The understanding of tinnitus has been transformed over the past two decades, with what was once viewed as an untreatable ailment now approached as a manageable condition. During these years of scientific advances and clinical developments, Richard Tyler, PhD, professor of otolaryngology–head and neck surgery and of communication science and disorders at the University of Iowa, has been a leader in tinnitus research and management.
As the Annual Conference on Management of the Tinnitus Patient at the University of Iowa approaches its 21st anniversary, Dr. Tyler, who has organized the meeting from the very start, spoke with The Hearing Journal about how tinnitus is managed today and what the future may hold, and also gave a preview of this year's conference.
HJ: What is tinnitus? Is it an ear disease or a brain disease?
Dr. Tyler: Tinnitus is the perception of a sound without there being an actual sound in the physical environment. It's an ear disease and a brain disease. The most common cause is noise exposure, and we know that noise exposure causes all kinds of damage in cochlea. However, from some of our early work in the late 1980s, we've also known that no matter where tinnitus is initiated, it has to be perceived in the brain.
For example, we've known that if somebody can hear tinnitus in the left ear, you can actually mask it—not in everybody, but in many people—by putting in a low-level noise in the right ear. We also tried to mask tinnitus with different pure tones. For some people, low levels of masker intensity could mask tinnitus for tones that were close to the pitch-match frequency of the tinnitus, but, for tones that were far away from the pitch-match frequency, it was more difficult to mask the tinnitus. That's more likely to be caused by tinnitus initiated on the basilar membrane. There are other patients for whom you couldn't mask it at all, no matter what the tone frequency was, or it required a higher-level intensity independent of the frequency of the masker. In those situations, it's more likely to be a central tinnitus.
HJ: Do you think there's a causal relationship between tinnitus and hearing loss, or are the two just correlated?
Dr. Tyler: I think hearing loss causes all kinds of changes throughout the auditory system and the brain, and because almost everybody who has tinnitus also has a hearing loss, I think that some of the changes in the auditory pathway that occur with hearing loss must be there in order for tinnitus to occur. Obviously there are a few patients who have tinnitus and don't have hearing loss, and lots of patients who have hearing loss and don't have tinnitus, so I think that they're somewhat independent but also somewhat interrelated.
HJ: How is tinnitus managed today?
Dr. Tyler: There are lots of things we can do to help tinnitus patients, and lots of things that they can do themselves. What's still a problem today is that many healthcare professionals don't know very much about tinnitus and tinnitus management. Their perception is, you need to go ahead and learn how to live with it, but there are things we can do as professionals to help patients learn how to live with it, and so, in that case, it is a treatable disease.
There are many, many different counseling procedures. The one that we've been promoting here at the University of Iowa for over a decade is tinnitus activities treatment. There are other counseling procedures based on cognitive behavior therapy or habituation therapy. Almost anything people can do to help them relax, including yoga, meditation, and mindfulness therapy, are going to help tinnitus patients—and all of us—deal with stress in our life. In addition, there are now many sound therapies available.
HJ: What is the role of hearing aids in tinnitus management?
Dr. Tyler: There's lots of evidence to suggest now that hearing aids can help tinnitus patients. You can think about this in two different ways. First of all, hearing aids help people hear better, and they therefore reduce the stress of listening hard, reduce the stress of not understanding what's going on in your environment, and enable you to interact with friends. Also, being able to hear is wonderful for providing a positive outlook on the future. All these things provide patients with the background to be in a better position to deal with the stress involved in not having control of their tinnitus. In addition to that, hearing aids activate the auditory system in a similar way to some of the sound therapy devices. Many patients often say that the activity throughout the auditory system provided by the hearing aids makes their tinnitus less noticeable or less loud.
HJ: Do you think professionals will someday be able to approach tinnitus as a treatable condition?
Dr. Tyler: Well, if you think about it as treatable in terms of will there be a pill somebody can take or a device somebody can use to make the tinnitus go away completely or reduce the magnitude of the tinnitus substantially, I think the answer is yes. Certainly cochlear implants have been known for many years to produce a signal that reduces the tinnitus. In the early days, many patients who got a cochlear implant to help their hearing would come back to us and say, thank you so much for helping me hear better, but, even better than that, my tinnitus is gone. I think that there will be a device within five years to treat tinnitus. It might not work for everybody, but I think it would help a substantial number of patients with tinnitus.
Annual Conference on Management of the Tinnitus Patient Celebrates 21 Years
Podcast Interview by Michelle Hogan
Only in the May iPad issue, listen in as Richard Tyler, PhD, professor of otolaryngology–head and neck surgery and of communication science and disorders at the University of Iowa, gives a sneak preview of the 21st Annual Conference on Management of the Tinnitus Patient at the University of Iowa and discusses how much has changed since the first meeting.
Here's just a sample from Dr. Tyler of the highlights attendees can expect at this year's conference, to be held June 14-15. To hear more about the meeting, download the app, and this podcast, for free today at http://bit.ly/AppHearingJ.
Dr. Tyler: Our guest of honor will be Fan-Gang Zeng [chairman of The Hearing Journal Editorial Advisory Board], and he's going to give two presentations. One will be on electrical stimulation for tinnitus, which is a very important topic because I think there's potential to have a device here in the near future. The other presentation will be on sound therapies.
We also have a special presentation by Dr. Carol Bauer, a physician who's been doing some behavioral and animal work and might have some ideas for tinnitus originating in the cerebellum of the brain, at least in some people. Tom Brozoski's going to be there talking about animal models and his work, and how that can help us understand and treat tinnitus. Jennifer Gans is going to talk about mindfulness-based therapy that she's developed for tinnitus stress reduction. Claudia Coelho will talk about medications and dietary supplements that she uses with her patients in Brazil. We're also going to have some new approaches and new contributions. Kathleen Mennillo, from the International Hearing Society, will share some insights and new developments.
It's a variety of people from quite different directions. I think it's very important to get a broad perspective of how people approach these tinnitus patients.