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Tinnitus Management with Dr. Alexandra Tarvin | Elevate Audiology

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Tinnitus affects millions, yet remains shrouded in misunderstanding, misinformation, and damaging myths. In this illuminating conversation, audiologist Dr. Alexandra Tarvin of Elevate Audiology brings clarity, hope, and cutting-edge solutions to one of hearing healthcare's most challenging conditions.

"There is hope and there is help," Dr. Tarvin reassures listeners as she guides us through the reality of tinnitus management today. Drawing from her extensive experience as a tinnitus specialist, she expertly distinguishes between subjective tinnitus (the perception of sound that doesn't exist externally) and transient ear noise (those brief, harmless episodes of ringing many people occasionally experience). This distinction alone provides immediate relief for many who fear their temporary experiences signal something serious.

The heart of effective tinnitus care, Dr. Tarvin explains, lies in truly listening to patients and implementing personalized strategies. Far from the dismissive "just live with it" approach many patients have encountered, modern management embraces a holistic perspective that considers each person's unique needs. From various sound therapy options to innovative treatments like Lenire (the first FDA-approved tinnitus treatment), patients now have more evidence-based options than ever before.

Perhaps most exciting is Twillo, a tinnitus management app Dr. Tarvin developed with her husband, a mental health counselor. This digital companion combines audiological expertise with mental health techniques, providing support between appointments and making tinnitus care more accessible. "If I could clone myself, if I could clone my husband... we would not need this app," Dr. Tarvin jokes, highlighting how technology can extend specialized care to more people.

Throughout our conversation, Dr. Tarvin methodically dismantles harmful myths – no, tinnitus doesn't cause dementia; no, caffeine isn't universally problematic for tinnitus sufferers – while sharing touching success stories of patients who've found relief through proper care. Whether you're suffering from tinnitus yourself, care for someone who is, or are a healthcare provider seeking to better serve your patients, this episode delivers invaluable insights and renewed hope. 

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

Thank you to our partners. Sycle: built for the entire hearing care practice. Redux: the best dryer hands down. CaptionC all by Sorenson: Life is calling. CareCredit:. Here today to help more people hear tomorrow. Fader Plugs: the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host, Blaise Delfino, and, as a friendly reminder, this podcast is separate from my work at Starkey. You're tuned in to the Hearing Matters Podcast. I'm your host, Blaise Delfino, and today's guest is audiologist Dr. Alexandra Tarvin, owner of Elevate Audiology in South Carolina. She is a true trailblazer in tinnitus care. From personal curiosity to building a tinnitus management app with her husband, who also happens to be a mental health counselor, Dr. Tarvin is leading a more holistic and informed approach to one of the most misunderstood symptoms in hearing healthcare tinnitus. Dr. Tarvin, welcome to the Hearing Matters podcast.

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

Thanks for having me. We've been looking forward to this episode for quite some time now, especially really leaning into tinnitus and tinnitus management. So before we really deep dive, let's talk about tinnitus what it is, define it, modern management. For those new to this space maybe you're a student, maybe you just came across this YouTube video and you're a consumer Dr. Tarvin, explain to us what tinnitus is and what some of the common causes or contributing factors are.

Dr. Alexandra Tarvin:

Yeah, absolutely so. The most common type of tinnitus is called subjective tinnitus, and that's usually when we talk about strategies and management. We're talking about subjective tinnitus, which is a person perceives a sound, whether it be in their ears or in their head, that's not existing in the outside world. It's very real, they really hear it. It's not a hallucination, it's a real perception of sound, but it doesn't exist. It's not an acoustic sound in the environment. And then there's also a different type of tinnitus objective tinnitus. That's pretty rare, so we're not going to be highlighting that today.

Dr. Alexandra Tarvin:

And then you also have a common misconception of transient ear noise. Transient ear noise is that sensation that is a very common in the general population. It's non-pathological and it's when all of a sudden you're sitting there and it feels like your hearing cuts off and then you hear or gets dull, and then you hear this like shrill ring that levels up and then it's going for 15, 30 seconds and then it just kind of fades away and you're hearing restorers and that is no cause of concern. But a lot of people will come into the office thinking that is tinnitus and that's scary to them. And I get to tell them that no big deal.

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

Doesn't that mean that someone's just talking about you, right, yeah?

Dr. Alexandra Tarvin:

It's like, yeah, exactly, it's one of those old lives too.

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

Because I have absolutely experienced that and obviously, being a hearing care professional, I'm like, oh, I know what that is. But if you've never experienced that, I could absolutely see how a patient can come and say, oh my gosh, why did I only hear it on one side. We talk about tinnitus management today and notice how we say management, not treatment. So, dr Carvin, what does tinnitus management look like today practically speaking, and can you just kind of walk us through a typical plan? And is that plan the same for every patient?

Dr. Alexandra Tarvin:

Yeah, I don't think there's a typical plan. I think it varies so significantly, but are there common things that tinnitus specialists do to help patients? Yes, so we would typically want to really understand how this is impacting somebody, what their symptoms are when they started. We need to look at all the medical stuff and rule out if they happen to be in the very rare small percentage of people that have something more significant going on so that's part of our test battery. In the very rare small percentage of people that have something more significant going on so that's part of our test battery.

Dr. Alexandra Tarvin:

In the audiology space, the ENT space, is to dig deeper into the medical sides of things and rule stuff out that the majority of people do not have to be concerned about. And then we have questionnaires and validated intake information and so we can help categorize how this is impacting somebody and then the management gets built from there. And it really depends on what are all these symptoms that the patient is experiencing. And in my perspective, I really like to take a very strong patient-centered approach, and so I like to educate my patient, counsel them on what is what isn't, inform them and empower them with information about what is going on with their body, and then we work as a team to figure out what is the right strategy to help them manage and do they even need a strategy and that's something that we spend a lot of time figuring out together.

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

I love how you said the patient-centered or person-centered approach, because really that's part of best practices today. And you see all these ads which we'll talk about later about if you take this magic pill, your tinnitus will go away. It's like not so much, let's have you visit a hearing healthcare professional first. So I'm just so happy that you really shed light on that person-centered approach, because every patient is different, everyone's ear is different, everyone's hearing loss is different. You could have two patients have the same hearing loss One has tinnitus, one doesn't and one could experience their hearing loss as being incredibly disabling and the other saying I get by. So thank you and Elevate Audiology for taking that person-centered approach. So sound therapies we have pink noise and white noise. Can you just explain the difference and why hearing care professionals implement sound therapies?

Dr. Alexandra Tarvin:

Yes, absolutely so. Sound therapy is the umbrella term for using sound to therapize yourself.

Dr. Alexandra Tarvin:

It is not unique to tinnitus care. It is not unique to audiology care. We use sound machines for babies, right, and that's something that most parents do when they have a newborn is they get a sound machine while they're pregnant and then they turn it on after the baby's born. So we know sound is very therapeutic. Lullabies that is a form of sound therapy. Right, you're relaxing your child and you're making them feel safe so they can fall asleep successfully. So we know that in a situation where sound, a perceived sound, can be a problem for somebody, that if we utilize the auditory system by using other sounds, maybe we can make it less problematic via distracting them. Right, even turning on ACDC, because you're jamming out and you're cleaning the house and you have your tinnitus, that's sound therapy. Putting a noise machine on while you're going to bed is a form of sound therapy.

Dr. Alexandra Tarvin:

Utilizing hearing aids without any additional sound enrichment beyond the actual prescriptive amplification is sound therapy. And then you have hearing aids where you turn on masking types of noises. Where you turn on masking types of noises, noise is the term for multiple sounds at once, right? So white noise is the entire sound spectrum that we hear as humans, from 20 hertz to 20,000 hertz at equal intensity, and then the colored noises still have all the same spectrum of sound but they're weighted differently. So, like, a pink noise has more low frequency energy than high frequency, a brown noise has even more low frequency energy than high frequency, and so somebody might like one more than another, right Just based on preferences, and that's okay. And so we think of white noise as more of a staticky sound. We think of brown noise as more of a staticky sound.

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

We think of brown noise as more of a fan noise which a lot of people tend to find relaxing, which, I have to say, being a first-time father and my son being four months old now Congrats, thank you. Brown noise love it, love the brown noise. It is honestly very soothing and therapeutic. Dr Tarvin, now let me ask you about tinnitus masking because, being a hearing care professional myself, being a former private practice owner, the technology today has brilliant tinnitus masking. But let me ask you, let's say you just had a patient walk in and they say I have tinnitus and I believe I have hearing loss, and they do in fact present with hearing loss and also tinnitus, what are you managing first and what does that look like? Because I feel like we can help a lot of patients here with this question.

Dr. Alexandra Tarvin:

I really like to ask tell me your story. What brought you here? What prompted us to meet? What's been going on? I learned so much from that question because the patient will uncover and reveal to me what their main problem is. That's very, very different. We do ask the question. You know what seems to be your main issue on the questionnaires, right Hearing, tinnitus, sound sensitivity, right. So we are asking those questions on the intake. But when I ask the patient to really give me information on their story, that can uncover some really helpful information. Here's why there is so much misunderstanding out there on a lot of health conditions, hearing and tinnitus being included. A lot of people have a misconception that if the ringing or the buzzing would just get out of the way, they would be able to hear X, y or Z.

Dr. Alexandra Tarvin:

That is the number one misunderstanding with tinnitus. The tinnitus is there because of the hearing loss. For many people not everybody, but for many people the hearing loss was there first. That is the chicken or the egg, depending on how you think about it. So the tinnitus is just also there. It's there as a symptom of that auditory deficit.

Dr. Alexandra Tarvin:

And so a lot of people will say I have a major, major hearing problem, but it's all because of my tinnitus. And so then, if somebody did not ask any additional follow-up questions, you would say, okay, well, we need to address the tinnitus first, right. But when you actually listen to the story in this situation, you would actually uncover the fact that the patient has been blaming the benign sensation of tinnitus for all of these communication issues. The communication issues is actually their presenting problem, and so now we know that we need to handle their hearing loss right. But the flip of that happens all the time too, and so it's really about having the knowledge and having the experience to ask these questions and uncover and follow the journey that the patient will take you on to figure out. Okay, but what is the actual issue? Not what they think the issue is, but what is the actual issue.

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

And early in my career. You have your patients and you just want to help.

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

And to learn you have two ears and one mouth. For a reason, listen twice as much as we speak. And to learn that motivational interviewing is in the best interest of your patient number one, but also you, and just listen to what they're saying and asking the correct follow-up questions. And because this patient could say well, I worked at the steel mill for 35, 40 years back in the day and you're like well, you definitely did not wear any hearing protection, so that's probably the cause of your hearing loss and now tinnitus. And thank you for bringing us through that, because some clinicians of course have their own philosophy with that.

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

But as it relates going back to best practices, if you are implementing those best practices, as every hearing care professional should, the patient should, with that proper care and management, walk out of the clinic with a smile on their face because they know that they've come to the right place. And I believe that's a great segue here, dr Tarvin, to really talk about your why. But I want our listeners to know your journey. What initially drew you to begin specializing in tinnitus management? Because not every hearing care professional specializes in this.

Dr. Alexandra Tarvin:

Absolutely yeah.

Dr. Alexandra Tarvin:

So I don't handle things well when I don't understand them well, and so I was a newer audiologist.

Dr. Alexandra Tarvin:

I had graduated and was working in private practice and started coming across a lot of patients that were experiencing tinnitus, and some of which didn't care, and some of them really did care, and for those that were really more disturbed or bothered by it, I found that I was lacking the skills, the knowledge and the tools to be able to walk through that journey with them, and so I no longer felt like I was doing them the greatest service, and that really did not sit well with me.

Dr. Alexandra Tarvin:

Then I thought it was a bit confusing, and then I thought, gosh, this is the brain, and I started taking some online courses and classes and reading articles that were being put out within our professional space and reading journals and figuring out like there's so much more to learn, but I want to do it in a more structured way, and so I ended up going up to Boston and doing a more advanced course with the tinnitus practitioners association at the time and meeting a lot of other professionals that were also committed to either having worked with tinnitus care for a very long time or were newer to it like me, and it just started assuaging all that curiosity because I came into audiology through neuroscience and so I was very interested in how the brain worked and centers of the brain and the emotional response system, and I was already really kind of more heightened to caring about that, and so this seemed to really check my boxes on further incorporating cognitive health, mental health and neuroscience into the profession of audiology, which has a lot of full circle moments.

Dr. Alexandra Tarvin:

I won't get into all the stories there, but it really felt like, okay, this is another check here that makes this feel like I'm well suited for this because I care about what it is about.

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

Well, and in audiology like many other fields. So I have a master's in speech language pathology and I am licensed in Pennsylvania and South Carolina as a hearing instrument specialist, now as an SLP. If I were practicing as a certified speech language pathologist and I was currently in the, let's say, school setting and I wanted to transfer into the medical setting and focus on swallowing disorders and voice disorders, I wouldn't just jump into that. You would go to courses, ceus, get re-educated on what is new best practice in the field.

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

So this is a great opportunity for us, dr Tarvin, to encourage our fellow hearing care professionals that if you want to offer tinnitus management as a service to your patients, do it the right way. Because if you just say, well, I'm going to start managing tinnitus, it's not in the best interest of your patient and it's also probably going to stress you out as a hearing care professional because taking the right step and doing it right is absolutely in the best interest of that patient. Because we know patients who do present with tinnitus. When you're a hearing care professional and you're doing the tinnitus handicap inventory with the patient and you find out it's severe, it's catastrophic, let's say you want to have the correct talking points right Now. Let me ask you because this just sparked here when you're implementing the tinnitus handicap inventory, which allows you, as a hearing care professional, to understand the severity of how the patient perceives their tinnitus, do you have the patient fill that out or are you doing it with them? Do?

Dr. Alexandra Tarvin:

you have the patient fill that out or are you doing it with them? Yes, sometimes both, or either Most of the time, for just time's sake, we're having our patients do intake paperwork prior to them coming to their appointment, or sometimes they're doing it right before their appointment has started if they didn't get to it online. So just for those who don't know, the THI, the Tinnitus Handicap Inventory, the TFI, the Tinnitus Functional Index, the TFI, the tinnitus functional index these are validated questionnaires. They've been studied and researched to show that they're repetitive like you could repeat it and have valid results.

Dr. Alexandra Tarvin:

I prefer the TFI for a couple of reasons, but either way, right, it's really about getting to the core. I prefer the patients to answer those questions without somebody staring at them, because some of those questions can actually get pretty emotional and can tap into things that can make them reflect and shed some light on stuff. And I actually think it's more appropriate to allow somebody to do that in the comfort of their own home than to have somebody staring that or even asking them that question where they feel pressured to answer it a certain type of way. So I prefer them to do it privately.

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

If I had to pick, yeah, and thank you for bringing that up, because even for our younger clinicians right now, I hope they hear this and they consider, you know, let's have our patients fill this out at home. And it really goes back to just general understanding of tinnitus, why a general understanding of tinnitus just isn't enough today and why proper training is so important. Can you talk to this, dr Tarvin?

Dr. Alexandra Tarvin:

Yeah. So I think just general knowledge and experience has told us, for where we have been thus far, that the general understanding of tinnitus is not enough. It has led to a lot of people that experience tinnitus, feeling hopeless, helpless and invalidated, and whether that is physicians learning a sentence in a book in medical school and carrying that with them for their entire professional career, and really it's not their responsibility to know about every specialty, right, they should refer to specialists and if it's on them, right.

Dr. Alexandra Tarvin:

But we see this within the healthcare space audiologists and hearing instrument specialists. We see this in other peripheral healthcare fields like chiropractics, for example, right, marketing or highlighting that they can cure or heal different things, tinnitus being one of them. Right, just because somebody attends a course on something doesn't make them an expert. That's the start of becoming more knowledgeable and skilled and experienced right to get to that point. And then you have also kind of the pretty critical part of state licensure, right. So across the country there are 50 states and each of these states can act independently on scope of practices. So in some states, hearing instrument specialists, even if they take course work or even if they take courses to get certified in something from, just you know, an organizational body, does not mean that they could provide tinnitus care within their state and other ones it is defined that they can right, audiologists can across the country. And so if you think, if you take that outside of just the hearing healthcare space and then you have other practitioners talking and speaking on things they may or may not be more skilled or knowledgeable about, it just further perpetuates maybe the misconstrued information that's out there about tinnitus. And so, as a specialist, as somebody who has devoted a lot of time and hours learning, making mistakes, growing, learning, learning, learning. It is so important that we know what is within our scope professionally but also what's in our scope and within our abilities personally. And working with patients with tinnitus gives you a wide spectrum of patients with mental health differences. And if we're not available for that emotionally ourselves and if we're not available to be able to learn or grow or network or partner, refer, know, you know where our limit is and we just say like, yeah, we do tinnitus because we heard about it, we know that hearing aids could help, and so we're going to say that we do tinnitus because we can put a hearing aid on somebody and 70, 80% of the time that might be enough, then we could be really harming some individuals hopefully not the majority, but some.

Dr. Alexandra Tarvin:

I will piggyback on that for a very personal story. So, or actually like between my husband and I, because he is a mental health counselor, I take in a course out of the UK on cognitive behavioral therapy for tinnitus, hyperacusis and misophonia Very interesting for me. I, you know, I spent the time and the money to do the coursework and learn and hop on programs we were on these trainings with people from all over the world. It was absolutely fascinating, it was incredible, and there was a subset of us that were in this course from America and we would meet individually and we would talk about how would we implement these tools and strategies, and then I would learn cognitive behavioral techniques, which everybody in America would agree that lives inside of the scope of mental health professionals, whether it's therapists, counselors, psychologists, psychiatrists right, that is their scope.

Dr. Alexandra Tarvin:

But we can utilize those principles and understandings and use psychiatrist right, that is their scope. But we can utilize those principles and understandings and use techniques right, that would be within our scope to a point. So I'm sharing all these ideas that I have with my husband that I'm learning from this course and my husband's respectfully listening. And then he goes yeah, and then when the patient says this, then what do you do when you ask them that question that you learned to ask them? And then this is their response. What's your response? And I said, well, I don't know, I didn't learn that. That's beyond what I know. He goes exactly, and that's why you should not be asking the question. And so it was a really valuable lesson in. We can learn and we can grow as professionals and we can integrate that knowledge, but if something is not in our scope, professionally or personally, you should not be marketing it as such and then certainly not doing it right.

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

Right, yeah, just because a keyword on Google is really you know, quote effective right now. Don't do that to the patient. And also don't do that to yourself, because, dr Tarvin, you're an advocate. You're very active in South Carolina licensure board. Listen carefully, ambassador. Thank you so much for all you do for our industry and our field.

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

The bad actors out there, because there are also organizations, even companies, who will sponsor Google ads and they'll use Tinnitus as the gateway. It's like a bait and switch and we hope to use this platform to educate consumers. We've always said since 2019, we are here to help patients make an educated decision about their hearing health care. Dr Tarvin, this is something I'm really excited for you to talk to our listeners about. A couple of weeks ago, we connected to really talk about this podcast episode and, unbeknownst to me, I had no idea that you and your husband were launching a tinnitus app. So when we talk about emerging technology, not only in the hearing healthcare field, but also mental health space, tell us more about this inspiration, about the app and how it works.

Dr. Alexandra Tarvin:

If I can clone myself, if I could clone my husband, if I can clone a lot of my professionals that I like very well respect, we would not need this app. You know, we can't go home with our patients, we can't reinforce some of the things that we might talk about in an appointment, and then you have the wide spectrum of professionals out there in the hearing healthcare space and outside of it that touch and talk with people that experience tinnitus right, that nobody would expect them to be an expert or to know everything about it. So there's a need for something that's affordable and accessible, that can almost be like a companion for tinnitus specialists, for audiologists and hearing instrument specialists that are not tinnitus specialists, for primary care providers, for ENT offices. There's a big opportunity for somebody to have a companion in their pocket right. And there are apps out there and there's plenty of reason to have more than one and more than one type and more than one kind with different focuses, and so there are a few tinnitus apps that are out there. Some of them are really just sound therapy apps, which are absolutely. Some of them are phenomenal and I recommend them regularly to patients because they do it well. And then there are some that are not so great, you know, and then there's some really robust ones. There's an app called Odo and that is a CBT heavy app. You pay for it and it does its job right.

Dr. Alexandra Tarvin:

But what I have found in my practice is that not everybody is willing to go all in. A lot of patients are. If they are on the spectrum of needing professional mental health care, that doesn't mean they're willing to do it, and so we're in a bit of a pickle when that's the case, and there are not very many mental health professionals that are versed in tinnitus to be able to speak on that knowledgeably and help them in the best way. So there was like a gap. And then there was an app that entered the market that a lot of my colleagues and I really really liked, and then it left the market very quickly and when that happened I looked at my husband and I was like I'm pretty bummed. I was kind of really using that. I really liked being able to integrate educational information on tinnitus and mental health techniques. And he looks at me and goes well, isn't that our marriage Like?

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

we're an audiologist and a mental health professional and we're married.

Dr. Alexandra Tarvin:

That is our foundation, that is a professional foundation, and so timing worked out because he had already started taking classes and courses on coding and technology.

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

Get out it was crazy.

Dr. Alexandra Tarvin:

It was meant to be, and then I thought well, how cool could it be for us to build something with both of our insights and knowledge and put it together and make something, but then have it kind of be like for us by us? So we're launching it. It's now available for professionals to utilize. They can offer it to their patients. They get a code, all that jazz. It's called Twillo T-W-I-L-L-O, but what's really cool about it is that it's something that if a provider is not specializing in tinnitus, they can still offer their patients something. I might not be the one to tell you about everything, but here is something that can, and if professionals or users of the app have an idea wish we would have delved into something more we can build it. It's not owned by a big corporation. That it's like kind of it is what it is. We can use that feedback, and so it's really exciting because we expect it to be adapting over time as we get feedback and usage.

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

Congratulations, first of all and second, on behalf of all the patients who present with tinnitus. Thank you for what you and your husband are doing. When it comes to the clinical practice, how do you envision Twillo being used by clinicians?

Dr. Alexandra Tarvin:

Yeah, I mean, in my practice I'm definitely, when I identify that a patient, like if I could go home with that patient and hold their hand, that they would benefit from that. I'm like, hey, here's a version of me that you can. You know, yeah, here's a tool, Like here's a we call it like a companion, and the really nice thing is it's your journey so you can go through it as you see fit. You're not forced to read anything or go through anything you don't want to. So if there's a section that just doesn't speak to you, you don't have to complete it. Right, Favorite stuff If you like exercises, you can favorite it so you can go back to them easier.

Dr. Alexandra Tarvin:

I see providers, colleagues and other providers using it as a tool, like I said, either in place of them having somebody to refer to locally to give them insight for their patient, or as that companion to reinforce what a provider says in the office, and then for some more robust treatment plans. Whether somebody is doing a sound therapy based program or tinnitus retraining therapy or the linear treatment device, this can be a tool that can be used in accompaniment with other treatments that are out there. That is, a lower cost and simple and not asking too much of people that are just not able to or willing to go or need to go, as elaborate maybe as some of their options out there.

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

That makes sense. You know this, so completely different industry. But the app Noom N-O-O-M right, so like I've used it, cause I'm like you know what, let me drop a couple LBs here. And I mean, dr Tarvin, it's really built on the psychology of weight loss. But what it's taught me? There's some things that I do, like tracking my water and my steps and tracking my food, but I can see Twillo being like the Noom in hearing healthcare. Where I've used Noom it's incredible. It's helped me.

Dr. Alexandra Tarvin:

I use it too and I've read through all of it and it's so funny because I'm reading through it, going like this is a CBT principle. This is a CBT principle. And it's so cool because none of us are reinventing the wheel.

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

We're just utilizing it differently.

Dr. Alexandra Tarvin:

Exactly. This stuff has been out there, it is tried and true, it's evidence-based, so you just have to work it, you know for you. But the biggest thing with tinnitus management, like in a nutshell, is it's in a world where we like instant gratification and we make really impulsive choices. This is not that, and that's really hard for some people to wrap their head around, right? Is that?

Dr. Alexandra Tarvin:

In order for if this is something that's significantly impacting my quality of life and really, really bothering me, I'm going to have to devote time and energy and oftentimes money to some extent, right, to get myself out of the pickle that I'm in. But there's so much hope there and it can happen and there are really inexpensive ways of doing that. Then there are some more significant treatment plans out there too, right, like there's a wide spectrum. As with anything, right, our bodies are complicated and what we have to do is complicated sometimes to make big change. But with big change comes big reward, and if it's something that somebody is struggling with significantly, then I just really want to enforce that. I say in my practice all the time there is hope and there is help.

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

I love that. Love it and so you had mentioned linear. Yeah, there's a buzz around linear providers. I believe Elevate Audiology is a linear provider, but can you explain what that is and how it fits into tinnitus care?

Dr. Alexandra Tarvin:

Yeah, so linear is a treatment for tinnitus, so linear is what we call. Like the system. It was built by a company called Neuromod and it came out of Ireland. 2015, 2016, they started doing trials. Ironically, I was on my belated honeymoon in Ireland, was looking at a newspaper, snapped a picture of a call for people to complete a tinnitus trial. That was actually the linear device.

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

This is all full circle, Dr Tarvin.

Dr. Alexandra Tarvin:

I was live in Ireland and the founder came to my office. Dr Ross O'Neill came to my office and I showed it to him and he was like yeah, that was Lanier. So I claimed to be the first American that knew Lanier existed, anyway. So, yes, so it got FDA approved. So it's been around for, let's say, seven years now on working on people in Europe. It's been FDA approved in America since March of 2023.

Dr. Alexandra Tarvin:

So we're over two years of it being on patients in America. It's taken off. More and more providers have been educated, credentialed and approved to provide it, but it's still specialty. The Neuromod team is still trying to be very intentional and making sure that they're working with clinicians that are already aware and knowledgeable about tinnitus. So linear is a tool, linear is not the tool.

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

Sure, If that makes sense which I truly do appreciate.

Dr. Alexandra Tarvin:

I think that's extremely valuable because it's not a standalone device, but it is the first FDA approved treatment for tinnitus specifically, and so it got de novo approval from the FDA, which is very, very hard to acquire. It went through a bunch of clinical trials and now it has published real world evidence data as well. And what it does is it takes two modes of input, so bimodal, that's, tactile stimulation on the tongue coupled with auditory stimulation via headphones, and there were a bunch of smart people that did a bunch of stuff and created protocols and tested them and refined them and tested them again and refined them and found that in the clinical trials it was over 70% and some of the real world data it's showing over 90% effective at reducing tinnitus severity.

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

Wow.

Dr. Alexandra Tarvin:

You look at severity as being measured by a questionnaire and somebody takes it before they start treatment and then they take it throughout treatment. We see clinically significance declines in how their tinnitus is impacting them across different modalities and that's what's defined as clinically significant. That doesn't mean that people don't ever hear their tinnitus again. That doesn't mean that it magically is cured or goes away. But if you were experiencing pain and you would say that your pain was an eight out of 10, and you could do something that the pain would go down to a four out of 10, you'd probably be pretty grateful.

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

Oh, yeah, absolutely.

Dr. Alexandra Tarvin:

If you had floaters in your eyes and your thermologist said we can't ever get rid of them completely, but we can get rid of 70% of them, you'd be like that's worth it. And that's kind of how we have to think about Lanier. There are some people who have crazy, amazing results Like they truly are, like I don't hear my tinnitus anymore, and they would tell you it was a cure for them. And then you have people on the other end of the spectrum that don't get a benefit at all because it's a medical device and nothing is a hundred percent right. We take medications all the time that are not a hundred percent effective, but it's a really strong, effective, valuable tool.

Dr. Alexandra Tarvin:

It's a pretty easy ask to how to use it and it can be very effective at reducing the severity of people's tinnitus. And yes, I use it in my clinic. It is not for everybody. Nothing is but for the people that it's right for holy cow. It's pretty awesome. Like I'm really glad to have it as a tool, because there are people who are like I don't have a hearing problem. Or you could tell me until you're blue in the face that I have a hearing problem but I'm not doing anything about it, tinnitus is my problem, and now we can say, okay, I can meet you where you are.

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

Right, which is absolutely brilliant, and so you have Twillo, the companion app and then as a linear provider for consumers tuned in right now. Dr Tarvin, if they do present with tinnitus and they go to a linear provider cause, you need to be certified as a linear provider. Is this something that's done in the office, that they go home to do? What does that process look like?

Dr. Alexandra Tarvin:

So you are fit in the office with the device, so it does need to be calibrated program, do you need a proper education on how to utilize it and then, with your provider, you will have follow-up care over the months. But you actually do the treatment at home or not in the office, and it's a very enjoyable experience for most people. What you're hearing is kind of a wide variety of noises and sounds and I kind of tell people it sounds kind of like spa sounds at times, and then what you're feeling on your tongue is very a gentle stimulation. It is using electrical pulses but you are not being shocked. I'm like if you've ever had a self-surgery, I'm like it's less aggressive than that at times, and so it's an enjoyable experience.

Dr. Alexandra Tarvin:

And again, one of the things that I look for when I'm seeing is somebody a candidate for linear as a treatment is are they willing to use it? Does their lifestyle allow them to make time to use it? What is their mindset or their attitude towards it? So it's not just what's their hearing loss and how bad is their tinnitus, there's a lot that goes into it and that's stuff that a lot of my colleagues that are also linear providers have learned on the hearing aid side, on the tinnitus side, on even equipment that we use in our offices, right, it takes time to vet that stuff and then you kind of figure out I do that on that person, I don't do that on that person.

Dr. Alexandra Tarvin:

You know, you learn, you're professional, and that's one of the benefits of being a doctor, and profession in audiology is that you make decisions for your patients. That's what a doctor does, and so you know whether it is sound therapy without hearing aids, sound therapy with hearing aids, just mental health techniques, linear, a combination of all of these things. That's something that we're helping our patients decide upon. And again, I like it with that team approach. When patients say, just tell me what to do, I don't love it Right, cause I'm like I can't want it more than you. It has to be a joint effort.

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

You could buy the gym membership, but if you're not going to go you're not going to see results. You could buy whatever app you're trying to do, whether it's lose weight or, you know, manage your tinnitus but if you're not utilizing that tool you're not going to see results Exactly. And attitude matters, yeah, not only in life but in hearing healthcare as well, because it takes a patient. There's studies that say seven years to visit a hearing care professional, others will say 10 years. Either way, if you're waiting seven to 10 years to address your hearing loss, when that patient comes through the door they more or less.

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

You have to understand the psychology of the hearing impaired and that to me, dr Tarvin, when I was practicing full time, was you're not really dealing with hearing loss and ears as much as you are the person in front of you and the brain between their ears, because it's all psychology and the foundation that you and your husband have built that on with Twillo is incredible. I want to deep dive a little bit into misinformation and myths, because you could go onto the 13th page of Google which, like probably no one ever goes on. Like what are some of these common myths around tinnitus? I know you've heard them. You know caffeine, riboflavonoids, even the idea that tinnitus causes dementia, yeah, what's the?

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

truth here.

Dr. Alexandra Tarvin:

Yeah, the good news is that a lot of the myths out there are myths. A lot of the stuff out there is not actually true, because a lot of it's pretty hopeless and pretty yucky and ugly, and misery loves company. So if somebody did something or tried something and it didn't work for them or they're like, oh, that's snake oil, you know, you have to take it with a grain of salt because misery loves company. But I will say there are some things that are pretty often recommended or even prescribed that we know are not really effectively on placebo, but they're so widely, it's so common, that we just accept it as that must be true. One of those is the riboflavonoids, and I looked into this because I had learned pretty early on that they were very placebo. But placebo is sometimes good right, as long as something's not harming you and it potentially could impact you. It's not a high risk, it's not overly expensive. Maybe it's worth it to try. But the idea behind the riboflavonoids is that or the bioflavonoids, riboflavonoid being one of them, is that it can increase circulation in the inner ear, which would be a healthier inner ear. Blood flow is pretty critical because the inner ear has the second smallest microvascular structures in the body second to the lungs. So you need good blood flow, you need those nutrients to go into those cellular structures and helping fatty deposits and all these other things that could be really good for you. It's a supplement, right? Supplements are not prescriptive and supplements are often not regulated by the FDA. You can give it a try If it helps you. Cool If it doesn't no skin off your back right?

Dr. Alexandra Tarvin:

There's a lot of stuff about don't drink caffeine, caffeine being like coffee soda. There's even caffeine in chocolate. That has been shown to be a myth. So that came out of some unreplicable studies a while ago that talked about caffeine and tinnitus like caffeine being a trigger for tinnitus. But I will say it's globally a myth. For an individual it might be true. If somebody's metabolism is very sensitive to stimulants coffee being a stimulant you may find that you have an increase in your tinnitus perception or you're more aware of it if you've absorbed any caffeine, or maybe a higher amount than is best for you. You can say the same thing about alcohol, I mean, but that is we know that to be true. Alcohol, stress, some recreational drugs we know that can be a trigger for tinnitus perception. That's not a myth. It just to the degree at which it impacts somebody.

Dr. Alexandra Tarvin:

The greatest, most disturbing myth that patients are coming into my office repeating is that tinnitus causes dementia. Because that's really scary, like the idea of that is really really scary. And if I was perceiving something that I didn't feel like I had control over and I felt like, or I read that it was a warning sign for something that I surely don't want to happen to me, I would feel pretty crummy. And I think I found the root source of that, which is like one article, but the media went crazy with it. And then the media went crazy with it. People read stuff. They believe it to be factual, then other people post it and then it gets on social media and then it gets put you know, and if too much stuff happens, then you get the like with AI thinking that's real data, right, but if you Google, does tinnitus correlate with dementia or it does, it's just tinnitus a cause of dementia. Google will tell you now. So we're in a good place there. I'm glad for that. But yeah, that is not true.

Dr. Alexandra Tarvin:

Now what is true? Untreated hearing loss is a risk, a significant risk for dementia, especially if somebody was already at a higher likelihood of developing dementia for other reasons. So if somebody is at increased risk of dementia and they also have untreated hearing loss now, they're at a further increased risk of dementia. But tinnitus is a symptom. It is not a disease, so you can have feelings about it. You cannot like your. Tinnitus is a symptom. It is not a disease, so you can have feelings about it. You cannot like your tinnitus. It can disturb you, it can cause other things from a mental health perspective and an emotional health perspective, but it is a symptom, so it cannot cause something physiological to happen within your body.

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

Dr Tarvin, counseling intake holistic care. As hearing care professionals, we find that one of the most undervalued parts of tinnitus care is the counseling. So we're talking about management and you've actually duplicated yourself with Twillo, but why is it so critical to really hear the patient's story?

Dr. Alexandra Tarvin:

I think the biggest thing is that when we can share our story with somebody who that we entrust with information that we're seeking and they're receiving, you actually have like mirror neurons and you can actually share through facial expressions and facial language and you can actually bond with other people, and that is extremely powerful. It could have a feeling of safety. I have patients that will come in I would say 50% of tinnitus patients. They're coming in for tinnitus care, tinnitus appointment information. 50% of them do not leave with any type of costly treatment plan. They just need to be heard, validated, respected. They need to know that there is a plan or there does not need to be a plan right For them specifically, and it's the time, it's the counseling, it's the education, it's that bond or that sharing of information that was therapeutic for them.

Dr. Alexandra Tarvin:

And without that right, just that constant spiral of is this a sign of a brain tumor? And what does this mean? And if this would get out of the way, I'd be able to hear better. So it's the stupid tinnitus, and that's why I can't hear my grandchild, or that's why I can't hear my son in the back seat. You know it's like, unless you're given corrected information and told like you're good or you're not, then the brain can take over and we have automatic negative thoughts and that could feed down the spiral of a lot of despair.

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

And so that time, with a specialist to tell you what is, or what isn't is invaluable, it just the word there I feel like to me is like synchronicity, and to be able to find that in a provider the patient has to just feel like such a relief of oh my gosh, you listened to me the fact that half of your patients roughly are leaving your clinic without costly treatment, but the fact that they were able to just share with you how they're feeling and you give them the strategies and management techniques to manage their tinnitus, that's really powerful. Now, on the flip side, many patients have been told just live with it. Those messages are incredibly invalidating. How do you help patients reframe that experience? Because maybe you had a patient come to you who went to another provider who wasn't trained in tinnitus management, and then they come to you. How do you help them reframe that?

Dr. Alexandra Tarvin:

Well, I let them vent because some of them are very angry that they've been told that or that their care has been delayed because they were maybe just brushed away. I let them vent because some of them are very angry that they've been told that or that their care has been delayed, you know cause they were maybe just brushed away. I let them vent if they need to vent, and then I kind of speak back what they're saying to me and get a feel for well, is this impacting you as much as you think it is or not? Right, and then go through the whole trajectory of like how we're going to help take care of that person. But I definitely like to validate the feeling that was unhelpful, that that information is less than helpful and that we want to make a change and that we want the medical schools and the PA schools and the nursing schools and continuing education for people who've already graduated and other peripheral healthcare providers to start learning that you don't have to know it, but you have to refer to a specialist.

Dr. Alexandra Tarvin:

I'm an audiologist. Audiologists are the doctors of vestibular care, balanced care. I am not a vestibular audiologist, right? I will refer to my colleagues that specialize in that. That I trust in my community because they're going to serve that person a lot better than I am. But I know enough information to refer or ask enough questions to be able to get their ball rolling right For the next person that's going to take care of them. So it's okay to not know and it's okay to admit that you don't know right, but then you have a responsibility as that person's provider in that moment to figure out well, what does this person need? And if I can't give it to them, then I need to have a resource, have a toolkit of people that can help them.

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

There are 44 million Americans who present with hearing loss. And then there's 26 million Americans who present with normal hearing on an audiogram but struggle in noisy situations and what I'm getting at here. There's a lot of people with hearing loss and there's not that many hearing care professionals. And then you have the internet. Consumers are getting all this information, so we wanted to sit down together and talk about this and share real, true educational material about tinnitus. So thank you so much for your time about tinnitus. So thank you so much for your time. I'd love to hear one of your favorite success stories from a tinnitus patient that you've helped. Now I know there's hundreds, but is there one that like really sticks out to you? That's like wow, you went home that day and you shared this story with your husband.

Dr. Alexandra Tarvin:

So there are two, two really positive stories that stick out to me. One of them was a really cool exercise in the opposite of placebo. So I had a patient that was a physician and she had come to me with moderately bothersome tinnitus, was willing to do, you know, kind of be open-minded to different options, was already on the right track with, like, her physical health. Her emotional health was pretty intact, but she was still really impacted by her tinnitus perception and I had recommended Lanier as a treatment option for her because she really did not have any treatable hearing loss. That was also not relevant for her and so we had talked about Lanier. We did a telehealth appointment and we had talked about Lanier as a treatment, a telehealth appointment and we had talked about Lanier as a treatment option and then she opted to move forward with it and on her. Two weeks into her treatment I had a phone call with her and she told me that she had spoken with her cousin, who was a very respected either researcher or physician but in the neuroscience space and kind of had poo-pooed some of the data and just wasn't really vibing with this idea and I got really nervous for this patient because I was like, oh no, is this going to bias you, right? Somebody that you love and you care about is like saying what you're doing is nonsense and I would be biased by that. That would definitely put doubt in my mind, right? And she was like, oh, I don't really know.

Dr. Alexandra Tarvin:

She was actually one of the patients who moved through her linear treatment so quickly. She didn't need her treatment anymore after 10 weeks and we normally tell patients that their linear treatment is going to be between three and six months to expect that and she had gotten so much benefit by 10 weeks that she was going on a trip, an international trip, and she didn't even take her treatment with her because she was in such a good space and that was. I was so happy for her. But it was also really interesting experience for me. That you know cause. Some people will say certain things are placebo, and I will acknowledge that some things are placebo, right, not everything, but some things are. But when you have somebody actively trying to tell you against something and you still get a benefit from it, well, that's the opposite of placebo, which is pretty cool, right? So that was really cool for her and really cool for me.

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

And I will say it's like when you're researching, let's say, a television for like 20 hours and you're set on the Sony and your best friend says don't get the Sony, get the LG.

Dr. Alexandra Tarvin:

It's like, and your best friend says don't get the Sony, get the LG. It's like it's out the window.

Dr. Alexandra Tarvin:

Yeah, first world crumbling problems, you know Absolutely, but it's true. Like I was buying a car, I had researched Toyota and then I get to the place and I drive a Nissan and I love it. I'm crying in the car dealership because this is breaking up by everything I thought I wanted Totally Like, totally Okay. And then another tinnitus patient that's coming to mind that was a really awesome story was that we had been working together for many, many years and every time he would come in he was. These are two linear stories, just because they're profound stories, not just because of linear. Please understand, there's other people that get benefit without linear too, but yeah, and this is not a Lanier sponsored episode at all.

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

I don't even need to tell them.

Dr. Alexandra Tarvin:

I was talking about them, but it's just about the power of listening to your patient and being open-minded to the kind of pivoting right. So he had been coming to me with a mild hearing loss that over time was getting more progressive but really did not. That was not his main problem and we had fit him many, many years ago with hearing aids and he wore them very, very reliably and he did get a benefit from them. But every time he came in he was still like my tennis is really bothering me, my tennis is really bothering me. And we had talked about mental health strategies and tools and this was a person who was just like unwilling to do certain things Right, and so we both kind of at times felt like we were beating our heads against the wall, even though I was trying to pull out all my socks.

Dr. Alexandra Tarvin:

And then Lanier enters the market as an option and his wife was one of the first people I called and she was super excited about it. And then he was coming in and he got a lot of success from doing that treatment, that b coming in, and he got a lot of success from doing that treatment at bimodal neuromodulation and then he was no longer using it. He no longer needed to use it. And then he was coming in and he was still wearing his hearing aids and he would never bring up a sentence and I was so used to this being like the main topic of our conversation. And then he's coming in and I'm like how are you? And he's like great. And I'm like that's all you have to say.

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

He's like yeah, Is there any more?

Dr. Alexandra Tarvin:

Is there any more, anything else you haven't brought up yet? And I look at his wife and I'm like how's it going?

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

And she's like don't even bring it up. Don't bring up the word because then he's going to hear it.

Dr. Alexandra Tarvin:

Yeah, we're good, we're good. And so it was really two different perspectives Of somebody who was really, really bothered by their tinnitus, and we made progress, and somebody who was bothered by it but not as much, and we made progress. And then there's yes, you're right, there are plenty of other stories and I don't want it to sound magical, right, like when somebody is experiencing something chronically, not everybody gets what they want.

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

Right.

Dr. Alexandra Tarvin:

And that's also part of my responsibility.

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

Right Is to work that work walk that journey through it with those people too and setting those realistic expectations. So, dr Tarvin, in closing let's close with professional and consumer takeaways. So for audiologists or hearing instrument specialists, especially those hearing instrument specialists in states where they can specialize in tinnitus management, where they can specialize in tinnitus management, what is your biggest piece of advice?

Dr. Alexandra Tarvin:

I would say my biggest piece of advice is care. If you truly care about the person that's in front of you and if you truly care about learning more and growing within your profession or within a specialty, then do it with care and you will help people just by that, because that will drive so many decisions that you make. And then, from my consumer perspective, I think I want people to know that it's okay to arm yourself with knowledge and information, it's okay to read things online, but if you have gotten to a point where you're in a state of any degree of distress because of tinnitus or hearing loss or a combination of those two, it's time to seek professional care. And if your level of distress is one of which it's really starting to impact your quality of life, then you're going to want to seek a specialist for tinnitus, if that's the main cause of the problem.

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

And I just have to ask, if we have providers that tune in to the Hearing Matters podcast, if they're interested in offering Twillo as a tinnitus management tool for their patients, who can they contact and how can they learn more about that?

Dr. Alexandra Tarvin:

Yeah, thank you. So we are trying to make it as affordable as possible. So we actually have it as a web app, so it's not like you can go to the Apple store or the Google Play store to find it. It's actually we can keep it at a lower cost for providers and users at that users currently at that option. So if you go to the website twilloappcom, t-w-i-l-l-o appcom, you can see information about it and then you can actually contact us directly on there and our team my husband will be in contact to kind of get the ball rolling and get the professional side of the portal hooked up and go through all of the details.

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

But it's very easy to use, Awesome, Excellent, Well, and, in closing, congratulations on just everything and truly thank you so much for all that you do for our industry as it relates to advocacy, tinnitus management, hearing healthcare, true trailblazer. Thank you so much. And you know, Dr Tarvin, thank you for reminding us that tinnitus management it's not just about masking a sound, but it's about restoring control, validating patients and doing right by those who are struggling. So thank you for your dedication and passion.

Dr. Alexandra Tarvin:

Thank you and your patients and community really do appreciate it. Thank you so much for your time today.

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