Carl Maronich (Host): Welcome to Meaningful Medicine, the Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Carl Maronich. And today, I'm joined by neurosurgeon Dr. Kevin Shah. Doctor, welcome to the podcast.

Kevin Shah, MD: Hi, Carl. Thank you for having me.

Host: Today, we're going to be talking about tinnitus from the neurosurgeon's perspective. So, maybe we could start by having you kind of give a definition as to what tinnitus is and what we know about the causes.

Kevin Shah, MD: Tinnitus is just a sound that someone might hear in their ear that's repetitive, but there's no external sound source. There's lots of different causes for it. I mean, it's basically some sort of dysfunction in the hearing pathway of the body that starts everywhere from the eardrum to all the sensors and nerve fibers that connect that eardrum to the brain.

And there's many different causes, as you can imagine, that can affect each little component. There's also sounds that people hear that are occurring from within their body, like blood flow around the ear or maybe fluid in the ear that can cause tinnitus.

Host: Is it a permanent condition? Or are there causes that could make it go away?

Kevin Shah, MD: Well, you might have experienced tinnitus in your own life. Sometimes when you exercise, you know, very strenuously, you might hear a pounding in your head or a pulsating in your head. That sort of sound is temporary, generally goes away after you've recovered. You can also have tinnitus from infections in the ear.

So oftentimes, most people experience transient or temporary tinnitus. But occasionally, you can have tinnitus that lasts for weeks, months, maybe even permanently, and that points to a more serious issue, I guess.

Host: Are there different types of tinnitus? And then, how do they differ In what patients might experience?

Kevin Shah, MD: I generally break it up into two separate types. There's tinnitus that can sound like a ringing or a high-pitched sound. That usually points to some sort of issue with the nerve or the hearing apparatus. And then, there's a pulsating sound that people can hear called pulsatile tinnitus, which can sound like a whooshing or a humming, and that points to a more vascular cause.

I generally, as a vascular neurosurgeon, see more of the latter. So, I deal with blood vessels of the brain, and that includes blood vessels of the inner ear, and these are the patients that actually can have a cure from their tinnitus depending on what is specifically causing it.

Host: I'm going to ask about diagnosis. And the first thing would be, well, if somebody's hearing something in their ear, then that must be tinnitus. But that may not always be the case. So, how do you go about diagnosing tinnitus?

Kevin Shah, MD: Well, it starts with a very detailed physical exam and history. I ask, you know, "When did it start? Are there any provoking factors? What makes it go away?" Sometimes, you know, something very benign can be the cause. Occasionally, they will need an audiological test, meaning a test where an ENT tests their hearing for any hearing loss.

Occasionally, we do imaging like an MRI. Sometimes even more serious conditions like brain tumors can cause tinnitus, and that can mean that you might need to see a neurosurgeon like me. And specifically, for people with pulsatile tinnitus, we usually do more specific vascular type imaging. So, looking at the blood vessels that run in and around that inner ear.

Host: Now, if someone's been around with loud noise for a bit, and then following that, you know, they have some ringing or some sound in their ear, that may not necessarily be tinnitus. Is that correct? So, diagnosing it specifically is what the process you just defined really works to do.

Kevin Shah, MD: Well, it's very subjective actually. I guess if you work around, you know, loud noises or heavy machinery, you might come home from a loud concert and you hear that ringing in your ears for a few days. That essentially is tinnitus, and it generally goes away. But obviously, if you're exposed to loud sounds consistently, it might not go away

Host: So, let's talk a little bit about treatment. What options exist? And, you know, from lifestyle or to medical interventions, what kinds of things can people expect if they are diagnosed with tinnitus?

Kevin Shah, MD: It depends on the cause. Like I said, there's lots of different causes. What I will say is, you know, for those patients who see me, a vascular surgeon, with pulsatile tinnitus, then there's a very good treatment which usually involves changing the pattern of blood flow in the inner ear to reduce the turbulence, which is what people are hearing.

And if that is able to be achieved, then their tinnitus can go away completely. And it's something that's very rewarding and obviously very satisfying, you know, in my own practice, and it's, you know, very satisfying for patients too. That specifically applies to pulsatile tinnitus.

Now, if it's tinnitus from other causes like exposure to loud sound, well, the treatment's kind of easy. Just try to avoid loud sounds. And if you can, people wear, you know, earplugs or earmuffs. If it's an infection, antibiotics usually take care of it. So, it kind of varies, you know. For those other types of tinnitus that involve the structure of the inner ear, those patients see typically an ENT surgeon to take care of those.

Host: Well, you mentioned something I'm going to ask a bit about, and that is wearing headphones and those types of things. We see more and more, and I notice younger kids wearing them right on their ear. So depending on volume, I'm guessing that could be potentially be an issue. How do you talk to patients about that and their children? How do you work to try to prevent these kinds of things?

Kevin Shah, MD: You may have noticed, you know, if you ever go to a sports game, all the little kids are wearing, you know, earmuffs. I think that's important to prevent any, you know, damage as we're growing to the nerve that controls hearing. What I say is if there are exposures to loud sounds, then you should take preventative measures to stop those loud sounds.

I don't really see that many people in that very early early part of their course, I guess. I usually see people on the back end where they have been already diagnosed with tinnitus. And now, they're looking for a solution. The preventative care for tinnitus usually is really, really heavily focused on primary care physicians and ENT physicians

Host: Doctor, is it normal for tinnitus to be synchronized with a person's pulse? So, you mentioned the pulsating type of tinnitus. Is that synchronized with the pulse, and what does that mean?

Kevin Shah, MD: Yeah. There's a specific subtype of pulsatile tinnitus, is what it's called. It's a type of sound that synchronizes with your own heartbeat. That's an indication that that sound is actually coming from blood flow or blood vessels around your inner ear. And this is why you would end up seeing a vascular neurosurgeon like me instead of seeing a regular ENT doctor.

Host: Beyond the sounds themselves, what side effects or impacts can tinnitus have on someone's sleep or their mood and their daily life?

Kevin Shah, MD: Well, it interferes with all aspects depending on how severe the sound is. You know, it's not just the loudness of the sound. It's really just how intrusive it is in your daily life. Most people hear the sound more at night because there's less environmental noise. But it can also affect you when you're trying to concentrate, when you're trying to work, when you're trying to hear very low sounds. And it can significantly disrupt your mood. You know, imagine just hearing a constant sound in your ear all the time. You can become anxious or irritable. Some people even feel like something bad is going to happen because they don't understand where that sound is coming from.

Host: Who is more likely to develop tinnitus if there is such a group? And are there certain risk factors or underlying conditions to watch for?

Kevin Shah, MD: There are some risk factors. As we get older, our hearing apparatus gets more and more deteriorated. And so, people can start hearing tinnitus. So, age is a risk factor. Like, I mentioned a little bit earlier, exposure to loud sounds are a risk factor; occupational hazard in some jobs, for example.

And then, there are sounds that just pop up for no reason. If they pop up for no reason and they don't go away, you know, that's when you should go see your doctor.

Host: What would you hope people take away from this conversation? And what should they think about going forward when it comes to their hearing and tinnitus?

Kevin Shah, MD: Tinnitus is a very common problem. People listening to this podcast may have experienced tinnitus in their own lives. And if it's temporary, it's not something to worry about. But if it lasts weeks to months, and this is something that should warrant further evaluation, you should see your primary care physician about it.

Host: Very good. Dr. Kevin Shah, neurosurgeon with Novant Health. We appreciate, all the information you've given us today. Very interesting.

Kevin Shah, MD: Thank you. Glad, to be here.

Host: For more information and to find a physician, visit novanthealth.org. If you enjoyed this podcast, share it on your social channels and explore our entire podcast library for other topics of interest. This is Meaningful Medicine. Thanks for listening.