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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