The Hearing the Call team lines up in front of a map of their latest mission, a trip to Turks and Caicos to fit hearing aids. See the full story below.
The sound of silence, a light in the darkness
Editor’s note: Recently several people have mentioned, in and out of chapter meetings, their concerns about tinnitus. So it seems like a good time to review an HAH article on the topic. The following story appeared in the Spring 2021 issue.
By Paula DeJohn
The phantom sounds known as tinnitus are the bane of many people with hearing loss. They may compete with real sounds in the environment, or they may just blast through our dreams, or deny us the blessed silence of solitude.
To understand why this happens, it helps to think of a candle. A candle in a well-lit or sunny room is hardly noticeable. Turn off the lights, and the candle flame dominates the space, lighting even distant walls.
That is the analogy Drew Price, AuD, uses to explain tinnitus. An audiologist with the Sound Relief Center in Denver, she fits patients with hearing aids specially modified to add pleasant sounds that mask the annoying ones of tinnitus. Another analogy she uses is that of phantom limb pain following amputation. Thus, when sound is no longer reaching our ears, our brain manufactures a substitute to replace the missing stimulus. “The strength of your tinnitus depends on how intensely your brain focuses on it and how distracted it is by it,” she says. Sound Relief has six centers in Colorado and two in Arizona.
The word “tinnitus” is derived from the Latin word “tinnire”, which means “to ring”. The technical term is “hyperactivity of the auditory neurons”. Ringing isn’t the only sound that sufferers hear, however. Some perceive hissing, drumming, buzzing, or cricket-like chirping. It is often associated with hearing loss, but may indicate other health problems, and more than half of sufferers have normal hearing, according to a Sound Relief estimate.
According to the American Tinnitus Association (ATA), which supports research, 50 million Americans have some degree of tinnitus, and for l6 million it is severe enough to require treatment. For 2 million, the condition is so debilitating they cannot function in daily life.
Rewiring the brain
“You can have bothersome tinnitus even with a very mild hearing loss,” Dr Price says. Along with hearing loss, stress of all kinds can trigger tinnitus, so healing efforts like exercise and good nutrition can help. But the Sound Relief treatment goes farther, to add low-level tones to the external sounds that we hear. Over time, generally 12 to 24 months of daily use, the tones reduce the stress on the auditory neurons and can dampen or even eliminate the perception of tinnitus. “You’re actually rewiring the brain,” Dr Price says.
She explained the process at the December 2020 Zoom meeting of the Denver Chapter. “In the first two or three months, the tinnitus sounds even more intense, and in a quiet place it seems louder,” she notes. Unlike the more common white noise used in masking headphones, the customized hearing aids do not hide all tinnitus sounds.
Humor helps
Ken Keuhlen, president of the HLAA Denver Chapter, was born with hearing loss and tinnitus, but he did not have a name for it until he was in his mid 20s. “Growing up, I thought everyone had ringing in their ears,” he recalls. Ken says his particular version is more like tones that change pitch, similar to the sounds played in a hearing test booth. “Is it the sound being piped into the booth? Or is the sound I hear my tinnitus?” he wonders. Listening to music helps distract his attention from the tinnitus. A sense of humor is a big help too, he finds.
Like a tuning fork
Andrea Boyle also developed tinnitus without recognizing it, and, at first, without hearing loss. (Full disclosure: She is my daughter.) Here’s her recollection: “When I was little, I remember noting ‘the sound of silence’. It was a ringing, like when they test your hearing with a tuning fork. I thought it was cool—and annoying. In my late 30s, I started hearing it out of the blue. It would last about 10 to 20 seconds. But it was happening when I wasn’t in a silent environment. It would be the middle of the day with noises all around me. Even when people were talking to me. Still I thought it was kinda cool, but odd.”
Gradual hearing loss followed. “The doctor said there isn’t a cure, but hearing aids can help both with the hearing and to help redirect my brain’s attention from the ringing.”
The role of head motion
Bernie Steinberg, past president of the Denver Chapter, has a type of tinnitus that comes and goes as he moves his head and jaw. “When I was really young, I could make the ringing louder and softer by moving my lower jaw; drawing it backward would make the sound louder, and jutting my lower jaw forward would make it softer. I can't do that anymore,” he says. What remains are hissing, humming and cricket sounds in the right ear that depend on head motion. According to Dr Price, the crickets are a manifestation of somatic tinnitus. It results from jaw tension, which irritates the trigeminal nerve, which controls chewing and other facial movements.
“I try to not pay attention to the tinnitus and to think about something else,” Bernie says. “It's a nuisance, but I don't obsess about it or let it control my thoughts.”
Bernie was an early member of the Denver Tinnitus Support Group, as it is now called. Current president is Rich Marr, and the group met monthly at Lutheran Medical Center until the pandemic sent them to Zoom.
No one is immune
It is not unusual for tinnitus to start in childhood, and the Sound Relief treatment is just as effective in children, according to Dr Price. Between 5% and 46% of children with normal hearing may experience tinnitus, while 23% to 62% of youngsters with hearing loss are affected. “There's a lot of variability in those stats,” Dr Price explains, “because kids either think it's normal or don't know how to report it to their families or health care providers.”
Tinnitus is the number one disability reported by military veterans, and hearing loss is number two. Combat and jet engines are not the only causes, but they exemplify the way exposure to loud noise can damage hearing and produce tinnitus. Audiologists and advocates are calling for reductions in environmental noise. Meanwhile, they advise using protection, such as earplugs in loud places or while operating machinery.
Barbara Barsook, AuD, an audiologist with the Denver VA Medical Center, says the stress of living through the events of 2020 made many people’s tinnitus worse. One dietary change that may help, she says, is reducing salt intake. In a class she conducts for military veterans with hearing loss, she advises, “Reducing our salt intake helps, whether it is watching how much take-out food we eat, how much sodium we use when we cook, or how much pre-packaged food we eat.”
Dr Barsook says masking sounds are not the only remedy. While a quiet room can be disturbing, the answer is not to turn up the music or TV. A fan or soft music or recorded water sounds can also help. “What you want is a distraction,” she says. “It is also important to take time for yourself. Stress will always be there, but it is how you deal with it that is the key.”
Psychologist Jennifer Gans, PhD, and her colleagues at the University of California, San Francisco, have found benefits in applying mindful meditation skills to relieving tinnitus. Dr Gans developed the Mindfulness-Based Tinnitus Stress Reduction (MBTSR) program as extension of Mindfulness-Based Stress Reduction (MBSR).
MBSR practitioners focus on awareness of physical sensations, emotions and thoughts, without judgement. “Rather than struggling (often in vain) to ignore tinnitus, MBSR teaches patients to wholly accept, embrace, and control their experience,” she explains.
Some of us may be relieved to learn that it is okay to say “tin EYE tus” rather than the common English and professionally preferred “TIN i tus”. In fact, the ATA uses “tin EYE tus”, although it accepts either version. In my opinion and speech ability, it is easier to say the alternate version—so tin EYE tus tin EYE tus tin EYE tus! <>
On a recent trip with her family, chapter member Sally Hodges toured Oatlands, a historic mansion in northern Virginia.
Remembering Vietnam
Several members of the Denver Chapter are military veterans who served during the Vietnam War. In her own way, Barbara Nguyen is also a veteran of that war, who saw first hand how it ended on April 30, 1975. Here is her story:
Fifty years ago, I had been in Vietnam three years where I married Que. I met him when he studied at Lowry Air Force Base before. He was in the Vietnamese Air Force.
The communists had taken over the north and now they were coming to the south where we were in Saigon. The Americans who were working there, had all left. I went to the Embassy to get papers for Que and the two boys. We waited at the airport until late at night to get on a U. S. AF Transport plane. We were lucky to get seats along the side but some had to sit on the steel floor. The Vietnamese Air Force came in and kind of checked people out but did not talk to Que.
Our government flew us to Guam U. S. AFB. We had to sleep outside in hammocks as there were no accommodations. They did have good food. After a few days, they put us on a plane and flew us here. We have been back three times to visit his family and tour the beautiful country. Now the daughter and another son have come over too, to be with us. They are all doing great and have beautiful families.
—Barbara Nguyen
Helping in Paradise
Denver Chapter Professional Liaison Dusty Jessen, AuD, spent a week in early April in the Caribbean nation of Turks and Caicos, fitting hearing aids for local residents as part of a team from the national non-profit organization Hearing the Call. Here is her story:
This was my first trip to Turks and Caicos. This is an invite-only trip and I was lucky enough to be invited as part of the audiology team. This was my fourth Hearing Humanitarian Trip with Hearing the Call, having previously served in Guatemala, Brazil, and Jamaica. While serving on four different islands (Providencialis, Grand Turk, North Caicos, and South Caicos), we fit 26 adults and one child with hearing aids and provided essential hearing health services to 155 patients.
We've been serving the local Turks and Caicos residents for several years and are supported by the T & C government. We go once per year to screen and test hearing of the children and older adults on the islands. And we fit hearing aids on those who have hearing loss. We also follow up with those who have been fit with hearing aids during previous trips. Sometimes they need a new device, or sometimes we are able to give them a hearing aid for their other ear, as we only fit one ear each time we go due to limitations in our hearing aid supply.
The nation of Turks and Caicos is known for its incredible beaches and turquoise waters. It is an elite destination for beach-goers around the globe. What the world doesn't know is that the minimum wage for locals working on the islands is $8 per hour. They don't have access to basic healthcare services and hearing care is included in that list. It was an incredible blessing to be able to serve these hard-working and beautiful people of the islands. To learn more about Hearing the Call or to make a donation, visit hearingthecall.org.
—Dusty Jessen
Dusty Jessen cleans wax out of a boy’s ear by rinsing it out with a machine called an Earigator.
Hair cell research adds new pieces to the puzzle
The Hearing Health Foundation has announced a new achievement in its Hearing Restoration Project: a list of genes they can work with. The researchers are trying to develop technology to restore hearing by regrowing damaged hair cells. They developed a database of 5,000 genes found in hair cells of various species, and were then able to isolate 900 that are shared among species and organ types. They hope to use that knowledge to help reverse hearing loss in humans by learning how to regenerate damaged hair cells.
For a more detailed explanation, see “Hair cell research takes off” in the Autumn 2021 issue of HAH. Here is an excerpt:
As a first step, researchers will examine sensory cells in various species, and try to learn how they can be regenerated after damage, according to the project’s director, Lisa Goodrich, Ph.D. of Harvard Medical School. She likens the way hair cells regenerate in immature animals to the way our skin heals after being cut. “The good news is we know it is possible,” she says. “Hair cells regenerate naturally in fish and chicks, and even in newborn mice. By studying these systems, we can design a blueprint for what needs to happen, and then use our rich understanding of the cells and molecules of the mammalian cochlea to make it happen.”
With the newly completed database of genes, researchers will be able to track future development of that regenerative ability. “Our new, comprehensive database, open to all researchers, offers the first objective metric to measure progress toward hair cell regeneration,” Dr Goodrich says.
Upcoming meetings
The next meeting will be Saturday, June 21, 1 p.m. to 3 p.m. at the Koelbel Library, 5955 South Holly St., Centennial, CO 80121. Speakers will be Dusty Jessen, AuD, Arthur Belefonte and Kit Mead. They will discuss finding financial assistance to purchase hearing aids. Before this and future meetings, members will have lunch at noon at Parry’s Pizzeria & Taphouse (across from the Koelbel Library) at 5970 Holly St. To reserve a seat, email davidmitchelle383@gmail.com.
The HOPE online meetings will continue on third Wednesdays; the next meeting will be June 18 from 5 p.m. to 6 p.m. To learn more or to receive an invitation with the Zoom link, email jen427mcbride@gmail.com.
Dues for 2025 are $20 for an individual and $30 for a couple. Please bring a check made out to HLAA Denver, or you can pay online at https://hearinglossdenver.org/ (scroll down to "Pay Annual Dues”).
Grocery fundraiser
The Denver Chapter is promoting a program by King Soopers, in which participants using a shopper’s card (the card you swipe to get a discount) can generate a contribution to the chapter with each purchase. There is no cost to you. Just log on to https://hearinglossdenver.org/community-rewards-program. You also can pay dues or make a donation to our chapter online at https://hearinglossdenver.org/.
Hearing loss comment of the month
As a Vietnam vet who depended on a battery of 155mm howitzers firing daily over our heads to keep us from being overrun, I say, “What? What’s that you say?” Okay, yeah, I have a raging case of tinnitus, and I don’t like listening to people anyway.
—Robert Hanson, commenting on a 2016 blog, Living With Hearing Loss, by Sheri Eberts
Deer are scarce these days in Cherry Creek State Park, but photographer Sue Weinstock managed to find this one.