Transcription:

Deborah Howell (Host): Welcome to Right Beside You, a Reid Health podcast. I'm Deborah Howell, and I invite you to listen as we discuss tinnitus treatment today. Joining me is Dr. Laura Fragomeni an Audiologist with Reid Health. Dr. Fragomeni, it's a pleasure to have you with us today.

Laura Fragomeni, AuD (Guest): Hi, well, thank you very much for having me.

Host: It's our pleasure. Now, my dad always used to say it's tinnitus, honey, not tinnitus. So, what would you prefer Dr. Fragomeni?

Dr. Fragomeni: Well, either one actually are correct. I have patients ask me that all the time. So, basically the general population uses the word tinnitus. Once you get into the medical field and academia, we then tend to stay tinnitus. So, either one are considered correct. And just depending on what you are used to hearing and what kind of background you are familiar with as far as tinnitus or tinnitus goes.

Host: So, this is a medical podcast, so maybe we'll go with tinnitus and make my dad happy. So, Doctor, what is tinnitus?

Dr. Fragomeni: Well, tinnitus the exact definition per se is the perception of sound when no actual external noise is present. So, it's a symptom basically of some other underlying health condition. It is many times described by patients as I hear a ringing sound or a buzzing sound, roaring, rushing, clicking, all kinds of different ways that people perceive this phenomenon and describe it. So, essentially it is just the term that we use that describes when we're hearing something that's not really there essentially.

Host: Got it. I didn't realize clicking and roaring were also tinnitus. That's new information. When is it time to see an audiologist?

Dr. Fragomeni: So, I would encourage anyone to definitely seek out an audiologist if their tinnitus is distressing in any way, shape or form. So, everyone experiences tinnitus at some point in our life. Most usually, it is brief in nature. It's not terribly bothersome, does not come into interfere with our day to day activities, things like that. But for others, it is more persistent, more bothersome, and can cause quite a bit of distress. So, at any level, if you are experiencing tinnitus and it is concerning to you, I would seek out an audiologist to kind of figure out what might be going on.

Host: Sure. Now, do we know what causes tinnitus?

Dr. Fragomeni: Well, it is one of these things where we have a lot of really good sound theories at this point. We do not have a real good concrete way yet of finding out a sole cause. However, we do know from lots and lots of years of research, some certain health conditions that presents, one of the symptoms I should say that comes up as a result of these conditions is this tinnitus phenomenon. So, one of the most common things that is associated with tinnitus, is hearing loss, even just even a small amount of hearing loss that may even not be detectable yet by the person, can be enough to present this tinnitus sound. And so in those kinds of cases, the cause is really felt to be all relating in the brain itself.

Our brain is this amazing organ that we know communicates with every nerve in our body and everything in our body. And so when there is some damage in the ear structures or the auditory system, there is a reaction from our brain neurologically. So, the brain is trying to activate some response in the area of the damage in the auditory system, by kind of working a little over time, sending some extra neural impulses down to the inner ear structures saying, where is that signal that I used to know and I don't hear it coming through anymore. I'm not getting any reaction out of this part of the auditory system. So, I'm going to send some more signals down and see if I can wake it up. Just kind of very basically describing kind of what we think is going on there. The brain is trying to compensate and kind of fill in the gaps where that damage is occurring.

Host: Almost like echolocation with dolphins?

Dr. Fragomeni: Well, yeah, it does very much sound like that. Yes, on a neurological level, yeah.

Host: Now how can tinnitus be treated?

Dr. Fragomeni: There are a number of different ways that we can go about helping someone with their tinnitus. The unfortunate thing that everyone is usually told at their doctor's office, is that well there's nothing we can do. You have to just live with it. That's just how it is. So, while that is true as far as pharmaceutically speaking and medical treatment speaking, there is no medication that we can give to make tinnitus go away or lessen. There's no procedure that can be done, nothing surgically. That does not mean there aren't other things that we have found that are useful. So, of those options, one really great way of helping someone with tinnitus if there is hearing loss present, in addition, is to remediate the hearing loss itself with hearing aides.

So, getting some stimulation, auditorily going back through the system, up to the brain so that the brain realizes, okay, I can stop working so hard to try to compensate. I'm getting some more external auditory information now. And many times that settles that down a little bit. The hearing aides and the amplification also means that the person's going to be hearing quite a bit better out in the environment around them externally.

So, tinnitus is going on inside our head. Whereas if we're not hearing enough outside our body, that's going to seem louder what's going on inside our head. We get ourselves hearing a lot more externally, than some of that internal noise lessens a little bit, because we've got other stimulation and other sounds coming through, that's covering that up and reducing that contrast. Communication is helped and then also a little bit of relief from that annoyance of tinnitus. So, that's one very direct and fairly straightforward way of helping someone with their tinnitus. The issue then becomes, well, what if I have tinnitus and I don't have any hearing loss or I have maybe some level of hearing loss, but it's not to the degree that we would need to amplify?

And so those types of patients, there are other things we can look into. So, a couple different ways about helping someone with their tinnitus is sort of getting down to the nitty gritty of what exactly in my life is the tinnitus affecting. Is it my sleep? Is it keeping me from falling asleep at night or waking me up? Is it my concentration? I sit down to do some work and all I hear is that tinnitus and I can't focus or is it my emotional status, my feelings and emotions? Am I constantly aggravated and on edge? Or am I feeling depressed and anxious because I have this going on a lot? And so, there is a great way to help people through things like this with a cognitive behavioral type of approach, a therapeutic approach.

So, I've met with some patients who it's typically this emotional part of the puzzle here that is what affects most people the greatest. So, having a lot of anxiety about things and even anger and frustration. And so, I've just got a program here where we can go step by step through every person's individual situation. And what kinds of issues this tinnitus is bringing up and work through some strategies, some actual applicable strategies of when I'm home or when I'm at work and I'm hearing the sound and I know I'm getting anxious. I can feel myself being angry or sad or whatever.

These are the steps that I can take to try and help with this. So, a lot of it is retraining our brain. It's not an easy task to do by any means, but with repetition and perseverance, we can actually retrain our brain to not really respond to the tinnitus. When we detect that it's there, we can condition ourselves to not view it as a threat, but rather something benign that's just is what it is and redirect our thought to something different.

So, it's challenging, but that is definitely an example of a way that we can help people with it. Another method, and sometimes these things are definitely combined together, but another type of method would just be talking through some sound therapy options. So, if I'm having trouble falling asleep, there are a million contraptions out there on the market that would provide some relief for someone while they're trying to fall asleep that presents some kind of background sound of some kind. And everybody, again is different on what they, what they like to listen to, or have playing, but you get like a little tabletop sound machine that maybe has the ocean waves or some other nature type of sounds that you can just have in the background while you're trying to fall asleep.

And what it does is twofold, helps relax you and get you in groove of, okay, this is bedtime routine. And it also then provides some external auditory stimulation to try and help sort of mask over the inside noise that we're hearing to help us fall asleep. And there are just a million really cool electronic things that are wirelessly paired up with your phone. There's a million apps out there that have different sound byte selections in them and meditation and mindfulness, thought processes and things like that. So, a lot of different sound therapy kind of options and even things that you don't even have to buy. Maybe just running a box fan in your bedroom at night is enough background noise to help you get to sleep. So, things like that.

Host: There you go. That's a lot of options. Are there any side effects to the treatment you are talking about?

Dr. Fragomeni: You know, there being that it's nothing pharmaceutical related because when I think of side effects, that's kind of where my mind first goes. Certainly, not going to have any risk of anything there. I really can't think of anything that would be a detrimental side effect to sound therapy or the individual cognitive behavioral therapy approach. So, that's kind of the nice thing have nothing to lose to give it a try.

Host: And how much improvement can a patient expect to have after treatment?

Dr. Fragomeni: Great question. Very, very patient specific for sure and situation specific. A lot of that depends on what is the underlying issue that we feel this tinnitus symptom is a result of. So, I can say that with hearing aide use and people with hearing loss, I have a tremendous amount of success and positive outcome with getting people into hearing aides that need them, primarily for the hearing loss, but as a nice benefit, they will notice, you know, I don't notice my tinnitus that much anymore. It's not really bothersome. So, I would say if this is the area we're working with a patient, I would say the outcome is great.

The improvement seen with the therapeutic side of things and the sound therapy side of things, doesn't seem to be as easily measured and quickly measured as the hearing aide fitting understandably so. I mean it's a long process to kind of get to there, especially the one-on-one therapeutic way of it. And so, that depends on just each patient and kind of the personality. There is a lot of hard work that goes into trying to retrain our brain and get some different thought processes going on. So, the patient has to be real open-minded and real willing to put that work in and really carry it through in between sessions, to do the homework that they should do throughout their week. So, that varies quite a bit, but really anyone who is suffering any way with this, I have found is very willing to try anything. And so, I think even moderate amount of improvement is definitely seen across the board.

Host: Wonderful. Well, this has been such an informative episode. Dr. Fragomeni, as we wrap up, do you have any other advice for people dealing with tinnitus?

Dr. Fragomeni: I wanted to just mention a wonderful, wonderful organization and website that is a great resource for anyone suffering or if you know anyone suffering with tinnitus. It is called the American Tinnitus Association and their website is a plethora of good sound information as well as information about support groups. There is a hotline that you can call and they will help you get established with an audiologist or a provider or answer any questions you have. Lots of patient testimonials and patient stories and updated research information and just lots of good stuff. So, I would definitely encourage patients to check out that website and that organization. And just want to reiterate that if you're ever told that there's nothing that we can do for you about your tinnitus, that is not true. Please seek out an audiologist if you are distressed about anything related to your tinnitus.

Host: Wonderful. And once again, that's the American Tinnitus Association. All great information. Thank you so much for your time today. I hope you'll join us again soon, Dr. Fragomeni.

Dr. Fragomeni: Thank you very much. I had a wonderful time. Thanks for inviting me.

Host: Of course. And you can call (765) 935-4477 to schedule your appointment today, or for more information, you can always visit Reidhealth.org to get connected with one of our providers. That concludes this episode of Right Beside You, a Reid Health podcast. Please remember to subscribe, rate and review this podcast and all the other Reid Health podcasts. I'm Deborah Howell. Have a great day.