All About Tinnitus via Telehealth – Episode 58 with Dr. Ben Thompson
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Today’s episode revisits the subject of Tinnitus, a highly debatable and often requested topic.
This time, I am joined by Tinnitus expert Dr. Ben Thompson, who will be sharing his tips on how to deliver help and support to those suffering from this condition.
This week on All About Audiology:
- 2:02 – Please support our podcast if you can, by visiting our Patreon account!
- 2:20 – Dr. Ben’s mom is a speech and language pathologist. When he was considering future career options, she suggested audiology. After looking into this profession, he began to feel a connection to preventing hearing loss.
- 3:20 – He participated in a new program, University of the Pacific, in San Francisco. This was taught by leading audiologists from the UCSF, one of the top 10 hospitals in the country.
- 5:33 – There are so many different paths you can take as an audiology student, so consider all of your options!
- 6:22 – If someone is suffering from tinnitus, treat the person as a whole. Tinnitus can be aggravated by stress, so getting to the root of the problem is important.
- 6:48 – While doing his externship at UCSF medical center, Dr. Ben had a patient travel 4 hours for a 90 minute consultation with him. This gave Dr. Ben the idea for online tinnitus therapy.
- 10:14 – The most popular video featured on Dr. Ben’s Youtube channel so far has been “What Does Tinnitus Sound Like?” and lets the viewer experience different tinnitus sounds.
- 12:14 – “The Ultimate Guide to Tinnitus Relief” is an Ebook written by Dr. Ben, and is filled with simple strategies for controlling tinnitus. This can be found on his website puretinnitus.com.
- 14:57 – Between the ages of 6-8, children become more self aware about what’s happening in their body. It is around this age where they might begin to voice their discomfort from tinnitus.
- 19:50 – Not all tinnitus is created equal – the type of treatment and its success depends on the individual. Just because one approach helped someone with mild symptoms, it doesn’t mean the same approach will help the next person.
- 22:16 – If you can get the body and mind feeling healthier, tinnitus can become less of a problem. This is why it is important to find out a patient’s history, to learn what might have triggered the tinnitus.
- 34:03 – Dr. Ben is now reviewing different hearing devices from large and small brands on his YouTube channel. The videos will all be tinnitus and hearing focused.
- 35:54 – No matter the current stage of your child’s journey, there will always be unknowns. Do the best you can with the resources you have.
- 37:48 – As an audiologist, it’s fine if you don’t feel comfortable counselling tinnitus patients. In this case, the best thing you can do is give the patient resources so they can explore different avenues on their own.
For more resources and research visit:
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Dr. Ben’s YouTube Channel
Dr. Ben’s Website
Mentioned in this episode:
Listen Next/Related Episodes
- Episode 35 – All About Tinnitus – with guest Dr. Kelly Dyson
- Episode 54 – All About Healing Tinnitus – with guest Joey Remenyi
Next time on All About Audiology:
Episode 59 – All About Advocacy Organizations – with Oren Dvoskin and Damien Kelman, Bekol
Transcript:
Welcome back to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein. And this is the podcast where we talk about audiology and how it impacts your life. It’s not just about hearing tests or hearing aids or cochlear implants, or all those things that we do talk about. What we really want on this show is to talk about how it affects your day-to-day life, your relationships, access to communication, education, all those things that really matter. So, it’s all about you.
And today, on the podcast, we are revisiting one of the most requested, debated, spoken about topics, and that is tinnitus. Ringing in the ears, buzzing in the ears, all those sounds that can actually be really, really bothersome, and for some people, can really affect their functioning. So, today we are joined by tinnitus expert, Dr. Ben Thompson, from puretinnitus.com. He’s from California, and he is going to share so many great tips and a lot of information about how to deliver help, and support, and services for those who are suffering from tinnitus.
We’re going to be diving into this topic and I do want to remind you that we’ve had two previous episodes all about tinnitus already. So, we’re kind of hitting this topic from all angles. You can go back and listen to our interview with Dr. Kelly Dyson. That was episode number 35. You’ll find that in the show notes. And we also had Joey Remenyi, Australian audiologist and author of the book, “Rock Steady” just recently in episode 54.
Well, without further ado, we’re going to dive right in.
Dr: Lilach Saperstein: “Welcome Dr. Ben.”
Benjamin Thompson: “Thank you Lilach for having me. I’ve been following your podcast for a while, and I want to say thank you for everything that this podcast is doing for families, for the audiology profession, and for anyone who’s looking to learn more and take a deep dive and get the expert opinion or perspectives about all these great topics.
Thank you.”
Dr. Lilach Saperstein: “Thank you. I really appreciate that. It is so fun, such a labor of love. And I do just want to put this out there. We do have a patreon and it would be so appreciated for anyone who would like to support the show. That’s just a little plug right there. It’s patreon.com/allaboutaudiology and there’s some cool perks on there too for some of my favorite listeners. I’m only kidding. I love you all. So, Dr. Ben, tell us all about how did you come into audiology and then tinnitus in particular?”
Benjamin Thompson: “Definitely. My path to become an audiologist started with my mom, growing up in our family. My mom has been a speech language pathologist for about 30 years. And as I was growing up, she of course wanted her son to have a good, safe, healthy profession. And we were throwing around some ideas and she said, “Hey, as an audiologist, this could be a good path for you. Have you considered speech pathology?” And I said, “No.” She said, “Have you considered audiology?” I said, “What is that?” So, we looked into it more. And I started to connect with preventing hearing loss by using ear plugs, researching loud noise exposure and tinnitus.
And then I applied to graduate school and I got accepted. Went to graduate school in San Francisco, California. The big move out West from the East coast where I grew up, moved out to California and started this new chapter of my life. Part of that journey then allowed me to be in this program which was new. It’s University of the Pacific program in San Francisco.
We were the first class of a new program and that has pros and cons. One of the pros that I took from it is that the curriculum, the classes, the coursework, it was strategically chosen to give new audiologists the best advantage in the market in the profession. So, classically programs have courses that have maybe changed slightly, but more or less the same for the last 20 years in the audiology profession.
So, being in this new program, the differentiator for me, what I learned was that we had two full semesters of tinnitus that were taught by the lead audiologists at University of California, San Francisco medical center, UCSF, which is a well-known institution, historically ranked one of the top 10 hospitals in the country and a great audiology program.
To be taught by a clinician instead of just a researcher was an incredible experience to learn about tinnitus. I connected with the tinnitus counseling and tinnitus therapy component because it was person to person and it involved the psychology. Classically as an audiologist, we rely on technology. And if anyone who is listening to this that is an audiologist or an audiology student, you know, there’s lots of our day where we’re waiting for hearing aid software to load or relying on technology or where we have a technological malfunction and we have to troubleshoot and fix it.”
Dr. Lilach Saperstein: “You have to plug it in, plug it out, take it out, put it back again.”
Benjamin Thompson: “Exactly. So, an audiologist needs technology to get the job done. What I found in tinnitus counseling is that it’s more of a holistic approach on focusing on overall wellness, getting into the fundamentals of psychology. And for me, that on my own personal journey in life, that connected to me very much. So, that’s why I pursued it deeply.
Fast forward a few years after doing research into, how can I use my skills of tinnitus? Because I had been trained extensively in tinnitus. How can I use that to share it to the world or to share it to the online community?”
Dr. Lilach Saperstein: “Okay. Cool. So, I think exactly what you’re mentioning is that audiology has so many different directions that you can go within the field. So, for all of our students who listen, you know, just because you had to do a whole two semesters of one thing doesn’t mean that has to be your whole career. There’s educational audiology, there’s fitting hearing aids, there’s cochlear implants, there’s medical, there’s working for the companies and doing research. There are so many things you could be doing. What about podcasts? And what about online courses? And what about reaching more people in a very specific way? That’s within tangential, outside of the actual medical model establishment.
So, I think we can agree on that. And I also love what you said about the holistic approach. Because it is about the whole person and that’s what this whole show is about. So, I’m really glad to hear more about the work that you do.
And for people also, we spoke about this with Joey as well, that if somebody is suffering from tinnitus, we don’t just say, “Okay, let’s try and only look at your ears.” And then it’s a ear thing.
It’s a brain thing. It’s a stress level thing. It’s a whole body, where you came from, traumas, experiences. We’re helping people, we’re treating people. So, I appreciate that approach.
All right. So, tell me more about what happened next when you were saying, let me bring this online. How did you approach that?”
Benjamin Thompson: “It started when I was in the residency, the externship at UCSF medical center in San Francisco. I had an appointment for 90 minutes for a tinnitus consultation. And this was a center that was well-known. And I was reviewing the case before the appointment. And I saw that this patient was from Lake Tahoe, which is four hours away. And they had an appointment in San Francisco. So, I thought, okay, are they actually from Lake Tahoe or is that just their address? They get to the appointment, they start the appointment. And they confirm, yes, “I live four hours away. I drove here for this appointment. That’s how much it means to get help for tinnitus.”
And they went to their primary doctor around Lake Tahoe, which is in the mountains in California, four hours from the coast. They were referred to the ear nose, throat, doctor. And both of them checked their ears. They said, “Well, there’s nothing physically wrong with the ears, so there’s no cure. I don’t have anything I can do for you. So, please get out of my office. That’s all I have for you. I’m sorry.”
Dr. Lilach Saperstein: “Your seven minutes are up. Haha.”
Benjamin Thompson: “That’s just their background. That’s just their training. It’s no fault of their own. It’s just the system and the education, perhaps, that these other doctors don’t have, that an audiologist can have with the right training.
So, that patient does what anyone today would do who wants help for anything. They go on Google or they go on YouTube and they searched “tinnitus doctor”, “tinnitus help”. Eventually they found the center in San Francisco. So, they saw me for this appointment. We had the counseling session for 90 minutes where I educated them on what’s going on, what they can do. How does their hearing impact it? What other factors related to their stress, their psychology, their nervous system are taking a role in this? How to use sound therapy, creating an individualized plan and how to move forward. And they felt relieved. They felt satisfied. It was worth them driving four hours, spending $300, having the time and actually implementing what’s next.
They left that appointment satisfied. And at that point, I realized that the skills I was developing in my passion in this field of tinnitus counseling and tinnitus therapy, mixed with my digitalm millennial mindset of using tele-health, using the internet to spread a message far and wide, that tinnitus counseling was the easiest and best way to create an online business, to create an online therapy, online telehealth project in the field of audiology.
And that was the seed that was the inspiration to start pure tinnitus. And that was a few years ago. I launched pure tinnitus about one year ago with a YouTube channel to build an audience and share the message of how exactly to get to the root causes of tinnitus and explain all that can be done.
That’s basically my story. So, I’m happy I can share that with your audience. Thanks guys.”
Dr. Lilach Saperstein: “Absolutely. And we’re also going to have links to your YouTube channel and a full transcript of today’s episode as always, will be at allaboutaudiology.com. So, tell us a little bit about what are the different topics, the videos that you have, the ones that are the most popular or maybe the ones that get the most comments. Haha.”
Benjamin Thompson: “Definitely. And that’s a great question, because for anyone who’s interested in creating videos or blog content or a podcast, we want to of course create something that’s fun for us. But more importantly, we want to create something that people actually want, people are actually searching for, it would actually benefit them, give them value.
So, for people with tinnitus who are looking for answers, there’s a large number of people who are asking, what is this? What am I experiencing? My most popular video thus far has been playing the 10 most common sound types of tinnitus: ringing, buzzing, roaring, whooshing, pulsatile, clicking, the steam coming from a train, the teakettle, and all these different sound samples, so people could match the quality, not the loudness, but the quality of their tinnitus. And they would comment on the video below. So, that was really powerful for people because tinnitus is invisible. It’s in the head. You can’t see it. No one else can hear it. You talk to your family and friends, people say, “Sure, I have it, but it’s not a problem” for them. So, to have a resource where they can realize, okay, this is real other people experience this and then now what.
That’s a really popular video. The topics that I’ve focused on that I feel are the most valued to the tinnitus audience are talking about stress related to tinnitus, anxiety, the nervous system, the physiology and the physical body, and how a message from the body of feeling tense or anxious, that sends the message through the nervous system to the brain. And that keeps us in the fight or flight response, which is why many people are challenged by tinnitus. Additionally, topics around hearing aids, hearing devices, sound therapy, how to use sound therapy. Those are the main topics that get the most interest on my YouTube channel, which is called BenThompson, AUD.”
Dr. Lilach Saperstein: “Awesome. When I think about explaining tinnitus to someone, to the uninitiated, sometimes the analogy of chronic back pain or stress and tension in your shoulder area. That’s something that pretty much everyone experiences when your shoulders are up and you’re tense. And then it’s like, Oh, you had a good day or a bad day based on how your shoulders are feeling.
That’s something that is kind of common. Everyone gets that. But then it comes and goes and then you stretch or swim or do your daily activity and you don’t feel the pain anymore. But for someone who’s really struggling with chronic pain, you want to investigate, is there a medical thing going on or is it more of the stress and mindset. So, I think understanding what tinnitus is and how it works, how it can be effective is so important and so powerful. So, those videos must be so well received. That’s why.”
Benjamin Thompson: “Yeah, thank you. And I have an E-Book where I give simple strategies for tinnitus. One day, a few months ago, I got an email and the email said, “Dr. Ben, thank you for creating this E-Book. I read your E-Book. I am an ear nose, throat doctor in Southern Africa. And I have patients in this rural health clinic that come to me with tinnitus. And I don’t have any tools to give to them. I feel bad for them. So, classically I’ve been prescribing them anti-anxiety/anti-depression medication and that’s all I thought I could do. Now, after finding you on YouTube, after reading these strategies, I’ve been implementing them with my patients here in this rural health clinic. And I don’t have to give them anti-depressant/anti-anxiety medication. Now I have some other tools that I can use, which are more holistic or more mind/body approach as to just numbing the psychological effect of tinnitus.”
So, in terms of the reach of YouTube and how there’s people all over the world in places I’ve never been, you’ve never been who have the same problems, they speak a different language, maybe the same message can be used. So, for me, that’s one of the most influential moments I’ve had on this journey of an ear nose, throat doctor in Southern Africa reaching out to me saying that what you’re providing has helped my patients, people that I’ve never met, people who I don’t even speak the same language as.”
Dr. Lilach Saperstein: “That’s the best feeling. And I want people out there to know that when you email or DM or send a message to someone who you liked what they said or what they wrote, or even comments on videos and Instagram, it really makes a difference to the creators because we work really hard. We put a lot into it and then to get that kind of feedback that it’s actually making a difference, that’s very meaningful.
So, in the spirit of the holidays, of all days and gratitude and spreading positivity, DM, and email, your favorite people that you watch or listen to their things, just saying.
That’s so cool. That’s really fun. I feel the same when I get those messages too, from parents, because the main focus of the things that I’m doing online are mostly for parent education, who all of a sudden have a new baby. They’re identified as deaf or hard of hearing, or they have lots of testing. They don’t have the full answer yet, the full scope. And they’re just like, “audio, audio what is this to all this new stuff?”
So, I hope that’s where a lot of people have come into my world. And yes, I can say those messages really mean the most, especially when you send me pictures of your babies, keep doing that. Hahaha.”
Benjamin Thompson: “What kind of far countries that you never thought you would visit or connect with, are reaching out and saying, hello?”
Dr. Lilach Saperstein: “Oh, all over. Pakistan, Thailand, a couple of students in Norway, a super cool mom in New Zealand. Really fun. I love it. And because I’m in Israel, I kind of do my evenings for North America. I’m kind of right in the middle of all these different time zones, it works out. It’s fun.
Okay. So, speaking of babies and children, can you tell us a little bit about tinnitus in pediatrics or for children, because I think this is another topic that gets very little attention. And people will say, what do you mean? Not everyone experiences this? And then, a teenager will say, “I’ve had this ever since I can remember.”
What can you tell us about that?”
Benjamin Thompson: “I work with pediatrics right now in an in-person clinic, as well, part-time. And when I was at a medical center, working with kids, working with pediatrics, what comes to mind is that when a child is between six, seven, and eight, they start to develop the language and the self-awareness that they can verbalize what’s happening in their body.
And, often, this is for children who’d have a late onset or develop hearing loss after the newborn hearing screening in one ear. I saw this multiple times where around seven years old, they start to tell their parents, “Yeah, I can’t hear you on that side.” And after a few times consistently the parents say, okay, we should get that checked out.
They’ve likely had a hearing loss in that ear for years, but around that age, six, seven, eight, for most normally developing kids, they’re able to voice what’s abnormal or what seems to be off in their system. And I would say it will be a similar process for a child with loud tinnitus. Again, around that age, they can just voice what’s happening in their body better.
And for someone who has tinnitus that may present as, “Mom, dad, I hear a noise in the ear or I hear something.” And of course, if a kid says I hear something that doesn’t mean a lot. Overall, it’s pretty rare for a child who’s under 12 years old to be adversely affected by ringing in the ears. Most children with a hearing loss probably do have ringing in the ears, but when they’re wearing hearing aids, it’s not necessarily noticeable. It’s hard. It’s not a well understood topic. It’s not a well-researched topic. It’s very subjective. It’s hard for a child to really describe the intricacies of hearing a sound that’s not physically there. We can’t measure it with a test.
Overall, I would say, the most common expression for a child is that if a child is entering teenage years, they start to develop social anxiety or depression. And if they latch on to the symptom of tinnitus, which is likely caused by some degree of hearing loss, if they latch onto the tinnitus being a reason why they don’t have energy, a reason why they’re not getting out of bed, why they want to stay home from school, it’s usually a sign that there’s more underlying conditions going on.
So, that would be my advice that if someone is a teenager going through challenges saying that the tinnitus is really loud, it’s bothering them, they’re not happy because of it, they wish it was gone. Go deeper. And maybe that’s with a counselor. Maybe that’s with the psychologist, maybe that’s with an ear, nose, throat, or audiologist doctor. Go deeper into what else is happening in that child’s life and realize that the sound itself isn’t likely the cause of stress. It’s something deeper.”
Dr. Lilach Saperstein: “It’s hard with kids. So, I have a story for you. Just the other day, on Hanukkah, we had a lot of donuts in the house and my six year old ate many. I don’t know if she ate four or seven. I was not around, #greatparenting.
I just came and there were less than there were in the box before, but I have three kids. I don’t know who ate what. Long story short, the next day, she had major belly pain. And my husband, the doctor, you guys know him from previous episodes, he was examining her belly and he got actually very concerned because of the type of pain she was having and the specific spot. He was like, “Actually, I think we need to check you out, is this appendicitis?”
And I was like, “No, it’s a belly ache from all the donuts.” So, we were having this debate. And that I think is common among children where you don’t know, are they just saying they don’t want to go to bedtime or do they really not feel well? And then two minutes later, you got to clean up the floor cause they threw up and you’re like, oh, I guess they were true that time. But it’s tough.
For anyone concerned, she was fine. It was a belly ache, but she got an ultrasound. So, she thought that was very cool seeing the inside of her stomach. That was quite a Hanukkah adventure. I like the way that you kind of opened it up to an interdisciplinary investigation. You’re like, what’s going on here and are we going to focus fully on the tinnitus?
But then, let’s say, that is the child’s main complaint. And then they go to an audiologist and discover that they do have a hearing loss that you can then maybe have intervention to that direction. And that helps it. So, it’s a good question. That’s a good thing. So, I think my main takeaway is that parents should trust themselves, trust their gut. And why not get it checked out? I’m pro going to see what’s going on.”
Benjamin Thompson: “Yeah, overall, it’s pretty rare for a child to say, “I have ringing in the ear, I’m hearing a noise” and then they actually care about it long enough to keep bringing it up. But entering those teenage years, it’s pretty safe to treat a teenager, almost like an adult in terms of tinnitus management.”
Dr. Lilach Saperstein: “Okay. Great segue. So, let’s talk about tinnitus management and tell us about the program that you run. I’ve seen on your website that you have so many happy testimonials from people who are like, yay. I feel better. So, tell us how people could get to that place.”
Benjamin Thompson: “Yeah, that’s a good question. It’s different for anyone. One of the big takeaways I’ve had to realize is, having the best clinical training possible for tinnitus is one thing. And then when I created the YouTube channel and put myself out there as a tinnitus doctor online, people come from all angles, all corners of the world with questions and personal experiences. I’ve learned a lot more after my training than I did in my training just with the diversity of questions and experiences people have had, who find me online.
So, one thing I’ve learned where I feel like a lot of doctors get wrong and a lot of tinnitus therapists and audiologists get wrong, is that all tinnitus is not equal. So, if one person’s testimonial seems to suggest their tinnitus was milder and they changed some things and it improved, that does not mean someone else should copy everything they do and expect the same results. Tinnitus is subjective, it’s not always created equal where I’ve seen, this comes in play.
Most people have relatively mild tinnitus. So, some slight adjustments to either hearing devices, sound therapy, focusing on getting good sleep or using sound throughout the day to keep them focused and not distracted, or getting into some of the fundamentals of their psychology and how they might be overreacting and making this a bigger deal than it has to be.
That applies to most people. But the people who actually work with me who come to see me have already gone to many doctors. They’ve already tried all the different things online. I would say that they’re not always able to be compared to the majority of people with tinnitus, because for whatever reason, whether it’s their physiology or their psychology, nervous system situation, their tinnitus might be a lot louder than someone else. And it’s an internal, subjective, loudness and experience. So, what I’ve learned, not all tinnitus is created equal and that’s important. That’s something that I didn’t know when I was getting trained in my residency.
In terms of the programs that I’ve developed, there’s two. It’s important for anyone listening, who is an audiology student or an audiologist, or interested in this question of how can us as professionals bring the medical research, which has been going on for decades, and a lot of funding. How can we simplify that and make the easy to understand and easy to implement for individuals or for groups or for people online. So, I believe that’s my main role here, is to take all this evidence and research that’s been done by institutions like the VA hospital, the veterans hospital in the US, who has thousands and thousands of people with very loud tinnitus. So ,they’ve obviously figured a lot out of what works for most people.
That is also called a progressive tinnitus management that came out before 2010, around 2005. Before that was tinnitus retraining therapy, which is created by Pawel Jastreboff. And it describes how there’s the psychological component of tinnitus and there’s also the sound therapy or audiology component of tinnitus. And when we work on the negative reactions in the psychology, then the sound usually gets a little softer too. So that’s an approach that is used commonly around the United States and around the world for treating tinnitus, that’s called tinnitus retraining therapy.
Progressive tinnitus management involves a larger interdisciplinary approach where it starts out by giving out information, it has a sort of pyramid approach. Where progressive tinnitus management, they start with group programs and that’s enough information for most people, but for those who are still challenged and still need the help, then it gets into individual consultation with an audiologist, considering hearing aids, sound therapy devices. For some people, they still need the extra layer of help, which will be one-on-one counseling.
And then for some people they would actually need to do cognitive behavioral therapy with a psychologist or a psychiatrist. That approach is used with the veterans because there’s many of them, but not everyone needs one-on-one care. Then going back to tinnitus retraining therapy, again, that focuses on the psychology and the sound therapy.
The way I created my programs was trying to use all that existing literature and research and use the internet, which can share the message most people need, to a lot of people for free, but also give the resources for those who need the extra help, where there’s some paid programs.
I created a group coaching program where we meet twice a month via zoom video to answer questions and have that group setting. So, people can have that support of a support group, but also get their direct guidance of a professional.
Up from that, I do one-on-one tinnitus counseling or health coaching about the fundamentals of the psychological component of tinnitus, as well as the holistic wellbeing, focusing on sleep, focusing on diet, nutrition, exercise. For most people, if we can get the body and mind feeling healthier, then tinnitus becomes less of a problem. So, that’s a good place to start.
Additionally, I perform tinnitus retraining therapy for those who are looking for the tinnitus coaching, the counseling, as well as hearing devices, hearing aids. So, that’s the research that allowed me to create these programs. And if I can add one thing to this, it’s that tinnitus retraining therapy is good, but I feel like it’s missing the important component of the nervous system in the body. Right?
Tinnitus retraining therapy is all in the head. We have our ears, we have the hearing system, the auditory nervous system, and then the psychology, the mind and the fight or flight response and the amygdala, the emotional system, the limbic system, the emotional brain. But it doesn’t bring in this body. It really doesn’t talk about the body, how, if my body is in an anxious state, if I’m not sleeping well, if my body is tight, if I’m not relaxed, if I’m not doing things throughout my day or week that relax me and ground my nervous system that does not help us get out of the fight or flight response. So, my personal interest in meditation and holistic living is what I also bring into the approach for tinnitus.
So, thanks for hearing all that.”
Dr. Lilach Saperstein: “Oh, of course. I always want to know how people can access what they need. And, unfortunately, in many, most parts of the world, people do not have full access to all of the medical care, but also otherwise care, like nourishing type of support. And so, the whole thing about how self-care is kind of putting the burden on the person. Like you didn’t take care of yourself enough. Meanwhile, they’re dealing with all these things that are out of their control like systemic issues that are around them. And it’s like, well, you didn’t take a bubble bath. That’s why you can’t pay rent. No, those are two very different things.
Anyway, that’s a tangent over there. We do that a lot here.
Recently, I gave a class, also via zoom to a group of Israeli speech language pathologists who were interested in this topic of tinnitus. I explained so much of what you just mentioned, the different approaches and the mind/body connection. And I think it’s something that is also so outside of the training, the specific communication strategies, communication mode, hearing focused that brings us back to what you said at the beginning of what we’re learning as students. And then, we become professionals and meet actual patients and say, well, actually, did I learn what I need in order to provide assistance and help to you? So, I appreciate that.
In this class, one person asked a very interesting question. I’d love to have your take on it. So, this was an audiologist who also works with industry and with a lot of equipment and various kind of instrumentation. She’s really an instrumentation specialist about all the equipment that we use in the clinic. And her question was, “what is my take on doing the loudness matching, pitch matching, and all those tests that we do in the booth where we can get information about this person’s tinnitus, as much information as we can.” And so, I answered that. I said, “listen, I don’t really understand the point of it, the clinical significance for a person who is suffering. I’d much rather spend the time on this other counseling aspect and discussing so many other things, than getting that their tinnitus matches this or that frequency. Because what am I really doing with that? Except for maybe giving them a band and their hearing aid and their sound therapy that would be matching it, but that doesn’t always necessarily correlate.”
So, I just said, “I have a less of a focus on that in the clinical sense.” Her response was that because it gives data and data and information can be researched, it also shows kind of a legitimacy to this whole field. And like you mentioned before of getting funding for research, so you kind of need metrics. So I’m wondering what your thoughts are on that whole topic.”
Benjamin Thompson: “Yeah, that’s great. In the clinic, if a patient comes in with tinnitus, that information of pitch matching, loudness matching in both ears is quantifiable, so it can be used to show someone, this is real. We can measure what’s happening and this is real. Also, a sensation level, which is the loudness of the tinnitus at a certain pitch. The difference between that and the softest sound someone can hear at that pitch, is usually less than 10 decibels. Usually five, six decibels. So, that is useful because we can show someone, look, your tinnitus isn’t actually that loud. It’s just that when you’re in a quiet place and there’s no other sounds, you can hear it. So, we don’t need that much background soothing, relaxing sounds to make your life a lot better and not have to think about the tinnitus so much.
It can be used in that aspect. Yes. What this individual alluded to, is also true, is that these are quantifiable data points that can be used for research and certain tinnitus devices that have come out that are used clinically, which are in clinical trials of sorts. For example, neuromodulation devices or old technology now, but neuromonics was commonly used. They would, try to categorize the pitch, the loudness of the tinnitus and see if it changes over the course of the treatment. In terms of tinnitus retraining therapy, that classically used model describes how the pitch of the tinnitus does not affect the treatment per se. Anecdotally, most people who have a high pitched tinnitus, prefer certain types of sound therapy. But of course, that should be figured out on the patient’s own time through the sound therapy apps on their phone or in the clinic on a hearing aid fitting by playing the different samples in the device.
Me personally, in the online telehealth model, I categorize the person’s experiences, but I don’t find any benefit of getting the exact pitch of the tinnitus, as opposed to them saying, I hear a high pitch ringing or I hear white noise. That’s my perspective on it, that it can be used in the complete comprehensive categorization of tinnitus in a clinic, but it’s not necessary to get good outcomes. And it definitely is useful to gather as much data points as possible for a research related project, keeping in mind that a more comprehensive subjective questionnaire, like the tinnitus functional index is more valuable than measuring the loudness or pitch of the tinnitus.”
Dr. Lilach Saperstein: “Okay. So, in that vein, sometimes when I administer those questionnaires, it almost feels like I’m making it worse because I’m bringing all their attention, like tell me, does this keep you from doing the things you like to do? Does this keep you from going outside? Does this distract you while you’re reading? And then they almost start to think and say, you know what? Yes, that does happen.”
Benjamin Thompson: “How is that different than asking someone those same questions about their hearing loss and then motivating them to doing something about it?”
Dr. Lilach Saperstein: “I hear you 100%. I just feel that in some cases it’s better to start with kind of a narrative question and answer and hearing their own words, their own perspective, and then doing the questionnaires rather than the other way around.”
Benjamin Thompson: “Yeah, I think we’re getting into a healthy subject that most audiologists didn’t sign up to be therapists or a psychologists. And most audiologists, frankly, don’t like working with tinnitus patients because they take up a lot of time. They ask hard questions and they are in a place of high stress and high anxiety. So, it takes education to know protocols of what to do in those cases, but it also takes a certain kind of person who’s willing to connect and feel into someone’s suffering. And as I said, most audiologists didn’t sign up to be psychologists or therapists. What do you think about how that plays into this?”
Dr. Lilach Saperstein: “Absolutely. And nor is the environment set up to support the audiologist to do that. For example, one place that I worked, there were people in and out of the room because we had a tympanometer in that room. So, one person on the computer, another person’s at the tympanometer, then someone needs to wash their hands because we had a sink in that room, not in a different room.
So, sometimes the environment is just not the right place to have a meaningful and empathetic, vulnerable conversation where you really need calm, non interrupted, for the person to feel safe enough to even disclose what’s happening. So, yeah, I think you’re right about the audiologists training, their interests, their motivation in coming into this and that I think is also an important thing of why it’s important for us as audiologists, and any professional really, to know what their scope is, how much they can do, and when is the right time to refer, even if it is within your scope. So, I love that there’s this option that we could refer to our colleagues and say, go to puretinnitus.com and maybe this is the plan for you because my private practice here or there doesn’t cater to this specific need.
And for my end, I love when people send new parents over to me because in the appointment with a new baby, you have to do probably an ABR and then you have to explain things and then you have the ENT visit and they’ve been in the hospital for three hours, but did they get the other part of it?
“Wow. What does this mean for our family? And what’s the path for having a child that’s deaf or hard of hearing?” So, that’s exactly what I do. I come out of that interaction that’s in a clinical setting and without the stress of the hospital parking meter. Seriously, that’s one of the biggest stressors of hospital visits that parents talk about. They’re like on the clock.
So, everybody’s on the clock. And so, the zoom modality, the tele-health, I think it’s so important for parents after the kid is sleeping, then let’s come and have our own conversation of your experience. So, I think there’s a lot of parallels there with someone who doesn’t necessarily need any more from their medical team and now they need something else, but they still want it to be someone who’s trained in this field. So, that’s the cool part of audiologists getting online.
Another thing on that topic is that there’s so much room for everybody, and the rising information, the rising tide of audiology is good for everybody in our profession. That’s another topic that the hullabaloo about, over the counter this, and are we valuable? And it’s like, “Oh, we are. Very, very.” Haha.
Benjamin Thompson: “Totally agree. And after about 10 months of creating YouTube videos twice a week for tinnitus, I’m also now incorporating different reviews of hearing devices. Some of them, your big hearing aid manufacturers that you’ve all heard the names of. Others, are more online, direct to consumer hearing aids. So, that’s something to check out. My YouTube channel is BenThompsonAUD, and it will be tinnitus and hearing focused.”
Dr. Lilach Saperstein: “That’s awesome. Exactly right. Those resources are so incredible. And the fact that, like you mentioned before about this pyramid, there’s so much free and available and accessible things. YouTube podcasts, downloads, and all sorts of things. And I think that for most people, there’s so much value in you forwarding a video. Be like, “Hey, I thought of you, you were mentioning this.” And then just pop them a video link or send them the podcast, or sign up for the free guide or free E-Book to not only think of yourself, but actually to think of people who might benefit from that. And honestly, this whole gift guide thing is happening around me on the internet. So, what a kindness you do for the person who needs it, and it’s also really, really wonderful for the person who created it to try and get it to the right hands.
You might think that’s a small thing. Like, I forwarded a YouTube video, but it can really change someone’s day, someone’s perspective. So, I hope some people will do that, visit the show notes and see all the links that were popping in from today’s conversation.”
Benjamin Thompson: “Absolutely. One thing I realized is that many people view the content. Many people listen to the podcast. Many people listen to the YouTube channel, et cetera, and very few comment. And there’s experiences that are shared. As another millennial audiologist myself, I want to say thank you for creating this podcast that I’m a guest on here, All About Audiology and how it can inspire younger audiologists to use our technology skills, because they are a skill. They have to be learned to share a message that can impact many lives outside of our own geographic area. So, I think it’s really fun. I think what you’re doing is great and I hope that you continue to do it at whatever pace feels right for you.”
Dr. Lilach Saperstein: “Thank you. All right, so, always my last question for our guests is: What advice do you have for our listeners, for parents of children who are navigating audiology, for our communication disorder students, audiology students, and for our colleagues and professionals? That’s very wide. Basically everyone. What do you have to say?”
Benjamin Thompson: “My advice for parents is that whatever stage of the journey they are on in terms of their child having a hearing condition, that there’s going to be unknowns. And the next step is to some degree, unknown and to simply do the best we can with the resources we have, where we are currently at. And trust with the right professionals, with the right doctors, the right technology, that things will happen however they’re supposed to happen, in the best way possible.
I was a student a few years ago. My advice for my old self as an audiology student would be to try diverse specialties in our field, and to not expect to know where I will be in five years. I had a five-year plan from where I was going to be from school till where I am now. It’s totally different. I thought I would be in a nonprofit. I thought I would be doing public service loan forgiveness. Now I’ve completely switched to more entrepreneur, digital, YouTube, telehealth model. So, not to project too far in the future.”
Dr. Lilach Saperstein: “I don’t have a five minute plan. I don’t know. Haha.”
Benjamin Thompson: “Oh, come on. You’ve got something.”
Dr. Lilach Saperstein: “No. It’s a tough one. I think 2020 is definitely the opener that’s like, you thought you had plans, life changes. But I have to say that when the first thing you said about the parents embracing the unknown is like all of parenthood pretty much, but specifically in this topic, it’s so, so true. And in the same time that you don’t have answers, to remember to hug your baby and hold your baby and look at their little cute face. Like not to forget all those things, even while you worry. Or maybe take the worry down a notch for like three minutes and also be there. Yeah, that’s really nice.”
Benjamin Thompson: “And then for audiology professionals, realize that the modern consumer is changing behaviors. They’re searching more online, and they’re searching more on Google, searching more on YouTube. Additionally, for the audiology professional, personally offering tinnitus services, just to share. If you don’t feel comfortable in the tinnitus counseling component, that’s okay.
You don’t need to force that, but to give resources to the patient so that they can pursue it on their own, whether that’s through a cognitive behavioral therapist, through the American Tinnitus Association and those resources, or through telehealth, like myself, just outsource what you don’t feel comfortable with to give the patient the option to continue.
Dr. Lilach Saperstein: That’s so true. I’m so grateful for all of the. Advice that you share and also your expertise. Thank you for coming on the show. If anyone is interested in working with Dr. Ben, visit pure tinnitus.com and all of resources and links will be in the show notes @allaboutaudiology.com. Anything else?
Benjamin Thompson:
Last words is that in the spirit of leaving comments and recognizing that we are just like any listener out there. Leave me a comment on my YouTube channel about where you live and that you arrived there from the all about audiology podcast. And I will respond to you personally.
Dr. Lilach Saperstein: Awesome. That’s great. Thank you so much. And thank you all for listening. This is the All About Audiology podcast. I’m Dr. Lilach Saperstein.
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