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Audiologist: Full hearing test is Step 1 in tinnitus treatment

In a world where we are constantly bombarded with noise, silence can be a relief. But for some, even with the absence of external sound, there is a constant noise in their ears – the annoying buzzing, ringing, clicking or whooshing sounds of tinnitus – and unfortunately there is no cure.

“Tinnitus is a symptom and not a disease,” said Dr. Sheila Case, doctor of audiology and owner of Intracoastal Hearing Center in Vero Beach. “There are so many theories on what causes it, including excessive noise exposure, wax infection, strong antibiotics, and even jaw and neck issues like TMJ. We do know for sure that hearing loss is the No. 1 cause of tinnitus. So anytime you notice a constant hissing, whooshing or other sound that others can’t hear, you should get a hearing test. Our biggest problem is that there is no objective way to measure tinnitus because it can only be heard by the patient.”

According to the American Tinnitus Association, about 26 million adults in the United States suffer from tinnitus. For some people it’s a minor nuisance and easily ignored. For others, it’s a constant distraction that can affect sleep, concentration, and lead to anxiety or depression. Tinnitus tends to increase with age, affecting 24 percent of older adults.

Exposure to loud noises such as those experienced in industrial settings or through recreational activities like concerts tops the list of suspected causes. Prolonged exposure damages delicate inner ear structures leading to phantom sounds. Additionally, age-related hearing loss, toxic medications and underlying health conditions like Meniere’s disease or temporomandibular joint (TMJ) disorders can contribute to the condition.

To understand tinnitus, you have to understand how we hear. Sound waves enter our ears and vibrate our eardrums. These vibrations turn into electrical signals that travel through the auditory pathway in the brain. The brain turns those electrical signals into the sound you hear. If you have tinnitus, researchers believe cells in the auditory pathway become hyperactive, causing your brain to perceive a sound that doesn’t exist.

“The first thing I do when someone comes to me complaining of tinnitus is conduct a complete hearing test, since hearing loss is the No. 1 cause of tinnitus,” said Dr. Case. “Then I have to figure out which modality of treatment is best for this individual patient. We start with amplification with the use of hearing aids as most patients will get some relief from tinnitus when we treat their hearing loss. Tinnitus is very often a symptom of hearing loss because if the hearing nerve isn’t receiving auditory input anymore it generates a sound of its own. Once we restore the auditory input with a hearing aid, the tinnitus often fades away.

“For those with no hearing loss, we can use a combination of amplification, sound therapy maskers and coping skills to manage their tinnitus.”

Tinnitus is the No. 1 disability reported by veterans returning from combat and researchers have developed a five-step Progressive Tinnitus Management (PTM) plan to help vets manage the condition. Patients at various levels might benefit from guided imagery, deep breathing, relaxation exercises and more engagement in pastimes they enjoy.

“PTM is not an attempt to alter the tinnitus,” Dr. Case said. “It’s really just reducing the patient’s reaction to it. By educating the patient about the condition and assuring them that it is not life threatening, it reduces their stress. It’s been so effective that the VA has approved it to be conducted via telehealth, making it more accessible to more people.”

Patients needing higher levels of care might receive other treatments such as sound therapy or cognitive behavioral therapy.

Cognitive behavioral therapy helps individuals reframe negative thoughts and develop effective coping skills. The therapy strives to help the patient reduce their emotional response to the tinnitus and change their thoughts from “I can’t take this anymore” to “It’s no big deal.”

Sound therapy utilizes devices such as white noise machines or hearing aids to provide relief by intrusive sounds. It can be music, water sounds of nature, white noise or sound that a patient finds pleasant.

Maskers are a step up from sound therapy. They look like hearing aids but with open ear buds. The technique uses ambient sounds to mask or drown out unwanted noise. By introducing a pleasant and consistent external noise, it covers up the internal noise caused by tinnitus.

“I take measurements of the patient’s subjective perception of tinnitus and then conduct tinnitus sound matching to determine how loud I have to make the mask for it to be effective,” Dr. Case explained. “People with tinnitus often have issues with loudness tolerance so we take all of that into consideration when coming up with a treatment plan.

“Hope is on the way with a new FDA-approved treatment for tinnitus which can only be obtained in approved audiology or ENT clinics,” she continued. “It’s called Bimodal Neuromodulation and it targets the brain by stimulating two sensory systems, the tongue and sound. It’s an at-home treatment and it’s been proven to deliver clinical benefits in as little as six weeks. My office is currently waiting on approval, and it will be available soon.”

During their treatment patients wear headphones and a mouth device every day for an hour for at least six weeks. The headphones play sounds across a range of frequencies, such as high-pitched and low- pitched tones, along with background noise. The mouth device delivers low level electrical pulses to the tongue. Scientists believe this combination helps the brain pay more attention to the tones on the headphones and less attention to the tinnitus sounds. They believe this shift in brain attention can help quiet the brain activity that causes tinnitus.

“I think we as audiologists are gatekeepers and it’s up to us as trained professionals to steer the narrative for the patient,” Dr. Case said. “Instead of saying there’s no cure so live with it, we can say while there is no known cure, there are treatments, and we can try a combination of these treatments to see what works best.”

Early identification of a hearing problem allows the audiologist to develop a strategy for treatment and prevent further hearing loss and hopefully prevent tinnitus or the worsening of tinnitus. The recommendation is that everyone should have a baseline audiogram at age 50 and have their hearing tested on a regular basis thereafter.

Dr. Sheila Case graduated from the University of Florida and has been in the field since 1989. She owns and operates Intracoastal Hearing Center, located at 522 21st St., Vero Beach: 772-758-8391.

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