Tinnitus Today • Winter 2021

l ue ua Iss nn h A arc e es R

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

Vol. 46, No. 3, Winter 2021

Funding Innovative Research How the ATA Is Helping Researchers and Patients Quieting Tinnitus With Vagus Nerve Stimulation Understanding FDA Oversight of Tinnitus Products

A publication of the

Visit & Learn More About Tinnitus at ATA.org

The ATA thrives through the dedication of a vast number of people who make a difference every day.

Join the Jack Vernon Legacy Society Jack Vernon, PhD and leading tinnitus researcher, was a founding member of the American Tinnitus Association who dedicated his career to helping people with tinnitus. Jack’s goal was to provide meaningful relief from the condition while cultivating a research community that could advance treatments and eventually find cures.

Thanks to his leadership and vision, we have a far better understanding of tinnitus, its causes, and ways to reduce its negative impact on patients. Most importantly, today, we have an active community of researchers carrying on his mission to eliminate tinnitus.

The ATA invites you to continue Jack’s mission to fund innovative research to put an end to tinnitus. How can you contribute?  M onthly or annual financial contributions  Name ATA in your trust or estate  Ask ATA to create a Tribute Page in memory of a loved one  Convert stock and/or real estate into a unitrust

   

Gifts of stock Gifts of real estate Deferred gift annuities Donations to ATA in lieu of flowers in memory of a loved one

For more information about adding the ATA as a beneficiary or ways to reduce your taxes through charitable contributions, please contact Torryn Brazell, ATA’s Chief Executive Officer, via email at tinnitus@ata.org.

Table of Contents SPECIAL FEATURES

04 |

What Is the VA Doing About Tinnitus?

49|

Vol. 46, No. 3, Winter 2021

ow Many People Are H Affected by Tinnitus?

Priority Areas for Epidemiological Research

ho’s Calling the 22| WATA’s Support

  uieting 11 | QTinnitus

With Vagus Nerve Stimulation

hat Could We Learn 33 | WFrom a Tinnitus Biobank?

17 27 37 TINNITUS TOOLS & RESOURCES

innitus Q&A 09 | TTelehealth

Today: Can My Audiologist Also Be My Therapist?

he Behavioral 38 | TNeuroscience

of Tinnitus: Progress and Hope for the Future of Tinnitus Treatments

Knowledge?

Severity With MRI

ore Exercise, Less 46 | MTinnitus Distress?

Journey Managing Tinnitus

ATA NEWS

Tinnitus Affect 35 | DOuroesAbility to Acquire redicting 44 | PTinnitus

Therapist’s 13 | APersonal

arbon Monoxide, My 28| CSilent Tinnitus Trigger

Line and How Is It Helping?

SCIENCE & RESEARCH NEWS

PERSONAL STORIES

|

The Researchers Who Review ATA Grant Applications

TA Awards 19| A$265,000 for

Promising Innovative Tinnitus Research

nvestigating 30| ITinnitus As a Side Effect of Covid-19 Vaccines

nderstanding FDA 42 | UTerms: Approved, Authorized, and Cleared

52 |

potlight S on Patient Providers

innitus 59 | TSupport Group Listings

ver-the-Counter 40 | OHearing Aids Coming to a Store Near You

 FROM THE BOARD CHAIR

Advancing Tinnitus Research Depends on Us

David Hadley, MBA Chair, Board of Directors

I developed tinnitus at a relatively young age thanks to years of music at a high volume. I got my first grunge rock tape when I was six years old (Pearl Jam’s Ten album) and, simply put, hearing protection was not top of mind. I preferred to keep the volume cranked up, and that habit didn’t change until my tinnitus was truly permanent 20 years later.

A few years ago, I made the decision that I was going to do everything I could to improve my situation. I was frustrated about my tinnitus, worried that it would get worse over time, and was waiting around for news about a cure. I wanted to do something. Advancing tinnitus research was at the heart of why I joined the ATA as a member.

So, what can we do together? If you want cures, you must invest in research because nothing with tinnitus will (sadly) be solved through wishful thinking. The ATA, as I discovered, is an outstanding vehicle for funding tinnitus research because it offers seed grants, which are few and far between and the basis of advancing new science to solve complicated problems.

How do we know which ideas are “best”? The ATA has a Scientific Advisory Committee, which consists of 13 independent researchers from around the world, that reviews and vets each application. Thanks to the committee and their peer review process, I am confident that my money is being well spent and that I can expect a “return” on my investment, because each successful grant yields data that can be used to secure larger funding from bigger institutions.

I know that many of you already understand this, because this year – thanks to your generosity – the ATA was able to provide $265,000 in funding for four promising investigations.

And if we want to do more to advance cures and better treatments, then we must continue to contribute.

As we close out 2021, please donate to research today, and support the ATA and its mission by becoming a member or renewing your membership. You can also transfer stocks or put the ATA in your will. To learn more about either option, email tinnitus@ata.org. Thank you for your contribution to help find cures.

MANAGING EDITOR Joy Onozuka American Tinnitus Association PUBLISHER Torryn P. Brazell, CAE, CFRE 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) www.ata.org TO GIVE TO THE ATA™ American Tinnitus Association c/o SunTrust Bank 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.

ATA is a registered trademark of the American Tinnitus Association.

2

TINNITUS TODAY WINTER 2021

FROM THE PUBLISHER 

ATA BOARD OF DIRECTORS David Hadley, MBA, San Francisco–Chair Gordon Mountford, South Pasadena, CA– Vice Chair Ron Zagel, Grand Rapids, MI–Treasurer Robert Travis Scott, Abingdon, VA– Assistant Treasurer Stelios Dokianakis, AuD, CH-TM, Holland, MI– Secretary Jill Meltzer, AuD, CH-TM, Chicago, IL– Immediate Past Chair Shahrzad Cohen, AuD, CH-TM, Sherman Oaks, CA Sara Downs, AuD, Duluth, MN Phillip Gander, PhD, Iowa City, IA Fatima Husain, PhD, Champaign, IL Brain Lofman, PhD, Salinas, CA John Minnebo, MBA, Philadelphia, PA Julie Prutsman, AuD, Highlands Ranch, CO Robert M. Traynor, EdD, MBA, CH-TM, Fort Collins, CO Joseph Trevisani, New York, NY Melissa Wikoff, AuD, CH-TM, Atlanta, GA Jinsheng Zhang, PhD, Detroit, MI Torryn P. Brazell, Vienna, VA–CEO HONORARY DIRECTOR William Shatner, Los Angeles, CA ATA SCIENTIFIC ADVISORY COMMITTEE Fatima T. Husain, PhD–Chair University of Illinois, Urbana-Champaign Champaign, IL 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 Mark S. Mennemeier, PhD University of Arkansas, Little Rock, AR USA Maria Rubio, PhD, MD University of Pittsburgh, Pittsburgh, PA USA 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

Funding Research With Your Support and Hope Fifty years ago, Jack Vernon, PhD and founding member of the ATA, was the only researcher in the United States investigating tinnitus. What inspired him? The voices of patients – just like you – whose lives had been upended by tinnitus. For years, Jack’s work focused on sound therapy to provide immediate relief, which laid the groundwork for today’s sound therapy tools that remain central to managing tinnitus. He believed that relief from tinnitus was as important as finding cures, because quality of life while living with an intrusive chronic condition matters.

Jack played a pivotal role in transitioning the ATA to a funder of tinnitus research through the ATA Newsletter (today’s Tinnitus Today magazine), which he launched in April 1975 to talk to tinnitus patients about research and how individuals could help advance science through donations. After 50 years, people naturally wonder why there is still no cure. We addressed that question in our Winter 2019 research issue, which outlined the complexity of the challenges, including the critical need for objective measures of tinnitus, subtyping because there are many causes of tinnitus that muddy research results and cloud potential treatments and cures that might work for specific types of tinnitus, and increased funding.

Much has improved over the course of 50 years, but the needs and interests of tinnitus patients remain largely the same, namely, an urgent desire for cures and treatments that work for most people. And the tinnitus patient has remained the guidepost for everything that the ATA does, including our ability to fund promising research, which totaled $265,000 this year as part of the ATA’s 2021 Innovative Research Grants Program (see page 19 to learn more about this year’s researchers and their projects).

As we close the year, I want to thank you for your faith in the ATA and for making this a banner year in research funding. I’d also like to invite you to make a contribution today to fund next year’s research. Each donor, each dollar represents a voice and a belief that tinnitus can be eliminated or better managed through innovative advances in science.

Torryn P. Brazell, CAE, CFRE 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.

Richard Tyler, PhD University of Iowa, Iowa City, IA USA Fan-Gang Zeng, PhD University of California, Irvine

Irvine, CA USA

TINNITUS TODAY WINTER 2021

3



SPECIAL FEATURE

What Is the Veterans Health Administration Doing About Tinnitus?

By James A. Henry, PhD

The VA refers to the Veterans Health Administration, which is “America’s largest integrated healthcare system, providing care at 1,255 healthcare facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatients clinics), serving 9 million enrolled Veterans each year” (www.va.gov/health).

I was recently asked, “What is the VA doing about tinnitus?” The question came from a person distraught about tinnitus and frustrated that no cure has yet been discovered. A lot of people may be asking the same question, and I’ll do my best to answer it. For starters, I have worked for the VA for almost 35 years, and the focus of my career has been research to improve clinical care for tinnitus.

Tinnitus, the VA, and Veterans Veterans can apply for a “serviceconnected disability award,” which means they can claim a disability that was caused by circumstances of their 4

TINNITUS TODAY WINTER 2021

military service. Tinnitus that is at least “recurrent” is considered a disability by the VA, and veterans can submit a claim to receive a service-connected tinnitus disability award. Since 2007, tinnitus has been the most commonly awarded service-connected disability for veterans.1 In fiscal year 2020, 2,327,387 veterans were service connected for a tinnitus disability (see https://benefits.va.gov/benefits). This number includes 149,368 new tinnitus disability awards in 2020 alone.

The tinnitus services that veterans receive in VA clinics are mostly delivered by audiologists, behavioral/ mental health providers (usually psychologists), and otolaryngologists.

Results of a survey targeting audiology and behavioral health leaders at the majority of VA medical centers suggested “wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training.”2 Considering the existing scientific literature covering tinnitus research, it is reasonable to conjecture that these same conclusions would apply in nonVA settings. The work we are doing is specifically targeted to improving

tinnitus care for veterans, but anything we accomplish has wider application to individuals everywhere who must cope with chronic intrusive tinnitus.

What About a Cure for Tinnitus?

Despite decades of research, no cure has been discovered for tinnitus.

Many laboratories have attempted to discover a means to normalize the brain activity that is associated with the sensation of tinnitus. Currently, no medication is proven to be effective for this purpose and consequently there is no FDA-approved drug for tinnitus.

History of Tinnitus Research at Our Center Our research group has a long history of conducting research projects focusing on the clinical management of tinnitus. This line of research began when I completed my doctoral program at Oregon Health & Science University (OHSU), where my research lab was the Oregon Hearing Research Center (OHRC).

OHRC housed the world-renowned OHSU Tinnitus Clinic – both OHRC and the Tinnitus Clinic were directed

by Dr. Jack Vernon, the cofounder of the American Tinnitus Association.

SPECIAL FEATURE

The VA Office of Research and Development (ORD) funds research much like the NIH (National Institutes of Health) funds research. The VA ORD has four services (branches), of which three have funded tinnitus research: Rehabilitation Research & Development (RR&D), Health Services Research & Development (HSR&D), and Clinical Science Research & Development (CSR&D).

My first tinnitus grant, funded by RR&D in 1995, focused on tinnitus psychoacoustic assessment (assessing tinnitus loudness, pitch, etc.). Since then, I have had more than a dozen grants funded by RR&D that have addressed different aspects of tinnitus clinical management. RR&D has also directly supported my salary as a Research Career Scientist since 2004. I work at the National Center for Rehabilitative Auditory Research (NCRAR), which has been funded

by RR&D since 1997. Additional investigators at the NCRAR have received funding from RR&D, HSR&D, and CSR&D to conduct research relating to tinnitus and decreased sound tolerance (hyperacusis).

They include (in alphabetical order) Kathleen Carlson, Robert Folmer, Erin Martz, Candice Quinn, Kelly Reavis, Sarah Theodoroff, and Tara Zaugg.

Many more individuals, both internal and external to the NCRAR, have contributed to the different tinnitus studies. An article is in preparation that will summarize, in a peer-reviewed journal, all of the tinnitus studies conducted by these investigators.

Due to space constraints, the present article is limited to reviewing primarily my own tinnitus research.

Overall, I have been funded to conduct more than 30 tinnitus projects,

including 13 controlled trials that have focused on intervention and rehabilitation for bothersome tinnitus.

These trials have identified procedures that are the most efficacious, and efficient, for clinical application. These efforts led to the development of Progressive Tinnitus Management (PTM), an interdisciplinary, steppedcare program that combines elements of sound therapy and cognitive behavioral therapy (CBT) for intervention.* The evolution of these 13 clinical trials and the contribution of many of them to the development and evaluation of PTM are described below. *The PTM workbook can be downloaded for free by visiting https:// www.ata.org/progressive-tinnitusmanagement-program.

First Clinical Trial The first clinical trial (N = 126, meaning 126 participants were enrolled in the study) compared the efficacy of tinnitus masking and Tinnitus Retraining Therapy (TRT).3,4 This study demonstrated that sound combined with counseling can be used to accomplish different therapeutic objectives for tinnitus management.5 With PTM, patients are taught how to use sound to self-manage tinnitus. This study also produced the prototype Tinnitus and Hearing Survey to differentiate hearing problems from tinnitus problems.6

Second Clinical Trial The essential component of intervention with TRT is its structured counseling. We hypothesized that administering TRT counseling to groups of veterans with bothersome tinnitus would be an effective and efficient intervention. To test that hypothesis, our second trial (N = 269) was a



randomized controlled trial (RCT) with three research arms that compared TRT counseling to a traditional tinnitus support group, and to a wait-list control group.7 This was a counselingonly study, and it was evident that outcomes would have been improved if participants had received a hearing evaluation, and hearing aids as necessary, prior to receiving the counseling. Hence, lessons learned from this study include the importance of audiologic care as the first stage of tinnitus management, and more broadly to use a stepped-care approach to provide only the services required for each individual.

Third Clinical Trial The third trial (N = 148) was a multisite (four VA medical centers) RCT to assess the effectiveness of masking and TRT when performed

by VA audiologists.8 At each site, participants were randomized into one of four groups, including TRT, masking, or one of two control groups: one that received tinnitus educational counseling (and hearing aids if needed), and a wait-list control group. Implications for tinnitus clinical management derived from this study include: (1) educational counseling can be as effective as sound-based therapy; (2) it is important to provide comprehensive training to clinicians; and (3) individuals who do not benefit from initial intervention should receive more intensive services. Further, the educational counseling protocol created for the educational control group led to the development of numerous concepts, techniques, and tools for using therapeutic sound that are described as part of the PTM educational counseling.9,10

TINNITUS TODAY WINTER 2021

5



SPECIAL FEATURE

Fourth Clinical Trial The fourth trial (N = 221) developed and pilot-tested a protocol to provide tinnitus services consistently across audiology clinics.11 Drawing on the prior trials, a clinical model was formulated, supporting materials in multimedia were developed, and a pilot study was conducted. Five hierarchical levels of care were defined and labeled Progressive Audiologic Tinnitus Management (PATM). Pilot testing demonstrated that PATM was clinically implementable and helpful to patients, and supported a clinical model with progressive levels of care.

Fifth Clinical Trial The fifth trial (N = 36) was conducted to develop and test a protocol for providing tinnitus services to veterans and civilians who had experienced a concussion (also known as a traumatic brain injury, or TBI).12 The PATM counseling was enhanced with CBT. Because the new protocol was multidisciplinary (that is, not audiology-centric), the name PATM was shortened to PTM. For this study, the counseling was telephoneadministered to individuals with and without TBI history located throughout the United States. All groups showed similar improvement in outcomes, with moderate to large effect sizes (indicating benefit).

Sixth Clinical Trial The sixth trial (N = 300) was a “clinically embedded” study.13 At each of two VA audiology clinics, 150 veterans were randomized into either PTM or usual care (wait-list control).

Participants in the PTM group attended Level 3 Skills Education, which involved two sessions of sound therapy selfcare education and three sessions of CBT. Significant improvement for the PTM group was observed with all outcome measures. The 6

TINNITUS TODAY WINTER 2021

Tenth Clinical Trial improvement was significantly better for the PTM group versus the wait-list control group, though observed effect sizes were small.

Seventh Clinical Trial The seventh trial (N = 30) compared tinnitus outcomes between hearing aids with and without use of a builtin sound generator.14 Both groups showed significant reductions in scores on the Tinnitus Functional Index (TFI),15 indicating reduced effects of tinnitus on things like sleeping, reading, and relaxing. Results of this study were important for shaping the PTM Level 2 Audiologic Evaluation protocol.16

Eighth Clinical Trial The eighth trial (N = 30) evaluated the potential efficacy of two types of sound therapy for tinnitus treatment, based on two prevailing theories for tinnitus generation, compared to broadband noise.17 This pilot study produced preliminary data showing the most improvements with respect to the loudness and functional effects of tinnitus for the participants listening to noise that was notched around the tinnitus pitch-matched frequency.

Ninth Clinical Trial For the ninth trial (N = 205), telehealth-based PTM (Tele-PTM) developed for patients with TBI in the pilot study (fifth trial, above) was modified, and a larger trial to evaluate its efficacy was completed.18 Recruitment of individuals with bothersome tinnitus took place nationwide. Results provided strong support for use of the Tele-PTM methodology, regardless of whether the person also has TBI symptoms.

The effect size for Tele-PTM was high for the primary outcome measure, the TFI, and all other outcome measures showed significant improvement.

The tenth trial (N = 55) evaluated the efficacy of extended-wear, deepfit hearing aids (Lyric™) for tinnitus relief compared to the efficacy of hearing aids with and without a built-in sound generator.19 All three groups showed significant reductions in TFI scores. This study essentially confirmed results from our previous similar trial (seventh trial, above) and established an effective protocol for the audiologic management of tinnitus (PTM Level 2).16

Eleventh Clinical Trial The eleventh trial (N = 60) was a three-group trial evaluating the Levo System for acoustic treatment of tinnitus during sleep compared to a sham device that presented broadband noise, and standard-ofcare (Marsona® 1288 bedside sound generator).20 Both the Levo and sham groups, compared to standard-ofcare, revealed greater improvement in reactions to tinnitus. The Levo group, compared to the other two groups, revealed greater reduction in selfperceived tinnitus loudness.

Twelfth Clinical Trial The twelfth trial (N = 40) involved development and testing of a smartphone app* that teaches PTM coping skills.21 Two focus groups provided initial feedback from potential users, followed by a field study to evaluate the app. In both the focus groups and field studies, participants responded favorably to the content. This new approach has the potential to improve access to coping skills instruction for those with bothersome tinnitus. *Components of what we developed were used in an app from ReSound: https://www.resound.com/en-us/ hearing-aids/apps/relief

SPECIAL FEATURE

Thirteenth Clinical Trial The thirteenth trial (N = 61) was conducted to compare outcomes between the Desyncra sound-based therapy device and CBT. The primary endpoint of the study was met, and results of the study will soon be published.22

Additional Studies In partnership with VA Program Offices (Mental Health Services; Audiology & Speech Pathology Service) and the HSR&D Quality Enhancement Research Initiative (QUERI), we conducted a preimplementation study to describe tinnitus management practices at VA sites nationally, and sites’ readiness for PTM implementation.2,23 This information is being used to develop approaches to dissemination and implementation that mitigate systematic barriers to the clinical uptake of PTM. Our research group is currently conducting a longitudinal epidemiology study, inspired by the Institute of Medicine report titled Noise and Military Service: Implications for Hearing Loss and Tinnitus, which recommended research on the causes of noise-induced hearing loss and tinnitus in military personnel.24 Our study has been funded by the Department of Defense (DoD) since 2013.25 To answer the long-term questions, the intent is to sustain the study for 20 to 30 years.26 Funding has been procured from both the DoD and RR&D through 2025. This multisite study includes the NCRAR (main site) and the DoD Hearing Center of Excellence in San Antonio, Texas. Our new DoD funding will add a third site in the San Diego, California area. To date, over 1,000 veterans and active service members have been enrolled in this study.27,28

Summary and Conclusion Whereas other labs are focusing on finding a cure for tinnitus (permanent elimination or reduction of the tinnitus sensation), our focus has been on developing and testing different methods of tinnitus clinical management with the overall purpose of validating clinical methodologies for routine application. Much more has been accomplished than has been described here, including trials by other NCRAR investigators and the development of numerous materials for both clinicians and patients to be used as part of clinical care. An online training course, consisting of five separate training modules, has been developed and many efforts are under way to update all of our materials and to develop new ones. We are part of the DoD/VA Tinnitus Working Group, which is working to develop clinical tools for tinnitus management at both the DoD and VA. This brief review should leave no doubt that the VA has substantially supported tinnitus research for many years, and continues to do so.

James A. Henry, PhD, is a certified and licensed audiologist with a doctorate in behavioral neuroscience. He is employed as a Veterans Affairs (VA) Rehabilitation, Research & Development (RR&D) Senior Research Career Scientist at the VA RR&D National Center for Rehabilitative Auditory Research (NCRAR) located at the VA Portland Health Care System. He is also Research Professor in the Department of Otolaryngology – Head and Neck Surgery at Oregon Health & Science University. For the past 25 years, he has devoted his career to tinnitus research. His overall goals are to develop and validate clinical methodology for effectively helping individuals with bothersome tinnitus and to increase accessibility to evidence-based tinnitus care.



1 K. F. Carlson, T. A. Gilbert, M. E. O’Neil, T. L. Zaugg, C. A. Manning, C. Kaelin...J. A. Henry. (2019).

Health care utilization and mental health diagnoses among veterans with tinnitus. American Journal of Audiology, 28(1S), 181–190.

2 T. L. Zaugg, E. J. Thielman, K. F. Carlson, A. Tuepker, C. Elnitsky, K. L. Drummond...J. A. Henry. (2020).

Factors affecting the implementation of evidencebased Progressive Tinnitus Management in Department of Veterans Affairs Medical Centers.

PLoS One, 15(12), e0242007.

3 J. A. Vernon & M. B. Meikle. (2000). Tinnitus masking. In R. S. Tyler (Ed.), Tinnitus Handbook (pp.

313–356). San Diego: Singular.

4 P. J. Jastreboff & J. W. P. Hazell. (2004).

Tinnitus Retraining Therapy: Implementing the Neurophysiological Model. New York: Cambridge University Press.

5 J. A. Henry, M. A. Schechter, T. L. Zaugg, S. Griest, P. J. Jastreboff, J. A. Vernon...B. J. Stewart. (2006).

Outcomes of clinical trial: Tinnitus masking vs.

Tinnitus Retraining Therapy. Journal of the American Academy of Audiology, 17, 104–132.

6 J. A. Henry, S. Griest, T. L. Zaugg, E. Thielman, C. Kaelin, G. Galvez, & K. F. Carlson. (2015). Tinnitus and hearing survey: A screening tool to differentiate bothersome tinnitus from hearing difficulties.

American Journal of Audiology, 24(1), 66–77.

7 J. A. Henry, C. Loovis, M. Montero, C. Kaelin, K.-A. Anselmi, R. Coombs...K. E. James. (2007).

Randomized clinical trial: Group counseling based on tinnitus retraining therapy. Journal of Rehabilitation Research and Development, 44(1), 21–32.

8 J. A. Henry, B. J. Stewart, S. Griest, C. Kaelin, T. L. Zaugg, & K. Carlson. (2016). Multisite randomized controlled trial to compare two methods of tinnitus intervention to two control conditions. Ear and Hearing. 37(6),e346-e359.

9 J. A. Henry, T. L. Zaugg, P. J. Myers, C. J. Kendall (Schmidt). (2010). How to Manage Your Tinnitus: A Step-by-step Workbook. 3rd ed. San Diego, CA: Plural.

10 J. A. Henry, T. L. Zaugg, P. J. Myers, C. J. Kendall, & M. B. Turbin. (2009). Principles and application of counseling used in Progressive Audiologic Tinnitus Management. Noise and Health, 11(42), 33–48.

11 P. J. Myers, S. Griest, C. Kaelin, M. W. Legro, C. J. Schmidt, T. L. Zaugg, & J. A. Henry. (2014).

Development of a progressive audiologic tinnitus management program for veterans with tinnitus.

Journal of Rehabilitation Research & Development, 51(4), 609–622.

12 J. A. Henry, T. L. Zaugg, P. J. Myers, C. J. Schmidt, S. Griest, M. W. Legro...K. F. Carlson. (2012). Pilot study to develop telehealth tinnitus management for persons with and without traumatic brain injury. Journal of Rehabilitation Research and Development, 49(7), 1025–1042.

13 J. A. Henry, E. J. Thielman, T. L. Zaugg, C. Kaelin, C. J. Schmidt, S. Griest...K. Carlson. (2017).

Randomized controlled trial in clinical settings to evaluate effectiveness of coping skills education used with Progressive Tinnitus Management.

Journal of Speech, Language, and Hearing Research, 60(5), 1378–1397.

14 J. A. Henry, M. Frederick, S. Sell, S. Griest, & H. Abrams. (2015). Validation of a novel combination hearing aid and tinnitus therapy device. Ear and Hearing, 36(1), 42–52.

15 M. B. Meikle, J. A. Henry, S. E. Griest, B. J. Stewart, H. B. Abrams, R. McArdle...J. A. Vernon. (2012). The Tinnitus Functional Index: Development of a new clinical measure for chronic, intrusive tinnitus. Ear and Hearing, 33(2), 153–176.

TINNITUS TODAY WINTER 2021

7



SPECIAL FEATURE

16 J. A. Henry & C. M. Quinn. (2019). Clinical protocol to promote standardization of basic tinnitus services by audiologists. American Journal of Audiology, 28(1S), 152–161.

17 M. L. Schad, G. P. McMillan, E. J. Thielman, K. Groon, C. Morse-Fortier, J. L. Martin, & J. A. Henry.

(2017). Comparison of acoustic therapies for tinnitus suppression: A preliminary trial. International Journal of Audiology, 57(2), 1–7.

18 J. A. Henry, E. Thielman, T. Zaugg, C. Kaelin, G. P. McMillan, C. Schmidt...K. F. Carlson. (2019).

Telephone-based Progressive Tinnitus Management for persons with and without traumatic brain injury: A randomized controlled trial. Ear and Hearing, 40(2), 227–242.

19 J. A. Henry, G. McMillan, S. Dann, K. Bennett, S. Griest, S. Theodoroff...G. Saunders. (2017).

Tinnitus management: Randomized controlled trial comparing extended-wear hearing aids, conventional hearing aids, and combination instruments. Journal of the American Academy of Audiology, 28(6), 546–561.

20 S. M. Theodoroff, G. P. McMillan, T. L. Zaugg, M. Cheslock, C. Roberts, & J. A. Henry. (2017).

Randomized controlled trial of a novel device for tinnitus sound therapy during sleep. American Journal of Audiology, 26(4), 543–554.

21 J. A. Henry, E. Thielman, T. Zaugg, C. Kaelin, C. Choma, B. Chang...B. Fuller. (2017). Development and field testing of a smartphone “App” for tinnitus management. International Journal of Audiology, 56(10), 784–792.

22 S. M. Theodoroff, G. P. McMillan, C. J. Schmidt, S. M. Dann, C. Hauptmann, M.-C. Goodworth, R. Q. Leibowitz, C. Random, & J. A. Henry. (in press).

Randomized controlled trial of interventions for tinnitus management: Desyncra™ versus cognitive behavioral therapy. International Journal of Audiology.

23 A. Tuepker, C. Elnitsky, S. Newell, T. Zaugg, & J. A. Henry. (2018). A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery. PLoS One, 13(5), e0196105.

24 L. E. Humes, L. M. Joellenbeck, & J. S. Durch (Eds.).

(2006). Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: National Academies Press.

25 J. Gordon, W. Helt, M. S. Lewis, et al. (2015).

Demographic and audiological characteristics of veterans and impact of hearing loss on their lives.

Paper presented at the AudiologyNOW! Annual Convention of the American Academy of Audiology, San Antonio, TX. 26 J. A. Henry, S. E. Griest, C. Blankenship, E. J. Thielman, S. M. Theodoroff, T. Hammill, & K. F. Carlson. (2019). Impact of tinnitus on military service members. Military Medicine, 184(Suppl. 1), 604–614.

27 J. A. Henry, K. M. Reavis, S. E. Griest, E. J. Thielman, S. M. Theodoroff, L. D. Grush, & K. F. Carlson. (2020). Tinnitus: An epidemiologic perspective. Otolaryngologic Clinics of North America, 53, 481–499.

28 J. A. Henry, S. Griest, K. M. Reavis, L. Grush, S. M. Theodoroff, S. Young, E. J. Thielman, K. F. Carlson.

(2021). Noise Outcomes in Servicemembers Epidemiology (NOISE) study: Design, methods, and baseline results. Ear and Hearing, 42(4),870-885.

ADVERTISEMENT

8

TINNITUS TODAY WINTER 2021

www.ATA.org

TINNITUS RESOURCES 

Tinnitus Q & A Telehealth Today: Can My Audiologist Also Be My Therapist?

By Gail M. Whitelaw, PhD

Question: Living in a large metropolitan area, I have various in-person and online options for learning how to live with my tinnitus.

I’m reaching out because I don’t understand what an online audiologist does. Does it matter if I can’t have inperson meetings? Can an audiologist also be my therapist to help me deal with the stress and anxiety from my tinnitus?

Gail Whitelaw, AuD: Thank you for the timely questions.

Telehealth Appointments What you describe as “online” audiology – also known as telehealth or teleaudiology – has been used for decades in some audiology settings, including Veterans Administration medical centers. However, the appearance of Covid-19 created an urgency in the field of audiology to expand provision of remote care services to meet the needs of patients who may not have been able to receive in-person services for a number of reasons, including closure of brick-and-mortar clinics and patient reluctance to participate in face-to-face services. Although the emergence of the pandemic established a greater need for remote services, it certainly appears that this service delivery model is here to stay. Research on www.ATA.org

teleaudiology has demonstrated that it provides improved access to services, is effective in-service delivery, and is a cost-effective model.1 Remote care can be offered in a number of ways, including via telephone, via email, and via an audio/video platform such as Teams or Zoom. Your questions raise a number of important considerations regardless of the method of remote care; however, the focus here is specific to the “online” or audio/video platform. An “online audiologist” can and should provide the same quality services that are provided in an inperson setting. These services may include diagnostic services, hearing aid adjustments, and counseling, and the range of services will depend on the access that the audiologist has to technology, equipment, and personnel that support teleaudiology.

The audiologist providing services, either in-person or via teleaudiology, must be licensed in their state and can provide services only in states

where they are licensed, although this may change in the near future with legislation related to an interstate compact, where states provide reciprocity to those licensed in states participating in the compact.

Regardless of the service delivery model, the audiologist should have expertise in tinnitus assessment and management. This can be demonstrated in a number of ways, including professional membership in the American Tinnitus Association, as a Certificate Holder in Tinnitus Management (CH-TM) from the American Board of Audiology, and/or having completed advanced continuing education in the area of tinnitus.

Although some audiologists may be able to provide both diagnostic and treatment services remotely for tinnitus, a comprehensive audiologic/ tinnitus evaluation should be the foundation for clinical care and may require a face-to-face appointment.

“Working with your audiologist to access their network of mental health providers and obtain appropriate services is key, regardless of services being delivered in person or online.”

TINNITUS TODAY WINTER 2021

9

 TINNITUS RESOURCES

Additionally, the remote platform used in teleaudiology must meet the same criteria as in an in-person appointment: privacy must be addressed and the platform must comply with requirements that ensure patients’ privacy and the security of their health information. To maximize the effectiveness of an online appointment, both provider and patient need to have access to a high-quality webcam and consistent broadband connection. Documentation of the information from the appointment should be the same regardless of the delivery model.

Although teleaudiology as a delivery model is growing, insurance reimbursement for these services may be lagging and inconsistent; the patient is encouraged to check with their insurance provider about reimbursement for telehealth services.

In addition to seeking an audiologist who is a qualified tinnitus service provider, evaluating the recommendations will consist of how well the services address your individual needs. The “online” option does not need to be either/or and patients and audiologists may prefer a hybrid model. This model involves a combination of in-person interactions and telehealth visits and has been demonstrated as being successful in managing tinnitus for patients.2 Anecdotally, many patients in our practice have reported being very satisfied with being able to access our clinical services in order to touch base, to address ongoing concerns, and to participate in remote programming to modify hearing aid fitting.

Additional data is required to continue to direct best practices in clinical care in teleaudiology. Many audiologists now consider teleaudiology to be an important aspect of their 10

TINNITUS TODAY WINTER 2021

practice, one that helps them reach more patients, including those who may be home-bound or in rural areas. Many others of us are interested in developing best practices in teleaudiology to help prepare future audiologists who are enrolled in Doctor of Audiology (AuD) programs.

Audiologist as Therapist A critical aspect of audiological care, regardless of the model of service delivery, is an accurate assessment of the needs of the person with tinnitus and recommendations on how to best meet those needs. Most audiologists working with people with tinnitus are skilled in the aspects of educational counseling on tinnitus and hearing loss. However, the distress experienced with tinnitus for many patients may be complex and may involve symptoms of anxiety, insomnia, and depression – conditions generally considered out of the scope of practice of audiology.

In our practice, we answer questions and address concerns yet generally refer to a therapist, psychologist, or social worker with experience working with people who have tinnitus and/or related sound tolerance disorders. Cognitive behavioral therapy (CBT), particularly in conjunction with use of sound enrichment, has demonstrated significant efficacy in tinnitus treatment.3 In this model, the therapist trained in CBT works in conjunction with the audiologist who is directing the sound enrichment treatment options and other audiologic recommendations and with the patient to maximize success in minimizing the impact of tinnitus in the patient’s life.

In general, based on knowledge and training, an audiologist cannot provide the same type of therapy services as those offered by a licensed provider

in the area of mental health. Asking about the qualifications of the provider in the area of therapy/mental health services is critical in understanding the direction of clinical care and the support that can be provided.

Currently, the demand for mental health/wellness services is significant, and it may be difficult to obtain services in a timely manner due to ongoing need. Working with your audiologist to access their network of mental health providers and obtain appropriate services is key, regardless of services being delivered in person or online. Mental health services are also offered online, and it appears that this service delivery model may be growing, based on the experience of our clinic and our patients. The same questions that you have asked here certainly apply to choosing a therapist who can address your needs.

Gail M. Whitelaw, PhD, is a clinical associate professor and the Director of the Speech-LanguageHearing Clinic at The Ohio State University in Columbus, OH. Dr. Whitelaw is a clinical preceptor in the Doctor of Audiology (AuD) program and also provides direct clinical care. Her clinical interests are in tinnitus and related sound tolerance disorders, auditory processing disorders, traumatic brain injury, and professional leadership development. She is a Certificate Holder in Tinnitus Management (CH-TM) from the American Board of Audiology.

Dr. Whitelaw is a frequently invited presenter on the topic of tinnitus management, particularly as it relates to children and teens.

1 P. H. Skarzynski, M. Krumm, K. Penar, & S. Hatzopoulos. (2020). Teleaudiology.

Advances in Audiology and Hearing Science.

Apple Academic Press.

2 T. Scaglione & B. Kuyzbyt. (2021). Tinnitus management: The utilization of a hybrid telehealth and in-person delivery model. Seminars in Hearing, 42(2), 115–122.

3 H. J. Jun & M. K. Park. (2013). Cognitive behavioral therapy for tinnitus: Evidence and efficacy. Korean Journal of Audiology, 17(3), 101–104.

SCIENCE & RESEARCH NEWS 

Quieting Tinnitus With Vagus Nerve Stimulation Summary by John A. Coverstone, AuD

Vagus nerve stimulation has increasingly become an area of interest for helping people with tinnitus. It is a type of neuromodulation, which is currently one of the most commonly researched methods for tinnitus treatment. This approach relies on the assumption that tinnitus, in most cases, is due to a disruption in part of the (neurological) auditory system. When the auditory system recovers from this disruption, it does not do so properly and phantom sound (tinnitus) is heard as a result. The name often used for this process is maladaptive plasticity.

The vagus nerve is the longest of the 12 cranial nerves (that emerge directly from the brain). It reaches the heart, respiratory system (trachea, esophagus, lungs and associated muscles), and digestive tract. It is vitally important to regulate those organs and systems as part of the parasympathetic nervous system.

The autonomic nervous system controls bodily functions automatically, or without conscious input, and is made up of of two counter-balancing systems: the sympathetic and

parasympathetic nervous systems. The sympathetic nervous system stimulates vital functions to prepare for activity – it is responsible for the fight-or-flight response. The parasympathetic nervous system is responsible for maintaining the body’s balance, as its activity supports functions – sleep, relaxation, digestion – that are important, but impossible to carry out during fight-or-flight episodes. Although rare, people with an overactive parasympathetic nervous system can experience dangerously low heart rate and respiration. Parasympathetic functions are extremely relevant in the body’s response to stress and anxiety, which may be why they were initially investigated to help with bothersome tinnitus.

The function of the vagus nerve extends beyond the parasympathetic nervous system and is a key nerve involved in regulating our vital organs.

Most important to tinnitus research is that stimulation of the vagus nerve can activate two nuclei (dense regions of brain tissue) in the brainstem: the locus coeruleus (sih-rue-lee-us) and nucleus basalis. These are known to

release neurotransmitters that most notably include norepinephrine (norep-i-nef-rin) and acetylcholine (uhseet-il-coe-leen), which are thought to drive changes (or plasticity) in the auditory system.

Vagus nerve stimulation (VNS) has been used for many years to treat major depressive disorder and epilepsy. This treatment is performed without other stimulation. However, scientists have recently been pairing VNS with auditory stimuli to investigate treatment of tinnitus.

This treatment often consists of a series of tones with the frequency of the tinnitus excluded. Vagus nerve stimulation itself may be performed using noninvasive stimulation – surface electrodes – or by surgically implanting a stimulation device with wires wrapped around the vagus nerve.

There is some debate as to whether paired auditory stimulation is TINNITUS TODAY WINTER 2021

11

 SCIENCE & RESEARCH NEWS

necessary. Some studies have found further benefit when using auditory stimulation with VNS, but others have shown similar benefit when using VNS alone. There is some evidence that suggests the interval between paired electrical/acoustic stimuli alters the amount of plasticity seen in the auditory system.1 Other researchers have investigated the ability of VNS to address reactions to tinnitus rather than tinnitus itself. The vagus nerve is a key component of the parasympathetic nervous system – accounting for some 75 percent of nerve fibers in the parasympathetic nervous system. For

this reason, researchers have sought to leverage the inhibitory effect of the vagus nerve on autonomic functions (instead of “fight or flight,” the parasympathetic nervous system addresses “rest and digest”). In this case, researchers pair a tinnitusmatched sound to VNS. The idea is to invoke the body’s resting state in the presence of the tinnitus sound. The hope is to create a sort of Pavlovian conditioning where the body goes into a state of relaxation in response to the tinnitus sound rather than a state of anxiety and stress.2 These approaches are still experimental and much work needs to be done regarding stimulus parameters for both electrical stimulation of the vagus

nerve (how intense, what intervals, for how brief/long a period of stimulation) and paired auditory stimulation (included or not, what frequency or frequencies, how long, how often, whether using tones or something more complex, and so on?). It is also necessary to further study VNS with noninvasive electrical stimulation devices because surgical implants will not be feasible for most people if a marketable product is developed.

1 M. S. Borland, C. T. Engineer, W. A. Vrana, N. A. Moreno, N. D. Engineer, S. Vanneste . . . M. P. Kilgard (2018). The interval between VNS-tone pairings determines the extent of cortical map plasticity. Neuroscience, 369, 76–86.

2 D. De Ridder, B. Langguth, & S. Vanneste. (2021).

Vagus nerve stimulation for tinnitus: A review and perspective. Progress in Brain Research, 262, 451–467. https://doi.org/10.1016/bs.pbr.2020.08.011

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 12

TINNITUS TODAY WINTER 2021

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.

PERSONAL STORY



A Therapist’s Personal Journey Managing Tinnitus

By Peter Vernezze PhD, LMSW

“Happy families are all alike,” wrote Leo Tolstoy in the opening line of his classic Anna Karenina; “every unhappy family is unhappy in its own way.” The reverse, I would argue, is true when it comes to tinnitus. Tinnitus patients are all, by definition, unhappy about their tinnitus but many of us are alike in sharing an unhappy initial diagnosis experience: We visit an ear, nose, and throat physician, undergo a battery of hearing tests, and are summarily discharged with little information and less hope regarding our newly acquired condition. This happened to me, too. One thing that does seem different about my situation, though, is that I am a behavioral health therapist.

I bring this up because my own tinnitus journey has been immensely informed by my profession. Just as any physician diagnosed with tinnitus would immediately begin researching the journals, scouring the internet, and calling on colleagues to determine what the medical profession had discovered about the condition, I initially devoted a good deal of energy to unearthing insights on tinnitus management from the mental health field. My research

Conflict-of-interest notice to readers: This article includes information about the author’s counseling services, which can be accessed for a fee. The author therefore stands to benefit financially if Tinnitus Today readers seek tinnitus care from him.

turned up quite a bit that I have put to use in managing my own tinnitus.

This process, in turn, revealed a second and more surprising way my tinnitus situation was different from others’: Being someone who applied therapeutic behavioral health interventions to their tinnitus made me almost as unique as being a therapist with tinnitus. Sadly, it seems, the mental health field is a greatly underused resource for tinnitus patients. This needs to change. Here are some behavioral health strategies I have applied to my own tinnitus – strategies I hope will be of use to you, too.

Tinnitus and Mental Health It all starts with cognitive behavioral therapy (CBT), one of the most researched and effective interventions for reducing tinnitus distress. While

the ATA website correctly points out that CBT “has been shown to significantly help many patients with tinnitus,” it is important to understand what CBT can and cannot do. To understand this, we need to look at the amygdala, the almond-shaped region of the brain that senses threats and, in response, mobilizes the sympathetic nervous system to put the body into fight-or-flight mode.

Imagine one night while you are sleeping your smoke alarm goes off. Heart pounding, you leap out of bed, prepared to do what’s necessary to save your family. This is the amygdala in action. After searching your home, you discover not a raging fire but a defective smoke alarm,

“To find meaning in our tinnitus is simply to use the loss as a catalyst for something positive and lifeaffirming. We are all capable of doing that.”

TINNITUS TODAY WINTER 2021

13

 PERSONAL STORY

and your body begins to calm down. This is your cortex – the part of your brain responsible for reasoning – kicking in, providing information to help calm the amygdala. However, the cortex has a limited ability to influence the amygdala. To understand this, imagine that after you discover there is no fire you go to bed without disengaging the alarm. How much sleep are you going to get with the alarm blaring all night? Despite your reason’s reassurance that all is well, the amygdala will invariably keep your body in a heightened state of stress.

Your inability to go to sleep with a smoke alarm sounding even though you know there is no threat illustrates a limitation of CBT in dealing with tinnitus. CBT works by challenging our beliefs and focuses specifically on challenging and changing irrational beliefs that cause emotional distress.

Although CBT does a good job in countering the irrational thoughts that some tinnitus patients develop about the impact of tinnitus on their lives or their ability to live with the condition, it is minimally effective in persuading the amygdala not to react to the tinnitus sound, just as telling yourself there

is no fire does not really help you get to sleep when the smoke alarm is going off.

Fortunately, an additional strategy exists that can assist in calming the body by, among other things, addressing the reticence of the amygdala to respond to reason.

Based on a 2,500-year-old tradition of Buddhist meditation, mindfulness burst on the mental health scene in the United States more than 40 years ago with Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) technique. Four decades of research and hundreds of studies have demonstrated the effectiveness of mindfulness, in general, and of the eight-week MBSR protocol, in particular, for dealing with a number of mental and physical health conditions, including but not only depression, anxiety, and chronic pain.1 Mindfulness training can actually rewire the brain through a process known as neuroplasticity, which can be defined as any form of lasting change that occurs in the structure or function of the brain.

Yet, research on mindfulness and tinnitus is in its infancy: a recent search turned up just seven related

“Although there is something admittedly peculiar about clients having to educate therapists about their condition, this may in fact be what needs to happen until there is more outreach within the mental health profession.”

14

TINNITUS TODAY WINTER 2021

studies. Nevertheless, research conclusions are promising, for example: “a decrease of tinnitus distress scores in MBIs (mindfulnessbased interventions) can be observed directly post-therapy based on moderate to high quality studies.”2 Although the causal mechanism that accomplishes this result is unclear, one possible explanation comes from research conducted on mindfulness and anxiety in which functional magnetic resonance imaging (fMRI) scans showed that after an eightweek course of mindfulness practice the brain’s fight-or-flight center, the amygdala, appeared to shrink.3 This example of neuroplasticity can be reasonably connected with the emphasis in mindfulness training on being an impartial observer of our experiences rather than reacting to them. In any case, the apparent ability of mindfulness training to impact the amygdala through noncognitive means makes it the perfect complement to CBT. In addition to utilizing interventions to reduce tinnitus distress, it makes sense to employ evidence-based strategies to improve our overall mental health. This makes positive psychology a useful tool in any tinnitus patient’s toolbox. Created by Martin Seligman, positive psychology focuses not on curing psychic illness but on creating mental health. It offers a variety of techniques for improving our sense of well-being. Gratitude practice is one example. An oft-cited study compared three groups of people: one group wrote about things that irritated them, another wrote about things they

PERSONAL STORY

were grateful for, and a third wrote about neutral events. At the end of the week, those who had written about gratitude were more optimistic and felt better about themselves.4 Another technique-driven therapy that can be useful is polyvagal theory, which focuses on the role of the vagus nerve, one of the main cranial nerves in the body, in emotional regulation.

According to polyvagal theory, at any one moment our nervous system exists in one of three states: a state of fight or flight (associated with activation of the sympathetic nervous system), a shutdown state (associated with activation of the dorsal pathway of the vagus nerve), or a connected state (associated with activation of the ventral pathway of the vagus nerve).

Ideally, we would like to minimize the amount of time we spend in the first two states and maximize our stay in the calming, connected ventral vagal state. This last state is primarily achieved through the process known as coregulation, which is defined as “the reciprocal sending and receiving of signals of safety.” Deb Dana, responsible for bringing polyvagal theory to the world of therapy, calls coregulation “a biological imperative: a need that must be met to sustain life.” The importance of trusted others within our network of relationships in regulating our nervous system (think of a crying baby being calmed by the reassuring presence of a parent) is one reason why the isolation necessitated by the pandemic has taken a toll on our mental health.

However, tinnitus patients can experience the exact opposite situation.

Tinnitus patients

can habitually exist in a dysregulated state, driven by their tinnitus to sympathetic fight or flight or by rumination to a depressed state of dorsal vagal shutdown. In addition, the isolation that sometimes accompanies their condition may cut them off from others, depriving them of the human connection that often facilitates the ability to calm down.

By applying the insights of polyvagal theory, tinnitus patients can learn to recognize dysregulation in its early stages, develop strategies to extricate themselves from toxic emotional states, and create the conditions for coregulation with others that help reshape the nervous system through habitual effort in the same way that mindfulness techniques depend on the brain’s neuroplasticity to rewire the brain and resulting behavior.

Perhaps the most powerful lesson I took from my profession and applied to my tinnitus comes from David Kessler, who worked with Elizabeth Kubler-Ross in applying the five stages of dying model to the experience of grief. In his most recent book, Finding Meaning: The Sixth Stage of Grief, Kessler has added a sixth stage to the grieving process: finding meaning. According to Kessler, finding meaning in loss “allows us to transfer loss into something else, something rich and fulfilling,” and “empowers us to find a path forward.”

It might not at first seem obvious that tinnitus is a grief-inducing condition, for what is apparent in tinnitus is not what is lost but what is gained – a chronic sound, noise, or ringing. Although the addition of tinnitus gets all the press, the loss of silence can be a shock to the nervous system.



Importantly, to find meaning in our loss does not imply that the loss is a good thing or that we are grateful it occurred. Reading Kessler made me realize that although I had made peace with my tinnitus, I had not made use of it.

Fortunately, my professional training provides the platform to do so. Recognizing that it’s difficult for patients to find therapists with a good understanding of tinnitus, I made it my mission to obtain advanced training in mindfulness and CBT, two evidencebased interventions that have been demonstrated to reduce tinnitus distress. I have also partnered with the online therapy company Stepstone Connect to develop an eight-week tinnitus education program based on the principles outlined in this article.

Although not everyone with tinnitus is in a position to produce an impact on a large scale, this is not necessary. To find meaning in our tinnitus is simply to use the loss as a catalyst for something positive and life-affirming. We are all capable of doing that.

Despite the numerous benefits of visiting a mental health professional, it seems that few people bothered by tinnitus seek out a counselor, clinical social worker, or psychologist.

On the flip side, conversations with fellow mental health professionals lead me to believe that an even smaller percentage of therapists are knowledgeable about tinnitus. Indeed, the whole situation can be read like the tragic tale of star-crossed lovers kept apart by some unknown force.

Although there is something admittedly peculiar about clients TINNITUS TODAY WINTER 2021

15

 PERSONAL STORY

having to educate therapists about their condition, this may in fact be what needs to happen until there is more outreach within the mental health profession.

Another option is for tinnitus patients to go it alone in the world of self-help, educating and ultimately treating themselves. This is far from ideal, especially considering the benefits of face-to-face counseling with a trained mental health professional. Still, there are self-help resources available for those who wish to take this route (some are listed in the box below).

My hope is that, instead of tinnitus patients all being alike in sharing a similar unsatisfactory initial diagnosis

experience, they can instead find relief and the support they need within the field of mental health. The profession, though vastly underutilized for tinnitus management, nevertheless includes caring individuals who can do much to increase the quality of our lives with tinnitus.

Peter Vernezze, LMSW, PhD, is a therapist living in Tucson, Arizona. A long-time Buddhist practitioner trained in the Shambhala tradition, he is currently a Mindfulness-Based Stress Reduction (MBSR) teacher-in-training at the University of California’s San Diego Center for Mindfulness and is on the National Provider Registry for cognitive processing therapy. Dr. Vernezze

is an emeritus professor of philosophy at Weber State University and has authored a half dozen books, including Don’t Worry, Be Stoic: Ancient Wisdom for Troubled Times.

1 A. Powell. (2018, April 9). When science meets mindfulness. Harvard Gazette. https://news.harvard. edu/gazette/story/2018/04/harvard-researchersstudy-how-mindfulness-may-change-the-brain-indepressed-patients/ 2 M. Rademaker, I. Stegeman, K. E. Ho-Kang-You, R. J. Stokroos, & A. L. Smit. (2019). The effect of mindfulness-based interventions on tinnitus distress.

A systematic review. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.01135 3 T. Ireland. (2014, June 12). What does mindfulness meditation do to your brain? Scientific American. https://blogs.scientificamerican.com/guest-blog/ what-does-mindfulness-meditation-do-to-your-brain 4 Giving thanks can make you happier. (2021, August 14). Harvard Health Publishing. https:// www.health.harvard.edu/healthbeat/giving-thankscan-make-you-happier

Self-Help Resources Cognitive Behavioral Therapy BOOKS The Association for Behavioral and Cognitive Therapies (ABCT) has a list of recommended self-help books at https://www.abct. org/sh-books/ APPS Many apps address psychological issues. To help identify useful ones, the American Psychological Association conducted a review and found Sanvello, MindDoc (previously Moodpath), and Moodtools met recommended criteria: https:// www.apaservices.org/practice/ business/technology/tech-column/cbtapp-depression ONLINE Bruce Hubbard, PhD, and cognitive behavioral therapist, offers useful resources on his website, CBT for Tinnitus: https://www. cbtfortinnitus.com/dr-bruce-hubbard

Mindfulness n To access a free eight-week Mindfulness-Based Stress 16

TINNITUS TODAY WINTER 2021

Reduction (MBSR) course, see www.palousemindfulness.com.

This is an authentic presentation and free version of the program that has been around for more than four decades. n Through the online therapy company Stepstone Connect, I offer an eight-week group program for tinnitus patients based on the principles in this article. For more information and pricing, see www.stepstoneconnect.com/tinnitus. n Jennifer Gans, PsyD, offers an eight-week online Mindfulness-Based Tinnitus Stress Reduction program.

For more information and pricing, see https://mindfultinnitusrelief.com/

Other Resources n The Polyvagal Theory in Therapy by Deb Dana was written for therapists but is helpful to readers interested in

understanding the role of the vagus nerve in emotional regulation. n The University of Pennsylvania’s Positive Psychology Center is where you can learn more about positive psychology: https://ppc.sas.upenn.edu/ n Authentic Happiness by Martin Seligman is a best-selling book that explains how to apply the principles of positive psychology to everyday life, written by the founder of the discipline. n Finding Meaning: The Sixth Stage of Grief, by David Kessler, can be a helpful resource for processing life with tinnitus. n Get Out of Your Mind and Into Your Life by Stephen Hayes, PhD, is a workbook-type introduction to acceptance and commitment therapy (ACT). Although not covered in this article, ACT has been shown to be effective in managing tinnitus.

ATA NEWS 

The Researchers Who Review ATA Grant Applications When it comes to understanding what new research might answer critical questions that could lead to important breakthroughs and possible cures for tinnitus, the ATA turns for guidance to its Scientific Advisory Committee (SAC), a team of 13 researchers, many of whom are also clinicians. This is the team of experts that the ATA Board of Directors relies on to review and vet

ATA grant applications before funding is approved.

We’d like to introduce you – ATA members and donors – to SAC members. We’re showcasing each of these dedicated researchers in our next three issues. May you find hope and inspiration from the individuals who are leading the way toward eliminating tinnitus and unraveling the many mysteries of the auditory system.

ATA Scientific Advisory Committee Spotlight

Marc Fagelson, PhD Marc Fagelson is a professor of audiology at East Tennessee State University. He received a BA in English and MS in audiology from Columbia University, and his PhD in hearing science from the University of Texas at Austin. His academic teaching includes courses covering hearing science, audiologic evaluation, pathologies of the auditory system, and tinnitus management.

Fagelson has co-edited with Dr. David Baguley two texts published by Plural that center on tinnitus and disorders of sound tolerance. A tinnitus and hyperacusis casebook, published by Thieme, is currently in production. He has more than 40 publications and has given more than 100 conference and workshop presentations.

In 2001, he opened the James H. Quillen Veterans’ Affairs Medical Center (VAMC)

Tinnitus Clinic that now enrolls more than 1,200 patients. The clinic offers extensive and interdisciplinary counseling for patients, as well as a variety of hearing aid fitting and sound therapy strategies designed to support a patient’s ability to manage their tinnitus and sound intolerance issues. Students in East Tennessee State University’s AuD program rotate through the clinic, as do fourth-year externs serving at the Quillen VAMC. A substantial proportion of the veterans in that clinic experience TINNITUS TODAY WINTER 2021

17



ATA NEWS

tinnitus that is complicated by the influence of co-occurring psychological conditions, in particular post-traumatic stress disorder (PTSD). Traumatic experiences and tinnitus appear to be linked, and because of this, counseling opportunities arise during which patients are provided information, and referrals as indicated, that support management of symptoms associated with both tinnitus and trauma, two conditions that appear to mutually reinforce each other. Current research with this group of patients includes investigating hearing aid compression and noise reduction schemes most acceptable to patients with PTSD. Fagelson also collaborates with the group headed by Beukes and Manchaiah investigating efficacy of an internet cognitive behavioral therapy program for patients with tinnitus.

In addition to supporting psychological interventions to be employed in conjunction with sound therapy, Fagelson hopes that current research and training models raise the interest of students and audiologists and encourage them to provide future solutions for patients

whose lives are affected by tinnitus and sound intolerance.

Inspiration Behind Pursuing Tinnitus Research The realization that PTSD and tinnitus could reinforce one another triggered substantial interest in their shared mechanisms and influences on a person’s quality of life. Learning about trauma’s durable effects and the potential benefits for patients who learned to tease apart tinnitus effects from trauma effects is an endeavor that will never be completed. Tinnitus, in this regard, is not so much a white whale as it is a compelling story that allows patients and practitioners to learn about each other, and themselves, while on the job. It is a story that may not have an ending, but one that requires telling and retelling just the same.

What Might the Next Five Years Hold?

Ironically, with regard to research requirements, investigating links

between tinnitus and trauma reveals that patients are sadly ubiquitous and available to any investigator willing and able to establish a dialogue in the safety of a reasonable clinic setting.

Much of the evidence for the care of these patients starts with the mental health literature and clinical practice, hence the need to enter such patients in experimental trials related to tinnitus is overdue.

In general, with regard to trauma and its consequences, collaborations between psychology and audiology must be more thoroughly mapped out and implemented. Such endeavors usually suffer from a “border war,” as professionals from different disciplines try to establish boundaries and protocols with which they are comfortable. It is a durable hope that we can determine ways to seamlessly merge and share resources with our colleagues in clinical psychology, for example, in order to provide opportunities for collaborative research. Ultimately, such research would require translation into clinical practice, and implementation studies might facilitate audiologists’ uptake of interventions, including audiological and psychological components.

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 18

TINNITUS TODAY WINTER 2021

www.ATA.org

ATA NEWS 

ATA Awards $265,000 for Promising Innovative Tinnitus Research The ATA prioritizes funding innovative research through seed grants because, as a smaller funding group, such grants have tremendous potential and – because of the complexity of tinnitus – bold thinking is necessary to advance science.

www.ATA.org

This year – thanks to the generosity of the tinnitus community – the ATA awarded $265,000 through its Innovative Tinnitus Research Grants Program to four researchers.

This year’s awardees represent some of the best and brightest tinnitus researchers in the field today.

The ATA funds early-career investigators to attract and retain younger researchers to the field, which reflects the reality that researchers – no matter what their interests are – follow funding opportunities.

The ATA Board of Directors votes on grant awards based on recommendations from its Scientific Advisory Committee (SAC), which represents an international 13-member panel of leading tinnitus researchers.

TINNITUS TODAY WINTER 2021

19



ATA NEWS

2021 ATA Research Grant Recipients ATA CLAYMOND CASTRO INNOVATION IN TINNITUS RESEARCH GRANT AWARD

The Use of Sound Therapy to Improve Sleep and Tinnitus: A Placebo-Controlled Ecological Study PRINCIPAL INVESTIGATOR: Sylvie Hébert, PhD School of Speech Pathology and Audiology, Faculty of Medicine, University of Montreal, Canada

Sylvie Hébert, PhD, is a full professor at the School of Speech Pathology and Audiology and program director of Audiology at the University of Montreal, Canada. Her research laboratory is particularly well known in the area of tinnitus stress and sleep disturbances. © Sarah Scott Hébert was awarded a grant to compare the efficacy of two types of sound therapy – white noise and relaxing music – to improve sleep, a primary complaint among 80 percent of adults with tinnitus.

Because poor sleep quality negatively impacts mental, physical, and cognitive well-being, in addition to increasing tinnitus severity, the need for evidence-based data on tinnitus sleep management is critical for patients and clinicians. The primary objective is to determine whether targeted sleep interventions can improve sleep and reduce tinnitus severity, and whether these effects can be captured with objective and subjective measurements. Achieving this goal might not only improve the immediate, overall wellbeing of tinnitus patients but also potentially reduce their risk of developing serious health issues down the road.

“This funding is essential to conduct an original human study designed to generate conceptual and practical advances that converge tinnitus and sleep research,” said Hébert. “It’s important to bring concrete solutions to people with tinnitus as well as make progress in the understanding of the condition. Our goal is to generate new knowledge to improve the quality of life of tinnitus sufferers.”

20

TINNITUS TODAY WINTER 2021

ATA DONALD BOWMAN INNOVATION IN TINNITUS RESEARCH GRANT AWARD

The Molecular Mechanisms of Tinnitus: Probing Deficiencies in GABAergic Inhibition With GABAedited MR Spectroscopy and [11C] Flumazenil PET PRINCIPAL INVESTIGATOR: Pim van Dijk, PhD Professor of Audiology, University of Groningen, University Medical Center Groningen, the Netherlands

Pim van Dijk, PhD, is a certified medical physicist audiologist at the University of Groningen in the Netherlands, with research interests in the neuroscience of tinnitus, clinical audiology, and the biophysics of the inner ear. Since 2004, he’s been a professor in audiology in the Department of Otorhinolaryngology of the University Medical Center Groningen.

His ATA grant will be applied to investigating whether deficiencies in GABA are involved in the development of tinnitus in individuals with high-frequency hearing loss, which is suggested in studies in animals. GABA is a molecule released by some neurons to block or modulate the activity of other neurons. Without GABA, neurons can excite each other uncontrollably, which, to some extent, is seen in epilepsy. The investigation will compare GABAergic neurotransmission between individuals with and without tinnitus. If the research confirms deficient GABA signaling as a cause for tinnitus, it will encourage new clinical research to alleviate it by enhancing GABA neurotransmission in the auditory pathway.

Reflecting on what attracted him to tinnitus research, van Dijk said, “Tinnitus struck me as a problem where there is much to gain from good research…. We’re taking tinnitus research to the level of molecular medicine, which is a necessary step to develop pharmaceutical treatments for tinnitus.”

ATA NEWS 

ATA J. & J. MELTZER INNOVATION IN TINNITUS EARLY CAREER RESEARCH GRANT AWARD

ATA INNOVATION IN TINNITUS RESEARCH GRANT AWARD

Clinical Implementation of Novel Tools for Pediatric Tinnitus: The Young-Persons Tinnitus Screener and the Young-Persons Tinnitus Inventory

Serum Prestin As a Biomarker for Tinnitus

PRINCIPAL INVESTIGATOR: Natalie Macaruso, MD

Otolaryngology; and Program Director, Division of Otolaryngology at University of Connecticut School of Medicine

Subspecialty Fellow at the Division of Hematology/Oncology, Department of Pediatrics, University of Toronto’s Hospital for Sick Children

Natalie Macaruso, MD, is a pediatric hematologist/oncologist currently completing additional training in the care of childhood cancer survivors at the Hospital for Sick Children at the University of Toronto. As a survivor of childhood cancer who developed chronic tinnitus as a result of her treatment, Macaruso finds improving pediatric tinnitus patient care is indeed very personal. She said she found her tinnitus frustrating throughout much of her adolescence, eventually developing her own coping mechanisms for it, but to her best recollection, no doctor ever talked with her about it.

To raise awareness within the medical community and to understand the impact of tinnitus on the quality of life of children, validated evaluation tools for this age group are essential. Because none exists, her research has focused on developing and validating novel instruments: Young-Persons Tinnitus Screener and Young-Persons Tinnitus Inventory.

Her ATA grant will be applied to evaluate the clinical implementation of these instruments, which she hopes will prove to be useful tools for clinical care and for future research in pediatric tinnitus. “Unfortunately, detection of tinnitus in young people is challenging because they are less likely than adults to self-report it; they can describe it when asked,” she said. “For young people with tinnitus, evaluating its severity – before treating it and after treatment has started – is also important.”

PRINCIPAL INVESTIGATOR: Kourosh Parham, MD, PhD Associate Professor of Surgery; Director of Research, Division of

Kourosh Parham, MD, PhD, is a faculty member of the University of Connecticut School of Medicine.

His current research focuses on the development of serological biomarkers for otological disorders using proteins that are primarily expressed in the inner ear.

Noting that tinnitus research has been hindered by lack of objective measures and understanding of the underlying mechanisms of the condition, Parham is investigating blood-based biomarkers, which could promote better scientific understanding of tinnitus and lead to successful management strategies. The blood test is intended to measure a well-known and important inner ear protein called prestin.

“Our investigation measures blood tests to determine if there are differences between patients with tinnitus/ hyperacusis and those who do not suffer from either of these conditions,” Dr. Parham said. He and his team hypothesize, on the basis of prior research, that tinnitus reflects abnormal cochlear gain from upregulated prestin exposure in the cochlea. “We have already demonstrated that blood levels of prestin, as a biomarker, can detect impending ototoxicity before a detectable change in hearing,” he said.

“I, like so many others, have tinnitus!” Dr. Parham said. Although his tinnitus isn’t bothersome, he notes that many of his patients find theirs unbearable. “While there have been many advances in tinnitus management, I am motivated to contribute to further advances, which may further improve tinnitus outcomes and alleviate suffering….It is humbling to be part of this effort.”

TINNITUS TODAY WINTER 2021

21



SPECIAL FEATURE

Who’s Calling the ATA’s Support Line and How Is It Helping?

By Rebecca M. Lewis, AuD, PhD, and LaGuinn P. Sherlock, AuD, ATA Tinnitus Program Advisors

For fifty years, the American Tinnitus Association has been a source of information and support for people with tinnitus and those wanting to help them, including family members, friends, and healthcare practitioners.

The lack of research-based information often extends to the medical community, so the ATA recognizes the difficulty people frequently encounter trying to find credible information, advice, and guidance regarding tinnitus. As such, as part of its mission to provide support to those struggling with tinnitus, the Tinnitus Advisors Program (TinnAP™) was launched in 2018 to provide a resource to people who are looking for guidance and support managing their tinnitus. It is currently staffed with audiologists who have extensive experience evaluating and managing patients with tinnitus.

22

TINNITUS TODAY WINTER 2021

When people call the TinnAP, an advisor may ask specific questions to determine appropriate guidance and recommendations relevant to the caller’s concerns. Questions may include tinnitus onset, the main reason for calling the support line, and questions about relevant medical and personal history. Advisors report responses to questions in a deidentified spreadsheet that can be analyzed so ATA can better understand the needs of callers and provide the best possible service to people calling for support. The spreadsheet contains several categories to facilitate analysis.

The predefined categorical reports, as well as some short unstructured anecdotes, were collected from 455 calls received between September 2019 and September 2021, by nine advisors. Although reports were not collected from every call by every advisor during this time, the data is useful for evaluating trends. It is important to note that responses

to questions were recorded by the advisor and therefore reflect the report of the caller as interpreted by the advisor. The information collected was assigned to multiple subcategories at the discretion of the advisor.

We share a select number of findings in this article along with guidance to frequently asked questions.

The Tinnitus Advisors Program (TinnAP™) TinnAP offers a free 15-minute one-time consultation that is intended to provide the following information: • Research-based guidelines for tinnitus treatment and management • Self-help strategies, including guidance on sound therapy and stress reduction tips • How to locate healthcare professionals who might be able to help This article, along with the provided service, is not intended as medical advice or as a substitute for seeking professional care from someone in your local community.

SPECIAL FEATURE

Why Call the TinnAP Support Line?

As a first step toward understanding how TinnAP serves the caller population, we recorded callers’ primary reasons for calling.

On the basis of previous calls and related research, we identified the following predefined categories for data collection: • How can I reduce my tinnitus volume or eliminate tinnitus?

• Which medical professional can help me?

• How can I reduce stress or anxiety?

• How can I improve concentration?

• How can I improve sleep quality?

• Is it safe for me to get an MRI? The most frequent reasons people called the TinnAP support line were related to (1) how to reduce the loudness of (or eliminate) tinnitus (Figure 1), closely followed by (2) identifying medical professional(s) who could best help them. It is striking to see that more than 80 percent of callers are included in each of these categories.

By contrast, the number of calls made specifically to address the

effects of tinnitus was lower. About two-thirds of callers wanted to know how to reduce the stress and anxiety related to their tinnitus, about half wanted to know how to improve their sleep, and about a quarter wanted to know how to improve their concentration. The data suggests that it is more common for callers to feel stress and anxiety related to their tinnitus than adverse effects on their sleep or ability to concentrate.

The substantial difference between the number of callers who requested general information about how to reduce the loudness of tinnitus and the number of callers who requested specific recommendations to reduce stress and/or improve concentration or sleep should not be lost on the reader. Many healthcare providers find it helpful to understand the specific reported effects (e.g., difficulty with sleep, concentration, or mood) of tinnitus on the patient so appropriate management can be recommended.

While there is currently no “cure” to reduce the loudness of or completely eliminate tinnitus, management strategies can help individuals cope with the negative effects of tinnitus.



  While targeted strategies are currently used to help manage the downstream functional effects of tinnitus, data from the TinnAP program supports the idea that the future of clinical care for people with tinnitus should attempt to offer strategies to eliminate or reduce the volume of their tinnitus. This observation illustrates the importance of increasing research that moves beyond tinnitus management strategies toward targeted cures to reduce the loudness of tinnitus.

TinnAP Caller Population Each caller reported how long their tinnitus has been present prior to the call. These reports fell into three categories: (1) chronic tinnitus, which had been present for more than six months, (2) acute tinnitus, which had been present for less than six months, and (3) unsure of duration.

We expected most callers to report long-term or chronic tinnitus, and the data verified this expectation.

We found that 58 percent of callers reported a history that was consistent with chronic tinnitus. Some callers reported a gradual onset of tinnitus

Figure 1: What Type of Help Callers Are Seeking

Distribution of Callers Reporting Chronic or Acute Tinnitus

How to reduce tinnitus volume Identifying the medical professional who can help How to reduce stress or anxiety How to improve sleep How to improve concentration Concerns regarding upcoming MRI

0

25

50

75

100

Percentage of Total Callers

Caller Report

Percentage

Chronic

58%

Acute

41%

Unsure of duration

1%

TINNITUS TODAY WINTER 2021

23



SPECIAL FEATURE

that became bothersome over time, whereas others reported recent onset tinnitus and subsequent attempts to navigate the healthcare system prior to seeking assistance from the support line. Although the majority of callers reported chronic tinnitus, the proportion is smaller than we expected.

There was a larger-than-expected proportion of callers who reported acute tinnitus (41%). It is reassuring to see that the ATA has been able to provide support to people with recent-onset tinnitus, providing information and strategies for tinnitus management. With millions of people in the United States struggling with bothersome chronic tinnitus, it is additionally important to understand that a greater number of individuals are also sufficiently impacted by shortterm tinnitus to seek professional guidance through a TinnAP phone call soon after their tinnitus starts. Some of the data presented later in this article will highlight divisions between callers who report chronic or acute tinnitus, as some of the trends were particularly informative.

Reported Histories of TinnAP Callers Knowing when tinnitus began, along with other life and health events surrounding tinnitus onset, can help a healthcare professional better understand coexisting conditions related to the onset of tinnitus. Again, we created predefined categories to collect data on callers’ history of other reported

 24

TINNITUS TODAY WINTER 2021



conditions. The categories are listed in Figure 2 along with their prevalence in this caller population.

Nearly three quarters of the callers reported seeing an ear, nose and throat (ENT) physician, whereas only a quarter of the callers reported visiting a mental health professional, prior to calling the TinnAP. One possible interpretation of these data could reflect the primary reason for the phone call, where people with tinnitus are more likely to seek a medical service (e.g., ENT) to diagnose and medically treat the condition rather than managing the anxiety and stress that can accompany tinnitus using behavioral strategies (e.g., mental health clinician). Another possible interpretation of these data is related to reporting bias; an audiologist serving on the TinnAP team may be more likely to ask if an individual has been evaluated by an ENT rather than ask if an individual has seen a mental healthcare professional, as it is considered best practice to rule out underlying medical issues.

Approximately half of the TinnAP callers reported learning something helpful from a healthcare professional prior to calling the TinnAP support line. Although this is encouraging to see that many people do find benefit when they seek guidance from a healthcare professional, it also underlines the complexity of tinnitus management – callers benefited from a discussion with a healthcare provider, but were still left with questions regarding next steps in their tinnitus management plan.

Most callers mentioned they had found the ATA TinnAP phone

number online. In a few instances, callers stated that they were referred to the TinnAP support line by their ENT; anecdotal information from these callers indicated more complex cases that moved beyond the medical aspects of tinnitus. Each of these callers received a set of recommendations tailored to their reported history.

It is disheartening to hear from people in distress who call the TinnAP support line and report that they have been told by a healthcare professional, “There’s nothing we can do for tinnitus.” From the perspective of a healthcare professional who does not specialize in the evaluation and management of tinnitus, it is likely that they lack the skill set or breadth of practice to address the concerns of a patient with bothersome tinnitus.

Nonetheless, healthcare professionals should refer patients with bothersome tinnitus to the appropriate discipline for follow-up. Considering that hearing loss and anxiety were reported by approximately 65 percent of callers, a referral to an audiologist and/ or mental healthcare professional could be beneficial as a next step in tinnitus management.

Tinnitus Distress Sudden changes in tinnitus can be distressing, which prompted some calls to the TinnAP support line.

Understanding the more common contributors to tinnitus can inform a management plan to help people with tinnitus find relief from the condition.

www.ATA.org

SPECIAL FEATURE

Guidance for FAQ As mentioned earlier, the TinnAP advisors are audiologists who were able to recommend next steps in the tinnitus management plan for each caller (see Figure 3). Given the complexity of tinnitus management, more than 94 percent of calls resulted in more than one recommendation.

We examined the call logs to identify the most common recommendations, and the top three recommendations were to: (1) enrich the sound environment (91%), (2) visit an audiologist (87%), and (3) use stress reduction strategies (82%) to assist with tinnitus management.

These recommendations directly address the most common primary reasons for the call. Generally, enriching the sound environment is recommended to reduce the contrast between a quiet room and the tinnitus.

TinnAP advisors most frequently recommended callers follow up with an audiologist, which ranked ahead of following up with an ENT, behavioral health specialist, dentist, primary care physician, or a sleep specialist.

Many callers also reached out to reduce their stress and/or anxiety related to their tinnitus; the third most frequent recommendation was to use stress reduction techniques to assist with their tinnitus management plan. Readers with tinnitus who share these areas of concern can use stress reduction techniques to get started with tinnitus management on their own (see the ATA Patient Navigator for more information on ata.org).

Although more than 50 percent of callers wanted to know how to improve their sleep, only about 10 percent received a recommendation www.ATA.org

to follow up with a sleep specialist.

For individuals with complaints related to sleep, the TinnAP advisors identified several general strategies that could help, such as a bedside noise generator or stress reduction strategies. When a caller reports regular use of these strategies with continued difficulty sleeping (along with other non-hearing specific flags),



a referral to a sleep specialist may be considered.

Because of the known connection between bothersome tinnitus and mental health, it is important for people who are struggling to reach out to a qualified behavioral healthcare professional for assistance. Given this connection, it shouldn’t be surprising that 70 percent of callers received a

Figure 2: Reported Histories of TinnAP Callers Visit with an ear, nose, and throat physician Anxiety Hearing loss Sleep difficulties Other health issues Already learned helpful information from a HCP Other mental health difficulties Use/Interest in prescriptions for tinnitus Visit with a mental health professional Use/Interest in mindfulness training History of dental work and/or grinding teeth Tinnitus changes with body movements Sudden change in hearing

0

25

50

75

100

Percentage of Total Callers

Figure 3: Recommendations for TinnAP Callers Enrich sound environment Visit audiologist Stress reduction strategies Visit a behavioral health specialist Find a tinnitus support group Visit ENT physician Visit primary care physician Visit sleep specialist Visit dentist 0

25

50

75

100

Percentage of Total Callers

TINNITUS TODAY WINTER 2021

25



SPECIAL FEATURE

recommendation to follow up with a behavioral healthcare provider. There are a few ways to interpret the data: • The caller has not yet sought out professional behavioral healthcare services prior to their call to the ATA, and the TinnAP advisor is encouraging them to seek these services to help manage their tinnitus.

• The caller previously visited a behavioral health professional and the TinnAP advisor is encouraging the caller to return for help managing their tinnitus.

• The caller could have neglected to report their relevant behavioral health services, triggering a referral from the perspective of the TinnAP advisor, but is ultimately a reporting error.

Due to the nature of how the data was collected, it is difficult to determine the reason callers received a recommendation to follow up with their behavioral health professional.

However, with 70 percent of calls receiving a recommendation to follow up with a behavioral health specialist, it is clear that this is viewed as a critical piece of tinnitus management for many people who report bothersome tinnitus.

 26

 TINNITUS TODAY WINTER 2021

Lessons Learned: Improving Support Systems for People With Tinnitus From the data, we learned about the characteristics of the TinnAP caller population, and we can use these lessons to improve service in the program. As we expected, most of the callers reported chronic tinnitus. This finding is helpful to ensure we provide training to the TinnAP team that best serves the majority of our callers.

Our TinnAP team is well qualified to provide recommendations to those with chronic tinnitus because of their clinical experience and expertise.

It is interesting to consider the large proportion of callers who reported acute tinnitus. With an expert in tinnitus readily available to provide personalized information, the data indicates that people with acute tinnitus will take the time and energy to seek guidance from a TinnAP advisor to discuss their next steps to optimize their tinnitus management.

This behavior may underline the need for a readily available first line of information to provide accurate and timely information to people with acute tinnitus, such as the ATA TinnAP support line and other publicly available information.

With the lessons learned from this data, the ATA looks forward to continuing to build and improve upon this support system for people with tinnitus. If you would like to donate to or support the operation of the ATA’s Tinnitus Advisors Program, visit the ATA website or call 800-634-8978 to learn more about how you can help.

Rebecca M. Lewis, AuD, PhD, completed her postdoctoral training at Massachusetts Eye and Ear in Boston and Walter Reed National Military Medical Center in Maryland.

She continues to participate in both clinical and research activities in many aspects of her career. In her primary position, she serves as Clinical Research Scientist with Whisper.ai. In addition, she currently serves as chair-elect of the American Board of Audiology and co-chair of the Association for Research in Otolaryngology External Relations Committee.

She is delighted to continue serving as an advisor for the ATA’s Tinnitus Advisors Program, which was described in this article, to support those struggling with tinnitus. She also serves as the ATA’s scientific grants project officer.

LaGuinn Sherlock, AuD, is a licensed audiologist with over 30 years of clinical and research experience. She started her career at Johns Hopkins Hospital, then spent nearly 20 years working at the University of Maryland Medical Center, home of one of the first tinnitus specialty clinics in the country. She currently works for the US Army Public Health Center, in the Army Hearing Program, with duty at Walter Reed National Military Medical Center. Over the course of her career, she has provided clinical care to thousands of patients with tinnitus and been involved in numerous research studies related to amplification, hearing protection, tinnitus and hyperacusis. She has served on the board of directors of the American Tinnitus Association, and continues to serve as an advisor with the ATA’s Tinnitus Advisors Program.

www.ATA.org

ATA NEWS 

The Researchers Who Review ATA Grant Applications ATA Scientific Advisory Committee Spotlight

Maria Rubio, MD, PhD Maria Eulalia Rubio received her medical degree in 1990 from the University of Alicante School of Medicine, and her doctorate degree in 1994 from the Institute for Neuroscience, University of Alicante School of Medicine, Spain. She was awarded a Postdoctoral Fogarty International Fellowship and joined Dr. Robert Wenthold’s laboratory at the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health in Bethesda, Maryland, where she worked from 1995 to 1999. In 1999, Dr. Rubio was awarded an Alexander von Humboldt Stipendiat research award and joined Dr. Walter Sthümer’s laboratory at the Max Planck Institute of Experimental Medicine, Germany (1999–2001). From 2001 to 2009, she held a faculty position at the University of Connecticut, where she was promoted and awarded tenure. In 2009, Dr. Rubio joined the University of Pittsburgh School of Medicine as a tenured full professor in the departments of Neurobiology and Otolaryngology.

Dr. Rubio has studied the response of cochlear nucleus neurons to deafness and hearing loss. Her studies in response to peripheral damage and monaural conductive hearing loss were the first to show in vivo www.ATA.org

and ultrastructurally the remodeling of synapses and modifications in the distribution of glutamate and glycine receptor subunits at specific excitatory and inhibitory synapses in the cochlear nucleus. Her studies indicate that molecular rearrangements are a widespread response to the loss of sensory input or changes in auditory experience. In addition, these studies provided novel information about the structural and molecular changes associated with decreased sensory experience, along with their potential reversibility. Dr. Rubio is currently investigating the role of glutamate receptors in sex-specific differences in normal hearing and hearing loss.

Inspiration Behind Pursuing Tinnitus Research The lack of understanding of sexspecific differences in the cellular mechanisms in persons with normal hearing and hearing impairments has inspired my research.

What Might the Next Five Years Hold?

Numerous studies have shown that there are multiple ways through which neurons in the cochlear nucleus and other nuclei along the auditory

pathway respond to fluctuations in their inputs. These responses relate to the etiology of hearing loss. Studies of different models of hearing loss are necessary to underpin the cellular mechanisms and determine standard features that will help us understand whether the synaptic modifications compensate for the hearing deficits or represent pathological responses to hearing loss, including tinnitus and hyperacusis. In addition, it is crucial that we use a variety of in vitro and in vivo approaches to study the same model of hearing loss.

In general, the vast majority of the anatomical and molecular studies are performed in mature animals, whereas most of the electrophysiological data come from animals at much earlier ages. Consequently, anatomical and molecular studies lack functional studies and, vice versa, electrophysiological studies lack anatomical and molecular verification.

Progress of the field would thus profit from closer interactions among anatomists, electrophysiologists, and molecular biologists.

Following these lines, the conversations among scientists should include feedback from physicians, audiologists, and patients who experience hearing loss and tinnitus.

TINNITUS TODAY WINTER 2021

27

 PERSONAL STORY

Carbon Monoxide, My Silent Tinnitus Trigger

By Marge V.*

It was December 30, 2018. My husband and I had just returned from a ten-day trip to Nassau, Bahamas, with my son and his wife. We were feeling fit and wonderful. That soon changed. We entered a chilly house and discovered that our furnace was off. The next day, a local furnace repairman fixed the boiler and the house warmed up.

During the first week of January 2019, I began feeling unwell – subtle and strange, but there was no reason for me to feel sick. I cut back on exercise and stayed home more, while my husband spent more time out and about with our grandchildren. I thought that whatever it was would pass with rest. But things got worse. My mind felt “weird” – I couldn’t think straight and my attention span shortened.

On January 10, just before eating dinner, I felt nauseous, confused, and overwhelmed by anxiety over nothing.

I went to a walk-in medical clinic,

“We had been breathing in lowlevel carbon monoxide – in the toxic range – for a month!”

28

TINNITUS TODAY WINTER 2021

where they checked for a heart attack.

They found nothing and prescribed a sedative and heart pill in case my heart rate accelerated. Nothing showed up in the standard blood tests and ECG I had the next day.

The entire month of January was bad. I couldn’t think straight, was anxious, couldn’t be with friends, couldn’t exercise or even walk around the block. I lost weight, couldn’t sleep, had memory loss, experienced IBS, struggled to find the right words, and had headaches, which I normally never got.

My previously very mild tinnitus, which had developed in one ear eight years prior following a long airplane ride with a congested ear, got louder.

It went from a 2.5 to a 5+ in both ears on a 10-point scale.

On January 30, I went to my doctor and told her I was very anxious and confused. She had me fill out an anxiety report, which confirmed I was indeed very anxious, and sent me home.

My son visited us that day and noted the faint smell of gas coming up the stairs. We phoned the gas company and were told to evacuate the house immediately. Within 30 minutes, one of their employees was at our house and had located a gas leak of 15–25 parts per million (ppm) resulting from the faulty repair of our furnace.

We had been breathing in low-level carbon monoxide – in the toxic range – for a month!

We have a CO detector in our basement but learned that it only sets off the alarm when a gas leak is over 70 ppm.

Even after the faulty gas leak was fixed, my symptoms continued to worsen because it takes months for new red blood cells to replace the damaged ones. During the following months – among other symptoms – I experienced extreme ringing in my ears, hearing loss (enough that the ENT doctor suggested that I be reexamined for a hearing aid within a year), and hyperacusis, which left me avoiding people and places. I bought high-fidelity earplugs that enabled me to sit in a quiet restaurant.

In the summer of 2019, with a doctor’s referral, I went to a tinnitus clinic at a local hospital that was attended by six other patients. It was helpful just to hear their stories and have the audiologist, who also had tinnitus, lead the group and speak to us about possible courses of action.

The best thing she told us was that we could phone her if we were really distressed. I did that once.

Basically, I learned that at this point in time there isn’t much that can be done about tinnitus other than accepting it as part of my life. I have found the book Tinnitus Treatment Toolbox by J. L. Mayes to be very helpful and pull it out when I need it.

She describes the tinnitus experience of more than 60 people and what

www.ATA.org

PERSONAL STORY

they did to help themselves. She also includes her own experiences.

My tinnitus fluctuates from about 5 to 8 on a 10-point scale. My hearing loss has been made more difficult to deal with since the pandemic means most of us are wearing masks. I can’t hear very well through a mask, which is frustrating.

Nearly three years have passed and my mental clarity has not fully returned. My head feels strange sometimes, especially in group settings, and my tinnitus is sometimes two-toned. I have hearing loss and continue to dislike loud places, even though my discomfort level has

significantly decreased from what it was shortly after the CO incident.

None of this has been easy. I had to quit volunteer work and remain careful about avoiding places that I can’t leave easily. In this sense, the isolation during the pandemic has been good for my condition. Doctors won’t comment on my recovery time since chronic CO inhalation is apparently uncommon.

For the last year, my symptoms have been virtually the same. But I am a hopeful and resilient person.

My tinnitus is generally better in the morning, after I am up and busy. I try to think of the ringing as a pervasive syndrome that many of us have.



I’ve looked up the names of famous people who have tinnitus (many musicians and former military persons share this condition) and note that they seem to be coping well. I see others living with constant pain such as a back injury, others with cancer, others with debilitating anxiety and have reached the conclusion that I should just get on with life.

I believe in spontaneous recovery, so – who knows – I may wake up tomorrow with no ringing in my ears. I trust at some point a cure will be found! *For privacy reasons, the author has chosen to remain anonymous.

Signs of Carbon Monoxide Poisoning Carbon monoxide is tasteless, colorless, and odorless, making leaks hard to detect. Because it is impossible to see, taste, or smell the toxic fumes, CO can make you ill or kill you before you are aware it is in your home. Because of their size, pets are the proverbial canary in the coal mine, typically falling ill before their owners. The effects of exposure can vary greatly between individuals, depending on the age, overall health, and the length and concentration of CO exposure.

According to the U.S. Environmental Protection Agency, sources of CO include:

• unvented kerosene and gas space heaters • leaking chimneys and furnaces • back-drafting from furnaces, gas water heaters, wood stoves and fireplaces • gas stoves • generators and other gasolinepowered equipment • automobile exhaust from attached garages • tobacco smoke • auto, truck, or bus exhaust from attached garages, nearby roads, or parking areas • incomplete oxidation during combustion in gas ranges, and unvented gas or kerosene heaters

• aged or poorly adjusted and maintained combustion devices (e.g., boilers, furnaces) The physical symptoms of poisoning in people or pets include the following: • Symptoms resembling those of the flu, a cold, or an infection • Tinnitus • Headache • Nausea • Weakness or dizziness If you suspect carbon monoxide poisoning, go to your nearest medical center emergency room or poison center as soon as possible.

TINNITUS TODAY WINTER 2021

29



ATA NEWS

Investigating Tinnitus As a Side Effect of Covid-19 Vaccines The ATA Board of Directors Visits Tinnitus Researcher Shaowen Bao, PhD, at the University of Arizona

By Joy Onozuka

Research is a deeply human endeavor, inspired by the unknown and the desire to solve real-world problems. It’s also inspired by funding and patient outreach, as Shaowen Bao, PhD, explained to ATA board members and staff during a recent visit to his auditory research lab, connected to the College of Medicine at the University of Arizona in Tucson. One striking comment, which illustrated how funding can propel career trajectory, was the acknowledgment that a 2008–2009 ATA grant for $99,949 to investigate cortical plasticity in tinnitus both launched and solidified Dr. Bao’s interest in the field.

Since then, his work has advanced tinnitus research in numerous

Shaowen Bao, PhD, director of the Auditory Perception and Learning Laboratory, University of Arizona

30

TINNITUS TODAY WINTER 2021

ways, including findings that were published in 2019 that revealed the role of neuroinflammation in tinnitus and its treatment.1 It’s an important area and one that’s explained in more detail in The Behavioral Neuroscience of Tinnitus, which was released in fall 2021 (see page 36 for more information).

For the most part, Dr. Bao’s lab work involves experiments using the animal model because inducing tinnitus and/or hearing loss cannot ethically be done with human subjects. The goal is to find ways to alleviate tinnitus and tinnitus distress in the millions of people who are bothered by the condition.

His research extends far beyond his lab, with collaborations taking place with other investigators in the United States, China, and elsewhere. Outside

the lab, he’s an associate professor of neuroscience.

Driving home the connection between patient needs and research is his most recent investigation of tinnitus as a side effect of Covid-19 vaccines, which he felt compelled to pursue after being inundated by emails from people who either developed tinnitus or experienced a significant spike following vaccination. “I got emails every day from desperate people asking about what to do,” he said. To help provide answers, he designed a survey, which included 398 participants, to determine what people were experiencing and which interventions might help.

Though his data analysis is far from complete, he notes that steroids appear to reduce tinnitus as a side effect of the Covid-19 vaccines in 30 percent of cases, with the benefit www.ATA.org

ATA NEWS 

“One striking comment, which illustrated how funding can propel career trajectory, was the acknowledgment that a 2008–2009 ATA seed grant for $99,949 to investigate cortical plasticity in tinnitus both launched and solidified Dr. Bao’s interest in the field.” appearing to be linked to dosage and treatment duration. “Prednisone prescribed at 30 milligrams per day and below seemed to provide little benefit, whereas the same drug at 40 milligrams per day and above for five days or longer seemed to improve the condition in 50 percent of cases,” Dr. Bao said. He was careful to note that those observations are preliminary and his findings have not yet been peer reviewed. A potential downside of steroid usage could be a reduction in the efficacy of the vaccination; hence, those considering steroid treatment should talk to their physician about risks and potential benefits.

Tinnitus as a side effect of Covid-19 vaccines, while concerning, is considered statistically uncommon.

Shaowen Bao, PhD, with Robert Travis Scott, ATA board member.

Dr. Bao said it’s critical to look at the big picture because Covid-19 vaccines reduce the symptoms of the disease, which might be associated with a higher risk of developing tinnitus along with other health issues. Which is to say, vaccinations may reduce a person’s overall risk of developing tinnitus if they contract Covid-19.

As researchers continue various lines of investigations, their findings build upon one another, and may be replicated by other investigators. A critical element to consider with regard to the broad context of tinnitus relates to the need of scientists to identify relevant underlying mechanisms of tinnitus. The auditory system is extraordinarily complex, more so than the other senses. While all of our senses are intricately linked to our brains, auditory events may produce responses that differ in substantial ways from those associated with our other senses. That tinnitus can drive various responses, including debilitating distress, highlights the need for researchers such as Dr. Bao. Indeed, Dr. Bao is one among an increasingly interconnected field of tinnitus researchers who are working together, building databases, sharing

ATA meets members of Tucson Tinnitus Support Group. First row, left to right, support group members: Trudy Jacobson, Lisa Goldsmith, Terri Rice, Peter Vernezze.

Back row, left to right, ATA: Torryn Brazell, Sara Downs (ATA board member), Joy Onozuka

information, all with the goal of helping patients. The ATA and patients can help by contributing to research through donations, participation in trials, and communication. No one solves anything on their own, and connections drive answers to problems.

The ATA and Tucson Tinnitus Support Group Round Table Talk Trudy Jacobson understands the full spectrum of the effects of tinnitus on the mind and spirit, from mild annoyance to suicidal ideation, which she detailed in a personal story in our Spring 2020 magazine. Her way to turn her tinnitus experience into something meaningful was to launch a support group in Tucson, Arizona, which met initially in person until the coronavirus pandemic necessitated moving it online. From there, an entirely new world opened up, connecting her to hundreds of people interested in joining her group, sometimes as a one-off, sometimes for every meeting. Most online meetings have approximately 25 people. “I don’t imagine ever going back to in-person only,” Trudy said TINNITUS TODAY WINTER 2021

31



ATA NEWS

during a casual get-together with ATA board and staff members.

The dinner, which featured takeout from the Texas Roadhouse, was held outside among a small group, reflecting ongoing concerns of limiting the spread of the coronavirus and protecting everyone’s health.

The gathering was intended as a networking opportunity to explore needs, interests, and roles that individuals play within the tinnitus community. Other support group members included Peter Vernezze, a therapist with tinnitus; Lisa and Kevin Goldsmith; Terri Rice; and Karl Hallsten. Hallsten and Rice are with the Adult Loss of Hearing Association (ALOHA) and have formed an alliance with Trudy in her role as a tinnitus group facilitator, assisting her with tech support so that online meetings are accessible for individuals with significant hearing loss. ATA members included CEO Torryn P. Brazell; board member Sara Downs, AuD; and Joy Onozuka, research and communications director.

hybrid meeting, 20 people attended (7 onsite, 13 offsite), including 17 board members, Scientific Advisory Committee chair Fatima Husain, and staff members Joy Onozuka and Kevin Willmann. And though the convenience of a hybrid meeting was appreciated by all, it was not without minor challenges, including periodic audio issues.

Membership on the ATA Board of Directors entails a three-year commitment, with a one-time renewal, minimum annual $1,000 contribution to the ATA, participation

on committees, and fundraising. If you think you’d be a valuable member on the board, self-nominations and nominations of others are accepted each spring. An email announcing openings is sent to ATA members annually.

1 W. Wang, L. S. Zhang, A. K. Zinsmaier, G. Patterson, E. J. Leptich, S. L. Shoemaker…S. Bao. (2019).

Neuroinflammation mediates noise-induced synaptic imbalance and tinnitus in rodent models. PLoS Biology, 17(6), e3000307. https://doi.org/10.1371/ journal.pbio.3000307

ATA’s First Hybrid OnsiteOffsite Board Meeting In normal times, the ATA Board of Directors meets four times a year, twice via teleconferencing and twice in person, with a tinnitus research laboratory visit typically scheduled as a part of ongoing education on tinnitus research and clinical care. The hybrid meeting in Tucson, Arizona, October 22–23, was the first time board members met in person since October 2019. Meetings are held to discuss such things as operations, finances, committee activities, research, strategy, and mission. For the 32

TINNITUS TODAY WINTER 2021

ATA board members and staff outside Dr. Shaowen Bao’s Auditory Perception and Learning Laboratory. First row, left to right: Melissa Wikoff, AuD, Sara Downs, AuD, Philip Cotton (ATA donor), Julie Prutsman, AuD. Back row, left to right: Robert Travis Scott, Torryn Brazell, Joy Onozuka, Ron Zagel, Dr. Shaowen Bao www.ATA.org

SCIENCE & RESEARCH NEWS 

What Could We Learn From a Tinnitus Biobank?

By David Stockdale

In a previous issue of Tinnitus Today, I introduced the British Tinnitus Association’s (BTA) Tinnitus Cure Map1 and discussed the many challenges that lie ahead on our path to finding a cure. Since then, the BTA has commissioned more research that will address our research priorities and help us on that road to achieve our vision of “A world where no one suffers from tinnitus.”2 We have also been working hard with our partners, the American Tinnitus Association, and statutory research funders in the UK to explore how to increase research funding across the board.

Our next big ambition is to create a tinnitus biobank. We believe a biobank, designed to capture all relevant information about tinnitus, could unlock many of the unanswered questions that remain and enable that step change in tinnitus research that we all want to see.

What Is a Biobank?

The Mayo Clinic gives the following definition of a biobank: A biobank is a collection of biological samples (such as blood) and

www.ATA.org

health information. Biobanks can be large and hold thousands of samples, or they may be small and hold only a few hundred samples. Different biobanks collect different types of samples and information. The types of information and samples collected depend on the specific purpose of the biobank. For example, some biobanks are specific to a particular disease, such as cancer. Other biobanks are population based and contain samples and information from people in a specific population or region.3 This is an excellent description and highlights how a tinnitus biobank would potentially enable tinnitus researchers to make a huge leap forward. A tinnitus biobank would: • Collect information from people living with tinnitus, such as general medical history, tinnitusspecific history (e.g., nature of sounds heard, how long it has been there, is it heard in one ear or both, how loud it is perceived to be, impact on quality of life, trigger factors), hearing tests, questionnaire data, and family history.

• Collect biological samples from people living with tinnitus, such as blood.

• Be condition-specific to tinnitus but include control subjects to enable meaningful comparisons.

• Be big! There would need to be many thousands of samples to be able to distinguish between the various possible types or causes of tinnitus or to unravel the genetic predisposition to tinnitus.

Once we have constructed a biobank, we will use the information contained within it to address many of the questions on our Tinnitus Cure Map – such as, “Is there an objective measure of tinnitus?” It may be that rather than creating one tinnitus biobank in one place, we develop several such resources, with volunteers around the world participating. This would ensure we have the best possible chance of coming up with the answers we need.

TINNITUS TODAY WINTER 2021

33

 SCIENCE & RESEARCH NEWS

What Are the Challenges?

The case for a tinnitus biobank is a powerful one and could really drive tinnitus research forward. There are, however, challenges on the way. The biggest is funding – can we secure the funds needed to establish such a vast undertaking? The BTA will be seeking to fundraise for a biobank with the intention of initiating work as soon as possible.

Further challenges include how to integrate a tinnitus-specific biobank with current general biobanks and with the existing tinnitus research infrastructure. There are already a few general biobanks that contain some information about tinnitus, but this information is often limited to one or two simplistic questions, which significantly impairs our ability to learn much from the data. Recent papers show the limitations of utilizing that data.4 A tinnitus biobank may make this data more useful in the future, though, as conclusions drawn from a tinnitus-specific biobank could then be tested in a wider, more generic resource. The second challenge is the capacity within the tinnitus research field to use and learn from a tinnitus biobank. In my previous article I showed how tinnitus research lags behind that of similar conditions.5 This is also the case for tinnitus research using biobanks.

For this project to be truly effective, we need researchers to become

34

TINNITUS TODAY WINTER 2021

engaged and interested in the data.

Our partnership work with the ATA will hopefully make a difference, as we seek to hold more events in the future at conferences and similar events, to inspire a wider cohort of researchers to consider tinnitus as a future research career.

The Opportunity A tinnitus biobank could allow us to understand the condition much better and answer many questions that remain unanswered, such as: • What is the underlying mechanism – or mechanisms – of tinnitus?

• Is tinnitus one condition or are there many different types?

• Is there a tinnitus biomarker?

• Is there a way to objectively test for tinnitus?

• What is the true link between tinnitus and other comorbidities, including hearing loss, hyperacusis, anxiety, depression, and post-traumatic stress disorder?

Of course, answering these questions on their own will not cure tinnitus. What this new knowledge will do is provide the tools for industry – and the big pharmaceutical companies in particular – to pursue better treatments and cures, through an advanced understanding of tinnitus. We know these challenges, such as the lack of an objective measure of tinnitus, hold back

investment in the pursuit of a cure.

If we are able to level the playing field, give the pharmaceutical companies the tools they need, and communicate effectively that such tools are available we could usher in a new era in tinnitus treatment development.

David Stockdale is the chief executive of the British Tinnitus Association (BTA).

His background is working in senior management positions in charities.

He started on that path while completing his bachelor’s degree in business studies at Sheffield Hallam University. His first role was working in youth consultation and advocating for better provision of services for children and young people. He joined the BTA in February 2010 and has sought to work alongside the global tinnitus community since then to promote better management of tinnitus, to enhance peer-to-peer support, to improve professional training, and, of course, to further research into tinnitus. He is most proud of increasing the number of tinnitus support groups in the U.K. from 34 when he started to 105 today. Having grown the team at the BTA, his focus is now on progressing research and looking at how the BTA responds to many of the points made in this paper.

1 See Tinnitus Today, Winter 2019, page 8.

2 You can find out more about the research we have commissioned here: https://www. tinnitus.org.uk/Listing/Category/active-btasupported-research-projects 3 Mayo Clinic Biobank, Mayo Clinic, https://www. mayo.edu/research/documents/introductionpamphlet-16kb-pdf/DOC-10027365 4 P. Dawes, J. Newall, D. Stockdale, et al. (2020).

Natural history of tinnitus in adults: A crosssectional and longitudinal analysis. BMJ Open, 10, e041290. doi:10.1136/bmjopen-2020-041290 5 See Tinnitus Today, Winter 2019, page 7.

www.ATA.org

SCIENCE & RESEARCH NEWS 

Does Tinnitus Affect Our Ability to Acquire Knowledge?

Summary by John A. Coverstone, AuD

In recent years, we have written about many ways tinnitus affects or is affected by other brain functions, including how it affects hearing (Summer 2020), how our personality affects our perceptions of tinnitus (Summer 2020), and the relationship of tinnitus to insomnia (Spring 2018) and emotional state (Winter 2018).

A common complaint of people with tinnitus is its effect on concentration, memory, processing, and other cognitive functions.

However, this issue has not been widely studied. Researchers from Charité-Universitätsmedizin and University of Regensburg in Germany and University of Zurich in Switzerland recently published results of their study investigating the relationship between tinnitus and cognitive performance.1 According to the authors, various theories had been published regarding why tinnitus seems to affect cognition.

Most of these theories described tinnitus as using brain resources that then become unavailable for other cognitive tasks. These theories assume the brain typically operates near 100 percent processing capacity and that tinnitus has a negative effect because it diverts some of the brain’s attention resources or even cognitiveprocessing resources from attention and thinking tasks. Some have theorized that tinnitus should be www.ATA.org

a nonrelevant stimulus in our brain, but top-down processing (meaning, how the brain controls lower-level functions) is impaired and therefore does not properly inhibit tinnitus as would normally occur for nonrelevant sounds. This impairment would cause the brain to use resources to process undesired signals and therefore reduce processing resources that are available for other tasks.

The current study included 107 adults – 49 male, 58 female – with a mean age of 51 years and chronic tinnitus (longer than 6 months). Each participant completed electronic questionnaires measuring behavioral and psychological factors. Researchers performed hearing threshold testing and tinnitus pitch and volume matching and then administered the Tinnitus Questionnaire, SWOP (SelfEfficacy, Optimism, and Pessimism Instrument; for those wondering about the w, “self-efficacy” in German is selbstwirksamkeit), and Perceived Stress Questionnaire to participants.

Cognitive functions were measured using the d2 Test, which measures attention and concentration, and the Stroop Test, which measures inhibition

and executive functioning by presenting both expected and unexpected tasks and measuring processing time.

The researchers looked first at age as a factor because age is already known to be correlated with cognitive performance and they wanted to be sure this effect was controlled in the data. Their analysis did show a negative correlation between age and both hearing loss and cognition (meaning, as age increased, the other abilities decreased). When controlling for age, they found that tinnitus distress negatively correlated with cognitive measures and positively correlated with perceived stress and hearing loss, meaning that, as tinnitus distress increased, effective cognitive processing decreased in participants with known hearing loss. The relationship between hearing loss and tinnitus is well known; the relationship between stress and tinnitus is often discussed professionally, but is not widely researched.

When analyzing the data for potential influences on cognition, the authors did not find any significant effects of perceived stress, coping (measured with the SWOP), or hearing loss on cognitive functions (measured with d2 and Stroop). There was, however, a clear relationship between tinnitus distress and performance on cognitive tasks. The authors believe that their data show an influence of coping (primarily self-efficacy – or an individual’s confidence in exerting TINNITUS TODAY WINTER 2021

35

 SCIENCE & RESEARCH NEWS

control over their behavior and surroundings) on d2 performance, which is a measure of attention. As mentioned, perceived stress and hearing loss each had a positive correlation with tinnitus distress. This correlation supports the common idea that stress is related to tinnitus severity and the well-known correlation between tinnitus and hearing loss.

The authors suggest that the association of tinnitus with cognitive functions indicates a bidirectional relationship. This means that tinnitus impairs cognitive function, as described in this study, but also that decreased cognitive function has an effect on potential inhibition of tinnitus.

They also point out that no control participants were included who did not have tinnitus because they chose

to focus on individual differences in participants instead.

Few studies have investigated the effects of tinnitus on higher-level brain functions, and we hope to see more research in this area in the future.

1 P. Brueggeman, P. Neff, M. Meyer, N. Reimer, M. Rose, & B. Mazurek. (2021). On the relationship between tinnitus distress, cognitive performance and aging. Progress in Brain Research, 262, 263–285.

How Your Seed Grant Gifts Grow Tinnitus Research Tinnitus researchers around the world look to the ATA for seed grant money to test innovative ideas or overlooked areas that underpin quality patient care. Why? Because most funding agencies will not provide grants without preliminary data, which is what seed grants are aimed at generating.

“With seed grants, researchers can test unknown ideas or new tools to improve clinical care,” said Torryn Brazell, ATA CEO. “If the hypothesis or tool works, then they can seek larger funding – sometimes gaining hundreds of thousands of dollars, even millions – from

Innovative Thought

36

Your Seed Grant Funding TINNITUS TODAY WINTER 2021

places like the National Science Foundation, the National Institute on Deafness and Other Communication Disorders, or the U.S. Department of Defense.” The seed data also gives investigators an idea of feasibility and directionality of their work, which is crucial when applying for larger funding.

The ATA’s 13-member Scientific Advisory Committee, composed of prominent tinnitus researchers, is responsible for vetting applications to

Investigation & Data

verify basic measures for potential success, including the investigator’s proposal and scientific background, appropriate laboratory for proposed work, and qualified team members to execute required tasks. It scores each application, according to standards used by NIH, then makes recommendations to the ATA Board of Directors, which then votes on funding.

Application for LargeScale Grant www.ATA.org

ATA NEWS 

The Researchers Who Review ATA Grant Applications ATA Scientific Advisory Committee Spotlight

Grant D. Searchfield, PhD Grant Searchfield has been an audiologist since 1994 and obtained his Doctorate in Audiology in 2004.

He is deputy director of the Eisdell Moore Centre for hearing and balance research based in Auckland, New Zealand. He is a primary investigator in Auckland University’s Centre for Brain Research and scientific director of Tinnitus Tunes, an online tinnitus resource. Searchfield is also an associate professor in the audiology section of the University of Auckland.

He also serves as an associate editor for the International Journal of Audiology, Scientific Reports, and Frontiers in Neuroscience and Psychology. Searchfield is well known internationally for his research investigating the use of sound and hearing aids for tinnitus management.

In addition to his tinnitus research, he is the lead investigator in a major multisite trial of hearing aids as a potential method to slow cognitive decline, which is being funded by the Health Research Council of New Zealand.

Inspiration Behind Pursuing Tinnitus Research As a new audiologist working within a hospital otolaryngology department, I frequently encountered patients with www.ATA.org

tinnitus for whom it had taken a great toll on their lives. At the time, I didn’t feel that I had the tools to help much.

Once I began looking to improve my clinical skills, it became clear that there was fascinating tinnitus research happening and I also had some good ideas to test. I already had a desire to pursue a research career, which was fostered by an ENT colleague, Dr. Ron Goodey, and my academic mentor, Professor Peter Thorne; but, the focus on tinnitus was cemented by encouragement from Professors Mary Meikle and Jack Vernon when I first met them in Portland in 1995.

The last 25 years have been hard, but satisfying, work helped along the way by many supporters, including the ATA.

What Might the Next Five Years Hold?

I am very optimistic that we will make great advancements in tinnitus in the next five to 10 years. At present, few tinnitus therapies are personalized; however, there is an opportunity to move from one-size-fits-all treatment models to individualized, tailored solutions. Behavioral and physiological predictors of treatment benefit are at an early stage, but they are beginning to aid therapy selection and predict treatment outcome. By drawing the physiological and behavioral changes

accompanying treatments together (e.g., electroencephalograms and tinnitus distress), a significant knowledge gap should be filled.

When we achieve this, we will be in a much better position to prescribe a therapy or treatment based on the individual’s needs and tinnitus.

Tinnitus-related neurophysiology is complex, meaning that multiple therapies and medications may be needed in different combinations for different people. It appears that individuals respond better to some sound therapies than to others; this variance may be underpinned by different tinnitus mechanisms, personal preferences, and individual circumstances.

International collaboration in tinnitus research is essential to enable the breakthroughs that tinnitus patients need and want.

Such work benefits from the diversity of knowledge across the globe, but it is challenging when research funding for tinnitus lags behind that of many other fields. It is incredibly important that tinnitus patients, organizations such as ATA, and scientists work together to drive public awareness of how debilitating tinnitus can be and encourage investment in a shared vision for effective tinnitus therapies and the goal of cures.

TINNITUS TODAY WINTER 2021

37

 TINNITUS RESOURCES

The Behavioral Neuroscience of Tinnitus: Progress and Hope for the Future of Tinnitus Treatments Review by Grant D. Searchfield, PhD

The origins of tinnitus and the development of effective treatments for tinnitus have puzzled scientists and clinicians for centuries. New technologies and understandings of the brain and auditory system are beginning to unlock the secrets of tinnitus. Recently, Professor Jinsheng Zhang (Wayne State University, Detroit) and I had the privilege of working with some of the world’s most esteemed tinnitus experts to create a book exploring these recent developments.

The book, primarily a reference textbook for researchers and clinicians, highlights the progress and hopes for future tinnitus treatments important for tinnitus sufferers. Each chapter represents the most important contemporary perspectives of tinnitus, with an emphasis on work toward the development of new diagnostics and therapeutics. New and emerging innovative approaches are covered whenever possible.

Six main topics are discussed in detail, providing insights into 38

TINNITUS TODAY WINTER 2021

(1) etiology, (2) mechanisms of tinnitus, (3) new biomarkers for objective and reliable diagnosis of tinnitus, (4) pharmacological and bioengineering advances toward cures, (5) psychotherapy methods, and (6) clinical assessment.

The book’s chapters cover the details of the main topics: “Epidemiology of Tinnitus” examines the current understanding of the population with tinnitus, and determinants of effect are reviewed (see p. 49 for more on this topic).

“Genetic Inheritance and Its Contribution to Tinnitus” reviews the genetics of tinnitus. “Pharmacological Evaluation of Drugs in Animal Models of Tinnitus” summarizes studies on pharmacological tinnitus treatment in different animal models. “Animal Models of Cochlear and Brain Stimulation Effects on Tinnitus” focuses on the modeling of electrical sensory and brain stimulation effects on tinnitus in animals. “Functional Neuroanatomy of Salicylate- and Noise-Induced Tinnitus and Hyperacusis” reviews

the development of different forms of biomarkers and mechanisms for tinnitus. “Neuroinflammation and Tinnitus” considers new discoveries about the role of inflammation in tinnitus. “Using Big Data to Guide Therapy Development” describes how the use of large data sets can inform treatments by exploring patterns in the tinnitus population.

“Pharmacotherapy of Tinnitus” describes pharmacotherapy and neuromodulation for tinnitus. “Sense and Sensibility” explores sound therapy and its mechanisms. “Brain Stimulation” examines invasive and noninvasive brain stimulation as a treatment. “Bimodal AuditoryElectrical Stimulation for the Treatment of Tinnitus: Pre-Clinical and Clinical Studies” reviews the combined use of somatosensory and auditory bimodal stimulation. “Neurobiology of Stress Induced Tinnitus” reviews stressinduced tinnitus and its modulation.

The behavioral correlates of tinnitus are summarized in “Psychological Comorbidities of Tinnitus,” which also covers the role of psychological

www.ATA.org

TINNITUS RESOURCES 

assessment in clinical management of tinnitus. “Psychosocial Variables That Predict Chronic and Disabling Tinnitus” systematically reviews how individual psychology influences tinnitus. “Momentary Analysis of Tinnitus: Considering the Patient” describes clinical assessment of tinnitus, including use of frequent measurements in the real world.

“Tinnitus Questionnaires for Research and Clinical Use” reflects on the different questionnaire-based tinnitus assessment methods and their use. “Principles and Methods for Psychoacoustic Evaluation of Tinnitus” reviews tinnitus matching methods and their value.

The final chapter presents a consensus from the contributing authors on some of the most exciting advancements in the field of tinnitus.

It has an optimistic message for tinnitus sufferers: More effective and targeted therapies are coming.

Advanced neuroimaging technology has shown tinnitus is associated with changes in neuronal activity and connectivity involving multiple brain regions. This means it is unlikely that tinnitus originates from a single source but is

rather a complex interplay of sensory, memory, emotion, and attention areas of the brain. Many of the chapter authors illustrate how these discoveries are leading to targets for different treatments and therapy.

Researchers realize that what individuals with tinnitus want is a cure. The most effective therapies in the future may be “polytherapeutics” or “multimodal.” A polytherapeutic approach does not use one drug, or therapy, but a combination that targets different origins, processes, and modulators of tinnitus. For example, a medication targeting the ear may be partially effective, but when coupled with sound

therapy or neuromodulation, it may be potentiated or each therapeutic element will switch off or turn down different tinnitus activities.

I hope that the book captures the tremendous progress that has been made in understanding tinnitus and that the developments will be encouraging for people experiencing tinnitus.

Grant D. Searchfield obtained his PhD from the University of Auckland, New Zealand, where he is an associate professor in audiology. He is director of the university’s Hearing and Tinnitus Clinic and deputy director of the Eisdell Moore Centre for Hearing and Balance Research. He began his association with the ATA in 1995 as an attendee of the Fifth International Tinnitus Seminar in Portland, Oregon, where he first met Jack Vernon and Mary Meikle. Searchfield is a current member of the Scientific Committee of the Tinnitus Research Initiative and ATA Scientific Advisory Committee, and he is a past recipient of ATA research funding.

His research for the last 20 years has focused on how to improve tinnitus sound therapy.

The Behavioral Neuroscience of Tinnitus ISBN-13 9783030855024 Current Topics in Behavioral Neurosciences Springer Nature Switzerland AG

Letters to the ATA 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.

www.ATA.org

TINNITUS TODAY WINTER 2021

 39



ATA NEWS

Over-the-Counter Hearing Aids Coming to a Store Near You

By Marilyn Richmond, JD and ATA Government Advocacy Liaison

Over-the-counter hearing aids have been the subject of consumer discussion, debate, and uncertainty for some time. This is hardly surprising considering that, according to some estimates, about 15 percent of Americans (37.5 million) age 18 and over have trouble hearing. For older individuals, hearing loss is one of the most common conditions, and hearing problems can be associated with depression, dementia, and risk of falls. With the pandemic, which necessitates mask usage and social distancing, communication has become even harder for those with hearing difficulties.

But, for various reasons, only about one-fifth of people who could benefit from a hearing aid use one. Mainly, hearing aids are not affordable for most Americans. By some estimates, the average price of a pair of hearing aids is $5,000 or more, and Medicare and most insurance policies do not cover them. Also, hearing aids must be prescribed by a qualified professional. And the fact that there are very few companies in the hearing aid market leads to higher prices and less innovation.

In a major step toward addressing hearing loss and hearing aid accessibility, the Food and Drug Administration (FDA), on October 19, 2021, moved forward with its longawaited proposed rule to establish

How to Comment On the Proposed FDA Over-the-Counter Hearing Aids Regulations The Food and Drug Administration is accepting comments from the public on “Medical Devices; Ear, Nose, and Throat Devices; Establishing Over-the-Counter Hearing Aids and Aligning Other Regulations” through January 18, 2022. Use the following link, https://www.regulations.gov/ docket/FDA-2021-N-0555/document, or search for FDA-2021-N-0555 to comment on https://www.regulations.gov. Note that your name and comment can be read by others.

40

TINNITUS TODAY WINTER 2021

a new category of over-the-counter (OTC) hearing aids. It should be noted that hearing aids are medical devices regulated by the FDA and subject to state and federal law. They are designed to improve hearing by making sound audible to people with hearing loss.

It is important to understand that this FDA OTC proposal is not a final rule. Rather, it opens a comment period during which all public comments will be considered. When the comment period closes, the FDA must issue a final rule within 180 days.

If finalized, the rule will establish a new category of OTC hearing aids that can be sold directly to consumers in stores or online without a medical exam or a fitting by a hearing professional. The OTC hearing aid rule will apply to air-conduction hearing aids that are intended for adults age 18 and older who have perceived mild to moderate hearing loss. Hearing aids for severe hearing loss will continue to be prescription devices.

The FDA approval process will ensure that the new OTC hearing aids are safe and effective, have appropriate output limits, and provide www.ATA.org

ATA NEWS 

necessary labeling for consumers. OTC hearing aids will likely be available to consumers sometime in 2022.

In the meantime, consumers have been rightly confused by company advertising that suggests OTC products that address hearing loss are already available. Often, the advertised devices are personal sound amplification products (PSAPs) meant for recreational use as a way to enhance sound for a person without hearing loss.

The FDA became so concerned about these company claims that it issued a statement on July 24, 2018, making it clear that there are currently no OTC hearing aid products on the market that can claim to address hearing loss. Along with the newly proposed OTC rule, the FDA has issued draft guidance to define the difference between a hearing aid and a PSAP.

The debate over OTC hearing aids actually began years ago with action by two of the nation’s most renowned policy organizations. In 2015 and 2016, the President’s Council of Advisors on Science and Technology and the National Academy of Sciences heard testimony from a host of consumers, providers, and manufacturers; identified age-related hearing loss as a substantial national problem; and made recommendations about how to improve access to and affordability of hearing aids.

On August 18, 2017, Congress passed the Over-the-Counter (OTC) Hearing Aid Act, with overwhelming bipartisan support. This law established the requirements for FDA regulation of OTC hearing aids and set deadlines for action. Though all of these deadlines are long past, the proposed OTC rule is finally becoming a reality. The FDA’s newly proposed OTC hearing aid rule is in direct response to President Biden’s Executive Order on July 9,

2021, requiring the FDA to act within 120 days.

Though they have been many years in the making, over-the-counter hearing aids will soon bring relief to many Americans suffering with hearing loss.

Marilyn Richmond, JD, has represented the American Tinnitus Association since 2019 as a tinnitus advocate on the Hill. After working many years as a government relations professional and attorney, with extensive experience in the executive branch, on Capitol Hill, and with major professional associations, she launched her own consulting agency. She specializes in developing shortand long-term policy objectives and political strategies to advance client interests.

Richmond has a law degree from the Georgetown University Law Center and an undergraduate degree from the University of Florida.

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 you have tinnitus as well as hyperacusis, misophonia, or sound sensitivity, we’d like to hear from you. We’re also looking for stories from people who have tried various treatments and/or products for tinnitus relief. Please send your story to editor@ata.org by January 30. Suggested word length is between 500 and 800 words.

www.ATA.org

TINNITUS TODAY WINTER 2021

41

 TINNITUS RESOURCES

Understanding FDA Terms: Approved, Authorized, and Cleared How Some Tinnitus Products Make It to Market

By Joy Onozuka

The U.S. Food and Drug Administration looks after public health by reviewing safety and testing data on foods, human and animal drugs, cosmetics, and dietary supplements in order to assure us that these products are safe and effective. It also regulates the tobacco industry and protects the public from electronic product radiation.

What Does “FDA Approved” Mean?

When a product receives FDA approval, it means the FDA has reviewed the safety and effectiveness data on that product and has officially decided that the product’s benefits outweigh the known risks for its intended use. To 42

TINNITUS TODAY WINTER 2021

get FDA approval, manufacturers must submit a premarket approval (PMA) application and the results of clinical testing.

It’s important to note that the FDA is not involved in the development or the testing of any of the products it evaluates. Instead, it reviews the results of independent lab and clinical testing supplied by the manufacturer to determine whether a product, drug, or food additive is as safe and effective as the manufacturer claims.

FDA approval to sell or market products in the United States is usually required for any product that might pose significant risk of injury or illness as well as for products that can benefit public health, such as prescription medications, over-thecounter medications, vaccines, and Class III medical devices (e.g., a heart valve, pacemaker, breast implant).1,2 However, not all products undergo premarket approval by the FDA. In some cases, the FDA may review a product after it is already on the market. Even when FDA approval is not required before a product is sold, such as the case with supplements, cosmetics, and Class I medical devices, the agency has regulatory authority to act if safety issues arise with that product.3 It’s important to note that not all

products approved or cleared by the FDA are necessarily safe.

What Does “FDA Authorized” Mean?

The FDA can authorize use of a product in an emergency, such as during a pandemic, if the benefits of the product’s use outweigh any known potential risks and there are no other options already approved and available for that use. We saw this with the emergency use authorization (EUA) for Covid-19 vaccinations, which were authorized by the FDA after review of clinical trial data, which demonstrated safety and efficacy, for each vaccine. Products that are authorized for emergency use by the FDA have not undergone the full FDA approval process.

What Does “FDA Cleared” Mean?

The term FDA cleared applies to medical devices; medical devices are not simply approved by the FDA but must be cleared for a specific indication. A medical device that has received FDA clearance means that it has been fully tested by an independent testing facility to verify its efficacy and that it meets the FDA’s requirements.4

www.ATA.org

TINNITUS RESOURCES 

The FDA classifies medical devices into three risk categories: Class I, low risk (e.g., tongue depressor); Class II, moderate risk (e.g., electric-powered wheelchair); and Class III, significant risk (e.g., implantable devices such as a pacemaker or heart valve).

According to the FDA, 47 percent of medical devices fall into Class I and are exempt from the regulatory process, while 43 percent fall into

Class II. The 10 percent of products that generally help sustain life, that is, they carry significant risk, fall into Class III and are required to have FDA approval prior to being put on the market.

A new product can be cleared (as opposed to approved) by the FDA if the manufacturer can show that it is similar enough to other products that have already been reviewed.

Manufacturers of novel products that fall into Class I or II can apply for

de novo classification, as was done for the Bose hearing aid in 2018.

1 About FDA product approval. U.S. Food and Drug Administration. Retrieved from https://www.fda. gov/news-events/approvals-fda-regulated-products/ about-fda-product-approval 2 Learn if a medical device has been cleared by FDA for marketing. U.S. Food and Drug Administration.

Retrieved from https://www.fda.gov/medicaldevices/consumers-medical-devices/learn-ifmedical-device-has-been-cleared-fda-marketing 3 Approvals of FDA-regulated products. U.S. Food and Drug Administration. Retrieved from https://www.fda.gov/news-events/approvals-fdaregulated-products 4 FDA approved, FDA cleared, FDA registered, what’s the difference? Contour Light. Retrieved from https://contourlight.com/fda-approved-fda-clearedfda-registered-whats-the-difference

Interested in Attending Tinnitus Research Lectures?

TRI Academy Online Seminar Series The Tinnitus Research Initiative (TRI) is hosting an open-access online seminar series featuring tinnitus researchers from around the world. To register for live lectures, see https://www.tinnitusresearch.net/ index.php (Past presentations can be accessed via the TRI Academy YouTube channel.)

Online Lecture Schedule Date Dec. 15, 2021 Jan. 19, 2022 Feb. 16, 2022 Mar. 16, 2022 Apr. 20, 2022 May 18, 2022 www.ATA.org

Topic

Featured Speaker

Counseling

Martin Schecklmann, PhD

Cognitive Behavioral Therapy

Derek Hoare, PhD

Pharmacological Treatment

Belén Elgoyhen, PhD

Neuromodulation

Laure Jacquemin, AuD/Stefan Schoisswohl, PhD

Are Hearing Aids Still a Valid Treatment for Tinnitus?

Steven Marcrum, AuD, PhD

Sound Stimulation

Patrick Neff, PhD

Pulsatile Tinnitus: Diagnosis and Treatment

Jae Jin Song, PhD

Objective Tinnitus: Diagnosis and Treatment

Emmanuel Houdart, PhD

Somatic Tinnitus

Sarah Michiels, PhD

Bimodal Stimulation

Hubert Lim, PhD

Evidence-Based Medicine

Alain Londero, MD

Alternative Medicine

Deborah Hall, PhD TINNITUS TODAY WINTER 2021

43

 SCIENCE & RESEARCH NEWS

Predicting Tinnitus Severity With MRI Summary by John A. Coverstone, AuD

Studying tinnitus in the brain has always been difficult. Scientists have tried to discover where tinnitus occurs in the brain, how tinnitus affects specific areas of the brain, and what triggers and sustains tinnitus. This research often involves methods of imaging, including magnetic resonance imaging (MRI, which creates an image of brain tissue), functional MRI (fMRI, which measures blood flow that indicates brain activity), and computed tomography (CT, which provides images of both hard and soft tissue).

Using imaging techniques to study tinnitus is especially difficult because relative differences seen between images may or may not be due to tinnitus. Carefully choosing research participants for control groups is key to addressing this difficulty. For example, imaging differences are seen between: females and males, children and adults, and people with certain health conditions versus those without them. Further, hearing ability, other auditory problems, and any history of conditions affecting brain function (injury, mental health conditions) can complicate the interpretation of images.

Researchers at the University of Illinois, in cooperation with those at

44

TINNITUS TODAY WINTER 2021

Ball State University and Columbia University, used fMRI in an attempt to measure presence and severity of tinnitus in four areas of the brain previously shown to be involved with tinnitus.1 Of the 91 participants, 60 had tinnitus and 31 (controls) did not. The tinnitus group was purposely larger to control for various types and severity of tinnitus as well as other factors, such as degree of hearing loss. To eliminate factors that might confound the results, study candidates were screened for other health conditions, including psychological disorders and history of traumatic brain injury.

Participants received an audiology examination, including a hearing test at ultra-high frequencies up to

16 kHz – the full range of human hearing (typical hearing exams only test up to 8 kHz). Those with tinnitus completed the Tinnitus Functional Index to gauge tinnitus severity.

Participants also completed the Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory; results from all these tests showed no significant differences between the tinnitus and non-tinnitus groups.

Traditional fMRI uses a contrast agent to enhance the image of blood flow in the brain. One brain region is compared to another region to see which region has higher blood flow, which would imply more brain activity.

Rather than using a contrast agent, these authors used a noninvasive technique called arterial spin labeling

Investigating tinnitus, blood flow and the brain.

B. J. Zimmerman, S. A. Schmidt, R. A. Khan, Y. Tai, S. Shahsavarani, & F. T. Husain. (2021). Decreased resting perfusion in precuneus and posterior cingulate cortex predicts tinnitus severity. Current Research in Neurobiology, 2(2021), 100010. https://doi.org/10.1016/j.crneur.2021.100010

www.ATA.org

SCIENCE & RESEARCH NEWS 

L

S R

I

P

A A L

I

120

S

R I

Perfusion (mL /100g tissue / min)

Figure 1: Higher tinnitus severity, measured by Tinnitus Functional Index, predicted lower perfusion in the precuneus

0

(ASL) to quantify blood flow. With ASL, the protons in arterial blood are labeled (“magnetized”) by radiofrequency pulses. ASL allows absolute measures of brain activity, whereas traditional fMRI techniques are relative measures, as described earlier.

To employ ASL techniques, an image is taken when the brain tissue is magnetized. This is called the tag image. Another image is taken without magnetization, called the control image. The tag image is subtracted from the control image to create what is called the perfusion (passage of blood) image that reflects the amount of blood delivered to each point in the image. The benefit of an absolute measurement of blood flowing into brain regions is that these measurements may be more easily compared across participants.

Relative measurements cannot be easily compared.

Analysis of differences between tinnitus and control groups showed

that perfusion (blood flow into a studied region of the brain) was more reduced for the group with tinnitus than for the control group.

This was true for measurements of both gray matter and white matter overall, as well as in the precuneus – an area of the brain implicated in memory retrieval, perception of the environment, and mental imagery.

Gray matter in the brain is responsible for processing information, while white matter enables communication

To learn more about how tinnitus may impact blood flow in the brain, watch a short video, narrated by Dr. Fatima Husain, who also serves as chair of the ATA’s Scientific Advisory Committee: https://twitter.com/BeckmanInst/status/1427994342124408837

www.ATA.org

Figure 2: Higher tinnitus severity, measured by Tinnitus Functional Index, predicted lower perfusion in the posterior cingulate 0

15

40

55

30

between brain regions and between the brain and the body. The decreased blood flow with the tinnitus group occurred independently of hearing loss, gender, and age, although it was noted that the range of ages was not large in this study. Further, increased severity of tinnitus was associated with decreased blood flow.

It is not clear why perfusion was associated with tinnitus. Does tinnitus lead to changes in the brain that affect perfusion or does decreased perfusion lead to or make tinnitus more likely?

The authors noted that their population was too small to completely study the effects of age and gender, both of which have been shown in previous studies to affect perfusion of blood into brain tissue (men overall have lower rates of perfusion than do women, as do older compared to younger individuals). The finding that the rate of perfusion correlated with tinnitus severity is promising for future lines of research to study the presence of tinnitus in the brain.

1 B. J. Zimmerman, S. A. Schmidt, R. A. Khan, Y. Tai, S. Shahsavarani, & F. T. Husain. (2021). Decreased resting perfusion in precuneus and posterior cingulate cortex predicts tinnitus severity. Current Research in Neurobiology, 2(2021), 100010. https:// doi.org/10.1016/j.crneur.2021.100010

TINNITUS TODAY WINTER 2021

45

 SCIENCE & RESEARCH NEWS

More Exercise, Less Tinnitus Distress?

By Fatima T. Husain, PhD

Patients with bothersome tinnitus have often turned to exercise to improve their quality of life and reduce the negative impact of tinnitus. In an earlier survey study, we found that those reporting milder tinnitus symptoms also reported higher levels of physical activity.1 Severe tinnitus has a negative effect on quality of life, whereas exercise boosts quality of life.

Later, we conducted a brain imaging investigation using magnetic resonance imaging (MRI) to investigate possible differences in neural mechanisms between those with mild tinnitus and those with bothersome tinnitus.2 We noted that those with mild tinnitus who also

46

TINNITUS TODAY WINTER 2021

reported higher physical activity levels exhibited greater engagement of the attention network and reduced engagement of the emotional processing network compared to those with bothersome tinnitus and lower levels of physical activity.

But what underlies this connection between exercise and tinnitus? Is there any direct evidence for a link between exercise and tinnitus?

Our current research sheds some light on this (see page 44 for a research summary). We used a magnetic resonance sequence called arterial spin labeling that is a noninvasive way to estimate regional blood flow in the brain. We compared brain blood flow measures between individuals with tinnitus and controls.3

We found that, in general, global cerebral blood flow is reduced in tinnitus. We tested for the effect of tinnitus severity and blood flow in specific brain regions, for which we had a priori hypotheses. We found that the severity of tinnitus was associated with further reductions in global cerebral blood flow as well as reduced blood flow in the brain regions of the precuneus and posterior cingulate cortex. The presence of hearing loss also resulted in further reductions in cerebral blood flow. These results point to a possible mitigation strategy for bothersome tinnitus: namely, an intervention that boosts cerebral blood flow.

Reductions in cerebral blood flow are seen in other conditions,

www.ATA.org

SCIENCE & RESEARCH NEWS 

particularly in aging. Interestingly, exercise remains an optimal method to boost cerebral blood flow and improve quality of life. Many studies on aging have investigated the effect of exercise on cognitive health.

But what type of exercise is most effective? In increasing blood flow to the brain, aerobic exercise, even in short bouts, appears to help.

Note that although we consider aerobic exercise here because of the way it affects blood flow and brain health, different modes of exercise exert benefits via distinct mechanisms. In consideration of this, we suggest that engaging in different types of physical exercise can lead to the greatest benefits for brain health.4 By extension, one can argue that some form of exercise can be useful in ameliorating bothersome tinnitus.

Future studies that investigate the impact of various forms of physical exercise in reducing tinnitus-related symptoms, the mechanism by which they have this impact, and assessing the noise level of the said exercises are needed.

The good news is that, while we wait for such studies to be conducted, we can incorporate various forms of exercise that work for us, knowing that such exercises may improve not only tinnitus symptoms but also cognitive health.

Fatima Husain, PhD, is a cognitive and computational neuroscientist by training, with a special interest in speech and hearing.

She is also chair of the ATA’s Scientific

Advisory Committee. For the past 15 years, the major focus of her lab has been the study of tinnitus. Her lab at the University of Illinois at Urbana-Champaign has studied tinnitus using a variety of methods, from behavior and surveys to several types of brain imaging. Dr. Husain’s goal is to better understand the brain-based mechanisms of tinnitus with a view toward testing and improving existing treatment options and eventually developing customized treatment plans.

1 J. R. Carpenter-Thompson, E. McAuley, & F. T. Husain. (2015). Physical activity, tinnitus severity, and improved quality of life. Ear and Hearing, 36(5), 574–581.

2 J. R. Carpenter-Thompson, S. Schmidt, E. McAuley, & F. T. Husain. (2015). Increased frontal response may underlie decreased tinnitus severity. PLoS One, 10(12), e0144419.

3 B. J. Zimmerman, S. A. Schmidt, R. A. Khan, Y. Tai, S. Shahsavarani, & F. T. Husain. (2021). Decreased resting perfusion in precuneus and posterior cingulate cortex predicts tinnitus severity. Current Research in Neurobiology, 2(2021), 100010. https:// doi.org/10.1016/j.crneur.2021.100010 4 D. F. Cabral, J. Rice, T. P. Morris, T. Rundek, A. Pascual-Leone, & J. Gomes-Osman. (2019). Exercise for brain health: An investigation into the underlying mechanisms guided by dose. Neurotherapeutics, 16, 580–599.

Insufficient research No clear definition Why is there no cure for tinnitus yet?

Unclear epidemiology Unclear mechanisms Multiple subtypes No objective measure From Dr. David M. Baguley’s presentation, given on Sept. 10, 2021, at the Andermatt Hearing Forum held in Switzerland.

www.ATA.org

TINNITUS TODAY WINTER 2021

47

ADVERTISEMENT

Breakthrough Evidence-Based Tinnitus Treatment

Neuromod Devices Ltd. has developed a noninvasive medical device that uses bimodal neuromodulation to treat tinnitus symptoms.

The device is CE-marked for use in Europe but is currently unavailable in the United States.

Neuromod is working to secure approval from the U.S. Food and Drug Administration to make the device available as soon as possible.

View our research at www.neuromoddevices.com/tenta1results

SPECIAL FEATURE



How Many People Are Affected by Tinnitus?

Priority Areas for Epidemiological Research

By Roshni Biswas, MBBS, PhD, MPH, and Deborah Hall, PhD

As the global pandemic rages on, epidemiological concepts and forecasting methods have been in the public eye for some time now. Starting from behavioral prevention methods such as wearing face masks, washing hands, maintaining social distance, and restricting movement, epidemiological research is now guiding national policy decisions about surveillance, screening, and vaccination. But what is epidemiology? Is it only beneficial in identifying the impact of communicable diseases, such as Covid-19? Or can epidemiological research methods be used in the context of noncommunicable conditions, such as hearing loss and tinnitus, too?

Epidemiology identifies the distribution and determinants of health-related states and methods for their control. Epidemiological research helps us answer populationbased questions such as “How many people are affected by tinnitus nationally and globally?” “Has the trend been increasing or decreasing over time?” and “What factors make one sector of the population more vulnerable than another?” From our critical evaluation of the published literature, we recognize the gaps in our understanding, and from this we’ve www.ATA.org

identified several priority areas for epidemiological research on tinnitus.

What Do We Know?

Tinnitus prevalence describes the proportion of existing tinnitus cases in the population at a point in time. Most population-based studies estimate tinnitus prevalence as between 10 percent and 15 percent. Prevalence estimates help us to understand the true impact of tinnitus on social, healthcare, and financial resources.

For tinnitus, this is particularly relevant because, from the World Health Organization (WHO) Global Burden of Disease study, we know that people rate a hearing health state with tinnitus as causing greater disability than a hearing health state without tinnitus.1 Prevalence studies often address tinnitus burden directly by asking people to rate how bothersome the condition is. Unsurprisingly, for severe tinnitus the prevalence estimate decreases, typically to around 2 percent to 3 percent, meaning there are fewer cases.

But the more debilitating form presents the greatest public health concern because severe tinnitus has substantial negative psychological and socioeconomic impacts.

Tinnitus incidence describes only those new cases to emerge over a certain period. Estimates of incidence help determine vulnerable

populations by identifying trends in newly developing tinnitus cases.

Incidence studies can also guide the exploration of what risk factors predispose individuals to develop tinnitus. Possible risk factors could be behaviors, exposures, or other diseases. The most widely reported risk factor for tinnitus is hearing loss, either a hearing impairment measured by pure tone audiometry or a selfreported hearing difficulty. Related to this, occupational or leisure noise exposures are also known to increase risk of tinnitus, probably through their negative impacts on hearing.

Both prevalence and incidence are important epidemiological measures for understanding tinnitus.

What Do We Not Know?

Reported prevalence estimates may not be a true reflection of the global picture because most of these studies have been conducted in western Europe, North America, and Australia. WHO recognizes that additional research is needed to gain a deeper understanding of hearing loss prevalence, concurrence with tinnitus, and hearing aid coverage in areas where data are limited.1 Apart from hearing loss and noise exposure, risk factors of interest TINNITUS TODAY WINTER 2021

49

SPECIAL FEATURE



include demographic characteristics (sex, age), otological conditions (infections, neoplasms) and ototoxic medications, neurological conditions (migraine, meningitis, epilepsy), psychological conditions (anxiety, depression), trauma (head and neck injury), comorbidities (hypertension, diabetes), lifestyle factors (smoking, alcohol, obesity), and, most recently, Covid-19. Unfortunately, there is not enough evidence to know whether these factors cause tinnitus or are merely associated with tinnitus via other intermediary factors. For example, traditionally men are more likely than women to engage in noisy leisure activities (such as going to baseball games or shooting ranges) and more likely to be employed in noisy workplaces (such as logging or construction sites). Therefore, “being male” might not in itself increase the

Study designs, timeline for risk factors and tinnitus, and strength of evidence.

COHORT STUDY

STRENGTH OF EVIDENCE

RISK FACTORS

TINNITUS

CASE-CONTROL STUDY RISK TINNITUS FACTORS

RISK FACTORS

CROSSSECTIONAL STUDY

TINNITUS TIME

50

TINNITUS TODAY WINTER 2021

risk of tinnitus but rather being exposed to intense noise does, so “being male” might be a factor associated with tinnitus via another intermediary factor.

What Are the Challenges?

There are several notable challenges for epidemiological research on tinnitus. Ideally, researchers would pool prevalence estimates from studies conducted across the world to derive a single global (or regional) prevalence estimate. However, not all studies measure the same concept of tinnitus, and this prevents epidemiologists from pooling data because we cannot combine “apples and oranges.”

Assessment questions mentioning the duration of tinnitus symptoms (i.e., lasting for five minutes) and time frame (i.e., in the last 12 months) give the most reliable estimates of tinnitus prevalence.2 Such wording distinguishes an isolated transient tinnitus episode from a long-lasting tinnitus. Similar diversity has also been observed for definitions of severe tinnitus. While many studies ask how bothered, annoyed, or worried it made the individual, not all severity assessment questions include all three emotional descriptors.

Prevalence estimates for tinnitus need to be reliable so that findings across studies can be compared and meaningfully interpreted. In 2019,

Biswas and colleagues therefore proposed two standardized questions in English for estimating tinnitus prevalence and tinnitus severity, and the team has translated these into 11 European languages, including Spanish.3 If these standardized questions and response options were used in all future epidemiology studies, then the resulting estimates would more likely be reliable and precise.

Research Priorities As the previous section indicates, epidemiological research is plagued by methodological challenges and major gaps in our understanding that identify specific priorities for future tinnitus research. Endeavors to standardize study methods are needed. This would enhance the confidence in pooling prevalence and incidence estimates across studies and making comparisons between populations.

To establish tinnitus as a global problem, investigators should ensure that all world regions are adequately represented in data collection and reporting, especially Africa and Asia.

Risk factor analysis can shed some light on tinnitus etiology. However, greater efforts are needed to conduct appropriate studies in order to

www.ATA.org

SPECIAL FEATURE

better understand cause-and-effect relationships. From a methodological point of view, to establish causality, exposure to the risk factor should occur before the onset of tinnitus symptoms. Unfortunately, most tinnitus-related studies measure the risk factor and tinnitus simultaneously (cross-sectional design) and this provides the lowest level of evidence for causal inference. (See box on page 52.) Instead of more cross-sectional research, efforts should be directed to cohort studies in which tinnitus-free individuals are followed over time to assess the development of tinnitus and to estimate which risk exposures are most likely to have precipitated that change. This study design provides the highest level of evidence for causality.

In summary, to ensure adequate scientific and policy responses, it is vital to establish the impact of tinnitus at a population level. Lack of

an agreed prevalence estimate has been identified as a crucial barrier to engaging funders, policymakers, pharmaceutical companies, and other commercial organizations in research and clinical practice. Knowledge about risk factors can guide the implementation of preventive strategies to curtail the growth in the number of new cases and prevent the aggravation of symptoms. For example, such information can help identify high-risk populations and guide them to modify their health behaviors and manage their physical health to fit their needs. Exploring the relationship between risk factors common to other prevalent communicable and noncommunicable diseases could also raise the profile of tinnitus by linking the condition to other betterfunded health priority areas, such as Covid-19, smoking, unhealthy alcohol consumption, obesity, and healthy aging.

What’s the value in asking, “Have you experienced tinnitus for more than 5 minutes in the past year?”

In epidemiological research, the aim is to identify the proportion of population affected by a condition. An isolated experience of tinnitus is not equivalent to being affected by tinnitus long term and constantly. In our lifetime, most of us have had at least one acute short-term episode of tinnitus immediately following some trigger, such as exposure to loud noise in a recreational setting. This isolated event does not affect our overall health, and has no societal impact as such.

The above question provides the most reliable estimate of tinnitus for epidemiological research. It identifies those for whom tinnitus is chronic. However, this question still does not address the public health perspective, where the main concern is about the psychological and socioeconomic impacts. To understand this aspect requires a follow-up question about severity of the tinnitus symptoms and healthcare resource use. (See Biswas et al., 2019.)2

www.ATA.org



Roshni Biswas, MBBS, PhD, MPH, is currently a postdoctoral scholar in the Department of Neurology at the University of California, Irvine. She recently completed her PhD in epidemiology and public health from the University of Nottingham, UK, under the Marie Sklodowska Curie Actions’ fellowship. Her PhD thesis was on tinnitus epidemiology. Prior to this, she earned her Bachelor of Medicine, Bachelor of Surgery degree in India and her Master of Public Health degree from the George Washington University, in Washington, D.C. She is an epidemiologist and medical doctor with an interest in cognitive aging, noncommunicable conditions, and modifiable factors.

Deborah Hall, PhD, is a professor of positive psychology and head of the Department of Psychology at Heriot-Watt University Malaysia.

Over the past 25 years, her research has spanned a range of topics on individual and societal well-being. She is recognized as a world-leading expert on tinnitus, but past research projects also include the relevance of positive soundscapes, developing a manualized psychological treatment to upskill audiologists in the National Health Service (NHS), and advocating to bring the public voice into clinical research.

1 GBD 2019 Hearing Loss Collaborators. (2021).

Hearing loss prevalence and years lived with disability, 1990–2019: Findings from the Global Burden of Disease Study 2019. The Lancet, 397(10278), 996–1009.

2 R. Biswas & D. A. Hall. (2020). Prevalence, incidence, and risk factors for tinnitus. In G. D. Searchfield & J. Zhang (Eds.), The behavioral neuroscience of tinnitus. Current Topics in Behavioral Neurosciences series (Vol. 51, pp. 3–28). Springer, Cham. https://doi.org/10.1007/7854_2020_154 3 R. Biswas, A. Lugo, S. Gallus, M. A. Akeroyd, & D. A. Hall. (2019). Standardized questions in English for estimating tinnitus prevalence and severity, hearing difficulty and usage of healthcare resources, and their translation into 11 European languages. Hearing Research, 377, 330–338.

TINNITUS TODAY WINTER 2021

51

HEALTHCARE PROVIDERS

Spotlight on Patient Providers Professional Members Listing current as November 1, 2021

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

UNITED STATES Alabama Jennifer S. Koczor, AuD, CH–TM Eastern Shore ENT Clinic Daphne, AL Susan Sheehy, AuD Alabama Hearing Associates Madison, AL

Alaska Emily McMahan, AuD, CH–TM Alaska Hearing & Tinnitus Center Anchorage, AK

Arizona Lynn Callaway, BC–HIS Affordable Hearing Solutions Green Valley, AZ Emily Densmore, AuD Sound Relief Hearing Center Scottsdale, AZ Judy Huch, AuD Oro Valley Audiology, Inc. Oro Valley, AZ Rachael Luckett, AuD Sound Relief Hearing Center Scottsdale, AZ

52

TINNITUS TODAY WINTER 2021

Sarah Pitrone, AuD Sound Relief Hearing Center Mesa, AZ

Amit Gosalia, AuD West Valley Hearing Center Woodland Hills, CA

David Velenovsky, PhD University of Arizona Tucson, AZ

Tracy Peck Holcomb, AuD The Hearing and Speech Center of Northern California San Francisco, CA

Peter Vernezze, MSW, PhD The Tinnitus Coach Tucson, AZ

Arkansas Kelley Linton, AuD, CH–TM Center for Hearing, Ltd Fort Smith, AR

California Kasra Abolhosseini, AuD Tustin Hearing Center Tustin, CA Melissa Alexander, AuD Alexander Audiology, Inc. Santa Monica, CA Joe Bartlett, BC–HIS Bartlett’s Hearing Aid Center Chico, CA Randall Bartlett, MA Tinnitus & Audiology Center of Southern California, Inc. Santa Clarita, CA Maryellen Brisson, AuD Hermosa Beach, CA Shahrzad Cohen, AuD, CH–TM Hearing Loss Solutions Sherman Oaks, CA David DeKriek, AuD Fidelity Hearing Center Cerritos, CA Gregory Frazer, AuD Pacific Hearing & Balance Center, Inc. Los Angeles, CA Jennifer J. Gans, PsyD Mindful Tinnitus Relief San Francisco, CA

Beverly Lew, AuD Sound Advice Burbank, CA Peter J. Marincovich, PhD Audiology Associates Santa Rosa, CA Sara Mattson, AuD Rancho Santa Fe Audiology Rancho Santa Fe, CA Kirsten McWilliams, AuD, CH–TM The Hearing Solution Sacramento, CA Amy Nelson, AuD, CH–TM Kaiser Permanente Santa Clara, CA Janine Newkirk, AuD, CH–TM Stanford Health Care Menlo Park, CA Joshua Nitenson, AuD, CH–TM Kaiser Permanente Sacramento, CA Marni Novick, AuD, CH–TM Silicon Valley Hearing, Inc Los Gatos, CA Angela O’Boyle, AuD Hearing Associates Inc. Northridge, CA Bruce Piner, AuD Hearing and Balance Center Encino, CA Brook Raguskus, AuD, CH–TM Pacific Hearing Service Los Altos, CA Samantha Ramirez, AuD Kaiser Permanente Redwood City, CA

www.ATA.org

HEALTHCARE PROVIDERS

Dena Riso, AuD Peninsula Hearing Center, Inc. San Diego, CA

Kevin McConnell, HIS Ideal Hearing Solutions LLC Lakewood, CO

Anne Carter, PhD, CH–TM Pasadena Hearing Care South Pasadena, FL

Jane Rosner, AuD West Valley Hearing Center Woodland Hills, CA

Abigail McMahon, AuD Sound Relief Hearing Center Fort Collins, CO

Maura Chippendale, AuD, CH–TM Chippendale Audiology Cape Coral, FL

Jessica D. Russell, MA The Hypnotherapy Centers Los Angeles, CA

Leah Mitchell, AuD Sound Relief Hearing Center Westminster, CO

Melissa Kipp Clark, AuD Suncoast Hearing Services Plus Bradenton, FL

Mimi Salamat, PhD Dr. Mimi’s Audiology Clinic Walnut Creek, CA

Natalie Phillips, AuD Advanced Otolaryngology & Audiology Fort Collins, CO

Ali Danesh, PhD Labyrinth Audiology Boca Raton, FL

William Stubbeman, MD TMS Psychiatry Los Angeles, CA

Drew Price, AuD Sound Relief Hearing Center Denver, CO

Kelly J. Dyson, AuD Suncoast Audiology, LLC Largo, FL

Christopher Sumer, NBC–HIS Coastal Hearing Aid Center Encinitas, CA

Julie Prutsman, AuD Sound Relief Hearing Center Highlands Ranch, CO

Melodi Fehl, MS ENT and Allergy Associates of Florida Boca Raton, FL

Ben Thompson, AuD Pure Tinnitus Berkeley, CA

Megan Read, AuD Sound Relief Hearing Center Highlands Ranch, CO

Lisa Gascay, AuD, CH–TM Rainbow River Hearing & Balance Inc. Dunnellon, FL

Brian Worden, MD Kaiser Permanente Woodland Hills, CA

Kenzie Reichert, AuD, CH–TM Sound Relief Hearing Center Highlands Ranch, CO

Karah Gottschalk, AuD NOVA Southeastern University Ft. Lauderdale, FL

Roger Wunderlich, MD (psychiatry) DSH-A, CA Dept. of State Hospitals Atascadero, CA

Jackie Smith, AuD Sound Relief Hearing Center Highlands Ranch, CO

Megan Labbe, AuD, CH–TM St. Luke’s Cataract and Laser Institute Tampa, FL

Mandi Solat, AuD, CH–TM Audiology Services & Hearing Aid Center Lakewood, CO

Sara Miers, AuD Jacksonville Speech & Hearing Center Jacksonville, FL

Robert M. Traynor, EdD, CH–TM Fort Collins, CO

Kelly Murphy, AuD, CH–TM Murphy Hearing Aids of Sarasota Sarasota, FL

Colorado Brian Bennett, BC–HIS Colorado Hearing Montrose, CO Lindsay Collins, AuD Sound Relief Hearing Center Centennial, CO Terry Cummings, AuD, CH–TM Columbine Audiology and Hearing Aid Center Sterling, CO Julie Eschenbrenner, AuD Flatirons Audiology, Inc. Lafayette, CO Kaela Fasman, AuD, CH–TM Sound Relief Hearing Center Golden, CO Emily Hensarling, AuD, CH–TM Kaiser Permanente Lone Tree, CO Tony Kovacs, AuD, CH–TM Sound Relief Hearing Center Fort Collins, CO Alison LaBrec, AuD Sound Relief Hearing Center Golden, CO

www.ATA.org

Connecticut Natan Bauman, EdD Auditory and Vestibular Institute of New England Hamden, CT Steven Lurie, PhD Torrington, CT

District of Columbia Patricia T. Demont, PhD Washington, DC

Delaware Megan E. Boehler, AuD Bayside Audiology & Hearing Aids Lewes, DE

Florida Indira Alvarez, AuD Palm Coast Hearing Center Palm Coast, FL

Janice T. Powis, AuD Mind Over Tinnitus St. Augustine, FL Cindy Ann Simon, AuD South Miami Audiology Consultants South Miami, FL Mindy Stejskal, MCD The Hearing Center Pensacola, FL Susan E. 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

TINNITUS TODAY WINTER 2021

53

HEALTHCARE PROVIDERS

Georgia Laura Barber, AuD, CH–TM Augusta University Health–Audiology Associates Augusta, GA Christopher V. Campellone, HIS GoToHearing Gainesville GA Sonia Hamidi, AuD, CH–TM ENT Institute Buford, GA Jan Henriquez, AuD At Home Hearing Woodstock, GA Liz Ramos, AuD, CH–TM ENT of Georgia/Advanced Hearing Atlanta, GA Nikki Weaver, AuD Fayette Hearing Clinic and Coweta Hearing Clinic Peachtree City, GA Melissa Wikoff, AuD, CH–TM Peachtree Hearing Marietta, GA

Hawaii Amanda Seeley, AuD Advanced Pacific ENT Wailuku, HI

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

Beki Kellogg, AuD Hope Hearing & Tinnitus Center Hiawatha, IA

Dawn Heiman, AuD Advanced Audiology Consultants Woodridge, IL

Jill Nesham, AuD Professional Hearing Solutions by Dr. Jill Cedar Rapids, IA

Jill Meltzer, AuD, CH–TM Jill Meltzer, AuD Consulting PLLC Northbrook, IL

Heather Thatcher, HIS Hope Hearing & Tinnitus Center Hiawatha, IA

Janaan S. Moore, AuD Michigan Avenue Hearing Health Chicago, IL Maria Morrison, AuD, CH–TM Geneva Hearing Services Geneva, IL Karen Pastell, AuD Prairieland Audiology, LLC Joliet, IL James H. Peck, HIS Life Hearing Health Centers Rockford, IL Jeanne Perkins, AuD Audiologic Services Glen Ellyn, IL Daria Popowych, AuD North Side Audiology Group, Inc. Chicago, IL Alyssa Seeman, AuD Illinois State University Normal, IL

Indiana Erica Person, AuD, CH–TM Flex Audiology Lawrenceburg, IN Elizabeth Zweigart, AuD Midwest Ear Nose & Throat Surgery Evansville, IN

Illinois Steve Bonzak, MS Health Traditions Chicago, IL

Iowa

Nancy Congdon, AuD, CH–TM The Hearing Care Clinic Downers Grove, IL Phillip Elbaum, LCSW Stritch School of Medicine Loyola University, Chicago Deerfield, IL Dru A. Geraghty, MS Audiologic Services Glen Ellyn, IL Stephanie Gutzmer, AuD Wholistic Hearing Care Wheaton, IL

54

Lori A. Halvorson, AuD, CH–TM Lake Forest Hearing Professionals Lake Forest, IL

TINNITUS TODAY WINTER 2021

Diana Kain, AuD Heartland Hearing Center Hiawatha, IA

Kansas Bryne Gonzales, AuD NuSound Hearing & Tinnitus Center Topeka, KS Rebekah J. Highfill, AuD Ascension Via Christi Rehabilitation Hospital Wichita, KS James Mangimelli, AuD Atchison, KS Susan Smittkamp, AuD, PhD Associated Audiologists Inc. Shawnee Mission, KS

Kentucky Vanessa L. Ewert, AuD Bluegrass Hearing Clinic Lexington, KY Ann Rhoten, AuD Kentucky Audiology & Tinnitus Services Lexington, KY Kari A. Wickstrom, AuD Bluegrass Hearing Clinic Nicholasville, KY

Louisiana Catherine C. Lo, AuD The Hearing Clinic Thibodaux, LA Mary Miller, PhD Premier Hearing and Balance Hammond, LA Ram Nileshwar, AuD The Hearing Center of Lake Charles Lake Charles, LA

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.

www.ATA.org

HEALTHCARE PROVIDERS

Elena Treadway, AuD Noel ENT Hearing Center Abbeville, LA

Maryland

Karen L. Wilber, AuD, CH–TM Boston Children’s Hospital Boston, MA

Michigan

Thomas Tedeschi, AuD Amplifon Americas Minneapolis, MN Jerry Zhou, PhD Hearing of America, LLC Oakdale, MN

Chelsea Carter, AuD University of Maryland Medical Center Baltimore, MD

Natalie Crossland, AuD, CH–TM Holland Doctors of Audiology Holland, MI

Katelyn M. Leitner, AuD, CH–TM Hearing Assessment Center Nottingham, MD

Stelios Dokianakis, AuD, CH–TM Holland Doctors of Audiology Holland, MI

Denise Boatner, MS ENT Physicians of North Mississippi Tupelo, MS

Christina Shields, AuD University of Maryland College Park College Park, MD

Allie Heckman, AuD, CH–TM Michigan Medicine–University of Michigan Ann Arbor, MI

Mollie Johnson, AuD ENT Physicians of North Mississippi Tupelo, MS

MaryRose Hecksel, AuD Audiology & Hearing Aid Center Lansing, MI

Jennifer Mize, AuD ENT Physicians of North Mississippi Tupelo, MS

Angela Lederman, MS Hear Now Audiology & Tinnitus Center Clinton Township, MI

Rhonda Sage, MS ENT Physicians of North Mississippi Tupelo, MS

Nina Lopatin, MA Direct Hearing West Bloomfield, MI

Stephenie Warren, MS ENT Physicians of North Mississippi Tupelo, MS

Massachusetts Dierdre Anderson, AuD Audiology Network Services Salisbury, MA Eugene Antonell, BC–HIS Hear Better Now Tinnitus & Hearing Center N. Dartmouth, MA Nataliya Ayzenberg, PhD, AuD, CH–TM Moon Hearing Services, LLC Woburn, MA Judith Bergeron, BC–HIS, CDP Beauport Hearing Care Gloucester, MA Joni Skinner Bullough, AuD Hampshire Hearing & Speech Northampton, MA Collin Campbell, Lac Campbell Acupuncture and Herbal Medicine Clinic South Dennis, MA Theresa Cullen, AuD, CH–TM Cape Cod Hearing Center Hyannis, MA Nancy Duncan, AuD, CH–TM Duncan Hearing Healthcare Fall River, MA Kenneth Grundfast, MD Boston University School of Medicine Massachusetts Eye and Ear Boston, MA Peter Harakas, PhD CBT Associates, LLC Lexington, MA Dana Mario, AuD Mario Hearing & Tinnitus Clinics Mansfield, MA Robert Mario, BC–HIS, PhD Mario Hearing & Tinnitus Clinics Cambridge, MA

www.ATA.org

Shannon Radgens, DO Red Cedar Ear Nose & Throat & Audiology Owosso, MI Michelle Rankin, AuD Rankin Audiology and Hearing, LLC Chelsea, MI Benjamin Wightman, AuD Sound Advice Audiology Livonia, MI Joel Young, MD Rochester Center for Behavioral Medicine Farmington, MI

Minnesota John Coverstone, AuD, CH–TM Audiology Ear Care New Brighton, MN Sara Downs, AuD Hearing Wellness Center Duluth, MN John Ehlen Hear Central Victoria, MN Samantha Ewing, AuD MN Ear & Sinus Center Blaine, MN Jason Leyendecker, AuD Audiology Concepts Edina, MN Laura Morrison, AuD, CH–TM White Bear Lake, MN

Mississippi

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

New Jersey Granville Y. Brady Jr., AuD East Brunswick, NJ Jade Igbokwe, AuD, CH–TM NTI Audiology Jersey City, NJ Valerie Kriney, AuD Northern Jersey ENT Associates Glen Rock, NJ William J. McDonnell, VSO Dept. of Veterans Affairs Mount Laurel, NJ Marion Rollings, PhD Holistic Health Counseling Center LLC Hillsborough, NJ

TINNITUS TODAY WINTER 2021

55

HEALTHCARE PROVIDERS

Beth Savitch, MA Advanced ENT/Hear MD Voorhees, NJ

Lori Trentacoste, AuD Island Better Hearing Inc. Melville, NY

Heather Sprague, AuD ENT & Audiology Associates Raleigh, NC

Maria Elena Sosa, AuD DNC Ears Dumont, NJ

Claudyne Vielot, AuD Montefiore Medical Center Bronx, NY

Donna Szabo, AuD Innovative Hearing Solutions Westwood, NJ

Erin M. Walborn–Sterantino, AuD Audiologic Solutions Rensselaer, NY

Emilee V. Tucker, AuD Carolina Ear, Nose & Throat–Sinus and Allergy Center, PA Hickory, NC

New Mexico Jeffrey W. Wise, AuD, CH–TM Expert Hearing Care Las Cruces, NM Catherine A. Worth, MS Capital Hearing Care Albuquerque, NM

New York Nicole Ball, AuD Hearing Evaluation Services of Buffalo, Inc Tonawanda, NY Lois Cohen, LCSW, ACSW, BCD Tinnitus Counseling Northport, NY Bruce Hubbard, PhD CBT for Tinnitus, LLC New York, NY Harriet Jacobster, AuD Lyric Audiology New Windsor, NY Tracey Lynch, AuD Island Better Hearing Inc. Melville, NY Sapna Mehta–Gertz, AuD Weill Cornell Medicine New York, NY Carolynne Pouliot, AuD Hearing Aid Works Audiology Rochester, NY Amy Sapodin, AuD Advanced Hearing Center Albertson, NY Leigh A. Sauerbier, AuD, CH–TM The Advanced Hearing Center Brooklyn, NY Jeffrey M. Shannon, AuD Hudson Valley Audiology Pomona, NY Alyssa Smyczynski, AuD Hearing Evaluation Services of Buffalo, Inc. Orchard Park, NY Jennifer Sutton, AuD Hearing Evaluation Services of Buffalo, Inc. Williamsville, NY

56

TINNITUS TODAY WINTER 2021

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, CH–TM Raleigh Hearing and Tinnitus Center Raleigh, NC Susan Bergquist, MS Heritage Audiology Wake Forest, NC Alicia L. Cristobal, AuD Hearing Health Care Services, PLLC Durham, NC Lisa Fox–Thomas, PhD UNCG Speech and Hearing Center Greensboro, NC Hannah Heet, AuD, CH–TM Duke Otolaryngology of Raleigh Raleigh, NC

North Dakota Mackensie Brandt, AuD Altru Professional Center Grand Forks, ND

Ohio Samantha Bayless, AuD, CH–TM The Hill Hear Better Clinic Cincinnati, OH Sarah E. Curtis, AuD Sounds of Life Hearing Center, LLC Concord Township, OH Kristie Dannemiller–Smith, AuD Ascent Audiology and Hearing Barberton, OH Cathy Kooser, MSW, LISW Hillcrest Hearing & Balance Center Centerville, OH Heather Malyuk, AuD Soundcheck Audiology Cuyahoga Falls, OH Heather Maze-Smith, AuD Maze Hearing, LLC Bellefontaine, OH

Julia Hubbard–Rossi, AuD Carolina Hearing and Tinnitus, PC Mooresville, NC

Eric Mounts, HIS Modern Hearing Solutions/Choice Hearing Center Canton, OH

Patricia Johnson, AuD, CH–TM UNC School of Medicine Chapel Hill, NC

Richard Reikowski, AuD Family Hearing & Balance Center Akron, OH

Kelly Knolhoff, AuD Birkdale Audiology Huntersville, NC

Eryn Staats, AuD Memorial ENT Marysville, OH

Nancy McKenna, AuD, PhD University of North Carolina Chapel Hill Chapel Hill, NC

Babette Verbsky, PhD, CH–TM Hearing Connections Audiology Lebanon, OH

Melissa Palmer, AuD High Point Audiological–Clayton Clayton, NC

Gail Whitelaw, PhD, CH–TM The OSU Speech–Language–Hearing Clinic Columbus, OH

Stan Phillips, MD South Lake Hearing and Tinnitus Center Huntersville, NC

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

Christina Seaborg, AuD Hearing & Balance Center Charlotte, NC

www.ATA.org

HEALTHCARE PROVIDERS

Oregon

South Carolina

Anna Forsline, AuD VA Portland Healthcare System Portland, OR

Todd Gibson, AuD Lake Murray Hearing Lexington, SC

Kristen Furseth, AuD, CH–TM Willamette ENT Salem, OR

Alexandra Tarvin, AuD Elevate Audiology Hearing and Tinnitus Center Easley, SC

Bryan J. Greenaway, AuD, CH–TM Pacific University Hillsboro, OR

Jennifer Waddell, HIS Sound Hearing Care Simpsonville, SC

James Henry, PhD National Center for Rehabilitative Auditory Research (NCRAR) Portland, OR

Jason P. Wigand, AuD LifeAloud, LLC Lexington, SC

Todd Landsberg, AuD South Coast Hearing Center Coos Bay, OR Erika Shakespeare, MSc Audiology & Hearing Aid Services La Grande, OR Sandi L.B. Ybarra, AuD Hearing Associates Eugene, OR

Pennsylvania Krista Blasetti, AuD York ENT Associates York, PA Gail Brenner, AuD Tinnitus & Sound Sensitivity Treatment Center of Philadelphia, PC Bala Cynwyd, PA

Angela Zuendt, AuD, CH–TM Greenville ENT Greenville, SC

South Dakota

Rhode Island Holly Puleo, AuD Gateway Hearing Solutions Warwick, RI www.ATA.org

Alexandra C. Harris, AuD, CH–TM Callier Center for Communication Disorders Dallas, TX Mary Sue Harrison, AuD Today’s Hearing Katy, TX

Margaret Hutchison, PhD, CH–TM Austin Hearing Services Austin, TX

Tennessee Tiffany Ahlberg, AuD Ahlberg Audiology & Hearing Aid Services Cleveland, TN Marc Fagelson, PhD East Tennessee State University Johnson City, TN

Andrea Plotkowski, AuD Ear, Nose and Throat Consultants of East Tennessee Knoxville, TN

Anthony Napoletano, HIS Lansdowne Hearing Lansdowne, PA

Shannon Frugia, AuD, CH–TM Southeast Texas Ear Nose & Throat Beaumont, TX

Stephanie Wubben, AuD Stanford Hearing Aids Sioux Falls, SD

Linda Dallas, MEd Allentown Ear, Nose and Throat Allentown, PA

Jeannie Karlovitz, AuD Advanced Hearing Solutions Exton, PA

Heather Dean, AuD Burleson Audiology Clinic Burleson, TX

Carla S. Hoffman, HIS Hoffman Hearing Solutions Corpus Christi, TX

Courtney C. Guthrie, AuD 4 Bridges Audiology Chattanooga, TN

Jennifer Isayev, AuD Audiometrics, Inc. Bryn Mawr, PA

Kristen Crawford, AuD ClearLife Hearing Care Allen, TX

Melissa E. Baker, MA Baker Audiology and Hearing Aids Sioux Falls, SD

Mindy Brudereck, AuD, CH–TM Berks Hearing Professionals Birdsboro, PA

Amy Greer, AuD, CH–TM Lemme Audiology Associates Ebensburg, PA

Bethany Brum, AuD, CH–TM UT Southwestern Medical Center Dallas, TX

Paul Shea, MD Shea Ear Clinic Memphis, TN

Texas S. Diane Allen, PhD The Grove Counseling & Wellness Center Dallas, TX Theodore Benke, MD Benke Ear, Nose, & Throat Clinic Cleburne, TX Lacey Brooks, AuD North Houston Hearing Spring, TX

Susan Hyman, AuD Hyman Hearing Beaumont, TX Kristen Keener, AuD IlluminEar Tinnitus & Audiology Center Austin, TX Christina Lobarinas, AuD UT Southwestern Medical Center Dallas, TX Rene Pedroza, AuD, CH–TM United States Department of Defense El Paso, TX Elly Pourasef, AuD Memorial Hearing Houston, TX Lisa Richards, AuD, CH–TM Callier Center for Communication Disorders Richardson, TX Christie Spencer, AuD Fort Bend Hearing Sugar Land, TX Bradley Stewart, AuD ClearLife Hearing Care Allen, TX Crystal Wiggins, AuD, CH–TM Memorial Hearing Houston, TX

TINNITUS TODAY WINTER 2021

57

HEALTHCARE PROVIDERS

Nicole Klatt, AuD Winding Creek Audiology & Hearing Aid Center Rothschild, WI

Patrick DeWarle, AuD, CH–TM Winnipeg Hearing Centres Winnipeg, MB

Dan Malcore The Hyperacusis Network Green Bay, WI

Heidi Eaton, AuD Argus Audiology Moncton, NB

Erin O’Leary, AuD AuD Hearing Lake Geneva, WI

Kimberly Eskritt, AuD Lambton Audiology Associates Sarnia, ON

Kimberly Abeyta, AuD Hearing Resource Center Fredericksburg, VA

Melinda O’Meara, HIS Defatta ENT Altoona, WI

Deborah R. Lain, MSc Hope For Tinnitus Calgary, AB

Ana Anzola, AuD Ascent Hearing McLean, VA

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

Carol A. Lau, HIS Sound idEARS Inc. Vancouver, BC

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

Virginia

Theresa H. Bartlett, AuD Virginia Hearing Consultants Virginia Beach, VA Ann DePaolo, AuD The Audiology Offices, LLC Kilmarnock, VA Cooper Evans, AuD Evolution Hearing Richmond, VA Julie Farrar–Hersch, PhD Augusta Audiology Associates, P.C. Fishersville, VA David Jara, AuD Alexandria, VA Kristin Koch, AuD Evolution Hearing Charlottesville, VA

U.S. TERRITORIES Puerto Rico Isamar Gonzalez–Feliciano, AuD Centro Audiológico e Interdisciplinario, Isamar González, Inc. Arecibo, PR

INTERNATIONAL Argentina Susana A. Dominguez Audiologist Buenos Aires

Australia

Fred W. Lindsay, DO Hampton Roads ENT and Allergy Hampton, VA

Washington

Crystal Atkins Hearsmart Hearing Solutions Warrandyte Lynne Blackford, BSc MQ Health Speech and Hearing Clinic North Epping, NSW

Thomas A. Littman, PhD, CH–TM Factoria Hearing Center Bellevue, WA

Minakshi Gupta, MA All Ears Hearing Mount Waverleye

Dustin Spillman, AuD, CH–TM Audiologists Northwest Bremerton, WA

Michael Segal, MA Pristine Hearing Nollamara, WA

Wisconsin

Canada

Jon Douglas, AuD, CH–TM University of Wisconsin Tinnitus and Hyperacusis Program Madison, WI Hugo Guerrero, AuD, CH–TM Mayo Clinic Health System Onalaska, WI Veronica Heide, AuD, CH–TM Audible Difference, LLC Madison, WI

58

TINNITUS TODAY WINTER 2021

Lacey S. Beierbach, HAP Connect Hearing Calgary, AB Ronald Choquette, AuD, CH–TM Montreal University Audiology Clinic Montreal, QC Sabrina DeToma, AuD Salus Hearing Centre Vaughan, ON

Larena Lewchuk, MClSc Audiology Clinic of Northern Alberta Edmonton, AB Lucy Xie, HIS Bow River Hearing Calgary, AB

Ireland Laurence McMahon, BComm Hypnosis Online Killarney, CO Kerry

Israel Noga Feiglin, MA Galfon Audiology Center Ltd. Haifa, Israel

Malaysia Wan Syafira Ishak, PhD, CH–TM Universiti Kebangsaan Malaysia, Malaysia Kuala Lumpur, KL

Serbia Milena Tomanic, MD, PhD Faculty of Medicine, University of Belgrade Novi Beograd

Taiwan Yumeng Shen Jiulong Po CDC Taipei, Taiwan

United Kingdom Lisa Caldwell The Hearing Coach Glossop, UK Maxine Harris Hi–Kent Maidstone, UK Alan Hopkirk The Invisible Hearing Clinic Paisley, UK www.ATA.org

TINNITUS RESOURCES 

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 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.

VIRTUAL MEETINGS Please email/call the point-of-contact person listed for information on upcoming meetings.

Arizona Tucson Tinnitus Support Group Tucson Tinnitus Support Group Contact: Trudy Jacobson T: 520–982–7813 E: trudyj@cox.net 4th Saturday of the month, 1:00 pm

California Los Angeles/Orange County Tinnitus Support Group Contact: Barry Goldberg E: bargold06@yahoo.com 3rd Saturday of month, 10:00 am The Palo Alto Tinnitus Support Group at Avenidas Contact: Ken Adler, Amy Nelson, AuD E: karmtac@aol.com E: Amy.Nelson@kp.org 3rd Thursday of the month, 5:30–7:30 pm NEW: Sacramento Area Tinnitus Support Group Contact: Pat Clark E: sactinnitus@gmail.com 2nd Wednesday of the month, 6:30–8:00 pm San Diego Tinnitus and Hyperacusis Support Group Contacts: Michael J. Fischer, michaeljohnfischer@hotmail.com Loretta Marsh, lorettamarsh@hotmail.com David Phaneuf, djphaneuf@yahoo.com Tom Sutton, tomsutton63@gmail.com 1st Wednesday of the month, 6–7:30 pm San Francisco Tinnitus Support/ Education Group Contact: Tracy Peck Holcomb T: 415–921–7658, ext. 35 E: tracy@hearingspeech.org 3rd Thursday of the month, 3:00 pm To be added to their group, visit https:// www.hearingspeech.org/services/educationcounseling-programs/support-groups/

www.ATA.org

Colorado Denver Tinnitus Support Group Contact: Rich Marr T: 303–875–5762 E: r.marr@comcast.net 2nd Monday of the month, 7:00–8:30 pm

Florida NEW: Tampa Tinnitus Support Contact: Joel DeAngelis E: joel.deangelis70@gmail.com 3rd Monday of the month, 7:00 pm

Georgia NEW: The ENT Institute Tinnitus Support Group Contact: Sonia Hamidi, AuD, CH–TM T: 678–347-–2123 E: shamidi@nsainstitute.com 3rd Thursday of the month, 6:00 pm

Maryland University of Maryland Tinnitus and Hyperacusis Support Group Contact: Christina Shields, AuD T: 301–405–5562 E: shields3@umd.edu Meets quarterly

Missouri St. Louis Tinnitus Support Group Contact: Tim Busche T: 636–734–4936 E: tbusche@stltinnitus.org

New Jersey South Jersey Tinnitus Support Group Contact: Beth Savitch, Erin Lustik E: tsg@advancedent.com Meeting virtually via Zoom 1st Thursday of the month, 7:00–8:30 pm

New York Bronx Tinnitus Support Group Contact: Dr. S. Karie Nabinet T: 917–797–9065 E: kkwn12u@aol.com 1st Thursday of the month, 6:30 pm

North Carolina Raleigh Tinnitus Support Group Contact: Saranne Barker, AuD T: 919–790–8889 E: info@rhatc.com 4th Thursday of the month, 6:00 pm

Pennsylvania Lehigh Valley Tinnitus Support Group Contact: Mary Brownsberger E: marbrownsberger@gsrh.org 2nd Tuesday of month, 5:30–6:30

Texas Dallas/Ft. Worth Tinnitus Support Group Contact: John Ogrizovich E: dfwtsg@yahoo.com Meets every 4–6 weeks, Meets Saturday, 10:00 am Houston Tinnitus Support Group Contact: Vinaya Manchaiah E: houstontinnitus@gmail.com San Antonio Tinnitus Support Group Contact: Matthew Randal T: 210–549–8579 E: atasg.satx@gmail.com

Virginia National Capital Region Tinnitus Support Group Contact: Elaine Wolfson, David Treworgy E: erwolfson@comcast.net E: david_treworgy@yahoo.com Meets monthly

Washington Seattle Tinnitus Support Group Contact: Keith Field T: 206–783–7105 E: Keith_r_field@outlook.com 4th Thursday of the month, 7:30–8:10 pm

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

TINNITUS TODAY WINTER 2021

59

 TINNITUS RESOURCES

IN-PERSON MEETINGS Due to ongoing Covid-19 concerns, it is critical to contact the support group leader directly to confirm meeting information and personal protection requirements. Information provided 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, 6:00 pm NEW: North Denver Tinnitus Support Group Broomfield Community Center Overland Room Broomfield, CO 80020 Contact: Melissa Golden T: 303–506–9389 E: mbaycon@hotmail.com

Florida Clermont Tinnitus Support Group Citrus Hearing Clinic, LLC 835 Seventh Street, Suite 2 Clermont, FL 34711 Contact: Dr. Laura Pratesi T: 352–989–5123 E: admin@citrushearing.com 2nd Monday of the month, 1:00 pm Sarasota Tinnitus Support Group Silverstein Institute 1901 Floyd St. Sarasota, FL 34239

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. 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.

60

TINNITUS TODAY WINTER 2021

Contact: Carmen Trotta, Tom Terrenzi T: 941–993–7616, 941–462–1311 E: sarasota.ata@gmail.com 3rd Friday of the month, 2:00–4:00 pm

Illinois Chicago Suburban Tinnitus Support Group Contact: Margie B. E: maggie318@yahoo.com

Massachusetts Boston Tinnitus Support Group Athan’s Bakery 407 Washington St. Brighton, MA 02135 Contact: Kevin Plovanich E: JKPMA@aol.com

Currently not meeting. Contact group leader by email 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

Michigan Grand Rapids Individual Support Robert Ellis T: 616–949–4911 E: prohitter@att.net Holland Tinnitus Support Group Holland Doctors of Audiology 399 E 32nd St. Holland MI 49423 Contact: Stelios Dokianakis Website: https://holaud.com/contact/ T: 616–392–2222 E: info@holaud.com

New York 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

*To allow for flexibility in planning, some groups do not or cannot schedule meetings far in advance. When we receive updates from support group leaders, we update meeting information in our online Events Calendar at 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/managing-yourtinnitus/support-network/support-group-listing.

New groups continue to be added so please check the website for updates periodically.

If you’re interested in forming a group, please contact Joy Onozuka at tinnitus@ata.org.

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

www.ATA.org

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

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

Editorial Copy Due

Photos Due

Ad Close

Digital Launch

Issue Mailed

Sound Sensitivity

1/15

2/1

2/1

4/1

April

Summer–Aug 2022

Improving Sleep

4/15

5/1

5/1

8/1

August

Winter–Dec 2022

Annual Research Issue

9/15

10/1

10/1

12/1

December

Issue

Theme

Spring–Apr 2022

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 ATA PODCASTS ARE FREE AND OPEN ACCESS

Tune In 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, while you work out, take a walk, relax at home, or commute to work. To access and learn more about this unique series, visit our website at www.ata.org. To enhance listening comprehension and accommodate those with noise sensitivity, transcripts are available with each podcast.

These are only a few of the episodes from our podcast library.

Episode 16: Considering the Psychophysiological Elements of Tinnitus SUBJECT MATTER EXPERT: Christopher Spankovich, PhD, MPH TOPIC: Dr. Christopher Spankovich discusses how tinnitus interventions should address both the psychological and physiological impact of tinnitus on patients. He explores how nutrition, emotional health, and physical health all play a role in mitigating the negative impact of tinnitus. He also discusses the importance of helping patients understand the power of sound to elicit positive or

negative emotions, aside from the tinnitus sound, in order to facilitate habituation. Noting that not all patients believe or accept the psychological component of tinnitus, Dr. Spankovich encourages providers to assess what best fits the needs of individual patients, taking into consideration their specific challenges, what the patient believes, and what he/she is likely to respond to, rather than focusing on a one-size-fits-all approach.

Podcast 13: Understanding Preferences for Loud Music SUBJECT MATTER EXPERT: Elizabeth Beach, PhD TOPIC: Dr. Elizabeth Beach discusses large-scale research that reveals why clubs, bar, and music venues are playing music at higher volumes than what most people prefer. And while it might seem easy to raise awareness that results in quieter recreational music venues, Beach says it’s complicated, so safe listening initiatives require support at various levels to achieve change. As head of the Behavioral Sciences Department at the National Acoustics Laboratory in Australia, she studies recreational noise in the music and entertainment industry, strategies for encouraging safe listening for staff and patrons, and how to motivate young adults to protect their hearing.

Episode 9: Implementing Successful Tinnitus Treatment SUBJECT MATTER EXPERT: Helen Pryce, MSc, PD (Health) TOPIC: Dr. Helen Pryce explains how healthcare providers can successfully implement shared decision-making with tinnitus patients through use of the Tinnitus Decision Aid, which was developed in the United Kingdom and presents evidencebased treatment choices. By empowering patients in conversations that weigh the pros and cons of each care option based on what’s most practical for the patient, Pryce believes patients are more likely to commit to a treatment plan that works.

Episode 6: Mapping Tinnitus In the Brain SUBJECT MATTER EXPERT: Phillip Gander, PhD TOPIC: Dr. Phillip Gander discusses his groundbreaking research mapping tinnitus in the brain during two different craniotomies.

His research has added clarity to fMRI studies and theories on the different networks of brain that process the phantom sound/s of tinnitus.

In addition to sharing unexpected things that happened during the research conducted while the patients were awake, he touches on how future research might be designed to track and compare changes in the brain of subjects with tinnitus, which could provide better understanding of subsets of tinnitus and why it affects people differently.

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