Wringing Your Hands Over Ringing In Your Ears: Coping with Tinnitus By Lawrence Cardano, Au.D.

TABLE OF CONTENTS: Dedication……………………….…………….……2 Introduction………………………………………..6 What is Tinnitus?................…………….……7 Who Experiences Tinnitus?...……….….…...8

Causes of Tinnitus………………………….......9 The Impact of Tinnitus………….….……..….10 Tinnitus Treatment Options.........………….11 References………………………………………….15 About the Author………………………………...16 Need Help?............................................17 (Note: This e-book is not intended to provide medical advice.) // Page 1

DEDICATION:

Tinnitus is personal

VISUAL HERE

Dad It was the bottom of the ninth inning with two outs. We were down by one run and we had a player on first base. The Bombers, the little league baseball team I was on, were playing the all stars from the rest of the league. Our team was so good that year that the decision was made to have us play the best players from all the other teams instead of having the regular end-ofthe-year all star game. My dad was our head coach.

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One of our best hitters was to be next at bat. But then my dad noticed that one kid on our team hadn’t yet gotten a chance to play. He was one of our worst hitters. But my dad always made sure that all the kids had a chance to play. So, to his surprise, my dad gave him a pat on the back, handed him a bat and told him to “go get ‘em.” With tension among the spectators and players at a peak, the boy hit a foul ball, took a strike, and finally struck out swinging. Though he was disappointed, he thanked my dad for giving him a shot. It was one of the most exciting games anyone there could remember.

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The way my dad handled his job as a little league coach was a good example of the kind of person he was. He taught me and the rest of the kids on the team a lot about teamwork, fair play and hard work - and he made sure we had fun. Knowing the kind of man he had been made it all the more heartbreaking for my family when we saw how tinnitus began to change his personality.

During the last year of his life, my father suffered from tinnitus to a degree that made it difficult for him to sleep and made him worry about his general health. At the time, less was known about how to handle tinnitus than we know today. In many ways he had a difficult life since childhood, yet he always remained upbeat with a positive attitude – until the onset of tinnitus. He was an active, outgoing person, but tinnitus made him depressed, anxious, and withdrawn.

Fear that tinnitus is a sign of a serious condition can increase the suffering it causes. // Page 4

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The stress that tinnitus caused my dad also resulted in more stress for family members who cared about him. I knew about tinnitus from my training as an audiologist, but seeing my dad suffering motivated me to take this potentially debilitating condition more seriously. I think of him often when I work with patients who have tinnitus. My dad taught me a lot. Appreciation of the potential debilitating effects of tinnitus was just one of those lessons. I dedicate this e-book to him.

Lawrence Cardano, Au.D. Doctor of Audiology Director, Hearing Center of Long Island

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INTRODUCTION: There has been much more attention recently on helping tinnitus sufferers than in the past. This has taken the form of more research on tinnitus, the introduction of new technology for tinnitus treatment, and more education for professionals who work with tinnitus sufferers. A number of treatment strategies that have proven successful for some people have been introduced and revised in the past few years. Unfortunately, this attention has also lead to the of marketing of purported “treatments” for tinnitus that have no basis for claims of effectiveness. Tinnitus and it’s treatment are not as clearly understood as many other conditions. It can seem confusing. That’s why I wrote this e-book. Here you will find basic information about tinnitus and its treatment that anyone with tinnitus - or who has a loved one with tinnitus should know.

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CHAPTER 1:

What is Tinnitus? The word tinnitus refers to a sound that is heard by an individual but is not present in the environment. It can sound like many different things. Some tinnitus sufferers describe the sound as being hissing, a buzzing, a whistle or other types of sounds. I have even had patients who describe their tinnitus as sounding like music. In some cases they say they can identify the song! Tinnitus is a symptom of a malfunction somewhere in the auditory system but it not necessarily a symptom of a serious or life threatening medical condition. This is important for tinnitus sufferers to understand because the emotions associated with fear of serious illness can contribute to the annoyance caused by tinnitus and the detrimental effect tinnitus may have on that person’s quality of life.

Tinnitus is not imaginary. It is real, but it is not a disease. // Page 7

CHAPTER 2:

Who Experiences Tinnitus?

PHOTO OF A CROWD

Tinnitus affects people young and old, male and female, from all walks of life. However, tinnitus is more common among the elderly. It has been estimated that nearly 30 million people in the United States have tinnitus. That’s about 10% of the entire population. The incidence of tinnitus is estimated to be as high as 26.7% for people ages 65-84 years. Although the majority of people with tinnitus have some degree of hearing loss, some people with tinnitus have no significant loss of hearing.

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CHAPTER 3:

Causes of Tinnitus Although the exact physiological cause of tinnitus is still being debated among researchers, there are a number of factors that are known to contribute to the development of tinnitus. These include exposure to loud noise, head trauma, and medical conditions such as ear infections, brain tumors, and hypertension. Some medications can also contribute to the development of tinnitus. These include loop diuretics, anti-depressants, non-steroid anti-inflammatories, and platinum based chemotherapy drugs. Even Aspirin can contribute to development of tinnitus if you take enough – although the effects are reversible.

In many cases tinnitus is not related to any disease or serious medical condition. // Page 9

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CHAPTER 4:

The Impact of Tinnitus

While some people with tinnitus are able to ignore it most of the time, for others it can have a dramatic impact on quality of life. It can interfere with concentration, job performance and sleep. In some cases it can lead to sever depression or anxiety disorders. It is interesting to note that the loudness of the tinnitus does not determine how much suffering people report it causes. I have seen patients who report that their tinnitus is not very loud, yet it causes them great distress. I have seen others who report their tinnitus is fairly loud but say they are not much bothered by it. In part, it seems that how distracting or bothersome the tinnitus is depends on how the person thinks of it. For example, if an individual thinks the tinnitus is a sign that they are going deaf or that they have a serious disease, it is likely to be harder to ignore and to cause more distress. // Page 10

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CHAPTER 5:

Tinnitus Treatment Options Before considering any tinnitus treatment option, a tinnitus sufferer should have a thorough medical evaluation to rule out any serious medical condition that might be related to the tinnitus. At Hearing Center of Long Island, we consider a complete audiological evaluation and tinnitus consultation with an audiologist to be the first step to choosing the most appropriate treatment option, once a medically treatable condition is ruled out. In spite of advertisements you might have seen or heard, there is no known “cure” for tinnitus. The goal of treatment is not to eliminate tinnitus but to reduce how much one is aware of it and to reduce its effects on quality of life. With patience and the proper treatment , dramatic reduction in the awareness of tinnitus and its annoyance can be achieved.

One of the simplest ways to help cope with tinnitus is to avoid silence.

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Chapter 5

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PHOTO OF A SHOE ON A FOOT

As you read this, you have the feeling of your shoes on your feet. However, until you read the previous sentence you probably did not notice that feeling. Most successful tinnitus treatments are based on this phenomenon: something can be perceptible but not noticed. Treatment options include the following. In many cases, a combination of two or more of these options may be most helpful. Medical treatment There is no drug designed specifically for tinnitus. However, certain antianxiety drugs, antidepressants and antihistamines are sometimes prescribed for tinnitus sufferers.

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Chapter 5 Alternative therapy Alternative therapies that have been suggested include Ginko Biloba or B itamins. However, none are proven to be effective.

It is interesting to note that, in a 2013 evaluation by audiologist Dr. Robert DiSignora of 25 over-the-counter products marketed with claims of relieving tinnitus, not one of the 25 manufacturers contacted were able to provide a reference list of published articles showing the efficacy and safety of the ingredients, consumer or medical reports of the long-term effects of continuous use of the products, or even the names and credentials of those who decided which ingredients would go into the product.

Sound therapy Specially designed sounds can help make tinnitus less Noticeable. Babbling Brook These sounds can be generated by wearable devices, including some hearing aids, or non-wearable devices like table top sound generators. (One example of a free “app” for either Apple or Android devices that can be used for this purpose is called Relax Melodies.) A number of treatment protocols have been developed using customized sound to partially mask tinnitus. Under the guidance of a professional, these can help make tinnitus much easier to ignore.

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Chapter 5

Counseling Basic informational counseling regarding the nature of hearing loss and tinnitus can be helpful because it demystifies tinnitus and helps individuals understand, on an emotional level, that their tinnitus is not dangerous. Removing the association of tinnitus with danger can reduce the anxiety it causes. In some cases, simple strategies learned during counseling can have a dramatic effect. Also, education and cognitive behavioral therapy – individually and in combination - have been shown to be helpful in the management of tinnitus. Hearing aids Many studies show that tinnitus sufferers with hearing loss often find that use of hearing aids is very Hearing Aids helpful. Among the possible reasons why hearing aids are helpful is that they can help people hear sounds in the environment they had not been hearing. These environmental sounds can stimulate parts of the auditory system that have been deprived of sound and thus “drown out” the tinnitus. Many hearing aids now include special features specifically designed to help tinnitus suffers. At Hearing Center of Long Island we customize these features to maximize the effectiveness. Tinnitus sufferers who begin to wear hearing aids often report that their tinnitus is not noticeable while they are wearing their hearing aids and even – in some cases – for a limited time after their hearing aids are removed. •

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REFERENCES •

Brown SC. (1990).Older Americans and Tinnitus: A Demographic Study and Chartbook. Washington, D.C.: Gallaudet Research Institute.

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Brown SC. (1990).Older Americans and Tinnitus: A Demographic Study and Chartbook. Washington, D.C.: Gallaudet Research Institute.

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Coles R. Medico-Legal Issues. In: Tyler RS (ed), Tinnitus Handbook. San Diego: Singular Publishing, 2000:399-417.

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Davis A, El Refaie A. Epidemiology of tinnitus. In: Tyler RS, ed. Tinnitus Handbook. SanDiego: Singular Publishing Group; 2000:1-24.

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DiSogra, RM (2014) Over-the-counter Tinnitus Relief Products. Audiology Today 26(4):24-29

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Henry JL, Wilson PH,;The Psychological Management of Tinnitus: Comparison of a Combined Cognitive Educational Program, Education Alone and a Waiting-List Control.; Int Tinnitus J., 1996;2:920.

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Sergei Kochkin, PhD, and Richard Tyler, PhD, The Hearing Review, December 2008; Volume 15, Number 13: Pages 14, 16, 17, & 18.

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About the Author

Lawrence Cardano, Au.D. Since 1989, Audiologist Dr. Lawrence Cardano has dedicated his professional life to helping individuals with hearing loss, and their families, to improve their quality of life. He earned his Master’s degree in Audiology from Columbia University and his Doctorate in Audiology from the University of Florida. Dr. Cardano is Board Certified in Audiology. Since 2002 he has written on topics related to hearing loss and hearing rehabilitation as author of the quarterly newsletter Long Island Sound. As director of Hearing Center of Long Island, Dr. Cardano provides personalized hearing care using state of the art technology and techniques. Dr. Cardano’s community service efforts include his work with the Lions Lend an Ear program, which he helped to create. Through this program, part of the Nassau County chapter of Lions Clubs International, Dr. Cardano works to provide hearing aids and related services to those who can not afford them.

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Need Help? To schedule personal consultation contact us at [email protected] or call 516-872-8485. For answers to your questions or to share your comments, contact Dr. Cardano at

[email protected]

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