Audiologist Shares Her Own Tinnitus Story & Progressive Tinnitus Management

Audiologist Shares Her Own Tinnitus Story & Progressive Tinnitus Management

Ben Thompson, AuD.

Hello everyone, this is Dr. Ben Thompson here for another podcast episode. Today, I am with an audiologist, a colleague of mine, Rachael Cook, who is an audiologist in Phoenix, Arizona, and originally from California. We’re going to talk about TMJ, tinnitus, stress-induced tinnitus, noise-induced hearing and tinnitus issues. Dr. Cook, please take it away. Tell us your story of tinnitus.

Rachael Cook, AuD.

Awesome. Thank you. Thank you for having me and reaching out and asking be on the podcast with you. So I started experiencing tinnitus probably right around six or seven years ago, I would think. Probably shortly after high school ended, and it started, I think, as the same as it does for most people of just a tiny little like, “What is that?” in the quietest of environments And over time, it just started to increase and increase and increase. And at the time, I was just barely starting my audiology coursework. I actually thought that I was going to be a speech language pathologist and then started transferring over to the audiology side of things once I started experiencing my own tinnitus and started learning more and more about it. And for a while, that was really bad for my tinnitus because I was so focused on it all the time. And then over time, I started learning about things like “Progressive Tinnitus Management” and TRT, and really just a lot of, kind of, I guess, not as spoken about ways to manage tinnitus as well and found some pretty good things that work for me, including the use of some ear level sound generators, too. So it’s been an interesting journey to be the provider and the patient at the same time, but helpful in that respect for sure.

Ben Thompson, AuD.

And what were your levels of tinnitus, right? When we quantify it, there’s some questionnaires that in the clinic we may use. But real world, quick and dirty, I find that just what were your tinnitus levels from 1, very, very soft, to 10, very, very loud. 1 to 10, how did that fluctuate over the years for you and how long have you had what you would consider bothersome or loud tinnitus?

Dr. Ben Thompson asks about Dr. Rachael Cook’s experience with tinnitus. 

Rachael Cook, AuD.

That’s a great question. So I started the tinnitus out, probably I’d say about a 2 out of 10, right? I could notice it, but with enough distraction going on around, eh, not so much. Then when I started grad school, I feel like it really started to kick up. And, you had said earlier, a noise-induced event, and I had gone to Coachella in 2017 and I was extremely close to the loudspeakers, very close to the stage, no hearing protection just really went for it. And it was really after that event, honestly, that I watched it go from a 2 to more like a 4. And, you know, a four doesn’t seem too bad on a scale of 1 to 10, but when you’re having it all day, every day, you know, in a lot of different environments, that can be pretty bothersome. And so now that I have a handle on it, definitely much more, I’ll have days where it’ll be a six, but I’ll have days where it’ll be a zero and I’ll search for it and search for it and search for it and can’t find it at all. And so I would say we’re definitely leaning more towards getting it back down to the 0, the 1, and the 2 range, which has been very, very welcomed change and is really just proof that even when you have those bad tinnitus days, they don’t always have to be that bad.

Ben Thompson, AuD.

What I want to bring up is that you work with ENT doctors, ENT physicians, those are our colleagues, and on another podcast episode, I interviewed an ENT physician out of Europe who had spent their career researching the different causes of tinnitus and they determined that 80% of tinnitus cases fall into these three categories, either TMJ, somatosensory, neck related, number one, number two, cochlear hearing loss related, or number three, we can simplify and call it stress-induced. Sometimes it’s a combination of those three factors, but that makes up the majority of cases and it’s important to accurately diagnose, okay, which subgroup are they in or which multiple factors are the individual in so we can help them accordingly. You now work with the ENT physicians. You may have had some of those subgroups happen to you in your own history. Let’s start with asking, which of those apply to you and have you found tools or techniques to manage those different elements?

Rachael Cook, AuD.

So I would think that I’m probably impacted by all three of them, honestly. I do believe that I have some TMJ issues. They haven’t really been diagnosed, but I do know that I get quite a good amount of stress intention in my jaw as many people do and we see it in the office all the time here. We really do. Almost every time if we can’t find the source of what we think that the tinnitus is related to, we’ll ask, you know, “Oh yeah, so talk to me about your jaw.” And they’re like, “Oh, terrible TMJ.” And we both immediately go, “Oh, okay.” I would also say that we’ve got the cochlear-induced and I do think that I’ve had a significant amount of noise exposure in my days when I didn’t know better, and so that definitely contributed to it as well. My audiogram is normal. I do have a pretty obvious little dip down at 3K and it does jump back up. So you see that there as well. And then lastly, the stress-induced-

Ben Thompson, AuD.

I’m sorry. Just to clarify for our listeners. So you have a slight or mild high pitch hearing loss, right?

Rachael Cook, AuD.

Yes. Sorry. So it’s right on the border. It’s right at 25. So it’s in between that normal-mild borderline.

Ben Thompson, AuD.

It’s very common for a lot of people who have bothersome tinnitus, have slight hearing loss, and are told, “Oh, your tinnitus is from hearing loss.”

Rachael Cook, AuD.

Absolutely.

Ben Thompson, AuD.

But something doesn’t click there.

Rachael Cook, AuD.

Right.

Ben Thompson, AuD.

Something’s off. It’s not just hearing loss because the hearing didn’t change, but the tinnitus came out of nowhere.

Rachael Cook, AuD.

I will completely agree with that. It’s like you’re looking at their entire audiogram as a whole, right? And you might have majority of your audiogram or all of your audiogram within a normal range, but that doesn’t mean that there hasn’t been some sort of damage to the hearing organ at some point. So you perform normal, but even then, what does that mean, right? Everyone’s different. So yes, you know, it’s on the borderline of normal and mild, but I definitely see it in many different aspects of my life, tinnitus, but also just in speech understanding as well, which is a huge point.

Ben Thompson, AuD.

How have you explored the TMJ jaw-neck as well as the stress-induced factors for managing tinnitus?

Rachael Cook, AuD.

So I was speaking with a physical therapist friend and I was asking, “Do you have any like exercises and movements and things that I should be doing with my jaw to try and release some of that tension and pressure?” Did some of those for a while and I don’t have any real pain associated with my jaw, so it’s difficult to remember to do those things. And I think that’s another point. I hope this isn’t too tangential, but I think that’s another point as well is like, you don’t have to have very obvious pain. You don’t have to have very obvious tension and you don’t have to be uncomfortable for your body to still be telling you that there’s discomfort somewhere. So just because you don’t think that your jaw is in any sort of pain or in any sort of tension doesn’t mean that it’s not showing up just in a different way and I think we see that often. So I did work on some of those movements and exercises with muscles and got a night guard. Like the dentist got me one so that I wasn’t doing as much compression or as much like chewing and grinding at night as well.

Ben Thompson, AuD.

You’ve come at this from all angles.

Rachael Cook, AuD.

Yes.

Ben Thompson, AuD.

And what have you found in terms of stress, anxiety, sleep, holistic health? How does that affect the levels of your tinnitus?

Rachael Cook, AuD.

I would say, hands down, that is the most important factor and that might not be the most important factor for everybody but it’s the most important factor for me and I think it goes overlooked very, very often. I think if you look at anybody day to day, right, and just do a solid inventory, like how much water did they drink? How much sleep did they get? Did they eat any fruits or vegetables today? Have they exercised recently? All of those things have a huge impact on our body’s state of rest, how we handle stress, how we think, how we act, and if those kind of core basic needs aren’t being met or they’re being met but maybe not met as well as your body would like, it’s going to respond. And how does it respond? It normally responds with just this stress reaction? And just even the word stress is difficult because it’s so vague, right? Like a lot of people are like, “Well, I’m not that stressed of a person.” But stress can present in your body. It can present in your mind. It can present in both interconnected together. And so I think looking at our habits, our daily habits, in terms of sleep, in terms of relaxation, you know, I’m a big fan of just putting on some light music and putting a couple of candles on and honestly, just crocheting for a while. Anything to just kind of wind the brain down because we are just so inundated with information and news, and bad news and good news, and all of these things all day long, it really takes a toll on our mind and it really then takes a toll on her body. And so it’s really, really important to look at all of these variables and go, “Okay, am I fueling myself? Am I taking care of myself? Am I getting adequate rest? Am I saying no to things I should say no to for my mental health and for my physical health?” Because if you’re not, all of those things are also impacting your tinnitus as well. All of them.

Ben Thompson, AuD.

You’re speaking so much wisdom here from personal experience, from your education. The average audiologist tends to come from the lens of hearing test, hearing aids, sound therapy, talk a little about stress, and it sort of stops there.

Rachael Cook, AuD.

Mm-hmm.

Ben Thompson, AuD.

And you’re getting into some important details here, which is that take a step back, take a bigger perspective, and ask, “Okay, what can I do in my day to day, week to week that can give 10% gains?” Because I’m sure, as you can imagine, as you know, 10% gains with tinnitus is a big deal. I want to ask you now, what’s important for you to share with the tinnitus community. There’s a strong community online. There’s a strong community here on YouTube. There’s online forums that may not be the best place to go. In fact, I would recommend avoiding them after you get the right information. What are your main messages to the tinnitus community from your experience, Rachael?

Rachael Cook, AuD.

I agree as well. There’s information from every angle and from every corner and it’s going to be really, really important to make sure that the information that you are getting is from a trusted source. When I say a trusted source, I’m just a huge proponent of the “Progressive Tinnitus Management”. I did my externship at the VA and so I got a lot of experience with that. And I do think that it works well. And for folks who don’t know what that is, it’s just a program that’s basically… I don’t know how to word it. It was put on or funded by the VA in terms of setting up kind of a very distinct game plan of how to best manage tinnitus. And that workbook is available online in a PDF form for free download and it is phenomenal. It’s like 126 pages of just questionnaires, questions, graphs. I mean, things that you can just fill out from every angle to really figure out what is my tinnitus, right? ‘Cause we just throw these words around. I have tinnitus. Okay. Well, is it even in both ears? Is one louder than the other? Is it high pitch or low pitch? Do you get it all the time or sometimes? And where is it coming from, right? That same TMJ somatosensory? Is it coming from stress? Is it coming from damage within the cochlea? Like all of these things, everyone’s tinnitus is so, so different. And so it’s really important to first nail down, I guess, what is your own tinnitus look like to you? How is it impacting your day to day? And I think audiologists can, you know… You can do some questionnaires and things like that. But a lot of this work has to be done at home. It has to be done at home and it can be guided by an audiologist that knows a lot about this topic. But you’re going to have to put the time in at home as well, to look at these different points of your life that might be impacting your tinnitus and define what does make a noticeable change in your tinnitus and what didn’t make any change at all? I will back that up by saying that I do think that some online forums have some really good information. 

I think very often as well though, we see someone takes a placebo effect and runs with it, and that’s fine because for that person, it worked for them enough for them to tell the whole world and that’s great, but it might not work for everybody in that same way. So I definitely like the “Progressive Tinnitus Management” handbook and you can find that just by typing that in Google and downloading it. I would also say that you got to be talking with an audiologist and you got to be talking with an audiologist that feels comfortable talking about tinnitus, because there’s definitely a difference there. Some audiologists love it and some hate it.

Ben Thompson, AuD.

And tell us about your experience. Thank you so much. And definitely “Progressive Tinnitus Management” is highly recommended from myself and it’s a protocol to follow. Tinnitus retraining therapy, it’s a protocol to fol