Tinnitus Today • Summer 2023

Untethering the Mind From Tinnitus

How a Renowned Therapist Lives With Tinnitus

What Are Tinnitus Guidelines?

Finding Peace and Inspiration Through Awe

Tips to Make the Most of Summer Festivities

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?

 Monthly 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 Sara Downs, ATA’s Interim Executive Director, via email at tinnitus@ata.org.

The

Jinsheng Zhang, PhD Chair, Board of Directors

Funding Is the Foundation for Progress in Research

As the new chair of the ATA’s Board of Directors, I’d like to share how I came into this role because it illustrates how you, as a member, and the ATA make a significant difference for tinnitus researchers charged with advancing progress toward cures and better patient outcomes.

In 2005, I received a three-year ATA grant for $162,027 to investigate the suppressive effects of electrical stimulation on tinnitus. That grant and investigation helped propel me to where I am today as a well-established tinnitus researcher and academician who remains fully committed to resolving the burden of living with unwanted sound. My research has included mechanistic studies of tinnitus and ventures into new treatment approaches using animal models, collaborations with researchers around the world, and, most recently, a Department of Defense–funded multisite clinical trial investigating the off-label use of an approved pharmaceutical to suppress tinnitus. (For more information, see https://classic.clinicaltrials.gov/ct2/show/NCT04066348.)

My work, like every tinnitus researcher’s, happens only when sufficient funding and clinical trial participants are available.

In June, I presented at the Tinnitus Research Initiative’s 2023 conference on a novel pharmacological approach to treating tinnitus. This was the first TRI in-person gathering of researchers since TRI 2019 Taipei. Like researchers other than Covid-19 investigators, our field is still recovering from that multiyear setback ushered in with the global pandemic, from closed laboratories to delayed in-person meetings where ideas and collaborations are often hatched.

A panel discussion highlighted the critical need for investigational findings to be translated into treatments for patients. But without ongoing research, without adequate funds, without incoming investigators to keep the field vibrant, that need is hard to fulfill.

Hence, my goal as chair of the ATA and a tinnitus researcher is to collaborate with other scientists, mentor young investigators in the field, and advocate for greater federal and private funding. Let’s work together to make that happen. You can join a clinical trial, contact your congressional representative to demand more funding, and/or make a gift to the ATA for research. Action brings about change!

MANAGING EDITOR AND PUBLISHER

Joy Onozuka

American Tinnitus Association

COPY EDITOR

Christina Palaia

Emerald Editorial Services

PODCAST PRODUCER AND WRITER

John A. Coverstone, AuD Sentient Healthcare, Inc.

EDITOR-AT-LARGE

James A. Henry, PhD (retired)

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

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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

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ATA BOARD OF DIRECTORS

Jinsheng Zhang, PhD, Detroit, MI–Chair

Stelios Dokianakis, AuD, CH−TM, Holland, MI–Vice Chair

Gordon Mountford, South Pasadena, CA–Treasurer

Shahrzad Cohen, AuD, CH−TM, Sherman Oaks, CA–Assistant Treasurer

Sara Downs, AuD, Duluth, MN–Secretary, Interim Executive Director

Samantha Bayless, AuD, CH−TM, Cincinnati, OH

Jeff Bingham, San Diego, CA

Marc Fagelson, PhD

Johnson City, TN

Phillip Gander, PhD, Iowa City, IA

Jennifer Gans, PsyD, San Francisco, CA

David Hadley, MBA, San Francisco, CA

Emily McMahan, AuD, CH−TM,

Anchorage, AK

John Minnebo, MBA, Philadelphia, PA

Julie Prutsman, AuD, Highlands Ranch, CO

Robert Travis Scott, Abingdon, VA

Dan Torpey, CPA, Irving, TX

Erin Walborn-Sterantino, AuD, Rensselaer, NY

Melissa Wikoff, AuD, CH−TM, Atlanta, GA

Ron Zagel, Grand Rapids, MI

HONORARY DIRECTOR

William Shatner, Los Angeles, CA

ATA SCIENTIFIC ADVISORY COMMITTEE

Marc Fagelson, PhD–Chair

East Tennessee State University, TN

Carey D. Balaban, PhD

University of Pittsburgh, Pittsburgh, PA

Christopher R. Cederroth, PhD

Karolinska Institute, Geneva, Switzerland

Avril Holt, PhD

Wayne State University, Detroit, MI

Jay Piccirillo, MD

Washington University, St. Louis, MO

Tricia Scaglione, AuD

University of Miami, Plantation, FL

Roland Schaette, PhD

UCL Ear Institute, London, England

Grant D. Searchfield, PhD

University of Auckland, Auckland, New Zealand

LaGuinn Sherlock, AuD, CH–TM

Walter Reed National Medical Center

Bethesda, MD

Sarah Theodoroff, PhD

VA Portland Health Care System

Portland, OR

Richard Tyler, PhD

University of Iowa, Iowa City, IA

The Power of Awareness and Qualities of the Mind

Our senses—sight, touch, hearing, taste, smell—help us understand and perceive the world. When one is weakened, others may compensate, but the deficiency remains, as I learned when I contracted Covid-19 and lost all sense of smell. Having read about this, I had imagined it would be annoying, but not too bad. Like so many things in life, imagination seldom prepares you for the reality of unexpected changes, particularly those affecting sensory perception.

Without smell, I couldn’t figure out the right combination of spices or when I needed to turn the burner down. Nothing tasted the same. I was overwhelmed with sadness when I couldn’t smell my pet parrot—the fragrant aroma of her colorful feathers being both exquisitely beautiful and calming. Life without smell left me in awe of the power of our finely tuned senses and how they add meaning to our lives, even though I know that they change with time and injury. Just like when I developed tinnitus, losing my sense of smell was harder than I had imagined.

Which brings us to quality of mind and emotion—a different type of sense that guides our thoughts and behaviors. Can we adjust? Do we feel overwhelmed or fearful? It’s a relief knowing—even if it may seem inaccessible—that it’s an area where we have some control, especially if we utilize the right professionals and the right tools.

In this issue of Tinnitus Today, we explore the seldomconsidered emotion of awe and how it may improve your quality of life; Acceptance and Commitment Therapy, which is part of third-wave cognitive behavioral therapy that calls on us to act in accordance with our values; and tinnitus research that illustrates how progress in tinnitus care and scientific understanding is happening in labs every day around the world.

If you feel tinnitus is impeding your ability to tap into joy or handle life’s challenges, please call our Tinnitus Advisors Program line at 800–634–8978, ext. 3. The free 15-minute consultation doesn’t offer medical advice but rather meaningful guidance on tools and approaches that may soften the impact of tinnitus in your life. It’s worth discussing!

Joy Onozuka Managing Editor and 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.

The Subtle Art of Letting the Ringing Ring

Acceptance and Commitment Therapy as a Tool for Tinnitus

By Steven C. Hayes, PhD

“Ringing in the ears is nothing like panic.”

I doubt if I was ever consciously aware of having such a thought in my head… but three years of needless suffering with tinnitus suggests that it describes my mindset at the time. How wrong I was.

Let me explain.

My name is Steve Hayes and I’m a reasonably well known if now rather old clinical psychologist (I’ll be 75 by the time you read this). I’ve spent my career researching how human cognition leads to suffering. Some of the psychological intervention methods I’ve originated are used around the world. For example, right now the World Health Organization (WHO) distributes Acceptance and Commitment Therapy (ACT—said as one word, not as three initials) in the Ukraine to help survivors of that dreadful war avoid the development of mental health problems.

I don’t allow people to say I “developed” ACT because literally thousands of researchers and

practitioners have done that over the last 40 years. I did originate it, though—metaphorically, I lit the match and thousands of others then brought empirical and clinical logs that created the bonfire that is ACT.

I’ll explain what ACT is in a moment, but I want to start this story where it began: in my own panic disorder.

As a young assistant professor, I almost lost my career to that mental health problem. I had my first panic attack in the late 1970s in a horrible psychology department meeting while watching full professors fight in a way that only wild animals and full professors are capable of. I raised my hand to ask them to please stop, but by the time they called on me, I was enveloped in a full-blown panic attack and could not make a single sound come out of my mouth. The professors looked at me for a few seconds as I silently gasped for air like a guppy out of water, paused, and then continued their pointless arguments.

I slunk out of the meeting, humiliated by my bizarre behavior.

My life was soon in a tailspin as I tiptoed through each day trying very hard not to feel anxious like that ever again, OR ELSE! Of course, with such a mindset, that meant I felt anxious almost all the time because now I was anxious about becoming anxious, and that can happen anywhere! Over two or three years I watched in horror as anxiety took away nearly everything I had. The panic attacks increased in frequency and impact until I had a hard time leaving my house, answering the phone, giving a lecture, riding an elevator, or doing much of anything except to hide all this from my friends.

Finally, I hit bottom—waking up in the dead of night thinking I was having a heart attack and then realizing with a sense of horror this was just a new and more nightmarish version of a panic attack.

Somehow that awareness tipped me over the edge, and I caught that it was a voice in my head that was telling me to run from anxiety. In a

sense I realized that if I could hear the voice, I must not be the voice—it was just in me or a part of me. There are more details I tell in my first TEDx talk (bit.ly/StevesFirstTED), but that very night I declared, “Never again. I will not run from me!”

I’ve tried to live that promise ever since. That declaration lit the psychotherapy bonfire now called ACT. (Yes, I’m aware I still have not told you what ACT is! Be patient, my friends!) And I’ve built a career atop that transformational moment.

Ironically, solving my panic disorder also freed me up to pursue my interest in punk rock! Crowds were okay once again! At the time, I was teaching at the University of North Carolina, Greensboro, and punk bands would play in small clubs on Tate Street midweek as they drove their

equipment-filled vans from weekend gigs in Atlanta to gigs in DC. Some of them were bands punk rockers would recognize even today: Black Flag, the Circle Jerks, Bad Brains.

You didn’t listen to this music. You felt it. Standing near floor-to-ceiling speakers roaring like aircraft engines, your whole body vibrated and people would literally pop up and down like pogo sticks from the energy.

Fast-forward to my late 50s and early 60s, now a full professor at the University of Nevada, Reno. In this magazine you can guess what this bit of fun as a young man led to.

At first just a buzz in my ears, the ringing became louder and louder and louder. The audiologist gave me noise makers. It didn’t help. And he warned me to avoid further damage by avoiding all loud noises. That

advice seemed logical, but soon I was almost afraid of noise. I did not even want to put the dishes away (oh, the sound of plates on plates!). I wore earplugs, avoided crowds, constantly told my kids to be quiet, and literally tiptoed through the house on the lookout for sounds I needed to control. I lived in fear that the ringing would get worse.

Which it did.

Aaaagh. Forever? I’m going to have this forever?! When I wake up? When I go to sleep? I can’t stand it! Who could? This is terrible!!

My thoughts about tinnitus became more and more distressed. Over a three-year period, I felt like my world was shrinking. This noise had to stop OR ELSE! This is totally unacceptable!

As I said in the first sentence of this story, I do not remember ever once thinking “ringing in the ears is nothing like panic,” but I suspect somewhere deep down that was my conviction. Otherwise, how can you explain that it took three years of suffering and the most distressing kind of thoughts a person can think before it even occurred to me, “ah, dude, perhaps you should apply your life’s work to this issue.”

Thankfully, finally, it did. A moment later it was suddenly startlingly clear. As Homer Simpson would say, “Doh!”

I went for an hour-long walk in my neighborhood, exploring my tinnitus from an ACT perspective, and when I came back, it was 60–70 percent handled. In a couple more days it was 100 percent handled. There it has stayed for nearly two decades since.

“The core target of ACT is ‘psychological flexibility’—the ability to experience your own thoughts, sensations, and emotions without needless defense or clinging, consciously attending to what is present inside and out in a flexible, fluid, and voluntary way, and then focusing on the chosen qualities of being and doing you want to manifest in life, and how to build habits of action that manifest them.”

What Is ACT?

Panic is like an anxiety storm that is fed by fearful judgment and avoidance. You start to feel anxious. You push down the anxiety for fear it will grow and that you will be embarrassed or lose control or any of a myriad of other terrible outcomes your mind can cook up. But credible thoughts about how terrible it would be if you got too anxious—you’d be humiliated or be unable to function or go crazy (name the disastrous outcome)—cause even more anxiety and you can sense that too. You push down even harder, backing up that renewed effort by even more frightening internal threats.

Voilà! In a self-amplifying loop, like a microphone held too close to a speaker, your whole mind can become consumed with overwhelming anxiety and you are virtually unable to function.

A panic attack.

What I sensed at the bottom of my panic struggles was that I could not win this war within by running away from anxiety, but I could turn and run toward anxiety and its fearsome

thoughts, seeing them merely as interesting experiences in the present moment. When I deployed that approach, I found an internal spiritual core from which I could deliberately feel what I felt without needless defense. Then instead of trying to run from my own experience, I could get clearer on the intrinsic qualities I truly wanted to manifest—my values—and I could work to put those qualities into my behavior.

ACT combines self-kindness and mindfulness skills with values and commitment skills and is perhaps the most researched new method of psychological intervention over the last 20 years. There are well over a thousand randomized controlled trials on ACT in almost every area of human functioning you can think of (bit.ly/ACTRCTs). There are thousands of ACT studies of other kinds. There are hundreds of books on ACT and several million of them in print. I estimate that about 50,000 to 100,000 professionals have been trained in ACT

worldwide (for a partial list, see bit.ly/ FindanACTtherapist).

The core target of ACT is “psychological flexibility”—the ability to experience your own thoughts, sensations, and emotions without needless defense or clinging, consciously attending to what is present inside and out in a flexible, fluid, and voluntary way, and then focusing on the chosen qualities of being and doing you want to manifest in life, and how to build habits of action that manifest them.

You can say that more simply: ACT is about learning how to be more open, aware, and actively engaged in life.

A really cool thing about these skills is that they apply so broadly. We have recently looked at the entire world’s literature on how change happens, and with every imaginable psychological intervention more than half of all properly done studies that have identified how change happens point to psychological flexibility or closely related skills as the reason. Said in another way: The skills you can

“I took at least three years before it occurred to me to apply ACT to tinnitus because hearing an ‘awful noise’ did not look anything like anxiety to me. It did not look like I was doing anything! It looked like noise was being done to me.”

learn that will help you with tinnitus will also help you elsewhere. Just don’t be like me and never think to apply them! I took at least three years before it occurred to me to apply ACT to tinnitus because hearing an “awful noise” did not look anything like anxiety to me. It did not look like I was doing anything! It looked like noise was being done to me.

Wrong. Eventually I realized that how I was handling the noise was indeed of my doing and it needed to change. That awareness allowed me to apply what was by then nearly 20 years of practice with ACT skills to my tinnitus.

Since that pivotal moment, ACT has been applied to tinnitus in several randomized trials with outcomes as good as those of cognitive behavioral therapy (CBT). CBT may have the most data, but ACT is broadly part of the CBT tradition anyway, and it gives people a reasonable choice. ACT tinnitus research has found that good outcomes occur because of changes in psychological flexibility. There are good self-help books on ACT (such as

Russ Harris’s The Happiness Trap and my own book written with Spencer Smith, Get Out of Your Mind and Into Your Life). There are books on ACT for tinnitus, too, but unfortunately today only in Swedish.

I describe each of the six psychological flexibility processes and give at least one example of how you might try to apply each to tinnitus in the box entitled “ACT as a Tool to Create Psychological Flexibility: Untether the Mind From Tinnitus.”

Me, my ears very rarely ring anymore—except that they ring constantly (I presume). Yes, whenever I look, there it is. Still, I go weeks and months without looking, and when I’m not looking, it’s not there. I don’t care that it’s not there (if I did, I’d have to look to see if it’s not there, and voilà! it would be back again!). I’m writing about tinnitus, so I have to look there and, yes, right now the ears are screaming. So what? I don’t care about that either and you can’t make me! Ringing or not ringing is equal. It’s not of interest—except for

right now because I would like to be of use, so I’m looking.

This is an odd form of acceptance—it’s more like what happens in chronic pain or in elderly persons who are dealing with the loss of functionality. It not exactly like how panic and anxiety worked earlier in my life—I found lots of very interesting things inside my panic. Ringing? Not so much—just for making a mental note to some future Steve to not stand in front of floor-to-ceiling speakers kicking out insane levels of sound.

Still, on that one-hour walk now many years ago, I discovered that ringing in the ears is something like panic: If you aren’t willing to have it, you’ve got it. And knowing that freed me almost instantly because then I knew what to do, even if my mind did not.

Yeah, I know that is not entirely logical. But as anyone practiced in ACT can tell you: It is psycho-logical. Peace, love, and life.

Steven

C. Hayes, PhD, the originator of Acceptance and Commitment Therapy, is a Foundation Professor Emeritus of Psychology at the University of Nevada. An author of 48 books and over 700 scientific articles, Dr. Hayes has received several national awards, such as the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapy. His popular book Get Out of Your Mind and Into Your Life for a time was the best-selling self-help book in the United States, and his book A Liberated Mind has been released to wide acclaim. His TEDx talks and blogs have been viewed or read by more than three and a half million people, and he is ranked by Research.com as among the top 75 most impactful psychologists in the world.

“…on that one-hour walk now many years ago, I discovered that ringing in the ears is something like panic: If you aren’t willing to have it, you’ve got it. And knowing that freed me almost instantly because then I knew what to do, even if my mind did not.”

ACT as a Tool to Create Psychological Flexibility

Untether the Mind From Tinnitus

By Steven Hayes, PhD

The goal of Acceptance and Commitment Therapy (ACT) is greater psychological flexibility. There are six key processes, but they are all interrelated.

The Now— Training Your Attention

ACT promotes contact with the present moment. Living with tinnitus can be mentally exhausting because the sound constantly pulls you into thoughts of the past (“how did this happen?”) or worries about the future (“what if this gets worse?”). The principle of contact with the present moment encourages you to anchor your attention in what is of importance in the here and now.

Long periods of focused attention* to the noise are rarely useful, but if you try to distract yourself from paying attention, then your attention has to

split into two streams: one that looks elsewhere and one that keeps track of the noise (“is it gone yet?” the mind asks, and instantly you have to look for what’s gone and then it’s not gone anymore). Flexible attention skills with tinnitus are a combination of a disinterest in the noise with an interest in what you are doing. Instead of a negative and hopeless distraction (why “diss” yourself?), focus on the attraction of living your life.

This is a tricky area, and it takes practice. You can practice by, for example, listening to only the brass instruments in orchestral music and then listening only to the strings and then only to the wind instruments and so on. If while listening only to the brass you try not to listen to the strings, the strings will be heard! Never become interested in subtracting interest—that is just another and very sticky form of interest. Instead, simply

abandon any interest in the strings (dispassionately: if you hear them, you hear them, if you don’t, you don’t, and let that be equal either way) and then listen to the brass.

As you learn this skill you can apply it to thoughts. By grounding yourself in the present moment, you can develop a greater awareness of your experiences, including the sound of tinnitus. Rather than ruminating on the past or anticipating the future, redirect your attention to the sensations and activities that are going on now, which can foster a sense of calm and peace. And, yes, as you get good at this, you can apply this same skill to the ringing in your ears.

By engaging in mindfulness practices, such as deep breathing and body scans, you can cultivate a sense of presence and reduce the distress caused by tinnitus.

Acceptance— Learning to Feel

A key principle of psychological flexibility is emotional openness or acceptance. It involves acknowledging and allowing the presence of experiences without trying to avoid or suppress them. Emotions are viewed as valid and a source of learning. Instead of struggling with thoughts, emotions, and physical sensations associated with tinnitus, deliberately notice where in your body you feel anxiety or annoyance. Imagine metaphorically what color that experience might be or what shape it is and see if you can observe it with a sense of dispassionate curiosity.

This shift in mindset allows you to refocus your attention on activities you value, such as engaging in hobbies or spending time with loved ones.

Defusion—Learning Cognitive Flexibility

Cognitive defusion refers to the process of observing thoughts without getting entangled or fused with them. When faced with distressing thoughts related to tinnitus, you can learn to view the thoughts as mental events that come and go rather than absolute truths or statements that must be disproved or believed. If I say, “Mary had a little ___,” you will likely think “lamb.” Need that be a problem? Can’t you just notice your mind doing its work with a sense of healthy distance? You have many, many thoughts. So?

For instance, a person experiencing tinnitus may have thoughts like, “My life is ruined,” and those thoughts will “hook” the person into belief or resistance. If this happens to you, instead, try to just observe and describe. You might begin a journey

of great cognitive openness by adding this bit of truth: I am having a thought. Is there anything inherently awful about “I’m having the thought that my life is ruined”? If you want to play with it a bit more, look at the skills I describe here: bit.ly/StevesSecondTED. Try saying that thought in the voice of your least favorite politician. Sing the thought. Say it in a funny voice. Is it really true that these thoughts are your enemy?

Sense of Self— Notice Who Is Noticing

Tinnitus does not define who we are as individuals. A healthy sense of detachment and perspective-taking promotes resilience and offers greater freedom of choice about how to behave in the presence of constant noise.

ACT cultivates a perspective-taking sense of self that is called “self-as-context.” This is the ability to observe yourself from a broader perspective and to find a sense of “I/here/now” that connects you in consciousness with others. See if that deeper, more spiritual sense of you is really threatened by internal noise.

When we step aside from identifying with the mask we each present to the outside world, it is easier to recognize that our thoughts, emotions, and sensations are just aspects of our self as a whole person. Imagine looking back at yourself with a sense of selfcompassion. What might you say to yourself that might be helpful?

Values—Choosing What Is of Importance

Values are chosen qualities of being and doing—what is truly meaningful and important in your life. Despite the challenges posed by tinnitus, you can

identify your values and align your actions accordingly. By focusing on activities and goals that are in line with your values, you can find purpose and fulfillment, even at times when the noise is bothersome.

For instance, a person with tinnitus may value connecting with others. They can choose to engage in activities that facilitate social interactions, such as joining support groups or participating in community events.

Committed Action— Creating Habits of Values-Based Action

Finally, consider how to put your values into action. If you’ve put your life on hold while fighting a war with the ringing, take your life back. What if there was a war and nobody came? What if you respectfully declined the mind’s invitation to care about the noise and instead put moments of chosen caring into your life in the form of behavior? As you do that, tinnitus interference may diminish in an almost point-to-point fashion, even if the ringing is there whenever you look.

Don’t expect this little foray into ACT to do much on its own, but if you have a sixth sense this might be useful, why not check ACT out? You can even do so at no cost (the WHO distributes ACT self-help for free here: bit.ly/WHO_ACT), so you have little to lose. Or you can seek out an ACT therapist and follow the book leads I’ve given elsewhere.

* To learn more about directed attention as a tinnitus coping skill, see Tinnitus Today, Spring 2023, Directed Attention: A Useful Skill in the Tinnitus Management Toolbox, by James A. Henry, pp 28–34.

Acceptance and Commitment Therapy Isn’t About Resignation

How the Originator of This Widely Acclaimed Therapy Views Tinnitus

Acceptance and Commitment Therapy (ACT) falls under the umbrella of third-wave cognitive behavioral therapies, which the 2023 Spring issue of Tinnitus Today highlighted. Although ACT, along with Dialectical Behavior Therapy and Mindfulness-Based Cognitive Therapy, shares certain similarities grounded in traditional cognitive behavioral therapy (CBT), there are important differences. ACT emphasizes values-based action, mindfulness and acceptance techniques, and flexible thinking, as opposed to trying to change or control difficult thoughts and emotions, which is part of traditional CBT.

As the field of psychology continues to evolve with ongoing research, the ATA is highlighting ACT as a therapeutic option for individuals struggling with tinnitus because it’s a tool—within third-wave CBT—that is evidence based yet not widely utilized within the tinnitus community. Its originator, Steven C. Hayes, PhD, also lives with tinnitus, so we asked him to share his experience with the

from bothersome tinnitus to nonbothersome tinnitus.

Joy Onozuka: As someone who struggled numerous years with tinnitus, what would you say to the person who cannot fathom the possibility of tinnitus receding from conscious awareness?

Steven Hayes, PhD: It seems impossible because the part of you

that is evaluating whether it can be done is the part of you that can’t do it. All of us know there is more to us than our literal, judgmental, predictive, evaluative, problem-solving mind, but if you seriously ask yourself, “Is there more to me than my literal, judgmental, predictive, evaluative, problem-solving mind?” that same mode of mind will be the part answering yes or no or maybe.

“…You can discover how to handle tinnitus using methods of ‘learning by doing’ that are more like how you came to be able to walk than how you came to be able to solve a math problem.”

But that part of you is not the whole person called “you.” Your judgmental mind is not the person who knows how to love, to dance, to throw a ball, or to play soulful music. It’s not the person who knows how to gaze at a beautiful sunset or to meditate without entanglement in judgment. And it’s not the whole person who can learn how to handle tinnitus.

There is more to you than language and cognition. You can learn solely by experience. You have a spiritual aspect. You are part of a human community. You can pick a direction in life. Only you as a whole person

can choose to attend or not, to care or not, to feed judgment or not. The guidance people need to deal with tinnitus is the kind that allows you to reconnect with a way of learning that you once knew before learning came to be a matter of following literal, analytic rules. We can then apply that method of learning to this very subtle Zen task of what to do with an endless noise. Uncounted others before you have learned it and now we have science as an additional guide. There is a way forward.

JO: How and why does ACT have the ability to neutralize a sound that can be perceived if one pays attention to it, consciously or not? And once the sound becomes hooked to one’s stress response, how does one unplug from that?

SH: The sound is hooked to a threat response. Your judgmental mind thinks the sound is inherently aversive or bad or awful or unacceptable or dangerous. It thinks these qualities are in the sound itself. The Dictator Within (that judgmental internal voice that gives us all a constant stream of behavioral guidance based on evaluation and prediction of events) tells you that the sound needs to be eliminated or at least diminished—it needs to be controlled. That is totally unhelpful advice, but once tagged in that way (and given your affirmation as a person), a situation is created in which the sound is a threat that needs to be managed. And once it is established as a threat of that kind, your body and brain will do what it does based on millions of years of evolution that go back far, far longer than human language itself. Your entire physical being will mobilize to manage the threat.

Boom. The trap has been sprung.

Even when you are not noticing it for some moments, your mind will scan for the threat. We all call it “stress from the noise,” but it’s actually more complex than that. The threat came from the sound, yes, but also from judgment and (most subtle of all) from the larger social and mental context of how to handle your own experience that led you to affirm the relevance of the judgments.

The social/mental context of deliberate control tricked you into an unnecessary and unhelpful action You likely did not notice that context and you did not notice that you did anything with the automatic judgment that showed up when your ears started to ring because it all happened

“The guidance people need to deal with tinnitus is the kind that allows you to reconnect with a way of learning that you once knew before learning came to be a matter of following literal, analytic rules. We can then apply that method of learning to this very subtle Zen task of what to do with an endless noise.”

so fast and automatically. Heck, I didn’t notice it.

Saying that is not meant to be blaming—it’s not your fault. It is your responsibility, however. Do not flinch from that! Knowing you are responsible can be a wonderful thing because it means that you now have the ability to respond. Woo-hoo! You are not helpless. You are not hopeless. You are not a victim.

You can become aware of how you got tricked into doing unhelpful things by a pervasive social/mental context, and your previously unseen affirmation that led to a noise being a threat can be withdrawn. Once there, you can discover how to handle tinnitus using methods of “learning by doing” that are more like how you came to be able to walk than how you came to be able to solve a math problem.

ACT (which, by the way, is said as a word, not as three letters) stands for “Acceptance and Commitment Therapy” (or “Acceptance and Commitment Training” when used outside of a psychotherapy context— ”ACT” in either case) and combines self-kindness and mindfulness with values and commitment. ACT is perhaps the most researched new method of psychological intervention over the last 20 years, with well over a thousand randomized controlled trials in almost every area of human functioning you can think of. You can see the controlled intervention trials here: bit.ly/ACTRCTs. There are thousands of ACT studies of other kinds. That is important to know not just because it means that what I am saying is evidence based but also because it’s cool to know that the skills you can learn by

applying ACT to tinnitus will be helpful to you in other places of your life.

What ACT focuses on is something subtly different from “changing your mind.” What ACT helps you do is to respectfully decline the relevance of the command instructions issued by that voice within by changing the mental context from one of agreement and compliance, or disagreement and noncompliance, to one of appreciation and choice.

so that you and your body can then go back to treating the sound as a sound, period, end of story.

Then sometimes you hear it and sometimes you don’t, and either way it lands in the same way. It’s not of particular interest. Said in another way, you don’t care. You don’t even care that you don’t care. You respectfully decline the mind’s

The Dictator Within is not you—it is just a tool within you. It is often useful—be thankful you have it. I would not want to do my taxes without it. But sometimes it is not helpful, and either way it is not you—it is just a tool you have (that sometimes rudely claims to be you. Ha!). You get to decide if or how that tool will be used. You do not get to decide what it says. You cannot argue it into silence. It’s more like, “Thank you very much for the advice, Mr. Mind. Thanks for trying to help me. However, no need to do anything in this instance—I’ve got this covered.”

That mental shift—once you learn how to make it in a profound way— removes the tinnitus sound as a threat

insistence that you must care.

I know this sounds like psychobabble. If your mind is telling you that while reading these words, it’s certainly understandable. But if it is, before you give that judgment full control over you by yet another act of affirmation, do remember this is the same mind of yours that walked you into a struggle with tinnitus in the first place. Ha! Should Mr. Smarty-Pants Mind be given such automatic power over you given its spotty record?

JO: When you discovered how quickly ACT could reduce tinnitus distress, how and when did you begin conducting research on ACT for tinnitus? What did the research show?

“ACT is perhaps the most researched new method of psychological intervention over the last 20 years, with well over a thousand randomized controlled trials in almost every area of human functioning you can think of.”

SH: I wrote about my experience and was lucky enough to connect with the best psychology researcher in the area of tinnitus: Gerhard Andersson at Uppsala University in Sweden. He quickly became interested and has done several trials of ACT and has created measures of tinnitus acceptance and values-based activity engagement. I’m an author on some of them, but really the work has been done by my colleague and friend.

I describe the basic principles of ACT and how they can be applied to managing tinnitus in “ACT as a Tool to Create Psychological Flexibility: Untether the Mind From Tinnitus,” which can be found on page 8.

JO: Are there specific ACT techniques or exercises that are particularly effective in helping people manage tinnitus-related distress?

SH: We’ve not unpacked the ACT package in this area with what are called “component analyses,” but we do know that with tinnitus both letting go of needless emotional control and making a choice to actively engage in life with ringing ears if and when you have ringing ears are important. In other similar areas, such as in chronic

pain, all six elements of psychological flexibility are known to be important.

JO: What do you say to a person who is skeptical or resistant to the idea of acceptance-based approaches to tinnitus since some people perceive “acceptance” as being resigned to tinnitus and a reduced quality of life?

SH: You will notice that I said ACT combines self-kindness and mindfulness with values and commitment. I said it that way to avoid the word “acceptance.” I usually do not avoid that word. I did that here because there are some conditions in life such as chronic pain or tinnitus where “acceptance” is used in the culture to mean “you have to put up with it,” and that is a poisonous idea. Often people throw that word at tinnitus sufferers as a kind of dismissal. It’s like, “In this area, I don’t like feeling what I feel when I see you feel what you feel, so why don’t you stop feeling what you feel so I don’t have to feel what I feel?” In other words, it’s people asking you to stop being bothered or at least stop talking about it because they can’t do anything and that’s distressing to them. Thus, the words “you just have to accept it!” Yuck.

But we do use “acceptance” in another way. If you are giving a precious gift to someone (your grandmother’s ring, say), sometimes as you give such a thing you might say, “Here, will you accept this?” You do not mean “will you resign yourself to having such a gift?” or “will you tolerate my grandmother’s ring?” Not at all! You mean “will you receive this willingly?”

That little bit of English usage is still in our culture because the Latin root of acceptance includes the connotation of active receiving, as if to receive a gift. And that is what ACT is about. To receive the gift of feeling, sensing, thinking, and remembering.

You might think that ringing in the ears is hardly a “gift.” Well, okay, but haven’t you noticed in your life how really difficult things often teach you major life lessons? Are you saying this cannot be true in this case? A recent study found that a fairly large number of tinnitus sufferers do learn positive things from it. I’m not talking about the power of positive thinking—I’m talking about engaging with this whole issue in a new way, with a “well, let’s see” attitude.

JO: Is ACT effective if someone is struggling with depression, anxiety, or insomnia because of the sound?

SH: These same skills are known to be powerful methods for addressing all these problems. There are over 400 meta-analyses of ACT (bit.ly/ ACTmetas), including all of these areas. So, the cool thing about ACT for tinnitus is that you will be learning very broadly applicable skills that will help your life in many areas.

“ACT targets processes of emotional openness, softening entangling judgment, and fostering presence from a deeper sense of self…”

Making the Most of Summer Socials and Travel

By Beth Field, AuD, ATA Tinnitus Program Advisor

With summer in full swing, chances are you’re indulging in your favorite outdoor activities and perhaps have plans for vacation travel. From swimming to gardening to traveling, a little bit of extra preparation for these events can keep them fun and exciting. Remember, “an ounce of prevention is worth a pound of cure,” which is the case when it comes to managing your tinnitus and protecting your hearing health.

Water World

Thoughts of summer often conjure images of pools, beach vacations, or tubing on a lazy river. Indeed, warm

weather and water sports go hand in hand.

Most of us show up for water sports with sunscreen and flotation devices. When we consider ear health, we should add some easy, inexpensive items to ward off potential illness or injury and know when it’s time to stay out of the water.

• Swim caps, swim plugs, or custom swim molds keep water from entering your ear canal, which wards off swimmer’s ear (otitis externa)—a bacterial infection caused by water pooling in the ear canal for an extended period.

If water gets in your ears, tilt your head to the side to let it run out. If that doesn’t work, rub a

towel gently around the outer ear to let it drain. If that fails, use a hairdryer on a low, cool setting at a safe distance from your ear to dry it.

And though you’ve surely heard it before, never insert anything into your ear canal, including a cotton swab; so resist the temptation to do that.

• Dynamic water sports like water skiing, high diving, and scuba diving pose a different challenge because the blunt impact of hitting the water at the wrong angle or, in the case of diving, failing to equalize eardrum pressure, can perforate the eardrum. If that happens, you’ll feel a sharp pain.

Although a perforated eardrum will usually heal on its own within a few weeks, it’s worth a trip to your physician to make sure it’s okay.

And while you might be tempted to go back in the water in a week or two, it’s best not to since the tear can allow water to pass through your ear canal into your middle ear, causing suddenonset dizziness.

• Limited research suggests a possible link between sun exposure and hearing loss. We often overlook our ears when applying sunscreen, so it makes sense to apply a thin layer of sunscreen on the outer area of your ears.

• To prevent rupturing their eardrums, scuba and free divers must continually equalize the pressure that builds on their eardrums as they descend into the water. There are various ways to do this, with the most common method being holding both nostrils closed and gently blowing, which forces air through the eustachian tubes and equalizes the pressure on the eardrums.

Sometimes you may need to go up a few feet to re-equalize pressure, then continue a slow descent, repeating equalization of both eardrums until you reach the depth you wish to explore.

If you’re unable to equalize pressure on your eardrums, it’s critical to slowly surface and dive another day.

Festivities

For many of us, summer may include fireworks, festivals, outdoor concerts, or cookouts, all of which are typically loud, often dangerously loud. If you have tinnitus and/or hearing loss, then you know that hearing protection is critical, and simple preparation can ensure that you’ll have fun and good memories, not regrets. Another factor to consider is if you’re taking certain medications (antibiotics, pain meds, chemo meds), you may be more susceptible to the effects of noise, so hearing protection is important.

• Foam earplugs are easy to use and inexpensive. Some brands offer up to 33 decibels of protection if properly inserted.

To properly insert foam earplugs, roll the earplug into a tight cylinder between your fingers, pull your ear back with one hand to open your ear canal, and insert the foam plug with

the other hand as deeply as it will comfortably go. Allow a few seconds for the foam to expand to provide the most protection.

To see how this is done, watch this video: https://www.nidcd.nih. gov/news/multimedia/hearingprotection-how-use-formableearplugs-video.

• If foam earplugs are uncomfortable or difficult to insert, use earmuffs or consider custom-made earplugs, which an audiologist can make for you.

• For people whose tinnitus is aggravated by salt or alcohol intake, bring low-salt dishes and nonalcoholic beverages to share with friends and family at picnics and cookouts.

• When noise levels are safe, you shouldn’t wear earplugs. If you’re unsure about the noise level, download a decibel reader app to monitor it. One easy-to-use free app was developed by the National Institute for Occupational Safety and Health (NIOSH). To learn more, see https://www.cdc. gov/niosh/topics/noise/app.html NIOSH also has guidelines for noise exposure levels that you may find helpful to better gauge safe sound. See https:// blogs.cdc.gov/niosh-scienceblog/2016/02/08/noise/

• Take noise breaks. It’s exciting to go to a concert or sporting event, but you should plan periodic sound breaks, especially if you find noise or crowds overwhelming.

“Fortunately, it usually only takes a few simple safety tips or steps to avoid potential ear issues that might disrupt your summer fun.”

If you have tinnitus, you may find exposure to noise makes you uneasy. So, besides hearing protection, a dosimeter app, and sound breaks, bring your stress management tools to summer events—breathing exercises, mindfulness, or whatever else you might find soothing. Prepare, so you’ll feel comfortable accepting invitations or planning summer events.

Travel

This summer, 85 percent of people in the United States are expected to take to the roads or skies to vacation. However you’re getting to your destination, consider these tips while packing.

• Air travel can cause pain or pressure on the eardrum with changes in altitude. Like scuba diving, the best way to ease that pressure is to hold both nostrils closed and gently blow, which

pushes air through the eustachian tubes, thereby equalizing the pressure. Once you get to cruising altitude, your ears should feel fine.

If your ears are sensitive to altitude changes, or you have a cold or are congested, consider using pressure-reducing earplugs during takeoff and descent to relieve the pressure on the middle ear.

• If you’re sensitive to ambient noise from the airplane or car, use noise-canceling headphones to listen to your favorite music, podcast, or to watch a movie.

• Once you reach your destination, try to keep your usual sleep hygiene practices. This includes avoiding blue-light screens an hour or two before you go to bed, going to sleep and waking up around the same time each day, not eating too close to bedtime, and sleeping in a dark room (pack a sleep mask in case your accommodations don’t have blackout curtains).

• If you use noise masking when you sleep, be sure to pack your tabletop speaker or purchase a travel version before you go.

• If your trip includes outdoor excursions or water adventures, refer to the tips under “Water World.”

Yardwork

Gardening can be a great way to alleviate stress and get exercise, but yard tools can also be dangerously noisy, especially gas-powered lawn mowers and leaf blowers. Refer to hearing safety tips under “Festivities,” and consider whether it’s time to transition to electric-powered yard tools, which cut down the noise and environmental pollutants.

With hearing protection, sunscreen, water to stay hydrated, and perhaps insect repellent, you should be able to enjoy your yard as it flourishes in warmer months.

Summer Care for Hearing Aids

Summer season can be challenging for people who wear hearing aids because, like computers and cell phones, these sophisticated devices don’t fare well when exposed to water. But fear not, by adding a few easy steps to your regular hearing aid care routine, your hearing aids should remain in great working order.

• In humid environments, consider adding a silica gel desiccant pack to your hearing aid storage case to absorb extra moisture. Small packets can be purchased online through Amazon or Walmart.

• Bring an extra hearing aid case on vacation so you have one in your room and one for the pool or beach.

• Some hearing aids are more water resistant than others, which is reflected in what’s called an “IP” rating, which indicates resistance to dust/sand and water on a scale of 1 to 8, with the higher numbers being better. For instance, IP68 means your hearing aids are highly resistant to dirt and sand (the first number) and have good resistance to temporary water exposure (the second number).

Unless your hearing aids are specifically designed for water—a handful of such devices are on the market—do your best to remember to remove your hearing aids before entering water. If they do get wet, remove the battery immediately and put

them in the case with a silica gel desiccant packet until you’re able to use a hairdryer on the coolest setting to completely dry them. This may help them return to their normal function after becoming waterlogged.

• Last, if you sweat more than usual in warm or humid environments, consider giving your hearing aids a break, assuming it doesn’t impede your ability to communicate or stay safe, by placing them in their storage case with a silica gel packet or in a dehumidifying case to keep them in good working order.

Wherever you may go this summer, I hope these tips enable you to enjoy being outdoors, join social events with ease, and manage your tinnitus and hearing health so you’re left with good memories and excitement.

*To learn more about loud noise dangers, visit the National Institute on Deafness and Other Communication Disorders website at https:// www.nidcd.nih.gov/news/2020/do-you-knowhow-loud-too-loud

Beth Field received her audiology degree from the University of Cincinnati in Ohio. She also has a master’s degree in linguistics from Ohio University. As a licensed audiologist, Dr. Field has worked for device manufacturers training audiologists how to use new hearing aid technology and tinnitus treatment devices, in addition to presenting at state and national audiology conventions. She is also a member of the ATA’s Tinnitus Advisors Program.

Looking Through the Lens of the Researcher

Action, Service, and Trust

By Dan Torpey

In June of 2023, I was fortunate as a relatively new ATA board member to spend three days with scientists who were presenting and attending the Tinnitus Research Initiative (TRI) conference in Dublin, Ireland. As an accountant by day and part-time weightlifter by night who lives with the sound of tinnitus 24/7, I set no expectations for the conference other than to listen and learn. If anything, I expected to be the stranger in a strange land.

It was quite the opposite as I stepped foot onto the grounds at Trinity College, Dublin, where I felt the words of the Irish poet W. B. Yeats resonate—“there are no strangers here: only friends you haven’t met.” Being of Irish ancestry, I felt the warm welcome and creativity of the Irish monks of the Middle Ages echoing across the magical island to the modern international city of Dublin

now hosting tinnitus researchers from around the globe. Just as the monks preserved classical learning, education, and scholarship and created art and illustrated manuscripts whose beauty is still showcased in the famous 800-year-old Book of Kells at Trinity College today, so too did the tinnitus researchers’ work and warm way about them reverberate throughout the halls of the conference.

Modern Ireland is now home to research, innovation, and collaboration with business, government, and higher

education that is driving business and medical breakthroughs across the country. For example, OncoMark developed a breast cancer prognostic test for early risk predictions, Synecco developed a medical device for orthopedics that makes procedures more accurate and efficient, Oxyxom developed breakthrough technology for wastewater treatment that significantly reduces energy consumption, and, of course, Neuromod developed the Lenire device to reduce the impact of tinnitus.

As a board member of a patientfocused nonprofit, I’d like to share observations:

First, TRI Dublin was held at Trinity Business School, part of Trinity College, and attracted 277 researchers, healthcare professionals, and a handful of individuals, like me, who are associated with tinnitus patient organizations. In total, 29 countries were represented, with

ATA board member Dan Torpey with Hubert Lim, PhD, chief scientific officer of Neuromod, ATA board member Melissa Wikoff, AuD, and ATA staff member Joy Onozuka.

Spain having the largest number of attendees. To enable people to mix and talk informally, there were several after-hours events.

Although I would have liked to have attended all presentations, two main tracks ran concurrently: neuroscience and behavioral science. Neuroscience presentations delved into neuromodulation, which included transcranial direct current stimulation to treat tinnitus, deep brain stimulation, and bimodal neuromodulation; neuroimaging, which included neurophysiological changes in individuals with tinnitus, mechanisms of neurofeedback for chronic severe tinnitus; and mechanisms of action, such as transcranial electric and acoustic stimulation, and the possible link of common blood parameters with tinnitus.

The behavioral sciences portion, which I was drawn to as a patient interested in current interventions, included ample coverage of investigations around cognitive behavioral therapy for tinnitus as well as presentations on cognition lifestyle factors, use of digital health, and so on.

Several general sessions discussed both research areas, including the UNITI project, which shares data across disciplines. A general session on gene studies, including advances in gene mapping related to tinnitus, delivered the message that there’s still a long way to go. Nonetheless, neat stuff.

My favorite keynote panel discussion was on the intersection of researchers, clinicians, patients, investors, and companies. Panelists included Dirk De Ridder, a clinician researcher affiliated with the University of Otago in New Zealand; Prof. Arnaud Norena of the University

of Lyon; Prof. Dominic Trepel, a health economist at Trinity College Dublin; and Ross O’Neil, CEO of Neuromod. The discussion spurred ideas for me on how we may explore tinnitus research going forward.

I thought these concepts were best presented by Dr. De Ridder about how innovation works and the need to have all groups working together. Those groups being:

a. Discovery/Findings: Role of the researcher, scientist, artist

b. Invention: Creating something that uses or converts the discoveries to a product (the inventor and businessman Thomas Edison is an example)

c. Innovation: Releasing a product into society that can be easily used (for example, Steve Jobs who was not an inventor but rather an innovator of current technologies)

When the complexity of these roles come together, they produce beauty such as that illustrated in the art of the Celtic knots spread across Ireland and the world. Ross O'Neill, CEO and founder of Neuromod Devices, Ltd., was also on the panel and echoed Dr. De Ridder’s description by defining the vision of the collaboration of Irish government to encourage higher education research and his company’s work with both researchers and investors to focus in select areas. For the behavioral health science track, I was impressed with the multitude of studies using cognitive behavioral therapy (CBT) or a combination of CBT with or without hearing aids, therapy sessions delivered live, in groups, via video, with or without additional educational training, and so forth. My big takeaway on these CBT presentations based on data was CBT and some form of therapy works to reduce the negative impact of tinnitus and helps in its management. Furthermore, the combination of counseling and sound therapy, including hearing aids if needed, seemed to be the best solution out there for now, particularly for the many people who have both tinnitus and hearing loss. Group therapy sessions, whether online or in person, all seemed to have positive results. Understanding that CBT and group therapy aren’t for everyone or necessarily easy to access, it’s notable that Gerhard

“My favorite keynote panel discussion was on the intersection of researchers, clinicians, patients, investors, and companies.”

Jinsheng Zhang, PhD, presents on targeting TNF-alpha and calpain pathways for treating tinnitus.

Andersson, one of the leading researchers in the field of psychology and tinnitus, presented data showing that mindfulness-based programs for tinnitus had statistically similar positive outcomes compared to CBT.

I was astounded at the power of our brains and how we can alter our body’s responses by drawing on the techniques presented in these sessions. By targeting negative thoughts and emotions, or calming the brain, CBT can modulate the brain’s response to auditory stimuli, potentially reducing negative effects of tinnitus by influencing the function of the vagus nerve. Mindfulness and CBT can leverage neuroplasticity to reshape neural pathways and thereby improve how we respond. By regularly engaging in either technique or other mind-based therapeutic strategies, individuals can potentially rewire the brain's response to tinnitus, leading to reduced activation of the sympathetic nervous system, which can decrease tinnitus-related distress.

For investigations testing the effect of sound therapy to manage tinnitus, because of inconsistent use of the devices by trial participants, there was not enough data to prove that the sound devices helped. Nonetheless, if you’re a person like me who finds sound therapy useful, you know anecdotal evidence points to its overall usefulness, even if it won’t help everyone.

Even though U.S. tinnitus practice guidelines recommend CBT for people

bothered by the condition, it seems that CBT for tinnitus is more readily available in Europe as a primary intervention. This is an area where the ATA and patient advocates can continue to educate and promote this evidence-based approach within the medical field and among the public in the U.S. At the ATA, we recently expanded our board and outreach to mental health professionals.

I had numerous discussions with panelists, from researchers to clinicians to therapists, all of whom were curious to hear my story and engage in dialogue about it. They collectively echoed the need to continue to explore options in and outside of CBT, such as devices, pharmaceuticals, and so on.

I was impressed with not only the intellect of the researchers but also their authentic desire to serve and care for people living with tinnitus. These are true leaders in the tinnitus research field. Leadership guru Alex

Havard, author of Virtuous Leadership, defines a leader as someone who does “great things,” exhibiting the virtue of “magnanimity” combined with service to others, or “fraternal humility.” I saw these attributes in many of the researchers I met. Another value I saw was “trust.” And I left with a great sense of trust that the global team of researchers are working diligently to find us relief. “Action, service, and trust” is how I would define the researchers attending the TRI conference.

While the Irish singer Bono from the band U2 sings that “he still hasn’t found what he is looking for,” I, however, left with a great sense of hope for continued improvement in treatments both for myself to immediately further explore CBT and to look forward to solutions, such as Lenire, which recently arrived on the U.S. market.

Next year’s TRI conference is in Vancouver, Canada, and though not known to be the home of Leprechauns, I plan to attend as an ATA board member to hear more about the good work of our researchers, the virtuous leaders seeking relief for tinnitus today.

Dan Torpey is a forensic accountant, board advisor, and public speaker. In early 2019, Dan was diagnosed with tinnitus, which hit him hard as he traveled around the world on corporate investigations. He has authored books and articles over the years and speaks on corporate culture, fraud prevention, and improving integrity in organizations. When he’s not investigating corporate crime, Dan competes as a master’s athlete in weightlifting events and is a board member of USA Olympic Weightlifting and the American Tinnitus Association. His book The Forensic Coach is scheduled to be published in late 2024.

“Mindfulness and CBT can leverage neuroplasticity to reshape neural pathways and thereby improve how we respond. ”

L, ATA staff member Joy Onozuka with Tricia Scaglione, AuD, following a lecture.

De Novo FDA Approved Tinnitus Treatment Device

De Novo FDA Approved Tinnitus Treatment Device

De Novo FDA Approved Tinnitus Treatment Device

Groundbreaking Lenire is the first US FDA approved bimodal neuromodulation device for the treatment of tinnitus. Lenire was awarded an FDA De Novo Grant following a third successful large-scale clinical trial.

Groundbreaking Lenire is the first US FDA approved bimodal neuromodulation device for the treatment of tinnitus. Lenire was awarded an FDA De Novo Grant following a third successful large-scale clinical trial.

Where is Lenire available?

Where is Lenire available?

Where is Lenire available?

Lenire is now available through select specialists across the US.

Are there real world Lenire patients?

Are there real world Lenire patients?

Are there real world Lenire patients?

Lenire is now available through select specialists across the US.

Lenire is now available through select specialists across the US.

Was Lenire’s third clinical trial controlled?

Was Lenire’s third clinical trial controlled?

Was Lenire’s third clinical trial controlled?

Yes, TENT-A3 was a rigorous controlled trial that was designed with FDA guidance. Takeaways include:

Yes. Lenire is trusted by thousands of tinnitus patients across the world. Watch their stories at www.lenire.com

Yes. Lenire is trusted by thousands of tinnitus patients across the world. Watch their stories at www.lenire.com

Yes. Lenire is trusted by thousands of tinnitus patients across the world. Watch their stories at www.lenire.com.

Yes, TENT-A3 was a rigorous controlled trial that was designed with FDA guidance. Takeaways include:

Yes, TENT-A3 was a rigorous controlled trial that was designed with FDA guidance. Takeaways include:

Scan to visit www.lenire.com/waitlist

Clinically Proven: 79.4% of all trial patients had a significant reduction in tinnitus severity1.

Clinically Proven: 79.4% of all trial patients had a significant reduction in tinnitus severity1.

Clinically Proven: 79.4% of all trial patients had a significant reduction in tinnitus severity1.

Lenire vs Audio-Only: Lenire was proven to be more effective than audio for tinnitus patients with moderate or worse tinnitus1

Lenire vs Audio-Only: Lenire was proven to be more effective than audio for tinnitus patients with moderate or worse tinnitus1.

Lenire vs Audio-Only: Lenire was proven to be more effective than audio for tinnitus patients with moderate or worse tinnitus1

Highly Recommended: 88.6% of patients would recommend Lenire to treat tinnitus1

Highly Recommended: 88.6% of patients would recommend Lenire to treat tinnitus1

Highly Recommended: 88.6% of patients would recommend Lenire to treat tinnitus1

Safe for Home Use: No serious adverse side effects linked to Lenire were reported1.

Safe for Home Use: No serious adverse side effects linked to Lenire were reported1.

Safe for Home Use: No serious adverse side effects linked to Lenire were reported1.

Groundbreaking Lenire is the first US FDA approved bimodal neuromodulation device for the treatment of tinnitus. Lenire was awarded an FDA De Novo Grant following a third successful large-scale clinical trial. www.lenire.com |

Lenire is available through a select number of tinnitus specialists in the US to ensure patients receive excellent care. Demand is high so join the Lenire Waiting List at www. lenire.com/waitlist or by scanning the QR code above.

Lenire is available through a select number of tinnitus specialists in the US to ensure patients receive excellent care. Demand is high so join the Lenire Waiting List at www. lenire.com/waitlist or by scanning the QR code above.

Lenire is available through a select number of tinnitus specialists in the US to ensure patients receive excellent care. Demand is high so join the Lenire Waiting List at www. lenire.com/waitlist or by scanning the QR code above.

1TENT-A3 clinical trial data in preparation for publication.

Bridging Academia, Technology, and Healthcare

Reflections on Tinnitus Research Initiative 2023 Conference

By Melissa Wikoff, AuD

As an audiologist specialized in tinnitus patient care, I am immersed in the enigmatic universe of tinnitus, a field as complex and ever changing as the auditory symptoms it represents. Each person I meet in my clinic requires a unique blend of empathy, expertise, and effective treatment. To ensure that I stay abreast of cuttingedge research and trends in the field, I attended the Tinnitus Research Initiative (TRI) 2023 conference in Dublin, Ireland, this June.

Looking back a decade, TRI 2013 in Valencia, Spain, showcased the shift toward an interdisciplinary approach to treating tinnitus that was underway as reflected in presentations and conversation. Fastforward to 2023, TRI’s conference theme was “Engineering the Future of Tinnitus: Bridging Academia, Industry, Medicine, and Society,” which perfectly encapsulates today’s multifaceted role that professionals like me are doing daily: proactively bridging gaps in care to provide more effective interventions to restore tinnitus patients’ quality of life.

The TRI conference brings together clinicians and scientists from every corner of the globe, with European representation being

particularly strong. Amid these unique perspectives, a stark contrast in the healthcare experiences between the United States and Europe was impossible to ignore. The access to affordable follow-up treatments for tinnitus in Europe stands in remarkable contrast to the low reimbursement rates and lack of insurance support for thorough tinnitus examinations performed by audiologists specialized in tinnitus care in the United States.

Although the future of tinnitus treatment seems to have abundant potential, with innovative therapies and interventions on the horizon, professional access to new interventions, such as the Lenire device in the U.S., has thus far been slower than we had hoped.

One emphasis of the conference was on the continued importance of an interdisciplinary approach.

Cognitive behavioral therapy (CBT), which was once a novel if

not an almost taboo concept to many professionals outside of the behavioral health community, remains a valuable tool in managing tinnitus. Nonetheless, we struggle to find mental health professionals who are well versed in understanding the distress caused by unwanted sound. More critically, demand for mental healthcare has outstripped supply of licensed mental health professionals in the U.S., which makes the challenge of accessing a therapist in a timely manner hard.

Presentations aimed at understanding the functionality of the brain and the auditory cortex, and how they respond to triggers and treatments, gave practitioners in the audience an enhanced knowledge base for managing this complex condition. The conference also highlighted new advancements in technology, such as over-the-counter, do-it-yourself, and internet-based treatments for tinnitus. While these advances and market shifts are

Jinsheng Zhang, PhD, presents on research conducted at Wayne State University, Mich.

L, Shaowen Bao, PhD, with ATA board members, Melissa Wikoff, AuD, and Jinsheng Zhang, PhD.

exciting, the limitations, particularly high dropout rates in online programs without in-person interface, underline the enduring value, if not necessity, of the human connection offered by qualified professionals in guiding a patient’s progress, which is true of managing other chronic health conditions as well.

This highlights another TRI consensus: There is an urgent need for more trained professionals—both audiologists and therapists—who have a keen interest in working with tinnitus patients. This call to action extends to U.S. clinicians who, I believe, can immensely benefit from participating in these enriching conferences and from the valuable

resources, including support, provided by the American Tinnitus Association. For those of us on the frontline of care, we eagerly await and anticipate bringing research-tested tools to explore their efficacy within the dynamic world of real-life tinnitus patient care, where each individual’s tinnitus is different as are needs. Many TRI speakers reiterated this key principle in tinnitus treatment: Each patient is unique. As such, our approach to treatment remains individually tailored and patient focused.

Melissa Wikoff received her Doctor of Audiology degree from Washington University School of Medicine in St. Louis’s Program in Audiology and Communication Sciences.

ATA Leadership News

Torryn Brazell, chief executive officer of the American Tinnitus Association for six and half years, resigned in July 2023, leaving the nonprofit in a strong operational and financial position. “We deeply appreciate Torryn’s commitment to the ATA and to the cause of helping those with tinnitus across the country,” said David Hadley, the past chair of the ATA Board of Directors. Sara Downs, AuD, a well-regarded tinnitus specialist and business professional, is serving as its interim executive director.*

Dr. Downs has served on the ATA Board of Directors for two years and has worked more than 20 years in tinnitus patient care. As the owner of Hearing Wellness Center in Duluth, Minn., Dr. Downs has an extensive background in healthcare management, organizational development, and a proven leadership track record. “I feel strongly positioned to lead the ATA as it conducts a search for a permanent

executive director,” she said. “It’s exciting to be able to expand my leadership role and passion for advancing quality care for tinnitus patients with my fellow board members, who represent all stakeholders: patients, healthcare professionals, and researchers. We have an amazing group that is fully committed to the mission of finding solutions to tinnitus, including prevention, awareness, effective treatments, and research aimed at cures and improved interventions that relieve tinnitus distress more reliably for more people.”

Dr. Downs will work closely with ATA Communications Director Joy Onozuka, who was named interim director of operations to ensure continuity of day-to-day work and a seamless transition. Ms. Onozuka has worked at the ATA for more than six and a half years and oversees a variety of ATA activities, including its Tinnitus

She earned her Bachelor of Arts degree in Speech and Hearing Science from the University of Maryland, College Park. She was the first student to be appointed to the board of directors of the American Balance Society (ABS).

Having seen the frustrating effects of hearing loss that affected her grandfathers after their service in World War II, Dr. Wikoff founded Peachtree Hearing in Atlanta, Ga., where she focuses on using the latest technologies and interventions to provide relief for patients living with tinnitus. She currently serves on the American Tinnitus Association Board of Directors. Originally from West Hartford, Conn., Dr. Wikoff now resides in Atlanta with her husband, their two children, and two dogs. She is a Peloton aficionado and a trained yoga teacher.

Advisors Program and publication of Tinnitus Today magazine. ATA board member Julie Prutsman, AuD, is leading the executive search committee.

During the transition, the ATA remains dedicated to maintaining its commitment to excellence and prioritizing the needs of individuals living with tinnitus, which includes funding critical research to advance solutions to tinnitus and access to meaningful care. “With Dr. Downs in partnership with Ms. Onozuka, we will navigate this transition with clarity while maintaining our commitments to the community, particularly in the areas of research and evidence-based information on tinnitus and its management,” said ATA board chair Jinsheng Zhang, PhD.

*Learn more about Interim Executive Director Sara Downs, AuD, on page 36.

Torryn P. Brazell Sara Downs, AuD Joy Onozuka

Understanding Tinnitus Guidelines and Their Evidence Base

By James A. Henry, PhD Introduction

This is a summary of the Langguth et al. review article, which looks at different clinical practice guidelines that have been published for the management of tinnitus. The authors analyze the different guidelines with respect to their strengths and weaknesses. The complete article is available for free online, including all the references. See:

B. Langguth, T. Kleinjung, W. Schlee, S. Vanneste, & D. De Ridder. (2023). Tinnitus guidelines and their evidence base. Journal of Clinical Medicine, 12(9), 3087. https://doi.org/10.3390/ jcm12093087

Treatments for tinnitus vary widely and are usually not based on scientific evidence. In effect, tinnitus clinical management does not follow evidence-based medicine standards.

“Evidence-based medicine integrates the best available scientific information with clinical experience and patient values to guide decisionmaking about clinical management” (p. 2). To make evidence-based medicine known to clinicians, it is commonly published as clinical guidelines

Developing clinical guidelines involves four steps:

1. Publications of relevant clinical trials are identified.

2. The quality of each trial is determined.

3. Results of trials meeting certain standards are summarized.

4. The guideline committee uses the information gained to develop the guidelines.

Randomized controlled trials (RCTs) provide the “strongest scientific evidence for creating clinical management guidelines” (p. 2). Conducting RCTs for tinnitus is challenging for a number of reasons. Tinnitus is a subjective condition that is difficult to assess. Everyone who has tinnitus experiences it differently, with respect to both its characteristics and how it affects their life. Whereas questionnaires and scales can reliably evaluate the impact of tinnitus, audiometric measures of tinnitus loudness are not helpful.

The number of RCTs for tinnitus has increased to the point where 50

or so have been published each year over the past 10 years. The authors list different treatments that have been evaluated by RCTs, including pharmacological interventions (antidepressants, anticonvulsants, benzodiazepines/GABAergic drugs, glutamatergic drugs, muscle relaxants, sodium channel blockers, “other”) and nonpharmacological interventions (acupuncture/acupressure, auditory training, bimodal stimulation, brain/ neural stimulation, combination approaches, electrical stimulation of the ear, hearing aids, hyperbaric oxygenation, low-level laser therapy, music therapy, neurofeedback, physiotherapy, psychotherapy, sound treatment).

A framework has been proposed for creating clinical practice recommendations, referred to as the GRADE system (Grading of Recommendations, Assessment, Development and Evaluations).

“GRADE has four levels of evidence— also known as certainty in evidence or quality of evidence” (p. 5). The four levels are: very low, low, moderate, and high.

The GRADE level selected for a study depends largely on bias, which “occurs when the results of a study do not represent the truth because

of inherent limitations in the design or conduct of a study” (p. 5). There are many potential sources of bias in any study (for example, study participants or study setting doesn’t represent real-life clinics). Many other factors affect whether a treatment is recommended (for example, potential for adverse effects, patient preferences, nonavailability of the treatment studied). Another concern is that a person may have comorbidities (such as hearing loss, anxiety, or depression) and treatment for tinnitus may primarily affect the comorbidity. Because of all the variables, it is clearly a challenging task to translate evidence from clinical trials into clinical recommendations.

Materials and Methods

Published guidelines for tinnitus management were identified. The intent was to compare existing guidelines with each other and evaluate the evidence basis for the different treatments that were mentioned in the guidelines.

Six guidelines were identified, including from the U.S. (2014), Switzerland (2019), Europe (2019), NICE (the British National Institute for Health and Care Excellence; 2020), Germany (2021), and Japan

(2019). For each guideline, the source of the evidence was identified. Treatments evaluated included those listed above (pharmacological and nonpharmacological) in the Introduction.

Results: Overview of the Evidence for Therapeutic Interventions for Tinnitus

Cognitive behavioral therapy (CBT) is the best investigated of all the treatments. It has been shown to be effective in reducing scores on tinnitus questionnaires, reducing symptoms of depression, and improving anxiety and health-related quality of life. The strength of evidence, however, is low and the availability of tinnitus-specific CBT is limited.

Counseling in general is recommended by all the guidelines, even with limited evidence.

Mindfulness-based treatments have been shown in moderate- to high-quality studies to decrease tinnitus distress scores, with no effect observed for depression and anxiety.

Auditory treatments (sound therapy) have used many modalities. Cochlear implants are helpful for patients with unilateral severe hearing loss or deafness. Evidence for hearing aids as treatment for tinnitus is very limited. Evidence for wearable sound generators is also very limited. A number of auditory treatments attempt to induce “specific neuroplastic changes in the central auditory system” (p. 13), but they have only been evaluated in pilot studies, so no recommendations can be made other than that more research is needed.

“To make evidence-based medicine known to clinicians, it is commonly published as clinical guidelines.”

Tinnitus Retraining Therapy (TRT) involves both counseling and sound therapy. Various studies have shown improvement, but the quality of evidence was low, with a high risk of bias. It has been debated whether sound therapy contributes to the effects of TRT.

Pharmacological agents have mostly shown negative results, such as studies of Ginkgo biloba, anticonvulsants, and antidepressants. Some drugs showed efficacy, but side effects would preclude their use. Some pilot studies were positive but need to be replicated in large RCTs. Some limited evidence exists for treatment of comorbid conditions such as anxiety, insomnia, and dementia.

Tinnitus Activities Treatment has not been studied in controlled trials. “Neural therapy and Botox” has some pilot studies. Different forms of physiotherapy have been studied with promising results, although most of these studies were for people with temporomandibular joint or neck disorders. Different forms of neurobiofeedback have been studied, also with promising results.

Noninvasive brain stimulation has been investigated using both transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) with some success. Invasive brain stimulation has been used, but these methods are “highly experimental” and not supported for clinical application.

Bimodal stimulation has involved different approaches. One is to present tones while the vagal nerve is stimulated via an implanted device. Other approaches use auditory

stimulation combined with electrical stimulation to the tongue or to areas of the face or neck. Studies of these methods have thus far “shown substantial reductions in tinnitus severity” (p. 14).

Complementary and alternative therapies have had limited investigation. The best studied of these therapies is acupuncture. A systematic review of eight RCTs for acupuncture used for tinnitus concluded that “the level of evidence is insufficient to draw any definitive conclusions” (p. 14).

E-health-based approaches involve web-based and smartphone apps. Evidence for smartphone apps is thus far limited. A number of studies have investigated internet-based CBT for tinnitus combined with face-to-face interaction, which was shown to be comparable in effectiveness to CBT delivered in person either individually or in groups.

Self-help interventions can refer to many different types of approaches, including online-delivered CBT. The more traditional self-help concept is self-help groups. A systematic review of self-help groups determined “no confident conclusions could be drawn regarding the efficacy of self-help interventions for tinnitus” (p. 14).

Overview of Guidelines

The authors also provide an overview of the different guidelines for the management of tinnitus. All of the guidelines indicate pharmacological treatment (including prescription medications and dietary supplements) should not be used. They all support treatment with CBT.

The NICE guidelines (2020) propose a stepwise approach: (1) online CBT; (2) group-based counseling (CBT, Acceptance and Commitment Therapy, or mindfulness-based cognitive therapy); (3) individual CBT.

The German guideline (2021) is the only guideline that recommends auditory training and recommends against sound therapy.

The U.S. guideline (2014) is unique in considering sound therapy a “treatment option.” The guideline is in need of an update.

The Swiss guideline (2019) is very brief and is not backed by a medical society or tinnitus experts. Only a very short summary of the available evidence is provided and there are no recommendations.

The European guideline (2019) was developed by researchers and clinicians from different countries in Europe. It is noted that there is no summary of the evidence that forms the basis of

“It is remarkable that tinnitus practice guidelines have only been developed in Europe, the U.S., and Japan.”

the guideline or the method for collecting the evidence and how the evidence was used to develop the guideline. Recommendations for or against different treatments are categorized as strong recommendation, recommendation, weak recommendation, or no recommendation.

The Japanese guideline (2019) was a formal effort that graded recommendations as strong recommendation, recommendation, and no recommendation. They also chose an evidence level for each recommendation (A, B, C, D).

Discussion: Current Evidence in Tinnitus Treatment—Limitations and Challenges

These guidelines differ in many respects. This variability is due to which body of evidence was used, how the evidence was collected, and the subjective process for translating the evidence into recommendations.

The authors note some contradictions in how recommendations were made. For example, CBT is recommended by all guidelines, but other treatments that have shown similar efficacy (rTMS, tDCS, acupuncture) do not have such universal support. This discrepancy is partially explainable because new and innovative treatments are evaluated using a different standard than treatments that are in routine use. This “double standard” also may impede the development of innovative treatments.

From the time an innovative treatment is shown to be safe and

effective, it would take at least 10 years for the treatment to be recommended in guidelines. Such a delay could prevent patients from receiving the innovative treatment and could be a disincentive to invest in developing novel tinnitus treatments.

The use of evidence-based medicine has undoubtedly improved the quality of healthcare services. The methodology, however, has its limitations. Obtaining evidence involves analyzing results across numerous RCTs as if they were one RCT, which is referred to as a metaanalysis. Meta-analysis works well for disorders that are homogeneous (having the same root cause). It does not work so well for a heterogeneous (having multiple possible causes and manifestations) condition such as tinnitus. Also, with tinnitus, methods of treatment are inherently variable. Further, treatment for tinnitus as administered in a clinical trial is likely to be used differently in clinical

practice. This would not be the case for administering a medication for which patients in the real world would receive the identical treatment as for a clinical trial. There is, of course, no medication for tinnitus.

It is remarkable that tinnitus practice guidelines have only been developed in Europe, the U.S., and Japan. This means that guidelines are not available for the rest of the world. Because of cultural differences, it is questionable whether existing guidelines are appropriate for other countries.

Considerations for Future Directions

Who should write the guideline? This is a difficult question to answer because so many factors are involved. The clinical management of tinnitus is a multidisciplinary field, and each discipline has its own perspectives and biases. For example, a psychologist might favor certain forms of

counseling, whereas an audiologist would favor sound-based treatments. These conflicts of interest can be partially resolved by ensuring that the composition of guideline committees represents all relevant disciplines.

Funding is essential for guideline development but is usually insufficient. Committee members may have varying levels of expertise. Experts are required both in tinnitus clinical management and in evidence assessment.

How should innovative treatments be assessed? Most importantly, patients’ interests should be the priority, and not the interests of

up-to-date. Guideline panels could evaluate the data on a regular basis (yearly should be appropriate).

What can contribute to better evidence in tinnitus treatment?

The RCTs published every year generally provide relatively low evidence for the treatments that are studied. Standardization is needed for clinical trial methodology and for valid outcome measures. Further, as tinnitus is known to be such a heterogeneous condition, appropriate subgroups of patients need to be identified.

Who should treat tinnitus patients?

Treatment options based on current guidelines are limited and often unsatisfactory. Newer and better treatments for tinnitus are urgently needed. The following strategies are suggested:

1. Use higher standards when conducting tinnitus clinical trials that also consider the heterogeneity of tinnitus.

2. Avoid the bias toward established treatments.

3. Rather than recommend against an intervention, suggest relevant research needs.

4. Use the living guideline concept for faster guideline updates.

5. Involve patients more when developing guidelines.

advocates for particular established treatments (who tend to be on the guideline committees). Innovative treatments that have merit should not be “recommended against” but, rather, given appropriate recognition with specific recommendations for needed research to verify safety and efficacy.

How can guidelines become more up-to-date? The “living guideline” process is a potential solution to the long delay between the publication of research findings and their inclusion in guideline development. A living guideline would involve pulling data immediately from relevant publications, entering the data into databases, and incorporating the data into “analysis workflows.” In this way a systematic literature review could always be kept

A single specialist working in isolation may be inferior to a multidisciplinary tinnitus center. If a center is not possible, then a multidisciplinary network of practitioners could address this concern.

Should patients be involved in guideline recommendations? Including patients in guideline development can introduce additional biases, but this concern is overridden by the need to address the final goal of guidelines, which is better treatment for tinnitus. It is therefore essential to include patients in guideline development.

Conclusions

Developing treatment guidelines based on evidence is an important step toward standardizing treatment.

The ultimate goal is to help the tinnitus patient. Clinicians should have the leeway to choose appropriate treatment, even if the quality of evidence is low (which is the case for most treatments). A holistic approach that considers all factors should be used in making clinical decisions.

James A. Henry, PhD, is an audiologist with a doctorate in behavioral neuroscience. He recently retired as a Senior Research Career Scientist at the Veterans Affairs (VA) Rehabilitation, Research & Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR) located at the VA Portland Health Care System in Portland, OR. For most of his 35year career, his focus was researching clinical methods of tinnitus management. In addition to providing consultation services, he is currently writing a series of books on tinnitus, hearing loss, and sound tolerance disorders, under the heading Ears Gone Wrong.

“Developing treatment guidelines based on evidence is an important step toward standardizing treatment.”

Former Marine Stays Faithful to Tools That Support Success

By Christopher Cuomo

I remember clearly waking up on Saturday, December 18, 2021, and thinking to myself, “What is that loud, annoying sound and where is it coming from?” After searching around my bedroom and bathroom, I realized that the sound was only on my left side, and no matter where I moved, it moved along with me. After plugging my ears with my fingers to block the sound, I realized what it was: tinnitus. The infamous “ringing in the ears” that I had heard of but hadn’t given much consideration to. Yet, there I was with tinnitus in one ear.

I could theorize for a month of Sundays what could’ve caused it. Was it triggered by my 20 years of active duty as a U.S. Marine, hearing loss, noise exposure, previous concussions, or the side effects of the Covid-19

booster I received five days before its onset? I’ll never know. What I do know is that I have unilateral tinnitus in my left ear, which set me on a new life journey. As with every journey, it started with a single step: trying to frame the problem through knowledge.

As with many cases of tinnitus, mine was beyond irritating and caused me much stress, anxiety, and loss of sleep. I also lost a lot of weight from the stress of constantly focusing on the tinnitus, which sounded like a fighter jet parked on the left side of my head. I had to figure out how to deal with this. Visits with medical professionals ruled out treatable issues such as earwax buildup or a perforated eardrum but didn’t offer anything more meaningful than conclusions that “it’s not curable and you’ll need to learn to ignore it.” With

that, I did what anyone else would do: search the internet for answers.

A deep internet dive was a misstep and one I would advise against for anyone with newly onset tinnitus. First, there are scam products everywhere offering a “cure” for tinnitus. Second, there are forums that mostly offer “doom and gloom” with absolutely nothing positive. It’s possible for a person suffering from tinnitus to lose all hope, have their anxiety go into orbit, and spike their tinnitus just from clicking around on the internet. However, one website stood out: www.ATA.org

The American Tinnitus Association’s toll-free number—1-800-634-8978— put me in contact with one of their tinnitus advisors, an independent audiologist specialized in tinnitus management. She keyed off one piece of critical information: as a former

U.S. Marine, I have access to tinnitus care. She strongly advised that I get in touch with the Department of Veterans Affairs. With a push from my amazing wife, I made that call.

I’ve heard many opinions about the VA from my fellow veterans and I’ve seen the negative press, but I’ve got to tell you, they came through for me. I had never used the VA healthcare system prior to that 25-minute call in January 2022, when I was registered in the VA healthcare system and scheduled for my first appointments with a physician and an audiologist at the Savannah VA Outpatient Clinic.

By February 2022, I was evaluated and diagnosed with hearing loss in my left ear, prescribed a hearing aid, and fitted for custom hearing protection, all at no cost! I was floored by how easy it was to get help. No arguments, no having to advocate for myself. All I had to do was make a simple phone call and ask some questions.

When I asked the audiologist about specific tinnitus care, I was referred to a VA behavioral health counselor who guided me through the VA’s Progressive Tinnitus Management (PTM) program. Although it was not available on site at the Savannah clinic, I was able to attend via telehealth appointments over a period of two months. PTM teaches you what tinnitus is and possible causes, but more importantly, it teaches you how to retrain your responses to it. It helps you to reframe focus away from the negative aspects of tinnitus and develop strategies for managing it, so it becomes less intrusive. What I found most beneficial was it helped me manage nutrition, exercise, and sleep, which are simple enough concepts that many of us easily overlook. The reality is the lack of attention to self-care can hinder your ability to deal with tinnitus. My counselor also introduced me to the VA’s Mindfulness Coach smartphone app. That app

enabled me to be self-aware regarding my stress and emotional state in a nonjudgmental way. Another VA benefit is their flexible telehealth options. I use it to join tai chi sessions via Zoom from my living room.

Disclaimer: I’m a retired Marine with unilateral tinnitus, not a medical professional. I’m sharing what worked for me, but nothing will work if you don’t try. So, go on and take the first steps: ask questions to qualified people, get competent medical care, and make positive lifestyle changes because it’s better than standing still in life with nothing but your tinnitus.

Christopher Cuomo is a former U.S. Marine who resides in Richmond Hill, Georgia, with his wife, their son, and four pets. Born in Brooklyn, New York, Christopher enjoys playing ice and roller hockey, rooting for the New York Rangers, fishing, and going on adventures with his beautiful wife Sarah.

Share Your Story With ATA Readers

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 and/or hyperacusis, we’d like to hear from you. Please send your story to editor@ata.org by Sept 15. Suggested word length is between 800 and 1000 words.

Christopher’s Code for Tackling Tinnitus With Meaningful Knowledge

By Christopher Cuomo

Understanding your tinnitus

Tinnitus is the perception of sound without an external stimulus, which can be caused by a range of things. Ruling out possible underlying problems is helpful, but it may not reveal what caused your tinnitus. Even without a clear answer for the cause, you must move forward.

Focus matters

Tinnitus can cause emotional reactions that heighten your focus on it. That focus made my tinnitus louder. Once I decided to redirect my attention to other areas of my life, it began to fade into the background.

What are your habits?

Controlling your emotional response will depend on where you’re starting from. Changing my eating habits and reintegrating exercise into my life was an impactful first step in the right direction. I’ve been retired from the Marines for 15 years, and on first contact with civilian life, physical training (PT) is typically the first thing we veterans offload to make room for our “new” lifestyle. Wrong answer. PT is a byproduct of personal integrity to yourself and your well-being. If you’re eating poorly, not exercising, and not sleeping, you’re on the wrong foot. Fix this and you’ll be surprised at the difference. Make time for it!

Sleep matters

“How do you sleep with tinnitus?” was the question I posed to someone else who had tinnitus for years. The response was stop focusing on tinnitus as the reason you can’t sleep. Sounds counterintuitive but when I broke this question down, it made sense. The reason was not the tinnitus, but rather my attention to it. Along with this came guidance to “prepare”

for sleep. If your eyes are glued to your electronics up until it’s time to sleep or you keep yourself busy up until it’s time for bed, you aren’t allowing your mind and body to downshift from the day. It’s much harder to sleep with all that sensory overload. Once I committed to a bedtime and shutting down all electronics and to-do lists one to two hours before bed, I was able to sleep. Having a calm nighttime mode facilitates sleep. Today, I get seven to eight hours of uninterrupted sleep, which significantly reduces the perception of my tinnitus the next day.

Tune in to your emotional state

Tinnitus often reacts to stress and agitation. Using healthy tools to manage stress and emotions gives you agency. I use daily exercise and tai chi to manage stress.

Don’t ignore what needs to be addressed

Like shifts in lifestyle, take the advice to address deficits. I wear my hearing aid, which allows me to hear better and focus on the world around me. This boost to my situational awareness helps keep my tinnitus in the background.

Hooked on Making a Difference?

Fishing Tournaments Cast a Net for Change and Remembering Loved Ones

The American Tinnitus Association is delighted to announce a very special event—the Douglas Lake celebrity Pro–Am Fishing Tournament (Sept. 11, 2023) and the Open Fishing Tournament (Sept. 16, 2023)—hosted by professional angler Mike Delvisco in honor of his late friend Kent Taylor, the founder of Texas Roadhouse.

“I am honoring the life of my dear friend, Kent Taylor, who—even as he struggled with tinnitus—found ways to give back to others. Alongside

Texas Roadhouse, I’ve partnered with the ATA to raise money for tinnitus awareness and research,” Mike said.

The multiday event kicks off on Sept. 11 at Douglas Lake in Dandridge, Tenn., with the celebrity Pro–Am Fishing Tournament, which runs from 9 a.m. to 1 p.m. A host of celebrities, including Mountain Man from Duck Dynasty and country music stars Restless Road and Smith & Wesley, have signed on to participate and will be available to talk before and after the day’s event.

On Sept. 13, a block party will be held at Texas Roadhouse in East Knoxville from 5 p.m. to 9 p.m. Everyone is invited to grab something to eat and meet vendors associated with the events.

On Sept. 16, members of the public are invited to join the Douglas Lake Open Tournament, which begins at daylight with weigh-in of fish starting at 3 p.m. The eight-hour event will feature two-person teams that pay an entry fee and compete for cash and prizes.

Proceeds will be donated to the ATA in honor of Kent, who committed

his life to proactively solving problems, caring for community, and facilitating change in areas in need of solutions. Tinnitus remains a complex heterogeneous condition that requires all of us to contribute in some way, so why not dive into giving to fish for a cure and better treatments for tinnitus?

If you don’t fish or live near Douglas Lake, Tenn., we invite you to donate to help change the tide on tinnitus suffering. For more information on the event or to donate, visit www.ATA.org.

Country music stars, Smith & Wesley

Mike Delvisco reeling in hope for the future.

Empowering the Person With Tinnitus

Case Studies Combined With Decades of Clinical Research Knowledge

Review by Marc Fagelson, PhD

Title: The Tinnitus Book: Understanding Tinnitus and How to Find Relief

Author:

James A. Henry, PhD

Publisher: Ears Gone Wrong, LLC

Date of publication: 2023

Number of pages: 234

Paperback ISBN: 979-8-88759-654-9

It is likely that more than 1 billion people experience and hundreds of millions suffer from, to varying degrees, the perception of a tinnitus sound. At the same time, the tinnitus sensation is as obvious to its owner as it is invisible, unhearable, and incomprehensible to other people. A tinnitus sound may be unobtrusive and ignorable, intermittently challenging, all-consuming, or anything in between. Consider also that tinnitus and emotional distress are often mutually reinforcing, while many patients indicate that hearing loud sounds

makes their tinnitus louder. Taken together, tinnitus’s high prevalence and heterogeneous presentation—the substantial diversity and uniqueness of patients and their concerns—confound efforts at curing the condition with standard medical interventions. Against this backdrop, and in an environment in which many patients may struggle to find accurate information conveyed in a reasonable and verifiable manner, Dr. James A. Henry offers The Tinnitus Book. Dr. Henry’s life, research, and career have focused upon delivery and improvement of clinical services and related counseling information intended to support patient coping and quality of life. In The Tinnitus Book, Dr. Henry provides a considerable amount of relevant and relatable information for patients, as well as for the students and practitioners who serve them. Boiled down, this is a book that will foster self-care for patients with bothersome tinnitus and, by extension, the confidence of those individuals charged with their care.

Dr. Henry’s text addresses the wide range of tinnitus-related patient challenges in a variety of ways. The book contains brief case examples to highlight aspects of tinnitus effects, its evaluation, and its management, and these brief case descriptions should resonate with readers who likely share similar experiences. Patients may benefit from observing elements of their own situation through the context of the cases offered, and at the same time practitioners may be reminded

of, and therefore able to (re)consider, past clinical encounters. Linking cases to diagnosis and intervention has long been one of Dr. Henry’s strong suits. Of particular benefit, the description of tinnitus management strategies includes substantial information regarding patient triage, onward referrals, and realistic expectations. Stepped interventions such as his research group’s Progressive Tinnitus Management (PTM) protocol, as well as options including cognitive behavioral therapy (CBT), are described in detail, but not belabored—the balance between providing adequate information without overwhelming the reader is clearly one of The Tinnitus Book’s most attractive attributes. Importantly, Dr. Henry conveys in several passages the notion that, as much as one might know about tinnitus, it is the patient who may claim expertise; as Dr. Henry’s mentor Jack Vernon suggested, most of what we know about tinnitus we learned from patients.

Dr. Henry uses a series of appendices to expand on material in the book for the curious reader and, hopefully, students and practitioners. The broad spectrum of tinnitus experiences springs from, at least in part, diversity of causes and exacerbators. The appendices provide Dr. Henry an opportunity to summarize and report elements from the literature related to, for example, mechanisms (Appendix A: Auditory Gain), measures (Appendix C:

Sound of Tinnitus), and management (Appendix D: Tinnitus Retraining Therapy [TRT]; Appendices E and H: CBT; Appendix F: Tinnitus Activities Treatment [TAT]). Such counseling and the related focus on information that may be provided by practitioners underscore the strategies that support patient coping and adaptability. Audiologic rehabilitation often employs devices (for example, hearing aids or maskers); however, it is widely accepted that device benefit relies substantially on counseling related to the devices and realistic expectations for the devices. The Tinnitus Book and appendices offer detailed information regarding rehabilitative interventions that work reasonably, consistently and that are least invasive. Indeed, when drugs and surgery fail more often than they succeed—as is the case with tinnitus—it is incumbent upon providers to support patient coping through other means.

Throughout the book, Dr. Henry displays both a comprehensive understanding of and working relationship with the tinnitus event

that could only emerge from the substantial effort he exerted throughout his career in this practice domain. As a decorated researcher—his hundreds of presentations, publications, and five prior books earned him top-of-theprofession career awards from both the VA system and the American Academy of Audiology—Dr. Henry can state with clear and unwavering tone that tinnitus, although for the most part incurable, is manageable. He discloses his own tinnitus and its effects, and it may be encouraging to patients that individuals can coexist with tinnitus even when, perhaps as an occupational hazard, they think about it and talk about it more or less all the time. His compassion, humor, and gracious touch with facts and theory permeate this text in ways that will ease navigating the material, some of which may, admittedly, appear at times counterintuitive to potential consumers. Dr. Henry tells us that this is his first book in a series about tinnitus and “ears gone wrong.” Although his accomplishments need no additional burnishing, the thought that he will continue to investigate ways in which

30th Annual International In-Person/Online Conference Management of the Tinnitus & Hyperacusis Patient

tinnitus can be explained and managed should provide patients, providers, and students a measure of assurance that the condition’s complexities and obstinance may be addressed in the future through Dr. Henry’s unique correspondences. Already looking forward to the next one.

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. Dr. Fagelson co-edited with Dr. David Baguley two texts published by Plural that center on tinnitus and disorders of sound tolerance. 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. Dr. Fagelson is chair of the American Tinnitus Association’s Scientific Advisory Committee.

The 30th Annual International Conference, Management of the Tinnitus & Hyperacusis Patient is scheduled to be held August 10-11, 2023, at the University of Iowa. The educational event is intended for otologists, audiologists, hearing aid specialists, and other healthcare professionals providing clinical services for tinnitus patients. Topics include an overview of current evaluation practices, management strategies, and research. Presentations are given by leading researchers, practitioners, and leaders in advocacy and include the latest developments in the areas of medical treatments, neuroscience, sleep therapy, noise-induced hearing loss, and hyperacusis.

The conference, which is being held in person and online, is intended to increase the knowledge and skills of clinicians; however, it is open to patients and their families, with the understanding that no individual diagnosis or treatment will be offered.

For more information, visit the University of Iowa’s website: https://medicine.uiowa.edu/oto/education/ conferences-and-courses/international-conference-management-tinnitus-and-hyperacusis

ATA is proud to be a DIAMOND SPONSOR

Consilience Bridging Wisdom Across

Disciplines to Create a New Model of Tinnitus Care

By Sara K. Downs, AuD

I was talking to a dear friend a couple years ago who asked me a fantastic question: “What are you doing that excites you at work right now?” This friend of mine is a genetic counselor and was more than happy to listen to my story of the “fireworks moment” I had about working with tinnitus patients. Telling of my undergraduate studies in psychology and subsequent degree in audiology, I described how the field of tinnitus had landed at an intersection that really piqued my interest. I explained how one of my favorite neuroscientists (we all have one of those, right?), Stephen Porges, had recently patented a new sound therapy protocol for sound sensitivity by stimulating the vagus nerve.

As I was explaining to her how perfectly Dr. Porges’s polyvagal theory fit with Dr. Jastreboff’s neurophysiological model of tinnitus, she had a big smile on her face.

“Consilience!1” she said. She went on to explain that consilience ensues when different fields of science are broken out of their silos and create new theories, therapies, and processes by linking together principles across disciplines. I love the concept of consilience for tinnitus because tinnitus is a multisystem

symptom that cannot be adequately explained or treated using any one modality on its own.

My 20 years in audiology have been focused on treating patients who have tinnitus. I was first trained in Tinnitus Retraining Therapy (TRT) by Pawel and Margaret Jastreboff in 2001. In the early days of my practice, I followed the TRT protocol down to the letter. TRT has its foundation in the neurophysiological model of tinnitus and has a protocol to follow for different types of tinnitus, hyperacusis, and misophonia patients. It is effective, and there are plenty of white papers showing this to be true.

Two of the contributing factors for successful habituation with TRT are the commitment of patients and their consistent adherence to the protocol. These can also be the clinical roadblocks to success. Depending on what else is happening in the life and health of a patient, it can be a long process, typically six to 12 months. Successful TRT depends on a skilled practitioner with lots of counseling and coaching tools at their disposal.

In those early years, I found myself searching the fields of psychology, neuroscience, and functional medicine for more tools to facilitate habituation. I became interested in nutritional and supplement support for the nervous system. I took the course “Food as

Medicine” through the Center for MindBody Medicine, which was my first exposure to functional medicine and the study of the role of self-care and regulation of the nervous system in medicine. I went through a twoyear certification process in Mind-Body Medicine (MBM) and now integrate those techniques into my audiology practice for tinnitus, hyperacusis, misophonia, and hearing loss.

While studying for my MBM certification, I learned about the polyvagal theory put forth by Dr. Stephen Porges. When I first learned the polyvagal theory, vagus nerve stimulation was already being discussed in tinnitus literature. In Porges’s work we learn about how the nervous system labels sensory information through a preconscious process called neuroception. The polyvagal theory also explains that vagus nerve stimulation can be achieved through diaphragmatic breathwork and other experiential exercises, many of which are techniques I was already using in MindBody Medicine. That was the fireworks moment!

That moment of consilience led me to develop a protocol that uses the neurophysiological model of tinnitus as the foundation and blends together different modalities of treatment.

Incorporating breathwork with other experiential exercises that encourage mind-body awareness into TRT and a sound therapy protocol customized to the hearing and tinnitus profile characteristics of the patient has been successful with patients in my clinic.

As I refined my protocol to include experiential exercises on a specific schedule, inspired by classical conditioning, habituation began to occur within six to 12 weeks. I believe this process, which I call “Active Sound Therapy,” encourages neuroception to create a new “nonthreatening” label for the tinnitus signal. My hypothesis is that by priming the nervous system for change and using sound therapy on a specific schedule while interacting with the person’s nervous system using experiential exercises, we can change the neuroception of tinnitus and facilitate faster habituation.

None of the different therapies in the Active Sound Therapy protocol are new. As clinicians, we stand on the

shoulders of predecessors who asked questions, performed research, and created new ways of treating different health conditions. The novelty of this protocol is how it combines classic, heavily researched, and validated therapies to produce a faster, more efficient, elastic, and interactive treatment program for patients.

I have trained a small group of audiologists to use the protocol, and I look forward to collecting more data as they use it in their clinics as a way to assess its effectiveness. I am excited to bring this protocol to a wider audience of both audiologists and people who struggle with tinnitus.

I joined the ATA Board of Directors two years ago because I believe in its mission of advancing research and supporting people touched by the condition, particularly those burdened by it. As chair of the Healthcare Relations Committee, we educate healthcare professionals on appropriate tinnitus care so that no one is ever dismissively told that they “need to learn to live with tinnitus,” with no meaningful information on how to move forward. The ATA does its best to fill that gap in numerous ways.

When I learned of the resignation of ATA’s CEO Torryn Brazell at the start of summer, I accepted the call to serve as interim executive director,

because I fully grasp the importance of the organization, particularly when it comes to keeping the spotlight on patients and their urgent need for quality care and support as we work toward better solutions and possible cures for tinnitus. I’ve been a healthcare professional for more than 20 years, so I feel confident that my background in healthcare management, organizational development, and leadership track record will serve the association well.

If you’re feeling stuck because of tinnitus or would appreciate greater engagement, I encourage you to utilize the ATA’s Tinnitus Advisor Program call line (800.634.8978, ext. 3), join an open-access online support group, or reach out to a peer-to-peer volunteer via email or telephone. For more information on these programs, visit www.ATA.org and click on the tab bar called “Your Support Network.”

You can also reach me by emailing tinnitus@ata.org .

Sara K. Downs, AuD, resides in Duluth, Minn., and is an owner and director of the Hearing Wellness Center and Tinnitus Treatment Center. She is a member of the American Tinnitus Association Board of Directors. In addition to being Board Certified in Audiology, she is also certified in MindBody Medicine and in providing the Safe and Sound Protocol. When Dr. Downs is off the clock, you’ll likely find her in the garden, on a mountain bike, or cheering her kids on at a sporting event.

Reference 1. Wilson, E.O. (1999) Consilience: The Unity of Knowledge. Alfred A. Knoft, New York, NY.

“Consilience ensues when different fields of science are broken out of their silos and create new theories, therapies, and processes by linking together principles across disciplines.”

Assessing and Treating Tinnitus-Related Anxiety and Insomnia

By Bruce Hubbard, PhD

Anxiety and insomnia are among the most common health problems in the United States. Over the course of our lifetime, one in five of us will experience an anxiety disorder, and one in three, a spell of insomnia.1,2 Although genetics play a role, the primary trigger for anxiety and insomnia is stress.

There is no question tinnitus can be sufficiently stressful to trigger anxiety and insomnia. Indeed, many people describe the onset of tinnitus as traumatic. Not surprisingly, then, studies find that close to 50 percent of people with tinnitus distress meet diagnostic criteria for anxiety and up to 80 percent complain of insomnia.3,4

In my experience, untreated anxiety and insomnia are the greatest cause for concern with tinnitus. These conditions make it harder to cope with tinnitus and can block habituation and recovery. It is critical, then, that you or your loved one know how to respond to these problems if they occur. In this article, I provide tips for addressing tinnitus-related anxiety and insomnia and accessing the right help.

TinnitusRelated Anxiety

The most common emotion associated with tinnitus is anxiety. Anxiety ranges in intensity from anxious anticipation to sheer panic. The functional impact of tinnitus distress on sleep, concentration, and leisure is partly due to the sound of tinnitus, and largely due to the anxiety tinnitus can trigger.

In the Assessment & Treatment for Tinnitus-Related Anxiety chart (p. 39), you can see levels of anxiety severity and steps you can take to address it. Self-help strategies can be effective at mild to low-moderate levels, but at high-moderate to severe levels, a consultation with a qualified healthcare professional is strongly recommended.

Finding the Right Help for Anxiety and Panic

In seeking anxiety treatment, your primary care physician is a good place to start. He or she may prescribe medication and/or refer you to a behavioral health specialist.

Cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT) are the treatments of

choice for anxiety. These approaches involve strategies that help us calm down, function better, and turn our attention to adapting and moving on. A behavioral health professional who is experienced treating tinnitus distress would be your best bet, but these experts are hard to find. So, a therapist who treats both anxiety and insomnia would be great. For more information on anxiety assessment and treatment, see www.ADAA.org

Medication for Anxiety

Medication is an evidence-based treatment for anxiety and panic. Effective medications include short-acting benzodiazepines (e.g., lorazepam, clonazepam), which can be used as needed or daily for brief periods to stabilize acute anxiety (and

insomnia; see Sleep Disturbance Assessment & Treatment chart). Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs; e.g., escitalopram, sertraline), are commonly prescribed for anxiety and panic. Medications like these can be used on a temporary basis to relieve tinnitus-related anxiety and promote recovery.

In its tinnitus guidelines, the American Academy of Otolaryngology (ENT physicians) suggests that, for tinnitus-related anxiety, antidepressants “could be indicated and useful.”5 Yet, there is concern in the tinnitus community that antidepressants, especially SSRIs, which are the most prescribed antidepressant, cause and worsen tinnitus.

If you are concerned about a medication causing or worsening tinnitus, I strongly encourage you to read Drugs and Tinnitus by otolaryngologist and tinnitus expert Don McFerran.6 Regarding anecdotal reports of medications triggering tinnitus, Dr. McFerran states, “In fact, when these claims are subjected to proper scientific scrutiny the number of drugs that genuinely cause

tinnitus is extremely small.” The one scientific study on the effect of an antidepressant (SSRI) on tinnitus volume found no change 7 In my opinion, the benefits of trying an antidepressant for tinnitus-related anxiety far outweigh any potential risks.

Tinnitus experts agree that overdependence on benzodiazepines can inhibit tinnitus habituation. However, under the guidance of a qualified expert, these medications can be used effectively to promote anxiety reduction and tinnitus distress recovery.

Tinnitus-Related Insomnia

It’s not surprising that sleep disturbance is the number one

Assessment & Treatment for Tinnitus-Related Anxiety

“Many people describe the onset of tinnitus as traumatic.”

complaint of people with tinnitus distress. You, at the end of the day, your tolerance spent, listening to tinnitus and worrying, is the perfect formula for a sleepless night.

The Sleep Disturbance Assessment & Treatment chart breaks down levels of insomnia and steps you can take to address them. At mild to moderate levels, relaxation strategies, in combination with good sleep habits, supplements, and over-thecounter medicines, can be useful. At more severe levels, these strategies combined with stronger prescription medications may be necessary.

Reduce Your Reaction to Tinnitus

A fundamental rule of insomnia treatment is to first address any health-related concerns that may be causing the insomnia. In our case, the source is clear: anxious, hypervigilant

attention to tinnitus. Addressing your reaction to tinnitus, then, is the first step to better sleep.

Relaxation techniques and sound enrichment are the simplest strategies. There are many good resources on these approaches for sleeping with tinnitus, so I won’t review them here. Yet, these simple strategies are only as helpful as our ability to respond to tinnitus in an emotionally neutral manner when we hear it. To do this, I recommend mindfulness of sound.

Mindfulness of sound helps us hear our tinnitus effectively, without

being distracted and overwhelmed by worried thoughts and anxious, irritable feelings. Mindfulness can help soften the perception of tinnitus by redirecting attention to other sounds and sensations. Practice mindfulness of sound during your waking hours so that you can most effectively apply it for sleep, concentration, and leisure.

Any strategies you try for sleeping with tinnitus should be applied in the context of cognitive behavioral therapy for insomnia, or CBTi, an evidencebased treatment for insomnia.

Information on CBTi can be found at https://www.cbtforinsomnia.com

Sleep Disturbance Assessment & Treatment

“Mindfulness can help soften the perception of tinnitus by redirecting attention to other sounds and sensations.”

Medications and Supplements

Primary care physicians are the first stop for insomnia treatment. They may prescribe medication and/or refer you to a sleep specialist. There are many over-the-counter options for insomnia, from supplements, like melatonin and CBD oil, to the antihistamine Benadryl (diphenhydramine), which can cause drowsiness. There is a wide range of prescription options for insomnia. I recommend working with your physician to find the best solution. Medications and supplements are intended to be used on a temporary basis while the stressors pass and you resume your prior quality of sleep.

Staying Focused on Your Recovery

Tinnitus distress takes a hole out of our lives, but with the right understanding, knowledge, and strategies, we can get a grip on tinnitus, stabilize our emotional

reaction, and guide ourselves through recovery and habituation. For many of us with tinnitus, getting a handle on anxiety and insomnia are required stops along the way.

On developing tinnitus distress in 2005, Bruce Hubbard, an experienced clinical psychologist, turned for help to the only evidence-based treatment, cognitive behavioral therapy (CBT). Following his recovery, Dr. Hubbard founded CBT for Tinnitus, LLC, to provide global access to online training and coaching to people struggling with tinnitus distress and tinnitus education for professionals. He has published numerous articles and podcasts on CBT, mindfulness, and tinnitus. His webinar, Cognitive Behavior Therapy for Tinnitus, sponsored by the Anxiety & Depression Association of America (ADAA), has received close to 400,000 views.

Dr. Hubbard is a visiting scholar at Columbia University, Teachers College, and past president of the New York City Cognitive Behavior Therapy Association (2016–2018). Additionally, he is certified in cognitive and behavioral psychology through the American Board of Professional Psychology (ABPP). He completed his doctorate

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 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

in clinical psychology at Binghamton University and his clinical internship at New York University Medical Center.

References

1. National Institute of Mental Health. (n.d.). Any anxiety disorder. Retrieved from https://www. nimh.nih.gov/health/statistics/any-anxiety-disorder Expiration date June 30, 2024.

2. T. Roth. (2019). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl.), S7–S10. https://doi. org/10.5664/jcsm.26929

3. S. Zöger, J. Svedlund, & K. M. Holgers. (2006). Relationship between tinnitus severity and psychiatric disorders. Psychosomatics, 47, 282–288. https://doi.org/10.1176/appi.psy.47.4.282

4. G. Asnis, K. Majeed, M. Henderson, C. Sylvester, M. Thomas, & R. La Garza. (2018). An examination of the relationship between insomnia and tinnitus: A review and recommendations. Clinical Medicine Insights: Psychiatry, 9 https://doi. org/10.1177/1179557318781078

5. D. Tunkel, C. Bauer, G. Sun, et al. (2014). Clinical practice guideline: Tinnitus. Otolaryngology—Head and Neck Surgery, 151(2 Suppl.), S1–S40. https://doi. org/10.1177/0194599814545325

6. D. McFerran. (2018). Drugs and Tinnitus. Originally published by British Tinnitus Association. Available at https://www.cbtfortinnitus.com/cbt-tinnitusresources

7. S. Robinson, E. Viirree, K. Bailey, et al. (2005). Randomized placebo-controlled trial of a selective serotonin reuptake inhibitor in the treatment of nondepressed tinnitus subjects. Psychosomatic Medicine, 67, 981–988. https://doi.org/10.1097/01. psy.0000188479.04891.74

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.

Can One Emotion Soften the Impact of Tinnitus?

Awe, unlike other emotions, can invoke a feeling of inspirational joy or fear. It’s something philosophers and religious scholars have explored for centuries, but it’s only in the last 20 years or so that awe has entered the realm of psychology and how this often fleeting, yet powerful, emotion can empower a person to shift perspective and find new direction.

At the helm of this research is Dacher Keltner, PhD, co-director of the Greater Good Science Center at UC Berkeley and author of the recently released book Awe: The New Science of Everyday Wonder and How It Can Transform Your Life.

Dacher has contributed extensively to multiple disciplines, including sociology and neuroscience, through his research on the physiological and behavioral manifestations of emotions that can

promote greater well-being, such as awe and compassion.

Understanding that the onset of tinnitus can trigger awe in its ancient form of fear inducement, the ATA asked Dr. Keltner for his perspective on how the science of awe, drawing on its positive manifestations, can be harnessed to diminish the impact of tinnitus on one’s life.

Joy Onozuka: What prompted you to devote your career to advancing scientific understanding of human emotions? How does expanding our conceptualization of emotions, both the intellectual and physiological experience, help us to thrive mentally and socially?

Dacher Keltner, PhD: I was raised by parents—a literature professor and an artist—who believe in the power of the passions and that emotions guide us to what matters for us in life, where we will find meaning and connection. And so, for 30 years I’ve studied emotions

like awe, gratitude, compassion, fear, anger, and shame. That new science is clear: The more we understand our emotions, use them wisely, and see their purpose in our lives, the better we fare mentally, socially, and physically.

JO: What has your research revealed about why awe can serve as a pathway to supporting mental and physical health?

DK: We’ve studied awe for 15 years in terms of how people shift when out in nature or around an inspiring person or when getting the goosebumps during music. This was really the first science on this mysterious emotion, and its benefits are extraordinary. Brief experiences of awe lead us to feel less stress, less physical pain, a sense of more time, a greater sense of community and connection, and more openness to others. Awe activates the vagus nerve, which is good for heart health, and cools the body’s inflammation response, also good for physical health. Awe also leads people to feel a greater sense of well-being overall.

JO: Awe seems to draw on Eastern concepts of mindfulness and taming the ego to promote a healthier awareness and connection to one’s immediate world and beyond. Is that an accurate interpretation?

“The more we understand our emotions, use them wisely, and see their purpose in our lives, the better we fare mentally, socially, and physically.”

DK: This is one of the central effects of awe—that it produces what we have called the small self. Namely, awe brings about less focus on self, a greater sense of humility, and less rumination. When people take pictures of themselves when feeling awe, those photos of the self are smaller [because there’s greater inclusion of what’s in the background]. Given the association between self-focus and anxiety, pain, and depression, these effects of awe are important.

JO: How do you find awe when you’re unable to find joy or comfort in your life because you’re struggling with tinnitus?

DK: First of all, let me extend my concern, compassion, and recognition of how hard tinnitus can be.… And my thoughts are with all of you. One of the things that gives me hope is that awe has been found to have benefits for people suffering from really hard physical and mental conditions. For example, in one of our studies we found a day of awe produced by rafting on a river led to a 30 percent drop in PTSD symptoms for a week among veterans. That is hopeful. I wrote the book Awe when suffering profoundly the loss of my younger brother, and I find personally, as I write, that brief experiences of awe help with grief. So, yes, I think the cultivation of awe in ways I’ve pointed to can help with the harder conditions of life.

JO: Why is awe more powerful than hope, joy, faith, or love?

DK: I think the key difference with awe is that it promotes a smaller self, and it heightens the sense that we as individuals are part of something larger than the self—a culture or ecosystem or musical tradition or political cause.

So, in this sense awe may be more powerful—it gets us out of the focus on the self more so than any emotion, and we enjoy the accompanying benefits of this shift in awareness.

JO: Are certain types of people more readily able to experience awe and its benefits?

DK: Yes, we’ve studied “awe prone” people, and they tend to be more open in general to other people, novelty, and cultural things like music and art.

JO: How does a person experiencing intense emotions, like hopelessness, grief, and fear, which aren’t necessarily fleeting emotions, tap into awe?

DK: I think you have to cultivate a regular practice of finding awe, be it in thinking about morally inspiring people in your life or listening to awefilled music or getting out in nature or looking at the sky or engaging in a spiritual practice. I write about an awe walk study we did that tells us we can cultivate a sense of awe easily and feel less pain. Michael Amster and Jake Eagle have a new book out—The Power of Awe—that describes an easy awe program to cultivate the emotion on a daily basis (see page 44), and we’re publishing results showing it helps people in healthcare settings with loneliness, stress, and depression.

JO: For individuals living with chronic conditions such as tinnitus and pain, which can disrupt the sympathetic nervous system, where does one begin in the pursuit of finding or rekindling the emotion of awe?

DK: I would study the eight wonders of life I write about—moral beauty, nature, collective effervescence (e.g.,

singing in choirs), music, visual design, spiritual practice, life and death cycles, and big ideas—and find specific things to do—small things like thinking for a moment about an inspiring person in your life—that bring awe. Make it a regular five minutes of your day.

However, if despair and depression and loneliness are too great for fleeting moments of joy or awe, it’s essential to see a good therapist. And build in more awe as one feels more agency and safety and hope.

JO: What other emotions have been shown in your research to help people overcome hardship and a sense of alienation?

DK: Compassion, gratitude, amusement are great for the real hard struggles of life. For practices, see ggia.berkeley.edu

Dacher Keltner (dacherkeltner. com) is Professor of Psychology at UC Berkeley and faculty director of the Greater Good Science Center (greatergood.berkeley. edu). Dacher’s research focuses on the biological and cultural evolution of compassion, awe, love, beauty, and humility, as well as power, social class, and inequality. Dacher is the author of many scientific articles and several books, including Born to Be Good: The Science of a Meaningful Life, The Power Paradox: How We Gain and Lose Influence, and AWE: The New Science of Everyday Wonder and How It Can Transform Your Life (https://www.penguinrandomhouse.com/ books/622175/awe-by-dacher-keltner/).

Dacher is the recipient of many research, teaching, and service awards and is a member of the American Academy of Arts and Sciences. He has consulted for Apple, Pinterest, Google, and the Sierra Club and was a scientific consultant for Pixar’s Inside Out and Soul and for the Center for Constitutional Rights in its work to outlaw solitary confinement.

The Power of Awe to Unleash a Sense of Possibility and Renewal

By Jake Eagle, LPC

I have been aware of the challenges associated with tinnitus for the past 13 years, not because I have it but because my wife does. And her condition is severe pulsatile tinnitus that she describes as “my entire head is ringing.” It started when we were returning from a trip to Japan in 2010. I had been teaching a psychology workshop, and my wife, Hannah, came with me to explore Japan. While we were on the flight home, the plane’s cabin lost pressure. Several people held their ears, babies cried,

and some were in severe pain. For Hannah, that was the beginning of her tinnitus. It started out with ringing in one ear, but over the years, it has grown into an exhausting, endless ringing in her entire head.

Hannah is a homeopath, and we prefer to use alternative medicine when possible, but she used Western medicine diagnostics to see if there might be a clear cause and treatment for her tinnitus. After multiple MRIs, ultrasounds of her carotid artery, and being probed by an ear, nose, and throat physician—no cause or solution has been discovered. She

has experienced temporary relief by treating the condition as if it were a sinus infection, but the benefits are modest and short-lived.

However, we have a glimmer of hope to share with you. The story of tinnitus changes when we think of it more broadly as a manifestation of chronic inflammation and stress from a dysregulated nervous system. This is an area I’ve been learning about for the past four years while researching the emotion of awe. Along with my colleague, Michael Amster, MD, I conducted a research study at UC Berkeley. In 2020, at the height of the

Photo by Hannele Lahti

pandemic, we enrolled approximately 200 frontline healthcare workers (physicians, nurses, hospital staff) and approximately 300 patients. Our study demonstrated that by using a simple method to access the emotion of awe, participants experienced decreased depression, anxiety, loneliness, and physical symptoms of pain. They also experienced increased well-being and mindfulness.

Since tinnitus can contribute to symptoms of depression, anxiety, and physical discomfort, there may be reason to believe that the emotion of awe can help those bothered by it. This is because awe has proven effective in reducing inflammation and regulating the nervous system. In a 2015 study published in Emotion,1 researchers concluded, “Dispositional joy, contentment, pride, and awe each negatively predicted levels of Interleukin 6 (IL-6). However, awe was

the strongest predictor. This finding was replicated in a second analysis, in which the amount of awe experienced that day also predicted levels of IL-6.”

IL-6 is one of many types of cytokine, a type of protein that helps regulate the immune system, and functions primarily as a proinflammatory (threat) cytokine. In communication with other cells and chemicals in the body, IL-6 stimulates inflammatory pathways to protect against infection and injury. IL-6 also poses a special risk: It can facilitate turning acute inflammation into chronic inflammation.

Awe, it turns out, is the only positive emotion known to significantly decrease proinflammatory (threat) cytokines and increase antiinflammatory (safety) cytokines, as measured by IL-6 levels.

Not only does the emotion of awe reduce inflammation, but it also supports the functioning of the parasympathetic nervous system. Parasympathetic activity promotes relaxation and what’s known as a higher vagal tone, which means the body can quickly return to a calm state after a stressful experience ends.

The vagus nerve represents the main component of the parasympathetic nervous system, which oversees a vast array of crucial bodily functions, including control of mood, immune response, digestion, and heart rate.

Our book, The Power of Awe, defines awe as “an emotional experience in which we sense being in the presence of something that transcends our normal perception of the world.”

Prior to the study we conducted at UC Berkeley, researchers used to study awe by using extraordinary sources of stimulation to elicit awe. These might include virtual reality or standing on the edge of the Grand Canyon. Our research was different because we asked our study participants to find awe in the ordinary. They could find awe in a beautiful object in their home, a photograph or memory of a loved one, a connecting moment with their pet, or an idea that captivated their minds. Finding awe in the ordinary means that awe is always available to us.

The technique we developed to help people access awe is very simple. We call it the A.W.E. Method, and it involves three steps:

A W E

Attention means focusing your full and undivided attention on something you appreciate, value, or find amazing.

Wait means slowing down or pausing.

Exhale and Expand means making a slightly deeper exhalation than normal and allowing what you are feeling to fill you and grow.

When we access the emotion of awe, several things happen. First, there is a sense of timelessness. Imagine the relief you might experience, if only for a few seconds, time disappears. No rush. No urgency. Nothing to do. As a result of entering a state of timelessness, people report feeling more patient. When people feel more patient, they tend to be more generous and form deeper connections with other people. They also experience a sense of vastness in which they take themselves less seriously. These traits that arise when entering a state of awe have obvious physical and psychological benefits.

So, you may be wondering, has the A.W.E. Method helped Hannah? She told me, “When I practice the A.W.E. Method, I get a break from my tinnitus, which is a relief. But it’s also a little tricky. If I practice it while thinking about my tinnitus, it doesn’t help because I’m thinking about my tinnitus. But when I allow myself to go fully into the sensation of experiencing awe, that’s when I experience relief. And although I can’t say this practice takes my tinnitus away entirely, I can say that the ringing doesn’t bother me nearly as much.”

It makes sense that Hannah isn’t as bothered by the ringing when she uses the A.W.E. Method because this method shifts one’s state of consciousness. You can think of your state of consciousness as your state of mind. As we shift from one state of consciousness to another, we experience the world differently. We value different things, ask different questions, and this creates physiological and emotional changes.

We have identified three levels of consciousness: safety, heart, and spacious. Most of us live in safety consciousness most of the time. In this state, we are focused on taking care of the things in our lives that need to get done—making meals, paying bills, organizing, planning, earning money, and so forth. We do these things to make ourselves feel secure, and it is an essential and valuable state of consciousness. However, it also is limiting.

When we shift to heart consciousness, we enter a state of gratitude. We feel deep appreciation for aspects of our lives, relationships, memories, and hopes. And it is possible to spend more time in heart consciousness even while taking care of the many tasks we need to do, but too often, we forget to be grateful for the simple things, such as our ability to make a meal, the variety of foods we have available to us, and the people with whom we may share the meal.

Spacious consciousness is a state people access through some kind of contemplative practice. That might be meditation, tai chi, yoga, or many other forms of mindfulness. But these practices take time to develop

and time to perform. It turns out the A.W.E. Method is a shortcut to access this state of consciousness. And unlike heart consciousness, which often involves thinking about the things and people we are grateful for, spacious consciousness does not involve any thinking. It is a state of timelessness and without words.

When we use the A.W.E. Method to access spacious consciousness, we are disconnecting from the trials and tribulations that are part of life; we experience a vast perspective that changes everything, including how we experience tinnitus. This is why Hannah said, “It doesn’t bother me nearly as much.” The A.W.E. Method is not a cure, but it is good for our bodies, minds, and relationships, and it may make tinnitus less bothersome.

Jake Eagle, LPC, is a psychotherapist, mindfulness instructor, fellow member trainer of the International Association of Neurolinguistic Programming, and cofounder of Live Conscious. After 30 years in private practice, Jake now works part-time as a meta therapist, working with people who want to go beyond the bounds of traditional therapy. Together, he and his wife, Hannah, lead lifechanging small group retreats at awe-inspiring locations around the world.

To learn more about the A.W.E. Method and Eagle’s recently released book The Power of Awe, visit https://thepowerofawe.com or email jakeeagle@gmail.com

Reference

1. J.E. Stellar, N. John-Henderson, C.L. Anderson, et al. (2015). Positive affect and markers of inflammation: Discrete positive emotions predict lower levels of inflammatory cytokines. Emotion. 15(2):129-33. https://doi.org/: 10.1037/emo0000033.

“As we shift from one state of consciousness to another, we experience the world differently.”

Does Covid-19 Infection or Vaccination Impact Children’s Hearing and Balance?

Summary by John A. Coverstone, AuD

As the world moves well into its third year since the start of the pandemic, Covid-19 and its variants continue to be a prevalent source of illness. Vaccines are now available for all ages, 6 months and older, but have been available for children younger than 18 years of age for about two years. As a result, the effects of both Covid-19 infection and vaccines continue to be studied.

A group of researchers from the University of Milan in Italy looked at auditory and vestibular (the inner ear’s balance system) health in children ages 5 to 11 years.1 They reviewed clinical files of children seen at their audiology clinic and referenced results against Covid-19 infection and vaccination records, looking for adverse effects on hearing and balance.

In all, 272 children were included in the study. Among them, 120 had existing unilateral hearing loss so that this factor could be studied as well. Patients were excluded if they had preexisting medical conditions of the ears, other hearing loss, known genetic conditions, or other history known to be associated with hearing or balance problems. As in many countries, the Italian medical agency (AIFA) approved the Pfizer-BioNTech vaccine for children 5 to 11 years old in December 2021.

This led to interest in studying these effects in 2022, after many children had been vaccinated.

In the study, 132 of the 272 children had contracted Covid-19, and 140 had received two vaccine doses. Populations were roughly equally divided by gender and age (younger than 8 years old versus older than 8). The most common symptom reported by children after Covid-19 infection or vaccination was a sense of pressure inside the ear.

When comparing children who received the vaccine with those who had confirmed Covid-19 infections, those infected had higher incidence of tinnitus, hyperacusis, sense pressure inside the ear, ear pain, fluid draining from the ear, and vertigo. Researchers reported that all symptoms, except vertigo, started within two weeks of infection and lasted for at least five days. Symptoms among those who received the vaccine resolved on their own within a day.

Four children with vertigo were diagnosed with a medical condition

involving inflammation of the nerve that carries balance information to the brain. The other three children with vertigo were evaluated without finding evidence of impairment within the ear or in the balance centers of the brain.

Two children who contracted Covid-19 were found to have new hearing loss in one ear. None of the vaccinated children experienced new hearing loss, which confirms other research that vaccination is safe regarding hearing and balance conditions.

There were also no differences in symptoms between children with preexisting hearing loss and those with normal hearing in both ears prior to their visits, suggesting that preexisting hearing loss is not a risk factor for audiological problems after Covid-19 infection or vaccination.

Reference

1. M. Aldè, F. Di Berardino, U. Ambrosetti, et al. (2023). Audiological and vestibular symptoms following SARS-CoV-2 infection and COVID-19 vaccination in children aged 5–11 years. American Journal of Otolaryngology 44(1), 103669. https:doi. org/10.1016/j.amjoto.2022.103669

Tinnitus Support Groups

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. Each support group referenced here is independently operated and led by volunteers who wish to provide education and support to the tinnitus community.

IN-PERSON MEETINGS

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.

To allow for flexibility in planning, some groups do not schedule meetings far in advance. When we receive updates from support group leaders, we update meeting information on our online Events Calendar at www.ata.org . The 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/ your-support-network/find-a-supportgroup/. 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 a 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/your-support-network/ telephone-support/

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

North Denver Tinnitus Support Group

Broomfield Community Center

Overland Room

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: Lori or Lisanne

T: 352–989–5123

E: office@citrushearing.com

2nd Monday of the month, 1:00 pm, RSVP required

Michigan

Marketplace Tinnitus Group

2020 Raybrook SE

Grand Rapids, MI 49505

Contact: Robert Ellis

T: 616–949–4911

E: robe7350@gmail.com

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

Meeting date and time TBD

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

Currently not meeting. Email support available.

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

Arizona

Tucson Tinnitus Support Group

Contact: Trudy Jacobson

E: trudyj@cox.net

4th Saturday of the month, 1:00 pm Arizona residents only

California

Hearing Loss & Tinnitus Support Group

Contact: Mimi Salamat

T: 925–937–4455

E: dr.mimiaudiologyclinic@gmail.com

1st Thursday of the month, 7:00–8:30 pm, via Meetup link Meetup Link: https://meetu.ps/e/L5Td7/ J3hcb/i

Los Angeles/Orange County Tinnitus Support Group

Contact: Barry Goldberg

E: bargold06@yahoo.com

3rd Saturday of month, 10:00 am No meeting in August and October

The Palo Alto Tinnitus Support Group at Avenidas

Contact: Ken Adler

T: 650–804–4524

E: karmtac@aol.com

3rd Thursday of the month, 5:30–7:30 pm

Sacramento Area Tinnitus Support

Contact: Pat Clark

E: sactinnitus@gmail.com

2nd Wednesday of the month, 6:30–8:00 pm

Colorado

Denver Tinnitus Support Group

Contact: Rich Marr

T: 303–875–5762

E: rmarr5275@gmail.com

2nd Monday of the month, 7:00–8:30 pm

Georgia

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, 4:30 pm

VIRTUAL MEETINGS

Maryland

Tinnitus and Hyperacusis Management Group

Contact: Christina Shields, AuD

T: 301–405–5562

E: shields3@umd.edu

Meets quarterly, date and time TBD

Missouri

St. Louis Tinnitus Support Group

Contact: Tim Busche

T: 636–734–4936

E: tbusche@stltinnitus.org

1st Wednesday of even months

New Jersey

South Jersey Tinnitus Support Group

Contact: Beth Savitch, Erin Lustik

E: tsg@advancedent.com

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

Oregon

VA Portland Health Care System

Tinnitus Education Group National Center for Rehabilitative Auditory Research

Contact: Anna Forsline

T: 503–220–8262, ext. 55568

E: Bryan.Shaw2@va.gov

Pennsylvania

Lehigh Valley Tinnitus Support Group

Contact: Luke Ciaccio, PhD

T: 610–776–3117

E: lciaccio@gsrh.org

2nd Tuesday of month, 5:30–6:30

Texas

Dallas/Ft. Worth Tinnitus Support Group

Contact: John Ogrizovich

E: dfwtsg@yahoo.com

Saturday, every six weeks, 10:00 am

Virginia

National Capital Region Tinnitus Support Group

Contact: Elaine Wolfson, David Treworgy

E: erwolfson@comcast.net

E: david_treworgy@yahoo.com

Meets monthly, date and time TBD

Wisconsin

Madison WI Tinnitus Support Group

Contact: Deb Holmen

T: 608–219–0277

E: dholmenihearu@gmail.com

Website: TinnitusWISupport.com

4th Wednesday of the month, 6:30–7:30 pm

HYBRID MEETINGS

California

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 Tuesday of the month, 6:00–7:30 pm

Texas

Austin & San Antonio Tinnitus Support Group

Contact: Matthew Randal

T: 512–660–7276

E: atasg.satx@gmail.com

1st and 2nd Saturday of the month, 11:00 am

Spotlight on Patient Providers

Professional Members

Listing current as June 30, 2023

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

Susan Sheehy, AuD

Alabama Hearing Associates

Madison, AL

Dana M. Walchek, AuD Hearing Solutions Inc.

Birmingham, 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, CH–TM

Sound Relief Hearing Center

Scottsdale, AZ

Judy Huch, AuD

Oro Valley Audiology, Inc.

Oro Valley, AZ

Bomina Kang, AuD

Sound Relief Hearing Center Peoria, AZ

Steven Lopez, CCHt

Awaking Healing, LLC

Glendale, AZ

Stephanie Mullins, AuD, CH–TM

Southeast VA Health Care Clinic Chander, AZ

Sarah Pitrone, AuD, CH–TM Sound Relief Hearing Center Mesa, AZ

Greg Swingle, AuD Arizona Hearing Associates Tucson, AZ

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

Joe Bartlett, BC–HIS Bartlett’s Hearing Aid Center Chico, CA

John Barrett, Lac

The Acupuncture Wellness Center, Inc. Los Angeles, CA

Randall Bartlett, MA

Tinnitus & Audiology Center of Southern California, Inc.

Santa Clarita, CA

Maryellen Brisson, AuD Parker Hearing

Hermosa Beach, CA

Shahrzad Cohen, AuD, CH–TM

Hearing Loss Solutions

Sherman Oaks, CA

David DeKriek, AuD Fidelity Hearing Center Cerritos, CA

Xavier J. Ernst, NP-C San Diego, CA

Gregory Frazer, AuD Pacific Hearing & Balance Center, Inc.

Los Angeles, CA

Jennifer J. Gans, PsyD

Mindful Tinnitus Relief

San Francisco, CA

Amit Gosalia, AuD

West Valley Hearing Center

Woodland Hills, CA

Alyse Gulack, AuD

VA Palo Alto Healthcare System

Menlo Park, CA

Tracy Peck Holcomb, AuD

Treble Health

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

Suzanne May, AuD, CH–TM

Treble Health

Sacramento, 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

Marni Novick, AuD, CH–TM

Silicon Valley Hearing, Inc.

Los Gatos, CA

Angela O’Boyle, AuD Hearing Associates Inc.

Northridge, CA

Cathie Pechnick, LCSW

Los Angeles, CA

Tina Penman, AuD

US Department of Veterans Affairs

Citrus Heights, CA

Ramsay Poindexter, AuD, CH–TM

Treble Health

San Jose, CA

Brook Raguskus, AuD, CH–TM

Pacific Hearing Service

Los Altos, CA

Jane Rosner, AuD

West Valley Hearing Center

Woodland Hills, CA

Mimi Salamat, PhD

Dr. Mimi’s Audiology Clinic

Walnut Creek, CA

Ben Thompson, AuD

Treble Health

Berkeley, CA

Eleanor Wilson, AuD

Hear Again 2

Bakersfield, CA

Brian Worden, MD

Kaiser Permanente

Woodland Hills, CA

Colorado

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

Krisztina Johnson, AuD, CH–TM Hearing Associates

New Castle, CO

Tony Kovacs, AuD, CH–TM

Sound Relief Hearing Center Fort Collins, CO

Sarah Mathews, AuD

Treble Health

Denver, CO

Abigail McMahon, AuD, CH–TM

Sound Relief Hearing Center

Fort Collins, CO

Leah Mitchell, AuD, CH–TM

Sound Relief Hearing Center

Westminster, CO

Drew Price, AuD, CH–TM

Sound Relief Hearing Center Denver, CO

Julie Prutsman, AuD, CH–TM

Sound Relief Hearing Center

Highlands Ranch, CO

Jackie Smith, AuD, CH–TM

Sound Relief Hearing Center

Highlands Ranch, CO

Mandi Solat, AuD, CH–TM

Audiology Services & Hearing Aid Center

Lakewood, CO

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

Delaware

Megan E. Boehler, AuD Bayside Audiology & Hearing Aids

Lewes, DE

Florida

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

Lindsey Banks, AuD Treble Health Miami, FL

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

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

Maura Chippendale, AuD, CH–TM Chippendale Audiology

Cape Coral, FL

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

Noel Crosby, AuD Advanced Hearing Solutions Englewood, FL

Ali Danesh, PhD Labyrinth Audiology

Boca Raton, FL

Edvaldo de Oliveira Leme, BS Medika

Jacksonville, FL

Kelly J. Dyson, AuD Suncoast Audiology, LLC

Largo, FL

Melodi Fehl, MS

ENT and Allergy Associates of Florida Boca Raton, FL

Karah Gottschalk, AuD NOVA Southeastern University

Ft. Lauderdale, FL

Kimberly Lamb, AuD Lake Medical Center

Eustis, FL

Megan Posey, AuD, CH–TM

St. Luke’s Cataract and Laser Institute

Tampa, FL

Janice T. Powis, AuD Mind Over Tinnitus Tallahassee, FL

Karthikeyan Sai, MD Palm Beach Kidney & Hypertension Wellington, FL

Melisa Sharpe, AuD

First Coast Mobile Audiology

Ponte Verda Beach, FL

Cindy Ann Simon, AuD

South Miami Audiology Consultants

South Miami, FL

Mindy Stejskal, MCD The Hearing Center

Pensacola, FL

Robert Taylor, MD Private Practice

Vero Beach, 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 Georgia

Elisa Bobbitt, AuD

Newtown Hearing Center

Alpharetta, GA

Christopher V. Campellone, HIS GoToHearing

Gainesville, GA

Sonia Hamidi, AuD, CH–TM

ENT Institute

Buford, GA

Liz Ramos, AuD, CH–TM

ENT of Georgia/Advanced Hearing

Atlanta, GA

Georgeanne Thomas, AuD

Hearing & Balance Clinic

Watkinsville, 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

Bailey Neuhaus, AuD, CH-TM

Boise VA Medical Center

Boise, ID

Tosha Strickland, AuD

Strickland Ear Clinic

Meridian, ID

Illinois

Steve Bonzak, MS Health Traditions

Chicago, IL

Nancy Congdon, AuD, CH–TM The Hearing Care Clinic Downers Grove, IL

Phillip Elbaum, LCSW Stritch School of Medicine Loyola University, Chicago

Deerfield, IL

Victoria Frank, AuD Sertoma Speech & Hearing Association

Palos Hills, IL

Dru A. Geraghty, MS Audiologic Services Glen Ellyn, IL

Lori A. Halvorson, AuD, CH–TM

Lake Forest Hearing Professionals

Lake Forest, IL

Dawn Heiman, AuD Advanced Audiology Consultants

Woodridge, IL

Jaclyn Jansen, AuD

Sarah Bush Lincoln Effingham, IL

Julie A. Lendzion, AuD Naperville Hearing Services Naperville, IL

Maria Morrison, AuD, CH–TM Geneva Hearing Services Geneva, IL

Mark Partain, AuD, CH–TM Treble Health Chicago, 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

Curt Esterline, HIS Concierge Hearing Healthcare New Haven, IN

Sharon Hirstein, MA

Elkhart Audiology Rehab Elkhart, IN

Erica Person, AuD, CH–TM Flex Audiology Lawrenceburg, IN

Iowa

Shane Gailushas, MD Mercy Ear, Nose, and Throat Marion, IA

Diana Kain, AuD Heartland Hearing Center Hiawatha, IA

Jill Nesham, AuD

Professional Hearing Solutions by Dr. Jill Cedar Rapids, IA

Jonathan Stirn, AuD Hope Hearing & Tinnitus Center Hiawatha, IA

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

Kansas

Bryne Gonzales, AuD NuSound Hearing & Tinnitus Center Topeka, KS

Darcie Hartwick, HIS Hartland Hearing Care Centers Manhattan, KS

James Mangimelli, AuD Mosaic Life Care Atchison, KS

Kentucky

Nachiketa Bhatt, RN Healthy Living Primary Care Louisville, KY

Ann Rhoten, AuD Kentucky Audiology & Tinnitus Services

Lexington, KY

Kari A. Wickstrom, AuD Bluegrass Hearing Clinic

Nicholasville, KY

Louisiana

Leanne Battler, AuD

United States Army

Fort Polk, LA

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

Elena Treadway, AuD

Noel ENT Hearing Center

Abbeville, LA

Maine

Ashlee Vandiver, AuD

Red Maple Audiology, LLC

Turner, ME

Maryland

L. Noelle Allemang, AuD

360care

Laurel, MD

Toni A. Brightwell, AuD Hearing Associates Inc.

Havre de Grace, MD

Chelsea Carter, AuD

University of Maryland Medical Center

Baltimore, MD

Ross Cushing, AuD

Live Better Hearing & Balance

Montgomery Village, MD

Chelsea Lambie, AuD

Allegany Hearing and Balance

Lavale, MD

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

Nottingham, MD

Candice Ortiz–Hawkins, AuD

Capital Institute of Hearing & Balance

Silver Spring, MD

Sofia Roller, AuD

The Hearing Wellness Center, LLC

Lutherville-Timonium, MD

Yael Schonfeld, AuD

Chesapeake Ear, Nose & Throat

Owings Mills, MD

LaGuinn Sherlock, AuD, CH–TM

Walter Reed National Military Medical Center

Bethesda, MA

Massachusetts

Emma Alscher AuD, CH–TM

Mass Eye & Ear

Boston, MA

Dierdre Anderson, AuD

Audiology Network Services

Salisbury, MA

Nataliya Ayzenberg, AuD, CH–TM

Moon Hearing Services, LLC

Woburn, MA

Judith Bergeron, BC–HIS, CDP

Beauport Hearing Care

Gloucester, 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

Sapna Mehta–Gertz, AuD Tufts Medical Center

Boston, MA

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

Boston, MA

Michigan

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

Holland, MI

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

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

Tiffany Inman, AuD Inman Audiology Troy, MI

Angela Lederman, MS

Hear Now Audiology & Tinnitus Center Clinton Township, MI

Jacklyn Miller, AuD Advanced Audiology DeWitt, MI

Shannon Radgens, DO Red Cedar Ear Nose & Throat & Audiology Owosso, MI

Virginia Ramachandran, AuD Oticon, Inc.

Plymouth, MI

Michelle Schuiling, AuD, CH-TM Holland Doctors of Audiology Holland, MI

Karrie Slominski, AuD

Henry Ford Health System

West Bloomfield, MI

Minnesota

Jennifer Anfinson, AuD

Treble Health

Plymouth, MN

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

Jason Leyendecker, AuD Audiology Concepts Edina, MN

Ann Miller, AuD Park Nicollet

St. Louis Park, MN

Laura Morrison, AuD, CH–TM Hearing Life

Edna, MN

Gayla Poling, PhD Mayo Clinic Rochester, MN

Jerry Zhou, PhD Hearing of America, LLC Oakdale, MN

Missouri

Laura Flowers, AuD Hearing and Balance Specialists of Kansas City Lee’s Summit, MO

Nevada

Robyn Lofton, BC–HIS Hearing Associates of Las Vegas

Las Vegas, NV

New Jersey

Deanene Berry, AuD Northeast Occupational Audiology Associates Hackensack, NJ

Granville Y. Brady Jr., AuD East Brunswick, NJ

Jade Igbokwe, AuD, CH–TM NTI Audiology

Jersey City, NJ

Michelle Neidleman Kennedy, AuD Treble Health

Newark, NJ

William J. McDonnell, VSO

Dept. of Veterans Affairs

Mount Laurel, NJ

Marion Rollings, PhD Holistic Health Counseling Center LLC Hillsborough, NJ

Beth Savitch, MA

Advanced ENT/Hear MD Voorhees, NJ

Maria Elena Sosa, AuD

DNC Ears

Dumont, NJ

New Mexico

Dorothy McCurley, AuD McCurley Hearing Design

Albuquerque, NM

Catherine A. Worth, MS

Capital Hearing Care

Albuquerque, NM

New York

Nicole Ball, AuD

Hearing Evaluation Services of Buffalo, Inc.

Tonawanda, NY

Dawn L. Bowerman, MS dB Hearing Center

Williamsville, NY

Lois Cohen, LCSW, ACSW, BCD

Tinnitus Counseling

Northport, NY

Natalie Crossland, AuD, CH–TM

Audiology Island

Staten Island, NY

Nancy Datino, AuD

Audiology and Speech Solutions

Rye, NY

Bruce Hubbard, PhD

CBT for Tinnitus, LLC

New York, NY

Tracey Lynch, AuD Island Better Hearing Inc.

Melville, NY

Leigh A. Randon, AuD, CH–TM

The Advanced Hearing Center

Brooklyn, NY

Alyssa Smyczynski, AuD

Hearing Evaluation Services of Buffalo, Inc.

Orchard Park, NY

Garrett Thompson, AuD

Treble Health

New York, NY

Lori Trentacoste, AuD Island Better Hearing Inc.

Melville, NY

Erin M. Walborn–Sterantino, AuD Audiologic Solutions

Rensselaer, NY

Carolyn Yates, AuD, CH–TM

Hearing Evaluation Services of Buffalo, Inc.

Amherst, NY

North Carolina

Jennifer Auer, AuD

Audiology Attention & Tinnitus Care, PLLC

Concord, NC

Katherine A. Baker, AuD

Raleigh Hearing and Tinnitus Center

Raleigh, NC

Susan Bergquist, MS

Heritage Audiology

Wake Forest, NC

Kendall Carroll, AuD

Atrium Health Wake Forest Baptist

Winston-Salem, NC

Alicia L. Cristobal, AuD Hearing Health Care Services, PLLC

Durham, NC

Lisa Fox–Thomas, PhD

UNCG Speech and Hearing Center

Greensboro, NC

Goutham Gosu, AuD Hearing Solution Center

Charlotte, NC

Danielle Jenkins, AuD

Raleigh Hearing and Tinnitus Center

Raleigh, NC

Patricia Johnson, AuD, CH–TM

UNC School of Medicine

Chapel Hill, NC

Saranne Lentz-Barker, AuD, CH–TM Spectrum Hearing Clinic

Henderson, NC

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

Chapel Hill, NC

Sheri Mello, AuD

Raleigh Hearing and Tinnitus Center Raleigh, NC

Melissa Palmer, AuD

High Point Audiological–Clayton

Clayton, NC

Stan Phillips, MD

South Lake Hearing and Tinnitus Center

Huntersville, NC

Ivy Saul, AuD

Audiology & Hearing Services of Charlotte

Charlotte, NC

Michael B. Slater, AuD

South Lake Hearing and Tinnitus Center

Huntersville, NC

Emilee V. Tucker, AuD, CH–TM

Carolina Ear, Nose & Throat—Sinus and Allergy Center, PA

Hickory, NC

North Dakota

Mackensie Brandt, AuD

Altru Professional Center

Grand Forks, ND

Erin O'Leary, AuD

Professional Hearing Services Minot, 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

Ellen Foltz, AuD, CH–TM Modern Hearing Solutions Canton, OH

Casey Haumesser, AuD VA Northeast Ohio Health Care System Lakewood, OH

Ryan Hill, AuD

The Hill Hear Better Clinic Cincinnati, 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

Samantha Morgan, AuD Mary Rutan Audiology

Bellefontaine, OH

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

Eryn Staats, AuD Memorial ENT Marysville, OH

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

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

Oklahoma

Mark Robertson, MD Ascension Medical Group Bartlesville, OK

Oregon

Anna Forsline, AuD

VA Portland Healthcare System

Portland, OR

Kristen Furseth, AuD, CH–TM Willamette ENT

Salem, OR

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

Hillsboro, OR

James A. Henry, PhD

Ears Gone Wrong, LLC

Portland, OR

Erika Shakespeare, MSc

Audiology & Hearing Aid Services

La Grande, OR

Sandi L.B. Ybarra, AuD Hearing Associates

Eugene, OR

Pennsylvania

Lisa Blackman, MA

A Hearing Healthcare Center

Philadelphia, PA

Krista Blasetti, AuD

York ENT Associates

York, PA

Gail Brenner, AuD

Tinnitus & Sound Sensitivity Treatment Center of Philadelphia, PC

Bala Cynwyd, PA

Mindy Brudereck, AuD, CH–TM

Berks Hearing Professionals

Birdsboro, PA

Linda Dallas, MEd

Allentown Ear, Nose and Throat

Allentown, PA

Amy Greer, AuD, CH–TM

Lemme Audiology Associates

Ebensburg, PA

Jacob Hulswit, AuD

Jefferson Balance and Hearing Center

Philadelphia, PA

Jennifer Isayev, AuD

Audiometrics, Inc.

Bryn Mawr, PA

Jeannie Karlovitz, AuD

Advanced Hearing Solutions

Exton, PA

Debbie Lombardi, AuD, CH–TM

Premiere Speech and Hearing

Brownstown, PA

Ashley Potter, AuD

ENT Specialists of NW PA

Erie, PA

Rhode Island

Rose LePorte, AuD

Keystone Audiology

Greenville, RI

Holly Puleo, AuD

Gateway Hearing Solutions

Warwick, RI

South Carolina

Laura Barber, AuD, CH–TM

Aiken CBOC—Audiology

Aiken, SC

Alexandra Tarvin, AuD

Elevate Audiology Hearing and Tinnitus Center

Easley, SC

Jennifer Waddell, HIS Sound Hearing Care

Simpsonville, SC

South Dakota

Melissa E. Baker, MA

Baker Audiology and Hearing Aids

Sioux Falls, SD

Gaurav Jain, AuD

Stanford Hearing Aids

Sioux Falls, SD

Tennessee

Tiffany Ahlberg, AuD

Ahlberg Audiology & Hearing Aid Services

Cleveland, TN

Marc Fagelson, PhD

East Tennessee State University

Johnson City, TN

Jennifer Hausladen, AuD University of Tennessee Health Science Center

Knoxville, TN

Andrea Plotkowski, AuD

Ear, Nose and Throat Consultants of East Tennessee

Knoxville, TN

Paul Shea, MD

Shea Ear Clinic

Memphis, TN

Texas

S. Diane Allen, PhD

The Grove Counseling & Wellness Center Dallas, TX

Katherine Alsop, AuD University of North Texas Speech and Hearing Center

Denton, TX

Theodore Benke, MD

Benke Ear, Nose, & Throat Clinic

Cleburne, TX

Arica Black, AuD

The Hearing Doctor

Lubbock, TX

Bethany Brum, AuD, CH–TM

UT Southwestern Medical Center Dallas, TX

E. Suzanne Carter, LPC

Private Practice

San Antonio, TX

Tracey Castillo AuD, CH–TM

Houston Ear, Nose and Throat

Houston, TX

Heather Dean, AuD Burleson Audiology Clinic Burleson, TX

Shannon Frugia, AuD, CH–TM

Southeast Texas Ear Nose & Throat Beaumont, TX

Mary Sue Harrison, AuD Today’s Hearing

Katy, TX

Jamie Hawkins, AuD Clarity Hearing

The Woodlands, TX

Mark Hedrick, AuD Texas Tinnitus and Hearing

Flint, TX

Rachel Higginbotham, AuD Estes Audiology Hearing Centers Boerne, TX

Carla S. Hoffman, HIS Hoffman Hearing Solutions

Corpus Christi, TX

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

Susan Hyman, AuD Hyman Hearing Beaumont, TX

Danielle Jenkins, AuD IlluminEar Tinnitus & Audiology Austin, TX

Candace Johnson, AuD Cook Hearing & Balance Cedar Park, TX

Kristen Keener, AuD IlluminEar Tinnitus & Audiology Center Austin, TX

Beki Kellogg, AuD Hope Hearing & Tinnitus Center Southlake, TX

Jenna Lemon, AuD Levo Medical Garland, TX

Christina Lobarinas, AuD

UT Southwestern Medical Center

Dallas, TX

Tony Milesi, AuD RK Audiology

Austin, TX

Celia Miranda, AuD, CH–TM Hear In Texas

New Braunfels, TX

Elly Pourasef, AuD Memorial Hearing

Houston, TX

Lydia Ramanovich, AuD, CH–TM

Dallas Ear Institute

Frisco, TX

Bradley Stewart, AuD

ClearLife Hearing Care

Allen, TX

Victoria Villareal, AuD RK Audiology

Austin, TX

Utah

Seth Austin, HIS Timpanogos Hearing

American Fork, UT

Layne Garrett, AuD Timpanogos Hearing

American Fork, UT

Jessica Lui Nelson, BC–HIS

Timpanogos Hearing Spanish Fork, UT

Lindsey Tubaugh, AuD Little Heroes Pediatric Hearing Clinic Layton, UT

Vermont

Stephanie Hollop, AuD, CH–TM Univ. of Vermont–E.M. Luse Center

Burlington, VT

Virginia

Kimberly Abeyta, AuD Hearing Resource Center Fredericksburg, VA

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.

Ana Anzola, AuD

Hearing Doctors

McLean, VA

Theresa H. Bartlett, AuD Virginia Hearing Consultants Virginia Beach, VA

Nicole Denney, AuD Evolution Hearing

Richmond, VA

Ann DePaolo, AuD

The Audiology Offices, LLC Kilmarnock, VA

Julie Farrar–Hersch, PhD

Augusta Audiology Associates, PC Fishersville, VA

Kristin Koch, AuD Evolution Hearing

Charlottesville, VA

Fred W. Lindsay, DO Hampton Roads ENT and Allergy

Hampton, VA

Washington

Troy J. Bacon, CHt New Being Hypnosis

Seattle, WA

Erika Kay, AuD Highline Audiology & Hearing Aids Burien, WA

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

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

Wisconsin

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

Dan Malcore

The Hyperacusis Network

Green Bay, WI

Christina Milos, AuD, CH–TM Audiologic Wellness, LLC Pleasant Prairie, WI

Mandy Rutta, AuD Gundersen Health System La Crosse, WI

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

U.S. TERRITORIES

Puerto Rico

Isamar Gonzalez–Feliciano, AuD Centro Audiológico e Interdisciplinario, Isamar González, Inc. Arecibo, PR

Claudia E. Puig Roman, AuD Torre Medica Auxilio Mutuo San Juan, PR

Cristina Rivera Febres, AuD The Hearing Center San Juan, PR

Soami Santiago de Snyder, PhD Universidad de Puerto Rico Medical Sciences Campus Gurabo, PR

INTERNATIONAL

Argentina

Susana A. Dominguez Audiologist Buenos Aires

Australia

Lynne Blackford, BSc

MQ Health Speech and Hearing Clinic North Epping, NSW

Minakshi Gupta, MA All Ears Hearing

Mount Waverley, VIC

Canada

Ronald Choquette, AuD, CH–TM

Montreal University Audiology Clinic

Montreal, QC

Sabrina DeToma, AuD Salus Hearing Centre

Vaughan, ON

Patrick DeWarle, AuD, CH–TM

Winnipeg Hearing Centres

Winnipeg, MB

Heidi Eaton, AuD

Argus Audiology

Moncton, NB

Kimberly Eskritt, AuD Lambton Audiology Associates

Sarnia, ON

Deborah R. Lain, MSc

Hope For Tinnitus

Calgary, AB

Carol A. Lau, HIS Sound idEARS Inc.

Vancouver, BC

Suzanne MacLaren, AuD

Calgary Ear Centre

Calgary, AB

Brittany Mott, AuD

Niagra Hearing & Health

Fort Erie, ON

Lucy Xie, HIS Bow River Hearing

Calgary, AB

Cayman Islands

Annette Stephenson, AuD

Cayman Hearing Center

George Town

Costa Rica

Silvia Bonilla, AuD

Conservacion Auditiva Ocupacional y Comunitaria CAOC

San Rafael

Juan Olmo, AuD

Conservacion Auditiva Ocupacional y Comunitaria CAOC

San Jose

Czech Republic

Lenka Povová, MD

Myrinx SRC, Ear Nose & Throat Specialist

Nový Bor

Ghana

Neal Boafo, AuD

NeuroAudiology Ltd

Haatso

Hong Kong

David Ho, MD

Shangzhi Medical Group

Hong Kong

Italy

Andrea Beghi, MD

Centro di Medicina Ferrara

Ferrara

Malaysia

Wan Syafira Ishak, PhD, CH–TM

Universiti Kebangsaan Malaysia, Malaysia

Kuala Lumpur, KL

United Kingdom

Lisa Caldwell

The Hearing Coach

Glossop

Alan Hopkirk

The Invisible Hearing Clinic

Paisley

TINNITUSTODAY

Editorial Calendar

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

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

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

PO Box 424049

Washington, DC 20042-4049

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 17: 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.

Episode 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.

ATA PODCASTS ARE FREE AND OPEN ACCESS

ATA’s Conversations in Tinnitus, with John A. Coverstone, AuD, and Dean Flyger, AuD