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Tinnitus (Part Four) 'Tinnitus Treatment'

by Michael Knapp on 08/10/14

Exert from Dr. Jane Burns, AuD.

Audiologist  (Referral Partner of New Way Hearing)

"Until recently, there has been little evidence showing effectiveness in the various treatment modalities. As a result, the Veterans Healthcare Administration (VHA) does not currently have a program of tinnitus therapy available to veterans on a national basis. The VAMC in Baltimore, MD, is currently using the Neuromonics program on a limited basis. The VAMC in Portland, OR, is using a modified form of Tinnitus Retraining Therapy on a limited basis. If outcome measures justify expanded trials then the programs may be made available to all veterans. The options currently available to the veterans not residing in an area undergoing trials of treatment protocols are to try a hearing aid if they have a hearing loss, counseling and medication for any concurrent depression and anxiety, or to try masking the tinnitus, either with maskers worn in the ear or with something that produces non-irritating environmental sounds, such as fans or fountains.


Before any treatment plan can be advised a thorough history including recent illness, family history, trauma, vertigo, tinnitus onset and noise exposure, as well as the characteristics of the tinnitus itself is important. An ENT evaluation is needed if there is trauma, vertigo or sudden onset. Any time the tinnitus changes character suddenly a physician should be consulted due to the risk of an aneurysm or very high blood pressure. Pulsatile tinnitus should be evaluated to ensure there is no vascular malformation or tumor, such as a glomus jugulare or glomus tympanicum. If there is an underlying problem then treatment of that underlying condition may relieve the tinnitus symptoms. Many tinnitus treatments are available, but none have been shown to be universally successful in the treatment of tinnitus, undoubtedly due to the many different causes of tinnitus.


?Treatments for tinnitus are as varied as the patients who are suffering tinnitus. From Hippocrates sending people to stand near a waterfall, to putting drops in the ears, from acupuncture to electrical stimulation, or from herbal supplements to surgery, there is a “cure” sure to appeal to nearly everyone. Unfortunately, the treatments are not equally effective. And as with most things, there is no quick fix shown to actually stop tinnitus. 


Tinnitus and Hearing Aids

Patients who have a hearing loss often find that their levels of tinnitus awareness decrease when wearing a hearing aid. Increase in ambient sounds may reduce the perceived loudness of the tinnitus, and the better communication environment provided by hearing aids may help the patient to perceive greater tinnitus reduction. There is the possibility also that providing the elevated stimulus to the regions of reduced stimulation in the auditory system may help alleviate the phantom noises perceived. Prior to the availability of open fit hearing aids many of the patients with relatively normal low frequency hearing were dissatisfied with hearing aids due to the occlusion effect. With the steep curve of the audiogram often seen in these patients they are more likely to have significant tinnitus symptoms which may now possibly be at least partially relieved by using hearing aids.



Maskers are designed to cover up the noise of the tinnitus. Some are worn in the ear like a hearing aid and produce a broadband sound. Many devices that can act as maskers are everyday items that produce sounds, like a fountain, radio or fan. The idea is to raise the ambient noise levels to reduce or modify the relative volume of the tinnitus sounds. It has been shown that for some patients the reduction in tinnitus continues even after the masking is removed. This inhibition may be due to supplying additional stimulation in the regions that missing frequency representation, thus reducing the likelihood of those regions receiving input from other areas of the brain and producing tinnitus.


Anecdotal evidence from the Veteran’s Administration Medical Center in Omaha, NE, shows mixed results in the effectiveness in controlling tinnitus with in the ear tinnitus maskers. One veteran who received benefit from the masker, and who was extremely vocal about how much benefit it gave him, was in reality experiencing a placebo effect. The veteran was convinced that the masker was reducing his tinnitus to the level where he could barely hear it. Upon inspection, the tinnitus masker had a dead battery. The veteran had not changed the battery since the masker was issued to him several months earlier. The audiologist did not inform the patient, and the veteran went off happy and convinced that the tinnitus masker was a wonderful invention. Another recent patient, who has normal hearing, claims she experiences complete relief of tinnitus while wearing the tinnitus maskers, but has trouble with word recognition when they are turned up to a therapeutic volume.


Scientists found that the level of sound needed to mask tinnitus may increase by as much as 45 dB as the exposure time to the masking noise increases. He theorizes that the auditory system may fatigue to the masker, but not to the tinnitus, thus requiring louder masker levels until a ceiling is reached. If this is the case, then maskers might need to be increased in intensity above levels where they can be used therapeutically in everyday situations without covering up or masking the desired auditory input.



A relaxation technique that has been useful in controlling many bodily functions, biofeedback relies on behavioral response modification. The way our bodies normally respond to stressful situations is a fight or flight response of the autonomic nervous system. It is known that elevated blood pressure may increase subjective tinnitus. By controlling breathing, for example, one can learn to reduce one’s heart rate, thus reducing blood pressure, which may lower the intensity of the tinnitus.


Elevated stress levels have been correlated with anxiety and depression. It has been shown that the scores on the depression questionnaires are often related to the ability of the tinnitus sufferer to deal with or habituate to the annoyance of tinnitus. Biofeedback is well known as a highly successful method of stress relief.



Numerous medications have been tried over the years, with variable benefit. Selective serotonin reuptake inhibitors (SSRIs) have been tried in individuals with concurrent depression with a high rate of improvement among compliant patients (n=30). Those patients were also undergoing psychotherapy, education and tinnitus management training. This makes it impossible to know without a follow-up study how much of the improvement was due to SSRI use alone and how much of the benefit was due to the therapy and tinnitus management training. A trial with paroxetine by researchers found that although the majority of patients in the trial were not suffering from depression or anxiety there was a significant improvement in the self-reported annoyance of tinnitus. Nortriptyline reduced tinnitus loudness by 10 dB in a study by other researches.


The majority of the SSRIs have tinnitus listed as a side effect. Many studies have shown that the onset of tinnitus may coincide with the treatment of depression using SSRIs but that the majority of those cases seem to improve or resolve after the patients have been on the treatments for a short period of time. Scientists did a retrospective study of 37 tinnitus patients who began SSRI treatment for tinnitus and found a significant improvement in the scores reported on the TSI. 


Benzodiazepines have also been tried, but the studies leave questions about whether the improvement in tinnitus is due to treatment or sedation. The over the counter nutritional supplement ginkgo biloba has been shown to be ineffective in the treatment of tinnitus. 

Riluzole is a neuroprotective medication, which has been shown to prevent or reduce apoptotic and necrotic cell death in rat spinal cords and in retinal ischemia. Researches conducted a study to determine the effect of riluzole as a protective agent against noise-induced hearing loss in rats. They used an osmotic minipump to perfuse riluzole directly into the cochlea. They found that the use of riluzole within 24 hours after acoustic trauma completely protected the hearing. By giving rats large doses of aspirin they were able to cause tinnitus, which was then verified by measuring the levels of electrical activity in the neural pathways. After training rats to respond to a tone, the aspirin treated rats were found to respond incorrectly more often than control subjects. The rats were responding when an external tone was not presented, presumably while hearing subjective tinnitus caused by the aspirin. Following treatment with riluzole the false-positive responses disappeared.


Research reports on the case of a woman with secondary tinnitus that became so severe and incapacitating that she went to the emergency room complaining that her tinnitus was driving her crazy. She described the tinnitus as roaring. The patient was given an intravenous drip of saline as a placebo, to find out if she would have an improvement in her symptoms, but she reported no relief. She was then treated with intravenous lidocaine. She was observed in the hospital for 24 hours. Over the next 2 years she had three more injections of lidocaine for severe recurrences, and each time she got relief from the tinnitus. On each occasion, prior to lidocaine administration, she was injected with the saline placebo, but the placebo treatments had no effect on her tinnitus. 


Researches used otoacoustic emissions, both spontaneous and evoked, along with a tinnitus questionnaire as a measure of change in tinnitus severity in patients treated with intravenous lidocaine. All of the subjects (n=30) had normal hearing with the exception of two who had a mild sensorineural hearing loss. The patients were asked to fill out the questionnaire before treatment, one day after, one week after and one month after the lidocaine infusion. The OAEs and the questionnaires indicate that lidocaine infusions may be effective in some individuals; however the effect in chronic sufferers is generally short lived, less than one month.


Many medications have side effects such as sedation, blurred vision or dry mouth that need to be taken into consideration. With any medication it is important to remember that since the exact mechanisms of tinnitus are generally unknown for a given patient, there is often no foundation on which to base a medication choice. It is also important to remember that some medications can cause tinnitus, either temporarily or permanently. Aspirin, non-steroidal anti-inflammatories, loop-diuretics, aminoglycoside antibiotics, quinine and chemotherapy drugs are among the medications that can cause tinnitus.


Electrical Stimulation

Researches at the University of Iowa, did a study to find out if it electrical stimulation of the eardrum would produce a reduction in tinnitus. The theory was first proposed by Grapengiesser in 1801, but the methods used by researchers over the years caused a considerable amount of pain to the subject and involved making a hole in the eardrum to place a probe into the middle or inner ear. Tyler found that it was possible in about half of his patients to reduce tinnitus intrusion by stimulating the eardrum itself using an eardrum electrode. The reduction in tinnitus lasted from less than a minute to about four hours after stimulation of ten minutes. Of the five patients who responded to the treatment, four had tinnitus matched to frequencies over 9000 Hz, and all had tinnitus that could be masked with low-level masking signals. They found that spectrally complex stimulation produced better results than pure tone stimulation, and the level of stimulation used can be low enough that it is not audible to the patient. 



Surgery may reduce or eliminate tinnitus when the symptoms are being caused by otosclerosis, vascular malformations and some tumors. A patient who had coarctation of the aorta repaired surgically had been suffering from tinnitus and a sensorineural hearing loss his entire life. After surgery to repair his aorta his tinnitus was completely gone and his hearing thresholds improved. Nerve section or labyrinthectomy have been used in cases of severe subjective tinnitus, but only about half of the patients get relief. Surgery may also help if the cause of objective tinnitus is temporomandibular joint syndrome.



Ericksonian Hypnosis is a form of therapy that uses a trance to access the subconscious mind. The subconscious is a creative environment in which patients find solutions to problems by examining those problems, while with traditional hypnosis a therapist would try to program the patient into ignoring the problem. A therapist might suggest to a patient that they probably can’t learn to ignore tinnitus because it is too intrusive. The subconscious mind would then work on finding a way to block it out in order to prove the therapist wrong. The subconscious mind tries to resist commands, but responds very well to indirect suggestion, metaphors and symbolization. 


Ericksonian Hypnosis has been studied to determine if it has an effect on tinnitus intrusion. A longitudinal study was conducted using 393 patients in an inpatient 4 week long treatment setting. The patients all had either chronic or sub acute tinnitus. The hypnosis was designed to reduce the perception of the tinnitus symptoms. Both the Tinnitus Questionnaire and Health Survey were completed by patients before and after therapy and at 6 and 12 months post treatment. Scores on the assessment instruments showed an improvement of 88.3% in the chronic tinnitus group and 90.5% in the subacute tinnitus group, and the improvement remained stable at follow-up.



Habituation refers to the phenomenon of helping patients learn how to treat tinnitus like an innocuous background noise to be ignored, similar to the way refrigerators and air conditioners fade into the background. Habituation can be achieved by using different treatment protocols as well as by using maskers. It is important to be able to hear the tinnitus in order to habituate to the sound. If one can not hear it then one can never get used to it to allow the sound to fade into the background. The effects can carry over and last even after the treatment is completed or the maskers removed. When the neural components that are not receiving stimulation normally are stimulated by the maskers or other auditory input they are less susceptible to responding to random stimuli, thus reducing or eliminating the phantom noise.


Neuromonics Tinnitus Treatment uses a device resembling an MP3 player, called the Oasis, designed to help in the habituation of tinnitus. The treatmen, developed by the Australian company Neuromonics, stimulates the neural pathways to the auditory system promoting neural plasticity. The device and therapy have an average cost of about $5000 per patient, and the therapy takes from 4-8 months to complete. Neuromonics Corporation has claimed that greater than 50% of patients using their device reported continued relief even months after treatment was completed. Currently this method is in limited use at the VAMC in Baltimore, MD.

The treatment protocol includes having the patients complete the TRQ and a Tinnitus History Questionnaire. The patient is assessed to ensure there is no medical intervention that is needed. The tinnitus is evaluated for frequency and intensity, and a complete hearing evaluation is preformed. The Oasis device is programmed specifically to meet the needs of the patient based on the tinnitus and hearing profile.


The device provides a low-level stimulus that is embedded in music and delivered via headphones. There are two stages to the treatment. Stage one lasts about two months and is intended to relieve the symptoms of tinnitus. The patient wears the Neuromonics device a minimum of 2 hours per day while doing routine things. The time worn can be divided over the day or can be consecutive. Stage two lasts about four months and is designed to encourage the neural plasticity and thus allow the brain to ignore tinnitus more effectively. After treatment is completed the patient may wear the Oasis device if they feel the need to, to help maintain successful outcomes.


Tinnitus Retraining Therapy (TRT) is based on the research of Pawel J. Jastreboff and his neurophysiological model of tinnitus which includes the limbic and autonomic nervous system involvement in tinnitus perception. In his description of TRT, Jastreboff (1998 retrieved from The Tinnitus and Hyperacusis Centre website) says, “Our goal is to retrain the patient’s brain so they treat tinnitus similar to the way they treat the sound of a refrigerator in their kitchen.” In other words, the idea is to have the tinnitus fade into the background. TRT uses a combination of broad band stimuli for sound enrichment and counseling to help patients habituate to the tinnitus. An astounding 80% of patients achieve a significant reduction in tinnitus according to Jastreboff, which typically requires 12 to 18 months of therapy to be most effective. An undated paper by Sheldrake, Hazell and Graham states that in an observational study that was not randomized and is “not of a rigorous experimental design” that 83.7% of subjects completing the TRT program achieved a 40% improvement level. 


A study on TRT was done at the Maryland Tinnitus and Hyperacusis Center in Baltimore, MD, between 1999 and 2001. Prior to beginning TRT, 32 patients were questioned about their full history and were examined by an ENT physician. They also had gadolinium-enhanced MRIs to rule out retrocochlear involvement. Patients were given the THI and a full audiogram at their initial visit to the Center. After six months of treatment the audiogram was repeated on 22 patients and a follow-up version of the THI was completed by all 32 patients. Berry et al. found that all of the patients in the study group had a significant improvement in tinnitus perception. The mean score on the THI at the initial visit was 52.8 with a standard deviation of 21. At the six month visit the mean THI score had dropped to approximately 25 with a standard deviation of approximately 15. Interestingly, the loudness discomfort level (LDL) of the nine patients who had both tinnitus and hyperacusis at the initial visit all showed a statistically significant improvement when they were tested at the six month visit.


Scientists reported on research that has been ongoing at the Veteran’s Administration Medical Center in Portland, OR, since 1995. The study was designed to help in the development of a tinnitus management program for veterans. The study looked at the effectiveness of TRT compared to tinnitus masking. The preliminary data shows that the two groups (TRT and tinnitus masking only) had similar outcomes through 6 months of treatment, but by 12 and 18 months there was a significant difference between the two groups with the TRT group showing significantly greater improvement in their tinnitus. 


Directive counseling is critical to the success of TRT and focuses on helping the patients form positive associations for tinnitus, or at least, less negative associations. If a person thinks that tinnitus indicates that something is wrong, the limbic system will be activated and cause the negative emotional reaction that is paired with the perception of tinnitus. The tinnitus sufferer then focuses on the tinnitus, which causes it to be noticed more, and on, and on. With the TRT therapy the patient is shown that there is nothing to fear from the tinnitus, and that it is just a symptom. Obviously, some cases of tinnitus can be caused by potentially serious conditions, and these patients would not be given TRT. When people learn that their tinnitus is harmless they become less fearful and it becomes less bothersome. Habituation will not occur if the patient can’t hear the tinnitus due to masking. You can not habituate to a sound you can not hear, so a sound generator that is designed to help in the habituation process has to be used at low intensities so that the tinnitus is still audible. These sound generators use a wide band signal and are thought to stimulate all the nerve cells in the auditory pathways, which then allows for easier reprogramming of the patient’s reactions.


Transcranial Magnetic Stimulation (TMS) is a method of non-invasive brain stimulation. Repetitive TMS (rTMS) is used for the treatment of major depression. Clinical researches reported on two patients who were treated with rTMS over the dorsolateral prefrontal cortex, and who wore earplugs during their treatment. Both patients developed tinnitus after their treatments. In both cases the tinnitus did not resolve even after treatment with clonazapam. Several studies have shown that rTMS, when not applied to the prefrontal cortex, can be effective in treating tinnitus. The specific location of the treatment was correlated with the beneficial effect. Scientists found that when rTMS was applied daily to the left temporoparietal cortex for a period of 2 weeks the patients reported a significant improvement in tinnitus. The response to treatment, as measured on the Tinnitus Handicap Inventory, was greater in the patients who had been experiencing tinnitus for the shortest amount of time. The sound frequency of the stimulus was varied and did not have an effect on improvement levels."

Tinnitus (Part Three) 'Tinnitus and the Military'

by Michael Knapp on 08/10/14

Exert from Dr. Jane Burns, AuD.

Audiologist  (Referral Partner of New Way Hearing)

"The Beck Depression Inventory can also be a good screening tool since tinnitus is often accompanied by depression. It was developed by Beck and Beck in 1972 as a rapid method of quantifying the level of depression a patient is experiencing. This information may give the practitioner a better idea of the personality type and psychosocial impact the tinnitus has on the patient. Interestingly found was that scores on depression and anxiety scales show a high correlation to the degree of handicap perceived by tinnitus sufferers.


Tinnitus that is determined to be due to long term excessive noise exposure, barotrauma or acoustic trauma incurred while serving in the military is considered a disability, and thus is subject to compensation under Veterans Administration (VA) guidelines. Tinnitus was the third most common disability among military veterans in 2004, but has taken the number one spot as of fiscal year 2006, with 51,360 new cases (VA Annual Benefits Report, 2007). There is currently no system in place for tracking tinnitus prevalence other than to wait until a veteran files a claim for a service connection for hearing loss or tinnitus.


Given the rapid pressure changes experienced by flight crews, paratroopers and submariners, intense noise produced by weapons and the close proximity to the ear of the person firing the weapon, it is reasonable to assume that a significant portion of the military members, especially those in combat situations, will have sufficient noise exposure or barotrauma to cause tinnitus and/or a hearing loss. Many veterans who are not in combat situations are exposed to excessive noise daily from aircraft, heavy vehicles and ships. Combat veterans may also find that they are suffering from Post Traumatic Stress Disorder (PTSD), which has been shown to be linked with tinnitus.


The military population is also experiencing a large surge in Traumatic Brain Injuries (TBIs) in veterans returning from Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom. At the Association of Veterans Affairs Audiologists (AVAA) annual meeting in April 2008, a report was given on research currently being done showing a strong link between TBI and tinnitus. Part of the link may simply be due to the noise exposure that accompanies most TBIs, but there appear to be certain areas of the brain, including the limbic system, that are damaged in veterans who report tinnitus along with the TBI."

Tinnitus (Part Two) 'What is Tinnitus'

by Michael Knapp on 08/10/14

Exert from Dr. Jane Burns, AuD.

Audiologist  (Referral Partner of New Way Hearing)

“Tinnitus is the perception of sound that does not have an external source.” The descriptions vary greatly, but the word tinnitus comes from the Latin word for ringing bell. Many sufferers describe it as a ringing in the ear, however it has also been described variously as whistling, hissing, buzzing, crickets, locusts, humming, static, whooshing, ticking or roaring, usually in association with a temporary hearing loss. Tinnitus can occur in one or both ears, or may seem to be localized in the head rather than an ear. It can occur in anyone, of any age, from deaf individuals to normal hearing individuals. Criteria for pathological versus normal tinnitus have yet to be formally established. Scholars suggest that a minimum duration of five minutes occurring more than once per week is pathological, while the typical tinnitus patient seeking treatment has tinnitus most or all of the time.


For most individuals it is a subjective problem, one that only they can hear. While there are sounds created in the inner ear that can be measured with special equipment, these spontaneous otoacoustic emissions are not generally audible. There are several documented cases of objective tinnitus that is audible to others, some cases were caused by muscle spasms and some by Temporomandibular Joint Disorder (TMJ). Some individuals have a form of subjective tinnitus referred to as pulsatile. This type of tinnitus is experienced as a pulsing sensation or sound in the ear, usually in sync with the heartbeat, and in rare cases may be a sign of a serious disorder requiring medical treatment. Other scholars state that tinnitus by its very definition is subjective. He says that tinnitus should be classified as being generated either neurophysiologically or somatically. Somatosounds are usually due to vascular, muscular, respiratory or TMJ causes.


Tinnitus is not a disease itself, but rather a symptom of an underlying problem. Current estimates of the prevalence range from 10-15% of the population, or about 30-50 million Americans and of these, about 10-12 million people have severe tinnitus that interferes with their daily lives. Prevalence rates are similar in other countries as well. Interestingly, scientists conducted a tinnitus matching study and found that only about 20% of their subjects matched their tinnitus to an intensity level greater than 6 dB above their threshold for the frequency of the tinnitus. Other scientists conducted a study which revealed similar findings with 87% of subjects reporting loudness matching levels of 10 dB or less.


There are many known and theorized causes of the tinnitus symptoms. Noise exposure, acoustic trauma, ototoxic medications, aging, hearing loss, infections, cerumen impaction, migraines, epilepsy, abnormally low levels of serotonin, Meniere’s disease, vascular malformations, benign intracranial hypertension and neoplasms such as acoustic neuromas and cholesteatomas can all cause the symptoms of subjective tinnitus.


Whatever the cause or trigger, the end result is the same: tinnitus. At this point there are differing theories as to what actually causes the sensation of ringing. One theory is that irritation of the stereocilia causes them to bend more than usual and discharge, sending a signal to the brain that sound is present when there is no stimulus. A related theory is that when the hair cells are bent or broken they can not discharge and charge normally and thus leak electrical signals randomly to the brain, where those signals are then interpreted as noise.


There are theories that tinnitus may be a non-adaptive change in the neural network. Neuroimaging studies have shown increased activity in the temporal cortex of patients with tinnitus. She believes that since there is a specific representation in the cortex for cochlear activity, a lesion in the cochlea could cause a frequency representation to be missing, leaving that region able to receive input from other areas of the brain producing the abnormal signal that is then experienced as tinnitus. She also compares this with the phenomenon of phantom limb pain. It has been noted that the frequency of tinnitus usually matched frequencies that had hearing loss. They also found a relationship between the steepness of the slope of the hearing loss and the severity of the tinnitus.


Research found that some tinnitus subjects have spontaneous electrical activity that can be measured at the eardrum. None of the control subjects, who did not have tinnitus, had these electrical spikes. They theorize that the spikes of activity may represent tinnitus, and that the lack of electrical activity in some of the tinnitus sufferers may be indicative of central tinnitus.


Positron-emission tomography performed on tinnitus patients shows increased activity in the temporal cortex of the left hemisphere when they were experiencing tinnitus in their right ear, but when real sound stimuli were presented to the right ear both the right and left hemispheres showed an increase in activity. Their theory is that when the damaged neurons are not being stimulated, the dorsal cochlear nucleus is not inhibited and the spontaneous activity level in the central auditory system increases and is heard as tinnitus.


Research scientists also found that tinnitus is not processed in the same way as pure tone stimuli. Their study had ten subjects, each with a sensorineural hearing loss and no known etiology for their tinnitus. The stimulus required for masking the tinnitus was different than that needed to mask pure tone stimuli. In eight of the subjects, the tinnitus needed less intensity to be masked than the pure tone signal did.


In the majority of cases of pulsatile tinnitus the cause appears to be vibrations from turbulent blood flow that reaches the cochlea, or from malformation of the capillaries. Underlying problems such as stroke, aneurysm, valvular heart disease and occlusive cerebrovascular disease can sometimes be found. Patients who are pulsatile tinnitus sufferers may possibly experience relief if there is an underlying disorder that can be treated.


Tinnitus may have a profound effect on the everyday functioning of sufferers. It has been linked with depression, annoyance, insecurity, difficulty concentrating on tasks, interfering with communication, disturbing sleep patterns, and in extreme cases has led to suicide. When the sensation levels of the tinnitus are measured there is no correlation to the annoyance level perceived by the patient. Research also found that 70% of subjects reported emotional difficulties and 93% reported that tinnitus affects their lifestyle.


There are not currently any definitive clinical tests for subjective tinnitus, but a preliminary report of a scientific study indicates that the antibody HSP-70 may be present in some patients with idiopathic tinnitus that is linked to an immune response. Diagnosing Tinnitus can be tricky. The vast majority of tinnitus cases are diagnosed by the history from the patient. There are several tinnitus self-assessment tools available for quantifying the severity of tinnitus, including the Tinnitus Handicap Questionnaire (THQ), the Tinnitus Severity Index (TSI), the Tinnitus Handicap Inventory (THI) and the Tinnitus Reaction Questionnaire (TRQ), each of which has been studied for validity. 


The THQ was developed in 1990 by Kuk, Tyler, Russell and Jordan. The original questionnaire had 87 questions, but was reduced to 27 items designed to assess the effect the tinnitus has on them physically, emotionally and in social settings, the hearing ability of the patient, and the patient’s view of their tinnitus.


The TSI was developed by Meikle, Griest and Stewart in 1995, and has 12 questions designed to assess the negative reactions of the subject to their tinnitus, how loud they feel it is, and how it affects them in various situations. The first nine questions refer to how often a situation occurs, and have 5 possible answers ranging from never to always, and there is an overall rating for estimating the usual intensity level of the tinnitus. 


The THI was developed by Newman, Jacobson and Spitzer in 1996. The THI originally had 45 items and was reduced to 25 questions in 3 categories relating to the subject’s functional and emotional states. The 3 subscales address the effect of tinnitus on the patient’s daily life. The functional subscale covers effects on occupation, social life, mental status and functioning, for example any difficulty falling asleep or concentrating. The emotional subscale deals with anger, anxiety and depression related to tinnitus. The catastrophic subscale covers the issues of desperation, inability to cope and loss of control.


The TRQ was developed by Wilson et al. (1990), as a scale for measuring psychological distress experienced by tinnitus sufferers, and may be used as a tool for measuring progress experienced by subjects in treatment programs. There are 26 items and a 5 point scale ranging from 0 (Not at all) to 4 (Almost all of the time)."

Tinnitus (Part One) 'History'

by Michael Knapp on 08/10/14

Exert from Dr. Jane Burns, AuD.

Audiologist  (Referral Partner of New Way Hearing)

"For centuries people have theorized about the cause of tinnitus. From almost the beginning of recorded history there have been references to noises in the ears. Hippocrates, in about 400 BC, believed that tinnitus was caused by sadness. Ancient Oriental mystics and Egyptians believed that if you had tinnitus you were sensitive to divination. Roman medical practitioners around the time of Christ believed it went along with depression and seizure disorders, and writings in the Babylonian Talmud refer to Titus’s curse, which is described as a gnat buzzing in the brain."

Today we have much more information about tinnitus, but there is still much to be learned. Animal research has given researchers information about how things work, but animals can’t talk to us about their subjective experiences. As such, the only way to ensure that an animal subject has tinnitus is to induce tinnitus by giving the animal a large dose of aspirin. Unfortunately, this method of inducing tinnitus may mean that the findings of the research may only apply to aspirin induced tinnitus and may not generalize to other forms of tinnitus. Human subjects can tell us what they are experiencing, but we are limited on the amount of probing and dissecting we can do to examine the hearing system on live subjects. The advent of Functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography (PET) has made imaging of tinnitus possible, but not practical for routine use due to cost considerations. Since there may be multiple causes of tinnitus experienced by an individual, there is, as yet, no universal answer as to the most effective treatment.”

Hearing Loss & Healthy Aging Important Facts Everyone Needs To Know!

by Michael Knapp on 01/01/14

Imagine being told your seven-year-old grandson, or twelve-year-old granddaughter, or some other child you love has just been diagnosed with a hearing loss. What would you do? You would probably do all that you could to help that child get the treatment they need, even if it meant paying out a good amount of money on hearing aids. And why would you do that? The most likely answers would be, ‘because they need to hear everything so that they’re able to do well in school, interact with their friends and family, and not feel left out to grow up healthy and happy.’

Now, let’s flip this scenario around to an older person that’s perhaps fifty- five or over. Imagine if they were just diagnosed with a hearing loss. What would they do?

The reality is, there’s no difference other than age. Just because someone is older doesn’t mean they should neglect being treated for hearing loss. Actually, with all of the new research that’s been done over the past twenty+ years, especially from Johns Hopkins University*, which shows how much hearing loss affects the brain over time, it’s very important for anyone with a hearing loss to be treated. They have found that even a mild hearing loss left untreated ages the brain quicker, and those individuals are five times more susceptible of obtaining dementia.

You would think that one of the main reasons why 85% of Americans with hearing loss don’t receive treatment with hearing aids is due to the cost. But, in the United Kingdom (UK), where hearing aids are covered by socialized medicine 100%, the statistics are exactly the same as the US. Hearing aids are absolutely free in the UK, and yet only 15% of individuals who know they have a hearing loss elect to get hearing aids each year. This means it’s NOT THE COST! But, why do we look upon a young person with hearing loss so differently than we do with someone older? And, why aren’t older people with hearing loss receiving the treatment they need?

The sad conclusion we face in answering these questions, especially for those of us living in the western world, with all of our technological advances, education, economic standards, and modern medicine, is that most people are truly ignorant to the effects hearing loss has on the aging process and the brain. The other sad reality is that vanity and pride also deter a vast number of people from being treated.

It is estimated that there are nearly 50 million Americans right now, walking around, asking people to repeat themselves over and over, turning up the volume on their TV’s so loud that it can be heard a block away, driving everyone else nuts with their hearing loss, who are doing nothing about it. Due to the greater risks associated with unhealthy aging as our population continues to get older and live longer, something has to be done about it. In order to combat these elevated risk factors of unhealthy aging, a paradigm shift has to occur in the way older Americans view the treatment of hearing loss with hearing aids and other assisted listening devices (ALD’s). Similar to what’s already been done with smoking, cholesterol, diet and exercise, enhanced education is the logical first step.

Additional education related to hearing loss and its aging affect on the brain needs to be implemented across the board, especially for all health care providers. Insurance carriers have to recognize the importance of healthy aging in relation to treating hearing loss with hearing aids and ALD’s by offering plans that offset the costs involved. Vital information regarding this issue needs to be made more readily available to the general public. And the hearing industry, including hearing aid and ALD manufacturers, audiologists and dispensers, as well as governmental agencies such as the Center for Disease Control (CDC), need to address this important matter more effectively.

Hopefully, someday in the not too distant future; family physicians will be more inclined to screen their patients for hearing loss and offer those patients in need of treatment available options; insurance providers will be more inclined to cover hearing aids and ALD’s; and the majority of older Americans with hearing loss understand the real benefits of healthy aging with hearing aids, and are also able to lay aside vanity and pride in order to receive treatment. The next twenty years will determine whether we stay on our current course of ignorance regarding the treatment of hearing loss for older Americans, or a whole new comprehensive perspective comes into place, whereby the vast majority are treated. The latter would benefit untold millions.

(*Source: - Internal Search Key = hearing loss and dementia)

Hearing Loss in Young People vs. Older People

by Michael Knapp on 12/19/13

Imagine being told your seven-year-old grandson, or twelve-year-old granddaughter, or some other child you know had just been diagnosed with a hearing loss. What would you do?


You would probably do all that you could to help that child get the treatment they need, even if it meant paying out a good amount of money on hearing aids. And why would you do that? The most likely answer would be because they are so young and need to hear everything so that they grow up healthy and happy, so they are able to do well in school, interact with you and your family, and not feel left out.


Now, let’s flip this scenario to you. Imagine you were just diagnosed with a hearing loss. What would you do?


The reality is, there is no difference other than your age. Just because someone is older doesn’t mean they should neglect being treated for hearing loss. Actually, with all the new research that’s been done over the past twenty-five years, especially from Johns Hopkins University, which shows how much hearing loss affects the brain over time, it’s very important for anyone with a hearing loss to be treated. They have found that even a mild hearing loss left untreated ages the brain quicker, and those individuals are five times more susceptible of getting dementia.


You would think that one of the biggest reasons why 85% of Americans with hearing loss don’t receive treatment with hearing aids is due to the cost. But, in the United Kingdom (UK), where hearing aids are covered by socialized medicine 100%, the statistics are exactly the same as the US.


Hearing aids are absolutely free in the UK, and yet only 15% of individuals with hearing loss elect to get hearing aids each year. This means it’s NOT THE COST! But, why do we look upon a young person with hearing loss so differently than we do with someone older? And, why aren’t older people with hearing loss receiving the treatment they need?


The sad conclusion we face in answering these questions for those of us living in the western world, with all our technological advances, education, economic standards, and modern medicine are truly ignorant to the effects hearing loss has on our aging process and the brain. The other sad reality is that vanity and pride also deter a vast number of people from being treated.


It is estimated that there are around 50 million Americans right now, walking around, asking people to repeat themselves over and over, turning up the volume on their TV’s so loud it can be heard a block away, driving everyone else nuts with their hearing loss, who are doing nothing about it.


Something needs to be done about it, and there are some things that can truly help. Healthcare providers, doctors and nurses, need more education related to hearing loss and the brain. Vital information regarding this issue needs to be made available to the general public. And the hearing industry, including hearing aid manufactures, dispensers, and societies need to address this important matter.


Education is the key. Hopefully, someday in the near future, the majority of older people with hearing loss will understand the real benefits of healthy aging with hearing aids, and are able to lay aside vanity and pride of the false perception that hearing aids make them look old in order to receive the treatment they need.

Are Men More Vain Than Women Regarding Hearing Aids?

by Michael Knapp on 11/24/13

Vanity has always been an issue with hearing aids, and national statistics show that men are actually vainer than women when it comes to wearing hearing aids. Cited issues men have are, “they would make me look old,” and, “they would make me look weak.”

With the advent of new digital micro technology, the hearing aid manufacturers have been successful in creating hearing aids that can hardly be seen, but that can still get the job done.

In the last few years some new "Behind the Ear" (BTE) aids are as small as a dime and can fit a wide range of hearing loss, especially with the advent of “Receiver In the Canal” (RIC) technology. They even come in a variety of colors that can match a person’s hair, skin tone, or if you dare to be bold, zebra and tiger stripes. There are some that even go deep in the ear and can stay in there for up to four month as what’s referred to as an “Extended Wear Device,” such as the Lyric®.

The reality of today is that just about everyone is wearing a device in their ear with all the new blue tooth technology. Don’t you think a person should be more embarrassed about asking people to repeat themselves repeatedly than wearing a hearing aid that can’t even be seen? Wouldn’t it be more shameful to jeopardize a job because of a hearing loss as opposed to wearing a hearing aid?

We would like to hear your thoughts. Please let us know what you think…

Auditory Deprivation

by Michael Knapp on 11/24/13

Many people experiencing a hearing loss, even a mild hearing loss; do not realize the negative effects this can cause on the auditory speech centers of the brain.

When we test an individual’s hearing, the most important scores are reflected in the speech portion of the testing, and are called the Speech Discrimination Scores. The Speech Discrimination Scores tell us how well the auditory speech centers of the brain are working. What happens when a person is no longer able to hear certain sounds of speech, for instance in the high tones where the softer sounds of speech are heard, the brain loses its ability to interpret these sounds.

When you are unable to hear the high tone sounds we make with our lips, our teeth and our tongue, like the letter “F” or “S” or the “TH”, over time the brain basically tosses the "memory files" of those sounds out and is unable to understand exactly what that sound is. The brain interprets these sounds as a noise rather than these soft consonant sounds like F, S and TH…

When this occurs an individual with this type of hearing loss often says something like, “everyone mumbles,” or “you’re talking too fast.” They are unable to fully interpret what’s being said. The person may not even realize that it’s their inability to hear, because they may hear just fine in the low tones where the stronger sounds of speech are heard like the vowel sounds.

Many of these folk are in a state of denial when it comes to having a hearing loss, and they have no idea what harm they can do to themselves over time if it’s not treated. This is why it is so important to have your hearing tested. Everyone over 55 years old should have their hearing tested once a year, and anyone that is experiencing difficulties, such as a person who thinks everyone mumbles or is talking too fast should have their hearing tested as soon as possible.

The term for this is Auditory Deprivation, and it’s a very serious matter. For more information, please contact a hearing professional near you. For more information regarding Auditory Deprivation, please visit:

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