger, so there’s so many different ways that you could be suffering from tinnitus. It’s got to be difficult to put your finger on what that is, but at least you can manage it for most people. What are the experiences that you see here in the office with some of your patients that are suffering?

Yeah, so we talk about what it is that they have, how they perceive it, what can we do about it? Analyzing, evaluating, assessing their hearing status, and then going from there, and then perhaps making recommendations to get them some other professional help.

Rebecca, the American Tinnitus Association is there for folks if they need it. It’s a great resource. What do you need to do? Can you become a member of the American Tinnitus Association? Is it just something online where people can go and learn more just to better educate themselves?

Absolutely, yeah. We have a great website that has some information for folks to review. It’s ATA.org. It does offer just written information that you can review on your own time as well as some links out to kind of other reputable sources of information, but if you are someone who is struggling and cannot quite find the right healthcare provider, it sounds like it would be out of range of your clinic, but someone who really needs that assistance in terms of trying to figure out what that next step is. I believe the best program that ATA offers is that Tinnitus Advisors program that I mentioned earlier. Through that program, we offer a one-time 15-minute consultation with a team of very experienced audiologists who are experienced specifically in that area of tinnitus management, and I, myself, was in that position and I continue to almost serve in that position, but kind of on call, and I will say that I’ve definitely seen folks who just haven’t found the right healthcare provider to really kind of guide them on that journey. Like you said, there’s so many different things that can feed into this tinnitus and sometimes you just really need to have someone to kind of think through this problem with you and say, “Well, you’ve done all of this work. You’ve checked off all these boxes. What should be your next step?” and I feel like that program has been really instrumental for a lot of folks, so I will make a quick plug for the phone number, which is 1-800-634-8978. You’ve got to follow the prompts, but it’s a fantastic program.

And if somebody is having a problem, probably I would guess the first place to start is go visit your audiologist. Come to Hearing Doctors or whatever audiologist is in your town. Start there. Start with a professional that can recognize what’s going on.

And somebody that really specializes in tinnitus. It’s not for everybody. Not all audiologists really specialize in tinnitus, but I think, you know, going to an audiologist and having a full comprehensive assessment that includes tinnitus assessments, it’s really important.

Yeah. Rebecca Lewis, thank you so much for your time with us today. It’s much appreciated. Dr. Ana Anzola, thank you for yours as well.
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