Tinnitus Today • Winter 2020

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TINNITUSTODAY Vol. 45, No. 3, Winter 2020

To Promote Relief, Help Prevent, and Find Cures for Tinnitus


Pandemic’s Impact on Tinnitus

Research Survey Reveals How Coronavirus Is Affecting Patients

Build Your Own Hearing Protection Toolkit Police Communication Tool Poses Risk at Demonstrations Telehealth for Tinnitus Becoming a Reality

A publication of the

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Table of Contents SPECIAL FEATURES


Multinational Survey Reveals the Impact of the Coronavirus Pandemic on People With Tinnitus

08| Research Hits Hurdles Tinnitus

During the Coronavirus Pandemic


How the 11 | Lockdown in

New Zealand Impacted Tinnitus Research

13 |

Stress and Anxiety in Germany: How the Pandemic is Affecting Patients

14 | Covid-19 Impact on

Glimpse of Tinnitus Patients in Italy

Researcher in United | 15 Kingdom Eyes Return

to Lab in February 2021

Regenerating | 22 Human Hearing Reducing Tinnitus | 25 Severity With

Mindfulness-Based Cognitive Therapy

20| 27|

Vol. 45, No. 3, Winter 2020

inding Open F Doors During the Pandemic: Telehealth Becomes Reality Coping With Tinnitus During the Covid-19 Pandemic


Accepting | 17 the Roar of Tinnitus

High-Intensity | 34 Tinnitus and Little

Help: Finding My Way Back to Myself

Subsides, 49 | Pandemic Will the Noise When the Return?

38 |

Rewiring the Brain With Tongue and Sound Stimulation to Reduce the Negative Impact of Tinnitus

Techniques | 48 for Improving

Use of Hearing Protection


30 | Q & A Taking | 31 Control of Sound to Rejoin Tinnitus

the Crowd: The SoundPrint App


Dose of Self23 | Daily Compassion Why You Need a

Police Communication | Poses Risk at 37 Tool Demonstrations Beware of Noisy | 44 Toys Still Wondering About | 52 the Role of Diet in Hearing Health? Questions from Podcast Listeners

Building a Hearing | 46 Protection Toolkit Tinnitus | 54 Support Group Listings

56 | Patient Providers Spotlight on


Research on Pause During Much of the Pandemic

Jill Meltzer, AuD Chair, Board of Directors

As we approach the end of the year, it’s hard to think of what hasn’t been impacted by the global coronavirus pandemic. Tinnitus research came to a grinding halt or moved at glacial speed, like other areas of research, with the notable exception of coronavirus studies. That prolonged pause will be felt for years to come in a myriad of ways. Fortunately, we’re now seeing a cautious return to laboratory activities, with steps in place to protect clinical participants, scientists, and staff from infection. On the patient front, social distancing and isolation left some of us overly focused on tinnitus, which is a bad thing. But, over time, many of us became comfortable venturing out to safe public spaces wearing our masks. We practice social distancing in the grocery store, go to necessary medical appointments in person, and attend gatherings online to see family, friends, and colleagues. Telehealth and tele-business are now an everyday reality. Zooming with a capital Z is now a verb. We evolve, we adapt, and we move forward. In 2021, the American Tinnitus Association will mark its 50th anniversary. One day soon I hope this column will announce a cure or cures for tinnitus. Then the ATA could say “mission accomplished” and close its doors, which would truly be a celebration of science and progress. But, in the meantime, the ATA remains resolute in its mission to support and fund research toward cures and expanded treatment, provide patients with research-based information on tinnitus and its management, and increase the number of healthcare providers qualified to work with tinnitus patients. Like much of this year, progress may sometimes seem to come in tiny steps. But, as spoken by Dr. Martin Luther King Jr., “If you can’t fly, then run, if you can’t run, then walk, if you can’t walk, then crawl, but whatever you do you have to keep moving forward.” The bottom line is the research world will persevere and we will keep moving forward.

MANAGING EDITOR Joy Onozuka American Tinnitus Association PUBLISHER Torryn P. Brazell, CAE American Tinnitus Association PODCAST PRODUCER AND WRITER John A. Coverstone, AuD Sentient Healthcare, Inc. EDITOR-AT-LARGE James A. Henry, PhD National Center for Rehabilitative Auditory Research (NCRAR) U.S. Department of Veterans Affairs EDITORIAL ADVISORY PANEL Marc Fagelson, PhD East Tennessee State University Johnson City, TN USA Gail M. Whitelaw, PhD Department of Speech and Hearing Science The Ohio State University DIGITAL DESIGN & PRODUCTION TEAM JML Design, LLC ADVERTISING Tinnitus Today is the official publication of the American Tinnitus Association. It is published three times per year in April, August, and December and mailed to members and donors. The digital version is available online at www.ata.org. To grow your company’s brand reach, contact tinnitus@ata.org. ATA HEADQUARTERS 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 424049 Washington, DC 20042-4049 The American Tinnitus Association is a nonprofit corporation, tax-exempt under 501(c) (3) of the Internal Revenue Code, engaged in educational, charitable, and scientific activities. Tinnitus Today magazine is © copyrighted by the American Tinnitus Association.



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ATA BOARD OF DIRECTORS Jill Meltzer, AuD, Chicago, IL—Chair John Minnebo, MBA, Philadelphia, PA—Vice Chair Bar-Giora Goldberg, San Diego, CA—Secretary

Ramping Up Research in the New Year

David Hadley, MBA, San Francisco—Treasurer Ron Zagel, Grand Rapids, MI—Assistant Treasurer Shahrzad Cohen, AuD, CH-TM Sherman Oaks, CA Stelios Dokianakis, AuD, Holland, MI Phillip Gander, PhD, Iowa City, IA Michael E. Hoffer, MD, FACS, Miami, FL Gordon Mountford, CPA, South Pasadena, CA Robert Travis Scott, Baton Rouge, LA LaGuinn P. Sherlock, AuD, Bethesda, MD— Immediate Past Chair Robert M. Traynor, EdD, MBA, Ft. Collins, CO Joseph Trevisani, New York, NY Ted Turesky, PhD, Boston, MA Melissa Wikoff, AuD, Atlanta, GA Jinsheng Zhang, PhD, Detroit, MI Torryn P. Brazell, Vienna, VA—CEO HONORARY DIRECTOR William Shatner, Los Angeles, CA ATA SCIENTIFIC ADVISORY COMMITTEE Michael E. Hoffer, MD, FACS—Chair University of Miami Health System Miami, FL USA Carey D. Balaban, PhD University of Pittsburgh, Pittsburgh, PA USA Shaowen Bao, PhD University of Arizona, Tucson, AZ USA Christopher R. Cederroth, PhD University of Nottingham, United Kingdom Marc Fagelson, PhD East Tennessee State University Johnson City, TN USA Fatima T. Husain, PhD University of Illinois, Urbana-Champaign Champaign, IL USA

In late January 2020, I arrived in San Diego, California, along with thousands of researchers from around the world for the Association for Research in Otolaryngology’s 43rd Annual Midwinter Meeting. In my bag were flyers announcing ATA grants for 2020–21. Each day, I left stacks of Tinnitus Today magazines and the flyers on a table in the Poster Session room, and each day they disappeared within hours. It was an extraordinary and exciting start to the year; then the coronavirus pandemic hit, upending everything. With labs shuttered in the spring, the ATA put its application for tinnitus grants on pause. As we moved into fall, with little containment of Covid-19, we made the decision to release our grant application in 2021 when researchers would likely be able to return to labs. Our funding plays a pivotal role in generating data for new approaches to tinnitus treatment and possible cures. When successful, the data is used to apply for larger funding from such agencies as the National Institutes of Health and the National Science Foundation. In that sense, we provide the critical first step for testing novel ideas. In 2021, we’re adding a new $60,000 grant in honor of our 50th anniversary. As always, we hope each of our grants results in a life-altering treatment or step toward better understanding of the pathophysiology of tinnitus. What is clear is greater effort and support are needed to help researchers get back on track for lost time and funding opportunities in 2020. We thank you for enabling us through your membership in the ATA and donations to offer grants that pave the way for breakthroughs in treatment and possible cures.

Torryn P. Brazell, CAE Publisher

The opinions expressed by contributors to Tinnitus Today are not necessarily those of the publisher or the American Tinnitus Association. This publication provides a variety of topics related to tinnitus for informational purposes only. ATA’s publication of any advertisement in any kind of media does not, in any way or manner, constitute or imply ATA’s approval or endorsement of any advertised product or service. ATA does not favor or endorse any commercial product or service.

Mark S. Mennemeier, PhD University of Arkansas, Little Rock, AR USA Maria Rubio, PhD, MD University of Pittsburgh, Pittsburgh, PA USA

Cover Artwork Credit: Melinda Beck

Tricia Scaglione, AuD University of Miami, Plantation, FL USA Roland Schaette, PhD UCL Ear Institute, London, England Grant D. Searchfield, PhD University of Auckland, Auckland, New Zealand Jeremy G. Turner, PhD Illinois College, Jacksonville, IL USA

Letters to the ATA

Richard Tyler, PhD University of Iowa, Iowa City, IA USA

The ATA encourages readers to send comments and questions about tinnitus and/or articles to editor@ata.org Emails selected for publication may be edited for brevity, clarity, and grammar.

Fan-Gang Zeng, PhD University of California, Irvine Irvine, CA USA


 3


Multinational Survey Reveals the Impact of the Coronavirus Pandemic on People With Tinnitus The coronavirus continues its march around the globe, disrupting nearly every dimension of life, from how we socialize to how we seek medical care and perceive the world around us. For those with jobs that can be done remotely, the pandemic eliminated or reduced commuting time, thereby creating more flexibility in achieving work-life balance. For others, the pandemic unleashed unrelenting turmoil, stemming from such issues as lost income, job insecurity, fear of exposure to the virus, and inability to access healthcare. We’re now seeing published research that shows higher levels of depression and reduced sense of well-being, as measured by increased stress, poor sleep quality, and less family support, among the general population during the coronavirus pandemic. We’re also seeing reports of tinnitus and hearing loss associated with contracting



Covid-19, but we’re only in the beginning stages of understanding the long-term implication of the virus on hearing health. Recognizing early on that people with tinnitus might be experiencing increased levels of tinnitus as a result of the added stress and anxiety brought on by the pandemic, we developed an exploratory study to examine changes in tinnitus, coping mechanisms, and areas of patient needs.

A Worldwide Study What makes this study unique is that it was distributed internationally, thus providing the opportunity to compare participants’ experiences based on location. The study – released in English, German, Swedish, Portuguese, Brazilian Portuguese, and Dutch – was a unique collaborative effort among researchers, tinnitus patient organizations, and people with tinnitus from different parts of the world. Through open questions,

it provided the opportunity for people with tinnitus to express individual experiences related to living with tinnitus during the pandemic. There were 3,103 respondents, representing 48 countries, although almost half (49%) were from the United States and Canada (see Figure 1).

Can Covid-19 Cause Tinnitus? The survey was aimed at those with preexisting tinnitus. One aspect we had not considered when the survey was distributed was that having Covid-19 could cause tinnitus and hearing loss. Seven respondents reported that having Covid-19 led to tinnitus and four reported it led to hearing loss, and that these symptoms remained despite recovering from the virus. One respondent said, “I did not have tinnitus before the virus. It came on when I was ill and is the only thing that has continued afterward” (female, 52 years). Since this investigation, news reports and research studies



have indicated more people are experiencing hearing loss and tinnitus as a result of contracting the virus.

“‘I [now] notice the tinnitus less because the virus has shown me there are bigger problems than my tinnitus’ (male, 55 years).”

Can Covid-19 Change Tinnitus? Among those reporting Covid-19 symptoms, 40 percent said their tinnitus worsened as a result. Only 26 respondents received a positive Covid-19 test result, and of these, 57 percent reported that their tinnitus was exacerbated by the virus. One 55-year-old female said, “I was too ill to notice at the time, but the tinnitus is definitely much worse now that I’m better enough to notice.” Those taking medication to ease their virus symptoms reported it significantly increased the presence of tinnitus. A few people reported that having the virus gave them a new perspective on their tinnitus, as noted

in the comment “I [now] notice the tinnitus less because the virus has shown me there are bigger problems than my tinnitus” (male, 55 years). Respondents also mentioned the stress associated with worrying about how contracting the virus might affect their tinnitus, as represented by the following comment: “I’m constantly worrying if I’ve been exposed. This increased stress makes my tinnitus very loud” (female, 31 years).

Figure 1: Representation of Location of Respondents With Tinnitus 3,103 Respondents Representing 48 Countries

Can the Pandemic Affect Preexisting Tinnitus? Although 67 percent of those with preexisting tinnitus reported that their tinnitus was stable, it worsened for 32 percent, and improved for 1 percent of respondents. Tinnitus was more bothersome during the pandemic for females and younger adults (under the age of 50 years). The respondents in these groups explained this outcome as partly resulting from changes in employment and increased childcare and household responsibilities in such comments as: “It is very busy because my child is at home, and in addition to work, housekeeping, teach[ing], and entertain[ing]. There is little time to relax” (female, 36 years).

56% 43% 1% 58 (+/-15) years North America n = 1,522 (49%)

UK n = 737 (24%)

Europe n = 710 40% 59% 1% (23%) 51 (+/-15) years

56% 43% 1% 64 (+/-12) years 44% 54% 2% 54 (+/-15) years

South America, Asia, Africa, Oceania n = 134 (4%)


61% 37% 2% 51 (+/-17) years




Why Did Covid-19 Affect Preexisting Tinnitus? A variety of factors increased tinnitus during the pandemic, including health-related concerns, social distancing restrictions, lifestyle changes, and mental health. Factors that exacerbated tinnitus included loneliness resulting from decreased social interactions, necessity of selfisolation, poor sleep, and reduced levels of exercise. Comments from respondents included: “So much time alone has just made me more aware of the tinnitus” (female, 71 years) and “I’ve not been able to sleep because of change in routine and worrying, which makes my tinnitus louder” (male, 56 years). Increased levels of depression, anxiety, irritability, and financial worries also contributed to tinnitus being more bothersome during the pandemic period. For example, respondents noted, “So many more anxieties – household appliances breaking that can't be fixed, worrying about food supply, worrying about the virus. Any kind of worr[y] has a negative effect on tinnitus” (male, 73 years) and “As a self-employed wedding photographer, all work has been canceled for the foreseeable future, and I have a massive loss in income which I think is contributing to



my tinnitus being worse” (female, 58 years).

much harder and raises my irritation levels” (male, 52 years).

What Was the Impact of Reduced Noise Levels During the Pandemic?

How Did Location Affect Tinnitus Experiences During the Pandemic?

For many people, their immediate surroundings were quieter during the pandemic. This change resulted in mixed experiences for respondents. Some people found it helpful; for example, one person said, “Working at home in quiet, instead of a crowded environment, gives me less tinnitus” (male, 53 years). Others noted that less noise resulted in more attention to tinnitus; for example, one respondent said, “I am now more aware of the tinnitus as my household is very quiet” (female, 59 years). Social distancing restrictions were reported to make listening harder. This was explained by statements such as “Having to understand [people talking] six feet away and through a mask is so

Most respondents completed the survey around May 2020. Different locations experienced the virus peaking at different times, and this could have affected responses. At the time of the survey, those living in the United Kingdom reported that the pandemic impacted them more than those in other countries, as shown in Figure 2.

What Makes These Findings Important? These findings highlight the fact that many external factors, such as social interactions and changes in the listening environment, and internal factors, such as stress and anxiety levels, can affect tinnitus experiences.

Figure 2: Perceived Negative Impact of Pandemic on Lifestyle by Those With Tinnitus in Different Countries 50% Percentage of Respondents

45% 40% 35% 30% 25% 20% 15% 10% 5% 0% USA

Other Countries





Support from families and friends, patient organizations, and healthcare providers should be informed by awareness of increased difficulties with tinnitus due to extenuating circumstances, like the coronavirus pandemic. By better understanding how people with tinnitus are affected by outside influences of exceptional nature, meaningful interventions can be identified and implemented.

Acknowledgments The researchers would like to express their appreciation to survey respondents and to patient organizations, including the American Tinnitus Association and British Tinnitus Association, for distributing the survey to English-speaking communities.


Prize (2019) from the British Association of Audiovestibular Physicians. Her research focus is the development and running of clinical trials to assess the effectiveness of internet-based interventions. Vinaya Manchaiah, AuD, MBA, PhD, is a Jo Mayo Endowed Professor of Speech and Hearing Sciences at the Department of Speech and Hearing Sciences at Lamar University, Beaumont, Texas. He received his BSc in India, his MSc from the University of Southampton, United Kingdom, and his PhD from LinkĂśping University in Sweden. He has worked in various clinical, research, teaching, and administrative roles, although his current academic appointment centers predominantly on research. His research focuses on improving the accessibility, affordability, and outcomes of hearing loss and tinnitus by promoting self-


management and use of digital technologies. He was awarded a grant from the National Institutes of Health to develop and investigate iCBT for tinnitus for patients living in the United States. He has published more than 100 peerreviewed manuscripts and three books. For the full article, see: Beukes, E. W., Baguley, D. M., Jacquemin, L., Lourenco, M. P. C. G., et al. (2020). Global tinnitus experiences during the Covid-19 pandemic. Frontiers in Public Health, 8, 592878. doi:10.3389/ fpubh.2020.592878

This work was partly funded by the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health (NIH) under the award number R21DC017214.

is a postdoctoral researcher at the Department of Speech and Hearing Sciences at Lamar University, Beaumont, Texas. She received her BSc in South Africa, her MSc in Audiology from the University of Manchester, and her PhD from Anglia Ruskin University, Cambridge, England. She is a clinical scientist in audiology and was awarded the Richard May Prize following her training. She received the prestigious Shapiro prize from the British Tinnitus Association for three consecutive years (2017, 2018, 2019) for her research and the Hallpike Research





Tinnitus Research Hits Hurdles During the Coronavirus Pandemic By Joy Onozuka

The U.S. federal government has committed roughly $10.79 billion as part of Operation Warp Speed, the program led by several departments within the federal government to accelerate the development, manufacturing, and distribution of vaccines and treatments for the coronavirus. For researchers in this field, it’s a boon. But for other areas of research being conducted at U.S. colleges, universities, and research organizations, the pandemic has been more of a bust, due to the disruption of every layer of traditional activities, from the ability to recruit participants for clinical trials, to the ability of teams to work in a laboratory, to the ability of researchers to collect data to stay on track for completing grants. All of this has resulted in reduced research output estimated between 20 and 40 percent.1 The rapid shutdown in the spring left thousands of researchers scrambling to figure out how to protect and preserve their research.

The fallout on the global research community will likely be felt for years and will be defined partly by how quickly a vaccine becomes available. The picture is relatively stable for academic researchers in the United States whose work is considered vital and part of a long-term investment in the future. With the closing of laboratories in the spring, the National Institutes of Health and the National Science Foundation, the two primary arms of federal funding for science, allowed substantial, but temporary, flexibility for their research grants. They also continued to review and approve grant applications, keeping funds in play for thousands of researchers. So even though university finances were hard hit from lost revenue from decreased tuition, housing and dining fees, athletics, and other areas, research funding remained relatively stable. It should be noted that federal funding typically accounts for well over 50 percent of research conducted at U.S. universities.2 Other funds come from industry, nongovernmental

“The rapid shutdown in the spring left thousands of researchers scrambling to figure out how to protect and preserve their research.” 8


grants, foundations, nonprofits, and state and local governments. Depending on the type and the stage of investigations, U.S. laboratories conducting tinnitus research were impacted differently. For instance, Susan Shore, PhD and principal investigator of a clinical trial at the University of Michigan involving bimodal stimulation for tinnitus relief, confirmed her research is behind schedule. “The trial was delayed about a year because we could not do in-person measurements for five months,” Dr. Shore said. Assuming that laboratories are able to remain open throughout the winter, with students maintaining social distancing guidelines and wearing masks, she anticipates experiments will continue. Funding of her lab is also stable. In nearby Wayne State University, in Detroit, Jinsheng Zhang, PhD and head of a laboratory that conducts tinnitus investigations with animals, said research has resumed with restrictions, which include excluding noncore lab members such as medical students and undergraduates who would normally visit for research exposure and class credit. Dr. Zhang’s other tinnitus research, which is a multisite clinical trial with human subjects, has been harder to resume because the hospitals www.ATA.org


and participating sites are not yet allowing in-person testing. Despite such difficulties, he is optimistic about the investigation. “Projects will pick up pace as labs and hospitals better define operational protocols and precautions that minimize the risk of coronavirus transmission in a research environment,” Dr. Zhang said. Patient recruitment is also an issue for Phillip Gander, PhD and neuroscientist at the University of Iowa, who is experiencing delays in an ongoing tinnitus investigation. “Recruitment of patients is dramatically hindered by the coronavirus,” he said, explaining that about half of people contacted about the tinnitus study cite the coronavirus as the reason for declining. This matters because lower recruitment of participants for funded research means that he’ll have trouble delivering on what was outlined in the grant. “That will not bode well for refunding efforts,” he said. “However, the other research I do, which involves epilepsy surgery monitoring [and tinnitus], is ongoing because those people still need the surgery,” Dr. Gander said. While California has been hard hit by the coronavirus and wildfires, Dr. Fan-Gang Zeng’s lab at the University of California, Irvine, is operating, albeit at 30 percent below normal capacity for testing of human subjects. Dr. Zeng’s lab is also financially stable. “We’re lucky to have another year left in our grant and were actually able to obtain an administrative supplement to perform an additional study on the cognition-tinnitus relationship,” he said. His team, like many others www.ATA.org

“Projects will pick up pace as labs and hospitals better define operational protocols and precautions that minimize the risk of coronavirus transmission in a research environment,” Dr. Zhang said. during the shutdown, used the shuttering of labs as a window to devote more time to analyzing data, writing manuscripts and theses, and developing grant applications. But the closure of labs had a detrimental impact on students who needed research data from laboratory investigations to complete their degrees. In Dr. Zeng’s lab, one student had to delay her PhD defense by at least six months because she couldn’t complete data collection. The pandemic created a precarious situation for graduate students, post docs, and early career researchers, particularly those dependent upon visas to stay in the United States. Moreover, many universities have suspended hiring and job searches in an effort to contain the ongoing financial strain, which is severe. The U.S. Bureau of Labor Statistics found that colleges and universities shed 337,000 jobs between February and August of 2020, the greatest number of jobs lost since the industry first recorded such data in the late 1950s.3 The employment angst created by such trends was reflected in a survey published in September by Nature that found that 61 percent of 7,670 postdocs working in academia believed that the pandemic has

negatively affected their career prospects.4 In this regard, the next 12 to 18 months will be critical. Without a return to some semblance of prepandemic operations that generate revenue at U.S. colleges and universities, labs could face hurdles to maintain their work, which is critical to fostering the next generation of researchers. Lost job opportunities that force young talent to pursue careers in other fields weaken the




world of research and slow progress in breakthroughs, like finding cures for tinnitus. 1 Council on Governmental Relations. (2020, August 25). Research impact under COVID-19: Financial crisis and the “pandemic normal.” Retrieved from https://www.cogr.edu/research-impact-under-covid19-financial-crisis-and-pandemic-normal-0 2 J. Radecki & R. Schonfeld. (2020). The impacts of Covid-19 on the research enterprise: A Landscape Review. ITHAKA S+R. doi:https://doi.org/10.18665/ sr.314247 3 R. Kelchen. (2020, October 15). Permanent budget cuts are coming: The outlook for higher education was dim even before the pandemic. Chronicle of Higher Education. Retrieved from https://www. chronicle.com/article/permanent-budgetcuts-are-coming 4 C. Woolston. (2020, September 8). Pandemic darkens postdocs’ work and career hopes. Nature, 585, 309–312.

Considering Covid-19 Toll on U.S. Research The Council on Governmental Relations released a paper at the end of August that analyzed the impact of Covid-19 on research conducted in the United States.1 Negative effects included the following as both real and possible outcomes: • Inability to achieve original program goals • Loss of entire research programs • Loss of the ability of investigators to collaborate across institutions, designated research centers, federal laboratories and via traditional subrecipient agreements • Loss of a generation of trained scientists and engineers, as well as researchers in the social, behavioral, and educational disciplines and the arts • Loss of foreign students and scholars and their major contributions to academia • Significant slowdowns in discoveries and technological development • Recurring costs of the “ramp down, ramp up, ramp down” cycle • Loss of cell lines, animal colonies, and continuity of trials using human subjects • Disruptions in core facilities and centers due to interrupted research • Fear of the unknown, including loss of employee morale and the persistent uncertainty about current and future employment • And ultimately, the decrease not only in volume but also in quality of research conducted in the United States

Medical Disclaimer The content in Tinnitus Today magazine is intended to provide helpful health information for the general public. It is made available with the understanding that the American Tinnitus Association (ATA) is not engaged in rendering medical, health, psychological, or any other kind of personal professional services. The magazine content should not be considered complete and, therefore, does not cover all physical conditions or their treatment as it relates to tinnitus and tinnitus management. The ATA always recommends that you consult and work with a medical, health, or other competent 10


professional, when considering the best course of tinnitus management. This begins with a medical examination to rule out possible underlying medical causes for tinnitus. If you’re interested in adopting guidance/suggestions made in the magazine, you should discuss this first with your medical provider before doing so. Any information about drugs and supplements contained in the magazine is general in nature, and does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned. The content of the magazine is not intended as medical advice for individual problems or for

making an evaluation for pursuing a particular course of action. The ATA and authors of articles in the magazine specifically disclaim all responsibility for any liability, loss, or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the content in the magazine. www.ATA.org


How the Lockdown in New Zealand Impacted Tinnitus Research The coronavirus lockdown in New Zealand was remarkable for its rigor and its brevity. The American Tinnitus Association reached out to Grant Searchfield, PhD and primary investigator at Auckland University’s Centre for Brain Research and clinical director at the university’s Hearing and Tinnitus Clinic, to learn how his research has been impacted by the pandemic. Searchfield is also a member of the ATA’s Scientific Advisory Committee. Question: New Zealand has done an extraordinary job in containing the spread of the coronavirus. How has the pandemic affected your work? Dr. Grant Searchfield: For a small country, we have a strong tinnitus research community. My current research includes assisting Otonomy, a biopharmaceutical company based in San Diego, California, in its


trials of a tinnitus medication, and collaborating with colleagues in our national Eisdell Moore Centre (EMC) for hearing research (EMB; https:// www.emcentre.ac.nz). Members of the EMC are exploring acute tinnitus, tinnitus biomarkers, and MDMA (3,4-methylenedioxymethamphetamine) as a possible adjunct to soundbased therapies. My own group at the University of Auckland has spent many years developing customized sound-based therapies using 3-D sound and auditory training. We’re now in a position to trial a “Precision Sound Therapy” system. As part of the ongoing development of the treatment system, we will be testing various artificial intelligence algorithms to predict best therapy options and modify the therapy based on measures of physiology. When considering the coronavirus pandemic and its impact, it’s important

to note that our university year runs from March to November. On March 21, 13 cases of Covid-19 were confirmed in New Zealand. Prime Minister Jacinda Ardern asked people 70 years and older and people with compromised immune systems to stay at home, which effectively paused all clinical tinnitus research. People who could work from home were asked to do so, which meant our teaching moved online. As part of public health policy, the government introduced a four-level alert system to combat Covid-19. Level 4, excluding essential workers, meant everyone should stay home (grocery runs permissible) and limit contact to immediate household members. All nonessential services were closed. Level 1 means society is functioning “near normal” with international travel restrictions and




two-week quarantine for all those entering the country. On March 25, New Zealand moved to Level 4, and the entire nation went into self-isolation. Over the coming months, we reduced alert levels and finally got to Level 1, which meant we could resume normal research. On June 8, we had no Covid-19 cases. We have been able to do most teaching online, and when not in lockdown clinical training and research have continued. It has been a great learning process in online teaching, which does have strengths, but it will take additional time for students to be at the same level of clinical competence as students from preceding years. Throughout the shutdown, we were able to write papers, complete grant applications, and plan. Participant recruitment and equipment setup began in June but was paused on August 12 when our city had another less-limiting Level 3 shutdown. By September 21, our research returned to near normal and on October 8 we

were at Level 1. On the day that I’m writing this – 4th November 2020 – there are two community Covid-19 cases in New Zealand, and 71 travelers to NZ from overseas who are quarantined in hotels. There are no restrictions on crowds or any aspect of life, apart from at the border. There are no current restrictions on research. Our students are busily completing their theses. I gave a large public talk in mid-October to recruit for a trial of our next-generation treatment, which was really exciting. The timeline of clinical trials has been disrupted, meaning the goals of some projects have had to be pared back a bit. For my group, the immediate risk of disruption is low; however, we believe that funding available for tinnitus projects will become harder to come by while the economy is recovering and priorities are on Covid-19 treatments. We have been able to obtain more commercially focused funding but have missed out on some government funding. We anticipate that some

philanthropic funds may be granting less in the next couple of years. Tremendous effort and funding have been placed into Covid-19 and related research, so funds are being channeled differently. Arguments have been made to consider tinnitus and hearing research alongside Covid-19 research and economic growth priorities. In summary, although we had periods when we had to work from home and when clinical work stopped, we came out of the pandemic in fairly good shape. But we recognize that this can change easily and quickly.

Support the American Tinnitus Association by Shopping at When you’re shopping for friends and family on Amazon, the American Tinnitus Association hopes you’ll link your shopping account to , the online retailing 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 of a percent of the cost of your eligible purchases to your favorite earmarked charity. Won’t you choose the American Tinnitus Association to help us advance tinnitus research and treatments? https://smile.amazon.com/ch/93-0749558





Stress and Anxiety in Germany: How the Pandemic Is Affecting Patients Summary by John A. Coverstone, AuD

Stress and anxiety in various forms are common traits that affect tinnitus severity. Psychological distress in general is widely accepted as a factor in the degree to which tinnitus is bothersome for individuals. Professionals who specialize in tinnitus are investigating whether the perceived risk of Covid-19 transmission and the resulting lockdowns and changes in behavior during the worldwide pandemic may be impacting the severity of patients’ tinnitus. A group of researchers in Germany sought to answer this question using an existing group of research subjects. The scientists, largely from University of Regensburg, used data from a clinical follow-up study in 2018 to compare tinnitus distress in the same patients as measured in 2020. The 2018 follow-up study included 318 patients, who completed several questionnaires, including the Tinnitus Handicap Inventory, Tinnitus Questionnaire, Major Depression Inventory, and the Big Five Index 2, which assesses personality traits. After Germany instituted a lockdown in response to the spread www.ATA.org

of Covid-19 in 2020, all patients from the 2018 study were contacted. Ultimately, 122 of the original study’s participants completed online versions of essentially the same group of questionnaires (with the inclusion of the mini Tinnitus Questionnaire), plus a newer questionnaire called the Social Isolation Electronic Survey. The primary goal of analysis was to compare the results of questionnaires between 2018 and 2020. An increase in score – and therefore in tinnitus severity – was noted for the Tinnitus Handicap Inventory and mini Tinnitus Questionnaire, although no significant differences were found on the Major Depression Inventory. The Big Five Index 2 indicated a significant decrease in neuroticism between dates, which is characterized by sadness, changes in mood, anxiety, and irritability. The authors also looked for correlation between items on the Tinnitus Handicap Inventory and mini Tinnitus Questionnaire and the items on the Social Isolation Electronic Survey that relate to what they call “Covid-19 burden,” or traits that are likely to be affected by social isolation and risk of disease transmission.

Items on the Social Isolation Electronic Survey that correlated significantly with items on tinnitus questionnaires included feelings of grief, frustration, stress, and nervousness. A similar analysis of the Big Five Index 2 was performed, and while the change in neuroticism between 2018 and 2020 was unexpected, the neuroticism scores of both points were correlated with tinnitus severity. In summary, the researchers noted a small but significant increase in tinnitus distress from 2018 to 2020. Increased tinnitus distress was correlated with traits that may relate to Covid-19 conditions or situations affecting daily life. The authors did note that there may be unrecognized factors influencing tinnitus as well. For instance, less ambient noise is present in the environment during a nationwide lockdown, making tinnitus potentially more pronounced for people. However, it does appear that the stress and anxiety brought about by pandemic conditions increase distress in people with tinnitus. Schlee, W., et al. The Effect of Environmental Stressors on Tinnitus: A Prospective Longitudinal Study on the Impact of the COVID-19 Pandemic. J. Clin. Med. 2020, 9, 2756. TINNITUS TODAY WINTER 2020



Glimpse of Covid-19 Impact on Tinnitus Patients in Italy By Thomas Scott

The global impact of the coronavirus pandemic on people bothered by tinnitus isn’t fully understood at this time, but information is emerging from various countries that suggests patients bothered by tinnitus are struggling more than usual. Given that stress can heighten tinnitus distress for many people, it is reasonable to assume that restrictions on socializing, being outdoors, and engaging in activities that relieve stress, such as going to the gym, can add to the burden of living with tinnitus. In addition, uncertainty about the future and one’s health can also fuel anxiety, which can further exacerbate the perception of tinnitus. A group of researchers in Italy, which locked down early in the pandemic, sought to understand the impact of the pandemic on tinnitus patients by conducting an informal survey of a small group of patients. The objective of the study was to gather evidence on whether previously diagnosed patients with chronic subjective tinnitus, who were self-stabilized and not receiving tinnitus treatment, experienced increased tinnitus distress during the Covid-19 lockdowns mandated by the Italian government. Although not explicitly stated, it appears that the



research team hypothesized that patients with chronic tinnitus may experience worsening symptoms due to more time spent in silence combined with the various stressors that the pandemic imposed. The researchers conducted a small nonblind Tinnitus Handicap Inventory (THI) survey with existing patients who had a pre-Covid-19 baseline THI available. They found that after the Covid-19 restrictions were imposed 12 out of 16 patients (75%) reported an increase in one level on the THI index. Notably, the THI index shifted from mild to moderate in 9 patients and from moderate to severe in 3 patients.1 Although this study lacks the robustness of clinical research, the findings should not be ignored because they add to growing global data on the subject of increased tinnitus annoyance during the coronavirus pandemic. The authors suggest that a combination of online interventions

and smartphone apps can provide tinnitus patients with adequate counseling and sound therapy. In this area, recent research suggests that health apps designed for tinnitus treatment can be of value. However, nearly all health apps lack clinical evidence of their efficacy, suggesting the future need for stringent clinical validation of such tools.2 Thomas Scott is a secondyear medical student at Northeast Ohio Medical University. He developed bothersome tinnitus at the age of 23, after years of working as a commercial DJ, while going to university. He completed the tinnitus retraining therapy program at the University of Maryland Medical Center in 2018, which enabled him to resume his goal of becoming a doctor. That experience has made him determined to raise awareness of noiseinduced hearing loss and tinnitus. 1 R. Anzivino, P. I. Sciancalepore, P. Petrone, A. D’Elia, D. Petrone, & N. Quaranta. (2020, June 22). Tinnitus revival during COVID-19 lockdown: How to deal with it? European Archives of OtoRhino-Laryngology. Advance online publication. doi:10.1007/s00405-020-06147-9 2 M. K. Nagaraj and P. Prabhu. (2020). Internet/ smartphone-based applications for the treatment of tinnitus: A systematic review. E European Archives of Oto-Rhino-Laryngology, 277(3), 649–657. doi:10.1007/s00405-019-05743-8



Researcher in United Kingdom Eyes Return to Lab in 2021 In late January 2020, thousands of researchers from around the world gathered for the Association for Research in Otolaryngology’s 43rd Annual Midwinter Meeting in San Diego, California. Among those scientists was Christopher Cederroth, PhD, who besides having research featured in several poster sessions received the Geraldine Dietz Fox Young Investigator Award for his research on the genetic influences of tinnitus. He was also a featured speaker at the American Tinnitus Association and the British Tinnitus Association’s Tinnitus and Big Data networking dinner. At that time, he was preparing to relocate from Karolinska Institute in Sweden to a new position in the United Kingdom. The ATA caught up with Dr. Cederroth to find out how his year has progressed since that celebratory week.


Question: How has the pandemic affected your tinnitus research activities this year? Dr. Christopher Cederroth: In Sweden, there was no lockdown. People were expected to be responsible by observing social distancing and working remotely when possible, and so on. The Karolinska Institute was not closed, but the buildings were almost completely empty. Given the fact that schools and childcare remained open, it made remote working much easier than in other countries where children were quarantined at home. Nonetheless, the Karolinska Institute functioned at a slow pace, from spring through fall, which meant animal research was dramatically reduced.

Focus also shifted to coronavirus concerns, as reflected in the priorities of administrative work, ethics committees, and funding. I was fortunate to have a research arm with human data related to genetic studies that had already been collected and is still being analyzed. On the other hand, we’ve been unable to start a neuroimaging study on the diagnosis of tinnitus using magnetoencephalography. The investigation has been on pause for more than 6 months, because these machines need a lot of liquid nitrogen to function, which isn’t available – the supply and delivery just stopped. That aside, would one




want data that could be confounded by possible undiagnosed Covid-19 cases? In fact, this has been a limitation for some large clinical trials in the European Union that were supposed to have started earlier this year. Some countries are refusing to authorize a clinical trial when the results may be impacted by the recruitment of participants who might have the virus. Nonetheless, there’s a lot of administrative work involved for getting extensions on our deadlines for such research. In June, I moved to Nottingham in the U.K. to begin my new position as an associate professor for translational hearing sciences. In contrast to Sweden, all access to university premises has been blocked, with waivers granted only for exceptional circumstances. Needless to say, research life is on pause. But here again, since I already have data from previous studies, I’m able to continue research. I have to say that the transition from Sweden, where my three children were able to attend school, to the U.K., where they are home every day,



“Some countries are refusing to authorize a clinical trial when the results may be impacted by the recruitment of participants who might have the virus.” has had an impact on my productivity. Also, the inability to meet colleagues here face-to-face and to understand the “geography” of people’s workplace has made the transition a bit more challenging. However, leadership has been extremely effective, so many things get done. I’m really looking forward to meeting my colleagues in person at work! Right now, we anticipate returning to the lab in February 2021. I’m lucky to already have the human data I collected the last 4 years to analyze!

Reflections on Funding In some ways it has become more difficult to secure or maintain funding. In Sweden, for instance, many foundations have redirected funds to Covid-19 research, which means the budget for promoting young researchers has vanished. Given that governmental funding is insufficient to cover all costs associated with research, it will be difficult for my colleagues in Sweden to survive.

The Impact on Tinnitus Researchers There aren’t many tinnitus researchers engaged in both animal and human studies. In both cases, data collection is at a standstill. However, for those who have access to data that has already been collected, research can be done. There are, in fact, many databases with data on tinnitus, and even if these may not all be optimal (e.g., tinnitus definitions), a lot of work can still be done. Moreover, the data we collected in our STOP study (Swedish Tinnitus Outreach Project) is available for all researchers around the world, once data transfer agreements are signed. So, if researchers are having trouble securing work, I’m happy to have them contact me. Once we have agreements in place, we can start collaborating because I can’t analyze all my data by myself.



By Steve DiCesare

Illustrations by Ian J. Miller

I’ve had tinnitus my entire life. I started noticing my hearing loss when I was around 10 years old, and by the time I reached 20, I was categorized with severe-profound hearing loss, or as “deaf.” Before my cochlear implant surgery in 2015, the tinnitus I had was a high-pitched hissing sound in both ears that I calculate as a 4 out of 10 loudness level. So in any given sound situation, 40 percent of what I was hearing was high-pitched hissing. As my hearing declined, the tinnitus remained and seemed louder because I wasn’t hearing other sounds. The decline was slow, so tinnitus just became a part of me. My friend as well as my torment. A consistent reminder that life is a challenge. It was a persistent and dependable presence…until I had the cochlear implant surgery. After my surgery, I was placed on a series of medicines, antibiotics, steroids, and diuretics. Weird things


started happening in my head as new tinnitus noises built up and took over my life. I eventually called them “the tinnitus flood.” The flood began when I awoke to a choir of what sounded like angel voices repeating a verse from a song. It was spacy, sustained, and ghost-like…a harmonized melody sequencing over and over in my head, but I couldn’t understand the words. I took off the cochlear implant in an attempt to figure out this tinnitus situation. The first of the flood was angel voices that I called Radio Broadcast. Sometimes it’s like a broadcast from a fifties-style radio featuring a male-sounding voice with clear and distinct diction but indecipherable words, like the parents’ voices on Charlie Brown cartoons. In other versions, a chorus of angel voices repeat musical phrases in harmony. Later I learned that others experience this; it’s a diagnosed condition called

nonpsychotic auditory hallucination syndrome, which is perceived sound without external auditory stimulation. The second part of the tinnitus flood is what I called Wind Through the Cave in a Storm. It’s like a howling wind or washout wave rolling in and out of my head through both ears. This one is a little scary because it can get fierce—fierce as in visions of a tsunami washing over a city block. Fierce like the stormy midnight waves crashing against the lighthouse standing alone in the harbor. Fierce like you should sit down right this second or hold onto the wall. The third I called Trains-Comea-Roaring. This is either a clicking or rhythmic tone that sounds like an engine. Fast and repetitive. The




sound of a train running over a rickety section of tracks. I believe this to be some sort of “hearing” of bodily functions—like blood running through valves near my ear. The last of the tinnitus flood is what I called Coach’s Whistle. This is a positional noise that I can hear when I tilt my head to the right. It’s the most distinct as well as the clearest and loudest of the whole flood. Unlike the others, it has an on/off switch. I move to that position and the whistle blows steady and clear until I move back. All this came on during a monthlong period. The flood would rage and create so many distractions that I couldn’t complete a sentence. I began waking up after a few hours of sleep in a state of emotion that I have never really felt before: despair. Over the next year, I visited around 25 different doctors and healers to try to gain an understanding about the tinnitus flood and possibly reverse it, but nothing helped. Not medicine,



“ It’s like a soft blanket—mellowing out the perceived piercing sounds from the gravel, blanketing the shrieking crunches.” naturopathies, acupuncture, chiropractics, or massage. Not diet changes or exercise. Nothing changed with my symptoms, mood, mental health, or energy until I fully accepted the situation. Steve, this is it. This is how it’s going to be. Deal with it. You are tougher than you think. You can figure something out. Acceptance allowed me to let go. To surrender. Total acceptance allowed me to open my mind to new ideas and thoughts about my tinnitus. It allowed me to try the cochlear implant again. A few weeks after reactivating the implant, an audiologist suggested white noise masking and explained that if we give the brain something to focus on, the tinnitus might fade into the background. Before the implant, I couldn’t try masking because I didn’t have enough hearing to hear the masking sounds. One night I was working on my laptop in the living room while my wife was in the kitchen doing the dishes. Dishes and glasses clanging and silverware clanking have forever been my nemeses. In addition to the deafness and tinnitus, I have hyperacusis, a sensitivity to certain sounds that my brain perceives as excruciatingly LOUD. These sounds would trigger flight responses and elevate my blood pressure and anxiety, which in turn would elevate

the tinnitus noise, which would elevate my heart rate. All this would cycle into exhaustion, elevated tinnitus, dizziness, and intense irritation. I searched YouTube for white noise and found a load of 10-hour loops of “noises” in different colors, with different frequency systems. I discovered that “pink noise” can give relief as a masking function to people also suffering with hyperacusis! The pink noise reminded me of the old TV static, and I watched the swirling pink cotton candy screen that accompanies the noise. It’s like a bunch of sea creatures swirling around the screen, or a closeup of blood cells or bacteria cells moving at high speed, or just some trippy cosmic space light thing. I was intensely studying a pattern on the screen when I suddenly wondered if my wife was still doing the dishes. She was. Wow! I hit the mute button, and the noise from clanging dishes faded back in. I hit the unmute button and the pink noise came roaring back on but then balanced out while the dish noises faded into the background. I started experimenting with pink noise masking in every situation I was uncomfortable in—from jogging on gravel trails to sitting in restaurants. I downloaded the pink noise loop onto my iPhone and would duct-tape it www.ATA.org


to my shoulder under the implanted side of my head before jogging on gravel trails. It worked! It’s like a soft blanket—mellowing out the perceived piercing sounds from the gravel, blanketing the shrieking crunches. In restaurants, I started to slide the phone under my shirt collar on my implanted side. It worked! It’s like a fluffy cloud of cotton candy haze surrounding me, dampening out the crap, distracting my brain from the tinnitus and environmental noise so I can actually focus on conversations. A weighted blanket over the tinnitus flood. A mask. Masking the tinnitus. With the help of the pink noise masking and my acquiescence to acceptance, I decided to face the noises head-on. I began to isolate and mentally block out the flood sounds. I create “rooms” in my head and put each noise in a room and close the door. Of course, at night, when I’m sleeping, the noises sneak out to cause havoc in my dreams. I find that early every morning, I need to massage my head and neck and work on breathing and blood flow.

When my wife asks what tinnitus noises I have today, I sometimes find myself wondering which. I can go to that room, knock on the door, and visit with the noise. It will actually seem to get louder! Then I leave the room and close the door and block it out to some degree, and focus on what I can hear, see, or feel as a distraction. It’s working. I’m also focusing on transforming the negative connotations associated with my symptoms. Changing the labels I gave them has fundamentally changed how I deal with and react to them. Radio Broadcast is now called Communication From My Ancestors. Wind Through the Cave in a Storm is now Female Moans in the Midst of Pleasure. Trains-Come-a-Roaring is now Funky Bass Line. Coach’s Whistle is a reminder of how lucky I am and how great life is. I call that one the Game Show Winning Buzzer these days. I go into the Game Show room, move my neck to the right—BUZZ! I’m reminded that I’m winning!

BUZZ! I’m lucky! BUZZ! I will get through this! BUZZ! I can do this!

Steve DiCesare is a special educator who teaches deaf and hard-of-hearing children in Colorado. He tackles the topic of hearing loss and tinnitus in his blogs and recently released book, Dear Steve, You’re Going Deaf. The heartfelt collection of stories chronicles his hearing loss as a music-loving child through his work as a recording artist to his cochlear implant, career, and family life today. Visit https:// www.youregoingdeaf.com to order a copy of the print or e-book and to read Steve’s blogs.

What’s Your Story? Every day, people struggling with tinnitus turn to personal stories to understand what the future might hold. The stories are honest, and don’t sugarcoat the challenges and time it often takes to learn how to manage and live with tinnitus. If your tinnitus has been particularly problematic this year because of the stress associated with the pandemic, we’d like to hear from you. We’re also looking for stories from people who have tinnitus as a result of temporomandibular joint (TMJ) or other dental-related issues, or as a result of undergoing a MRI. Please send your story to editor@ata.org by January 15. Suggested word length is between 500 and 800 words.





Finding Open Doors During the Pandemic Telehealth Becomes Reality

By Melissa Wikoff, AuD

Telehealth has long been considered a wonderful healthcare option but something for the future, and then came the global coronavirus pandemic, which upended everything. According to McKinsey & Company, the number of U.S. patients who have used telehealth rose from 11 percent in 2019 to 46 percent in 2020.1 I am among the thousands of healthcare providers who offers telehealth options for my patients to ensure they feel safe and are able to maintain continuity in their healthcare. Some types of audiology appointments must be done in person, but others can be done virtually, which saves time and money and increases accessibility and flexibility for patients. This is wonderful news for tinnitus patients, who often struggle to find qualified healthcare providers in their area. For many people with tinnitus, treatment is key to improving quality of life and is necessary no matter what the circumstances are. Fortunately, tinnitus therapy can be done remotely. As someone specialized in tinnitus care, telehealth has enabled me to work with patients – existing and new ones – across the United States and from around the world.



What Should You Expect During a Telehealth Visit? Each patient’s journey to relief from tinnitus is different, but it typically starts with a thorough intake, which includes filling out various questionnaires and forms; these can be completed and returned electronically or through the mail for telehealth visits. The next step, which is a critical component in diagnosing and resolving the negative effect of tinnitus, is documenting your hearing health story. How did the tinnitus start? How is it disrupting your life? What fears and anxieties are weighing on you? Such information is the beginning point so a healthcare practitioner can know where to start and how to move forward with treatment. Traditionally, such conversations are done in person during an appointment, but this step, too, can be done remotely by telephone or using a secure online video conference call. The tinnitus evaluation usually comes next but cannot be done reliably via telehealth. So patients should complete an in-person appointment with a local hearing care provider to rule out any underlying medical conditions that might be causing tinnitus, have an audiogram to determine hearing acuity, and complete tinnitus pitch matching, when possible. Such information combined with questionnaires, helps the tinnitus telehealth provider develop an action plan.

An exciting development in tinnitus treatment is the ability to program hearing aids over the internet. Hearing aids are often used in tinnitus management or for management of tinnitus and hearing loss. Remote programming means I can help patients via a telehealth appointment while they relax in the comfort of their home. In most cases the patient’s hearing aids must include this remote-programming feature, and a smartphone is used to unlock hearing aid access. Different types of hearing aids give audiologists remote access to a range of features, from simple actions such as adjusting the overall gain to more complex actions across the entire fitting menu such as activating masking noise or shaping other aspects of sound quality. Other components of tinnitus treatment can also be done remotely. These include counseling and tinnitus rehabilitation training, mindfulnessbased stress reduction therapy, and cognitive behavioral therapy.

If You’re Beginning Tinnitus Treatment Ideally, your treatment would begin with an in-person appointment with an audiologist trained and specialized in diagnosing and treating tinnitus. An initial tinnitus evaluation involves several questionnaires and tests, including a thorough hearing examination and diagnostic tests for tinnitus that include pitch and loudness matching. In many cases, this appointment is essential www.ATA.org


for putting together your tinnitus story and how your tinnitus can be effectively addressed. These steps cannot be reliably performed remotely. This detailed intake process provides the baseline needed for an audiologist to begin working with you remotely. Many people I work with remotely completed these steps with a healthcare provider in their area who didn’t offer tinnitus care. Using these initial results, I can work with the patient to create a plan unique to him or her, incorporating telehealth when and where suitable. In some cases, due to the coronavirus, a patient cannot be seen in person but is seeking immediate relief. In such cases, I use whatever data I can compile and begin treatment. Lack of diagnostic information is an issue, but lack of treatment is greater cause for concern, particularly when a person feels alone or isolated and sees no way forward in dealing with unwanted sound.

What Does Treatment Entail? Tinnitus treatment plans are not the same for all patients. Your treatment plan depends greatly on what your hearing is like, what your tinnitus sounds like, and how bothered you are by it. That being said, the majority of my patients are treated through tinnitus counseling, use of a smartphone app, and/or ear-level devices (hearing aids or maskers). Because of the ease with which I can program hearing aids using the internet and provide counseling through telehealth, I feel telehealth is here to stay. Throughout the pandemic, I’ve been able to help my existing patients as well as new ones. Most telehealth appointments run 30 to 60 minutes. The key is taking the time to listen to www.ATA.org

each person’s unique needs and finding the best way to offer relief.

How Long Does It Take to Feel Better? Many patients are eager to understand when they’ll begin to feel better. The quick answer is any time after two to 10 appointments. The honest answer is each patient is unique, as is their tinnitus, which means treatment is different and follows a different timeline for everybody. I cannot stress enough how much unrealistic expectations can interfere with a patient’s goal of getting to a point when tinnitus is no longer interfering with their lifestyle and wellbeing. Some of my patients improve quickly, while others take much longer to realize measurable results. One of the most important elements in successful treatment is attitude. Having a good attitude and being invested in finding relief are two critical components in making progress. A properly trained tinnitus practitioner understands this and can counsel you appropriately. Until we have a vaccine that is widely available, the coronavirus pandemic will stay with us, forcing us to limit in-person interactions and reducing our access to people and things that help us cope with life. For many with tinnitus, the pandemic has made them feel anxious, afraid, and alone, which can contribute to more bothersome tinnitus. Telehealth is one pathway in addressing tinnitus concerns and turning down the volume on tinnitus during these difficult times. If you are looking for a healthcare practitioner trained in tinnitus management, the American Tinnitus Association maintains a professional listing on its website and in this

magazine. Once you’ve found a practitioner, you should ask them which treatments they provide. A tinnitus-trained practitioner typically offers a multidisciplinary approach, which means they offer various treatment options, not just hearing aids. For instance, in a multidisciplinary approach a practitioner may recommend a patient wear earlevel devices for masking and begin cognitive behavioral therapy at the same time. The point is that a good practitioner has options, and often combining them is the best approach for offering effective relief to patients. If you are suffering from tinnitus, don’t wait any longer to do something about it. Telehealth is now a reliable option to get care, no matter where you are. Melissa Wikoff received her Doctor of Audiology from Washington University in St. Louis School of Medicine’s Program in Audiology and Communication Sciences. She earned her Bachelor of Arts degree in speech and hearing science from the University of Maryland, College Park. Dr. Wikoff is licensed to practice audiology in the state of Georgia. She was the first student to be appointed to the board of directors of the American Balance Society (ABS). She currently serves on the board of directors for the American Tinnitus Association and for Aloha to Aging, a nonprofit in Atlanta. Originally from West Hartford, Connecticut, Wikoff now resides in Atlanta with her husband, their two children, and two dogs. She is a Peloton aficionado and a trained yoga teacher. Having seen the frustrating effects of hearing loss that affected her grandfathers after their service in World War II, Wikoff founded Peachtree Hearing, a private audiology practice. 1 O. Bestsennyy, G. Gilbert, A. Harris, & J. Rost. (2020, May 29). Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company. Retrieved from https://www.mckinsey.com/industries/ healthcare-systems-and-services/our-insights/ telehealth-a-quarter-trillion-dollar-post-covid-19-reality TINNITUS TODAY WINTER 2020



Regenerating Human Hearing

By Joy Onozuka

Birds, fish, amphibians, and lizards spend their lives seldom missing a sound thanks to their ability to regenerate cochlear hair cells, which keeps them safe from predators and makes them the envy of humans, particularly researchers trying to solve the human problem of sensorineural hearing loss (SNHL). Frequency Therapeutics, a Massachusetts-based biotech company, made headlines earlier this year when it announced that participants in its Phase 1/2 study of the experimental drug FX-322 showed significant improvement in speech intelligibility, and, in some patients, increased audibility threshold values at higher frequency 21 months after receiving it. For the study, researchers injected FX-322 into one ear of 15 participants and gave a placebo to eight other participants. They then measured 22


participants’ hearing 15 days, 30 days, 60 days, and 90 days after treatment using various hearing tests. Four participants, who received the injection, showed significant improvement in their hearing after treatment. Researchers continued their follow-up over the course of 21 months and found that three of those participants sustained hearing improvements. Based on these findings, researchers have begun preparing for a Phase 2a study of the drug, which is a randomized, double-blind, placebocontrolled, single- and repeat-dose study that will involve up to 96 patients with SNHL between the ages of 18 and 65. FX-322 is a combination of two molecules that affect progenitor cells, specialized cells in the inner ear. The cells are the source of sensory hair cells, which lie dormant in the human ear once the ear has finished

developing. The activation by these two molecules causes the progenitor cells to divide and grow, which is a significant breakthrough. However, until larger studies are conducted, it remains unclear whether the drug holds the key to restoring hearing for humans with SNHL. SNHL affects more than 40 million people in the United States and hundreds of millions of people worldwide, and accounts for 90 percent of all hearing loss. SNHL typically results from damage to the hair cells in the cochlea, which send auditory signals to the brain, and is typically caused by chronic noise exposure, aging, certain viral infections, and ototoxic medications. To learn more about research on the regeneration of hair cells to repair SNHL, see “Regenerative Therapies: Targeting Hearing Loss and Tinnitus,” Tinnitus Today (2019), 44 (3), 14. https://issuu.com/tinnitustoday/docs/tinnitustodaywinter2019-06?fr=sYzdiODEyMDMzMg



Why You Need a Daily Dose of Self-Compassion Warning: This article may increase happiness and self-confidence and improve your quality of life. By Lisa Caldwell, MA

For many years after my tinnitus started, I carried around a huge burden that was made up of many things: • Anger about the tinnitus happening on top of single-sided deafness and immediately after a series of lifesaving operations. • Self-pity – why me? This was completely unfair! • Despair about living with this unbearable sound for the rest of my life. • Grief for the old life that I had lost. • Guilt about the impact my lifestyle changes were having on my husband, family, and friends. • Sadness for the part of me that had disappeared. I felt like I’d lost a huge chunk of my personality. I wasn’t sure who I was anymore. Toting that around was so exhausting. In fact, reading through the list now makes me realize what a hard situation I was going through – for years. However, I didn’t recognize that at the time, and in fact, I was my own worst critic.


I blamed myself for my tinnitus – I don’t know how I think I caused it – but I decided it was my fault! I called myself a killjoy because I couldn’t bear to go to parties or the movies. I told myself I was weak because the buzzing in my head made me irritable and depressed. Wow! I know from many of my students I am far from alone in talking to myself like this. We tend to judge ourselves negatively about many things, including our tinnitus. We might experience self-critical emotions, such as shame or guilt. Or we might think self-critical thoughts, such as “I’m no fun anymore” or “I’m weak because I can’t cope when others can.” If you have any of these thoughts or feelings, let me tell you they are not kind and certainly not true. How can we counteract this selfcritical voice? With mindfulness and self-compassion.

What’s Self-Compassion? Self-compassion is showing the same compassion toward ourselves that we show to others. When we are self-compassionate, we treat ourselves with kindness and gentleness. Self-compassion can help us look at things that happen from a more

positive perspective. Our critical voice may say: “How could you have allowed yourself to get tinnitus?” “Why didn’t you wear ear protection?” “You’re weak because you’re still struggling with tinnitus when other people have learned to cope.” Our compassionate voice is kind and caring and accepts things as they are. It says, “What happened has happened. You are struggling because you are human, just like everyone else.” Self-compassion is also a form of acceptance. It recognizes how very hard it can feel to live with tinnitus and how well we are doing in managing it as we are, moment by moment.

“I am doing the best I can with what I have in this moment. And that's all I can ask of myself and others.” TINNITUS TODAY WINTER 2020



Nurturing SelfCompassion To become self-compassionate, we first need to become aware of our self-criticism. Through practicing mindfulness, we learn to notice all those negative thoughts and emotions that stream through our mind and body. It can be sobering when we realize how self-critical we are. Being mindful of this also helps us understand what an adverse impact this constant selfcriticism has on our mood, self-belief, and resilience in managing our tinnitus. Once we start practicing selfcompassion to counter this critical voice, we soon appreciate the difference this has on our mental and physical well-being. For many, including myself, it is life-changing. Here’s a great way to start:

Finding Your Compassionate Voice Grab a pen and paper right now and list 10 things about yourself that you really like or appreciate. If you feel a bit embarrassed or shy about doing this, remind yourself that you are not claiming you’re better than anyone else, nor that you’re perfect. You’re simply noting good qualities that you possess. And you don’t have to show the list to anyone else!



Once you have listed 10, acknowledge and enjoy the positive qualities you have, lingering over them and appreciating them. Keep this list tucked away for those hard times when you need a boost. Here’s another effective practice you can use right now, and whenever you need it:

Practice for Compassionate Awareness


Think of a situation in your life where tinnitus has an adverse effect. Acknowledge the emotion that arises – “This is upsetting” or “This hurts.” This is being mindful – experiencing the feeling without resisting it or trying to distract yourself. Recognize you’re not alone. Millions of Americans struggle with tinnitus just like you are struggling now. Choose a comforting phrase such as




Repeat your chosen phrase for the next minute as you breathe calmly in and out. For many of us, self-criticism is a long-term habit, and habits take time to change. That’s why learning to be self-compassionate consistently is a marathon, not a sprint. Like most training, it takes time, intention, and repetition. Lisa Caldwell studied law at Cambridge University and was a solicitor in London and Manchester before suddenly losing her hearing on one side and gaining tinnitus in 2005. Mindfulness became the key to accepting her tinnitus and living life on her terms. Now certified as a mindfulness meditation instructor, the Hearing Coach founder offers mindfulness-based tinnitus management courses for a fee – Bee Empowered – to improve the lives of people struggling with tinnitus. For more information, see www.thehearingcoach.com.

“I am doing the best I can.”

“I accept where I am right now.” “It’s okay to feel like this.”



Reducing Tinnitus Severity With Mindfulness-Based Cognitive Therapy Summary by John A. Coverstone, AuD

When tinnitus is bothersome, it is often because we react negatively when we hear it. Some people may even experience feelings of anxiety or dread when they hear tinnitus. This is a common reaction to the onset of tinnitus because people are unsure what they are hearing and why, fearing that it may indicate a serious medical condition. That is rarely the case, but it is the fear response and the extra attention that is given to tinnitus that frequently lead to tinnitus becoming bothersome and intrusive in daily life. Psychologists often address these reactions with cognitive behavior therapy (CBT). This therapeutic approach teaches patients to be aware of reactions to tinnitus and to respond to tinnitus in a more constructive way. In recent years, therapists have increasingly used mindfulness for a variety of mental health issues. Mindfulness is a way of approaching our feelings, thoughts, and sensations. It encourages a person to be aware (mindful) of what is happening in the present, rather than focused on what may happen in the future. As mindfulness has grown in popularity it has also been applied to treating tinnitus, including being used in conjunction with CBT. This approach www.ATA.org

has been termed mindfulnessbased cognitive therapy (MBCT) and has been shown to be effective in reducing tinnitus severity and distress. Three researchers in the United Kingdom sought to answer another question and determine why it might be successful.1 To do this, they approached patients of a previous randomized clinical trial of MBCT and invited them to participate in a study after their 6-month follow-up. During the prior study, patients had received 8 weeks of MBCT, consisting of weekly 2-hour group sessions. The first nine patients responding to the invitation were interviewed and their responses analyzed to determine which characteristics of MBCT led to successful outcomes. The research team identified four primary themes of MBCT from the interviews. The first was “Relating to tinnitus in a new way.” All patients described a change in their relationship with tinnitus. Many indicated that they had previously tried to resist and control the tinnitus by distracting themselves with other sounds (covering it up) or other means. Instead, they learned to accept their tinnitus and focus on other things in the present, such as breathing, sights or sounds around them, or sensations. Acceptance was

a key step because it allowed patients to stop trying to control or avert their tinnitus, which may draw attention to it and usually makes it worse. The second theme was “Holistic benefits.” As patients became less distressed by their tinnitus, their emotional state improved, they were less anxious, less stressed, and more positive regarding themselves and those around them. “Connection, kindness, and compassion” was the third theme identified by the researchers. They described this trait as kindness and compassion toward suffering and a desire to prevent or alleviate suffering in themselves and others. This was attributed at least in part to the group nature of the MBCT sessions, where participants were exposed to others dealing with tinnitus and were able to connect with other people who were experiencing the same distress they were. The compassion that participants felt for those in their therapy group translated to every day situations and resulted in being better prepared to deal with challenging situations, TINNITUS TODAY WINTER 2020



conflict, and certainly anyone else they met who had tinnitus. The fourth theme was identified as “Factors supporting engagement and change.” The authors found that people were engaged and committed to completing the 8-week program in part because of past attempts to deal with their tinnitus. Participants had tried a variety of therapies and coping strategies that may have left them open to new approaches, such as MBCT. The participants themselves reported that the most important practice in the program was the focus

in sound and hearing meditation. In particular, they appreciated the learned practices of focusing on the entire “soundscape,” not just tinnitus, and noticing sound directly, rather than thinking about sound/tinnitus. The authors indicated that these four themes correlate well with qualitative research for other applications of mindfulness-based programs. They also pointed out that the program followed during the original study included specific teaching of kindness in week seven. They believe that this is a key part of a mindfulness program

and leads to individuals being more accepting of themselves and what they are experiencing, giving themselves time and space “to simply be” and not judge or seek change in response to hearing tinnitus. 1 E. Marks, P. Smith, & L. McKenna. (2020). I wasn’t at war with noise: How mindfulness based cognitive therapy changes patients’ experiences of tinnitus. Frontiers in Psychology, 11, 483.






Coping With Tinnitus During the Covid-19 Pandemic

In the survey designed to explore the impact of the coronavirus pandemic on tinnitus experiences (see article on page 4), we found that 32 percent of respondents experienced increased tinnitus, 1 percent had decreased tinnitus, while 67 percent experienced no notable changes. To understand how people coped with tinnitus during the pandemic, we surveyed 1,522 respondents living in the United States and Canada. The average age of respondents was 64 years (age range was 18 to 97 years), with more males (56%) than females.

Support During the Pandemic To find out what support was sought during the pandemic, we compared the support sought prior to and during the pandemic. The findings revealed that significantly less support was sought during the pandemic, as shown in Figure 1. This was partly attributed to concerns about the risk of unnecessary exposure to the virus, as noted by one respondent: “My GP has referred me to an ear nose throat doctor, but I am hesitant to make an appointment due to the risks involved” (male, 60 years). www.ATA.org

Some respondents also indicated in open questions that they sought help but were unsure where to access it. For instance, one person said, “I don’t know what I can do about my tinnitus and wish there was information on where to access online help at a time like this” (male, 67 years). Some participants were concerned about being unable to maintain their hearing aids, as noted by the following

comment: “My left hearing aid squeals. I am in a retirement home and we are in lockdown, so I am unable to have the aid repaired” (female, 85 years). Others were concerned about access to other healthcare services, including mental health services. One respondent said, “They need to understand that other health problems didn't stop because the coronavirus arrived. People still need healthcare” (male, 68 years).

Figure 1: Comparison of Tinnitus Support Sought Before and During the Pandemic 35 71

Internet Intervention


Group Therapy

96 52 110

ATA Support



203 105

Self-Help Support

418 25

Primary Care Physician

724 104


1193 0



Support During the Pandemic


800 1000 1200

Past Support




groups, as evidenced by statements such as: “I think it would be great if Zoom meetings were available for support” (female, 77 years).

Coping Resources During What About Support the Pandemic Participants were asked what From People Living resources helped them cope with Under the Same Roof?

Role of Tinnitus Support Groups

their tinnitus during the pandemic. The most frequently utilized resources were family and friends (reported by 65 percent), followed by spending time outdoors or in nature (reported by 57 percent), as shown in Figure 2. Other activities for coping included arts and crafts, woodworking, cooking, reading, online courses, pet therapy, music, prayer, movies, gardening, house/yard maintenance, and other projects. One comment included the statement: “Being at home means I have more time to sleep, meditate, do yoga, and eat healthy meals, which all help me” (female, 42 years). These findings illustrate the importance of social contact, relaxation, and activities that underpin and improve quality-oflife experiences.

Only 17 percent of respondents reported attending a tinnitus support group prior to the pandemic, and only 0.2 percent attended an online tinnitus support group during the pandemic. Some expressed missing in-person meetings, such as “I miss my in-person group support. Since the pandemic, everything closed down. I am missing support, which leaves me feeling less confident in dealing with the ups and downs of everyday tinnitus, and each day I struggle with who is stronger – me or tinnitus – as it is on constant and is a relentless tyrant at times” (female, 66 years). Others were unaware of the existence of online tinnitus support

Figure 2: Coping Resources Utilized During the Pandemic 294

Other Activities




Indoor Exercise


Outdoor Exercise




Spending Time in Nature/Outdoors


Contacting Family/Friends 0

200 400 600 800 1000 1200 Number of Respondents


Being surrounded by supportive people can aid in coping with tinnitus, so respondents were asked about the people they live with. Respondents indicated household members were moderately (31%) or very (43%) understanding and/or supportive of issues related to their tinnitus, with only 7 percent reporting not living with supportive people. Ninety-two percent of respondents said the level of support was similar to pre-pandemic support, and 4 percent reported receiving more support and 2 percent feeling less support. For those lacking support, enduring the pandemic was difficult, as noted by the following comment: “I want to discuss my problems with someone who has experienced the debilitating events that occur with tinnitus and understand without them rolling their eyes” (female, 71 years).

Desired Tinnitus Support During the Pandemic




Overall this survey population sample appeared to draw on active methods of coping behaviors and relied less on unhelpful behaviors, such as drugs or alcohol.

Respondents were asked, “What type of support would help you better manage your tinnitus or hearing related issues during these uncertain times?” and “What advice/suggestions for healthcare professionals and/or researchers can you offer so that we might provide/develop more effective care for the future?” Respondents identified help with hearing loss, having peer support, www.ATA.org


“Even in normal times, accessing tinnitus care can be challenging. The pandemic, which greatly limited access to healthcare and social support, has illustrated the importance of organizations and professionals working together to provide improved outlets for tinnitus patient care.” finding a cure for tinnitus, having access to reliable information about tinnitus, and ensuring trained and understanding doctors were available to help them. Many respondents expressed a need for more online support, such as online support groups, information, and access to online therapies.

Why the Survey Findings Matter This study is valuable because it reflects the experiences and concerns of individuals with tinnitus. Professionals and tinnitus associations, like the American Tinnitus Association and the British Tinnitus Association, can use these results to work together to provide more effective support for those living with tinnitus. Even in normal times, accessing tinnitus care can be challenging. The pandemic, which greatly limited access to healthcare and social support, has illustrated the importance of organizations and professionals working together to provide improved outlets for tinnitus patient care. One such option is providing evidence-based interventions such as


internet-based cognitive behavioral therapy for tinnitus. Online tinnitus support groups as well as access to credible information on tinnitus and its treatment seem to be underutilized. Free webinars given by tinnitus experts would also help fill the information void many people with tinnitus felt. Like before the pandemic, the need for greater awareness of the toll of tinnitus on patients is paramount within the healthcare community. Unintended, dismissive comments can represent a serious setback for patients in need of care. Respondents also affirmed the critical need for research to find effective treatments and cures for tinnitus.

Acknowledgment We would like to thank the American Tinnitus Association for distribution of the survey and the many people who completed it.

Funding This work was partly funded by the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health (NIH) under the award number R21DC017214.

is a postdoctoral researcher at the Department of Speech and Hearing Sciences at Lamar University, Beaumont, Texas. She received her BSc in South Africa, her MSc in Audiology from the University of Manchester, and her PhD from Anglia Ruskin University, Cambridge, England. She is a clinical scientist in audiology and was awarded the Richard May Prize following her training. She received the prestigious Shapiro prize from the British Tinnitus Association for three consecutive years (2017, 2018, 2019) for her research and the Hallpike Research Prize (2019) from the British Association of Audiovestibular Physicians. Her research focus is the development and running of clinical trials to assess the effectiveness of internet-based interventions. Vinaya Manchaiah, AuD, MBA, PhD, is a Jo Mayo Endowed Professor of Speech and Hearing Sciences at the Department of Speech and Hearing Sciences at Lamar University, Beaumont, Texas. He received his BSc in India, his MSc from the University of Southampton, United Kingdom, and his PhD from Linköping University in Sweden. He has worked in various clinical, research, teaching, and administrative roles, although his current academic appointment centers predominantly on research. His research focuses on improving the accessibility, affordability, and outcomes of hearing loss and tinnitus by promoting self-management and use of digital technologies. He was awarded a grant from the National Institutes of Health to develop and investigate iCBT for tinnitus for patients living in the United States. He has published more than 100 peer-reviewed manuscripts and three books.




Tinnitus Q & A Answered by Jan L. Mayes, MSc

Question: My tinnitus has been relatively quiet for 20 years. However, it’s recently become much louder for no apparent reason, which really scares me. I don’t know if I can habituate to this. What should I do? What would cause my tinnitus to get louder? Jan Mayes, MSc: There are many reasons your tinnitus might grow louder. These include changes in health, hearing health, or lifestyle, as well as stress-related flare-ups. Possible causes are earwax blocking the eardrum, high blood pressure or diabetes, hearing changes, and family, workplace, or financial stress. Your tinnitus could have worsened as a result of increased anxiety about the coronavirus pandemic as we struggle with uncertainty, fears, and restrictions. Or you could have worse tinnitus from straining to understand conversations when facial features needed for speech reading are hidden under masks. I recommend consulting with your family doctor to check for possible medical reasons for your increased tinnitus. Your physician can refer you to an ear specialist if necessary. An appointment with your local audiologist could also be beneficial to check for nonmedical reasons and provide counseling support as needed. It is always frustrating when your tinnitus changes for no apparent reason. Whether a specific reason can be identified or not, the usual habituation strategies apply. I always encourage patients to direct their attention away from the tinnitus, thinking about it as 30


little as possible. Coping options include relaxation techniques, such as yoga, meditation, or mindfulness, distraction techniques, like enjoyable hobbies or activities, and sound enrichment, such as playing soft music or audio in quiet environments where your tinnitus is more noticeable. Anything that has helped you habituate or cope better in the past should be beneficial again. Question: Will my tinnitus get worse as I age? JM: Tinnitus doesn’t typically get worse with aging alone. The percentage of people reporting tinnitus starts to decrease around age 60. By the time people are in their 80s, only about 3 percent report tinnitus distress. When I saw older patients with histories of longstanding tinnitus, I would ask whether their tinnitus had changed over the years. People reported the tinnitus was better than when they were younger. Even though my sample size was small, it supported the science showing tinnitus doesn’t get worse with age. Question: I know it’s important to stay social, but the pandemic has given me the perfect excuse to shut myself off. Previously, I’d meet up with friends at a restaurant or bar, then spend days with my tinnitus in high gear. It was awful. What can I do differently to avoid these noise-induced spikes (reactive tinnitus) so I can enjoy my friends and stay active once things return to normal? I don’t want to struggle with tinnitus when I can avoid it; but I need to see my friends.

JM: Noise-induced spikes, or reactive tinnitus, is challenging for many people. If a restaurant or bar plays loud, amplified music, high-fidelity hearing protection might help limit spikes. This type of hearing protection cuts high sound levels while still allowing you to hear speech in a way similar to how sunglasses screen out harmful light while still allowing you to see. Popular high-fidelity or high-definition hearing protection includes pre-molded music earplugs or custom-molded filtered earplugs. Although tinnitus spikes could still happen even if you wear hearing protection, the reaction might not be as severe or last as long. Another option is to use a smartphone sound level meter app, such as the free SoundPrint app (https://www.soundprint.co/), to check restaurant or bar noise levels ahead of time. This type of app maps typical sound levels at different venues using data shared by patrons. This helps people find quiet venues to meet with friends. The quieter the restaurant or bar, the less likely reactive tinnitus will happen. Jan L. Mayes, MSc, has had tinnitus for more than 30 years. She is an awardwinning author of nonfiction health books. As a newly retired audiologist, Mayes continues to write about tinnitus, hyperacusis, and community noise impact on disability access, communication, and hearing health. In her spare time, Mayes enjoys writing horror paranormal fiction. To learn more, visit her website: www.janlmayes.com www.ATA.org


Taking Control of Sound to Rejoin the Crowd: The SoundPrint App By Gregory Scott

Ever been frustrated when noise has interfered with your ability to enjoy time with a date, friends, family, or colleagues at a restaurant, café, or bar? Afraid your tinnitus will spike if you take a Zumba or spin class at the gym? You aren’t alone. These were some of the issues behind the creation of the SoundPrint app. As a person with hearing loss, I would search out quiet places around my city where I could converse and enjoy being out without ambient noise ruining my time. A few years back, I started compiling information on where the quiet venues were in New York City, and then I found that even my friends with normal hearing wanted my list, so – as an analyst and person interested in meaningful change – I launched the SoundPrint app in 2018. The app is free, easy to use, and empowering for anyone concerned about sound in their environment. You can use SoundPrint to measure sound levels for listening safety or to find a quiet venue near you. The app also includes noise complaint and quiet recommendation features that


enable you to highlight high-noise places to be avoided and easylistening locations to enjoy. When you submit a complaint, SoundPrint reaches out to the loud venue directly, offers noise mitigation recommendations, and links venue managers with acoustic professionals who can help educate them and optimize the venue’s sonic experience. A quiet recommendation allows us to promote the quiet venue by placing it on our curated Quiet Lists, which all app users can access. Like other decibel readers, you can use SoundPrint to measure sound at any venue, including parks, offices, hospitals, retail stores, gyms, and schools, among others, to gauge your level of noise exposure.

Why Should You Use It? Noise-induced hearing loss is a serious and rising public health issue from which 24 percent of adults experience. Noise is the most common environmental cause of hearing loss. Studies show that large numbers of adults in the United States are exposed to noise levels that exceed the recommended guidelines issued by both the National Institute

for Occupational Safety and the U.S. Environmental Protection Agency. For individuals who have a sensory disorder, such as hearing loss, tinnitus, hyperacusis, or autism, or for those who simply want to find a quieter venue or avoid noisy ones, sound measurements can help determine whether you will patronize a place. This sound-level information is hard to come by yet critical for many people.

Your Sound Measurements Matter Today, the SoundPrint app is used by more than 100,000 people worldwide, mostly in the United States and Canada. It’s also available and growing in usage in Europe and Australia. Users have generated more than 120,000 SoundChecks for restaurants, gyms, cafés, outdoor spaces, and bars, and this data has led to: • Creation of the Quiet List for various cities in the United States and abroad • A nationwide noise database on recreational venues • Use of sound readings to talk to staff and managers about noise problems




that required raising one's voice to be heard, and that, in some areas of the establishments, noise approached levels that could endanger the hearing health of patrons and employees. The figure for NYC bars revealed that 60 percent were dangerously loud.

Working Together for Change • The ability to reward restaurants that offer quiet spaces • The ability to call out places that are too loud • Data that can inform public officials on the danger of noise in public spaces The app’s extensive crowdsourced database also provides public health officials and researchers with evidence-based sound level data that they can use to help educate the public on the dangers of excessive noise levels, advocate for those with hearing loss and tinnitus, and work with venue managers to reduce loud noise at their venues. Here is an example of how each person – each user of SoundPrint – contributes to changes that can promote hearing health for all of us: for the first time, one of SoundPrint’s large-scale noise studies was used to establish the sound level of a major U.S. city (New York City), giving city officials a useful baseline for future hearing health endeavors. Our data revealed that NYC restaurants routinely approached noise levels



SoundPrint’s mission is to use data collected by the app to lead the effort in advocating for a quieter world. And change can only happen once data-based evidence is objectively gathered and disseminated. To that end, SoundPrint partners and shares data widely with public health officials and noise activists, including the World Hearing Forum, an affiliate of the World Health Organization, whose mission is to promote hearing loss prevention worldwide. Data gathering is a critical part of SoundPrint’s hearing health mission. The data that app users capture establishes a sound-level baseline of an area (i.e., a country, state, city, or neighborhood) or venue (i.e., a restaurant, café, gym, office, hospital, or movie theater). Public health officials can then use this data to determine whether a certain area or venue is safe or dangerous for hearing health.

Partnering for Greater Awareness The American Tinnitus Association and SoundPrint are teaming up for Tinnitus Awareness Week – February

1–7, 2021 – to raise awareness about the SoundPrint app and its features aimed at preserving hearing health. It can be used as a tool for guarding against tinnitus spikes and noiseinduced hearing loss, plus app users contribute noise data for research and can highlight venues that present either a safe or a dangerous hearing environment. To learn more about the SoundPrint story, the app’s measurement process, and how to download the app to your smartphone, visit the SoundPrint website: https://www.soundprint.co/ To read the NYC study, see https://www.scirp.org/journal/ paperinformation.aspx?paperid=86590

Gregory Scott is the founder of SoundPrint, a crowdsourcing app that empowers users to search for places based on how quiet or loud they are using the app’s decibel meter. He is a frequent presenter and resource in the audiology and noise awareness communities. He has spoken at numerous conferences, including the Acoustical Society of America (ASA), the National Hearing Conservation Association (NHCA), and the Hearing Loss Association of America (HLAA). He lives in New York City.



WHAT THE SOUNDPRINT APP CAN DO FOR YOU EMPOWERMENT Use the SoundPrint decibel meter to take a SoundCheck and make sure your current environment is safe for hearing and manageable for tinnitus or hyperacusis.

HEARING HEALTH Did you know? The 24-7 weighted decibel average should be 70 dBA or below. Exposure to loud noise puts individuals at risk of noise-induced hearing loss and tinnitus.

ADVOCACY Contribute decibel data to support the hearing health mission. Based on your submissions, SoundPrint shares data with public health researchers and reaches out to venues to address noise or commend their quiet status.

TINNITUS MANAGEMENT If you suspect a place is too noisy, either leave and submit a noise complaint on the app, or request that the manager mitigate the noise. Consult Quiet Lists to find reliably quieter venues for better self-care.

SEARCH & ACCESSIBILITY Review the app's searchable database of previously measured venues. There are over 100K venues worldwide along with curated Quiet Lists!






High-Intensity Tinnitus and Little Help: Finding My Way Back to Myself By Robert Travis Scott

For those of you who have recently acquired a bad case of tinnitus, let me tell you: There is a path to relief. For those of you without tinnitus, allow me to tell you what it’s like so that you may better understand. In May 2017 in Baton Rouge, Louisiana, a pickup truck pulling a trailer was driving the wrong way on a one-way street and T-boned my car at an intersection. The impact popped my vehicle like a baseball off a bat and the 360-degree spinning motion drastically wobbled my head. For a moment, everything went bright white. Fortunately, the worst of my apparent injuries was “only” a concussion. Unfortunately, this was the beginning of my tinnitus story. Over the next few weeks, the intense symptoms of post-concussion syndrome slowly faded. Bit by bit, the ultrasensitivity to light, the slurring, the loss for words, the fatigue and irritability slid away. For several months my brain was inflicted with that phantom menace: episodic cranial sensory shock, an electrical, metallic-sounding sensation inside my head like a blown fuse mixed with a dozen snapping piano strings. Although supposedly a benign form of parasomnia, this “exploding head syndrome” struck loudly and frequently as I came in and out of sleep and disrupted my ability to rest. 34


But a different phantom menace took hold and did not let go: a piercing, screaming, unrelenting siren of a sound with multiple layers of highpitched tones. It’s damned loud. I’m still amazed at the volume of my tinnitus. It penetrates my head deeply, like a home fire alarm. But the most damnable part is how unforgiving it is. It just doesn’t stop. And it shakes my world in ways that the people around me can’t quite understand. Sleep was the first casualty. Tinnitus is famous for keeping people awake. The remedy? I fell for a bad one, inadvertently. Just stay up late as you can at night, tiring yourself until you collapse, exhausted. Eventually your body will succumb to sleep because of the acute fatigue. Not smart! But for a while I slipped into that unhealthy routine without recognizing how extreme weariness was my misguided way of coping with tinnitus-induced insomnia. A similar scheme took over my daylight hours. Stressful thoughts and situations can be used as distractions to tinnitus. By conflating work stress and life stress, the mind and body might avoid preoccupation with the tinnitus sound. Unconsciously and unintentionally, I was escalating stressful conditions to try to outshout the tinnitus noise. It’s hard to imagine a more harmful cycle: hyping one type of stress to beat another type, tinnitus. This became a behavior pattern. From

what I’ve heard and read, it’s a problem for other sufferers of high-intensity tinnitus as well. Meanwhile, the loss of silence had cut off my normal gateway to relaxation and meditation. For 30 years, I had been able to tune in reliably to a state of peace through quiet and unfiltered listening. Now the tinnitus was saying, “You shall not pass.” So, stress increased while destress dwindled. I don’t hear things the way I used to. My hearing is still mostly intact, but I had to learn new ways to listen to hear around the tinnitus siren. My work world is filled with meetings, conversations, and listening to people making presentations. Concentration became a challenge. Tinnitus interrupts the flow of thought and dialogue and demands a higher level of focus to stay in the groove. A central part of my job is public speaking. For this, my whole approach had to change. I need greater preparation, more careful notes, and handy prompts to stay on track. A few months into my tinnitus life, I looked at recorded broadcasts of myself in TV interviews from before and after the tinnitus. The difference was very noticeable. There was something wrong with that guy with the tinnitus. My family was upset watching the difference. Generally, my family and colleagues have noticed pronounced impacts. www.ATA.org


All my life I had enjoyed listening carefully and deeply to music, especially live performances of classical and choral music. Now, there are times when my enjoyment is simply ruined. Live music no longer sounds the same. The violins in particular sometimes just “disappear.” I play classical guitar as a hobby. The tinnitus is an obstacle as I attempt to separate its gnawing din from the notes of my guitar. These days, I rarely get the same relaxed enjoyment just listening to music. How do you explain all this to those unafflicted? By way of analogy, imagine you had within your field of vision a permanent, fixed image of something truly unpleasant, like a spooky clown, witch, or insect. You can still see clearly otherwise, but that disturbing image never goes away, even when you close your eyes. It’s not on your eye; it’s burned into your brain. Your best tool is to try to distract yourself from it by focusing your sight on other images or engaging in activities that preoccupy your mind. As time goes on and you realize that this horrible sight will never leave you, the effect would very likely create anxiety, discouragement, and at times even a sense of panic. You might be concerned about how you would maintain a healthy mental state over the long term based on the expectation that the ghastly image would be there the rest of your life. A severe case of tinnitus is somewhat like that. It can interfere with hearing, but does not block it out. It’s an awful sensation that won’t go away and can make you feel trapped and claustrophobic within your head. Although it does not harm you directly, its effects can be harmful and must be dealt with proactively. www.ATA.org

In that first year of tinnitus, in my worst paranoid moments, I wondered if the tinnitus was out to kill me. No wonder my score on the Tinnitus Handicap Inventory was right at the edge of “catastrophic.” “Tinnitus is like some alien entity that thrives on stress and emotional energy,” says Dr. Paul D’Arezzo about his tinnitus in a previous edition of Tinnitus Today. “I had to take an active role in my own rescue.” Amen. So, let’s talk about the rescue part. After the concussion, my primary care doctor referred me to an audiologist, who gave me a hearing test and turned her back to me while I was explaining what I was experiencing. She suggested dietary supplements. I sought out a second audiologist who was compassionate and seemed truly frustrated that he didn’t have a good treatment for me. He gave me a hearing test and suggested ginkgo biloba. I soon guessed I was on my own. If I have a single message to convey to the healthcare community about tinnitus it would be this: Too often, the approach to tinnitus care is waitand-see. It should be the opposite. Yes, habituation eventually will ease the suffering for many. But the road to that destination needs to be mapped immediately for the new patient. In late 2017, I became a member of the American Tinnitus Association. When my first edition of Tinnitus Today came in the mail, I straightaway read it cover to cover. The edition’s focus was research for cures. The articles made clear that although innovative research was going on, science had nothing on the near horizon to stop the noise.

“Too often, the approach to tinnitus care is wait-andsee. It should be the opposite.” That was the abyss. I was crushed. No one around me, even my family, could really understand. The last drop of faith that I would ever be free from the screaming in my head was wrung out of me. I think it’s probably only other sufferers of severe tinnitus who can really relate to that moment of reckoning. What I love about the ATA is that while it provides the truth, the organization also offers hope and meaningful direction. The magazine talked about a thing called cognitive behavior therapy, or CBT. In fact, CBT is part of the Clinical Practice Guidelines for tinnitus. I had heard of CBT but did not know much about it; CBT was not mentioned in my audiology appointments up to then. I also discovered that some major insurers cover CBT treatment for tinnitus. Wow! So, the search for a therapist was on. At first, I made the mistake of trying to connect with a therapist via audiology professionals, thinking that would be the expedited way to get a good referral. I wasted time with that strategy. Finding a cognitive behavior therapist in my area who accepted tinnitus sufferers turned out to be a difficult task. In fact, the leading audiology practice in my area recommends CBT for tinnitus patients, but the audiology practitioners have trouble finding cognitive behavior TINNITUS TODAY WINTER 2020



“I acquired tools to stop the negative invaders at the gate, so to speak, before they could move around inside my thoughts.” therapists who will take tinnitus cases. I got the impression that the therapy profession was missing out on a significant population of business for their services. Positive developments came by mid-2018. I discovered the book Living with Tinnitus and Hyperacusis, by Drs. Laurence McKenna, David Baguley, and Don McFerran. The authors’ intelligent and frank explanation of tinnitus, combined with a clear walkthrough of how CBT can help, offers guidance I strongly recommend. CBT is neither magic nor academically convoluted. Its concept and application are accessible to ordinary people. If you work it, it works. About this same time, a compassionate therapist returned my phone call and really listened. She could not take me. But, God bless her, she mentioned a local clinical psychologist and certified hypnotherapist, whom I will call Dr. T. It was an interesting suggestion. Dr. T had seen many patients who dealt with pain from disease or accidents and he had written a book about hypnosis to help athletes deal with sports injuries. He had little experience with tinnitus patients and he made no promises to me about results. 36


As I began with Dr. T, it had been more than a year since my concussion, and the tinnitus was frightful as ever. I was desperate to find one single second of tinnitus relief that I could authorize by my own volition. Just one second – under my initiative – to be aware of the affliction, but not hearing it. Just that one second, just one time. Such an event would open the door to bright hope. Just. One. Second. The combination of therapy and hypnosis led to a breakthrough, and launched a remarkable journey. I learned how to stop the vicious cycle of doubt, anxiety, and hopelessness. I acquired tools to stop the negative invaders at the gate, so to speak, before they could move around inside my thoughts. I followed new paths to relaxation and meditation. I learned a universal human lesson that is so easy to recite and yet so hard to put into practice: You can’t control everything that happens to you, but you can influence how you react. And I found my one second. It was a reconnection to faith in life. Even when miniscule, faith is never a small thing. From that point, more good things transpired. Swimming laps at the YMCA pool – those steady beats of watery sounds -– has become a regular respite. I’m lousy on the violin, but playing notes on it is a remarkable counterpunch to the tinnitus. I found an audiology practice with great resources for tinnitus testing and a staff who know how to listen and respond. Eventually, I was fitted with hearing aids that deliver tinnitus sound therapy. Though skeptical at first, I’ve found that the device does help. Nowadays, I repeat to myself frequently the thought process that is part of the treatment: • Remind yourself you’ll be okay. This is absolutely No. 1 all the time.

• Identify the stresses your mind tries to use to distract you from the siren. Recognize that stress wants to be the antidote. That kind of medicine is worse than the illness. • Use and have faith in CBT because it has worked and will keep working. • Practice hypnosis and self-hypnosis properly and with guidance. • Use healthy techniques you’ve learned to get good sleep. • Stay engaged with the resources of the ATA (a vital part of my recovery). Recently, I looked back on a report I wrote to myself about my tinnitus a few months after the concussion. Its message was rather grim: “Based on what I am observing and learning, I’m led to believe that this is an unusually detrimental case. It is difficult to accept the fact that I might always have this level of tinnitus, and based on what I have learned so far, that outcome is likely. That is very discouraging.” But in the same report I wrote, “One by one I will identify the effects and learn to manage them.” That was the hope talking. And I’m glad to say, three years later, those resolute words are being fulfilled. Robert Travis Scott is president of a nonprofit, nonpartisan public policy research organization founded in 1950 that focuses on Louisiana. Previously, he was an award-winning journalist for political, business, and investigative reporting at the metro newspaper in New Orleans. He also was a newspaper business editor and columnist in South Carolina and an associate director of a national security policy organization in Washington, D.C. Scott is a Rotarian, a facilitator for Dialogue on Race Louisiana, and a member of several state task force groups. He serves on the board of the American Tinnitus Association. He lives in Baton Rouge and is the father of three perfectly amazing young ladies.



olice Communication Tool P Poses Risk at Demonstrations As the coronavirus swept across the United States, so did a wave of civil unrest, sparked by police killings of Black people. Large protests, marches, and demonstrations include police to ensure public safety. One tool police use to maintain order and communicate with crowds that also made headlines is the LRAD 100X, which stands for Long Range Acoustic Device. It was originally developed for the military as a communication tool and sonic weapon. Unlike a bullhorn, the LRAD can transmit sound clearly over long distances, which ensures that police communications can be heard. Police departments in Portland, Oregon; San Jose, California; Colorado Springs, Colorado; Phoenix, Arizona; Columbus, Ohio; Charleston, South Carolina; and other cities used the device at protests this year, which led to questions about its safety because those standing within the 30-degree beam of sound – an angle similar to that of a flashlight beam – are exposed to noise levels that can cause hearing injury, including tinnitus and hyperacusis. The portable LRAD device typically used by police can produce a continuous output of 136 decibels at three feet and can project 88 decibels up to approximately 750 feet over background noise. Loud noise above 120 decibels can cause immediate harm to your ears. Using alert mode, the system can emit a high-pitched tone that can cause sensorineural hearing loss. Numerous lawsuits have been filed over the years against police departments when use of the device at demonstrations resulted in permanent www.ATA.org

hearing damage for some participants and bystanders. The courts have found that using LRAD improperly could constitute excessive force.

The takeaway for the public is to use earplugs or earmuffs if you’re near or attending large gatherings where police are present for crowd control.

How Loud Can It Really Get? Typical Sound

Levels of Noise in dB (LRAD max. shown in dark yellow)


No sound perceptible to human ear


Threshold of hearing

Normal breathing




Library / Quiet Office / Watch ticking


Quiet residential/rural area


Quiet suburban area / Rainfall / Fridge


Dishwasher / Air conditioner


Highway traffic / Vacuum cleaner


Alarm clock / Doorbell / Ringing phone


Noisy restaurant / Heavy traffic


Tractor / Bus or truck


Electric drill / Underground train


Motorbike / Walkman (max. volume)


Disco / Pneumatic drill / Car horn


Chain saw / Rock concert / Stadium


Jet plane taking off / Thunder


Vuvuzela horn (world cup)


Power drill / Orchestra percussion


Air-raid siren




Firearms / Gunshot






Artillery fire (at 500ft / 150m)




Balloon pop (at 3ft / 1m)




Rocket launch


Normal conversation

Maximum permitted level in work-place (8 hours) Sustained exposure may result in hearing loss

Threshold of pain

Brief exposure can cause permanent damage

Death of hearing tissue

Credit: Reprinted with permission from Acoustic Deterrent Systems FAQ, South African LRAD Distributor TINNITUS TODAY WINTER 2020



Rewiring the Brain With Tongue and Sound Stimulation to Reduce the Negative Impact of Tinnitus Beyond the effort to understand the science behind different types of tinnitus in order to find cures, the research community has long sought to develop treatments to provide relief for people bothered by tinnitus. This year, Neuromod Devices Limited of Ireland unveiled the results of its large-scale randomized trial for its Lenire device, which uses bimodal neuromodulation combining sound and tongue stimulation to modulate the brain. To learn more about the research and the development of the device, the ATA interviewed Hubert Lim, PhD, senior author of the published study and leading researcher in the field of neuromodulation. Joy Onozuka (JO): What is neuromodulation and the theory behind bimodal neuromodulation? How does the somatosensory system fit into tinnitus treatment? Hubert Lim, PhD (HL): Neuromodulation can be defined narrowly or broadly. In a very broad sense, anything that modulates – or tunes or adjusts – the 38


nervous system could be said to be neuromodulation, even if it is achieved through drugs, behavioral approaches, and sensory inputs, such as a TV or sound generator. In a narrow view, neuromodulation is related to research that was done in the mid- to late 1900s with spinal cord stimulators (such as for pain or motor recovery) and deep brain stimulation (DBS) in the head (such as for reducing tremors or modulating affective/addiction circuits). This narrow view relates to applying electrical stimulation to neural circuits to alter their ongoing activity in order to improve a condition or symptoms of a health condition. As the field expanded and evolved, these treatments also began including noninvasive approaches that use electrical stimulation on the surface of the body or skin – or tongue as is used in our approach – as well as magnetic, radiofrequency, ultrasound and optical (laser) energy to reach different neural targets in the brain. Researchers are also looking at ways to modulate the nervous system by combining more than

one stimulation approach, such as Neuromod’s technology, which combines neuromodulation from sound with neuromodulation from electrical stimulation of the tongue. We know through extensive studies spanning more than 40 years that there are vast numbers of neural connections in the body between different nerves, organs, and brain regions, including from the tongue and trigeminal nerves (e.g., those responsible for sensation in the mouth and face) that connect with the auditory pathways and brain regions involved with hearing function. So, when we stimulate with sound, we activate certain auditory neurons in a person’s brain in response to the specific stimulus. For example, if we play a 1 kHz sound, we activate the auditory neurons sensitive to 1 kHz. Now, if we also stimulate the tongue, we can drive converging activation into the person’s auditory region so that those neurons active at 1 kHz also receive input from the tongue stimulation, so this dualmode stimulation provides a kind of reinforcement, telling those neurons www.ATA.org


and the brain that 1 kHz is important – that is, why else would the brain be receiving activation by 1 kHz and, oddly, some tongue stimulation at the same time? Something must be important or at least deserve the brain’s attention. At least that is the hypothesis of how the brain is responding. Then we do this for 2 kHz, and then for 8 kHz, and so on. If we present enough acoustic stimuli, the brain begins to pay more attention and becomes more sensitive to these many different acoustic stimuli. The brain and mind have only so much bandwidth to dedicate attention to and focus on multiple stimuli and inputs. So if we make the auditory brain more sensitive to many inputs and acoustic stimuli, then it becomes distracted away from and less sensitive to, or less aware of, the tinnitus. So, we seek to ”retune” or “rewire” the brain away from being focused on or bothered by the tinnitus neurons and sensations. This is how we (my lab and those at Neuromod Devices) believe the treatment is working. The somatosensory system, which includes nerves from the tongue,

has many projections to the auditory system of the brain, and the tongue is a strong driver of plasticity in the auditory brain relevant for tinnitus treatment, which is supported by previous animal research from my lab at University of Minnesota. Plasticity is the scientific word we use to describe the brain’s continuous ability to rewire or fine tune itself, such as in learning or development. JO: What was the control for the device treatment in your recently published TENT-A1 study (Treatment Evaluation of Neuromodulation for Tinnitus – Stage A1)? HL: When designing clinical trials, an important consideration is the selection of an appropriate condition for comparison. This comparison condition is referred to as the “control”. A control is usually thought of in terms of a “placebo” control. You can also have an “active” control or what is referred to as an active comparator. A placebo control is generally preferred because it allows the research community to compare

“The brain and mind have only so much bandwidth to dedicate attention to and focus on multiple stimuli and inputs. So if we make the auditory brain more sensitive to many inputs and acoustic stimuli, then it becomes distracted away from and less sensitive to, or less aware of, the tinnitus.” www.ATA.org

what happens with the intervention under investigation and without. However, for a placebo to be useful, it must be unrecognizable from the active arm, or it will introduce bias – i.e., those participants who know they are getting a placebo will assume that they are getting no benefit and those who know they are getting the investigational treatment will assume benefit thus biasing the results of the trial. For our treatment, we deliver sound and tongue stimulation at the same time – both stimuli are calibrated specifically for each patient – so it becomes challenging for us to give a patient a device with no sound or tongue stimulation without them knowing that it was placebo. There could be possible methods to overcome this bias but they need to be carefully designed for each specific study’s situation, and whether it worked to avoid bias may not be fully known until after a study is completed when it is possible to confirm with the patients that they were unbiased to their treatment. So we chose an active comparator design for the TENT-A1 study. We developed three different combinations of sound and tongue stimulation and compared those to one another, so that they served as active controls to one another. Arm 1 tested sounds and tongue stimulation delivered at carefully coordinated timings, Arm 2 tested the same sounds and tongue stimulation but with variations in the timing of delivery, and Arm 3 tested lower energy sound and tongue stimulation with even greater variation in the timing of delivery. There were several other differences among the arms TINNITUS TODAY WINTER 2020



that are further described in the published paper. Participants were randomly assigned to one of the three arms, and neither the participants nor the clinicians could tell which treatment they were getting – this is referred to as blinding. We prespecified two sets of primary endpoints. One set of primary endpoints was to demonstrate that each treatment

setting drove significant reduction in tinnitus symptom severity (based on the two outcome measures, Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI), which are widely used in the tinnitus field for these types of studies). We achieved this set of endpoints. The second set of primary endpoints was to demonstrate a between-arm difference between the

TENT-A1 CLINICAL TRIAL Demonstrating Long-Term Therapeutic Relief from Tinnitus TENT-A1 concludes that bimodal neuromodulation combining sound and tongue stimulation can significantly reduce tinnitus symptoms, and can be sustained for up to 12 months post-treatment.

86.2% of treatment-compliant participants demonstrated an improvement in tinnitus symptom severity when evaluated after 12 weeks of treatment.

80.1% of treatment-compliant participants experienced continued improvement in tinnitus symtom severity when evaluated at 12 months post-treatment.

77.8% of participants when asked at their final visit, said they would recommend the Lenire® treatment to others with tinnitus.

Reference: B. Conlon et al., Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study. Sci. Transl. Med. 12, eabb2830 (2020).



settings, particularly between arm 1 and arm 3. So, you can view arm 3 as the active control; our expectation was that all three settings would be effective, but we expected to see differences between at least arm 1 and arm 3, which differed the most from each other in terms of stimulation parameters. We did not see a significant difference between arm 1 and arm 3 at the end of treatment; however, we observed that for long-term therapeutic effects up to 12 months after treatment ended, arm 1 showed the most sustained benefit, especially compared to the effects of arm 3. We recently completed a largescale clinical trial, Treatment Evaluation of Neuromodulation for Tinnitus – Stage A2 (TENT-A2), that further investigated different contributions of tongue and sound features to these short-term and long-term therapeutic effects. The TENT-A2 trial allows us to further delve into how different stimulus features affect tinnitus symptoms, including changing the nature of the sound stimulation and evaluating sound stimulation from the device before the addition of tongue stimulation. We will submit these findings for peer review publication once the database has been verified and validated. Further details of TENT-A2 clinical trial design were published in a protocol paper. JO: Why utilize the tongue to deliver electrical stimulation instead of the ear or neck? HL: It is fascinating that multiple groups have been working in parallel and independently on bimodal neuromodulation for tinnitus, and www.ATA.org


they have found consistent and encouraging benefits for tinnitus treatment. Since 2009, my lab at University of Minnesota has been exploring how electrically stimulating different body regions (or brain regions associated with different body and non-auditory regions) combined with sound could change activity patterns in neurons/ cells in the brain relevant for tinnitus treatment, which we investigated in a series of experiments in guinea pigs. At first, we took a completely openended trial-and-error approach, where we tried electrically stimulating many different body locations combined with sound stimulation. From our open-ended research, we discovered that electrical stimulation of the ear or electrical stimulation of the tongue combined with sound stimulation drove some of the greatest changes in the auditory brain relevant for tinnitus treatment. My lab then pursued pilot treatment studies with tinnitus participants to investigate electrical ear stimulation with sound, and these led to encouraging preliminary results. We were not able to investigate tongue stimulation so easily because we didn’t have a device to comfortably or reliably put into the mouth for that purpose.

In parallel, Neuromod Devices Limited in Ireland was developing a bimodal device that presented sound combined with electrical stimulation of the tongue. The company started in 2010, but the CEO, Ross O’Neill, had investigated the use of tongue stimulation in his PhD research. Dr. O’Neill was investigating how neuromodulation could address maladaptive sensations following sensory loss, such as with phantom limb pain. He understood that tinnitus is a form of phantom sensation where a reduction in sensory input from the auditory pathway results in phantom sensations that can be debilitating and distressing. He and his collaborators had the idea to do electrical stimulation of the tongue combined with sound to activate or modulate the auditory system and ultimately to treat tinnitus. He established the company to develop a prototype and investigate the clinical effect of the approach. He ran two pilot studies and showed positive findings for tinnitus treatment using this approach, which supported a market application in the European Union, securing CE mark certification to allow the device to be used in Europe. It was encouraging to see two separate groups both discovering

“It was encouraging to see two separate groups both discovering that tongue, or somatosensory, stimulation combined with sound could drive positive changes in the brain relevant for tinnitus treatment.” www.ATA.org

that tongue, or somatosensory, stimulation combined with sound could drive positive changes in the brain relevant for tinnitus treatment. In parallel, and also independent from these two groups, another group at University of Michigan, led by Dr. Susan Shore, was using electrical stimulation of the face/cheek region or neck region combined with sound to treat tinnitus, and their research also has shown positive results. They published an important paper in 2018 in Science Translational Medicine showing improvements in tinnitus symptoms that could last up to three weeks. That is consistent with our findings in this current paper. Interestingly, we followed therapeutic outcomes for 12 months after treatment ended, and saw that the improvements persisted in our TENT-A1 study. It may be that tongue stimulation drives longer-term changes than neck/face stimulation or it could be because the duration of treatment: we evaluated 12 weeks of treatment whereas Dr. Shore’s study investigated 4 weeks of treatment. These are all interesting questions to be further investigated. JO: Are there any risks involved in electrical stimulation of the tongue?




HL: The device is designed to be low risk. In fact, the tongue allows us to achieve our desired result with very little electrical stimulation compared to stimulation on skin since saliva serves as an excellent conductive medium for electrical stimulation. The sound stimuli are delivered at safe loudness levels within the NIOSH limits and are also calibrated to each patient’s hearing thresholds. Overall, there were no serious side effects related to the treatment, and we concluded that the device is low risk and well tolerated. JO: In the early stages of your research, what were the primary challenges and indications that you were on to something meaningful? How important was the animal model in your research? HL: The main challenge is that there are so many parameters to test and evaluate and also that there are multiple subtypes of tinnitus patients. In animals, it is easier to try many different parameters and also to record directly from the brain. However, there is still so much we don’t understand about how the animal brain mimics the human brain, and especially the way tinnitus is coded in the animal brain and how that then translates to



what happens in the human brain for a specific treatment. My view is that animal research is important. But it has its limitations. At least for noninvasive and low-risk neuromodulation approaches, animal research is useful to see whether a stimulation approach can greatly modulate or alter brain coding, such as in the auditory brain relevant for tinnitus treatment. We do not necessarily have to show that we can actually treat tinnitus in animals, but instead we first show that we can greatly alter coding patterns in the auditory brain. This means our treatment approach, in this case bimodal neuromodulation, has the ability to alter coding in the auditory brain, which could potentially benefit tinnitus treatment. Since the bimodal neuromodulation approach is noninvasive and low risk, it is then possible to directly investigate different parameters in human tinnitus participants to confirm that the approach treats tinnitus or helps alleviate the symptoms of tinnitus, and it can be done in a more meaningful and informative way compared to in animal research (that is, you can directly ask tinnitus participants whether they feel better or whether their tinnitus is better, which is not possible in animals). In academia and at a university, it is challenging to run large-scale studies because it takes a large group of people and infrastructure to make it happen. I struggled in this aspect because I wanted to try multiple parameters of bimodal neuromodulation but also wanted to perform them in a large number of patients to make sense of the outcomes. This

just isn’t easy to do in a university research lab. This is one major reason why I decided to work together with Neuromod Devices because it offered us a unique opportunity to combine our best ideas and vision to run a series of large-scale clinical trials to try multiple parameters. We’ve been able to run two large-scale studies thus far and have investigated multiple parameters in many tinnitus patients (517 total enrolled participants). One other challenge was that even in a large-scale study, we couldn’t try too many parameters because, otherwise, we would need thousands of participants. Instead, we bundled up several parameters into each treatment group to look for general differences in outcomes. The downside of this approach was that when we saw differences in treatment outcomes between the different treatment groups we couldn’t always know which specific stimulus feature component or components drove those outcomes. However, from those results, we can then pursue a second followon large-scale study where we can hone in on specific stimulus features. This is what we did in the second study (TENT-A2, following our first TENT-A1 study), which focuses on several features of bimodal neuromodulation that contribute to therapeutic outcomes. JO: What was the most surprising outcome? HL: The most surprising outcome was how the therapeutic effects lasted up to 12 months after the www.ATA.org


treatment stopped. We didn’t check beyond 12 months. I didn’t expect such long-term effects. I had always thought bimodal neuromodulation could cause long-lasting positive brain changes so I was delighted to see such long-term effects. Even a previous clinical study by Dr. Susan Shore from University of Michigan with 20 participants and published in 2018 showed a benefit that could last for three weeks following treatment, and this occurred for bimodal neuromodulation patients, but not for those who received acoustic-only stimulation. So, her study also supports the idea that bimodal neuromodulation is key to long-term effects. But for the effects to last up to one year was quite surprising. JO: When we talk about positive outcomes, what does that mean for patients? Is tinnitus loudness reduced? HL: Our main outcome measures are THI and TFI questionnaires. Through discussion with company experts and scientific/clinical collaborators (including the coauthors of the paper), we decided to use these measures of tinnitus symptom severity. Discussions in the field suggest that one should also use a measure to assess the loudness of tinnitus. Although I agree that this type of measure would be helpful, I am not aware of any objective measure of tinnitus loudness. There are several subjective methods of measuring tinnitus loudness, such as Visual Analog Scale–Loudness (VAS-L) or minimum masking level. We measured some of these subjective measures of tinnitus loudness in www.ATA.org

the TENT-A1 study and will report on them in a proceeding publication that includes many of our secondary and exploratory analyses, including different outcome measures and effects in different subtypes of tinnitus patients. The key reason we used THI and TFI is because they capture the tinnitus symptom severity and how a person is feeling in response to their tinnitus. I agree that if the tinnitus loudness is completely eliminated, then a person cannot be bothered by it. But reducing tinnitus loudness does not necessarily mean a person will feel better or that their daily life or symptom severity situation will improve. For this reason, in addition to using THI and TFI, we also just asked the participants if they felt better after the treatment. Out of 272 who completed the exit interview, 66.5 percent said yes. So regardless of THI or TFI, or whether the loudness of their tinnitus changed, 66.5 percent of participants said they felt better. We also asked them if they would recommend the device to other people suffering from tinnitus. Out of 270, 77.8 percent of participants said yes. So even if some didn’t benefit from Lenire, they would still want others to try it, showing that they felt it could work for others. So, this is what we mean by having positive outcomes. JO: Understanding that there are subsets of tinnitus, which types of tinnitus patients are most likely to benefit from using the device? HL: We looked at several different subtypes of patients and the effects of different stimulation parameters in those subgroups. These data from

“We want to obtain approval from the U.S. Food and Drug Administration to bring the device to the United States.” TENT-A1 are still being analyzed and prepared for additional publications. The information is related to the secondary and exploratory analyses we describe in our published protocol paper for TENT-A1 (available on the Neuromod Devices website: https:// www.neuromoddevices.com/ company/clinical-advancement). So please stay tuned. JO: What’s the next step in your research? HL: We are closing out a second large-scale clinical trial sponsored by Neuromod Devices from which we are learning more about which tongue and sound features are contributing to the tinnitus treatment. My personal interest, also echoed by Neuromod Devices, is to continue further mechanism studies to better understand how the brain changes in response to bimodal neuromodulation that improves tinnitus. I would like to further identify subtypes of tinnitus patients who could benefit from different stimulation TINNITUS TODAY WINTER 2020



settings, toward more personalized medicine. The device is currently available in Europe, where it is CE-marked (meaning, it meets European Union safety, performance, health, and environmental requirements). We want to obtain approval from the U.S. Food and Drug Administration to bring the device to the United States. We are also interested to see what other brain conditions can be treated with the device and bimodal neuromodulation in general. Conflict of interest statement: Hubert Lim is an associate professor at the University of Minnesota in the Department of Biomedical Engineering and the Department of Otolaryngology. His lab has been involved with bimodal neuromodulation research in animals and humans, which relate to several of the opinions expressed in this interview. He also serves as the chief scientific officer of Neuromod Devices in Dublin, Ireland, and has equity in the company. The Lenire device discussed in this interview was developed by

Neuromod Devices. The clinical study with the device was sponsored by Neuromod Devices. He also holds equity in and serves as the chief scientific officer of SecondWave Systems, which is developing wearable ultrasound stimulation technologies for treating various health conditions. This interview does not relate to activities associated with SecondWave Systems.

Hubert Lim, PhD, is an associate professor in the Biomedical Engineering and Otolaryngology Departments at the University of Minnesota and was hired as an Institute for Translational Neuroscience Scholar. He completed a Bachelor of Science in bioengineering at UC–San Diego, followed by a dual master’s in biomedical engineering and electrical engineering and computer science, and then a PhD in biomedical engineering at the University of Michigan.

At the University of Minnesota, his lab’s research focuses on neural engineering, neuromodulation technologies, sensory neuroscience, neural plasticity, and neuroimmune physiology with the aim of developing new stimulation treatments for hearing disorders, pain, and inflammatory conditions in collaboration with multiple clinicians and companies (Medtronic, Cochlear, Blackrock Microsystems, MED-EL, GE Research, Starkey, Neuromod Devices, SecondWave). For more information on Dr. Lim and his lab, see http://soniclab.umn.edu For more information about Neuromod Devices, visit https://www.neuromoddevices.com To read the Science Translational Medicine paper, visit https://www.neuromoddevices. com/tenta1results B. Conlon, B. Langguth, C. Hamilton, S. Hughes, E. Meade, C. O Connor, M. Schecklmann, D. A. Hall, S. Vanneste, S. L. Leong, T. Subramaniam, S. D’Arcy, H. H. Lim, Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study. Sci. Transl. Med. 12, eabb2830 (2020).

In collaboration with Cochlear Limited, Dr. Lim completed postdoctoral research at the Hannover Medical School in Germany, where he oversaw a clinical trial for a new deep-brain stimulation implant to restore hearing.

Beware of Noisy Toys: Sight and Hearing Association’s 23rd Annual Noisy Toys List The message every year from the Sight & Hearing Association (SHA) is that loud toys recklessly expose children to decibel levels that can damage their hearing. SHA annually highlights toys, such as those from Vtech and Fisher price, that appeal to adults and children in its Noisy Toy List, now in its 23rd year. This year’s list includes 14 out of 24 toys that reached noise levels louder than 85 dB, the level set by 44


the National Institute of Occupational Health and Safety (OSHA) for mandatory hearing protection for adults. The loudest toy blasted in at over 105 decibels (dB), which can damage hearing in less than 30 minutes when placed near a child's ear. Toys are required to meet the acoustic standard set by the American Society of Testing and Materials (ASTM), which states that the soundpressure level produced by toys should

not exceed 85 dB at 20 inches (50 cm) from the surface of the toy. While ASTM has acknowledged that 10 inches (25 cm) would be considered an average use distance for toys, they found 20 inches was a superior distance for measurement. And while there are no known sound limits that apply specifically for children, ASTM bases compliance on OSHA and U.S. military noise level limits for adults.



According to SHA’s Executive Director Kathy Webb, “ASTM's testing standard is unreasonable. Toys should be tested based on how a child would play with it, not how an adult would play with it. If you watch a child playing with a toy, you will see them hold it close to their face, next to their ears, which is much closer than a child's arm's length of approximately 10 inches, let alone 20 inches for an adult.” SHA reminds consumers that hearing loss is cumulative and does not typically occur from one event; it gradually develops over time as we

age. Most importantly, it is critical that we protect children's hearing. If you own a smartphone, you can download a sound level meter app that can measure the sound level of a toy. But if you don't own a smartphone, your ears will do just fine, because if a toy sounds too loud to you, it is too loud for a child's young ears. If your child receives a noisy toy this holiday season, look for volume controls or on/off switches. You can remove batteries or place clear packing tape over the speaker to reduce the sound level.

Because of Covid-19, it’s expected that more toys will be purchased online this year. Fortunately, most retailers offer a return policy should you decide to return a noisy toy. If you’re shopping in person, push buttons and hear the sound of the toy before you purchase it. The Sight & Hearing Association was founded in Minnesota in 1939 and is dedicated to enabling lifetime learning by identifying preventable loss of vision and hearing. For more information about SHA and its 2020 Noisy Toys List, contact Kathy Webb at kwebb@ sightandhearing.org.

Sight & Hearing Association's Noisy Toys List 2020 Toy



Type of Toy

Little Baby Bongo Drums Fisher-Price® Little People® Travel Together Airplane Baby Einstein® Glow & Discover Light Bar™ Chomp & Count Dino™ Batman: The Caped Crusader™ Voice Changing Mask Fisher-Price® Little People Swing & Share Treehouse Spin & Sing Alphabet Zoo™ Scout’s Learning Lights Remote Deluxe Land of B.™ Woofer’s Musical Driving Wheel Fisher-Price® Laugh & Learn® Rumble & Count Piggy Bank Wheelz Slammin’ Racers™ Monster Truck Start Up Circuits (tested the whistling siren circuit) Blippi Recycling Truck Fisher-Price® Linkimals™ Counting Koala Sesame Street Brushy Brush Elmo Care Bears™ Cheer Bears™ Lights & Sounds Ricky Fisher-Price® Laugh & Learn® My Smart Purse PAW Patrol Ryder’s Pup Pad™ Bright Lights Soccer Ball™ Musical Rhymes Book Pinkfong® Baby Shark™ Sing & Swim Bath Toy PAW Patrol Learning Watch Blues Clues & You! Sing-a-long Guitar

The Learning Journey Intl. Mattel® Baby Einstein® Vtech® Spin Master™ Mattel® Vtech® LeapFrog Enterprises, Inc. Maison Battat, Inc. Mattel® Little Tikes® Wizmo Jazwares, LLC. Mattel® Hasbro Basic Fun, Inc. Tomy® Mattel® Spin Master™ VTech® Vtech® Zuru Vtech® Just Play

12m+ 12m – 5y 3m+ 12m – 3y 4y+ 12m – 5y 6m+ 6m+ 2y+ 6m – 3y 3y+ 18m – 6y 3y+ 3y+ 18m+ 4y+ 3y+ 6m – 3y 3y+ 6m – 3y 6m – 3y 18m – 6y 3y – 6y 3y+

Floor, Hand-held & Tabletop Floor, Hand-held & Tabletop Floor & Tabletop Floor & Tabletop Face Mask Floor & Tabletop Floor & Tabletop Hand-held & Tabletop Hand-held Floor & Tabletop Floor Hand-held Floor & Tabletop Floor & Tabletop Hand-held Hand-held Floor Hand-held Floor & Tabletop Floor & Hand-held Floor, Tabletop & Hand-held Bathtub Hand-held Hand-held

dB (A) dB (A) 0 inches 10 inches 105.5 105.1 104.0 94.3 92.6 92.2 92.1 90.7 89.1 88.8 87.9 87.7 86.6 86.5 84.7 83.7 82.1 78.8 77.0 76.9 75.8 71.6 68.1 66.3

89.7 89.2 89.0 79.5 83.8 80.0 79.6 76.3 76.6 74.7 81.4 73.3 79.3 77.4 72.4 72.2 78.2 72.4 70.8 69.2 67.8 64.5 58.1 61.3

Decibel (dB) level measurements were taken with a hand-held digital sound level meter (Tenma®, Model 72-935) calibrated to manufacturer’s specifications. A-weighted scale, set at a slow response time capturing the maximum sound level. 0 inches is equal to a child’s ear to the toy. 10 inches is equal to a child’s arm length from the toy. Toys were tested at their highest volume setting. To decrease the volume of a noise-producing toy, SHA recommends setting the volume at the lowest setting and then apply clear packing tape over the speaker of the toy.

Sight & Hearing Association – 1430 Concordia Ave. #40009, Saint Paul, MN 55104 – 800-992-0424, x11 – kwebb@sightandhearing.org

Celebrating over 80 years of identifying and preventing vision and hearing loss, in partnership with other professional and community organizations by providing screenings, education and research. www.ATA.org




Building a Hearing Protection Toolkit By Jan L. Mayes, MSc

You won’t wear hearing protection if you don’t have any, which is why I suggest that you build a hearing protection toolkit today. Exposure to loud noise in everyday life – no matter how short or infrequent – can cause immediate and long-term damage. This includes noise-induced tinnitus or worsening of preexisting tinnitus. By building a hearing protection toolkit, you can protect yourself from preventable damage. Many people need a toolkit that contains different hearing protection options to protect against different noise sources or in different environments. The two basic styles of hearing protection are earplugs and earmuffs. Because sound waves move like water waves, hearing protection must fit like swim goggles do. Earplugs should seal off ear canals, and earmuffs should fully seal around the ears. In environments where noise can’t be avoided, children under age 3 should use earmuffs designed for babies or toddlers. Children aged 3 to 12 can use appropriately sized earmuffs. People aged 13 and older can use earmuffs or earplugs, depending on which fit best. Choose among comfortable, goodfitting styles. Some people can’t use earplugs because of fit factors such as ear size, chronic ear infections, or lack of finger dexterity for inserting. Some people prefer wearing earmuffs 46


in cooler weather and using earplugs in warmer weather for outdoor activities. There are several types of hearing protection, including high noise reduction, high fidelity, and specialty. High noise reduction is fine for situations when listening and communication demands are low. High fidelity is best for environments or activities that include conversations or music enjoyment. These work by special filters or electronics that turn down the volume while allowing speech and music through clearly. Custom earplugs are available that let the user switch between high noise reduction and high fidelity as needed.

Some electronic earmuffs include safe amplification. Specialty hearing protection is the best option for certain noise sources such as firearms. Medical MRI testing is one of the rare situations when earplugs plus earmuffs are recommended to protect patients against loud noise exposure; clinics should have MRI-safe hearing protection available. Hearing healthcare professionals can fit or recommend hearing protection for your age, ear size, and listening and communication needs. Other sources include online or local retailers, hearing protection manufacturers, and workplace safety

Hearing Protection Toolkit Options Types


Examples of When to Use

• Formable and no-roll earplugs • Custom solid earplugs • Earmuffs • Earplugs and earmuffs with safe personal audio input

Hobbies, chores, or activities with low communication or listening needs; for example, using power tools or equipment like lawnmowers, weed eaters, leaf blowers, pressure washers, saws, drills, or chainsaws; using loud appliances like vacuums, blenders, or hair dryers

High fidelity

• Premolded music, filtered, or high-definition earplugs • Custom filtered earplugs • Electronic earmuffs for persons with hearing impairment

Social and musical activities with high communication or listening needs; for example, cinemas, dance clubs, nightclubs, concerts, sporting events at stadiums or racetracks, and loud parties, weddings, or other large gatherings


• Firearms or shooters’ earplugs or earmuffs • Motorcycle and motorsports-specific or in-helmet

Activity-specific noise sources; for example, hunting or shooting, riding a motorcycle, all-terrain vehicle, or snowmobile

High noise reduction



supply stores. Prices can range from under $20 for premolded earplugs to around $200 for electronic earmuffs or custom earplugs. Cost is a factor, but maybe one day hearing protection coverage will be included under hearing healthcare just as sunglasses are under vision healthcare. My hearing protection toolkit includes premolded musician’s earplugs kept in a keychain case for each teen and adult in my family and earmuffs we can use while doing yardwork or home

repairs. I have tinnitus and decreased sound tolerance (hyperacusis), so I also use corded foam earplugs for concerts, where high noise reduction is more comfortable. With the coronavirus pandemic, more people are doing loud home projects, which require hearing protection for the person doing the work and those nearby. Although noise from social and musical activities is limited or restricted now, life will return to normal one day. Building a hearing protection toolkit is a smart prevention approach to protect yours and each

family member’s hearing health from loud sound. Jan L. Mayes, MSc, has had tinnitus for more than 30 years. She is an awardwinning author of nonfiction health books. As a newly retired audiologist, Mayes continues to write about tinnitus, hyperacusis, and community noise impact on disability access, communication, and hearing health. In her spare time, Mayes enjoys writing horror paranormal fiction. To learn more, visit her website: www.janlmayes.com

Letter to the Editor Dear Editor, On August 10, 2020, a powerful derecho crossed Iowa. Residents of Cedar Rapids, where I live, had only a few minutes’ warning before wind, averaging 140 miles per hour, roared through. In a mere 40 minutes, the raging wind uprooted or snapped in half 65 percent of my town’s trees, leaving lawns and streets blockaded by twisted limbs and tree trunks. When the wind subsided, people discovered shocking damage to homes, businesses, and surroundings. Soon the air was filled with the sounds of sirens, generators, and chainsaws. Immediately following a disaster, adrenaline kicks in and people heroically try to restore normalcy. Safety is ignored. In the hot days following the storm, inexperienced, shirtless men operated chainsaws without wearing ear or eye protection. Many drank beer during breaks from the endless hours of cleanup. Saw chaps, leather gloves, boots, and safety glasses reduce the odds of hurting yourself while operating a chain saw, and earmuffs protect your hearing. Drinking alcohol while working with such power tools is an invitation to the emergency room. Disasters are noisy. Recovery efforts often are hazardous. We can’t predict what’s going to occur, but if you own powerful tools, invest in the basics to protect yourself from injury. I hope this is a message hearing healthcare professionals and general practitioners will tell patients during routine visits, not emergency ones. Rich Patterson Cedar Rapids, Iowa www.ATA.org




Techniques for Improving Use of Hearing Protection Summary by John A. Coverstone, AuD

Most readers of Tinnitus Today are likely familiar with the importance of using hearing protection when around loud sounds. Many probably wish they had become aware of this sooner. The need to use hearing protection is not widely taught in school or generally reinforced by society. As kids, most of us learned not to stare at the sun, lest it permanently damage our eyes. Somehow the message of not listening to loud sound got lost. Four researchers from the University of Manchester in the United Kingdom performed a systematic review of literature on the subject.1 They wanted to see whether any common strategies to improve hearing protection use among the general public were in use. Database searches resulted in 1,908 articles, from which eight were selected for full review and analysis. Five articles on the subject described studies using pre- and



post-tests to measure the effects of attempts to change behavior. The other three looked only at hearing protection use after attempts to change behaviors. The authors identified 17 techniques used to change behavior, the most common of which was education. Schoolchildren were targeted in five studies, and young adults in two others. The final study did not report a specific age group for participants. The individual studies employed multiple techniques, including instructional education regarding hearing protection, education regarding the negative effects of hazardous noise, education including a talk by someone with hearing loss, and providing free earplugs and demonstrating their use. The scientists reviewing these articles noted a large disparity in methods, as well as minimal controls. The majority of data was self-reported and therefore subject to bias. Also, no control groups had been used that would allow a

comparison of different methods of intervention. Therefore, they were somewhat discouraged by the quality of the science in the eight research studies and felt that a valid statistical analysis across studies (called a meta-analysis) was not possible. But in looking at trends in the studies, they did find that providing hearing protection to people at risk of hearing loss showed promise and was a useful tool to educate the public. They noted that studies primarily used education as a motivator and did not attempt other strategies such as incentives, modeling desired behaviors, or enabling desired behaviors through prompts. More research is needed in this area to support efforts at raising awareness of noise exposure hazards and to work to motivate people of all ages to protect their hearing. 1 M. T. Loughran, S. Lyons, C. J. Plack, & C. J. Armitage. Which interventions increase hearing protection behaviors during noisy recreational activities? A systematic review. BMC Public Health, 20, 1376. https://doi.org/10.1186/s12889-02009414-w



When the Pandemic Subsides, Will the Noise Return? By Rick Reibstein, JD

Quiet is a public good that became apparent to many people when our cities fell silent during the height of the shutdown. So, what happens when we reboot our economy and our lives? What will that look and sound like? Will our cities once again burst with sound or remain cleaner and calmer spaces where we all can enjoy being outside? At the beginning, the coronavirus pandemic grounded airplanes around the globe and halted most other modes of transportation, creating an astonishingly quieter and less polluted world, which is perhaps the only benefit of this nightmare. As increasing numbers of people took note and commented on this, one central question arose: Can some of these changes be maintained?

Experts Should Consider Alternatives With the shift in our work activities, now is the time for people in the fields of energy and industrial design and production, transportation, www.ATA.org

construction, and urban planning to turn their attention to rethinking how their industries work. In the 1970s, the 3M Company launched a Pollution Prevention Pays (3P) program that inspired a movement among state governments, and then in Congress (the 1990 Pollution Prevention Act), and then at the United Nations (UNIDO’s Cleaner Production program). The program demonstrated how many polluting production processes could be made cleaner. Estimates of what the “pollution prevention revolution” achieved are astronomical – in 2000, on the basis of only 60 small state program reports, the National Pollution Prevention Roundtable counted 167 billion pounds of toxic chemicals avoided and hundreds of millions of dollars saved.1 Although that movement is all but forgotten now and the staffs of state programs have been greatly reduced, production supervisors, product designers, factory managers, and owners have had time during the pandemic to ponder questions that state pollution prevention assistance professionals, such as I, like to ask: • Why do you use processes that make noise loud enough to

damage people’s hearing, as well as emit toxic smoke, discharge wastewater, and produce drums of hazardous waste – all of which endanger workers, nearby communities, and consumers? • Can you accomplish your purposes another way? • Can you make your products without those harmful outcomes?

Insisting on Accountability for “Externalities” The great takeaway from my years of experience in government providing companies assistance in toxics use reduction is that the people working in most industrial facilities are professionals who care about quality – but only from a management perspective. They are reluctant to change processes that are working profitably, and they are busy making their products at top speed under terrific constraints of consumer or customer preference, cash flow, and market pressures. And they are not held accountable for what are regarded as “externalities” to their business, namely, pollution and noise.




These professionals generally don’t have time to adjust processes that are functioning or even to consider changing them. The value of the assistance we in government provided was that we made it much easier to consider alternatives by bringing fresh eyes to industrial processes. Well, we now have a little more time on our hands – why not use it to ask how industry can make their processes cleaner, and quieter too? Pollution and noise often go together. Noise is a form of pollution that endangers health in numerous ways, but it is also a sentinel, a “canary in the coal mine,” indicating inefficiencies and other forms of pollution.

Reconsidering Our Own Backyards Sequestered at home, many people with no connection to product manufacturing or design processes noticed and enjoyed the reduction in noise and pollution in their communities. As March gave way to April, were they bothered by the sudden noise and smell of

gasoline emitted by lawnmowers and other landscape maintenance equipment that ripped through their quiet communities? Before the environmental calm that came with the pandemic, we might have accepted that noisy, polluting equipment as part of the tradeoff for well-kept front lawns and walkways. But as the peaceful outdoors became a necessary escape for many of us confined to home, those industrial devices stood out as offensive disrupters of our quiet space. Are we now willing to demand use of batterypowered yard maintenance tools, which are quieter and produce less health-threatening pollution?

Clean Lawncare Alternatives Why not simply replace gaspowered yard equipment with battery-powered? Maybe we can make time to rake like we did in the old days. Maybe we can decide that raking is good exercise; maybe we can realize raking is far better for our yards than being pelted with forceful blasts of air and it’s better for our

“Can we maintain a world that is quieter, safer, and less polluting than the world we lived in prior to the pandemic? Can we preserve these cleaner and calmer skies and oceans? Do we have the ability to redesign and rethink our industrial processes?”



lungs and quieter than any blower. Maybe contractors could offer raking as a service once again, if consumers asked for it, now that their business model is under scrutiny. And for those who insist on having that absolutely pristine look, leave the blower for a final touch. Maybe there’s time to consider why we stopped using sensible lawncare methods and turned management of biological spaces into a mechanized, polluting process. Maybe we can notice and value the insect life we shouldn’t destroy, for the sake of the birds who need to eat, and the beauty of a lawn that has a more natural look rather than an antiseptic “man-made” green.

Reasserting State and Local Rights Maybe there’s time to ask how we came to have such noisy, polluting industrial equipment in the first place. The answer has a historical basis since federal legislation played a significant role. Not many people know that the Clean Air Act (CAA Section 209[e][1 and 2], codified as 42 U.S.C. § 7543[e][1 and 2]) preempts state action to control use of those little two-stroke gas engines that power lawnmowers, weedwhackers, scooters, and ultralight airplanes. This means that the federal policy, which is looser than some states would prefer, prevents states from protecting air quality for their citizens – and gas-powered leaf blowers and landscape maintenance equipment certainly create serious local and general air pollution. In fact, this year in California, pollution



from this equipment (called small off-road engines, or SORE) is expected to exceed the amount of pollution produced by all of the cars and trucks in the state. California is presently taking action against the federal government on this point in the CAA, and other states could follow California – though the current Environmental Protection Agency would likely refuse to amend the act.

Balancing Public Good and Private Enterprise Federal preemption does not seem to be a great way of accomplishing the central mission of the Clean Air Act, though it serves manufacturers, dealers, and users of these devices. So, a central question for all citizens is: Though there are good reasons to accommodate the needs of businesses when crafting laws to protect the public good, has an appropriate balance among all constituents’ interests in this matter been achieved? For those who have upheld states’ rights in the past, why are those rights not important when it comes to protecting our lungs and ears?

Considering the Effects of Our New Choices Even for those of us who are busy working at home, can we steal time from our schedules to ask a few more questions? For instance, if we all switch to electrically powered tools, blowers, mowers, cars, and homes, which use a far cleaner source of energy, what will we do with all the batteries when they need to be replaced? Will we


require that they be recycled? Are we developing that capacity? Will we ship our old gas-powered devices to lesser developed countries, where dangerous techniques will be used to extract the valuable materials from them? Will we realize that extraction of necessary materials, such as lithium, from the earth is extremely damaging (as is nearly all extraction), and that we should limit it by using advanced technologies to recover these materials from used devices? Will we be complacent until we hear of the horrific environmental damage being done on the front and back ends of our new electricpowered societies? Or can we think and plan ahead, and achieve a virtuous cycle that loses the least amount of necessary constituents and that is truly clean – not simply considered safe because we’re neglecting the externalities?

Creating a Virtuous Cycle to Break the Vicious One Perhaps you’ve enjoyed the relative peace of being at home and have not considered these questions. But as federal and state government leaders move to reopen our world and reboot the global economy, it’s vital you consider them. Ask yourself, Can we maintain a world that is quieter, safer, and less polluting than the world we lived in prior to the pandemic? Can we preserve these cleaner and calmer skies and oceans? Do we have the ability to redesign and rethink our industrial processes?

If we don’t ask these questions now, we will revert to simply accepting the insults and injuries to our bodies and souls, to our dignity, that noise and pollution impose in our daily lives. Why not ask for something better? Rick Reibstein, JD, teaches environmental law and policy at Boston University and is on the faculty at Harvard University's Continuing Education Program. He is also chair of the Legal Advisory Council of the national 501(c)3 nonprofit professional group Quiet Communities, Inc. (https:// quietcommunitiesinc.org/), where he also chairs the QCoP program, Quiet Conversation on Policy. Reibstein helped create and manage a state program in Massachusetts to assist businesses and others to reduce toxics and energy and water use, and he has served as an environmental enforcement attorney at state and federal levels. 1 National Pollution Prevention Roundtable. (2003). An ounce of pollution prevention is worth over 167 billion* pounds of cure: A decade of pollution prevention results 1990–2000. Washington, DC: Author. Retrieved from https:// www.csu.edu/cerc/researchreports/documents/ AnOunceOfPollutionPreventionIsWorth2003.pdf




Still Wondering About the Role of Diet in Hearing Health? Questions from Podcast Listeners

For the Summer issue of Tinnitus Today, we released a Conversations in Tinnitus podcast with Christopher Spankovich, PhD, one of the magazine’s contributors who specializes in translational research that focuses on prevention of acquired forms of hearing loss, tinnitus, and sound sensitivity. Spankovich is an associate professor and vice chair of research in the Department of Otolaryngology and Communicative Sciences at the University of Mississippi Medical Center. To hear the podcast “Does Diet Play a Role in Tinnitus and Hearing Health?” visit https://www.ata.org/podcasts/ podcast-14-does-diet-play-role-tinnitus-and-hearing-health

Hello Dr. Spankovich, I've been a tinnitus sufferer for the last 20 years. Sugar spikes my tinnitus a lot. Working constantly on my laptop also causes my tinnitus to spike, as does smoking and cold weather. In light of these symptoms, what do you think is the reason for my tinnitus? Christopher Spankovich, PhD, MPH, AuD: Thank you for your comments. I am happy to hear you found some positive takeaways from the podcast. I am unable to specify a tinnitus cause based on factors that may create spikes in tinnitus perception. The most common cause of tinnitus is hearing loss, but other factors 52


can include medications and headneck trauma, among others. Spikes in tinnitus can plausibly be related to attention, stress, highlevel sound exposure, medications, change in auditory input (decreased hearing or change in environmental sound levels), or they can be idiopathic and coincidental. By recognizing factors that consistently increase perception of tinnitus, you can try to make lifestyle modifications to decrease their odds of occurring. Sugar can be inflammatory; work may elevate stress or affect vascular function due to extended periods of sitting; smoking and cold weather can have additional cardiovascular and neurological effects. Of course, these are just possible factors related to spikes. Another question to consider is “What reduces perception of your tinnitus?”

Hello Dr. Spankovich, You are spot on with how a Mediterranean diet is so important. However, your contempt for all supplements is really troubling. Just because the mass retailers sell questionable supplements, one shouldn’t condemn the whole industry. Many holistic doctors and naturopaths prescribe good-quality supplements that have improved ear health. I would be glad to mention these supplements. Thank you for the great work. CS: In no way do I believe all supplements are bad or do not have a place in maintaining health. Persons can find benefit from many supplements, particularly for common nutrients with greater likelihood of deficient intake, such as vitamin D or B12 in a vegan. Nevertheless, consumers need to be cognizant that there is limited www.ATA.org


oversight of supplement quality by the Food and Drug Administration (FDA) and that the source (natural vs. synthetic) can have implications for the available isoforms (types) and bioavailability. Furthermore, supplements do not replace the need for a healthy diet and exercise; they are meant to supplement, not replace. As for use of supplements directly suggested for tinnitus, persons with tinnitus should take care to determine whether a supplement marketed for tinnitus meets several standards, for example:

1 Are there randomized, placebo-

controlled trials that support its efficacy? 2 Is the product of good quality, with data supporting its chemical integrity, and manufactured according to Good Manufacturing Practice (GMP)? I am not aware of any supplements marketed for tinnitus that meet either standard in an adequate way that I would

recommend them to my patients. However, I am always open to new treatment approaches with sufficient evidence of their efficacy.

Does Earwax Cause Tinnitus? No, earwax doesn’t cause tinnitus. It may, however, lead to it by obstructing the ear canal. Earwax plays an important role by trapping dirt and slowing growth of bacteria in the ear canal. If too much wax accumulates, it can form a plug, leading to tinnitus and hearing loss. You should never attempt to remove earwax by using a cotton swab or other items, which can push the wax farther into the ear and cause injury to the ear canal or eardrum. If you have concerns about earwax buildup, see your physician, who can examine your ear canal and ear drum with an otoscope.





Tinnitus Support Group Listings 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. Below is a list of groups and meeting dates, current at time of print. To reconfirm dates and times, please email/call the point-of-contact person listed.

Support Groups Holding Online Zoom Meetings If your regular support group is not meeting virtually during the coronavirus pandemic, consider joining a virtual one to stay connected with other members of the tinnitus community. To join a meeting that fits your time schedule, email the point of contact listed below. Note that meeting times reflect the geographic location of the group.

Arizona Tucson Tinnitus Support Group Meeting virtually until further notice Contact: Trudy Jacobson T: 520–982–7813 E: trudyj@cox.net 4th Saturday of the month, from 1 pm California Los Angeles/Orange County Tinnitus Support Group Meeting virtually until further notice Contact: Barry Goldberg E: bargold06@yahoo.com Meeting dates and times TBD San Diego Tinnitus and Hyperacusis Support Group Meeting virtually until further notice Contacts: Michael J. Fischer, Loretta Marsh, David Phaneuf, Tom Sutton E: michaeljohnfischer@hotmail.com E: lorettamarsh@hotmail.com T: 858–484–9267 E: djphaneuf@yahoo.com E: tomsutton63@gmail.com 1st Wednesday of the month, 6–7:30 pm

The Palo Alto Tinnitus Support Group at Avenidas Meeting virtually until further notice Contact: Ken Adler, Amy Nelson, AuD, Brandon Cyrus, AuD E: karmtac@aol.com E: Amy.Nelson@kp.org E: brandon@landmarkhearing.com 3rd Thursday of the month, 6:30–8:30 pm San Francisco Tinnitus Support/ Education Group Meeting virtually until further notice Contact: Tracy Peck Holcomb T: 415–921–7658 E: tracy@hearingspeech.org Meeting dates and times TBD Colorado Denver Tinnitus Support Group Meeting virtually until further notice Contact: Rich Marr T: 303–875–5762 E: r.marr@comcast.net 2nd Monday of the month, 7– 8:30 pm Maine/New Hampshire/Vermont Maine/NH/VT Virtual Tinnitus & Hyperacusis Support Group Meeting virtually until further notice Contact: Mark Rossnagel E: mark.rossnagel@gmail.com Meeting dates and times TBD

Maryland University of Maryland Tinnitus and Hyperacusis Support Group Meeting virtually until further notice Contact: Christina Shields, AuD E: shields3@umd.edu T: 301–405–5562 FB: https://www.facebook.com/ UMDHearingSpeechClinic Meeting dates and times TBD Michigan Holland Tinnitus Support Group Meeting virtually until further notice Contact: Stelios Dokianakis T: 616–392–2222 E: info@holaud.com Meeting Dec. 2, time TBD Missouri St. Louis Tinnitus Support Group Meeting virtually until further notice Contact: Tim Busche T: 636–734–4936 E: tbusche@stltinnitus.org Meeting Dec. 2, 7–9 pm New York Bronx Tinnitus Support Group Meeting by phone until further notice Contact: Dr. S. Karie Nabinet T: 917–797–9065 or 718–410–2301 E: kkwn12u@aol.com Meeting dates and times TBD





Support Groups Holding Online Zoom Meetings

North Carolina Raleigh Tinnitus Support Group Meeting virtually and in-person Raleigh Hearing and Tinnitus Center 10320 Durant Road, Suite 107 Raleigh, NC 27614 Contact: Saranne Barker, AuD T: 919–790–8889 E: info@rhatc.com Typically meeting 4th Thursday of the month, 6 pm



Dallas/Ft. Worth Tinnitus Support Group Meeting virtually until further notice Contact: John Ogrizovich E: dfwtsg@yahoo.com

Seattle Tinnitus Support Group Meeting virtually until further notice Contact: Keith Field T: 206–783–7105 E: Keith_r_field@outlook.com

Meeting dates and times TBD

3rd Thursday of the month, 7:30–8:10 pm

Virginia Northern Virginia Tinnitus Support Group Meeting virtually until further notice Contact: Elaine Wolfson, Marian Patey E: erwolfson@comcast.net E: pateywomyn@aol.com Meeting dates and times TBD

Wisconsin Madison Tinnitus Support Group Meeting virtually until further notice Contact: Deb Holmen T: 608–219–0277 E: dholmenihearu@gmail.com 4th Wednesday of the month, from 6:30–7:30 pm

Other Support Groups Due to the coronavirus pandemic, it is critical to contact the support group leader directly to verify meeting dates and times, and personal protection requirements. Information on the ATA website is provided by support group leaders and is subject to change.

Colorado Mesa County Tinnitus Support Group Community Hospital, Legacy Room 1 2351 G Road Grand Junction, CO 81505 Contact: Elaine Conlon T: 970–589–0305 E: conlonelaine@aol.com 3rd Wednesday of the month, from 6 pm No meeting in December Florida Clermont Tinnitus Support Group Citrus Hearing Clinic 835 7th St., Ste. 2 Clermont, FL 34711 Contact: Dr. Laura Pratesi/Lisanne T: 352–989–5123 E: drlaura@citrushearing.com 2nd Monday of the month, from 1–2 pm

Sarasota Tinnitus Support Group Silverstein Institute 1901 Floyd St. Sarasota, FL 34239 Contact: Carmen Trotta, Tom Terrenzi T: 941–993–7616, 941–462–1311 E: sarasota.ata@gmail.com Meeting 3rd Friday of the month from 2–4 pm Georgia Atlanta Tinnitus Support Group Dekalb County Public Library Dunwoody Branch, Meeting Room 5339 Chamblee Dunwoody Rd. Dunwoody, GA 30338 Contact: Erica Caplan E: elcatl@aol.com Currently not meeting. Contact group leader by email for support. Illinois Chicago Suburban Tinnitus Support Group Contact: Margie B. E: maggie318@yahoo.com Meeting dates and times TBD

Maryland DC & MD Tinnitus Support Group Potomac Audiology 11300 Rockville Pike, Ste. 105, Rockville, MD 20852 Contact: David Treworgy, Gerry Baill E: david_treworgy@yahoo.com E: gsbaill@yahoo.com E: TinnitusDC@gmail.com Meeting dates and times TBD Massachusetts Boston Tinnitus Support Group Athan’s Bakery 407 Washington St. Brighton, MA 02135 Contact: Kevin Plovanich E: JKPMA@aol.com Meeting dates and times TBD New Jersey South Jersey Tinnitus Support Group Advanced ENT/HearMD 1020 North Kings Highway, Ste. 201 Cherry Hill, NJ 08034 Contact: Beth Savitch, Erin Lustik E: tsg@advancedent.com Meeting dates and times TBD





Other Support Groups New York


The Long Island Tinnitus Group Long Island Jewish Hospital 900 Franklin Ave Valley Stream, NY 11580 Contact: Anthony Mennella, T: 516–379–2534 E: aem830@verizon.net Currently not meeting. Contact group leader by email/phone for support. Oregon VA Portland Health Care System Tinnitus Education Group National Center for Rehabilitative Auditory Research 3710 SW US Veterans Hosp. Rd. Portland, OR 97239 Contact: Bryan Shaw E: Bryan.Shaw2@va.gov Meeting dates and times TBD Pennsylvania Lehigh Valley Tinnitus Support Group Contact: Ed Kozelnicky T: 610–739–6675 Meeting Dates and Times TBD

Houston Tinnitus Support Group Business Center, Village at West University Apartments 5151 Edloe St. Houston, TX 77005 Contact: Vinaya Manchaiah T: 409–466–0427 E: houstontinnitus@gmail.com Meeting dates and times TBD San Antonio Tinnitus & Hyperacusis Support Group Contact: Matthew Randal Email: atasg.satx@gmail.com Meeting dates and times TBD Each support group referenced here is independently operated and led by volunteers who wish to provide education and support to the tinnitus community. The American Tinnitus Association (ATA) does not sponsor or endorse these activities and expressly disclaims any responsibility for the conduct of any independent support group or the information they may provide. The ATA is not a healthcare provider and you should consult with a primary care

physician or hearing healthcare professional for qualified medical advice on tinnitus and related disorders. *Some groups do not schedule meetings far in advance to allow for flexibility in planning. The ATA posts information provided by support group leaders on upcoming meetings, which can be found under the events calendar on www.ATA. org. The above information was provided to ATA staff at the time the magazine went to print; therefore, please confirm meeting details with the contact person prior to a meeting or reference our website at: https://www.ata.org/news/events This is a partial listing of support groups and scheduled meetings. A complete list can be found at https://www.ata.org/managingyour-tinnitus/support-network/supportgroup-listing. If you don’t find a group near you, please consider joining one of the online support groups. If you are interested in forming a group, contact Kevin Willmann at tinnitus@ata.org The ATA also publishes an extensive network of volunteers who provide email and telephone support. To connect with a volunteer, see: https://www.ata.org/ managing-your-tinnitus/support-network/ telephoneemail-support-listing

Spotlight on Patient Providers Professional Members


Listing current as November 1, 2020

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.

COLOR KEY Purple: Audiology Green: Medical practitioner Blue: Hearing aid dispenser Orange: Therapist Pink: Complementary/Alternative Medicine practitioner Navy: Other



Alabama Susan Sheehy, AuD Alabama Hearing Associates Madison, AL

Alaska Emily McMahan, AuD Alaska Hearing & Tinnitus Center Anchorage, AK

Arizona Lynn Callaway, BC-HIS Affordable Hearing Solutions Green Valley, AZ Judy Huch, AuD Oro Valley Audiology Inc. Oro Valley, AZ

Jonathan Ramirez-Lira, AuD Desert Hearing Care Mesa, AZ Neal Sorenson, BS Moore Audiology Sun City, AZ

Arkansas Kelley Linton, AuD Center for Hearing, Ltd. Fort Smith, AR

California Kasra Abolhosseini, AuD Tustin Hearing Center Tustin, CA Melissa Alexander, AuD Alexander Audiology Santa Monica, CA



Randall Bartlett, MA Tinnitus & Audiology Center of Southern California, Inc. Valencia, CA Troy Cascia, AuD UCSF Health San Francisco, CA Shahrzad Cohen, AuD Hearing Loss Solutions Sherman Oaks, CA Jean M. Deiss, AuD VA Northern California Health Care System Martinez, CA David DeKriek, AuD Fidelity Hearing Center Cerritos, CA Jerilyn Dutton, AuD Salient Sounds Audiology La Jolla, CA Gregory Frazer, AuD Pacific Hearing & Balance Center Inc. Los Angeles, CA Jennifer J. Gans, PsyD Mindful Tinnitus Relief San Francisco, CA Amit Gosalia, AuD West Valley Hearing Center Woodland Hills, CA Jennifer Hill, LPC Healing Hearts Counseling Encinitas, CA Sara Mattson, AuD Rancho Santa Fe Audiology Rancho Santa Fe, CA Amy Nelson, AuD Kaiser Permanente Santa Clara, CA Marni Novick, AuD Silicon Valley Hearing Inc Los Gatos, CA Charles Steven Peltz, MFT Steven Peltz, MFT San Francisco, CA Bruce Piner, AuD Hearing and Balance Center Encino, CA Jane Rosner, AuD West Valley Hearing Center Woodland Hills, CA Mimi Salamat, PhD Dr. Mimi's Audiology Clinic Walnut Creek, CA William Stubbeman, MD TMS Psychiatry Los Angeles, CA Christopher Sumer, NBC-HIS Coastal Hearing Aid Center Encinitas, CA Benjamin Thompson, AuD Pure Tinnitus Berkeley, CA Brian Worden, MD (ENT) Kaiser Permanente Woodland Hills, CA www.ATA.org

Colorado Brian Bennett, BC-HIS Colorado Hearing Montrose, CO Lindsay Collins, AuD Sound Relief Hearing Center Centennial, CO Terry Cummings, AuD Columbine Audiology and Hearing Aid Center Sterling, CO Kaela Fasman, AuD Sound Relief Hearing Center Golden, CO Abigail McMahon, AuD Sound Relief Hearing Center Fort Collins, CO Natalie Phillips, AuD Advanced Otolaryngology & Audiology Fort Collins, CO Julie Prutsman, AuD Sound Relief Hearing Center Highlands Ranch, CO Mandi Solat, AuD Audiology Services & Hearing Aid Center Lakewood, CO

Connecticut Steven Lurie, PhD Torrington, CT

Florida Anne Carter, AuD Pasadena Hearing Care South Pasadena, FL Maura Chippendale, AuD Chippendale Audiology Cape Coral, FL Melissa Kipp Clark, AuD Suncoast Hearing Services Plus Bradenton, FL Ali Danesh, PhD Labyrinth Audiology Boca Raton, FL Brooke Davidson, AuD Baptist ENT Specialists Jacksonville Beach, FL Ericka DeVore AuD All About Hearing/Lake Audiology & Hearing Aids Longwood, FL Wilson DuMornay, MD Broward ENT Services Fort Lauderdale, FL Kelly J. Dyson, AuD Suncoast Audiology, LLC Largo, FL Melodi Fehl, MS ENT and Allergy Associates of Florida Boca Raton, FL Lisa Gascay, AuD Rainbow River Hearing & Balance Inc. Dunnellon, FL

Margaret Richards, AuD The Hearing Center Pensacola, FL Sharon Rophie, AuD Harbor Hearing PA Palm Harbor, FL Cindy Ann Simon, AuD South Miami Audiology Consultants South Miami, FL Mindy Stejskal, MCD The Hearing Center Pensacola, FL Anne Marie Taylor, AuD ALPHA Audiology Panama City Beach, FL Susan Terry, AuD Broadwater Hearing Care St. Petersburg, FL Liz White, AuD Harbor City Hearing Solutions Melbourne, FL Kayla Wilkins, AuD Aspire Hearing and Balance Lakeland, FL

Georgia Laura Barber, AuD Augusta University Health-Audiology Associates Augusta, GA Nikki DeGeorge, AuD Fayette Hearing Clinic and Coweta Hearing Clinic Peachtree City, GA Jan Henriques, AuD At Home Hearing Woodstock, GA Brian K. Jones, MEd Greater Atlanta Hearing Inc. Cumming, GA Melissa Wikoff, AuD Peachtree Hearing Marietta, GA

Idaho Christine Pickup, AuD Mt. Harrison Audiology & Hearing Aids, LLC Rupert, ID Tosha Strickland, AuD Strickland Ear Clinic Meridian, ID

Illinois Steve Bonzak, MS Health Traditions Chicago, IL Nancy Congdon, AuD The Hearing Care Clinic Downers Grove, IL Phillip Elbaum, LCSW Deerfield, IL Lori A. Halvorson, AuD Lake Forest Hearing Professionals Lake Forest, IL




JoAnn Harano, AuD Loyola University Health System Chicago, IL Maria Morrison, AuD Geneva Hearing Services Geneva, IL James H. Peck, HIS Life Hearing Health Centers Rockford, IL Jeanne Perkins, AuD Audiologic Services Glen Ellyn, IL Alyssa Seeman, AuD Illinois State University Normal, IL

Indiana Erica Person, AuD Flex Audiology Lawrenceburg, IN

Mary Miller, PhD Premier Hearing and Balance Hammond, LA

Maryland Chelsea Carter, AuD University of Maryland Medical Center Baltimore, MD Christina Shields, AuD University of Maryland College Park College Park, MD

Massachusetts Dierdre Anderson, AuD Audiology Network Services Salisbury, MA Eugene Antonell, BC-HIS Hear Better Now Tinnitus & Hearing Center N. Dartmouth, MA

Elizabeth Zweigart, AuD Midwest Ear Nose & Throat Surgery Evansville, IN

Iowa Diana Kain, AuD Heartland Hearing Center Hiawatha, IA Beki Kellogg, AuD Hope Hearing & Tinnitus Center Hiawtha, IA Jill Nesham Professional Hearing Solutions by Dr. Jill Cedar Rapids, IA Heather Thatcher, HIS Hope Hearing & Tinnitus Center Hiawatha, IA Richard Tyler, PhD University of Iowa, Dept. of Otolaryngology – Head & Neck Surgery Iowa City, IA Shelley Witt, MA University of Iowa Hospitals & Clinics Iowa City, IA

Kansas Bryne Gonzales, AuD NuSound Hearing & Tinnitus Center Topeka, KS Lauren Mann, AuD University of Kansas Medical Center Kansas City, KS Michael Schneller, HIS Focus Hearing Overland Park, KS Susan Smittkamp AuD Associated Audiologists Inc. Shawnee Mission, KS

Kentucky Ann Rhoten, AuD Kentucky Audiology & Tinnitus Services Lexington, KY




Nataliya Ayzenberg, AuD Moon Hearing Services, LLC Woburn, MA Judith Bergeron BC-HIS Beauport Hearing Care Gloucester, MA Joni Skinner Bullough, AuD Hampshire Hearing & Speech Northampton, MA Theresa Cullen, AuD Cape Cod Hearing Center Hyannis, MA Nancy Duncan, AuD Duncan Hearing Center Fall River, MA Peter Harakas, PhD CBT Associates, LLC Lexington, MA Robert Mario BC-HIS Mario Hearing & Tinnitus Clinics Cambridge, MA Karen L. Wilber, AuD Boston Childrens Hospital Boston, MA

Michigan Terese Alsum, AuD Kaczmarski Hearing Services Wyoming, MI Stelios Dokianakis, AuD Holland Doctors of Audiology Holland, MI MaryRose Hecksel, AuD Audiology & Hearing Aid Center Lansing, MI

Beckie Kaczmarski, AuD Kaczmarski Hearing Services Wyoming, MI Angela Lederman, MS Hear Now Audiology & Tinnitus Center Clinton Township, MI Shannon Radgens, DO Red Cedar Ear Nose & Throat & Audiology Owosso, MI Michelle Rankin, AuD Ascent Audiology & Hearing Chelsea, MI Michael Robinette, AuD Michigan Ear Institute Farmington Hills, MI Karrie Slominski, AuD Henry Ford Health System West Bloomfield, MI Benjamin Wightman, AuD Sound Advice Audiology Livonia, MI

Minnesota John Ehlen Hear Central Victoria, MN Sara Downs, AuD Hearing Wellness Center Duluth, MN Jason Leyendecker, AuD Audiology Concepts Edina, MN Thomas Tedeschi, AuD Amplifon Americas Minneapolis, MN

Missouri Laura Flowers, AuD Hearing and Balance Specialists of Kansas City Lee's Summit, MO Linda Guhe, MSW Mind Body Clinical Hypnosis St. Louis, MO Jay Piccirillo, MD Washington University School of Medicine Saint Louis, MO

Nevada Robyn Lofton, BC-HIS Hearing Associates of Las Vegas Las Vegas, NV Elana Walker, AuD VA Southern Nevada Healthcare System Las Vegas, NV

Please note that the American Tinnitus Association does not verify providers’ certifications and expertise in tinnitus treatment. The list is meant expressly for informational purposes and should not be construed as the ATA’s endorsement of the providers listed. The ATA strongly advises anyone using the list to check practitioners’ websites and tinnitus services before scheduling appointments. Please note that the list includes hearing aid dispensers because hearing aids can be helpful to some people in the management of their tinnitus.



New Jersey Catherine Ahrens Berke, BC-HIS Ahrens Hearing Center Fair Lawn, NJ Granville Brady Jr., AuD East Brunswick, NJ Valerie Kriney, AuD Northern Jersey ENT Associates Glen Rock, NJ Beth Savitch, MA Advanced ENT/Hear MD Voorhees, NJ Donna Szabo, AuD Innovative Hearing Solutions Westwood, NJ

New York Nicole Ball, AuD Hearing Evaluation Services of Buffalo, Inc Tonawanda, NY Carol Bass, MS All Ears Audiology Tinnitus & Hyperacusis Audiological Consulting Ithaca, NY Diana Callesano, AuD Hearing and Tinnitus Center Woodbury, NY Collin Campbell Campbell Acupuncture New York, NY Lois Cohen, LCSW Tinnitus Counseling Northport, NY Tracey Lynch, AuD Island Better Hearing Inc Melville, NY Amy Sapodin, AuD Advanced Hearing Center Albertson, NY Leigh A. Sauerbier, AuD The Advanced Hearing Center Brooklyn, NY Rivka Strom, AuD Advanced Hearing NY Inc Brooklyn, NY Jennifer Sutton, AuD Hearing Evaluation Services of Buffalo, Inc. Williamsville, NY Lori Trentacoste, AuD Island Better Hearing Inc Melville, NY Carolyn Yates, AuD Hearing Evaluation Services of Buffalo, Inc. Amherst, NY

North Carolina Jennifer Auer, AuD Audiology Attention & Tinnitus Care PLLC Concord, NC Saranne Barker, AuD Raleigh Hearing & Tinnitus Center Raleigh, NC


Susan Bergquist, MS Heritage Audiology Wake Forest, NC

Babette Verbsky, PhD Hearing Connections Audiology Lebanon, OH

Dawn de Neef, MD Carolina Ear, Nose & Throat–Sinus and Allergy Center Hickory, NC

Gail Whitelaw, PhD The OSU Speech-Language-Hearing Clinic Columbus, OH

Hannah Heet, AuD Duke Otolaryngology of Raleigh Raleigh, NC

Kyle Woods, MA Modern Hearing Solutions/Choice Hearing Center Canton, OH

Julia Hubbard-Rossi, AuD Carolina Hearing and Tinnitus Mooresville, NC Kelly Knolhoff, AuD Birkdale Audiology Huntersville, NC Nancy McKenna, AuD University of North Carolina Chapel Hill Chapel Hill, NC Melissa Palmer, AuD High Point Audiology Clayton, NC Caroline Pittman UNCG Speech and Hearing Center Greensboro, NC Sandra Royle-Tabak, AuD CarolinaEast Ear, Nose & Throat Morehead City, NC Christina Seaborg, AuD Hearing & Balance Center Charlotte, NC Emilee Tucker, AuD Carolina Ear, Nose & Throat–Sinus and Allergy Center Hickory, NC Gina Whritenour, FNP Robeson Family Health Lumberton, NC

Ohio Samantha Bayless, AuD The Hill Hear Better Clinic Cincinnati, OH Neil Cherian, MD Cleveland Clinic Gates Mills, OH Sarah E. Curtis, AuD Sounds of Life Hearing Center, LLC Concord Twp, OH Cathy Kooser, LISW Hillcrest Hearing & Balance Center Centerville, OH Eric Mounts, HIS Modern Hearing Solutions/Choice Hearing Center Canton, OH Joseph Pietrolungo, DO Summa Health Chagrin Falls, OH Richard Reikowski, PhD Family Hearing & Balance Center Akron, OH Jeffery Vehr, AuD Hearall Hearing Center Dayton, OH

Oklahoma Christy L Mitchell, AuD Talihina Hearing Clinic Talihina, OK

Oregon Anna Forsline, AuD VA Portland Healthcare System Portland, OR Kristen Furseth, AuD Willamette ENT Salem, OR James Henry, PhD National Center for Rehabilitative Auditory Research (NCRAR) Portland, OR Todd Landsberg, AuD South Coast Hearing Center Coos Bay, OR Ha-Sheng Li-Korotky, AuD Pacific Northwest Audiology LLC Bend, OR

Pennsylvania Gail Brenner, AuD Hearing Technology Associates LLC Bala Cynwyd, PA Mindy Brudereck, AuD Berks Hearing Professionals Birdsboro, PA Amy Greer, AuD Lemme Audiology Associates Ebensburg, PA Jeannie Karlovitz, AuD Advanced Hearing Solutions Exton, PA Melissa Reitnour, MA Valley Forge ENT/Pinnacle ENT Phoenixville, PA

Rhode Island Holly Puleo, AuD Gateway Hearing Solutions Warwick, RI

South Carolina Margaret Kalady, AuD Kalady Audiology Beaufort, SC Alexandra Tarvin, AuD Elevate Audiology- Hearing and Tinnitus Center Easley, SC Jennifer Waddell, HIS Sound Hearing Care Simpsonville, SC TINNITUS TODAY SUMMER 2020



South Dakota Melissa Baker, MA Baker Audiology and Hearing Aids Sioux Falls, SD Lindsey Jorgensen, AuD University of South Dakota, Communication Sciences & Disorders Vermillion, SD Stephanie Wubben, AuD Stanford Hearing Aids Sioux Falls, SD

Tennessee Tiffany Ahlberg, AuD Ahlberg Audiology & Hearing Aid Services Cleveland, TN Cynthia Ellison, AuD Franklin Hearing Center Franklin, TN Andrea Plotkowski, AuD Ear, Nose and Throat Consultants of East Tennessee Knoxville, TN Paul Shea, MD Shea Ear Clinic Memphis, TN

Texas Diane Allen, PhD The Grove Counseling & Wellness Center Dallas, TX Theodore Benke, MD Benke Ear Nose & Throat Clinic Cleburne, TX Lacey Brooks, AuD North Housting Hearing Spring, TX Bethany Brum, AuD UT Southwestern Medical Center Dallas, TX Christie Cahill, AuD Family Hearing & Sensory Neural Center Huntsville, TX Shannon Frugia, AuD Southeast Texas Ear Nose & Throat Beaumont, TX Mary Sue Harrison, AuD Today's Hearing Katy, TX Kristen Keener, AuD IlluminEar Tinnitus & Audiology Center Austin, TX Christina Lobarinas, AuD UT Southwestern Childrens Health Specialty Dallas, TX Cynthia Lockhart, HIS Carrollton, TX

Elly Pourasef, AuD Memorial Hearing Inc. Houston, TX Lydia Ramanovich, AuD Dallas Ear Institute Frisco, TX Bradley Stewart, AuD ClearLife Hearing Care Allen, TX

Vermont Elizabeth Adams, AuD Univ. of Vermont – E.M. Luse Center Burlington, VT Stephanie Hollop, AuD Univ. of Vermont – E.M. Luse Center Burlington, VT

Virginia Ana Anzola, AuD Hearing Doctors McLean, VA Theresa Bartlett, AuD Virginia Hearing Consultants Virginia Beach, VA Ann DePaolo, AuD The Audiology Offices LLC Kilmarnock, VA Margaret Cooper Evans, AuD Evolution Hearing Richmond, VA Julie Farrar-Hersch, PhD Augusta Audiology Assoc., P.C. Fishersville, VA Virginia Lindahl, PhD Virginia Lindahl, Therapy and Psychological Testing Alexandria, VA

Washington Thomas Littman, PhD Factoria Hearing Center Bellevue, WA Dustin Spillman, AuD Audiologists Northwest Bremerton, WA

Wisconsin Hugo Guerrero, AuD Mayo Clinic Health System Onalaska, WI Kathleen Hadsell, AuD Children’s Wisconsin Milwaukee, WI Veronica Heide, AuD Audible Difference, LLC Madison, WI

Pedro Montano, MD McAllen, TX

Dan Malcore The Hyperacusis Network Green Bay, WI

John Moring, PhD UT Health Science Center – San Antonio San Antonio, TX

Samantha Sikorski, HIS Sikorski Hearing Aid Center, Inc. Spooner, WI

Rene Pedroza, AuD United States Department of Defense El Paso, TX

Nicole Smith, AuD Everclear Hearing Products Eau Claire, WI



U.S. TERRITORIES Puerto Rico Isamar Gonzalez-Feliciano, AuD Centro Audiologico e Interdisciplinario, Isamar Gonzales, Inc. Arecibo, PR

INTERNATIONAL Argentina Susana A. Dominguez Hospital Italiano de Bs.As,, Argentina Capital Federal, BA

Australia Lynne Blackford, BSc MQ Health Speech and Hearing Clinic Macquarie University, NS Michael Segal, MA Pristine Hearing Nollamara, WA

Canada Sabrina DeToma, AuD Salus Hearing Centre Vaughan, ON Patrick DeWarle, AuD Winnipeg Hearing Centres Winnipeg, MB Kimberly Eskritt, AuD Lambton Audiology Associates Sarnia, ON Deborah Lain, MSc Hope for Tinnitus Calgary, AB Carol A. Lau, HIS Sound ID Ears Inc. Vancouver, BC

Malaysia Wan Syafira Ishak, PhD Program Audiologi, Fakulti Sains Kesihatan Kuala Lumpur, KL

Taiwan Chin-Lung Kuo, MD DoctorKuo ENT Clinic New Taipei City

United Kingdom Hashir Aazh, PhD Hashir Tinnitus Clinic Guildford, Surrey Lisa Caldwell The Hearing Coach Glossop Alan Hopkirk The Invisible Hearing Clinic Paisley


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 condition that affects millions. Editorial Copy Due

Photos Due

Ad Close

Digital Launch

Issue Mailed

Causes of Tinnitus






Summer—Aug 2021

Hearing Aids






Winter—Dec 2021

Annual Research Issue








Spring—Apr 2021

Editorial Calendar is subject to change.

To advertise, contact: tinnitus@ata.org

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 decisionmaking, 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. www.ATA.org

DEPT 424049 WASHINGTON, DC 20042-4049

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 accommodate those with noise sensitivity, transcripts are available with each podcast. ALL PODCASTS ARE FREE AND OPEN ACCESS

Podcast 14: Does Diet Play a Role in Tinnitus and Hearing Health? (Part 2)

Podcast 16: Does Tinnitus Retraining Therapy Improve Quality of Life?

SUBJECT MATTER EXPERT: Christopher Spankovich, PhD, MPH TOPIC: Dr. Spankovich discusses the influence of nutrition on hearing health and tinnitus, based on extensive research on the subject. He outlines what everyone should know about how nutrition can contribute to better hearing or hearing problems. As a researcher and clinician, he also shares recommendations he makes to patients so they can better manage their tinnitus and overall hearing health.

SUBJECT MATTER EXPERTS: Roberta Scherer, PhD, and Craig Formby, PhD TOPIC: Drs. Scherer and Formby guide us through the decades-long journey to conduct the first and only phase III trial of tinnitus retraining therapy, an influential habituation-based treatment protocol for alleviating the negative reactions to tinnitus. The researchers explore findings that highlight the importance of sound enrichment and working with a caring and qualified healthcare provider.

Podcast 15: Exploring Noninvasive Neurosensory Tinnitus Treatment

Podcast 17: Understanding the Problem of Painful Hyperacusis

SUBJECT MATTER EXPERT: Hubert Lim, PhD TOPIC: Dr. Lim, a leading scientist and thought leader in auditory neuroscience, discusses the research and development of non-invasive bimodal neuromodulation for treatment of tinnitus. He explains the scientific concept and the research being conducted, which is aimed at developing

SUBJECT MATTER EXPERT: Bryan Pollard, BA TOPIC: Bryan Pollard, founder of the nonprofit Hyperacusis Research, explains what it is like to live with noise-induced pain and what is known about this often overlooked condition. As someone who lives with painful hyperacusis and tinnitus, Pollard provides unique insight into the struggles,

a treatment that decreases the perception of the tinnitus sound and the negative emotional reactions caused by it.

his mission to increase research on the condition, and the importance of developing tools to enable sufferers to return to a more normal life, without fear of setbacks.

To subscribe to the print or digital issue of Tinnitus Today, which is published three times a year, visit www.ata.org or email tinnitus@ata.org