WEBINAR: Let’s Talk Tinnitus!

>> Hamlin: So let me — so people can actually
understand what I was trying to say, so welcome. Welcome, you all, thank you for joining our
webinar entitled "Let's Talk Tinnitus." Our presenter today is Shahrzad Cohen, Au.D.,
FAAA, lead audiologist and founder of Hearing Loss Solutions. My name is Lise Hamlin, I'm the director of
public policy at the Hearing Loss Association of America and I'm your host today. The mission of HLAA is to open the world of
communication to people with hearing loss by providing information, education, support
and advocacy. HLAA provides people with hearing loss the
tools for self help, educates and advocates for the needs of people who have hearing loss
and promotes the understanding of the nature, causes, complications and ways to address
hearing loss.

We offer educational information on many aspects
of hearing loss, from technological and medical advances to coping strategies, hearing assistive
technology and more. HLAA provides a wide range of local and national
programs and events such as the Walk4Hearing and our annual convention. We also have a nationwide network of chapters
around the country that offer peer support, education, and advocacy in local communities. And of course we advocate for communication
access from the national office. Please see our website, hearingloss.org, for
resources on hearing loss and information on HLAA events. Before we even begin, I would like to thank
our CART provider for this evening, Whitney Riley. Thank you, Whitney, for providing the caption
services for this webinar. If you have any questions, if there are any
questions from the audience, please go to the Q&A, that button at the bottom of the
screen, and then you can type in a question at any point, and at the end of the presentation,

Cohen will answer the questions. I'll read them and she will respond to them. Let me give you a little bit more about Dr.
Cohen. She is the lead audiologist and founder of
Hearing Loss Solutions, as I mentioned. Hearing Loss Solutions is an audiology clinic
that strongly focuses on patients with tinnitus. She is board certified and a fellow of the
American Academy of Audiology, and the Academy of Doctors of Audiology. Dr. Cohen is a member of the California Academy
of Audiology and currently is serving on the advisory board of California Speech and Hearing
Association, District 7, as the Continuing Education Officer.

Dr. Cohen was the director of operations and
lead audiologist for Desyncra — probably pronounced that wrong, but it's close — Neuromodulation
Tinnitus Therapy system, that was in October 1st, 2019. Dr. Cohen received her Masters of Science
degree in Communication Disorders, Audiology, in 2001, from California State University
at Northridge and received a Doctor of Audiology degree from University of Florida. She also holds an Audiology Board Certificate
in Tinnitus Management. Thank you, Dr. Cohen. I appreciate your coming here, and I'm going
to turn the screen over to you for your presentation. Let me do that, and then you can start when
you're ready. >> Cohen: Thank you, everyone. Lise, thank you for the beautiful introduction. I appreciate that. I hope everybody hears me okay. It's my first webinar, so — if I go too fast
or too slow, please do not — please do let me know. Do not hesitate.

Okay. Well — I want to thank everyone. (indiscernible) in tinnitus. Okay. So here we go. We are going to talk about tinnitus solutions,
and we're going to demystify the myth which everybody thinks tinnitus has no solution. I'm hoping that my — okay. Lise, help me, because — here we go. Let us start by talking about the definition
of tinnitus. As all of you know, tinnitus is perception
of sound in head or in your ears, and absence of any external stimuli. So a lot of people think tinnitus is a phantom
disorder. It could be described as a ringing, buzzing,
hissing, roaring, and I have even patients who explain it to me as if it sounds like
a void, they hear a void, absence of sound.

So regardless of how we define tinnitus, we
can categorize it the same way. We have two main categories of tinnitus, and
one is primary tinnitus, which means we do not know the causation of tinnitus, and the
second one is called secondary tinnitus. Secondary tinnitus is always associated with
an etiology or a causation, a factor that comes before the perception of tinnitus. So usually when people complain of suffering
from tinnitus, the major issue becomes is this a primary tinnitus that we cannot give
an etiology to, or it is something else which is causing that tinnitus? And if we are dealing with a secondary tinnitus,
that means we can always go back and alleviate that cause which actually helps the perception
of tinnitus.

There are two things which we are going to
shed the light on, and that is pulsatile tinnitus which means the patient actually hears the
rhythm of their heart beat in their head or in their ears, and that pulsatile tinnitus
needs to always be ruled out prior to any another category, and that is the body sound. It could be that it's a spasm of a muscle,
which is sitting behind the eardrum, or it could be the popping of the eardrum going
in and out due to eustachian tube dysfunction, so somatic tinnitus is another thing which
is given to the patient.

My slides unfortunately are not working. Okay. So in order to figure out what is giving — what
is the etiology, or where the tinnitus is coming from, I want everyone to realize that
it could be that the causation could be of two different. [ Audio fading ]
So one is tonotopic. So that means, thinks about keys of a piano,
we go from lower keys to the upper keys, and every key has a different purpose and a different
sound. So we have outer hair cells and inner hair
cells which those actually by any vibration of sound, the vibration of the hair cells
causes us to hear. So any specific vibration would lead to specific
vibration of the hair cells.

Now, if we have hair cells which are damaged,
we are going to actually have the brain perceive a sound which comes up and it's not of a good
quality for interpretation. So that gives a causation for perception of
tinnitus, because our brain's job is to. [ Audio fading ]
… perceive the sound and associate the sound which is coming in, and if the sound is — I'm
hoping to see if I can have — I have a message saying that you guys don't
have my voice, is that correct? >> Hamlin: Dr. Cohen, this is Lise. You've been fading in and out, but I'm hearing
you now, so let's try to move forward. Okay? And I'll let you know if we're having trouble
with the — >> Cohen: I'm sitting at the same location
not moving, so I'm hoping you guys do not have the problem; however, my slides are not
working right now.

>> Hamlin: Try putting your cursor overtop
of the slides and then try to move them forward after the cursor is there. If you would like, I can take the screen back
— I can try taking the screen back and moving them forward, you just let me know when to
move them, do you want to try that? Okay. I'll move them for you. You tell me when to move them. >> Cohen: Next slide. Okay. Sorry about the trouble, guys, we actually,
believe it or not, we've been playing with game with each other, Lise and I, about three
times, and we've never run into a problem.

[ Audio fading ]
Until right now. So continuation is that if the hair cells
— if you look the hair cells are missing, we have damaged hair cells and the sound that
comes up to the brain for interpretation is not of good quality and could be perceived
as tinnitus. Next slide please? Okay. So this is a tonotopic representation of the
cochlea and the brain. So not only our cochlea has hair cells, each
one plays like keys of a piano, rather our auditory cortex has a different association
of each pitch that comes in. So if a pitch comes in, an auditory cortex
gets stimulated, that's what we know that that is the sound which is coming in. Now, sometimes, we — there is a new idea
— right now there is a new idea in tinnitus treatment and that is tinnitus is perceived
by overstimulation of… and one specifically. >> Hamlin: Dr. Cohen, we've lost a little
bit again, I think what happens is you lose Wi-Fi every so often, the screen freezes and
we'll go forward.

I'll try to let you know when that happens. You're back, okay?
>> Cohen: Okay. >> Hamlin: So I think you can go ahead now. >> Cohen: Can I have the next slide, please? Okay. So if you can look, this is a left hemisphere,
a right hemisphere of auditory cortex, you can look at the different coloration, which
actually corresponds with the stimulation area in the brain. So — next slide, please? All right. So one idea about tinnitus, as I said, is
that we think tinnitus is actually perceived in the auditory cortex due to overstimulation
of the brain. And functional MRI is a way for us to actually
research that.

And if you look, the head which is in the
left hand side, you see the area green, and that is a patient who is suffering from tinnitus. And the right side actually shows after we
treat tinnitus, the overstimulation is not there and the auditory cortex becomes small
again. Next slide, please. Okay. So we are, as I mentioned, the pathophysiology
of tinnitus could be of two kinds. It could be a cochlear damage which is a damage
to the outer hair cells of the cochlea or it could be a cortical damage, which is hyperactivity
in the auditory cortex. Now, we have one — another idea which is
coming in and it is getting proposed by scientists and that is that actually tinnitus could be
due to the way that the sound gets transferred from cochlea all the way up into the auditory
cortex, and that is called the demyelination or central auditory fiber disorders which
is coming up, and this, again, right now, what is the actual etiology or causation of
tinnitus is still up for debate.

Next slide, please. All right. Before I start to talk about the tinnitus
treatment, I want to talk about tinnitus and what are the red flags that people should
be paying attention to? Tinnitus is a red flag if it is associated
with a unilateral hearing loss or a symmetrical hearing loss, means one side of one of the
ears perceives tinnitus or perceives a sudden hearing loss or sudden change in the hearing
loss in recent years — in recent months. So I want anyone who suffers from tinnitus
or hearing loss or has any sudden changes to their hearing see an audiologist or an
ENT physician as soon as they can, because there are a lot of treatments that we could
give to the patient who has that issue, and hopefully then the tinnitus doesn't become
a permanent issue.

If there is pain, vertigo or any vision problems,
if there is pulsatile problem, pulsatile tinnitus or if there is any rhythmic problem to tinnitus
that I want people to refer to a physician. Next slide, please. All right. So we are here to debunk a few myths about
tinnitus. One of them is that you have to learn to live
with your tinnitus. Or tinnitus is a curse of sins previously
committed. The other is that there is no treatment to
tinnitus. One major one for me and my pet peeve is that
people are told wait six months before you seek treatment for your tinnitus. Actually, the research shows that patients
who wait six months, the rate of their success in alleviating tinnitus is much less. Not true. And tinnitus will drive you crazy, definitely
not. Next slide, please. So I'm hoping that everyone after the end
of this webinar will agree with me that these are all myths and nobody has to live with

So we're going to talk about treatments of
tinnitus which is currently available. Next slide, please. So I have categorized tinnitus management
options to two categories. One's based on Neuro- physiological model,
and the other one is based on Neuro-desynchrony model. Tinnitus is a
reaction to sound that comes in. Hyperactivity and desynchrony model talks
about model of tinnitus as it's perceived in hyperactivity in auditory cortex, and we
will go through all these details of each therapy, but I want you to think that neuro
physiological model basically talks about disassociation of the perception of tinnitus
and the emotional reaction to tinnitus.

This means if we actually take control of
our tinnitus, and we do not negatively associate tinnitus and we do not react to it, the tinnitus
becomes like our shoes that we wear every day. Once we put on our shoes, we feel our shoes
and as we go through the day, we really do not feel our shoes anymore. The hyperactivity model talks about as previously
mentioned in the last slide, about the overactivity in the auditory cortex and all the treatments
which are offered talk about the ways that we can actually take away this — desynchronize
all of those overactivity, because the overactivity is not there, the tinnitus gets treated. So next slide, please. So in this slide, again, I have different
methods of tinnitus treatments listed in a different category. So they are the same treatments, Cognitive
Behavior Therapy; Tinnitus Retraining Therapy. These are the ones which actually follow the
psychological options they have then we have instrumentation options, those are the options
that actually offer a treatment through use of an instrument to the patient, like hearing
aids, Levo System, and neuromodulation therapy systems. And then we have acoustic options, which basically
we offer sound to the patient which because the brain starts perceiving a meaningful sound,
then the tinnitus, which is not a meaningful sound, takes the back seat.

So all these therapies, this slide and the
last slide offer the same therapies; the only difference is the categorization of them,
and I want — now we're going to go through each category one by one. Next slide, please? Before I start talking about acoustic therapies
or sound therapies, I want to talk about what could effectively been done in your everyday
model that — daily life that you can actually try to see if you can decrease perception
of tinnitus. Dietary modification is one in which I usually
talk to my patients about, so we usually start in my private practice, I usually start with
dietary modification and asking my patients to keep a journal of what they eat. The reasoning is that there is an idea behind
tinnitus perception that if we actually increase the hydration in the body, and if we increase…

>> Hamlin: I'm sorry, Dr. Cohen, we've lost
you — >> Cohen: I'm here. Do you hear me? >> Hamlin: Okay, we lost you at the part you
were talking about hydration, so if you could back up just a bit to talk about that, that
will — your Wi-Fi is back. >> Cohen: Sure. Sure. Sure. Okay. So going back — so in my private practice,
I will say that … Always start a food journal. >> Hamlin: Sorry, we're losing you again. Okay, you're back. I'm sorry. >> Cohen: Okay. So research shows that if they have some sort
of an allergic reaction in the body, we actually have patients complaining of perceived perception
of tinnitus.

Sodium intake, salt, is one of the main …
Areas, research which indicates that increased sodium intake actually is associated with
perceived loudness of tinnitus in a lot of patients. Coffee is another food modification which
I request my patients to make. I need to tell you about coffee, and that
is it's not about caffeination or decaf coffee, rather it is the chemistry of coffee which
is causing the tinnitus perception. So a lot of patients, if they stop the intake
of coffee, they would possibly perceive a decrease in perception of tinnitus. Chocolate, strawberries, dairy. All of these, alcohol, white sugar intake,
and Turmeric are the other factors which we — I try to actually have my patients pay
attention to, and again the idea behind the dietary modification is that there is some
sort of a hyperallergic reaction of the body.

>> Hamlin: Dr. Cohen, your Wi-Fi is frozen
again. >> Cohen: Tinnitus —
>> Hamlin: We still can't hear you. We're getting sounds and I think it's the
Wi-Fi problem. Now we've lost you altogether. Okay. So be patient, we may need our presenter to
reboot or to get a stronger Wi-Fi signal. There she is. She's back. Okay. Dr. Cohen, if you can monitor the captions,
and you can see where Whitney loses you, and that's where the rest of us can't hear you
either. Are you able to see captions? Still frozen here. >> Cohen: I see the captions. I see the captions. >> Hamlin: Okay. So if you see where Whitney cannot hear you,
that's where no one can hear you, okay? Okay. I think we're good. You can try again. We're talking about coffee —
>> Cohen: can I have the next slide please.

Okay. You lost me at coffee. Basically, everyone, I apologize for this. I have no idea what is happening. So basically, just this slide talks about
— can cut out of your diet in order to see if you see any positive results in decreasing
the perception of your tinnitus. Coffee, chocolate, strawberry, and Turmeric
are all things that you can take away from your diet to see if your tinnitus loudness
or frequency of perception could get decreased. Next slide, please. Okay. One thing which I always ask my patients to
do is to hydrate often. Green tea has been used in treatment of tinnitus
in Chinese medicine over many, many years. The reason for use of the green tea is number
one the fact that green tea is a diuretic. That means if there is any excessive fluid
buildup in the body, we can actually use green tea to get rid of it. Sometimes if we have many years of …
Asking patients to try green tea, we actually see a decrease in perception of tinnitus.

So I want everyone to try the green tea with
talking to their physicians first, because of the factor that the green tea is diuretic
and in people who have diabetes or liver problems or kidney problems, they actually should use
green tea after talking to their doctors. So next slide please. All right. So the life modification that I want you guys
to think about is of two categories. Increasing the blood flow to the cochlea,
which in turn causes the oxygenation of cochlea. The reason is this, that sometimes, like in
cases of Meniere's disease or cochlear hydrops, if we increase the oxygen flow to the cochlea,
we see the decrease in perception of tinnitus. What are the things that you could do in order
to decrease the oxygenation? Light exercise. Walking, dancing, yoga. All of these not only are considered a light
form of exercise, rather because they have involvement of the good hormones, we actually
see positive effect in the perception of tinnitus.

I have actually a research and development
which talks about dancing and decrease in perception of tinnitus, and we are using dancing
because of a few factors. Number one, as it's involves our good hormones,
happy hormones, the second thing is because it involves positive use of acoustic, which
is sound, and the third is because it's actually increasing the blood flow all over the body. Last thing which I ask everyone to try to
see if they would positively effect tinnitus is actually listen to tinnitus. We have been telling our patients to ignore
tinnitus, and there is research coming out of the field of psychology which talks about
if we actually have patients effectively listened to tinnitus, the negative emotional reactions
go away, and that is the cause for the tinnitus to take a back seat, because suddenly the
tinnitus is not the enemy anymore. I hope all of you guys by trying these few
things, you will see very positive outcome in your daily life. Now, if none of these work, the next slide
is going to talk about… the specific. All right, environmental modification before
we get to any acoustics.

Avoid quiet. Quiet is the enemy of tinnitus. Use music, nature sounds, any meaningful sound
in the background in order to have your brain avoid the perception or fixating — fixation
on the perception of tinnitus. Overexposure to loud noises, such as police
officers or people who listen to loud noises, is one of the most important suggestions that
I have for everyone. The next suggestion that I have is to avoid
maskers. Maskers are not a treatment for tinnitus and
a research came up about two or three months ago that actually shows that usage of maskers
is aging the brain faster than what we expected. So in my own private practice, I try to ask
my patients to avoid maskers, and I usually suggest use of music or nature sounds. What we don't like about maskers is that they
all use cochlea at one — usually parallels with the damage to that specific frequency
in cochlea, so we do not want to overstimulate that damaged area.

And we want to sort of increase the frequency
bandwidth that the cochlea is using the sound. Next slide, please. Cognitive Behavior Therapy, CBT. CBT is a psychological method of dealing with
tinnitus, and the modified version of CBT under different titles are being used in audiology
offices. CBT, Cognitive Behavior Therapy, is what audiologists
treat tinnitus. And …
>> Hamlin: Dr. Cohen, we've lost you again. >> Cohen: When we have issues, an audiologist
… Do you have me again. >> Hamlin: Okay, you're back. >> Cohen: All right. So when we have offices that psychologists
and audiologists do not work with each other, then we have to choose a treatment when the
audiologist can provide this direct, and TRT, Tinnitus Retraining Therapy, and Progressive
Tinnitus Management, PTM, both are one of those CBT-related treatments that we are offering.

Next slide, please? Tinnitus Retraining Therapy, which is based
on the idea of habituation was introduced by Dr. Jastreboff. Dr. Jastreboff is the lead researcher in tinnitus
and tinnitus treatment. And his idea of tinnitus therapy basically
talks about this association of tinnitus and negative emotional reaction to tinnitus. This method usually is based on education
of the patient about what tinnitus causation is and how we can actually take tinnitus from
something that the brain perceives as enemy to something that the brain actually associated
with, oh, I know what is happening, so I don't have to worry about it anymore. So TRT brings tinnitus from an idea which
the brain has to fight with in order to keep us alive to, oh, I know — quote, unquote
I know what is happening so I don't have to worry about it anymore. The emphasis of this method of tinnitus treatment
is Habituation.

Habituation is when we get used to something. Basically thinking about wearing our shoes
in the morning again, or the first day that we get married, we start wearing wedding band
on our fingers, that it feels odd, but after so many years, if we don't have the wedding
band, that's when we miss it, so we hopefully try by using Habituation method, and the Jastreboff
model to bring tinnitus from an enemy standpoint that, oh, I know what that is, I'm going to
let it go and not pay attention to it. Next slide please. Progressive Tinnitus Management is a behavioral
modification, and this treatment is being used in VA in most of our veterans which are
coming back. This treatment method is used by Mr. James
Henry of Portland, and if you need information if you put James Henry, a lot of data shows
up, and I have actually, my patients, doing this, research prior to I actually offer it
in the office for them, because once they start reading about it, usually after the
second or third session, they have the control of their tinnitus and they don't need many
me anymore.

So I'm hoping that this becomes a method that
you guys could all research. Next method — next slide, please. Tinnitus activities treatment is another behavioral
modification that is offered in tinnitus clinics. This talks about basically things that a patient
could do in their normal daily life in order to decrease the negative emotional reaction
to tinnitus. So basically, this method of tinnitus treatment
concentrates on, for the lack of better word, homeworks, things that you could do in your
daily life that would decrease the perception of tinnitus or takes attention away from the
perception of tinnitus. So in this method, patient is encouraged to
find their own solutions through counseling and appropriate situational results or scenarios
that the therapist and the patient come to an agreement. Most I would say that I see success within
my own private clinic is with sleep or concentration issues.

Tinnitus activities treatment is very, very
useful when we are trying to have a patient find solutions to the things that they could
do to alleviate issues of bothersome tinnitus, during concentration time and sleeping time. Next slide, please. Neuromodulation Therapy is the latest development
in world of tinnitus therapies. This method of therapy talks about cochlear
overstimulation — I'm sorry, about Auditory Cortex Overstimulation. Through the Neuromodulation therapies, what
we do is that we try to use specific binary systems in order to regenerate auditory brain
pathways or use the brain plasticity overcome perception of tinnitus. So Neuromodulation therapies that are currently
being used are of — are offered by two companies. Next slide, please. The first company is Desyncra offers the therapy
through an iPod, and it has its own specific head phone.

This system of therapy basically has for calculated
tones which the audiologist is trained to program this device based on the perception
— the specific perception of tinnitus of the patient. This device is FDA approved and currently
is being used in many clinics in the USA, and the session of the therapy for this is
about 36 weeks, the course of the therapy, and it requires a few visits to the audiologist
in order for reprogramming as the tinnitus perception changes. Next slide, please. Neuromod of Dublin, Ireland, is another therapy
using the Neuromodulation. Neuromod actually uses tiny electrodes so
we have stimulation. It's not only an acoustic signal, rather as
you see in the next slide, you are going to see that they actually have a little electrode
that the patient puts into their mouth and locates it on the tongue.

Can I have the next slide, please? Okay, so as you see, that white tongue part
sits on the front part of the tongue and the patient is listening to the acoustic signals. So true delivery by modal delivery of electric
shock, very small electric shock, and the sound that is perceived in auditory cortex,
we see that patients tell us that the tinnitus has better — or actually tinnitus is decreased,
the loudness perception is decreased, and it's not as often. Neuromod currently is not offered in USA and
only has a CE seal of approval which is for Europe. Next slide please. Levo System is forceful habituation. Levo System is developed by otoharmonics,
it's available in the USA, it has the FDA approval. It's forceful habituation to the sound of
tinnitus. If you see the next slide — can I have the
next slide, please? If you sort of pay attention, Levo System
uses the same iPod, and the sound that the patient hears is the same as their own tinnitus,
so in this, the use of this device, we actually have the audiologist match the sound that
the patient hears as closely as possible to their own sound of tinnitus, and because the
patient is forced to fall asleep to their own tinnitus, when we take the sound away
through the daily life, the brain is already retrained to ignore the tinnitus.

Next slide, please. Hearing Amplification Technology is another
method that we deal with tinnitus. This method of treatment talks about or basically
uses the concept of the stimulating other parts of the brain and other outer hair cells. Hearing amplification also works because we
increase the perception of sound, and take attention away from tinnitus. I want to bring a little bit more attention
to using amplification as a tinnitus treatment, because a lot of offices are using hearing
aid as the only method of treatment of tinnitus, and I, in my private practice, believe that
this should not be it. Hearing aids are very, very effective; however,
other solutions should be used in addition to use of an amplification. Next slide, please. I'm going to jump over this and let everyone
read this. Basically the reason is this: We don't have
time and I want to be able to answer some questions.

Can I have the next slide, please? Okay. Acoustic Sound Therapy are all the masking
systems that we use. So maskers are — here we go, that's good. So maskers are any kind of sound that is used
in addition… Which introduces the sound. I lost caption. Okay. Are you guys still hearing me? >> Hamlin: I'm sorry, it took me a minute
to unmute. I lost you for a minute. Can you speak now? Okay. You're good. Go ahead. >> Cohen: Okay. Acoustic Therapy Systems are any system that
you use regardless of how you introduce the sound to the — to the ears or to the brain.

I want everyone to think about this. It could be a hearing aid, it could be a head
phone. It could be therapy systems. Regardless of the delivery method, any time
that we increase the sound in the environment, we actually can mask the tinnitus perception. Next slide, please. Next one. We're going to jump over these few slides
because we're going to leave ten minutes for everyone to answer. Surgical treatment of tinnitus and this usually
talks about secondary tinnitus, secondary tinnitus could be treated once we fix the
problem which is causing the tinnitus. So if the tinnitus causation is because of
the lack of hearing, cochlear implants, bone-anchored hearing aids or middle ear implants could
actually benefit the patient, because of increase the perception of regular environmental sounds. Next slide, please? You are going to see all the alternative treatment
methods which are listed in this slide. All these alternative methods are the methods
which are not proven through scientific studies rather we see a lot of patients reporting
back to us that these methods of therapy are proving to be beneficial. I'm going to just leave it at that.

I want everyone to just have a list of these
things which are available, but if anybody needs to ask me any specific questions, I
will release my e-mail and you can send me e-mails so I can answer your specific questions. Next, the slide and last thing before I revert
to questions would be who can treat tinnitus? I want everyone to know that main treatment
of tinnitus lie with audiologists who hold a certificate in Tinnitus Management. So American Academy of Audiology has recently
offered a CHTM course, Certificate Holder Tinnitus Management, for all the audiologists
who are interested in dealing with tinnitus. I want everyone to pay attention to this detail,
because audiology, like any other profession, has general practitioners, and specialists,
and if there is only one thing that you walk away with today, that is please find a specialist
who would be able to help your specific situation.

If you walk into a clinic and the only option
that they offer you is a hearing aid, that office is not a tinnitus clinic. And all the offices, which are associated
and work on tinnitus, the therapist or the audiologists have multiple methods of dealing
with tinnitus. And I would love to hear your feedback if
you find an office which is advertising as a tinnitus treatment, but actually is not
offering anything beyond hearing aids. All right. I'm going to wait to hear some questions and
I will love to answer some of the questions. Again, I want to thank everyone. And I apologize for all the technical issues
that we have been having. >> Hamlin: Thank you so much for actually
muffling through all our technical problems here. I do have some questions here. I will say this to everyone. Dr. Cohen has said she will release her e-mail. You can also e-mail Hearing Loss Association
of America if you have questions that we don't get to, and then I'll forward them to Dr.

So the first one is a very basic question
which was what is a hair cell? >> Cohen: If you go back to the beginning
of the slides, and organ of hearing, cochlea, we have little — go — this is it. That's it. So an organ of hearing, which is cochlea,
which is located under our brain, in our inner ear, this row of hair cells is — the vibration
of these rows of hair cells is what is causing the perception of sound. So basically hair cells are the coding mechanisms
of our brain for sound.

Next question, please? >> Hamlin: Okay. So we have a question from somebody who says
I saw your slide mentioning the use of CBD — CBD, I'm sorry, it's my eyes here now — with
tinnitus. Okay, you know what we're talking about then? Okay. She says she found — this person says they
found a PubMed study and have tried dosing low five to fifteen milligram on a daily basis
and I had great improvement. I had already made the dietary changes because
of cochlea hydrops diagnosis, so do you have any comments about that? >> Cohen: Correct.

Yes. Again, this method of treatment falls into
the category of anecdotal reports. Right now we are just in the beginning stages
of doing clinical research studies and scientific research studies about the positive or negative
effects of CBD, but from what I see in my own private practice, many patients report
that use of CBD positively affecting their tinnitus perception. And what I can tell you from personal experience,
it's because tinnitus and anxiety go hand in hand. What CBD does is that it decreases the anxiety
and the frontal lobe involvement of the negative emotional reaction to tinnitus and that causes
the decrease in the perception of tinnitus. >> Hamlin: Okay. I think I have time for another question here.

Why do I perceive tinnitus in the right ear
which is this person's deaf ear, and it is the left ear with severe-to-profound hearing
loss, or sometimes equally in both ears? >> Cohen: Okay. So this is a very good question. This actually is where we talk about the different
category of the tinnitus. So if we have damage to the outer hair cells,
tinnitus becomes the phantom perception, and that is where we have the overstimulation
of the auditory cortex. So this person, when you hear the tinnitus
… That's when we talk about that patient could
actually benefit from the use of Acoustic Neuromodulation therapy. And when we talk about the patient who has
a hearing loss and a tinnitus, those are the patients who actually could benefit from acoustic
therapies. >> Hamlin: Okay. We are coming up on 3:59 here. Again, please feel free to e-mail — you can
email me, lhamlin@hearingloss.org or email us at inquiry@hearingloss.org and we will
make sure — and Dr.

Cohen, did you want to say something too. >> Cohen: Yes, please. Actually, we have a new Facebook page that
everybody could go and actually place their questions on. We have a group of tinnitus therapies to answer
questions on that page, and that is Tinnitus Professional Support on Facebook. So if you go to the last page on this slide,
all the information is there. Tinnitus Professional Support on Facebook. We would love to answer all your questions. >> Hamlin: I'm going to try to put that up
now. Okay. Sorry. Went too far Let me see if I can go back here. Okay. I lost it again. But we do have to end, so I want to thank
you so much for, with all our technical problems, that you got through this.

I want to thank Whitney once again who is
fabulous in picking up what things I could not hear, I'm sure others could not hear as well. There's the page where you can contact Dr.
Cohen and again thank you so much Dr. Cohen. It's a lot of really wonderful information. >> Cohen: It's a pleasure to be amongst you, bye bye.
>> Hamlin: Bye bye now..

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