How has Tinnitus World Changed Since I Revised Tinnitus Treatment Toolbox in 2012?

My tinnitus started about 30 years ago in 1986 after a bad car accident. I was worried. I saw my family doctor. He sent me to an ENT. He told me it wasn’t from my car accident. I was mad. He told me nothing could be done. Learn to live with it. I was sad. I became an audiologist. Learned nothing could be done. More worried, mad, sad. Realized I had to figure out how to live with my T on my own.

Things have changed a lot since then. There are lots of coping tools to help people with tinnitus distress including options from self-help to tinnitus therapy. Nobody should be told nothing can be done. Nobody should be told just learn to live with it without being given information on how. But it is still trial and error. There are lots of questions still unanswered:

• Are there different types of tinnitus? With different patterns of brain hearing system overactivity?
• Which sound type works best? (e.g. coloured noise, relaxation music, tinnitus match, personal music library)
• Does it matter when you listen to sound (e.g. as needed, awake, asleep, awake and asleep)?
• Which tinnitus therapy works best? (e.g. Progressive Tinnitus Management, Tinnitus Retraining Therapy, Neuromonics Tinnitus Treatment, Cognitive Behaviour Therapy, etc.)
• Why don’t tinnitus sound therapy manufacturers call their product a tinnitus aid? Then they can call the product as fancy a name as their marketing department wants.

For Example:
Product = car
(Note: We don’t call a car a 4Roller or ZoomZoom.)
Different models (e.g. compact, sedan, SUV)
Many manufacturing companies (e.g. Chevrolet)
Each has own product line names (e.g. Corvette)

Product = hearing aid
(amplification for people with hearing loss)
Different models (e.g. in ear, behind the ear)
Many manufacturing companies (e.g. Phonak)
Each has own product line names (e.g. Lyric)

Product = tinnitus masker, noiser, system, etc.
(at-ears sound therapy for people with tinnitus)
Different models (e.g. in ear, behind the ear, headphones)
Many manufacturing companies (e.g. Restored Hearing)
Each has own product line names (e.g. Sound Relief)

• Wouldn’t it be better for tinnitus world if we actually have one name for a sound therapy product used directly at the ears? My vote is for tinnitus aid. So we know what different manufacturers offer (e.g. hearing aid, combo hearing aid and/or tinnitus aid, tinnitus aid).

There are other issues. I have turned into an obsessed tinnitus world stalker. I do continuing education every year as an audiologist, taking every tinnitus related course. I follow tinnitus world on facebook, twitter and evidence-based websites and research. But change comes slowly with tinnitus.  There’s no cure. Yet. Cure $ales are $till going $trong. Great research is happening. But it takes time for scientific evidence based research, especially if starting with animal trials, to evolve into something clinically available for the tinnitus community. Updates over the last 5 years include:

OBJECTIVE TINNITUS TESTING

Objective brain imaging tests are showing hearing system activity differences in people with tinnitus and sound sensitivity (hyperacusis). Functional MRI is being used in legal cases to prove whether a person has tinnitus. As research continues using brain imaging testing, could therapy become more targeted based on what pattern of brain activity the person with T has?

TINNITUS EVALUATION

Is tinnitus world consistent in how tinnitus or sound sensitivity is evaluated? From family doctor (GP) to ear specialist (ENT) to audiologist? It still depends on who you see.

UNIVERSAL OUTCOME MEASURE

There is still no universal outcome measure for tinnitus distress. There are several being used by researchers and clinics offering tinnitus services. Some might use the Tinnitus Handicap Inventory (THI): 25 questions; scored from 0 – 100. THI-S also valid: 10 questions; scored from 0 – 100. Some use the Tinnitus Reaction Questionnaire (TRQ): 26 questions; scored from 0 – 104. Some use completely different outcome measures. So when Research Team 1 finds 20% improvement on THI for a specific tinnitus therapy approach, and Research Team 2 finds 20% improvement on TRQ for a different tinnitus therapy approach, which approach is better? Same problem for clinics offering tinnitus services. If you improve 50% at Clinic 1 using THI and 50% at Clinic 2 using TRQ, which clinic helped more? Nobody knows because it’s comparing apples to oranges. Researchers and tinnitus care providers need to pick one single universal outcome measure. One with a valid shorter version for clinics would be nice. So we could compare apples to apples.

HEARING PROBLEMS

If you have hearing loss, the first tinnitus coping tool is still to aid your hearing. But now devices are digital. Lots more features including wireless connectivity, built-in tinnitus aid, apps, etc.) Research has found that people with tinnitus have a harder time with a listening task than someone with no tinnitus. It’s like having a mild hearing loss, so you may need to use some communication strategies if you have tinnitus and normal hearing. If you have tinnitus and hearing loss, I would predict you would have more trouble with a listening task than someone with hearing loss alone.

VAPING

There is concern about e-cigarettes or vaping causing hearing loss and/or tinnitus because of an ototoxic (ear damaging) ingredient called propylene glycol. The Hearing Review, Healthy Hearing and the FDA have all warned consumers. Research on this will be challenging because of the number of factors to consider including frequency of vaping and whether there are any differences in ear damage from different vape juices (e.g. no nicotine, nicotine at different concentrations). Plus can they use human trials if they are testing whether it might cause you permanent damage?

PERSONAL HEARING PROTECTION

Listening to music or noise at 80 – 85 dB and above can cause hearing loss (and/or tinnitus). This type of hearing loss is painless and permanent (if it continues over time). You don’t know the ear damage has happened until it’s too late. As always, many types of earplugs and earmuffs are available. From basic to special features including built-in amplification or 2 way communication. Now some hearing protection manufacturers are using noise cancellation technology in their product which sounds interesting. Note the military and workers with hazardous noise exposure must be provided appropriate hearing protection.

For music, people should use hearing protection when going to concerts, nightclubs or other places with loud music (especially amplified). There are musician’s earplugs available. But if you’re not picky over a bit of distortion, any hearing protection will do.

Often people don’t use hearing protection for personal noise either. Power tools, hunting, ATVs, snow mobiles, gas lawnmower…The list goes on.

Why aren’t we all wearing hearing protection when we should? There are options for babies and children (small sized earmuffs) and teenagers to adults (earmuffs and earplugs with basic or high tech features). It’s like seat belts in cars. Or bike helmets for bikes. Using personal hearing protection for hazardous music/noise should be the norm for society.

VOLUME LIMITING HEADPHONES/EARBUDS

Why are we worrying over the loudness of personal listening devices? Why are we trying to calculate safe listening times? Why are we hoping and crossing our fingers that if we use a low enough volume setting-50%? 60%?-that people won’t get hearing loss and/or tinnitus (children, teenagers, young adults, adults)? Because I think we’re missing the real issue with personal listening. Why don’t headphone/earbud manufacturers make products with built-in volume limits (e.g. <85 dB)? That can’t be tampered with? Then the product would be safe no matter how loud you turn up the volume or how long you listen. No painless permanent hearing loss from personal listening in our society. We’re almost sending people to Mars. With current technology, shouldn’t this be possible for all manufacturers to make?

Some manufacturers do offer “volume limiting” headphones (limit <85 dB). But I have seen a manufacturer offering <95 dB limit for “older children”. And researchers have found that only 1 in 3 limit the volume as advertised. Why are the manufacturers allowed to continue with this false advertising/packaging? These are often used for kids.

CURING HEARING LOSS

Gene therapy research for curing sensorineural hearing loss is very exciting. Scientists are re-growing hearing hair cells in deaf mice. After the therapy, the mice can hear around 25 – 30 dB. That’s amazing when normal hearing is 0 – 25 dB. Human trials might happen in approximately 3 years. Imagine a cure for sensorineural hearing loss. What would it do for tinnitus? When they get to human trials, I’m sure there will be lots of people with sensorineural hearing loss and tinnitus willing to do anything to sign up.

GROWING OUTER EARS

Scientists are growing human-ish ears on rats. Ingredients include human DNA and cow collagen. This could be useful in future if somebody needed a new outer ear for some reason. But if you’ve read Oryx and Crake by Margaret Atwood, this could lead to apocolyptic results.

It will be interesting to see what the coming years will bring.  Jan

© 2017 Jan L. Mayes