Dale Johnson: Doctor Sandra Miller is in this morning on KFOR FM 103.3 12:40 AM. It is time for the Conversation Starts Here. Dr. Miller from Complete Hearing. Good to have you in. Thank you.
Dr. Miller: I’m so glad to be back.
Dale Johnson: I know a personal friend that had tinnitus and that’s our subject today. Tinnitus, the perception of noise or ringing in the ears. Didn’t realize one out of five. So it’s no surprise that I know someone.
Dr. Miller: It’s no surprise you know someone. Very common. We say it’s probably about 15% of the population in the U.S., about 50 million Americans have some type of ringing in the ear. It can be called tinnitus, it can be called tinnitus. A lot of my patients say, am I saying that right? And we say both of them are correct. So it’s just this sound that comes really that people hear. And so there’s two types of tinnitus. We call the tinnitus most people have as being subjective. That means you’re the only one who can hear it. About 1% of the population have something called objective tinnitus, and that’s where somebody like ourselves could put like a stethoscope up to the ear and actually hear that sound. Very rare. We just don’t see that very often at all. So the 99% of the population is going to have something that’s very common in terms of having subjective tinnitus.
Dale Johnson: I learned early on from one of our first conversations from you that we hear with the brain.
Dr. Miller: We do.
Dale Johnson: We don’t hear with the ears. So is tinnitus or tinnitus an ear issue or a brain issue?
Dr. Miller: It’s really, I’m going to say both. It’s really coming from your brain. So what happens when we have hearing loss, think about your ears, we talked about your ears are always open. So your ears require … Sorry, your brain requires a certain amount of sound, and when your brain doesn’t get that sound, what happens is the brain gets this internal amplifier, just starts roaring up. And your brain is really creating that sound trying to fill in the gaps of the information it’s not receiving. Now, can normal people have ringing? The answer to that is yes, but there’s many other factors that go into that and it’s not as common. So there might be something where we’ve done hearing tests before and people have normal hearing, and their ears ring and we might do a more in depth test to find, hey, you are having a little bit of hair cell damage, is what we call that where the brain is not getting what it needs. So yes, this comes from the brain, and it’s again, very, very common.
Dale Johnson: I’ve had temporary ringing.
Dr. Miller: Yep.
Dale Johnson: It will come out of nowhere. Starts loud, slowly fades, lasts just seconds.
Dr. Miller: Yeah. So sometimes I would tell you we’re going to get into some of the aggravating factors like, if I have ringing or sometimes I get it, why do I only get it sometimes? Or if I have it, what’s making it worse? We use this acronym and we call it cans, C-A-N-S, like cans, and we add a couple of S’s on the end. And we tell you your diet is very dependent on that ringing. And that means if you have too much caffeine, too much alcohol, nicotine, salt, and then the S’s on the end that we add are stress and not enough sleep. So when you have those aggravating factors, what can happen is even if you don’t have ringing, for me I have a little bit of high blood pressure, when I haven’t hydrated myself enough I find that my ears will definitely ring worse, and that’s just because I’m having an increase in blood pressure, I’m having an increase in salt in my diet, and so that just makes a huge difference for me personally. So those aggravating factors, sometimes we just have to talk about these, can actually make things worse.
Dale Johnson: Causes other than diet?
Dr. Miller: Such a good one. So causes, obviously we’re going to say the number one cause obviously is going to be hearing loss, and most people don’t know they have hearing loss because it could be so slight that you just don’t notice it. So hearing loss is one of the number one causes. We can go back to it also being tied to medications. So we know we take a lot of medications, you want to read the side effects that might be on the bottle that you’re taking. So medications. It can be illness or disease. But the most common cause is hearing loss.
Dale Johnson: But not all people with hearing loss have tinnitus?
Dr. Miller: That is so very true. Isn’t that interesting? Yeah. So, it’s like, what’s the mystery there? Why don’t all people have this ringing sound? It can be simply, we can go into the discussion of, when tinnitus happens, really your limbic system gets involved. And so when your ears ring, you start to pay attention to it and it becomes almost so much more noticeable. So I use the analogy of, you’re at the birthday party and somebody lights the birthday cake, and you’re all talking and all of a sudden somebody turns all the lights off, and all you see is the birthday cake. It’s kind of like ringing is the very much the same way. So my patients tell me, Dr. Miller, when I go to bed, that is when I notice this ring the loudest. It’s quiet, there’s nothing else going on. And so your focus is definitely on what that is doing. It’s ringing. And then when you focus on it, that takes your limbic system to a whole new level, and your emotions get involved and then the ringing just becomes worse.
Dale Johnson: White noise.
Dr. Miller: Well we’ll talk about I think in terms of treatment or what are some factors we can use. First, maybe we should just talk about some of the relieving factors. We tell our patients definitely hydrate yourself, and people be like, yeah, you tell me to drink water all the time. Water’s good for you. It is really good for you. Hydration is one of the most important things you can do for your health. And that ties to the ringing part of it as well. Reducing stress in your life. Oh, really?
Dale Johnson: Wouldn’t that be nice?
Dr. Miller: Wouldn’t that be nice. It’s not that easy. Getting a great night rest. You need to make sure that you’re resting well, because when we’re under more stress, we don’t sleep as well. And these factors just compound on each other. And I would really tell you to watch your diet. And that just means, really, I have to have my coffee. Or, really, I love chocolate or I love chips. Sometimes it can be a simple diet modification that really helps mediate some of the factors. I’m not telling you that all those things are going to make things go away, but you may find that you have some trigger points that really do make your ringing worse. And so, if you can do some of those lifestyle things or you can do some of those diet type things, you may find it’s helpful. I’ve also had the comment, ugh, Dr. Miller, I’ve drank coffee all my life for, or I’ve always done this. And I would tell you your cells are constantly changing, your brain is constantly changing, and so sometimes just changing those habits can really be effective.
Dale Johnson: Can it be humming? Can it be buzzing?
Dr. Miller: Such a great question.
Dale Johnson: Because we’ve talked about ringing, and I think of it as ringing.
Dr. Miller: So when our patients come in and they have ringing, we have them do a whole separate intake form that just talks about, when did this start? Where do you think it happened? What does it sound like? Is it a high pitch, low pitch, hum, bird chirps? A lot of people say they’re cicadas. So the description is different for everyone. I’d say the most common description is, I have a high pitched ringing sound. But other people will say it sounds like crickets. I’ve had people have, we call them auditory hallucinations, I hear Bob Dylan playing in my ear. That’s not as common, but that’s better than ringing I guess, right?
Dale Johnson: Yeah.
Dr. Miller: Yeah. That comes from a whole nother factor. But I think when people describe it it’s different for everyone, and it can honestly be something that changes. For most of our patients they’ll say, it’s consistent all the time. This is what it sounds like. Other patients will say, well, some days it’s higher pitch than others. Other days it’s louder than others. Sometimes it comes and goes. Sometimes it’s constantly there. It just depends on the patient and what they’re experiencing.
Dale Johnson: I told you that mine is temporary, and it starts out loud and then fades down and doesn’t last very long. Is it important to be able to remember, for your purpose, when it started?
Dr. Miller: It really is, because we want to make sure, did this start because of something that happened to the ear? Was this something where it’s, hey, I had an upper respiratory infection and then I took this medication, then my ears started to ring. We want to find out. We was talk about the why. Why do you have this? We want to definitely know it and we want to find out the cause of it, and potentially just say, this could be something significantly that we could pinpoint to. Sometimes it’s that’s not the case, but boy if you can give us a really comprehensive history on where this started, what you think this came from, we might be able to kind of pinpoint, yeah, this was definitely the cause. Now what are we going to do about it?
Dale Johnson: You see it in your practice?
Dr. Miller: Every day.
Dale Johnson: Every day you get someone in with ringing?
Dr. Miller: Every day. Mm-hmm (affirmative) Every day. And so what I would tell you is typically it’s a secondary factor that they’re coming in more often that they don’t hear as well, but we do see patients for just the complaint of ringing in the ear. So what I’m going to tell you, if you just have ringing and you don’t think you have hearing loss, I always just get an evaluation. Your first step, number one always is, ringing is not normal, and I want you to come in and just be evaluated to see what’s going on. And it’s just even to do establish a baseline. If you don’t feel like you have hearing loss, let’s at least find out why you have ringing.
Dale Johnson: Do deaf people suffer tinnitus?
Dr. Miller: Yeah. It goes back to that brain question you said. So, I had a patient last week who said, he came in and he said, I have all this hearing loss. All of a sudden I woke up one morning and I can’t hear out of this ear. And we test his hearing. Sure enough, no hearing. It was viral for him, but he said, why does my ear continue to ring? My ear rings, but I can’t hear. And that’s more for the fact of the brain again is not getting the information it requires from the ear, and that brains just turning on those internal amplifiers and just making things louder.
Dale Johnson: What do your tests show?
Dr. Miller: Such a good question. So typically we’re going to be looking for a couple of things. Number one, we’re going to look at the overall ear, of course. But when we test hearing and people are complaining of tinnitus, we want to know is their hearing loss, number one? And then if they do have hearing loss, or even if they just simply have tinnitus, we’re going to look at the frequency range where it occurs, what pitch is this ringing at for you? So we’re going to do something called frequency matching, and then we’re going to do loudness matching. And that just means we need to know what frequency this happens at, and then we also need to know what intensity this happens at, and that will help us develop a treatment plan for you.
Dale Johnson: Different intensity, different pitch.
Dr. Miller: Mm-hmm (affirmative).
Dale Johnson: You react to that differently and you subscribe to different treatments based upon that?
Dr. Miller: Correct. So, that’s such a good question. People say, well my doctor tells me there’s no cure for this. And I’m going to agree that there is no cure for this, but there are definitely treatments that we can help you with that will really help you alleviate some of the factors that you’re having with the ringing. So when we can develop more of a treatment plan when it comes to what we’re going to provide to the ear, we need to know exactly what’s happening with the ear so we know how to provide the sound it needs.
Dale Johnson: You’ve already mentioned diet. That can be a lifestyle alteration that might help. But other than medications and diet, what are some of the other treatments?
Dr. Miller: Yeah, let’s talk about that. I’m going to give you probably four treatments, and then we’ll talk about the other factor of, what are these other alternatives that me might have? People, the way they want to treat tinnitus is I want you to think about, there’s one effect that we can call masking. We just want to turn something on that will overtake what we’re hearing. So there’s apps out there for that. We have a company that’s called Starkey. They develop hearing aids, but they also have this great app called the Starkey Relax App. And if you just download their app you can actually, it’s so great, you can pinpoint and match your tinnitus to the frequency range, what kind of sound you want to listen to, whether it’s white noise, pink noise, brown noise, music, and then you can adjust the intensity and mask it out. So it gets your brain focusing on something else. So masking is number one.
Dr. Miller: Number two, I would say is a hearing aids. Honestly, hearing aids, we say when our patients come in and get hearing aids, we find that a very large percentage of them say, my ringing is so much better during the day. Well, yeah, we’re providing stimulation to the brain where it’s missing that information. The third thing is called habituation. What we want to do there is we want to get the brain to not react with the limbic system to have that emotional response. So we want to have the brain be okay that your ear rings. And a lot of our patients, that’s why they’re like, Sandra, I’ve had this for years and I just live with it. It doesn’t really bother me. I know it’s there. They have detached the emotional response to the ringing. Their limbic system is going, yeah, that’s okay. And the brain becomes okay with it. And a way we habituate is we try to provide sound to the brain and kind of just let the brain understand that this is an exterior sound kind of mixing with the interior sound, and then the brain becomes okay with it.
Dr. Miller: There’s a great company called Neuromonics, some I’m going to throw this out there for you too. And they’re finding that an 83% effectiveness in terms of they have a way to pair music with the level of your ringing, and all those measurements I told you we took that we can really retrain the brain and the limbic system to not react to that the way it does. Lifestyle we talked about. And then I would tell you what we’re going to suggest in our office is always going to be researched based. That’s why I tell our patients you can try things over the counter online, but I would tell you is is that research base, and we’re not finding that they work. They may have a good placebo effect, but over time are they working in being effective? Alternative medicine is kind of the same way, whether it’s acupuncture, whatever you might be searching out. If you find benefit to it, do it. We’re going to tell you use whatever avenue you need to use, but we have some good ways we can go about this and really help you cope through this process.
Dale Johnson: A lot of information for you today. If you missed it, the invitation to go to the Complete Hearing website, complete-hearing.com, and there you will find a connect link.
Dr. Miller: Absolutely.
Dale Johnson: Drop down, and there you will see the podcasts. And you’ll be able to go back and listen to this conversation with Dr. Miller, and previous conversations on the Conversation Starts Here. We’re here every Saturday morning. Thank you, Dr. Miller.
Dr. Miller: Thank you.