The Best Advice I’ve Ever Received From An ENT Doctor About Tinnitus

Ben Thompson, AuD.

Hello everyone. My name is Dr. Ben Thompson, audiologist based out of California. This is a special episode of my podcast, where we have Dr. Michael Golenhofen, who is coming to us from Europe. Dr. Golenhofen, please introduce yourself.

Michael Golenhofen, ENT Specialist

Thank you. My name is Michael Golenhofen, I’m an ENT specialized physician working in Germany and treating tinnitus patients for the last 25 years, approximately. And I did describe a way of treating tinnitus patients by doing a very accurate differential diagnosis before we start treating.

Ben Thompson, AuD.

And you have some research published on the differential diagnosis and how to treat tinnitus patients effectively, correct?

Michael Golenhofen, ENT Specialist

That’s accurate. That’s actually the center of my work. ENT physicians do not really care very much about tinnitus patients all over Europe, and I try to improve this situation a little bit.

Ben Thompson, AuD.

Yeah, thank you so much. And I have some questions to ask during this podcast about medications, about TMJ, about neck contribution to tinnitus, about what your perspective is on treatment, on the audiology intervention and the psychology intervention.

But let’s start by having you explain what were the major findings of this research, how to effectively diagnose and treat tinnitus patients?

Michael Golenhofen, ENT Specialist

Well, I think the center is that we read how to investigate, to assess a tinnitus patient and then some recommendations for treatment. However, the daily practice is that we somehow stop thinking very much and do a step very quickly forward into the direction of cognitive behavior therapies. So we do not really assess our patients in an accurate way. We forget about the different disorders that are causing the tinnitus, we consider tinnitus to be the disorder itself, which it is not, and we forget about doing our job in diagnosing our patients.

Ben Thompson, AuD.

In your perspective, what are some common mistakes or errors that doctors make with tinnitus patients that you have tried with your research to improve?

Michael Golenhofen, ENT Specialist

Well, the main misunderstandings and faults that are made are that a patient approaches a doctor and hears, “I can’t do anything about it, you’ve got to live with it and so on.” And this causes a lot of fear and disorientation, and we need to improve this because this is a major problem in the management of tinnitus patients in general.

Ben Thompson, AuD.

How about other misunderstandings of the different types of tinnitus or the subgroups, and how to effectively manage the condition based on the subgroup.

Michael Golenhofen, ENT Specialist

Well, the major misunderstanding is that we do know that you can ask the question, which subtype does the patient come from, okay? And this is important. I try to show that in my research that it is not that difficult, whereas the treatment always is difficult with tinnitus patients, tinnitus is a symptom that occurs very late in the disorder when the disorder has gotten severe. So the treatment always is difficult, but the diagnosis actually is not so difficult. There is a very large number of disorders that are causing the tinnitus in general, but in practice, there are not so many different disorders. In my research, I’ve found that only three disorders cause 80% of the tinnitus conditions. So to learn about those three is not so difficult. And when we make this distinction, then we can already be so much more specific and the patient is so much more helped.

Ben Thompson, AuD.

And what are those three subcategories? What are the three most common representations of tinnitus from your research?

Michael Golenhofen, ENT Specialist

There is one type that is very generally understood already, that’s the subtype that is located in the auditory cortex, which is some kind of a hearing attention disorder where I focus very much on auditory phenomenon. And I start to hear a sound that is actually intrinsic in the human auditory pathways. And that is usually filtered out, but from subconscious mechanisms, this sound is consciously heard, okay? And this is most often a condition that needs to be treated psychotherapeutically, or at least with a good positive counseling from an expert helping this patient. And the second one, the second condition is the sensory motor disorder that happens in the TMJ, in the neck muscles, in the head bones, and so on, coming from a craniomandibular or craniovertebral disorders, causing most likely a monolateral high pitch sound and that needs to be treated accordingly with a dentist, with an orthodontic dentist or with orthopedic osteopaths and so on. And the third, of course, for an ENT doctor, very obvious is the cochlear disorders, the hearing loss acute or chronic, which can cause or which causes very often a tinnitus perception, especially when it occurs very acutely, by sudden hearing loss, for example, that causes usually a monolateral tinnitus sound. These are the major three.

Ben Thompson, AuD.

Thank you, and what comes to mind, I work with a lot of tinnitus patients as well, what comes to mind is that it’s sometimes a combination of the three. The first group that you described, I think right now a lot of professionals would describe that as stress-induced tinnitus. Do you find that people are using that language to describe that first group?

Michael Golenhofen, ENT Specialist

Oh, that’s as a matter of fact, the case, this is some kind of distress, I tried to explain my patients that we have the hearing function to protect ourselves, and the moment we are distressed and we seek from our evolution, we try to find the predator, okay? And that’s why we listen very strongly. And this is the way this type of tinnitus occurs. And what we need to do is to defocus, to help to defocus our patients, by explaining how this subtype actually works and its pathology. But as a matter of fact, this is stress-induced and I wouldn’t mind, what then as the next step is very important to help those patients not to focus on the tinnitus perception itself, but to focus on the distress, the cause of the distress. In this subtype, the tinnitus perception is the symptom of the distress situation, not the other way around, in other subtypes it’s different. But this subtype has the tinnitus because of the distress.

Ben Thompson, AuD.

A lot of patients ask, “Can stress cause tinnitus?” My answer is the stress is like the heat, and if I’m making hot water to make tea with a tea kettle over the stove, if there’s enough heat underneath the tea kettle, it will create enough pressure inside of the tea kettle to create allowed auditory sound, a whistle of the tea being ready. And similar effects can happen with the nervous system and stress on the system. In your medical perspective, how do you define stress in this relationship with tinnitus?

Michael Golenhofen, ENT Specialist

That’s a very good question, difficult one. I just try to find when I do the medical history with these patients, and investigate them from the neck muscles situation and so on, I try to find this tension, okay? And then I try to explain that the tinnitus sound itself is intrinsic, okay? But we usually filter it out and do not perceive it consciously. But the stress kind of deactivates the filter mechanism, okay? And this is what I try to communicate that let’s forget about the sound itself, but let’s care about the filter, which acts accordingly to the distress level. And then we need to focus on what is the distress for the individual? And then we’re on the right track.

Ben Thompson, AuD.

Thank you. And what is your opinion on anxiety and tinnitus? A common question is did my anxiety make my tinnitus worse or did my tinnitus make my anxiety worse? What came first?

Michael Golenhofen, ENT Specialist

Yeah, that’s a very good question. As a matter of fact, anxiety increases the tinnitus perception. Every single time when I start to focus on the tinnitus, for example, because you mentioned medication when I take this pill, my subconscious asks, “Why are you taking this pill?” And I answer, “Because I have the tinnitus, I want to get rid of it.” And this whole process increases the tinnitus phenomenon in my subconscious. So that’s not what I want. And defocusing means to clarify a situation and to communicate very clearly the management, how this perception can be lowered or made disappear. And this is what is most important.

Ben Thompson, AuD.

Absolutely, what are the common situations you see, the common circumstance in someone’s life, what is happening at the time of developing this type one? Of course these categorizations are from your research, but the terms we’re using now are not widely used amongst all doctors, but from what you laid out, this stress-induced or this type one tinnitus, what are the common life situations in someone’s life? Is it work stress? Is it family stress? From your experience, what do you see in the case history that comes up over and over?

Michael Golenhofen, ENT Specialist

Yeah, that’s a very good question. I once tried to define this subtype by saying it is a lack of order structured in a life. And my question to these patients when they describe, “I have this tinnitus sound since two years.” Is usually what actually happened in the 12 months before the onset of your tinnitus perception? What went wrong? And very often people describe something that creates a deep distress in terms of an existential question, depending a work situation, a family, a partnership situation where I develop a deep fear of a loss, and in this fear I get into a disorientation. So what needs to be provided most is to restructure a life in terms of what is the order structure in my life, and what is my exit strategy for the distress I feel inside?

Ben Thompson, AuD.

Thank you. I know that was also studied in 1995, I believe, and they looked at what are the factors associated with the emergence of bothersome tinnitus? I believe from the Hazel group in 1995. And it was something like retirement or work stressors, emotional distress, other types of fear, and then some anxiety illness, things like that. And yes, on the list was an acoustic trauma or an auditory trauma, but it was not number one, number two, nor number three, it was number four on the list. So it makes us realize that this is much more than just an ear condition. Can you please tell us about the second category you found in your research with the jaw and the neck, and what should someone do? Is there a quick way for them to test it or should they go to a doctor who can test it for them?

Michael Golenhofen, ENT Specialist

Well, I think generally tinnitus situation should be seen by a doctor. I think ENT physicians have the duty to make a proper assessment. That helps so much, creates so much clarity. But of course, the somatosensory subtype is not something ENT doctors are trained well in. Okay, that’s why I communicate that we need interdisciplinary teams in the assessment and in the treatment. And I try to learn a little bit more about those sensory motor disorders, our training in work, and on educational semantics. So to understand what actually happens in somatosensory subtype, tinnitus patients is very complex. Sometimes it’s a dental treatment, sometimes it’s an orthopedic treatment, a chiropractor treatment, sometimes it’s just an orthodontic treatment or for example, and this subtype is very complex, but you can hear from the medical history actually very clearly that patients describe this monolateral symptom of tinnitus usually a high pitch, but sometimes also a hissing sound, usually without a hearing loss situation and very often combined with the somatosensory modulations phenomenon that occurs also in other subtypes, but very often is found in the type that is caused by a sensory motor disorder.

Ben Thompson, AuD.

And what should I be asking my patients when I’m an audiologist performing a consultation forwards in this patient? What should be my case history question so that I can refer these patients to the appropriate doctor.

Michael Golenhofen, ENT Specialist

I think that this table is helpful that I put in my publication that the symptom itself, when we ask accurately, perhaps it’s very much to find out about the subtype even if we’re not physicians, if we’re not specialized in the ENT, we simply listen to the way a patient describes the symptom, and from that, if we know the subtypes, we realize and we recognize what we know, okay? As long as we do not care about, it will be difficult, but the moment we know those subtypes, we recognize them very quickly when a patient tells a story. And so for the somatosensory subtypes, it’s the monolateral perception, the lack of a hearing loss situation, and the very typical sudden onset. You know, I fell asleep on the sofa and I woke up and had this tinnitus perception, very typical. Or I woke up at night and I all of a sudden had this tinnitus perception and I had no hearing loss, okay? And this is the main distinction to the cochlear subtype, no hearing loss, monolateral high-pitch sound, most often a subtype from the sensory motor disorder.

Ben Thompson, AuD.

I think that professionals are good at referring when there is pulsatile tinnitus in the history, tinnitus that seems to have the rhythm of a heartbeat. But what you described is taking it another step of no, we’re saying that if the hearing test does not suggest unilateral or asymmetrical hearing loss, if they have a sudden onset of tinnitus on one side, and especially if there’s some modulation that can happen, correct me if I’m wrong, through neck movement or jaw movements, and we’ll talk about that in a little bit, then you’re saying this patient may fall into this subcategory, subtype of somatic tinnitus. So I have two questions here, it’s common, it happens to me when I clench my jaw, the little muscles behind the eardrum will change the auditory perception. And to a lesser degree, moving my neck can change my tinnitus slightly. So tell me, I don’t want to over refer every single patient who can do that, so where’s the threshold? How much of those changes from the jaw and the neck are significant enough to warrant a referral?

Michael Golenhofen, ENT Specialist

Very important question. First of all, the human middle ear is something only mammals have. And we created this 50, 60 million years ago to improve our hearing capacity the moment we encounter a predator or prey, okay? The moment we turn our head sideways, our somatosensory system increases the hearing on the left ear because we hear better on this side. And this is also what happens when you clench your teeth, because the middle ear muscles are actually masticator muscles. That’s why clenching the teeth does change our hearing. This is a physiological phenomenon. Also the somatosensory modulation, I press somewhere, I move my jaw and so on, changes, not only the hearing or a tinnitus perception, it’s still something that happens to actually everybody only tinnitus patients focus much more on it because they focus so much on auditory phenomenon. So this is not really a reason to refer somebody to a specialist, okay? What we want to do when we have from the medical history signs of the somatosensory subtype, is that we try to clarify, where does it come from? And we start that by asking questions, did you have a dental treatment? What did happened to your neck? Did you have an accident, a car accident or sports injury or anything that leads us to the source? And this is something we already can ask, and then we make the decision, I send it to an osteopath or wherever. For example, every single tinnitus patients has an orthopantomogram of all teeth. That’s a normal diagnostic tool. For me I would never see a tinnitus patient without having a dental investigation beforehand, okay? But we need to learn that we need to integrate this part of the assessment in our work.

Ben Thompson, AuD.

That’s great.

Michael Golenhofen, ENT Specialist

Could I answer your question?

Ben Thompson, AuD.

Absolutely, just in summary, so I’m making sure I understand, and the listeners understand as well, that some changes to the jaw, clenching the teeth, the neck, having some auditory changes from that are expected for most people, and that may change tinnitus in that moment. However, if someone can press the jaw or the changes through these movements are significant, and they also have a case history which may suggest a somatic factor for their tinnitus, then it’s in the responsibility of the doctor, provider, in the best interest of the patient to see either an ENT physician or a dental professional who has experience with tinnitus, who can make the next steps. And what might be those next steps? Is it an MRI exam? Is it a dental exam? What are the typical tests that you like to see for someone who may be having the somatic tinnitus? Because in all honesty, I don’t have much experience in this area and it’s probably very underserved population.

Michael Golenhofen, ENT Specialist

That’s definitely true. The somatosensory subtype is maybe the most misunderstood and not know to the subtype. And for sure, ENT physicians are not well-trained in that subtype, not well trained. In Europe, we would usually have cortisone treatment with a monolateral tinnitus perception, even if you do not have any cochlear sign of a hearing loss. Okay, this is basically a misdiagnosed situation.

Ben Thompson, AuD.

And that would be steroid treatment?

Michael Golenhofen, ENT Specialist

Yes, yes. Yes, with a monolateral tinnitus perception, even if there is no sign of hearing loss in the audiogram, you’ll have a steroid treatment usually.

Ben Thompson, AuD.

But that’s not what you would do in most cases, correct?

Michael Golenhofen, ENT Specialist

Definitely not, no. As long as I do not see any sign of cochlear damage, I would not prescribe a steroid. Definitely not. There’s no reason, it’s just a disorder happening in the brainstem that is causing this tinnitus perception, it has nothing to do with the cochlear. And that’s why we should treat it as such. And the assessment integrates an x-ray picture because the trigeminal trigger can be caused by an inflammation on a root, on a dental root. Dental assessment clarifying if there is some kind of craniomandibular disorder. Sometimes even coming from a leg length difference, shifting the balance of the hip and then shifting the balance in the upper neck. But usually we start with a dentist or the orthodontic dentist, and then go further to an osteopathic or orthopedic diagnostic.

Ben Thompson, AuD.

When the patient is listening to this podcast, they might say, “Dr. Golenhofen, you know a lot, I know nothing. I think I may have this, my symptoms sound like this, but I don’t trust my local doctors, I don’t know who is trained well enough.” How do you approach that? How do you help that patient communicate and advocate for themselves?

Michael Golenhofen, ENT Specialist

Yes, that is a very important question. And actually, the reason why I tried to initiate this TiniCare initiative that tries to focus exactly on this phenomenon. I think that it is possible to differentiate a subtype only by asking the right questions. And with that, I can just listen to an experienced person and learn more about this pathology and this subtype. And when there is a little PDF file at the end of this introduction or this tutorial, that is a letter to a doctor that says, “Okay, we have the idea that there is a somatosensory disorder happening in the upper neck or the TMJ area and we want to ask you to please diagnose this situation.” Then I can show this letter to a dentist. And I think then we are some step closer to a solution. Because in medicine we work very often, very reflectory, very quick in a certain direction. And if we’re asked the correct questions, then we can answer them. And we cannot teach any physician what is to be known about tinnitus. But I think then if we are more specific in our assessment, and if we create something like a platform that helps to communicate better between doctors and between patients and doctors, then we can improve significantly the situation of tinnitus patients.

Ben Thompson, AuD.

I agree and thank you so much. I’m excited to learn more about your project you’re working on. I want to get to that in a few minutes. And now let’s talk about the last sub-category that represents the majority of tinnitus patients, which is, I would assume the category that ENT physicians and audiologists are most familiar with, which is tinnitus as a result of hearing loss. What is your opinion on age-related or noise-induced hearing loss and the tinnitus that it can create?

Michael Golenhofen, ENT Specialist

Yes, very important questions. Of course, the cochlear subtype is the major area where ENT physicians feel comfortable, because that’s the area we can investigate and we know so well. And we also know very well that a sudden hearing loss causes a tinnitus perception, and usually the intensity of a tinnitus perception is equivalent to the amount of hearing loss, okay? At the same time, the cochlear subtype is not so critical in terms of creating a mental burden, okay? It is not so problematic. Many, many patients tell you that they are deaf on one ear and they have a tinnitus sound, but it means nothing in their life. So the cochlear subtype is pretty simple to treat because all we want to do is audio stimulation. We want to balance out the hearing loss, if possible, either with hearing aids or with a cochlear implant or whatever is needed. And the rest doesn’t bother a patient so very much, you know. And the same with a sudden hearing loss and tinnitus sound, if it is the case that the sudden hearing loss does not recover, then we can counsel a patient in saying, “Okay, wait some months, you will see that the tinnitus sound will improve gradually, and you can balance out your hearing loss by wearing a hearing aid, and this tinnitus sound will not really cause a problem in your life.” Completely different with the other subtypes, okay? The somatosensory subtypes can never manage the tinnitus sound itself, it’s always bothered to a maximum by the tinnitus sound. Here the mental burden is the result of the tinnitus sound. Whereas in the first subtype, the cortical subtype, the tinnitus sound comes after the distress. So the tinnitus sound is the result of the distress, but in the cochlear subtype, the mental burden is not the real problem. And it is manageable maybe the best way, because we know how to do audio stimulation, there are many techniques out there, every year there’s a new one and this is not a critical subtype really.

Ben Thompson, AuD.

And a lot of times patients who are in a challenging place with their tinnitus, they would fall into that category one subtype, but they also get a hearing test which shows there is some cochlear-related tinnitus as well, and this can confuse patients because they say, “Oh, well, the hearing loss caused my tinnitus and I’m wearing hearing aids, and I still have it and it’s still driving me crazy.” So it’s usually a combination of group one and group three in my personal experience. Would you agree with that?

Michael Golenhofen, ENT Specialist

Definitely, that’s a very important aspect because cochlear damage as some hearing loss, for example, or an onset and somatosensory tinnitus attack focuses so much the auditory attention of a person to any auditory phenomenon, that the cochlear subtype and the somatosensory subtype very often pull along the first subtype, okay? Patients so often tell you the story, “It began on one ear, but now I have also another tinnitus that is on both ears or inside my hand. That’s definitely the case.” And very often we see those three subtypes altogether, not rare. It’s definitely the case that these subtypes occur together very often. And as you mentioned before, that the cortical reaction and the attention disorder that focuses the auditory attention of a person to tinnitus sound is the result of what was happening before to their ears. And this is the moment why it is so important to have an expert. I read that in some referrals from your patients, that someone is there who can explain the situation to them so that they can start to defocus because they say, “Oh, that’s the reason why I hear this now. Well, I can defocus, it will go away the moment I defocus the situation.” This is so important why we need experts that do an accurate and a good counseling. Hazel was completely right, focusing so much on the counseling because it is so important for our patients.

Ben Thompson, AuD.

Thank you so much. I think we’re going to have to have you on for another podcast episode, some months in the future, because you’re providing so much great information and value. And, if you’re watching this on YouTube, or if you’re listening to this podcast, go to YouTube and in the comments write yes, yes, I am learning from Dr. Golenhofen, ’cause I am certainly learning, thank you so much.

Michael Golenhofen, ENT Specialist

You’re welcome.

Ben Thompson, AuD.

We’ll have just last point here before we ask you what kind of projects you’re working on, and research you’re working on, want to make sure you have time to share that. What is your approach of medication for tinnitus patients and specifically as it relates to insomnia, sleep disturbance, and anxiety?

Michael Golenhofen, ENT Specialist

Yeah, it’s a very important question. As I mentioned before, we do not want to focus the attention of the patient towards the tinnitus perception. And whenever we ask them, “How is your tinnitus today?” Or whenever they take any kind of medication and the inside says, “Why don’t you take this because you want to get rid of your tinnitus.” We do increase the tinnitus situation inside their subconscious. We don’t want that, and that’s why medication plays a very small role in the treatment of tinnitus patients. We can communicate in subtype one to say, “I want to give you this into that to help you to improve your distress situation, to improve your sleep, to get you smoother on the path of your treatment and of your improvement of your tinnitus situation, but I do not give you that to improve your tinnitus, okay?’ We do this to improve your overall health, but we try to pull this tinnitus word out of the situation. And there is no drug, not today, not yesterday, and in my opinion, not tomorrow, that we could use to treat tinnitus of the central form.

We can always use drugs, but the side effects are much worse than the improvement of the tinnitus situation. So medication for subtype one does not really play a major role, and we need to be very cautious. At the same time we need to be cautious with anything we do with these patients, because they always make the relationship between their tinnitus perception and their treatment. If it’s an osteopathic treatment, if it’s an acupuncture treatment, if it’s anything we do, we need to say, “We do this to improve your overall, but we do not primarily want to treat the tinnitus, okay?” The main thing is to help people in this subtype to defocus the tinnitus situation and to care about what’s really important for them, and essential. And for the second subtype, I usually like to give magnesium, for example, I like to give some hydroxytryptophan as a serotonin precursor because it makes people a little bit easier. I once created a supplement called auditory ease, which contains some tryptophan and some magnesium and some other things that just help to improve the situation that people can get a little bit easier and release that tension. This is not very critical in the somatosensory subtype, I can also use some muscle relaxants to improve the situation a little bit, but again, it’s not the causal treatment and the causal treatment is what we want to focus on. And for the cochlear subtype, yes, if there is a sudden hearing loss and acute one, one day old, two days old, I start with a steroid treatment as well, because we simply want to do anything that helps those patients to improve their cochlear damage, and whatever we can do, we do. We can do a hyperbaric oxygen treatments in acute cochlear subtype, or prednisone as a steroid or anything that helps. With the acute cochlear damages, there the fear, because you mentioned the anxiety, I have learned from Chinese medicine that cochlear damages happen when there’s anxiety in the background, when there is some fatigue coming from an exhaustion in the background, combined with an emotional stimulus. That is the typical situation that can cause acute cochlear damage. And here anxiety plays a major role. But yeah, here in the acute cochlear subtype, the medication plays a major role, in the chronic, far less, there is no real treatment for that. I once tried to use some medication that improves the mental resilience in some ways, there are some herbs, some plants out there, but it’s not the main focus.

Ben Thompson, AuD.

Thank you so much, this has been incredibly valuable for me, for all the listeners, and we thank you for sharing your time and your expertise. Are you working on a new research? And tell us about TiniCare.

Michael Golenhofen, ENT Specialist

I do only a little bit of research because I’m primarily an ENT physician that cares for patients. And I simply do not have so much time to do a high level of research. But of course I want to focus on those aspects that are most important for us in the practice. When I read publications on the tinnitus, and not really making a distinction between the subtypes, and then investigating any kind of treatment, I stop reading it usually. And I do not feel very comfortable about those types of research. And my practical works will end anytime within the next years because I’m over 60 years old.

And so what I tried to do is to bring my expertise into a digitalized form so that it can reach more patients worldwide, and if they like to, and to bring the expertise and simply a digitalized form so that it can be used by anyone and still have the same level of expertise. And I try to do this in a project called TiniCare. I try to be very clear in the assessment from the medical history, I do a tinnitus test algorithm that people can use to find out their preliminary subtype, and then verify or falsify this preliminary subtype by using further diagnostics, asking their doctors and so on, and then stepping further to the treatment. And I describe the treatment, I do PDFs to communicate with the doctors, explaining them what to do. And this tries to do the three steps from diagnostics to management and treatment to the healing process that the patient needs inside with the different subtypes. And I try to bring this on a platform that serves patients and that serves doctors or healthcare professionals of any kind, to just read my expertise and actually listening to it because that’s tutorials video tutorials, and I publish them on YouTube and other platforms, and try to, yeah, bring it into a form that is really helpful and makes the assessment and treatment of tinnitus patients more sustainable, more medically sustainable, and by that also economically being more sustainable because people find more quickly their treatment that is appropriate and necessary for them.

Ben Thompson, AuD.

I’m excited to use it myself. Where can we find it?

Michael Golenhofen, ENT Specialist

It will be published in the next weeks, it’s out there in preliminary form, it’s not done yet. There are some information out, tutorials given so far about the misunderstandings, about the problem of tinnitus patients, about this actual way that is really helpful for patients to walk on, and the tests tutorials and the explanatory tutorials about the subtypes in diagnostics and treatment will be out there within the next two months I hope, and it will be found on www@tini/right@care.com.

Ben Thompson, AuD.

Great, when that is ready and published, we will put it underneath the YouTube video here and make sure that anyone watching has access to that. And I am personally on your side, I am your professional colleague who supports this, and I am going to use it in the training of my providers via Telehealth, so it’s going to help us out in our patients out too. So thank you for that. Do you have any last words for the listeners as we finish the podcast?

Michael Golenhofen, ENT Specialist

Well, my word would be to not give up, seek as long as you need to find an expert that can really support you in first of all, giving you a good counseling on the disorder that is causing the symptom. It is still the case that more than 80% of disorders causing the tinnitus are diagnosable and are treatable. And so don’t worry.

Ben Thompson, AuD.

Thank you, Dr. Michael Golenhofen. And I am Dr. Ben Thompson, audiologist in the United States. Thank you so much for listening to this episode and we’ll see you on the next one, bye.