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Scott Webb: Have you or someone you know experienced ringing in your ears that just won't go away? The American Tinnitus Association estimates nearly 15% of people or more than 50 million Americans experience tinnitus. The National Institute on Deafness and other communication disorders says about 10% of US adults or nearly 25 million people have experienced tinnitus lasting at least five minutes in the past year. And today, I'm talking with Dr. Deanna Nickerson. She's an audiologist with Summa Health, and we're going to learn more about tinnitus and treatment options.

This is Healthy Vitals, the podcast from Summa Health. I'm Scott Webb. Doctor, thanks so much for your time today. As I was just mentioning, I sort of know about this topic, tinnitus, but mainly it's through like my musical heroes and them complaining about getting it, developing it, not being able to hear as they get older. So, it's really great to have your expertise today. So as we get rolling here, let's learn more about tinnitus. What is it and what causes it?

What is tinnitus and what causes it? 

Deanna Nickerson: So, the true definition of TIN-ni-tus or tin-NYE-tus, they're both commonly accepted terms, is when there is a sensation of hearing a sound in your ears, but there's no external sound present. This noise can be anything from like a ringing, a buzzing, humming, crickets. I've even had people who have said that they've heard music or Christmas music playing constantly in their ears. So, it's basically when you hear a sound, but nobody else can hear it.

Scott Webb: That's really interesting. And I should have asked you before we started, is it tin-NYE-tus or TIN-ni-tus, but good to know that it's tomayto, tomahto. So, I'm wondering, we've all heard, we've all experienced anyway, I think, having sort of an earworm, you know, where something's playing in our heads, a song just keeps playing in our head. Is that different than tinnitus or tinnitus?

When is it classified as tinnitus?

Deanna Nickerson: It can be a little bit different. When it is classified as tinnitus is when it's lasting longer than usually about five minutes out of time. And it's constantly there. You know, those ear worms are common. It's our brain's way of kind of focusing and picking up on something that's familiar and comfortable. But when it turns out to be tinnitus is, again, when it's there for longer than five minutes, and it can last anywhere from days to weeks to years.

Scott Webb: Yeah. And we could probably do a separate podcast on why when we get those ear worms, it's often the worst song possible, why that horrible song keeps playing over and over in our heads. But we'll table that for a different podcast. So for true tinnitus, based on the definition you're giving us, what are the symptoms? And are there really any long-term effects? Like if it happens occasionally, is that okay? If it happens constantly, is that how we know it's really tinnitus? Maybe you could take us through this.

How do you really know if it is tinnitus?

Deanna Nickerson: It kind of goes back to what it is and what causes it. Some of those underlying symptoms or why do we have it there? So, what I tell patients is that it is an ear-related concern, and that's why an audiologist or an ENT is the best provider to talk about tinnitus. But that being said, the issue line is within the brain. So, the brain creates this type of noise and then essentially doesn't remember what created that noise and why it's there. So now, the brain is trying to classify it and to figure out where this noise is coming from and how can we fix it.

So, these multiple causes that can be the reason why we have tinnitus, the most common is going to be hearing loss. I would say 90% of patients with any degree of hearing loss, whether it be mild or severe, they have some report of tinnitus. That can be pretty bothersome, that can be, "Oh, yep, I hear it when it's quiet," where it changes is going to depend on how that person's brain is interacting with the tinnitus. So when there's hearing loss, the brain isn't getting the proper stimulation that it needs, so it causes those nerve impulses from the brain, from the ear to the brain to overfire, or it just doesn't send any response at all. So in this case, the brain is turning up the volume to kind of find where that missing information is, so then we have this buzzing, or this hissing or this humming noise.

Other causes of tinnitus can be from noise exposure, which then causes damage to those fine hair cells that are within the inner ear, so then the brain's not getting that proper stimulation. Ototoxic medications, which are considered to be damaging to the hair cells inside the ear, like IV antibiotics or chemotherapy medicines, even some over-the-counter medications and prescription medicines can be called ototoxic. They cause those hair cells to die out, which then the brain can't get that stimulus, so it creates that noise again. Sometimes even head trauma can cause that, because then the brain's not just being stimulated the way that we need it to be. So, a lot of the symptoms or a lot of the causes to tinnitus can be more brain-related, like unfortunate, some psychological effects like anxiety or depression, paranoia, because now we're hearing this constant noise and the brain can't classify it and it snowballs into this bigger issue.

Just because of the actual pathophysiology of tinnitus, meaning how it's affecting the brain, our limbic system becomes involved, so our fight or fight response. So, it's possible that we can see not only these psychological symptoms, but also some physical symptoms like sleep disturbance and tension headaches or migraines, in addition to those like anxiety and issues that can cause from it, because our brain just can't classify it and doesn't know what to do with it.

Scott Webb: Right.

Deanna Nickerson: So, there's no real long-term effects of tinnitus. But there's longer term effects of the underlying symptoms like sleep disturbance or anxiety. So, somebody who may be dealing with tinnitus and subsequent depression, they may lead to more of a reclusive lifestyle. They may be more withdrawn, causing a big drop in their quality of life which then just increases other issues with that.

Scott Webb: Really interesting, just taking all this in. So, it's kind of an ear thing, kind of a brain thing. So, it presents obviously, I'm sure, some challenges for you and the team there, just as you say, because it's really the underlying causes. It's really what's causing the tinnitus or tinnitus that's behind it. So, is that kind of what you all do, is that you're sort of treating, you know, the ringing or the buzzing or the hissing, but you're really trying to get at the root cause?

How are you able to find treatments for tinnitus?

Deanna Nickerson: We are, we're trying to figure out where the issue is lying. Say for example, hearing loss, the issue with the tinnitus is because you have a hearing loss. Now, let's treat the hearing loss by hearing aids. When we treat that, we treat the symptom or we treat that underlying cause, then in turn we may help that symptom, that tinnitus, because now we're stimulating the brain. When we're providing access to the sound, the brain doesn't need to focus on an imaginary noise that it's created itself. And that's where it makes it difficult as audiologists to properly treat, and I use that word with air quotes, because we're not treating it per se. We're managing it because everybody's cause is different. You know, mine could be from noise exposure, yours could be from hearing loss. We have somebody else that comes in that's now from medication use. So because there's not one exact cause to why tinnitus is there, we can't find a cure, but we can find management options.

Scott Webb: Yeah. And I apologize if this is like the most layperson question you've ever gotten, but just sort of wondering, you started talking about the ears and the hairs, do you ever find that folks just really need to clean their ears? Is it possible that some of the sensation, some of the symptoms they're experiencing is just from poor ear hygiene?

Is it possible you just have bad ear hygiene, and it is not tinnitus?

Deanna Nickerson: That is a perfectly good question and a very common question because yes. More times, I wouldn't want to say more times than not, a lot of tinnitus concerns can be exaggerated because we have wax in the ears or we have ear infections that aren't treated. Anytime that eardrum isn't healthy that we can't get sound to the brain because of wax or an ear infection, or even something in the ear, then we can't get sound stimulated up to the brain, which then can cause that tinnitus as well. So yes, that's a very, very valid question.

Scott Webb: Okay, good. Because I was like, "This just feels like the most like basic level question ever." But I just wondered, I was like, "Well, maybe if we just clean our ears better." And of course, things in the ear that don't belong in the ear, maybe that's more a thing with children. You would hope adults weren't just sort of sticking things in their ears, but I'm sure it happens as well.

Deanna Nickerson: You never know.

Scott Webb: You're right. You never know. This has been really educational and actually kind of fun in a way. As we wrap up here, you've mentioned that it's not so much about curing tinnitus or tinnitus. It's really more about managing. So, take us through what a patient can expect if they've been diagnosed and you're working on the root causes. What can they expect in terms of management?

What can you expect in terms of management for tinnitus?

Deanna Nickerson: So, how we manage it is we try to manage the level of the noise and its associated negative effects. So, hearing aids, like we mentioned, are probably the biggest treatment option that are available because 90% of those patients who have tinnitus have hearing loss. So by providing sound simulation and treating that underlying hearing loss, we can manage the tinnitus that way because not only are we stimulating the ear, we're providing access to that sound. But now, hearing aids also come with maskers that are embedded inside that can allow for the audiologist to add different types of noise to help retrain the brain.

So, what I do, if I have a patient that's coming in with tinnitus, we look at the level of their noise coming from their brain and the level of noise that's coming from the masker that I'm putting into the hearing aid. We link that noise up together, you listen to that static noise through the hearing aid with your own noise that's coming from your brain. Through time, I turn down the level of that noise. By turning down the level of the noise from the masker, the thought is that the brain will turn down its own level as well. So, we retrain the brain to kind of associate itself with two different types of noise. So when we take away one, the brain then takes away its own noise.

So in addition to that type of masking therapy, we also use some counseling strategies, like cognitive behavioral therapy, which provides techniques and strategies to help those patients change the way we think about it and how we feel about the tinnitus and those negative effects. So being able to get to a point where say, "Okay, it's there. I'm not going to let it bother me. I'm going to go on with my day and just have this noise in the background, remembering that it's there, it's not harmful, there's no horrible cause to it, and we're going to manage it together. Me and my provider are going to find a way to get this tinnitus where it's not bothering me anymore." So, we really do sit there and a tinnitus specialist who has that background and that cognitive behavioral therapy and the specific detail with hearing aid management can work side by side with those patients to get the best benefit from those devices.

Scott Webb: I mean, I just have to say, this is just undeniably cool, you know. I mean, I just assumed as I'm sure many people did, that, "Well, what are you going to do?" You get old, you get this ringing in your ears, it affects your quality of life, but there's probably not much that can be done. But as we're learning what an audiologist does and all the different treatment modalities, it's just, as I said, undeniably cool. So, thank you so much for your time today. You stay well.

Deanna Nickerson: Thanks. You too. I appreciate it.

Schedule an appointment with Summa Health's audiologist

Scott Webb: And for more information or to schedule an appointment with an audiologist, go to summahealth.org/ent. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.