Talking Tinnitus: Gael Hannan and Her Audiologist Discuss Effective Care Approaches

Welcome to this Week in Hearing. I’m Gael Hannan and this week our guest is Glynnis Tidball. Glynnis is an audiologist specializing in cochlear implant care and tinnitus at St. Paul’s Hospital, which is part of the Providence Health Center Network in Vancouver. Glynnis regularly speaks to healthcare professionals across the country which in our case is Canada. And I have to let you know that Glynnis is also the hearing care professional in whom I placed my trust for the last few years for my cochlear implant aftercare and for my tinnitus. So, Glynnis, welcome. Thank you, Gael. I’m so pleased to have you here. This is a different type of get together than what we normally have and I have asked you to come and talk with us because I am really fascinated by, as a recipient of tinnitus care, I’m fascinated by what would drive or compel or inspire a hearing care professional to specialize in tinnitus. So I’m just going to ask a really broad question. What was your journey on that and what made you decide to do this? Yeah, I don’t think tinnitus care is appealing to all hearing healthcare professionals, for sure. I came to it through happenstance. I was doing work with an ENT at St. Paul’s Hospital who came into my office one day and threw two articles on my desk and said, I think we should start a tinnitus clinic. Read these articles, and that was it. And we started. And it was a little bit of trial and error. But I really grew to love it. What I love is tinnitus is a bit of a puzzle. So as a symptom, tinnitus is like a headache. It can happen for many different reasons, so, and it can worsen for many different reasons. So it’s a bit of a puzzle working with patients to figure out what’s going on. Exactly when did tinnitus arise? Was there anything going on with hearing or their ears at the time? Anything medical, like a change in medication and very importantly, what was going on in their lives. Was it a stressful period of time? And I grew to also really enjoy the journey with the patient because, as you know, it’s very much a journey. It’s not usually for most people, a one stop visit with their audiologist. I can see patients for years and years and years to stay on that journey with them. And I love that part of it. To me, that’s very appealing. You know, I Love how you say. It’s a bit of a puzzle. So my impression is that it’s a big puzzle. I always think of it. Yeah, no, as it’s kind of from my perspective as a patient, as a client, it’s kind of o, I guess in your field, sort of one of the frontier that really is being explored. And there’s so much we don’t know because it’s the brain. Right. So tell me, like, that’s fascinating. And your clinic and you said it was a bit of trial and error to get it going. Was that more from the administration or just drawing patients? What? Oh, well, to be really honest, scale, I was a newbie clinician then, and the primary way we were managing tinnitus was tinnitus retraining therapy, which can be quite didactic. Meaning you are working with the patient to figure out where tinnitus is most problematic for them, but you’re kind of feeding information to them through educational counseling. And if I compare that to where I am now now at St. Paul’s Hospital, we have an ENT psychiatrist that works with us and she’s been amazing. She and I run cognitive behavioral therapy group for tinnitus that’s eight weeks long. So that’s introducing CBT to tinnitus care. I work closely with physiotherapists in the community who deal with jaw and neck issues that might influence tinnitus. And then there’s always the hearing health piece. And that’s been consistent through the years. So I think for me, there’s been an evolution and I work more and more collaboratively with my patients. Usually what I say when someone comes in is, we’re going to build a buffet table for you and I’m going to put different options of tinnitus treatment on there. And I want you to tell me what’s most palatable and appetizing to you at this point in our journey, and then you can always come back for seconds and you can come back for thirds. And so I, I think I’ve moved more towards that. And that’s standard patient centered care. I don’t ever recall you inviting me to the buffet table, but perhaps we use different terminology for that. And I have not been introduced to this ENT psychiatrist. So whether we can talk about that in our next clinical appointment. But I think that’s fantastic. I just think that’s a great idea because the mental health stresses that can go along with Severe tinnitus such as I have, I believe you once referred to me as exotic. And I have just, I do have a buffet table of tinnitus and hyperacusis and reactive tinnitus and all know. So I mean that’s fascinating. So one thing you did introduce me to which has made a difference for me and it coincides with my commitment to overall health to help improve my journey with hearing loss. And that is the mindfulness piece. And I would love you to talk a little bit about that. So there’s some evidence that mindfulness based stress reduction or MBSR is effective in reducing tinnitus distress. Now there’s tinnitus, which is that perception of sound. And the tinnitus distress is how it makes us feel emotionally and physically as well. So we know that mindfulness helps to reduce distress. And what is mindfulness? I think it gets distilled and into something that, and loses its essence. Sometimes in a popular culture it’s not just about taking a moment to breathe deeply, although that can be part of a mindfulness practice. It is about being in the present moment with intention and not resisting or judging or trying to change anything, for example tinnitus, but just noticing and coming at tinnitus and other sensations in the body, pain for example or events in our lives, emotions as well. Coming at these things with curiosity and noticing. And when you stop and you’re in the present moment and you notice, you start to see things. They call that the beginner’s mindset. You notice things that you probably don’t usually notice because we’re not often doing things mindfully, we’re doing them mindlessly. A great example is we drive somewhere where we drive all the time that we drive to all the time. And then you turn off the ignition and think, oh, how did I get here? Right? That is scary. That’s scary. It is a bit scary. And we’re all doing it. And to drive mindfully would be to pay attention to everything in the moment. So it’s a different experience’s a different way of being. And again I think with an emphasis on learning to experience tinnitus without judgment, without reaction, without trying to change it in any way, just notice it and noticing how it makes you feel, not resisting. What a beautiful description. You and some others we participated in an eight week course that was to have tinnitus as its focus. All of us were experiencing tinnitus or related somehow and it was great. It introduced me to mindfulness. It to reintroduced me to meditation. And since that time, I have discovered a couple of things. On days where I spend at least 5, 10, 15, hopefully 20 minutes on some meditation, whether it’s guided meditation or whether it’s just in quiet with what I’ve learned. Also on days where on those days as well, when I participate in some good cardio exercise Preferably outside. But heart pumping exercise, which my doctor, as a senior person, want me to be doing at least 20 minutes of cardio exercise when those things are all in place. I have noticed often the next morning, but sometimes the same day. I can only describe it as a lowering calming down. A calming down of what I will call the neural pathways. And that noise calms down. It doesn’t go away by any means, but it calms down. I handle it better and I hear better. And so I really work to. And also I realized that I’m probably the most dehydrated person around. I don’t drink enough water. And I read somewhere there’s a correlation with hydration and hyperacusis. So I have started drinking more water. It made a difference for me and it’s just my commitment and also how I react to it. Some days I let it get to me because it’s really loud. But I have tried to respond differently, which is kind of a fundamental. Yeah, it’s a different way of being. Yeah. It is. Can I pick up something from there, which. Please do. Well, I think it’s interesting because tinnitus care. Tinnitus management has to be individualized because not everything works for everybody. So for you, the tinnitus improves when you exercise. Some people will find that heart pumping exercise elevates their tinnitus temporarily. Right. Doesn’t mean you shouldn’t exercise. It might just mean, oh, this is going to happen. I’m going to have a temporary exacerbation of tinnitus, but then it’s going to get better. Right So it’s different for different people. But ultimately, one thing that people can do is look at optimizing their health in many domains. And so physical health, mental well being, optimizing sleep. Sleep is elusive for a lot of people with tinnitus. They have difficulty getting to sleep or getting back to sleep. Sometimes using a sound machine in the bedroom at night can help so that when they’re falling asleep, they’re not falling asleep, only hearing tinnitus because it’s in a quiet environment. Or if they wake in the night, which we all do, we all wake multiple times in the night. They’re not waking to silence. They’ve got sound in the background. That’s hard with a cochlear implant because you’re not obviously wearing your cochlear implant at night. But optimizing sleep may also mean looking at what other factors are contributing to sleep issues, because people will often Pinpoint everything on tinnitus. But it’s not always tinnitus. When I talk to patients, sometimes what else is going on is rumination at night or worrying. And I think, you know, during times of stress, we can all do that. You wake in the night and suddenly your brain kicks into gear. And so optimizing sleep also helps to reduce tinnitus distress and finally optimizing hearing function. I mean, hearing health, yes, but hearing function. And that means going hard with using all the tools available to optimize hearing ability. So it’s not so effortful because, as you know, it’s stressful working to hear all the time. And anything that we can do to improve that usually helps with tinnitus. So that might mean just like hearing devices, hearing aids, cochlear implants, assistive listening technology like a remote microphone or partner microphone, a TV streamer. A lot of people take a hearing loss management course. That’s 12 weeks. It’s a big commitment. I give. I tell everybody about your book Hear & Beyond as another tool in the toolkit to help with that aspect of it. So the better you hear the outside world, the easier it is to ignore tinnitus for most people. I. Sorry, I just wrenched everything away from you Gael and took. Oh, no, no, no. That’s why you’re here. That’s why you’re here. It’s wonderful. I think that – Two things. One thing I wanted to say just to go back briefly to the idea of exercise. When I’m exercising. Yes. Anytime there’s adrenaline going on, adrenaline when I’m exercising or excited about something or having sex, the noise is going. Going to be, as you say, temporarily increase. But it does go back down. The benefits later of exercise are. You can’t dispute them. Were talking about all these tools which are fantastic and which I use. I look through. Because I’m on bas as a writer, I. I’m often on social media and I see on the tinnitus Facebook groups. It’s really heartbreaking. People are struggling so much and they are grasping for any quick fix or what can I do. And there’s just unfortunately a lot of misinformation going around. So I think it’s really important for people who have tinnitus to to explore and read and learn as much as they can about the reality of tinnitus and the reality of hearing loss if it is related for them and to really get a better grasp so often they say, people tell, My doctor told me that nothing can be done. I have to live with it. And I think sometimes that that’s their takeaway from that. That they’re not hearing the other piece. But there are some things you can do to help you live with it. And I think that is so important. Its something that I will always live with. I know, but I deal with it so much better now and in large part to you and having expert care from a provider who cares about the issue. So I applaud you and all your colleagues who do this. Is there anything else before we close at any other tips for any people with hearing loss who are watching this? Well, I think we work hard to find a provider that is comfortable working with you. With tinnitus, the goal is to shrink the significance of tinnitus in everyone’s lives and to lower tinnitus distress. I would say if you’re working with a provider, you know, ask them, sort of interview them a little bit at the beginning and say, tell me, what is your experience working with tinnitus and, and what approach do you take? There are various approaches out there but just make sure it’s a good fit for you when you’re working with that provider. Its really not only about, in my experience, it can be for some, but for the patients I see, it’s never just about slapping on hearing aids with the noise generator built in and off you go. Its usually much more in depth than that. So work hard to find someone. If you’re, if you’re wondering about a supplement or a novel treatment for tinnitus, check out the websites like Tinnitus UK or the American Tinnitus Association have a search there to see what their reviews of the supplements or treatments are. And then lastly, if you’re interested in looking at what trials are going on clinical trals.gov is where any study that’s recruiting subjects you can, you can see on the website where they’re actively recruiting subjects. So you just need to search tinnitus and you would see that there. Yeah there’s, there’s some good information on the Internet, but there’s a lot of misinformation, so be sure to go to a credible source. Yeah, that’s great. Thank you. What we’ll do at the we’re going do at the end of this podcast, we’ll put up those websites, and that’s great information, and it’s something that I’ll start sharing as well. Glynnis Tidball, I love you. I love working with you. Yeah. And it’s been not only major, major help in my life in dealing with it. I’m sure that you have that same impact on all of your patients. So thank you so much. And I’m probably overdue for anoint, so I will make one, and we’ll come in, and you can maybe offer me more from the buffet. Table. Ok – haha thanks Gael Okay. Until that time. Thanks so much. Bye.