Includes the following article: Tinnitus and
Amplification 2002 Study Participant Prospectus Questions
may be submitted online through the "READER RESPONSE
FORM" section of this website or sent directly to:
DigiCare Hearing Research & Rehabilitation, P.O. Box
706, Rye, CO 81069, or faxed to (719) 66-6882. Your
name, address, and telephone number along with your
request are required in order to receive a reply from
the Digicare team.
DigiCare® Hearing Research & Rehabilitation
TINNITUS & AMPLIFICATION STUDY:
Participant Prospectus
by Max Stanley Chartrand, M.A.,
DigiCare Hearing Research & Rehabiliation
By enrolling in the Tinnitus & Amplification 2002 Study
you’ve taken the first step of an exciting journey of
discovery. Most of all, you’re about to discover some
things about yourself, and how you may improve your
personal, social and communicative well-being while
pursuing better management of your tinnitus.
Better communicative capability will serve as a
foundation for your journey. So that, if you suffer from
uncorrected (or undercorrected) hearing loss, you’ll be
professionally guided to appropriate amplification or
medical treatment solutions. “What’s hearing have to do
with the noise in my ears?” you might ask. “Well,
actually, a lot,” comes the reply. “For the same
mechanisms, lesions, and problems that cause one nearly
always cause the other.” But, no doubt, your noise
problem likely involves more than just one cause, and it
may require more than one solution.
DEFINING THE PROBLEM
The term “tinnitus” may be described as internally
produced “noise within one’s head”, which is caused by
one or more physical abnormalities. In some cases the
noise can actually be amplified by means of a probe mic
and amplifier, in which case it is referred to as
“objective tinnitus”. In most cases, however, the noise
cannot be externally reproduced or amplified, and only
the sufferer can hear it. This is referred to as
“subjective tinnitus”. Theoretically, subjective
tinnitus cannot be reproduced only because the
technology to do so is not yet available. However,
researchers have developed excellent mechanical models
and explanations for each of the various types of
tinnitus and how they occur. So, please rest assured
that it’s not “just your imagination”, as some might
suggest. The noises that keep you awake and add stress
to your life, are just as real (and annoying) as the
static produced on a radio tuned between two stations,
or crickets caught behind your couch or the sirens that
wail all through the night!
(ILLUSTRATION)
With more than 40 million Americans suffering with at
least some degree of tinnitus, according to the American
Tinnitus Association (ATA), “you’re not alone”. But
possibly you’ve been told you must “learn to live it”,
or that “nothing can be done” by one who’s area of
expertise does not include in-depth knowledge and
research of tinnitus. Just as frustrating are the many
dubious claims of “cures” for tinnitus, as if it were
one singular condition. In either event, patients we see
for the first time nearly always report tremendous
frustration and discouragement from searching for
reliable answers or professionals who truly care about
their particular problem. That is why we feel the most
important achievement of our work is patient education.
For an informed patient is an effective partner in
finding solutions. So, we encourage you to carefully
study all of the materials in this packet, and to fill
out the questionnaire(s) prior to arrival for your
hearing health and tinnitus assessment. We also ask you
to bring with you:
A list of any medications, vitamins, minerals,
including dosage levels and your primary care
physician’s name, address, and phone number.
A brief statement regarding your tinnitus complaint,
and how it is affecting your life
Copies of any previous audiograms (hearing test
results), if possible, and the name of the audiologist
you’ve seen.
Any hearing aid(s) or other assistive devices you may
have used
NEEDED: A TEAMWORK APPROACH
Over nearly three decades we’ve studied and compiled a
vast amount of information on tinnitus. We gleaned
studies from all over the world, and have worked with
thousands of tinnitus sufferers nationwide. As a result
we’ve been fortunate in developing proven assessment and
treatment protocols in achieving realistic outcomes. In
most cases, we’ve found that “something” can be done,
whether by factors in your control (abstaining from
tobacco, alcohol, caffeine, fatty foods, MSG, noise
exposure) or things within your doctor’s control
(treatment, medication, pain and stress management) or
within our control (hearing aids, auditory
rehabilitation, counseling) or a combination of all
three of entities. If you do have a sensorineural
(non-medical) hearing loss in addition to your tinnitus,
especially in the high frequencies, you’ll want to
pursue amplification correction as at least a partial
solution for managing your tinnitus while you enjoy
better hearing. This fact is a given----unmitigated
hearing loss should be treated regardless of whether
doing so mitigates the tinnitus. In doing so you may
realize the following benefits from properly fitted
hearing aids:
1) Residual inhibition (or reduction of tinnitus during
hearing aid)
2) Environmental masking (sounds in the environment,
when amplified, create some masking of the tinnitus)
3) Auditory Reattention (Taking your focus away from the
tinnitus through “habituation” and directing it to the
things you should be hearing)
Rarely evidence of a single problem tinnitus is almost
always more than one problem or site of lesion. For our
purposes here, a “site of lesion” is the place of injury
or from where the tinnitus originates. In truth, our
observations show that most sufferers of tinnitus
experience a combination of sites of lesion. Older
Americans especially present with multiple causes for
tinnitus. A good example is the complaint of hearing
“crickets”. The most likely sites for this complaint
arise from a ringing as a result of deteriorating
sensory hair cells in the inner ear combined with
vascular constrictions in the strial vascularis
(millions of tiny capillaries that supply the inner ear
with blood). Hence, the pulsation of the heartbeat
through constricted blood vessels and the constant ring
or hiss together sound similar to a chorus of crickets.
Also, high LDL cholesterol, high sodium and high blood
pressure amplify or make the problem worse and variable.
But there is yet another variable in our example above:
Without appropriate amplification correction for one’s
hearing loss, “sensory deprivation” enters the picture.
This results in another phenomenon referred to as
“phantom hearing”. Phantom hearing is not unlike the
“phantom limb effect” experienced by amputees whose
amputated limbs still “itch”. As a general rule the
longer you go without help for your hearing loss the
louder and more constant the noise of tinnitus becomes.
Therefore, there is no single “cure” for tinnitus, as it
is rarely just one malady. Instead, there are treatment
patterns and solutions that can provide varying degrees
of “relief”. Finding causes and solutions, however, is
not an instantaneous task. It is in a sense a journey
requiring time, patience, and involvement of multiple
resources and professionals. Initially, we ask all
participants to study over certain materials and
literature on the topic.
TRANSIENT TINNITUS, are those cases which are generally
associated with the normal hearing population, but also
are experienced by those who also suffer from hearing
loss and more permanent forms of tinnitus. A head cold,
hay fever, or sudden change of altitude is examples of
tinnitus that is here today and gone tomorrow.
MIDDLE EAR BASED TINNITUS conditions are conditions that
are usually best treated medically: middle ear
infections, mastoiditis, cholesteatoma, glomus tumors,
and severe mastoiditis. Some of these are long-term that
will not resolve until medically treated while others
are only temporary until the underlying cause heals or
runs its course.
COCHLEAR-BASED TINNITUS, as you can see from the chart
above, is by far the most common site of lesion for
permanent or long-term tinnitus. Perhaps it is the core
of your problem. Conditions variously reported in the
literature under this section are:
• Cochlear hair cell damage (noise damage)
• Auditory deprivation (“phantom hearing”, untreated
hearing loss)
• Vascular constrictions (causing pulsation)
• Ototoxicity (medication, tobacco, caffeine, aspirin,
drugs)
• Food allergy (sugar, high salt, MSG, aspartame)
• Explosion (ruptured Reissner’s and/or basal membrane)
• Diabetes, hypoglycemia, gout (pH imbalance)
• Hyper and hypotension
• Hypernatremia/hyperkalemia
• Hardening of the arteries
• Varicose veins
• Hyperlipoproteinemia (high blood lipids)
• Meniere’s disease
• Vestibular disorder (vertigo, nystagmus, ataxia)
• Tumors (vestibular schwannomas, acoustic neuromas)
• Osseous trauma (temporal bone or labyrinth fracture)
• Nutritional deficiencies of all kinds (zinc,
magnesium)
• Otosclerosis (osteo/rheumatoid arthritis,
osteoporosis)
• Cortical lesion (concussion, cerebral abnormality)
• Hormonal imbalances
• Stress, depression, anxiety, insomnia
MIXED SITES/CAUSES
Any of these sites/etiologies or a combination thereof
can cause tinnitus. Many of these causes are general
health conditions (diabetes, neuropathy, hypertension,
arthritis, etc.). Medications also can have a profound
effect upon your tinnitus. If you are taking into your
body items that are not good (fatty foods, tobacco,
alcohol, caffeine, etc.), or in proportions not healthy
(salt, sugar, artificial sweeteners, etc.) these also
may contribute. Add insomnia, stress and anxiety and the
factors that can cause or exacerbate your tinnitus are
many.
WHAT DOES YOUR TINNITUS SOUND LIKE?
From our study in the ‘80s we compiled personal
descriptions of tinnitus from more than 2000 patients.
Then, we formed a focus group so that we could look more
closely at these descriptions. Here is what we found:
% Focus Group Description Hz Range
63% “Ringing” 1.5KHz-3KHz
27% “Buzzing” .53Hz-3KHz
11% “Pulsating” Wide-band
7% “Crickets” NB 1KHz-4KHz
7% “Multi-Band” Wide-band
(Note: Totals more than 100% because of multiple
descriptions. Most common frequency description was from
3KHz-6KHz.)
OUTCOMES: ACHIEVING THE ACHIEVABLE
The most important thing to understand is the need for
realistic expectations. For it would be disingenuous for
anyone to expect a simple “cure” to longstanding
tinnitus. There is no such thing. The key word is
“management”. By managing the problem we will find far
more relief, peace of mind, and a better quality of
life.
Managing tinnitus takes several forms depending upon
your particular case. To help profile a typical case, if
there were such a thing, we will use the example of Mr.
Smith:
o 68 year-old Mr. Smith has suffered for years from two
types of tinnitus, one a steady high pitch ring and the
other a loud fluctuating roaring tinnitus.
o His body size is 5’10” and he weighs 180 lbs.
o He takes medications for high blood pressure
(165/110), high sodium, diabetes II, high LDL
cholesterol, inhalant allergy plus 325 mg. of aspirin
per day.
o On his forearms and other parts of his body, he
exhibited unexplainable bruises (bleeding under the
skin).
o His diet is fairly low-fat, low-sodium, and his wife
sees that he gets lots of fresh vegetables and fruits,
so he is puzzled as to why lipid and sodium counts are
so high on tests.
o As a result of his hearing evaluation, we find that he
has a split band hearing loss, exhibiting a “mixed
loss”---low frequencies are conductive, high frequencies
sensorineural.
Here is what transpired after several months of work
with Mr. Smith between our office and his doctors:
o He was fitted with hearing aids, which focused on
threshold correction of the high frequencies. After
several weeks of wear and adjustment, the fitted
instruments provided the following benefits for his
chronic high pitch “ringing” complaint:
1. Residual inhibition (slight reduction of loudness)
2. Environmental masking
3. Auditory reattention (taking attention away from the
tinnitus noise)
4. Reduced stress as a result of corrected hearing
o Upon further physical examination by his doctor it was
determined that Mr. Smith was suffering from
hypernatremia as a result of dehydration. He increased
his daily water intake from about 3 pints to one gallon,
and after 2 weeks his blood pressure came down, as did
his triglycerides and LDL readings. His medications were
reduced accordingly.
o He maintained and improved good dietary practices with
a notable reduction in red meats and animal fats. He
avoided MSG and caffeine where possible. He also added
the following supplements to his daily diet:
-Chelated Calcium Citrate w/ Vit D, 600 mg.
-Vitamin E, 400 IUs
-Ginkgo Biloba, 120 mg.
o His doctor placed him on prophylaxis dosage of
antihistamine for his chronic inhalant allergy, which
mitigated his Eustachian tube dysfunction. This, in
turn, resolved most of the source of the “roaring”
component of his tinnitus complaint.
o Aspirin intake was reduced from full-strength 325 mg.
to an enteric-coated 81mg. dose, and the bruised spots
on his forearms began to clear up after about a month.
Evidently, the full-dose aspirin was thinning the blood
vessel walls.
OUTCOMES: At the end of Mr. Smith’s case, his high pitch
ring, which correlated with his cochlear pathology,
continued on but at a lower and more acceptable level.
He was able to manage the fluctuations better that
occurred with changes of blood pressure and emotional
stress. His increased ability to hear and understand
speech significantly improved his relationships with
others, particularly his wife; and his overall cognitive
function appeared to have improved. Though he was unable
to completely eliminate his tinnitus complaint entirely
he felt he had accomplished optimum results, and was
“satisfied that all that could be done was done”.
PUTTING YOURSELF IN THE PICTURE
The above case history is actually quite common among
many Older Americans. The successful outcome, however,
is quite a different story. For much hinged on some of
the items over which our office has little control:
1. A patient who will take the time to study out the
problem and pertinent solutions, including trying
amplification for the correction of his loss of auditory
sensitivity. Also, a willingness to make dietary
changes, and to stick with the program from beginning to
end, and to recognize where improvements have been made.
2. A family doctor that is willing to work with the
patient and our practice in modifying his medication
where indicated.
3. And support from spouse and close family members in
meeting the challenges faced by the patient.
From this example you may see yourself. The facts may
vary, and also the solutions. But with diligent effort
yours can be one of our success stories. Unlike other
studies, a positive mental attitude (PMA) is not just a
nice touch; it is a requirement for success. |
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