Hi, I'm Jim Cuddy and this is Ask The Hearing Doctors. And I'm joined today by Dr. Wendy Thorne, doctor of audiology with Hearing Doctors. The Washington DC area's highest-rated audiology practice with over 1500, five-star reviews. Wendy, as always great to see you. You too.
So tinnitus. We have talked about tinnitus from time to time on this podcast. Give us kind of an overview. The, the kind of the clinical definition of tinnitus.
Yeah, so tinnitus is any sort of a sound that someone is hearing within their ears and it's not an external sound. It can come in lots of different sizes and shapes I can say. So you can have a ringing, it can sound like a buzzing, a roaring, a heart beating. So it's really any type of sound that is not external that the patient is hearing. So it's coming from within? Yes.
What causes that?
So, there's a lot of different things that can cause tinnitus. There's different things like certain medications can cause it. A lot of stress, caffeine, alcohol, nicotine. Lots of different things. Probably the most common one or common ones are like high blood pressure, diabetes, and hearing loss.
Some of those are correctable, um, to some degree, not for everybody. Does tinnitus go away? If so somebody, if somebody is diabetic because of dietary reasons and they they fix that and then and that abates does tinnitus go away at that point? Or does it stay with you?
Tinnitus is a very tricky thing where different things can make it worse, different things can make it intermittent or constant and it's very different from person to person. So I always get, you know, patients ask me is this ever going to go away and I’m always like, I don't know, because it's so unique to that person.
Can you give us kind of some scenarios, maybe some real-life scenarios of of people that you've had to work with, or that you have worked with I should say, that suffer from tinnitus and maybe the differences between them as you say it affects different people different ways?
Yeah, so I think probably the most amount, the most type of people I see is someone with a very mild case of tinnitus where they say yes, you know it’s something I have every now and then. It doesn't bother me, doesn't keep me up at night, anything like that. Um, that's and tinnitus is very common so most of the population probably has heard a little ringing here and there.
Um, occasionally though too I also get those patients with really severe, severe cases. One gentleman I can think of came in and it was so significant. We have a rating scale where they can rate how tinnitus is affecting different scenarios in their life and he rated the highest category possible which is considered catastrophic. He was actually suicidal from it. It was causing him to not be able to sleep. It was just really interfering with his daily life. That's horrible. Yeah, it was very, yeah it was awful.
What, what do you do? What are the steps you take to to to help? You can't, you can't cure it correct?
Yes, so I always say there's no cure. Meaning that there's no medication you can take to get rid of it but that does not mean it cannot be managed. So, I always try to tell everyone I see that there are different management strategies, there is hope. So the first thing we always want to do is establish that that there are different things that we can do to make it more manageable for you.
In the, in the instance of the the gentleman who has it so bad that to the point where he's suicidal, I mean oh my goodness, I can't even imagine. What steps do you take for for that? I mean, so I'm assuming the steps that you take for the individual are different from from individual to individual? Yes. So, in this, in this horrible scenario what what steps do you take there?
So, the very first thing that we do here in the office is first we want to see is there a hearing loss. Because if there is a hearing loss a lot of times they coexist so we always want to correct the hearing loss because a lot of times that will help the tinnitus. Um, he had a little bit of hearing loss, not significant. You know his severity for hearing loss and tinnitus were very different. Which is you know I would expect that in some cases. Um, so we always you know we fit him with hearing aids that also have the ability to mask the tinnitus. So the devices themselves can play a static or different musical tones that kind of calm his brain down. Because when you're hearing the ringing that's all your brain is listening to is that sound and it's a lot, it's a lot in the brain.
Help me understand so the the hearing aids you're talking about, in particular, they actually create a static noise of some sort. How does that, because you're talking about an internal noise and now you're going to feed it more noise in order to correct or to to level it out, how does that work?
So, I kind of use the analogy of if you're in a completely dark room and you light a candle that candle is very obvious. So I kind of think of that as the tinnitus that you're hearing. But then if you turn the lights on in that room that candle's brightness is not as significant. So that's kind of like putting the masking sound in it. It gives your brain something else to focus on so it's going to start focusing on that static and start moving away from just listening to that ringing that it's hearing.
And does that static which you're you're doing on purpose to to to help with the tinnitus, so it balances out to the point where now I can think about other things? And and that noise doesn't bother me because it's so much better than what I was dealing with?
Yes. Is that essentially what we're talking about? Yeah. Like your brain can understand that the tinnitus is not a sound around you so it kind of, um, triggers your fight or flight um response. So it causes that anxiety, that stress and it just hyper listens to that sound. But when you listen to the static your brain knows that's an external sound and then it starts to take its attention away from that internal sound.
Milder cases you mentioned that it could be pretty much, most people probably have some. A little flutter here and there. Is it something, is it always constant or can it come and go?
Either one. Really? And does it affect one ear, both ears? Does it, does that also change? That changes too.
Is it difficult to diagnose tinnitus? I mean does it sometimes mirror other things?
Not usually, um, and the the only really way to diagnose tinnitus is if someone just reports that they hear a sound in their ears and they know it's not something around them.
So if you're hearing noises that you know are not external, audiologists first? ENT? Who, who should somebody go see?
So, I would, um, you know if I would definitely see an audiologist they're the ones that are going to be able to do the full diagnostic test. See if, is there hearing loss or anything like that. I would also recommend to see your primary care physician because it could be caused by medications. And for any cases like that, I’m like talk to your physician. That you know, if it is a certain medication they can see if they need to change something to see if that helps.
If I came to you let's say I have some some noise of some sort in my ears and I come to you first are you able to say hey, you know what because of that list of medications you just told me about I want you to go see your primary care? In other words do you do a diagnostic and then say I think you should go see the primary care or?
Yeah, and I’ve had a couple times where patients have said, oh it's they know exactly when it started. It started two weeks after I started this medication. And I’m like well it's probably the medication-related. I'm not gonna be the one to tell you to change that so talk to your doctor about changing the dosage or switching to a different type. Sure. Sure
Wow, I mean it's it's fascinating that just the variations of it and and and the and the different things that you do to not get rid of it because you can't get rid of it per se, but to just to help it along. It's just I mean it's fascinating.
Yeah, there's tinnitus is such a big topic in the audiology world. Um, I think I this is very rare but I think the most unique type of tinnitus I’ve seen in a couple cases it's actually called musical tinnitus. So instead of that person hearing like a ringing or buzzing they actually hear music. Um, and it's usually a very calming sound so it's very different than you know hearing a ringing that kind of drives you crazy.
Um, one and it's usually something that's very um personal to that person. Uh, one patient I can think of is, he had recently lost his wife. He was Italian and he was actually hearing his wife singing Italian love songs in his ears. And it's it's a very real condition, it's very rare, though. Um, unfortunately a lot of times patients like that you know, if they see another professional they always you know, kind of treat them as dementia or schizophrenia and it's not that. It is actually a different type of tinnitus. I would imagine that something like that could be easily misdiagnosed. Yeah. And usually, you know, those patients love their tinnitus and they always say don't take it away. You know because it's a very soothing type of sound.
Yeah, I mean, I just. That's interesting. To hear music in my ears which you know I love listening to music. I put headphones on when I’m on the bike, you know that kind of thing. At a low level. Yeah, at a very low level. Um, but that's got to be a very difficult thing for that patient to have to to deal with. Because at some point that could be very disruptive. Yes, yeah. I would imagine in the workplace or any number of scenarios. Yeah, and that's why those masking devices are good especially for someone who's having trouble being able to concentrate or focus or fall asleep. Giving your brain something else mundane really to listen to so that it can kind of just calm down.
Well, it's just I mean it's fascinating all the different types of tinnitus. Which I had no idea, the music in your ear and that kind of thing. Before we go, the patient we talked about, that severe case where he was potentially suicidal. How is he doing now?
He is doing so great. So, he loves his hearing aids. He loves the masking devices. Um, the last time I saw him he actually did tell me I saved his life because it was that severe. Uh, when we re-rated him on that scale he was at the lowest category. That's phenomenal. Which is yeah, so it's you know I always try to use his story as an example to someone that there is hope.
Anything you look online -it's always like there's no cure, live with it. For some people, that's not an option. So there is definitely hope and there's help. Get your ears checked. If you have a ringing sound or whatever it is go see an audiologist. There's nothing wrong with it. They don't bite. Not to my knowledge anyway. And um it's it's, your ear health is is related to so many more things like we've talked about so it's extremely important. Wendy, thank you as always. Thank you.
If you're in the Washington metropolitan area and you'd like to schedule an appointment with Hearing Doctors click the link in the description or visit hearingdoctors.com.