Two Tinnitus Success Stories You’ve Been Waiting To Hear

– Hello, welcome to episode
24 of today's podcast. We are here with Sapna Mehta-Gertz, Doctor of Audiology at
Weill Cornell Medical Center in New York city. Welcome, Sapna. So glad to have you here. Sapna was a previous adjunct professor at the City University of New York, and I'm so happy to feature her today because we're going to talk about tinnitus retraining
therapy success stories. I'll pass it now to you, Dr. Mehta-Gertz. Please go ahead, introduce yourself, tell us what you do in
our audiology community, and then get right into these
success stories with TRT. – Thank you, Ben. And thanks for having me on. It's a pleasure to be able
to speak about tinnitus. So my name is Sapna, you
can just call me Sapna. I been working as an
audiologist for about six years. I, as Ben mentioned, I
worked at a medical center and so I do see a lot
of variety of patients. One of my passions is
seeing and helping patients manage their tinnitus. And so in about 2017, me and a colleague of mine at that time, helped start to develop
kind of a tinnitus program where we tried to have more structure into how we approach patients
who come to us with tinnitus rather than kind of having
too much of a scatter program where you get different
answers from different people.

So that I think is often
a very typical experience for a lot of patients. I can jump right into
some success stories. Definitely have quite a few of those. I think you kind of
think about this as well and talk about this a lot as well, but I think tinnitus is something that can very successfully be managed. I think there's a lot of
negative thoughts and stigma around tinnitus that there's nothing that can be done about it, that you just kind of
have to live with it.

I know a lot of people do say that and a lot of patients
hear that, unfortunately, but I think we probably both agree that there's actually a lot that can done. – Absolutely, we'd love to
hear your success stories whenever you're ready. – Okay, so I'll tell you
one example of a story. A case that I have is a patient who did do tinnitus
retraining therapy with me. She had had tinnitus for about eight years before I had seen her. And it wasn't bothersome
for the full eight years, but about four or five years
prior to her coming in, it did start to become
louder, more bothersome. And she started to have
sound tolerance issues where she eventually stopped, avoided going out to
like the grocery store, just even going outside social gatherings, because it was very bothersome
to her and distressing and could make her tinnitus louder. So she came into us and we found that she had
a unilateral hearing loss in one ear, and she had been
treated with a hearing aid previously to this, but
she'd never really worn it because she found it uncomfortable, probably because of her
sound tolerance issues.

And so we started to work with her, doing tinnitus retraining therapy, which involves sound therapy as part of it and counseling as a major part of it. Educational counseling and
also a I little bit of, kind of cognitive
restructuring counseling, where we really try to help patients frame their tinnitus in a different way and frame their approach to
how they're thinking about any kind of treatment for
tinnitus in a different way. And I won't get into the numbers too much, but one of the first things we do is assess the tinnitus with some kind of objective tools we have.

So one is a kind of a handicap inventory, which just gives us a kind of baseline of what the tinnitus severity is in terms of how the tinnitus impacts the person's emotions and behaviors. And hers was a severe degree. It was a 72 out of 100 score. And so from there, we started to fit her with her own hearing aid. We refit it actually, just completely reduced the amplification so it wasn't bothering her as much. And gave her a sound masker
because sound masking, I think, and I think a lot of people
probably do feel this way 'cause it's one of the most
common treatments for tinnitus, it can really give a person control over their tinnitus in the moment, which I think that the
ability to have that control, even though we know that the sound therapy probably will not forever
and ever stop the tinnitus, take it away, I think giving that sense
of control to somebody really helps kind of train their brain into thinking that this
is not as dire an issue.

It starts getting you in that mode that you do have some control over it. There are things that
we can do to reduce it, which is very helpful. And so she started to use the
masking therapy for some time. We started her kind of on
a regimen with a therapy in increasing the loudness
of that sound masker to help reduce her hyperacusis, her distress with the loud sounds. – Let me ask you a quick question. And you said they've had
tinnitus for eight years.

Was there a period of time where it spiked or became bothersome, got out of control, and is that when they sought help? – So, yeah, that was
about four or five years before she saw me. It had gotten louder. So she had seen somebody
prior to coming to our center. She had seen an ENT because
she did have some medical, other medical issues. She had dizziness, a
hearing loss at that time. So those medical issues
definitely had to be addressed, and they were initially, and that's when she was initially
fit with the hearing aid, about four or five years ago. When she came to see us, she didn't have a particular
spike in her tinnitus. She was just still looking for a solution. – Got it, it was a chronic
case and it was progressive and it was constant and- – Yeah she just-
– It was on her mind and she wanted to get
an expert help opinions. – Yeah, she just, you know, I think that's pretty typical. Sometimes people will kind
of just look, you know, they're looking for an answer
and it can take a while to find somebody who is, you know, I don't want to say willing to help me, 'cause I think everyone, all healthcare providers are
willing to help the patient, but it definitely is a kind of a niche where there's not a lot of
medical treatment for tinnitus because most tinnitus cases don't have a medical pathologic basis to it.

There are, of course, some
and they definitely need to be medically treated, but most cases are idiopathic
or related to hearing loss or even if it's like
very slight hearing loss. And so it's a tricky thing
to find help for sometimes. – Yeah, definitely. So bring us back. You're working with this patient. You diagnose tinnitus
unilateral hearing loss and hyperacusis sound sensitivity. So how do you approach the expectations, the timeline, and the technology? – So for the expectations for
tinnitus retraining therapy, generally I will set the expectation that it's going to be
about a year to 18 months. And I do tell patients that I do think that's kind of an overshoot. I think most people probably
will notice benefits long before that and that, I
mean, in clinical practice, that's what I've seen. It's really true that it
doesn't usually take that long, but I think realistically it could. And I think having that
timescale can be helpful in not making patients
worry when they don't think that they are where they
should be potentially.

So we set a year as a timeline. She had her own hearing aid, so we adjusted the hearing aid right away. She had it with her, so she
was like that was ready to go, which is nice. Sometimes it can take a couple
of weeks to get that started. We set her hearing aid, like I said, for minimal amplification,
basically nothing. And we put the tinnitus masker in. When I set a tinnitus masker, I'll try to find a comfortable level and I'll do some measurements
with the tinnitus masker to make sure that we're not too loud 'cause she had a pretty
severe hearing loss. So this is going to be a
noise she's going to be having in her ear constantly. Don't want it to be
damaging to her ear further, so you have to make sure that it wasn't putting out too much, but also still be audible to her. And so we started with that then every couple of months
I would follow up with her, do counseling with her in terms, you know, following up, of
course, how she's doing.

And honestly, she very
quickly adapted to her, her loudness tolerance
increased very, very quickly, which I think is typical. And her tinnitus distress
decreased really quickly too, actually a lot faster than I expected. I have here on my notes here. Within a month she had
reduced the amount of time she was hearing her tinnitus. So she was hearing, it
was very bothersome, sometime about 25% of the time when she first came in to see me. And that's primarily when she was in… She would call it bothersome when she would like feel
irritated with her family members, get very, very anxious about it. But it was always present to her, she wasn't able to sleep well. After about a month, she was sleeping. She didn't have any
troubles with sleep anymore. And then after three months, her tinnitus handicap score
dropped from a 72 to a 10. And a 10 is basically
a slight to no handicap from her tinnitus, which
was really amazing.

I did follow up with-
– Say that again so everyone can hear that
a second time please. – Yes, her attended his handicap score dropped from a 72 to a 10 within
about three to four months. She was able to sleep well. Her tinnitus did not go away completely, but she was managing it as
if it wasn't bothering her, as if it was just another
sound in her environment which is really where
we wanted her to get to. – I want to celebrate that great job and great job to the patient. And their brain and their work, obviously, was not a completely passive process.

They put effort into it. – Definitely.
– Earlier, you had stressed the importance of setting
long-term expectations, that this may take a
year, a year and a half, 12 to 18 months before your tinnitus feels significantly different. That said, we often see
patients six months, they're feeling a lot better. So I want to make sure
everyone who's listening in the community here gets that message because it's so important, not to give up. If there's no medical cure, if
there's no medical procedure, or medication that's going to
dramatically change things, then we have to take the long
path and it might not be easy. It might be hard, in
fact, but it's worth it. It's worth it. And what you shared is
important for us to hear. So what was the resolve with this patient after three or four months? How often did you have touch points and what did they report back to you? – So after the three to four month, I did see her at the six month mark, just as part of our kind
of standard or protocol, just to check in on her device, make sure everything was working.

And I usually will often try to do some tinnitus assessment
measurements during the therapy and we actually weren't even able to do it because every time we
put her into the booth she wasn't hearing her tinnitus while we were in the therapy session, which was really great. I mean, actually, maybe we
didn't get our measurements, but obviously, for her, she had times where she wasn't even hearing it. – And that's in a quiet room
where there's no other sound. – In a soundproof, yeah,
well sound-treated room. Yeah.
– Yeah, well, that message is something that I've shared on a different video
with a different patient on a podcast episode. And the response is the
comments were lighting up because that message
is not what people find when they search tinnitus on the internet. – Yeah. – And a big question that honestly I have not had the
long-term care of a patient who's had chronic tinnitus
for years and years and years and who's come to me and we've
dramatically changed things.

So to hear this from you now is, and this is a question that
I get, okay, that's amazing. Then how this patient has
had tinnitus for six months, one year, two years, and it
got better, but what about me? I've had it for four years. I've had it for eight years. I've had it for 20 years. And what you're saying is
this patient had it for, what was it?
– Eight years. – Eight years.
– Eight years, yeah.

– Yeah, so another important point to share to anyone who's listening to each of these podcasts closely, is that you're adding
a very valuable piece that we haven't touched on so
far in these podcast series. That's great. Is there anything else you
want to add on this case study before you switched to another
one you may have heard? – No, I mean, last I've
spoken to her, which is, of course with the pandemic, a lot of things did fall off, but I actually did see her last year. Even with the pandemic, the high stress, she was in one of those
high stress, hard hit areas in the beginning of kind of all of this. And even with that, she was
able to manage her tinnitus. We know that stress can often
spike up tinnitus again. or cause a new distress, but
she was managing very well.

So I think that's probably
good to know that, 'cause I think a lot of
people have that worry too, that what if my tinnitus
gets re-triggered? Or what if I get a new sound
or something like that. And it certainly, I think
it's important to be realistic that it's possible that that can happen. But the therapy isn't treating
your tinnitus sound, right? It's treating your brain's ability to reorganize and deal with it. And that's a skill that you learn and that you'll be able
to use going forward.

– I love that. And what is your opinion on, what's the breakdown between is this a psychological value we're giving or is this a technology
value we're giving? Or if it's somewhere in the
middle, what's the breakdown? Because most of audiologists
are recommending technology. Some of audiologists are
performing counseling techniques that are aimed at the
limbic system of tinnitus. What is your opinion? What was your role in that success story? Technology plus counseling
or one or the other? – I think that's a good question. I think as an audiologist, our role, I think our role should always
be to bring the two together. I think hearing certainly
is a peripheral issue that can partly be treated with
technology amplifying sounds or generating sounds to the ear is definitely one part of it.

But you're always dealing
with the whole person and everything, hearing and tinnitus, all of that happens in the brain. The brain is extremely, extremely complex. And even psychology, like psychological behaviors
and emotions things like that, they do also have a
physiologic basis to them. So I think if we think
of it that way that, and I try to educate
patients this way too, that they themselves also have a role in combining the technology piece, whether it's with an on-air device or an app that has some
noise that they like, or even a behavior,
maybe not a technology, but doing some like exercise, even just exercise,
cardiovascular exercise. So anything to help reduce
their stress levels. And that's where, I think for tinnitus, that's where I think the
technology does come in. It helps reduce some of… It gives you kind of a break
from the constant onslaught sometimes of the tinnitus. And that allows you to focus
on the psychological part, which is the relaxation, stress reduction, and really reframing
the way you're thinking about the tinnitus. And sometimes you can't
do that in certain stages if it really is so bothersome, right? If your anxiety is so up
because of a stimulus, it's very hard to (crackling
drowns out speaker) that's our nature, that's
the way it's supposed to be.

But we're very anxious. Our brains are not supposed
to be focusing on anything except the thing that's making us anxious. That's our survival response. And so taking a break for that is needed to retrain yourself. – Yeah, thank you so much, Sapna. Love that. We have about five more minutes here on today's podcast episode. So we'd love to have you
back for another conversation at a later time where you
can have more success stories and maybe there'll be new success stories that patients you haven't even seen yet.

But I'll now give you an opportunity if you'd like to have more
of a sort of rapid fire case study within five minutes, did you prepare another case
study you'd like to share? – Yeah, sure. I can quickly go through another one. It's a similar type of story
where we, it's with TRT rather. So not a similar history,
but we're using TRT here, so same thing with the technology. Patient came in with a
sudden onset of tinnitus, kind of out of the blue,
doesn't know where I came from, and she came in a very acute state. So this is not someone who
had it for years and years. She was all of a sudden had it and she came within within
the first month of having it and she couldn't sleep. She lost 20 pounds, like
very, very distressed. Also very severe score
on the tinnitus handicap. Her progress was different than the first patient that I discussed. So we fit her with hearing
aids after a couple of weeks.

But the first time I saw her, we did a lot of intensive counseling and really went into very
deep detail about the, as you were mentioning, the limbic system and its important role in
her reaction to the tinnitus. And her husband was with
her, he's an engineer, and he was very interested in kind of learning more about this. So I told him to read the tinnitus retraining therapy
handbook by Dr. Jastreboff and he read it cover to cover. So he ended up being a very
good support for this patient during her therapy, because he kind of
learned all the principles that I was also using to counsel. So with the sound therapy she kind of had a so-so reaction to it. She didn't love having
the sound in her ear, but did find that it
helped reduce her tinnitus.

And so she was a little
intermittent with her usage of it and we did have to adjust
it quite a few times. So that was a bit rocky, but she was getting benefit from it. When I saw her one month later, before we even fit the hearing aids, her handicap score dropped by 20 points, which is significant. And that was just from
the counseling alone. Just the knowledge that
there's some plan in place, that there's a reason for this happening. Over the next five to six months, she had kind of ups and downs where her tinnitus did
get the changed pitch. She had a medical treatment that seemed to make it
worse for some time, but she was always able to come back down and I'll just kind of briefly jump ahead. Where we ended with her essentially was that she was able to eventually sleep with her windows closed, fan turned off, no masking noise on. She didn't stop hearing her tinnitus, she was still hearing it. And she did have periods
where she was like, I want to find a solution
to get rid of it, but she definitely was
able to manage her health and her wellbeing better
around her tinnitus.

So I think it's still a little
bit of a work in progress because she's still looking for a solution to eliminate her tinnitus. I think her husband is
there to support her, to kind of reframe her way of thinking that we're not trying
to take away the sound and that she has been very successful in reducing her tinnitus. But I think that can often happen. I don't know if you've seen that, where sometimes the measure
of what's a success story can be different for different people. – Very much so. And it sounds that you met this patient in what we have coined here, the urgent care phase, where high anxiety,
insomnia, panic states, and it's tough place to be in. And we are there to help that person, and oftentimes that's a team approach. So getting someone through
that urgent care phase as quickly and pain-free
as easy as possible, that's a big part of it. And then the timeline for that case was how many months after? So did you follow them? – That was about five,
six months afterwards.

She lived out of state, so that was also a bit of a Hurdle for her coming in and out. We followed on the telephone quite a bit. And so during the pandemic,
I followed up with her to see if we could do anything remotely, if she needed any follow-up. She actually said she was okay postponing because she felt she felt
comfortable with where she was at. So, so far it's been good. I'm still to follow up with her to kind of see where
she she's left off now. – Great, and that message is so important for those who may have
developed sudden onset loud obtrusive tinnitus
with anxiety, insomnia, and panic tendencies. In those first few months
after that it's really tough. We know, you and I Sapna,
we help people through that. It's not easy and if I've
had to go through that, it would not be easy for me, but there are tools that
work for most people.

And if someone's case
history is like most people, then it probably will work for them too. I really thank you for joining us and I know those listening
will get a lot of value. When we can learn through
others' successes, others' experiences it makes
it much easier and relatable. Tinnitus can be an invisible
and an isolating condition. So anytime we get these stories out there, it's a great thing. I want to pass it to you. Where can someone find you if
they wanted to work with you? And do you have any last messages or projects you're working on
for the tinnitus community? – Well, thank you for having me, Ben.

I want to say also patients can find me at Weill Cornell Medical Center and New York Presbyterian
Hospital in Manhattan. I do provide teletherapy for
patients in New York State. So that's another option for people who are not able to travel in. And in terms of projects I'm working on, I'm not particularly working on any tinnitus research projects, but definitely I'm looking into expanding teletherapy services. I think that's probably one
of the most beneficial ways to reach out to patients. – Thank you so much. This has been episode 24. Tune in for the next episodes, and Sapna, hope to have
you on again sometime. – Thank you, Ben.
– Bye..

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