Understanding Tinnitus and How to Find Relief feat. Dr. James Henry

Discover the subtle distinctions between primary and secondary tinnitus with the help of Dr. James Henry, a leading audiologist and seasoned researcher who joins us to unravel the enigma of ringing ears. By dissecting the American Academy of Otolaryngology's guidelines, we shine a light on the rarity of secondary tinnitus and underscore the necessity of thorough evaluations for those experiencing this lesser-known type. As we navigate the often-misunderstood symptoms and implications of unilateral tinnitus, Dr. Henry also imparts wisdom from his latest book, providing a beacon of understanding for both patients and professionals striving to find relief in the cacophony of tinnitus.

Step into the world of cutting-edge therapies that promise to reshape your relationship with tinnitus. As we compare and contrast Tinnitus Retraining Therapy (TRT) and Progressive Tinnitus Management (PTM), you'll be introduced to the revolutionary neurophysiological model behind TRT and its quest for habituation. In parallel, we scrutinize PTM's multifaceted approach, blending cognitive-behavioral therapy with sound strategies, all while placing a spotlight on patient education. Grasp the transformative power of these treatments as they interweave sound therapy with psychological support to offer real relief.

Confront the reality of living with tinnitus head-on and join us as we discuss the vital importance of setting realistic expectations for treatment. While acknowledging the frustration that often accompanies this condition, Dr. Henry and Dr. Beck draw comparisons with other chronic health challenges to foster a sense of hope and perseverance. We share strategies and advice, including ear protection tips vital for anyone exposed to the risks of tinnitus, concluding with a heartening message—that with effective management, life can still be lived to its fullest, even with the whispers of tinnitus in the background.

Transcript

Blaise M. Delfino, M.S. - HIS: 0:19

You're tuned in to the Hearing Matters Podcast with Blaise Delfino and Dr. Douglas Beck, the show that discusses hearing technology, best practices, and a global epidemic: Hearing Loss. Before we kick this episode off, a special thank you to our partners Sycle - built for the entire hearing care practice. Redux - faster, drier, smarter, verified. Otoset - the modern ear cleaning device. Fader Plugs - the world's first custom adjustable earplug. This episode is going to be hosted by none other than Dr Douglas Beck himself. Get ready for expert insights and invaluable discussions coming your way.

Dr. Douglas L. Beck: 0:54

Hi, this is Dr Douglas Beck and you're listening to the Hearing Matters podcast. Today's guest is Dr James Henry. He's an audiologist with his doctorate in behavioral neuroscience. He has six years working on his doctorate in behavioral neuroscience. His six years working on his doctorate under the tutelage of Dr Mary Michael and Dr Jack Vernon ignited his passionate interest in tinnitus research. During his 35-year career at the Veterans Administration National Center for Rehabilitative Auditory Research, that's, ncrar, in Portland, he was principal or co-principal investigator for 43 research grants with a total funding of $28 million. He has authored or co-authored some 250 publications, 140 of which were peer-reviewed, and seven tinnitus-related books. He has given lectures and presentations nationally and internationally. His accomplishments resulted in numerous awards, including the Juerger Career Award for Research in Audiology from the AAA, and he is retired from NCRAR since October of 22. He currently spends his time writing books about tinnitus, hearing loss and sound tolerance disorders, and he's also a consultant and lecturer under the auspices of earsgonewrongorg, and again, his website would be wwwearsgonewrongorg.

Dr. Douglas L. Beck: 2:11

Jim, welcome. Than k you, doug, I appreciate it. Yeah, happy to have you here. So, jim, I think of you as the go-to guy in tinnitus, and you and I've done some work in years past on different interviews we've published in print and it occurs to me that the new book that you just wrote I'm going to see if I can hold it up and see if people can see the cover there this brand new book just came out and it is available for purchase and it's Understanding Tinnitus and how to Find Relief. So the new book let's start there written for consumers or professionals.

Dr. James Henry: 2:46

I targeted it to consumers because I feel like consumers need this information and it's hard to come by in a consumer-friendly format. But I also realized after I wrote it that it would actually make a good textbook for audiologists learning about tinnitus, because I pretty much cover the waterfront. There's a lot of information in there and it's the information that I've gained over my career learning about tinnitus and I just felt like I wanted to share that with mostly consumers, but also with other audiologists.

Dr. Douglas L. Beck: 3:21

Right, and when I go through the book I noticed right off the bat that some of your own terminology, which I like because it simplifies things and it makes things a little bit easier. So let me ask you about that. I just published a paper a couple of months ago on tinnitus with Dr Darrow, and he and I talk about subjective versus objective tinnitus, objective tinnitus but you don't use those terms in this book. You use, I think, primary and secondary. Can you tell me about that? What's the primary and what's secondary tinnitus?

Dr. James Henry: 3:51

Yeah, that's part of the problem is we have different terminology in the field and I go with primary and secondary tinnitus because that's what the American Academy of Otolaryngology, head and Neck Surgery Foundation, the AAOHNSF, recommended in their clinical practice guidelines for tinnitus. So primary tinnitus is tinnitus that is generated and perceived in the brain and there are no sound waves involved in primary tinnitus and that's what you would refer to as subjective tinnitus. Sure, secondary tinnitus actually has sound waves generated somewhere in the head or neck region that are perceived by the auditory system through bone conduction and that would also be considered objective tinnitus.

Dr. Douglas L. Beck: 4:40

Some people don't even want to call objective tinnitus tinnitus because it's a completely different animal which is an interesting observation, right, because we think of tinnitus generally as primary or subjective in my vocabulary, and those would be sounds that are perceived without an objective or a physical stimulus being created. There's lots of physical origins, but still, when you talk about secondary tinnitus, my understanding is that's only about three or four, maybe 5% of all tinnitus patients and 95% or so would be primary. Is that correct?

Dr. James Henry: 5:20

Yeah. Yeah, we could even call secondary tinnitus rare relative to primary tinnitus. Primary tinnitus is what we're dealing with with most people Very few people have secondary tinnitus, but the thing about secondary tinnitus is that it could indicate an underlying disorder that needs treatment or surgery, and any patient suspected of having secondary tinnitus should be evaluated by an otolaryngologist.

Dr. Douglas L. Beck: 5:48

Yeah, I agree with that 100%. What do you tell patients when they say that they have tinnitus in just one ear? Does that send up any red flags for you?

Dr. James Henry: 5:59

Yeah, so tinnitus it kind of depends on other circumstances. If it was sudden onset hearing loss in one ear with associated tinnitus, I'd be very concerned about a possible tumor. If they describe it as unilateral, they hear it in one ear. It may be bilateral but asymmetric, so they may hear it more predominantly in one ear, but it's also in the other ear and they're not even aware of that. So if you mask the one ear with the tinnitus, then they hear the tinnitus in the opposite ear. So there's always a question of what do they mean by they hear it in one ear? Yeah, very interesting point.

Dr. Douglas L. Beck: 6:42

And then we have people who will tell you that they hear their tinnitus within their head. They can't necessarily localize it to a left or right or both ears right, and what does that tell you? What sort of information do you get from that?

Dr. James Henry: 6:57

You know it's interesting, like I hear my tinnitus in each ear separately. I can hear it in my right ear, I can hear it in my left ear and it's basically the same sound, but there's some kind of interaction between the two sounds. Sure, some people describe it in their head, in the middle of their head, on one side of their head, and there are implications for mechanisms of tinnitus, whether you hear it in your ears or whether you hear it in your head. Some people even say they hear it outside of their head and they can point to the location, which is really interesting. So there's just mechanistic implications, depending on where they hear it, that haven't really been sorted out and most people with tinnitus would tell you that it's ringing in the ears.

Dr. Douglas L. Beck: 7:39

That's kind of the generic description sound that people will pull on is ringing, but I think that that's not really accurate. What's your impression of the most common tinnitus sounds?

Dr. James Henry: 7:54

Yeah. So some people say, well, it doesn't sound like ringing, so I must not have ringing in my ears, so I must not have tinnitus, right. But you know. So a lot of people just refer to it as ringing in their ears, sort of generically. I've got sound in my ears. I think it's mostly a high frequency hiss, a tonal sound, narrow band noise. I'd say it's in the higher frequency range for most people. But it can't be in the lower frequency range for other people.

Dr. Douglas L. Beck: 8:24

Yeah, I think that's consistent with what I've read in your materials, of course, but others as well that typically tinnitus would be a narrow band of noise or what might be described as the sound of an electric wire. When people think of electricity pursing through a wire and and generally, I I think if, when, when we pitch match it and loudness match it, it turns out to be often, uh, around 5,000, 6,000 Hertz Is that? Is that correct?

Dr. James Henry: 8:55

Yeah, I think the majority of people with tinnitus have, uh have, the center frequency of the sound above 3,000 hertz. Probably between 3 and 6 or 7,000 hertz would be most typical.

Dr. Douglas L. Beck: 9:08

So when I think about the universe of tinnitus patients and let's just talk about the USA we have 335 million people in the USA and when I read the old statistics from the American Tinnitus Association and others, it seems there's about 50 million people in the USA who would perceive tinnitus. If you ask them do you have tinnitus? Maybe 50 million would say yes, but it's not disabling for the vast majority. There's perhaps I want to say 10 to 12 million people for whom tinnitus would be their chief complaint. Is that accurate, dr Justin Marchegiani?

Dr. James Henry: 9:44

Uh. So most epidemiology studies would indicate that about 10 to 15% of all adults experience chronic tinnitus and that's pretty much worldwide. It's somewhere in that range. Now it could very well be higher. In fact our studies at the VA indicate that it's quite a bit higher than that for the veteran and the military populations. So you've got about 10 to 15 percent of people, adults and maybe even children. We don't know for sure about children, but for pretty, pretty sure for adults. It's between 10 to 15 percent of all adults experience chronic tinnitus and of those, about 80 percent are not particularly bothered by it. They habituate to it naturally, and about 20% are significantly bothered by it. That's a general breakdown that's been observed pretty consistently. So I would say there's three primary areas and they can be broken down into sub-areas. But number one is sleep.

Dr. James Henry: 10:46

Sleep is the problem for the majority of people who have tinnitus. They just have trouble falling asleep. They have trouble falling back to sleep in the middle of the night and their tinnitus is roaring in the. They really need treatment for their sleep problems. And then there's concentration inability to concentrate, and that's typical. If you're sitting reading and it's quiet, it's hard to concentrate on your reading if you have this sound in your ears and then there's emotional reaction. So anxiety, depression, those would be my big three. When people think tinnitus disrupts their hearing, they're blaming their tinnitus for their hearing loss. And they don't even know they have hearing loss, but they know they have tinnitus. They're having difficulties hearing, but they know they have tinnitus. They're blaming those difficulties on their tinnitus. That doesn't rule out the possibility that tinnitus does actually disrupt hearing sensitivity.

Dr. Douglas L. Beck: 11:56

Yeah, it's a good point Tell me about from your perspective and your history. You know 35, 40 years studying tinnitus. I remember publishing something about that eight or 10 years ago where I came up with something called the 80-80 rule and I said something along these lines about 80% of the people with substantial hearing loss will have tinnitus and about 80% of the people with substantial tinnitus will have hearing loss. So that's a high correlation, but certainly not a one-to-one relationship between tinnitus and hearing loss. That's where I'm coming from, but I'd love to get your perspective on that.

Dr. James Henry: 12:30

Yeah, I think you're right. About 80, even 90 percent of people who have tinnitus have measurable hearing loss and if they don't, they may have subclinical hearing loss or they may have hidden hearing loss. But you know, I think if a person does have chronic tinnitus, it's very likely that they also have hearing loss and that means they need to have their hearing evaluated by an audiologist and find out what's going on with their hearing. And then for people who have tinnitus I don't know if it's 80 percent of them are people who have hearing loss. I don't know if it's 80 percent of them that have tinnitus loss. I don't know if it's 80% of them that have tinnitus. I've heard more like 50 to 60% of people who have hearing loss also have tinnitus.

Dr. Douglas L. Beck: 13:15

Yeah, it's a bit elusive and it just depends on who you read, but the fact is that these are correlations Whatever causes one can cause the other. But there was a study I want to say seven, eight, 10 years ago, looking at stress, and in this study it was 21,000 people or so and about 11,000 of them said that their tinnitus is worse when they're under stress. Can you talk about the correlation between stress and tinnitus?

Dr. James Henry: 14:29

Well, for one thing, a lot of people who report the onset of tinnitus say that it came on just during a period of extreme stress and, other than that, they have no idea why they got tinnitus. So there does seem to be an association between severe stress and the onset of tinnitus. Some people just report that the tinnitus came on out of the blue. It's just idiopathic. They have no idea what caused it. Stress and the loudness of tinnitus seem to be correlated. We can't objectively measure the loudness of tinnitus, but people have often reported that when they're more stressed their tinnitus seems louder to them, and that's a pretty consistent correlation. So it's very possible the tinnitus actually is getting louder when people are more stressed and it's getting softer when they're more relaxed.

Dr. Douglas L. Beck: 15:22

Many of our colleagues in hearing healthcare talk about TRT tinnitus retraining therapy and some talk about PTM progressive tinnitus management to which you were one of the principal investigators and authors. Can you tell me what each of those two types of therapies are and what separates the two? What's the difference between them?

Dr. James Henry: 15:43

So I did just write a book on TRT for consumers, so that's available now and I'm writing one on PTM and I'm almost through with that. It should be available this summer and it's kind of a series of books. That's going to be my three tinnitus books In a nutshell, which is kind of hard to do. Trt both TRT and PTM. Trt is tinnitus retraining therapy, ptm is progressive tinnitus management. Both of them utilize sound therapy and counseling. With tinnitus retraining therapy, patients are grouped according to their symptoms. If they have tinnitus, if they have hearing loss, if they have normal hearing, if they have hyperacusis, which is a loudness tolerance disorder, they get grouped into different categories and then they're treated according to what category they're in.

Dr. James Henry: 16:40

The treatment is based on the neurophysiological model and people who know about TRT are very familiar with that model and it's basically describing what's going on inside of the brain when a person has tinnitus, and there's the auditory system in the brain and there's the emotional components of the brain, the limbic system and the autonomic nervous systems. And so Dr Jastrowoff, pavel Jastrowoff, developed this whole concept and he drew out this neurophysiological model that shows the auditory system, the limbic system, the autonomic nervous system and when a person has tinnitus that is not bothersome, only the auditory system is activated. And when they have bothersome tinnitus then the limbic system and the autonomic nervous systems become activated and that results in a higher level of stress and it results in a vicious circle of reacting to tinnitus and being aware of tinnitus. So the whole idea with TRT is to teach patients what's going on in their brain, to get them to the point where they understand it and they're not fearful of it.

Dr. James Henry: 17:54

And once they can bring the person's fear level down, they also use sound therapy to promote habituation, to get patients to stop thinking about their tinnitus, and the idea of sound therapy with TRT is to have a low level of sound that's always going on in the background. That would be considered passive listening, and passive listening would promote habituation. And then there's two aspects of habituation One is habituating to the emotional reactions to tinnitus and the other is habituating to the awareness of tinnitus. And so, basically, a person treated with TRT. The goal is to get them to the point where they're not reacting emotionally to their tinnitus. And so, basically, a person treated with TRT. The goal is to get them to the point where they're not reacting emotionally to their tinnitus and they're not thinking about their tinnitus most of the time.

Dr. Douglas L. Beck: 18:41

And there's a point here called the mixing point right, and that's what you're targeting, which is not easy to find. For every patient it's a little bit different.

Dr. James Henry: 18:52

Yeah, the mixing point is very misunderstood in the literature. I see it written up wrong most of the time. The mixing point is just taking the level of noise from the sound generator up to where it mixes or blends with the tinnitus, where the two kind of become one. And that's the mixing point. It is difficult to find and a person has to work at it and practice it to find that point. And according to Dr Jastrowoff, you turn the sound down below the mixing point so that they can hear the tinnitus clearly, because they have to hear the tinnitus clearly to habituate to the normal tinnitus. So it is a critical point. Now, whether that's really true or not, we can't really test that, but that's the concept anyway.

Dr. Douglas L. Beck: 19:44

Well, and Powell's been very successful with that, so I think that it has a lot of merit. Now, how would you contrast that to PTM, progressive tinnitus management?

Dr. James Henry: 19:53

So PTM is a stepped care program. So we start with those five levels of PTM. The first level is a referral level and that's basically getting the patient in the right place, the right discipline based on symptoms, and usually the default is to audiology. And so level two is the audiologic evaluation, and it's pretty straightforward. We do a medical history, we do the tinnitus and hearing survey, which is just a short, one-page instrument, and we do a basic hearing evaluation. That's level two. Now, you can do more than that, you can do much more than that, but that's basically what most patients need is those three things done. The tinnitus and hearing survey is what distinguishes between a hearing problem and a tinnitus problem, and that's often the confusion that patients have. They're blaming their tinnitus for their hearing problems, and this sorts that out and it says how much of a problem do you really have with tinnitus? How much of a problem do you have with hearing loss?

Dr. Douglas L. Beck: 20:57

And that's available online, correct?

Dr. James Henry: 20:59

Yeah, it's available for free online. And then, based on that evaluation, we determined does the patient need intervention or treatment for their tinnitus? And if so, they go to level three and we call level three skills education and we're teaching them skills based on sound therapy and based on cognitive behavioral therapy. So a series of skills are taught over four or five sessions. They can either be group sessions or individual sessions and that seems to take care of most people. They need to be informed about tinnitus, so we need a general information session or they need to read a book like my book, or they need. They just need to know what tinnitus is, why it causes a problem, why some people are affected and others aren't and what can be done about it. They need that information to make an informed decision whether they want treatment or not. And then the treatment is the skills education, the series of sessions, sound therapy by an audiologist and coping skills from a behavioral health provider.

Dr. Douglas L. Beck: 22:04

Now, when you mentioned CBT cognitive behavioral therapy you know I've been looking for years at CBT and I think it's very, very effective. But what I like to mention and I want your thoughts on this, people will say well, cbt is the single most effective treatment for tinnitus. Why shouldn't everybody go there? And I love that question because I say this most of these people have hearing loss, and if you just go to a cognitive behavioral therapist, the hearing loss will remain undiagnosed and untreated, and so what I'd rather do is do it exactly the opposite way, is have everybody see a hearing care professional first, and then the people that you and I are not able to help. I would refer to somebody who's doing CBT, whether that's a social worker, psychologist, whomever and then I think we're maximizing our clinical abilities and taking the best care of the patients. Now, does that make sense or am I missing something?

Dr. James Henry: 22:58

Yeah, you're basically describing a stepped care method. You're saying they start with audiology. You got to get that hearing evaluation. Before you do anything. You need to know how well they're hearing. Do they need hearing aids? Hearing aids have all kinds of tinnitus features available. That's the starting point and that takes care of the majority of people. And then, if that doesn't take care of them, they need information, they need to learn all about tinnitus and then they need to make a decision. Do they need specific treatment? Now that treatment could be TRT counseling and it could be PTM counseling, it could be Rich Tyler's counseling, tinnitus activities treatment.

Dr. James Henry: 23:41

Cognitive behavioral therapy has more literature support than any other method. So all of these clinical practice guidelines and I mean all of them recommend CBT as treatment for tinnitus. They don't recommend sound therapy and they don't recommend anything else. But that does not mean that those methods don't work as well as CBT. In my view, they need a combination of sound therapy that's individualized to the patient and certain components of cognitive behavioral therapy Basically learn relaxation techniques, distraction techniques and cognitive restructuring, which is thinking differently about their tinnitus, framing it more positively. And now we're moving into third wave, cbt, which is mindfulness techniques, which is not distraction techniques. It's a different approach and an act which is acceptance and commitment therapy. So CBT, uh, and a lot of psychologists and behavioral health providers are moving in that direction now, but it's, it is a very effective method.

Dr. Douglas L. Beck: 24:41

Sure, sure, and we talked a couple of times already about um using sound therapies, and, and, and, and, and, and, and, and, and, and, and, and, and, and, and, and, and, and, and, and, and. As an audiologist, one of the things that I like to do with my patients is that I would generally do loudness and pitch masking. I'd want to get some idea as to what it is the patient is perceiving. I would try with hearing aid therapy and see if just making the world a little bit louder helps to distract them from the tinnitus, perhaps add some environmental sound masking and helps them habituate to the sounds around them rather than the sounds of their tinnitus. Is that a reasonable starting point or what would you recommend? I think that's a reasonable starting point, or what would you recommend.

Dr. James Henry: 25:34

I think that's an excellent starting point Evaluate their hearing, even if they have mild hearing loss, and even if they have no hearing loss. Hearing aids can be helpful, especially now with streaming features and sound generators built in, there's all kinds of options for sound therapy with hearing aids, and that is, I think that's normally a good starting point for patients.

Dr. Douglas L. Beck: 25:58

So there was a very famous neuroscientist who wrote about masking therapies and he was talking about how it would not be a good idea to use a white noise masker, because he said there's a very strong potential for your brain to habituate to that and that white noise then would become your normal background sound. And I wonder, does that have much validity in your mind? Are you a fan or are you opposed to white noise maskers?

Dr. James Henry: 26:29

Yeah, I'm not sure if that's the same article I'm thinking of, but there was a report that broadband noise masking could be harmful to the auditory system, Right?

Dr. Douglas L. Beck: 26:40

exactly.

Dr. James Henry: 26:40

That might be the same one, and we actually wrote an argument in response to that, a letter to the editor, and said we disagree with the conclusions of that report. I think there's no evidence. I mean, go back to the Jack Vernon days, when that's all they did was fit maskers. There's no evidence that masking noise caused any damage to the auditory system and I'm not aware of that in any studies. So it's almost like this study came out of the blue and made this argument that masking noise can be harmful to the auditory system, and I just don't. I don't see any evidence for that.

Dr. Douglas L. Beck: 27:17

I'm glad you mentioned that because I think that that article, the original article, was more of a theoretical argument and less a data based argument. And, and it's interesting because you know, your doctorate is in neuroscience, mine is not, mine is an audiology, and I'd be more concerned about the long-term neurologic impact if there was any. But again, I have never heard or read of that and it's interesting that you haven't seen any evidence of that either.

Dr. James Henry: 27:48

No, it's theoretical, and I mean there's a lot of theories related to tinnitus that haven't been borne out by evidence. But I think any theory is worth considering and considering seriously and if there is a potential for damaging the auditory system, we need to take that seriously and maybe somebody needs to study it.

Dr. Douglas L. Beck: 28:10

Okay, fair enough. Tell me your thoughts on patients who describe earworms or musical hallucinations. What are the differences? What are the red flags there?

Dr. James Henry: 28:31

and that song is still going in our head. We're just replaying a song that we are, or we might think about a song, and then we start playing it in our head. It's controllable, it's a familiar song. It can be turned off when you think about something differently. So that's just what everyone. Everyone has earworms. Musical hallucinations some people call it musical tinnitus think about something differently, so that's just what everyone. Everyone has earworms.

Dr. James Henry: 28:54

Okay, musical hallucinations some people call it musical tinnitus are a completely different thing. They are actual songs, not necessarily songs they're familiar with, that are uncontrollable, that are constantly playing in a person's mind. They can hear it, they know what it sounds like. It's generally all instrumental, no lyrics, no voices, and some people would think well, that's you know. Those are people who need psychological treatment. Not necessarily. It's very common in people who are hearing impaired, older, socially isolated. It's more common than we realize and it's always worth asking a patient if they hear music in their head and trying to define what that is. A lot of patients don't want to talk about it because of the potential stigma of having a mental health issue. But it's not necessarily. It's just, it's a phenomenon that occurs more often than we realize and it's really generally nothing to be worried about, except that it is a sound that's stuck in a person's head and what about?

Dr. Douglas L. Beck: 30:09

so? This is kind of where it crosses the line for me is when a patient reports that they're hearing voices or they're communicating with voices. To me that's always meant potential psychotic patient and an emergent referral to their physician. Is that right?

Dr. James Henry: 30:28

Yeah, that's a great question. So with music, it's pretty obvious that this is just a normal phenomenon for a lot of people and it doesn't indicate a mental health issue. If they're hearing voices, that would be more of a concern to me. I would want to ask some more questions about it. And now, if they seem just basically psychologically normal and they're occasionally hearing voices and that's what they describe, then that could be a form of tinnitus. I think we know so little about that that it's hard to make any opinion about what exactly does that mean? But it does mean in some cases that they have a mental health problem and they need psychiatry or psychology to deal with it.

Dr. Douglas L. Beck: 31:13

At what point would you refer somebody who's hearing voices? I mean, if somebody says to you that they hear their mom's voice and she's been deceased for 20 years, or they hear a child that they went to school with 40, 50, 60, 70 years ago, is that concerning at all? Or are we really just looking for people who hear voices telling them to do things? Is there any sort of qualification there?

Dr. James Henry: 31:44

You've kind of stumped me on that one. I would be more concerned about other potential symptoms that could indicate they need a psychological assessment. But hearing voices is a red flag that there's something going on that needs to be evaluated. But it's not necessarily the sign of a mental health problem, but it is a red flag and I would be inclined to refer them for a psychiatric or psychological workup.

Dr. Douglas L. Beck: 32:15

Okay, thank you, jim. In the new book you have the tinnitus and hearing survey on page 92. And there's three sections Section A is tinnitus, b is hearing and C is sound tolerance. Do you recommend this on every patient in lieu of the other surveys?

Dr. James Henry: 32:34

this on every patient in lieu of the other surveys, or is this an addendum? No, I and most of my group would recommend just the tinnitus and hearing survey, along with the medical history which you'll ask a lot of questions about the tinnitus, to characterize it and what caused it, and you know just general questions about tinnitus. And the tinnitus and hearing survey gets at how much of a problem is their tinnitus, from their perception, not confused with a hearing problem and how much of a problem do they think they have with hearing, and then also screening for a sound tolerance problem. It covers all of those areas and it does it very effectively, those areas and it does it very effectively.

Dr. Douglas L. Beck: 33:18

Now a person, an audiologist or a clinician, can administer a more traditional tinnitus questionnaire but it really isn't necessary for the initial evaluation when would you use, or would you use, the tinnitus handicap inventory, the THI, and I ask you that because I think that that's probably the most popular tinnitus questionnaire of all time.

Dr. James Henry: 33:36

It probably is. The tinnitus functional index is catching up, but tinnitus handicap inventory, the THI, is probably more used than any other tinnitus questionnaire around the world. I would use a questionnaire like that before they receive treatment. Basically it's a baseline so that you can assess outcomes at the end of treatment. So you want to compare the score at baseline to the score at outcomes and see how much of an improvement you got hopefully a good improvement.

Dr. Douglas L. Beck: 34:08

That's a great point, and you've published a couple of times over now that just that quantified number, just having that objected number, actually isn't enough. They also have to emotionally feel like they're doing better, right.

Dr. James Henry: 34:23

For an outcome assessment. Yes, yeah, we just published an article on that where you can't just rely on a reduction of so many points. You can't just rely on a reduction of so many points. They have to confirm that they feel better or that their symptoms have improved since the beginning of treatment. So we need those two things. We need the questionnaire score how much of a change did they get? And we also need we call it the global perception of change. How much do they feel they changed? Did they get better? Did they get worse? Are they unchanged since the beginning of treatment?

Dr. Douglas L. Beck: 34:56

All right, I think that's a really good point to keep in mind is it's not just the objective number, but that number has to be correlated with a self-improvement assessment by the patient as well. Jim, let me ask you one last question before I let you run. What should people know about tinnitus? Because there's so many myths and there's so many misunderstandings. What are the two or three things that are so important to understand that many people with tinnitus don't understand?

Dr. James Henry: 35:25

Great question. So one thing is is protect your ears. Everyone should be protecting their ears with earplugs, earmuffs, whatever it takes to keep their ears as healthy as possible for as long as possible. And most young people are oblivious to the fact that loud noise causes hearing loss and can also cause tinnitus and can cause hyperacusis. I mean it can cause all kinds of problems. I was a musician back in my younger days. I see a guitar in your background.

Dr. Douglas L. Beck: 35:56

Yeah, still a musician.

Dr. James Henry: 35:57

That is the cause of my tinnitus. I played loud music and I had tinnitus and I've had it ever since. I also. It also caused some hearing loss. I do pretty well, but I use sound therapy continually, so I'm trying to keep my ears as healthy as possible by always stimulating it with low levels of sound.

Dr. James Henry: 36:18

But that's one thing is just. People need to protect their ears and they need to know, if nothing else, carry earplugs in your pocket or in your purse and be ready for loud noise and be educated about what noise can do to the ears. And so that's number one. Number two is that if a person does have tinnitus, it's not the end of the world.

Dr. James Henry: 36:42

Some people feel like it is, but the natural history of tinnitus is that people habituate to it over time. At least that's our 80% of people who naturally habituate to it, 20% are going to end up with a problem that they probably need treatment for. But people who either habituate to it naturally or they learn to habituate it through treatment. And so the norm is that people aren't going to be as bothered by it over time as they are at the beginning, and people have trouble realizing that and they do get erroneous counseling that nothing. You're going to have to live with this the rest of your life. Nothing can be done about it. I mean, we all know that that's what physicians often tell their patients. It's negative counseling and it can really distress them.

Dr. Douglas L. Beck: 37:35

And it's wrong, it's just out there wrong.

Dr. James Henry: 37:37

They can't even imagine living with it. But so, I mean, those would be two things that are important. One is protect your ears and the other is tinnitus is not the end of the world, and there are lots of things that can be done to help a person live a normal life in spite of having tinnitus.

Dr. Douglas L. Beck: 37:53

And I want to address one last issue then. So some people talk about a cure for tinnitus and there's OTC cures and I'd like to get your thoughts on that.

Dr. James Henry: 38:04

Well, there's labs around the world trying to discover a cure, and that's going to be a goldmine. Whoever really does discover, most likely a medication that can reduce or eliminate the sound of the tinnitus without significant side effects. Now, if they can come up with that, they've really got something, and there are a lot of studies going on to try to discover that. It's amazing research that's going on and how much they've learned about what is going on in the brain when a person has tinnitus. They just don't know technically what causes it and how to target the cause so that they can eliminate or at least reduce the sound without affecting anything else in the brain.

Dr. Douglas L. Beck: 38:49

But that doesn't exist here on March 1st 2024, does it? Nope, Nope, Nope. We don't have that and this is an important distinction as well.

Dr. Douglas L. Beck: 38:59

Many people who are overwhelmed by their tinnitus. They are totally distracted, they are at their wits end because of their tinnitus. They think, and respectfully, they would like a cure. Respectfully, they would like a cure. The important thing I think that they may not be aware of is that probably 90% of primary or subjective tinnitus can be effectively managed. And that may not sound like enough, but here's some perspective on that.

Dr. Douglas L. Beck: 39:29

We can't cure diabetes, but we can manage it Most of the time. We can't cure cancer, but we can manage it most of the time. We can't cure cancer, but we can manage a lot of it. We can't cure a lot of things, but we can manage them. And I think you have to put tinnitus into that perspective that even though it is driving you to distraction, even though it is annoying as all get out, we can manage it effectively 90% of the time and that's as good as medical care gets for many, many things. So with that, Dr Henry, I want to just endorse this book for patients and other professionals. I think it's a really good, quick read. I think it'll help patients a lot. Dr Henry, you are, as always, a joy to know and thank you so much for being with us here on Hearing Matters Podcast.

Dr. James Henry: 40:12

I appreciate the opportunity to speak with you and to talk to your viewers and listeners.