Why do I have ringing in the ears and what can I do to treat it?
“I cannot remember ever NOT hearing a slight, high pitched ringing in my ears any time I am in a quiet room. My tinnitus has been present since childhood. It is why I have always slept with a fan or white noise on at night, but other than that, it has never really bothered me because my brain just doesn’t know any differently!” While I hear this story often, I often hear complaints from patients who are struggling to overcome the ringing in the ears.
Tinnitus, that “ringing in your ears”, generally develops because of some level of hearing loss for most patients. Hearing loss does not always cause tinnitus, however, and some patients experience tinnitus with perfectly normal hearing and no physiological problem with their ears (like me). So, what does your tinnitus mean? What tinnitus treatment is there for you?
Over 14 years of working with hearing loss and tinnitus patients has taught me that the answers to those questions are as varied and individual as the patients I treat. The history of tinnitus treatment and tinnitus cures date back to the ancient Egyptians who would pour all kinds of things into the ear canal to try to treat tinnitus. In the middle ages, a Welsh treatment involved cutting a hot loaf of bread in half and putting it over each ear as hot as you could take it to “sweat” out the tinnitus. Modern medicine today has yet to find a cure for tinnitus, but certainly has some better options to treat tinnitus than our ancestors.
We understand now that while tinnitus can be the result of damage to or a disorder of the hearing nerve, it is really coming from the brain in most cases. There is ongoing research in this area and as science and medicine continue to evolve there is no reason to believe that we won’t find a cure for tinnitus at some point. Currently, there is no one treatment that has been proven to be effective to cure tinnitus, but there are many options for treatment.
The first step in evaluating and treating your tinnitus is a hearing test. An audiologist, like myself, can assess your hearing and determine if you need to visit with an ENT physician about any conditions causing your tinnitus that could be treated medically or surgically. For many patients, the process of having a hearing test and reviewing the results can reduce the anxiety that often comes with the new onset of tinnitus. Recommendations such as keeping noise in your environment and having a noise source operating while trying to sleep can be all that is needed for some patients to manage the ringing in the ears. There are smartphone apps out there to help with creating this white noise experience. Remember that I said my brain does not know what it is like to NOT have tinnitus. I believe that is why it does not bother me. Most patients can learn to habituate to their tinnitus and in time, their brain stops focusing on it and is no longer bothered by it ether.
If you have hearing loss, an audiologist can prescribe the best hearing aids for your specific loss. I agree with the statistic that about 60% of patients with hearing loss and tinnitus find the use of hearing aids effectively treats the ringing in the ears. I have heard the phrase, “my crickets are gone,” more than once over the years when tinnitus patients first experience wearing their hearing aids. Most modern hearing aids have features that can be programed and customized by your audiologist to help mask the tinnitus sounds you hear as well. They are not a tinnitus cure, but they can be an excellent treatment.
What happens if even the best hearing aids do not alleviate the irritating ringing? The American Tinnitus Association recommends patients consider these tools for use in tinnitus treatment: hearing aids, sound therapy, cognitive behavioral therapy, drug therapy with medications that reduce symptoms of anxiety or depression, maintaining general wellness and temporomandibular joint treatment. As an audiologist, I have seen patients benefit from various combinations of some or all these tools to treat their tinnitus. Tinnitus can be debilitating, and if you are experiencing anxiety, depression, or withdrawal from social activities due to your tinnitus you should absolutely talk to your audiologist about what you have tried and what tools might be available to try to give you some tinnitus relief. I believe firmly in a patient centered approach to treating tinnitus and in working with physicians and therapists to find the best combination of treatments for each patient.
The bottom line is there is no one size fits all answer to tinnitus treatment. What may work for you may not work for your neighbor. Therefore, consulting an audiologist familiar with tinnitus treatment is the best first step to answering your questions and determining what will work best for you. If you or someone you know struggles to overcome their tinnitus, request a consult today!
Rachel Bringewatt, Au.D, F-AAA
Top 10 Questions Patients Ask Before & After Sinus Surgery
When your ENT specialist recommends surgery for chronic sinusitis, this is often received with a lot of anxiety about what to expect. In an attempt to help those patients trying to decide whether or not this is the next step in treatment of their chronic sinus infections, we have asked our nursing staff and surgery schedulers their top 10 questions they receive from patients before and after surgery.
10. Am I a candidate for sinus surgery?
Sinus surgery is offered to patients who have failed medical treatment for sinusitis symptoms that have lasted over three months and show areas of obstruction on a sinus CT scan.
While sinus surgery can be indicated for other reasons such as tumors, facial trauma, etc., sinus surgery is most often performed for patients who suffer from chronic sinusitis.
9. What will sinus surgery cost?
Due to everyone’s insurance being different and everyone’s anatomy being different, cost for sinus surgery is different for everyone.
Sinus surgery is most often applied to insurance deductibles and co-insurance, so it is helpful to know how much your insurance requires you to pay before they start paying. Most patients meet their deductible with sinus surgery, even if they have a high deductible, due to costs associated not only with their surgeon but also anesthesia, hospital costs, and laboratory bills. You should also note that follow up visits for sinus surgery are all billable as well.
8. Can I continue to take my regular medications before and after surgery?
If you take a medication that thins your blood, you will be required to stop it 1-2 weeks prior to surgery and stay off it for 1-2 weeks after surgery.
Excess bleeding makes surgery more difficult for your surgeon and makes your recovery tougher as well. It is important that you discuss your medications with your surgeon, and they will let you know if you need to talk to your primary care or Cardiologist about discontinuing your regular medications.
7. How long do I need to be off work for sinus surgery?
For patients working a desk job, most will take from 4-7 days off work; however, for patients who work labor jobs, 10-14 days off work is more realistic.
The time off work is usually due to discomfort felt after surgery, effects of anesthesia, and post-op bleeding risks.
6. When can I resume my exercise routine after sinus surgery?
Because of the increased risk for bleeding, patients are advised to avoid exercising for two weeks after surgery.
While your surgeon may allow a leisurely walk after one week, they will certainly ask that you avoid any activity that gets your pulse or blood pressure too high such as running, heavy lifting, etc.
5. How much pain will I feel after sinus surgery?
Pain is different for everyone, and while some people require their narcotic pain medications, others take nothing at all.
4. What is the most common complaint of patients after sinus surgery?
Severe nasal congestion that causes a lot of pressure and makes it difficult to breathe out of the nose is a guarantee after sinus surgery.
Clear to bloody drainage is also common, as the nose’s response to trauma is first to swell and second to increase mucus production.
3. When can I blow my nose after sinus surgery?
Your surgeon typically will not allow you to blow your nose for two weeks following sinus surgery.
Not only are you a bleed risk during this time, you are also at risk to rupture the paper-thin bones in the areas around your brain and eyes by forcing air into those spaces.
2. When can I start using my sinus rinse after sinus surgery?
You can begin rinsing your nose the day after your sinus surgery.
You can over use the sinus rinse, and more is usually better in this scenario. Think of it this way, the more your rinse, the less stuff there is for us to suck out of there at your follow up visits!
1. What tips and tricks would you recommend to help ease recovery from sinus surgery?
It is a good idea to sleep in a reclining position and use over the counter Afrin a couple times a day to help with pressure and swelling.
Saline spray throughout the day and sinus rinses four or more times a day is highly encouraged to help with drainage and any residual dissolvable packing.
If you have a question about what to expect before or after your sinus surgery that isn’t listed here, please do not hesitate to contact us here online, through your Patient Portal, or call us at 402-778-5250.
What is the Pollen Count in Omaha?
The weather in Omaha is finally nice – after the snow we had in April. This brings with it beautiful flowers, green grass, full trees, and a plethora of outdoor activities to enjoy. For people with environmental allergies (tree allergies, grass allergies, weed allergies), this time of year, which should be something to look forward to, is often a time of dread and measure of endurance. But does it have to be?
First thing to consider when venturing out into the great outdoors if you have allergies is the pollen count. High pollen counts = increase in allergy symptoms.
How do I check the pollen count for my area?
Easy! Just follow this link, and for ease of access make it a favorite on your web browser for easy access.
Still not easy enough? Why not try a pollen forecast app! There are many to choose from depending on if you have an Android or iPhone. Some of the top apps for predicting whether the weather is going to cooperate with your allergies include (but are not limited to): My Pollen Forecast (iPhone only) and WebMD Allergy (iPhone & Android). Other weather apps include the pollen count feature, but these two apps focus solely on pollen counts.
How do I prevent an allergy attack if I have to be outside?
Before heading out to mow the grass or watch your kid (or grandkid) play baseball, make sure that you have taken your oral antihistamine. Available over the counter, these medications include: Claritin, Zyrtec, Allegra, and Xyzal or their generic equivalents. Also advised by our ENTs is a steroid nasal spray such as Flonase, Nasacort or Rhinocort – again available over the counter. And if you have been outside and suffer from allergies, you should shower after coming inside and rinse your nose with a sinus rinse or NettiPot.
What do I do if avoidance and medication is not working for my allergies?
At this point, you should probably consider seeing an ENT! You may need something stronger that is only available by prescription to get your allergies under control. Also, it may be time to start thinking about allergy testing and allergy shots – or allergy drops, which are also available through our Allergy Clinic. If this scenario sounds familiar, request your appointment online today!
...or Laural Yanny as Explained by a Doctor of Audiology
By now you have heard the audio file that went viral last week of the voice recording of the word, “Laurel.” Some people swear they hear “Yanny,” and others only Laurel. Some hear both, and even a handful of others hear something different entirely (I heard “cherry” reported by one listener). As an audiologist and lifelong student of music and sound it intrigued me enough to click along and read the origins and explanations people were giving.
The internet is ablaze with explanations about this phenomenon. It seems to have originated from the website www.vocabulary.com and the voice recording available for play on that site of the word, “Laurel.” Someone listened to it, heard “Yanny,” and shared it. I first saw it pop up on a Facebook group for audiologists and even in a group of hearing science experts, results were very divided!
The spectrum of frequencies that comprise the two words overlap and depending on the speakers you are listening recording on it can sound different. Taking the same recording and reducing the low frequencies while increasing the highs results in a more “Yanny” sounding result. Shifting the emphasis to the lows and decreasing the highs makes it sound more “Laurel” than ever. Some have pointed out that if you have high frequency hearing loss (which is a common result of noise exposure and the natural process of hearing loss related to aging), you are less likely to hear Yanny. This may be true, but does not explain how two individuals, both with normal hearing, can listen to the same recording on the same speakers and hear something different!
The explanation is truly all in your head. While we often think of hearing occurring at the level of the ear, our brain is where that sound is processed and truly “heard”. Our brains and expectations of what we are hearing are individual to us. If we are predisposed to thinking we will hear one thing vs. another we are more likely to hear it. For example, two audio recordings were shared on the following page https://news.nationalgeographic.com/2018/05/yanny-laurel-hear-sound-audio-explained-science-spd/
In the first clip, you hear a very distorted signal that sounds like noise with no discernable words. The second recording plays a clear phrase in the forefront of the noise, “The juice of lemons makes fine punch.” Listen to that first recording again, and you clearly hear that phrase stand out from the noise even though the recording has not changed at all! Our brains are truly amazing.
Two things stand out to me in all of this fun and curious debate. One: the quality of the speakers you are listening to or through can affect how you hear what you hear. Two: hearing is a somewhat personalized sense! As an audiologist I can attest to both of these things from years of experience fitting hearing aids. I can have two patients with the exact same audiogram and same degree and type of hearing loss, but they may not both prefer the same hearing aid or function optimally with the exact same settings. This is the reason why poor-quality devices produce less than optimal results. It is also why obtaining the best fit with hearing aids and personal sound amplifying products really takes some customization. The process by which I have been most successful helping individuals with their hearing loss and listening needs is centered around the unique and individual hearing concerns and needs of each patient. There is no one size fits all product out there for hearing loss and, even though your neighbor loves product X, it may not be the best for you!
So, whether you hear Laurel OR Yanny, know that I would love the opportunity to listen to your unique hearing needs and customize a personalized solution for you.
But, it is LAUREL in my brain :)
Rachel Bringewatt, Au.D., F-AAA
Tinnitus is an annoying problem with no known cause or cure. The main treatment for ringing in the ears is known as masking. There are multiple apps out there for people to mask their tinnitus; however, we have made this easier by narrowing it down to our top 5 favorites. To make the list, the app had to be free, available on both Android and iOS devices, and have a rating higher than 4 stars.
5. ReSound Relief.
User Rating: 4 Stars
This app uses a combination of relaxing exercises to help ease anxiety caused by tinnitus as well as offering a white noise generator to train the brain over time to focus less on the ringing in the ears. The ReSound Relief app allows users to use default white noise or create their own from a collection of environmental sounds and light music.
4. Beltone Tinnitus Calmer.
User Rating: 4.5 Stars
Much like the ReSound Relief app, the Beltone Tinnitus Calmer offers similar feature of a white noise generator along with exercises to manage anxiety. This app will track your usage, so you can see which sounds work best for you. Also, if you wear Beltone hearing aids, you can stream directly through them, and the sound will be adjusted to compensate for your hearing loss.
User Rating: 4.6 Stars
This app was featured in the Wall Street Journal and offers everything from white noise and natures sounds to Tibetan choirs and space noises. This app is designed to match the frequency of the disturbing noise through a calibration process and better mask your tinnitus or nuisance background noise.
2. Oticon Tinnitus Sound.
User Rating: 4.8 Stars
The Oticon app helps to relieve that annoying buzzing in your ear by allowing you to create your very own Sound plan. This app is designed for people with tinnitus, so it focuses less on relaxation and anxiety relief and more on masking. The app can be used with Oticon wireless masking aids.
1. White Noise (free & paid versions).
User Rating: 4.8 Stars for free version & 4.9 Stars for the paid version
The White Noise app was featured in Consumer Reports and promises users to help them to relax during the day and sleep better at night. This app’s sound catalog ranges from driving cars and air conditioner sounds to water dripping and crickets chirping. This app also allows you to record and mix your own white noise and share them with other White Noise users! The app has an alarm and timer system to fade noises in and out and connects to Bluetooth speakers and devices such as home assistants.
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