Guiding Patients Through Tinnitus | Dr. Suzanne May

Dr. Suzanne has tinnitus herself, is an audiologist that specializes in tinnitus and is an audiologist with Treble Health working with us.

Ben Thompson, AuD.

Hello everyone. My name is Dr. Ben Thompson with the Treble Health podcast. Today I am here with Dr. Suzanne May. Dr. Suzanne has tinnitus herself, is an audiologist that specializes in tinnitus and is an audiologist with Treble Health working with us. So, for the last few months, Dr. Suzanne has been working in our telehealth model with patients. Now, let me introduce her. And then we’ll go into the details of how Dr. Suzanne developed tinnitus and then share some other insights and perspectives on what you can do about it. So, Dr. Suzanne May has been an audiologist for 18 years helping patients with hearing loss and tinnitus. She got her Doctor of Audiology degree from the University of Florida and worked in various roles including manufacturing of devices, clinical at the Veteran’s Hospital. Dr. May herself has tinnitus and she enjoys helping patients learn how to manage tinnitus. For the majority of her career. Dr. Suzanne has worked at a major hospital in Sacramento, California. And she has also presented educational seminars to physicians on hearing loss and tinnitus. Dr. Suzanne joined Treble Health in 2022. She is board certified in the American Board of Audiology for a board certification in Tinnitus Management and she also has a certificate in Progressive Tinnitus Management from the Veterans Hospital. A fellow of the American Academy of Audiology and subject matter expert for the State of California license board. All that to say, Dr. Suzanne, welcome. And if you could please tell us about your story with tinnitus and what has been your journey so far?

Dr. Ben Thompson introduces a new addition to our team of audiologists at Treble Health, Dr. Suzanne May. She herself has tinnitus and brings with her a perspective of the tinnitus patient.

Suzanne May, AuD.

So, my story with tinnitus is that when I was in my 20s I developed it because I had noise exposure from playing drums in a band. And it was a low level hum for a long time. Three years ago, I had a head injury and my tinnitus ramped up to, I would say about an eight out of 10 volume. And I worked with doing tinnitus retraining therapy, sound therapy, doing holistic approaches and got my tinnitus down to today’s two out of 10 volume.

Ben Thompson, AuD.

And how much time did that take, what did you learn during that process when you developed tinnitus? As an audiologist it’s one thing to know what to do, it’s another thing to actually do it and to go through the challenges of the retraining and putting in the time and the effort and being with different doctors, figuring out different technology. Tell us about those first few months as you were figuring it out after it got louder?

Suzanne May, AuD.

Yeah, the first few months you’re definitely in the fight or flight mode and you’re very much aware of the tinnitus’ front in your brain. And that is probably the hardest part of the habituation process is when you’re in that mode. So, you know, working with a counselor, working with someone from Treble Health to, you know, get to a better place to break that emotional loop cycle, I found very helpful. Using sound therapy, you know, I had a wearable device that would play white noise in my ear, I would say to keep my ear busy so that I would be not focusing on my tinnitus and have that in the front. And overall it took about 16 months to get down to where I am now.

Ben Thompson, AuD.

And what did you see in yourself in your progress? How quickly did things start to change? How did the sound therapy play a role? And what was the difference for you between sound therapy from devices like tinnitus maskers or hearing aids versus sound therapy from other more consumer electronics? How did you approach that? And what did you learn?

Suzanne May, AuD.

What I learned was the first few months I had to wear a device because I was always moving around to keep myself busy. So, and I was still working. So, I was in a clinic, I was in a busy hospital setting and I needed something that I could wear on my ears at all times. And I needed that sound therapy at all times. I’m finding that everyone’s individual in their process and so they might not need it at all times, like how I did. And at my point in my journey now, I don’t need it at all times. So, I picked a device that actually was a hearing aid and it did not have any amplification on it because I don’t have hearing loss, but it had a white noise and pink noise generator. So, that way I could just have that and I can have control over it.

Ben Thompson, AuD.

Hmm, and was your tinnitus in one ear, both ears or the center of you head?

Suzanne May, AuD.

My tinnitus feels like it’s in both of my ears.

Ben Thompson, AuD.

Hmm, and what levels are you at now? You said that at the peak, after this concussion, after this head injury, that it was an eight out of 10 loudness. And how did that change over the 16 months?

Suzanne May, AuD.

I actually found it very interesting at first. I described it as like sounding almost like a jet engine in my head, very staticky, buzzy and whatnot. And it changed throughout the process. And one thing I, you know, from being an audiologist, I know there’s, you know, 16,000 nerve fibers and it’s like a piano. You can get one tone, several tones, or even distorted tones and the tones can change. And overall it was a downward trend, but you do have what I call these bunny hops happening. So, you’re still making progress but you’ll have a day where it’s bad and then a day where it’s better and a day where it’s bad and then three days where it’s better. But overall you’re noticing improvement over a long period of in time. So, it’s important to keep focus that if you’re having a bad day, it’s okay. That you can still have good days ahead.

Ben Thompson, AuD.

Mm, so even you, who’s a professional in this field who had studied tinnitus for years prior and has helped patients with tinnitus for years prior, there was nothing you could do to really expedite this, to make this process happen instantly or quick or very fast. Is that right?

Suzanne May, AuD.

That is correct. I always describe that it’s like an injury. If you were to injure any other part of your body, it takes time for your body to heal. And we definitely with, when you have tinnitus that is loud and distracting in the front of your brain, you want to try to get it over with as soon as possible. Anybody would. But you have to keep in mind that it is a long and slow process and that’s okay. But eventually you can get there. Your brain can habituate.

Ben Thompson, AuD.

And what were the hardest challenges when your tinnitus was bothersome? Especially in those first, let’s say six months. Was it work? Was it personal life? Was it falling asleep? Was it anxiety? Was it concentration? What were the areas that affected, that the tinnitus affected you in your quality of life?

Suzanne May, AuD.

So, definitely I would say all of the above. So, sleep for sure was a very hard one for me. And I came up with a kind of a sleep hygiene strategy plan, if you will, where I had a very regimented technique that I still use to this day. I sleep with a sound machine to this day. That’s my, I call it my security blanket, but I’m fine with that, my husband likes it. So it works. And you know, in the very beginning there are days where you can be very down, what I say down the rabbit hole. And when that’s happening, it’s important that you reach out to a professional, a loved one and let them know what you’re feeling and thinking and make sure you have that support system in place. I find that’s very, very important. I had anxiety, I had depression, but I used all the resources I could to help me through those times.

Ben Thompson, AuD.

And you made it through it, and we’re very glad you’re here and now even serving patients and being a telehealth provider with Treble Health and having these appointments, guiding people through their own habituation. How many months do you think you are working with your average patient? We see different lengths of time that our patients need our help, that they are choosing to working with us, that we’re recommending we continue working with them. Based on your own personal experience plus professional experience, what’s the time window that you would recommend someone work with an audiologist, for example, for the retraining, counseling and the neuroplasticity coaching?

Suzanne May, AuD.

I would say on average, you know, from my VA personal experience before and my own personal experience, and now working with Treble Health that I would typically see, you know, nine to 12 months seems about the average. Again, like you mentioned, everyone’s different. So, I have had patients, you know, have faster progress and be able to graduate sooner. And I’ve had patients that take longer time and every case is individual. And it’s important to know that we are there for you no matter what your length of time might be.

Ben Thompson, AuD.

Absolutely. And our goal is always to help someone to the point where they can manage it on their own. Have you had some of those cases, let’s say recently where patients are, you know, graduating your appointments, graduating the counseling, the care that you’re giving, because they are in a better place and they are managing it on their own now?

Suzanne May, AuD.

Yes, I actually had a graduate yesterday and he’s been working with me for a while and he started off with his volume about a seven out of 10, his score on our questionnaire that we use for our patient was definitely on the higher side where it was a big problem for him. And over the time we’ve now gotten to where yesterday he says, “I’m not noticing it in the front of my brain anymore. I spend most of my day ignoring it. At night I’m able to sleep. My anxiety levels are down.” And after our conversation he said, “You know, I think I graduated.” And I said, “I think you did too.” So, it was very, a very exciting moment. I’ve had several of those things happen when I was at the VA before as well. And it’s always a positive experience when, you know, when you have someone graduate.

Ben Thompson, AuD.

Yeah, absolutely. And that’s our goal for everyone who works with us. And tell us about what is your approach to medical tests? How do you counsel, how do you advise one of your patients who has maybe had a hearing test, maybe been to an ENT, maybe their primary doctor, what kind of medical tests are relevant for you to have certainty that you can understand the likely cause of their tinnitus?

Suzanne May, AuD.

The medical tests are important. You know, hearing tests. We like to know if you have hearing loss, ’cause hearing loss can cause tinnitus but also you can have normal hearing, like how I have normal hearing and have tinnitus. We know for a fact that cervical issues, like, I had the head injury and neck injury, mine was from a concussion and from cervical issues, jaw issues, you know, anxiety, depression, there are so many things that can cause tinnitus. So, it is important to have those medical tests, whether it be seeing an ear, nose and throat, an audiologist, having a test called an OAE that checks the outer hair cells of your hearing organ, having an MRI, you know, basically kind of, I would say checking off the boxes to make sure, okay, there’s nothing medically causing it. And if there is a medical cause then we need to go and help you find treatment.

Ben Thompson, AuD.

Absolutely. And I know you and I both perform guest presentations for the ATA, American Tinnitus Association local support group meetings via Zoom, you and I both volunteering to give guest presentations. And one of the recent groups that I was working with, they had expressed how it’s overwhelming and challenging to navigate this on one’s own as an individual because it seems to most of us that the primary physicians aren’t that knowledgeable about what kind of tests should be performed, what should be ruled out? ENTs sometimes can take that leadership role, but other times not. And then the audiologist or the psychologist, if someone chooses to work with a psychologist, those are the professionals who might be left to either pick up the pieces. Who do you think is best fit to guide the patient through the process? And what is the role of these different doctors and all working together?

Suzanne May, AuD.

Audiologists I feel are the number one professional to help you with the process. Some audiologists don’t specialize in tinnitus. And so I would search out someone who does specialize in tinnitus. Treble Health obviously is a great option because all of our audiologists specialize in tinnitus and we can help you guide you through the process. It’s one of the things I do with a lot of my patients and I love that our service actually allows patients to, you know, email us, text us with questions and say, “Okay, now I went to see the ear nose and throat doctor. Now he wants me to get an MRI, what do you think?” And I can guide them on that process. So, audiologists, we are the most well versed in knowing about tinnitus and I feel like having a professional in that arena can help you the most.

Ben Thompson, AuD.

Yeah, and when we see a report, let’s say, from a doctor about the MRI result, those reports are written so that any medical professional can understand whether there is a potential factor here, whether there’s something abnormal or things are clear. And even though you and I as audiologists are not evaluating MRI imaging, we can read reports and we can make sense of the results to tell someone, is this part of why you have tinnitus or not? And same thing with the dental exams for the TMJ like you had mentioned the jaw and different evaluations for the upper neck, either by physicians, doctor of osteopathy, potentially chiropractor. So, all those results coming together give us as the guide here, all the data we can possibly get to identify what is the real cause of your tinnitus? Because the treatments we do sometimes depend on the cause, right?

Suzanne May, AuD.

Yeah.

Ben Thompson, AuD.

Yeah. And then what abo