By Max Stanley Chartrand, Ph.D.-candidate,
Behavioral Medicine
Glenys Anne Denyer-Chartrand, AdDip, OTR
In the U.S. today, more than 50 million Americans
experience tinnitus or noises of the ear (ringing,
buzzing, roaring, hissing, crickets, etc.) at some
time in their lives. About 12 million adults
experience tinnitus so bothersome that they seek
medical help for it only to be told that they must
"learn to live with it". The daily lives of about 2
million of these people are so disrupted that they
cannot sleep or function normally.
Tinnitus is the body's way of telling us that
something is wrong (acoustic trauma, disease,
obstruction, allergy or hearing loss). Those that
may be treated medically are usually called
Structural or Objective Tinnitus-- in other words,
others under certain condition can actually hear the
noise the sufferer hears. By far the most common of
the permanent types of tinnitus is call Functional
or Subjective Tinnitus, or that which can be heard
only by the sufferer. In such cases, the problem
usually lies in the delicate inner ear region or
even further up into the central auditory pathways.
Experience tells us that most sufferers of long-term
tinnitus exhibit three major causal factors:
Auditory Contributors, Medical Contributors, and
Lifestyle Contributors.
Introducing the Multimodal Approach
The DigiCare Multimodal Tinnitus Management Program
utilizes time-tested principles from several models
of tinnitus therapy and identifies causal
explanations from within three areas of
contributors:
Auditory Contributors are those related to hearing impairment. These
are addressed by one’s hearing health practitioner
who will utilize appropriate fitting of hearing
aids, assistive devices, and counseling to help
manage the tinnitus.
Lifestyle Contributors are causal factors over
which only the consumer has control, such as the use
of tobacco, alcohol, caffeinated drinks, high sodium
diet, MSG, etc. It also includes such lesser
recognized--yet critical—factors as dehydration,
lack of sleep, and psychosocial stress.
Medical Contributors are those primarily within
the domain of the consumer's physician. These
contributors may involve unresolved (or
unrecognized) disease or injury, such as developing
diabetes mellitus II, gout, osteoporosis,
atherosclerosis, and allergy. Medication
side-effects are paramount in many cases today
Sometimes lifestyle contributors collide with
medical contributors. Today, many older adults
suffer from semi-dehydration, due to a declining
sense of thirst. As a result, the Pituitary gland to
produces Anti-Diuretic Hormone (ADH) to prevent
blood volume from dropping causing the kidneys
retain sodium, causing blood pressure to rise.
Rather than investigate potential dehydration, the
busy medical practice tends to prescribe diuretic
medication to lower the blood pressure. Underlying
causes continue to advance while medication
side-effects wreak havoc (freezing feet,
light-headedness) on the body, making a short-term
problem (not enough water) become long-term
(hypertension, high cholesterol, and resulting pH
conditions, such as Diabetes Mellitus II….and
tinnitus, hearing, and balance disorders.
Under the Multimodal your practitioner will address
these issues with the latest available knowledge.
For it is crucial that all contributing factors are
addressed and accommodated for optimal tinnitus
management and success. Doing so will depend upon
the hearing care professional's skillful assessment
and technical and counseling resources for those
presenting with both tinnitus and hearing loss.
Lifestyle and common sense health factors will need
addressed by the consumer, and medical contributors
will need to be addressed by one’s medical doctor.
What to Expect on Your First Visit
In preparation for your first visit several things
need to take place:
With your permission, we will contact your
physician for clearance to assess your hearing and
tinnitus. If we find that you meet criteria, we will
also be furnishing written reports to your doctor to
make sure he or she is aware of our findings and
recommendations.
You will need to study this and other material
enclosed in this packet.
Please, complete the enclosed Questionnaire and
bring your packet with you.
Also, you will need to bring a detailed list of
current medications, food supplements, and anything
that you feel may be contributive to your case in
any way.
If married, it is imperative that your spouse
come with you on your appointment.
When you arrive on your appointed day, expect to
spend about two hours in the initial hearing health
and tinnitus assessment. You will begin in the
waiting room, where more material will be provided
for further study, plus other brief questionnaires.
This process will take about 15-20 minutes. This is
important time for reflection over what you have
learned thus far. For you become the most important
partner in the process for optimizing tinnitus
management.
Your formal hearing and tinnitus assessment will
begin with a complete and thorough case history,
video otoscopy biomarker investigation, and a
complete evaluation of your auditory status,
including such problems as abnormal loudness growth
and loudness tolerance issues. Concurrent with the
testing of your hearing will also be an assessment
of your tinnitus. This will involve tinnitus
description, pitch and loudness matching, and
residual inhibition effects.
If you are now a hearing aid user, we will try to
assess whether the parameters of your device are
sufficient. In the vast majority of cases the
bandwidth is too narrow, loudness growth
accommodation insufficient at the center band of the
tinnitus, and there is no on-off internal
programming switch on the microphone noise
suppression. This often means starting with a more
advanced device. For not all hearing aids are the
same.
Most importantly, there are three main application
parameters necessary for amplification to be
optimally beneficial in cases of tinnitus:
The bandwidth must be at or above 8 KHz,
preferably up to 13 KHz or higher.
There must be three adjustable (tertiary) peaks
that can be manipulated to stimulate the tinnitus
frequencies, as well as meet communicative needs.
The Microphone Noise Reduction or Suppression
feature must be turned off to provide a wide-band
masking floor.
The technicians designing and building the
device must be well-versed in digital amplification
tinnitus management.
Remember, the "best doctor in the house is one
inside your body". But that doctor can only do its
job if given the right tools. In the foregoing,
we’ve enumerated a number of those tools. In the
final analysis, the most important tool is your
motivation to make the program work for you.
About the authors
The authors serve as Managing Director and Director
of Rehabilitation, respectively, for DigiCare
Hearing Research & Rehabilitation, based in Colorado
City, Colorado. They research, write and lecture
extensively worldwide on topics relative to hearing
health, mental health, and occupational therapy.
They may be contacted at www.digicare.org.
Copyright 2006 by DigiCare Hearing Research &
Rehabilitation. All rights reserved. No copying
without written permission of the authors.
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