Guiding Patients Through Tinnitus | Dr. Suzanne May

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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?

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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 about those who can’t necessarily find their cause or they’re not sure? And there’s no hard and fast objective test that says this is why you have tinnitus. How do you approach the treatment there? And is it necessary to find a cause to habituate?

Suzanne May, AuD.

It is not necessary to find a cause to habituate at all. I was actually talking to a patient yesterday and he is still going through his medical tests and trying to find out if there is a cause for his tinnitus and I told him in the meantime we can still use our tinnitus retraining therapy that we’re doing at Treble Health. We can still use our sound therapy to help our brain habituate to get out of these feedback loops that are happening, you know, the tinnitus loops that are happening, the emotional loops that are happening. And that’s important that you, we can do that at any point in time, whether we know the cause or not. So, it’s important for patients to know that even if you don’t know your cause, you don’t know what’s happening, there still is hope, there is still help and there’s still things that we can do.

Ben Thompson, AuD.

Mm, absolutely. Totally agree with you. And how about in your personal experience, getting back to that. Tell us about the things you did that were not the psychological tools that were not sound therapy? You had mentioned some holistic wellness, mental health type things. Could you share with us what worked for you?

Suzanne May, AuD.

Yes, so one of the tools I used is something called imagery, which is similar to meditation where you, and I kind of joke with my patients that it’s picturing your happy place. So, I would picture the beach, but it is imagery involving all five senses. So, you’re feeling the sand, you’re picturing the blue sky. You’re smelling the salt in the air. You’re maybe tasting a cold drink in your mouth. You’re hearing the ocean waves and you’re fully immersing yourself in that image as you’re doing some very deep breathing exercises to help your brain kind of get out of this fight or flight mode. So, that was something that I used routinely. Another technique I used was something called the STOP technique. It’s a cognitive behavioral technique where you kind of stop what you’re doing and you take a deep breath and observe your surroundings and try to put things into perspective and that was very helpful. So, those were, I did stretching, I did yoga. I, you know, did Tai Chi and I got massage therapy. Those were other things that I used routinely.

Ben Thompson, AuD.

Excellent, yeah, I love to hear that. Whatever can help we want to consider it. First start with the foundation and then consider these alternative or holistic compliments. Completely agree there. And you have with you a tinnitus masker. A hearing aid that’s programmed for tinnitus masking. Would you be able to show us that on the video and explain how you use it?

Suzanne May, AuD.

Yeah. So I actually have two, but I’ll show you the red one. It’s easier to see on screen. But, so there it is. So, there’s this piece here that, and then there’s a little wire and a little bud. So, what it does is it sits on top of my ear. So, there it is. And then there’s a little wire that goes inside my ear. So, the best part about it is that, you know, you can’t see it. Even if I were to tie my hair up you can’t see it. And it doesn’t leave my ear plugged up so I can still hear my environmental sounds, so I can still hear my dog barking, my kids laughing, the tea kettle whistling, but then in the background it’s just making a noise. And I have it set kind of low in the background, just kind of happening. It doesn’t have any amplification on and I just wear it when I need right now.

Ben Thompson, AuD.

And do you wear, do you have that in both ears or just one?

Suzanne May, AuD.

I have it in both ears.

Ben Thompson, AuD.

Very nice. And what do you mean that, “it does not plug your ear?”

Suzanne May, AuD.

So, the little wire that goes inside your ear is just a little tiny bud. And so the ear canal, you know, if it’s a large hole like this, it’s just like a little tiny bud that sits inside my ear, meaning that it’s not going to block it up. So, an example I would use is maybe an ear plug. That’s something that’s blocking your ear and you can’t hear environmental sounds. So, with just a little tiny thing inside your ear, it doesn’t block or completely occlude your ear canal.

Ben Thompson, AuD.

Yeah, It’s really important. I’m holding up some headphones that I use sometimes, which I do not use for sound therapy, but I use for just communication and listening to music, et cetera. This completely blocks my ear. Also the AirPods Pro, pretty popular electronic device, that also blocks the ear. That means I cannot hear ambient sound around me. We don’t really want that for habituation. Habituation goes better, goes easier when one can hear the ambient sound around you. Do you find this is something that most patients need to be educated on? Because it’s not an intuitive thing. You think, “Oh, you put something in your ear, it’s blocking your ear. Why would I block my ear?” Well, hearing aids, tinnitus maskers are manufactured, they’re made for tinnitus and hearing loss. Considered that. Is that something that you have to educate to most people?

Suzanne May, AuD.

Yes, absolutely. A lot of people don’t realize that they can have a device like this and maybe they are, they’re trying to use something else. And they’re frustrated because it is blocking their ear and they can’t hear the environment. So, they want to switch to something else. Of course, there’s tons of choices out there, but for me having be able to have it on, set it in the morning at a level that was just under my tinnitus and we would just go throughout the day. So, there would be times during the day where I would be so busy I wouldn’t hear my sound therapy, but I also wasn’t hearing my tinnitus because I’m hearing all the environmental noises around me. And that to me was like a sign of success of like, “Oh, environmental sounds are now helping me cope as well.”

Ben Thompson, AuD.

Mm. And are tinnitus maskers, for example, the style you’re wearing, professionally in our industry, we call them tinnitus maskers. They’re not completely covering the tinnitus. They’re lower or softer than the tinnitus, but they are mixing and they’re providing a sound therapy. It’s a type of masking sound, which is either white noise, pink noise or other similar sounds. So, that’s what tinnitus maskers are. They look like hearing aids because they actually are hearing aids but they’re programmed for tinnitus, not for hearing loss.

Suzanne May, AuD.

Yeah.

Ben Thompson, AuD.

And I wanted to ask you, Dr. Suzanne, are tinnitus maskers right for every single person who has bothersome tinnitus? And who would not be a good candidate for them?

Suzanne May, AuD.

I feel like everyone could benefit from having sound therapy in their ear. I always hate calling, unlike you, I hate calling it a tinnitus masker, ’cause we’re never trying to cover up our tinnitus. But I feel like every everybody could benefit from having a device, a wearable device on their ear. It’s not always an affordable option for everybody. And there are some people who, especially in the very beginning stages, you may feel like you don’t want to have something in your ear. And so having a speaker on in the background is also another option to use, or, you know, some people will use AirPods for an hour to use for sound therapy and they’ll use something else in the meantime to just help them get through that time until they can have something that’s a wearable device.

Ben Thompson, AuD.

And since we’ve started to use tinnitus maskers and hearing aids for tinnitus with Treble Health, online via telehealth, we’ve gotten experience of how can these tinnitus maskers be programmed from someone’s own home, from the convenience of home by having the devices arrive to your house, having them remote programmed based on your hearing test within the last six months? And how has that system been for you when you’re working in this telehealth model which is utilizing the technology that was made for good audiologists to do good work, to help patients with tinnitus as soon as possible? What have been your experiences let’s say, in 2022, so far with telehealth, tinnitus maskers, hearing aids?

Suzanne May, AuD.

Oh, it’s been amazing. I mean the hearing aids and the tinnitus maskers are Bluetooth enabled. So, we can have you connect them to your smartphone, from my home to your home. I can connect directly to you and I can program your devices to your specific individual needs. And what’s great is that I didn’t have to leave my house to do that, you didn’t have to leave your house to do that. And so the convenience factor is so nice. A lot of our patients, you had a YouTube a while ago where, you know, your people are driving four, five, six hours to come and get help. You don’t have to do that anymore. I have you right in my living room and I’m right in your living room. So, to be able to have that technology and the convenience factor of if there’s something going wrong, you can email me and I can get right back to you the next day and help you with whatever problem you’re having. So, it’s been an amazing experience. And I’ve felt like I’ve helped a lot of people this way.

Ben Thompson, AuD.

Yeah, absolutely. And you know, also is that we can solve the problem pretty quickly in terms of getting the maskers to the house, programming them, getting them fit, getting them programmed. I think a lot of private audiology practices, private clinics can operate on a similar speed of getting things done quickly and providing a great service. Major hospitals however, are often very slow and have a long wait time. So, some tinnitus cases should be treated like urgent care emergencies, not, “Oh, I have a symptom in my ear that can wait two months.” Have you heard that at least in your local area when you were working in different clinics and then now with telehealth, have you heard that waiting for a doctor’s appointment is part of the struggle with getting the right kind of help for tinnitus?

Suzanne May, AuD.

Yes, so, I mean, when I worked in clinic before at a major hospital in Sacramento, I worked at the VA. You do have long times where you can get in to see a professional. And especially when everything’s shut down with COVID, now things are opening up and now there’s these longer wait times, ’cause people are now feeling more comfortable going back to seeing their doctor. And so, yeah, I have a lot of patients that said they actually specifically reached out to Treble Health because they called their doctor and they were told it’s going to be six to eight weeks to see a professional. And they were like, “I need help now.” And it’s been a great I think advantage and a great service that we’re providing.

Ben Thompson, AuD.

Yeah, and we know those first few months of tinnitus are so crucial. Everything with the brain is easier sooner rather than later. Learning an instrument, learning a language, learning a new skill, retraining the brain for tinnitus, starting with hearing aids if you have a hearing loss. The earlier we start any of these things the better. Therefore providing, you know, like we do, free consultations via Zoom video, just like we’re recording this podcast right now, to speak with an expert of tinnitus without having to leave your home. I’m just really proud of that. And it’s a great offering. And now anyone who’s listening knows it’s available to them as well. As we’re wrapping up here I do have a few more questions. And I would love to learn about how you’re approaching the current year with your tinnitus. Does it cross your mind every day? Do you think about it every day? Does it affect your decisions? Are you choosing to not go to loud places? Or are you basically back to normal function? After it’s been now three years since your tinnitus was once an eight of 10 and then you went through the 16 month retraining period.

Suzanne May, AuD.

So, now it’s at a point where it’s in the background and for the most part I don’t notice it and it doesn’t affect me unless I’ve had, you know, a bad night of sleep. Then it might get a little bit louder the next day, or if I’m very, very stressed I might notice it a little bit louder. When it happens that it’s louder, I kind of just reach into my toolbox and do the things that I know to do is just take some deep breathing, do some stretching. I still do protect my hearing. When I am going to a loud concert, like a stadium concert, I’m going to wear my ear protection ’cause that’s what I do. I was just on vacation and in some louder environments and I had some musicians earplugs that I use just to kind of filter the sound down a little bit. So, I do protect myself still. For the most part my tinnitus is in the background, it doesn’t really bother me that much.

Ben Thompson, AuD.

Mm, excellent. Very nice. And do you have any last words here? I know that we’ve talked lot. We’ve talked about your own journey. We’ve talked about how you approach your care via telehealth with Treble Health, for your patients that you’re working with. And it was great to see the tinnitus maskers that you use and see them on your ear. That was really nice. Do you have any last words of hope, encouragement or insights for our community here?

Suzanne May, AuD.

Yes, I would say at, you know, any stage that you’re at even if this is new to you, even if you’ve had it for, you know, 18 years, if you’ve had tinnitus for 18 years, there are still things that we can help you with at Treble Health and so I want to spread the word that don’t give up hope. There are things that can help you. We have a ton of information, knowledge and things that we can share with you. So, please reach out to us so we can get you through your experience and your journey.

Ben Thompson, AuD.

Mm, thank you, Dr. Suzanne. You’ve been a wonderful guest, sharing amazing perspectives and personal experience. Hope to have you back soon. Let’s do another one of these in a month or so and continue the great tinnitus care. Thank you so much. And for everyone listening, please do subscribe to my YouTube channel and leave a comment of how this video affected you. If you have any questions for us, let us know in the comments and we’ll do our best to respond. Thank you, Dr. Suzanne.

Suzanne May, AuD.

Thank you.

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