Tinnitus Management with Dr. Alexandra Tarvin | Elevate Audiology - Hearing Matters Podcast

Episode Transcript
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Welcome back to another episodeof the Hearing Matters Podcast.
I'm founder and host, BlaiseDelfino, and, as a friendly
reminder, this podcast isseparate from my work at Starkey
.
You're tuned in to the HearingMatters Podcast.

(00:58):
I'm your host, Blaise Delfino,and today's guest is audiologist
Dr.
Alexandra Tarvin, owner ofElevate Audiology in South
Carolina.
She is a true trailblazer intinnitus care.
From personal curiosity tobuilding a tinnitus management
app with her husband, who alsohappens to be a mental health

(01:20):
counselor, Dr.
Tarvin is leading a moreholistic and informed approach
to one of the most misunderstoodsymptoms in hearing healthcare
tinnitus.
Dr.
Tarvin, welcome to the HearingMatters podcast.
Thanks for having me.
We've been looking forward tothis episode for quite some time
now, especially really leaninginto tinnitus and tinnitus

(01:44):
management.
So before we really deep dive,let's talk about tinnitus what
it is, define it, modernmanagement.
For those new to this spacemaybe you're a student, maybe
you just came across thisYouTube video and you're a
consumer Dr.
Tarvin, explain to us whattinnitus is and what some of the

(02:04):
common causes or contributingfactors are.

Dr. Alexandra Tarvin (02:08):
Yeah, absolutely so.
The most common type oftinnitus is called subjective
tinnitus, and that's usuallywhen we talk about strategies
and management.
We're talking about subjectivetinnitus, which is a person
perceives a sound, whether it bein their ears or in their head,
that's not existing in theoutside world.
It's very real, they reallyhear it.

(02:28):
It's not a hallucination, it'sa real perception of sound, but
it doesn't exist.
It's not an acoustic sound inthe environment.
And then there's also adifferent type of tinnitus
objective tinnitus.
That's pretty rare, so we'renot going to be highlighting
that today.
And then you also have a commonmisconception of transient ear
noise.
Transient ear noise is thatsensation that is a very common

(02:51):
in the general population.
It's non-pathological and it'swhen all of a sudden you're
sitting there and it feels likeyour hearing cuts off and then
you hear or gets dull, and thenyou hear this like shrill ring
that levels up and then it'sgoing for 15, 30 seconds and
then it just kind of fades awayand you're hearing restorers and
that is no cause of concern.

(03:12):
But a lot of people will comeinto the office thinking that is
tinnitus and that's scary tothem.
And I get to tell them that nobig deal.

Blaise M. Delfino, M.S. (03:20):
Doesn't that mean that someone's just
talking about you, right, yeah?

It's like, yeah, exactly, it's one of
those old lives too.

Blaise M. Delfino, M.S. (03:26):
Because I have absolutely experienced
that and obviously, being ahearing care professional, I'm
like, oh, I know what that is.
But if you've never experiencedthat, I could absolutely see
how a patient can come and say,oh my gosh, why did I only hear
it on one side.
We talk about tinnitusmanagement today and notice how
we say management, not treatment.

(03:47):
So, dr Carvin, what doestinnitus management look like
today practically speaking, andcan you just kind of walk us
through a typical plan?
And is that plan the same forevery patient?

Yeah, I don't think there's a typical
plan.
I think it varies sosignificantly, but are there
common things that tinnitusspecialists do to help patients?
Yes, so we would typically wantto really understand how this
is impacting somebody, whattheir symptoms are when they
started.
We need to look at all themedical stuff and rule out if

(04:19):
they happen to be in the veryrare small percentage of people
that have something moresignificant going on so that's
part of our test battery.
In the very rare smallpercentage of people that have
something more significant goingon so that's part of our test
battery.
In the audiology space, the ENTspace, is to dig deeper into the
medical sides of things andrule stuff out that the majority
of people do not have to beconcerned about.
And then we have questionnairesand validated intake

(04:41):
information and so we can helpcategorize how this is impacting
somebody and then themanagement gets built from there
.
And it really depends on whatare all these symptoms that the
patient is experiencing.
And in my perspective, I reallylike to take a very strong
patient-centered approach, andso I like to educate my patient,

(05:01):
counsel them on what is whatisn't, inform them and empower
them with information about whatis going on with their body,
and then we work as a team tofigure out what is the right
strategy to help them manage anddo they even need a strategy
and that's something that wespend a lot of time figuring out
together.

Blaise M. Delfino, M.S. - HIS (05:21):
I love how you said the
patient-centered orperson-centered approach,
because really that's part ofbest practices today.
And you see all these ads whichwe'll talk about later about if
you take this magic pill, yourtinnitus will go away.
It's like not so much, let'shave you visit a hearing
healthcare professional first.

(05:41):
So I'm just so happy that youreally shed light on that
person-centered approach,because every patient is
different, everyone's ear isdifferent, everyone's hearing
loss is different.
You could have two patientshave the same hearing loss One
has tinnitus, one doesn't andone could experience their
hearing loss as being incrediblydisabling and the other saying

(06:02):
I get by.
So thank you and ElevateAudiology for taking that
person-centered approach.
So sound therapies we have pinknoise and white noise.
Can you just explain thedifference and why hearing care
professionals implement soundtherapies?

Yes, absolutely so.
Sound therapy is the umbrellaterm for using sound to
therapize yourself.
It is not unique to tinnituscare.
It is not unique to audiologycare.
We use sound machines forbabies, right, and that's
something that most parents dowhen they have a newborn is they

(06:42):
get a sound machine whilethey're pregnant and then they
turn it on after the baby's born.
So we know sound is verytherapeutic.
Lullabies that is a form ofsound therapy.
Right, you're relaxing yourchild and you're making them
feel safe so they can fallasleep successfully.
So we know that in a situationwhere sound, a perceived sound,

(07:04):
can be a problem for somebody,that if we utilize the auditory
system by using other sounds,maybe we can make it less
problematic via distracting them.
Right, even turning on ACDC,because you're jamming out and
you're cleaning the house andyou have your tinnitus, that's
sound therapy.
Putting a noise machine onwhile you're going to bed is a

(07:27):
form of sound therapy.
Utilizing hearing aids withoutany additional sound enrichment
beyond the actual prescriptiveamplification is sound therapy.
And then you have hearing aidswhere you turn on masking types
of noises.
Where you turn on masking typesof noises, noise is the term

(07:51):
for multiple sounds at once,right?
So white noise is the entiresound spectrum that we hear as
humans, from 20 hertz to 20,000hertz at equal intensity, and
then the colored noises stillhave all the same spectrum of
sound but they're weighteddifferently.
So, like, a pink noise has morelow frequency energy than high
frequency, a brown noise haseven more low frequency energy

(08:13):
than high frequency, and sosomebody might like one more
than another, right Just basedon preferences, and that's okay.
And so we think of white noiseas more of a staticky sound.
We think of brown noise as moreof a staticky sound.

Blaise M. Delfino, M.S. - HI (08:25):
We think of brown noise as more of
a fan noise which a lot ofpeople tend to find relaxing,
which, I have to say, being afirst-time father and my son
being four months old nowCongrats, thank you.
Brown noise love it, love thebrown noise.
It is honestly very soothingand therapeutic.

(08:46):
Dr Tarvin, now let me ask youabout tinnitus masking because,
being a hearing careprofessional myself, being a
former private practice owner,the technology today has
brilliant tinnitus masking.
But let me ask you, let's sayyou just had a patient walk in
and they say I have tinnitus andI believe I have hearing loss,
and they do in fact present withhearing loss and also tinnitus,

(09:11):
what are you managing first andwhat does that look like?
Because I feel like we can helpa lot of patients here with
this question.

I really like to ask tell me your story.
What brought you here?
What prompted us to meet?
What's been going on?
I learned so much from thatquestion because the patient
will uncover and reveal to mewhat their main problem is.
That's very, very different.
We do ask the question.
You know what seems to be yourmain issue on the questionnaires

(09:43):
, right Hearing, tinnitus, soundsensitivity, right.
So we are asking thosequestions on the intake.
But when I ask the patient toreally give me information on
their story, that can uncoversome really helpful information.
Here's why there is so muchmisunderstanding out there on a
lot of health conditions,hearing and tinnitus being

(10:05):
included.
A lot of people have amisconception that if the
ringing or the buzzing wouldjust get out of the way, they
would be able to hear X, y or Z.
That is the number onemisunderstanding with tinnitus.
The tinnitus is there becauseof the hearing loss.
For many people not everybody,but for many people the hearing
loss was there first.

(10:25):
That is the chicken or the egg,depending on how you think
about it.
So the tinnitus is just alsothere.
It's there as a symptom of thatauditory deficit.
And so a lot of people will sayI have a major, major hearing
problem, but it's all because ofmy tinnitus.
And so then, if somebody didnot ask any additional follow-up

(10:47):
questions, you would say, okay,well, we need to address the
tinnitus first, right.
But when you actually listen tothe story in this situation,
you would actually uncover thefact that the patient has been
blaming the benign sensation oftinnitus for all of these
communication issues.
The communication issues isactually their presenting
problem, and so now we know thatwe need to handle their hearing

(11:07):
loss right.
But the flip of that happensall the time too, and so it's
really about having theknowledge and having the
experience to ask thesequestions and uncover and follow
the journey that the patientwill take you on to figure out.
Okay, but what is the actualissue?
Not what they think the issueis, but what is the actual issue
.

Blaise M. Delfino, M.S. - H (11:26):
And early in my career.
You have your patients and youjust want to help.
And to learn you have two earsand one mouth.
For a reason, listen twice asmuch as we speak.
And to learn that motivationalinterviewing is in the best
interest of your patient numberone, but also you, and just

(11:47):
listen to what they're sayingand asking the correct follow-up
questions.
And because this patient couldsay well, I worked at the steel
mill for 35, 40 years back inthe day and you're like well,
you definitely did not wear anyhearing protection, so that's
probably the cause of yourhearing loss and now tinnitus.
And thank you for bringing usthrough that, because some

(12:09):
clinicians of course have theirown philosophy with that.
But as it relates going back tobest practices, if you are
implementing those bestpractices, as every hearing care
professional should, thepatient should, with that proper
care and management, walk outof the clinic with a smile on
their face because they knowthat they've come to the right

(12:29):
place.
And I believe that's a greatsegue here, dr Tarvin, to really
talk about your why.
But I want our listeners toknow your journey.
What initially drew you tobegin specializing in tinnitus
management?
Because not every hearing careprofessional specializes in this

(12:51):
.

Absolutely yeah.
So I don't handle things wellwhen I don't understand them
well, and so I was a neweraudiologist.
I had graduated and was workingin private practice and started
coming across a lot of patientsthat were experiencing tinnitus,
and some of which didn't care,and some of them really did care

(13:12):
, and for those that were reallymore disturbed or bothered by
it, I found that I was lackingthe skills, the knowledge and
the tools to be able to walkthrough that journey with them,
and so I no longer felt like Iwas doing them the greatest
service, and that really did notsit well with me.
Then I thought it was a bitconfusing, and then I thought,
gosh, this is the brain, and Istarted taking some online

(13:34):
courses and classes and readingarticles that were being put out
within our professional spaceand reading journals and
figuring out like there's somuch more to learn, but I want
to do it in a more structuredway, and so I ended up going up
to Boston and doing a moreadvanced course with the
tinnitus practitionersassociation at the time and
meeting a lot of otherprofessionals that were also

(13:56):
committed to either havingworked with tinnitus care for a
very long time or were newer toit like me, and it just started
assuaging all that curiositybecause I came into audiology
through neuroscience and so Iwas very interested in how the
brain worked and centers of thebrain and the emotional response
system, and I was alreadyreally kind of more heightened

(14:18):
to caring about that, and sothis seemed to really check my
boxes on further incorporatingcognitive health, mental health
and neuroscience into theprofession of audiology, which
has a lot of full circle moments.
I won't get into all the storiesthere, but it really felt like,
okay, this is another checkhere that makes this feel like
I'm well suited for this becauseI care about what it is about.

Well , and in audiology like many
other fields.
So I have a master's in speechlanguage pathology and I am
licensed in Pennsylvania andSouth Carolina as a hearing
instrument specialist, now as anSLP.
If I were practicing as acertified speech language
pathologist and I was currentlyin the, let's say, school

(15:04):
setting and I wanted to transferinto the medical setting and
focus on swallowing disordersand voice disorders, I wouldn't
just jump into that.
You would go to courses, ceus,get re-educated on what is new
best practice in the field.
So this is a great opportunityfor us, dr Tarvin, to encourage

(15:25):
our fellow hearing careprofessionals that if you want
to offer tinnitus management asa service to your patients, do
it the right way.
Because if you just say, well,I'm going to start managing
tinnitus, it's not in the bestinterest of your patient and
it's also probably going tostress you out as a hearing care
professional because taking theright step and doing it right

(15:47):
is absolutely in the bestinterest of that patient.
Because we know patients who dopresent with tinnitus.
When you're a hearing careprofessional and you're doing
the tinnitus handicap inventorywith the patient and you find
out it's severe, it'scatastrophic, let's say you want
to have the correct talkingpoints right Now.

(16:07):
Let me ask you because thisjust sparked here when you're
implementing the tinnitushandicap inventory, which allows
you, as a hearing careprofessional, to understand the
severity of how the patientperceives their tinnitus, do you
have the patient fill that outor are you doing it with them?
Do?

you have the patient fill that out or are
you doing it with them?
Yes, sometimes both, or eitherMost of the time, for just
time's sake, we're having ourpatients do intake paperwork
prior to them coming to theirappointment, or sometimes
they're doing it right beforetheir appointment has started if
they didn't get to it online.
So just for those who don'tknow, the THI, the Tinnitus
Handicap Inventory, the TFI, theTinnitus Functional Index, the

(16:45):
TFI, the tinnitus functionalindex these are validated
questionnaires.
They've been studied andresearched to show that they're
repetitive like you could repeatit and have valid results.
I prefer the TFI for a couple ofreasons, but either way, right,
it's really about getting tothe core.
I prefer the patients to answerthose questions without
somebody staring at them,because some of those questions

(17:08):
can actually get prettyemotional and can tap into
things that can make themreflect and shed some light on
stuff.
And I actually think it's moreappropriate to allow somebody to
do that in the comfort of theirown home than to have somebody
staring that or even asking themthat question where they feel
pressured to answer it a certaintype of way.
So I prefer them to do itprivately.

If I had to pick, yeah, and thank
you for bringing that up,because even for our younger
clinicians right now, I hopethey hear this and they consider
, you know, let's have ourpatients fill this out at home.
And it really goes back to justgeneral understanding of
tinnitus, why a generalunderstanding of tinnitus just

(17:50):
isn't enough today and whyproper training is so important.
Can you talk to this, dr Tarvin?

Yeah.
So I think just generalknowledge and experience has
told us, for where we have beenthus far, that the general
understanding of tinnitus is notenough.
It has led to a lot of peoplethat experience tinnitus,
feeling hopeless, helpless andinvalidated, and whether that is
physicians learning a sentencein a book in medical school and

(18:20):
carrying that with them fortheir entire professional career
, and really it's not theirresponsibility to know about
every specialty, right, theyshould refer to specialists and
if it's on them, right.
But we see this within thehealthcare space audiologists
and hearing instrumentspecialists.
We see this in other peripheralhealthcare fields like
chiropractics, for example,right, marketing or highlighting

(18:42):
that they can cure or healdifferent things, tinnitus being
one of them.
Right, just because somebodyattends a course on something
doesn't make them an expert.
That's the start of becomingmore knowledgeable and skilled
and experienced right to get tothat point.
And then you have also kind ofthe pretty critical part of

(19:05):
state licensure, right.
So across the country there are50 states and each of these
states can act independently onscope of practices.
So in some states, hearinginstrument specialists, even if
they take course work or even ifthey take courses to get
certified in something from,just you know, an organizational

(19:26):
body, does not mean that theycould provide tinnitus care
within their state and otherones it is defined that they can
right, audiologists can acrossthe country.
And so if you think, if youtake that outside of just the
hearing healthcare space andthen you have other
practitioners talking andspeaking on things they may or
may not be more skilled orknowledgeable about, it just

(19:47):
further perpetuates maybe themisconstrued information that's
out there about tinnitus.
And so, as a specialist, assomebody who has devoted a lot
of time and hours learning,making mistakes, growing,
learning, learning, learning.
It is so important that we knowwhat is within our scope

(20:07):
professionally but also what'sin our scope and within our
abilities personally.
And working with patients withtinnitus gives you a wide
spectrum of patients with mentalhealth differences.
And if we're not available forthat emotionally ourselves and
if we're not available to beable to learn or grow or network

(20:30):
or partner, refer, know, youknow where our limit is and we
just say like, yeah, we dotinnitus because we heard about
it, we know that hearing aidscould help, and so we're going
to say that we do tinnitusbecause we can put a hearing aid
on somebody and 70, 80% of thetime that might be enough, then
we could be really harming someindividuals hopefully not the

(20:50):
majority, but some.
I will piggyback on that for avery personal story.
So, or actually like between myhusband and I, because he is a
mental health counselor, I takein a course out of the UK on
cognitive behavioral therapy fortinnitus, hyperacusis and
misophonia Very interesting forme.
I, you know, I spent the timeand the money to do the

(21:11):
coursework and learn and hop onprograms we were on these
trainings with people from allover the world.
It was absolutely fascinating,it was incredible, and there was
a subset of us that were inthis course from America and we
would meet individually and wewould talk about how would we
implement these tools andstrategies, and then I would
learn cognitive behavioraltechniques, which everybody in

(21:34):
America would agree that livesinside of the scope of mental
health professionals, whetherit's therapists, counselors,
psychologists, psychiatristsright, that is their scope.
But we can utilize thoseprinciples and understandings
and use psychiatrist right, thatis their scope.
But we can utilize thoseprinciples and understandings
and use techniques right, thatwould be within our scope to a
point.
So I'm sharing all these ideasthat I have with my husband that

(21:54):
I'm learning from this courseand my husband's respectfully
listening.
And then he goes yeah, and thenwhen the patient says this,
then what do you do when you askthem that question that you
learned to ask them?
And then this is their response.
What's your response?
And I said, well, I don't know,I didn't learn that.

(22:15):
That's beyond what I know.
He goes exactly, and that's whyyou should not be asking the
question.
And so it was a really valuablelesson in.
We can learn and we can grow asprofessionals and we can
integrate that knowledge, but ifsomething is not in our scope,
professionally or personally,you should not be marketing it

(22:41):
as such and then certainly notdoing it right.

Right , yeah, just because a keyword
on Google is really you know,quote effective right now.
Don't do that to the patient.
And also don't do that toyourself, because, dr Tarvin,
you're an advocate.
You're very active in SouthCarolina licensure board.

(23:04):
Listen carefully, ambassador.
Thank you so much for all youdo for our industry and our
field.
The bad actors out there,because there are also
organizations, even companies,who will sponsor Google ads and
they'll use Tinnitus as thegateway.
It's like a bait and switch andwe hope to use this platform to

(23:25):
educate consumers.
We've always said since 2019,we are here to help patients
make an educated decision abouttheir hearing health care.
Dr Tarvin, this is somethingI'm really excited for you to
talk to our listeners about.
A couple of weeks ago, weconnected to really talk about
this podcast episode and,unbeknownst to me, I had no idea

(23:46):
that you and your husband werelaunching a tinnitus app.
So when we talk about emergingtechnology, not only in the
hearing healthcare field, butalso mental health space, tell
us more about this inspiration,about the app and how it works.

If I can clone myself, if I could clone
my husband, if I can clone a lotof my professionals that I like
very well respect, we would notneed this app.
You know, we can't go home withour patients, we can't
reinforce some of the thingsthat we might talk about in an
appointment, and then you havethe wide spectrum of
professionals out there in thehearing healthcare space and
outside of it that touch andtalk with people that experience

(24:25):
tinnitus right, that nobodywould expect them to be an
expert or to know everythingabout it.
So there's a need for somethingthat's affordable and
accessible, that can almost belike a companion for tinnitus
specialists, for audiologistsand hearing instrument
specialists that are nottinnitus specialists, for
primary care providers, for ENToffices.
There's a big opportunity forsomebody to have a companion in

(24:51):
their pocket right.
And there are apps out thereand there's plenty of reason to
have more than one and more thanone type and more than one kind
with different focuses, and sothere are a few tinnitus apps
that are out there.
Some of them are really justsound therapy apps, which are
absolutely.
Some of them are phenomenal andI recommend them regularly to

(25:11):
patients because they do it well.
And then there are some thatare not so great, you know, and
then there's some really robustones.
There's an app called Odo andthat is a CBT heavy app.
You pay for it and it does itsjob right.
But what I have found in mypractice is that not everybody
is willing to go all in.

(25:31):
A lot of patients are.
If they are on the spectrum ofneeding professional mental
health care, that doesn't meanthey're willing to do it, and so
we're in a bit of a pickle whenthat's the case, and there are
not very many mental healthprofessionals that are versed in
tinnitus to be able to speak onthat knowledgeably and help

(25:52):
them in the best way.
So there was like a gap.
And then there was an app thatentered the market that a lot of
my colleagues and I reallyreally liked, and then it left
the market very quickly and whenthat happened I looked at my
husband and I was like I'mpretty bummed.
I was kind of really using that.
I really liked being able tointegrate educational
information on tinnitus andmental health techniques.
And he looks at me and goeswell, isn't that our marriage

(26:19):
Like?

we're an audiologist and a mental
health professional and we'remarried.

That is our foundation, that is a
professional foundation, and sotiming worked out because he had
already started taking classesand courses on coding and
technology.

Get out it was crazy.

It was meant to be, and then I thought
well, how cool could it be forus to build something with both
of our insights and knowledgeand put it together and make
something, but then have it kindof be like for us by us?
So we're launching it.
It's now available forprofessionals to utilize.
They can offer it to theirpatients.

(26:56):
They get a code, all that jazz.
It's called Twillo T-W-I-L-L-O,but what's really cool about it
is that it's something that ifa provider is not specializing
in tinnitus, they can stilloffer their patients something.
I might not be the one to tellyou about everything, but here
is something that can, and ifprofessionals or users of the

(27:21):
app have an idea wish we wouldhave delved into something more
we can build it.
It's not owned by a bigcorporation.
That it's like kind of it iswhat it is.
We can use that feedback, andso it's really exciting because
we expect it to be adapting overtime as we get feedback and
usage.

Blaise M. Delfi (27:39):
Congratulations , first of all and second, on
behalf of all the patients whopresent with tinnitus.
Thank you for what you and yourhusband are doing.
When it comes to the clinicalpractice, how do you envision
Twillo being used by clinicians?

Yeah, I mean, in my practice I'm
definitely, when I identify thata patient, like if I could go
home with that patient and holdtheir hand, that they would
benefit from that.
I'm like, hey, here's a versionof me that you can.
You know, yeah, here's a tool,Like here's a we call it like a
companion, and the really nicething is it's your journey so
you can go through it as you seefit.

(28:15):
You're not forced to readanything or go through anything
you don't want to.
So if there's a section thatjust doesn't speak to you, you
don't have to complete it.
Right, Favorite stuff If youlike exercises, you can favorite

(28:36):
it so you can go back to themeasier.
I see providers, colleagues andother providers using it as a
tool, like I said, either inplace of them having somebody to
refer to locally to give theminsight for their patient, or as
that companion to reinforcewhat a provider says in the
office, and then for some morerobust treatment plans.
Whether somebody is doing asound therapy based program or
tinnitus retraining therapy orthe linear treatment device,
this can be a tool that can beused in accompaniment with other

(29:00):
treatments that are out there.
That is, a lower cost andsimple and not asking too much
of people that are just not ableto or willing to go or need to
go, as elaborate maybe as someof their options out there.

That makes sense.
You know this, so completelydifferent industry.
But the app Noom N-O-O-M right,so like I've used it, cause I'm
like you know what, let me dropa couple LBs here.
And I mean, dr Tarvin, it'sreally built on the psychology
of weight loss.
But what it's taught me?
There's some things that I do,like tracking my water and my

(29:38):
steps and tracking my food, butI can see Twillo being like the
Noom in hearing healthcare.
Where I've used Noom it'sincredible.
It's helped me.

I use it too and I've read through all of
it and it's so funny becauseI'm reading through it, going
like this is a CBT principle.
This is a CBT principle.
And it's so cool because noneof us are reinventing the wheel.

We're just utilizing it differently.

Exactly.
This stuff has been out there,it is tried and true, it's
evidence-based, so you just haveto work it, you know for you.
But the biggest thing withtinnitus management, like in a
nutshell, is it's in a worldwhere we like instant
gratification and we make reallyimpulsive choices.
This is not that, and that'sreally hard for some people to

(30:26):
wrap their head around, right?
Is that?
In order for if this issomething that's significantly
impacting my quality of life andreally, really bothering me,
I'm going to have to devote timeand energy and oftentimes money
to some extent, right, to getmyself out of the pickle that
I'm in.
But there's so much hope thereand it can happen and there are

(30:48):
really inexpensive ways of doingthat.
Then there are some moresignificant treatment plans out
there too, right, like there's awide spectrum.
As with anything, right, ourbodies are complicated and what
we have to do is complicatedsometimes to make big change.
But with big change comes bigreward, and if it's something
that somebody is struggling withsignificantly, then I just

(31:10):
really want to enforce that.
I say in my practice all thetime there is hope and there is
help.

I love that.
Love it and so you hadmentioned linear.
Yeah, there's a buzz aroundlinear providers.
I believe Elevate Audiology isa linear provider, but can you
explain what that is and how itfits into tinnitus care?

Yeah, so linear is a treatment for
tinnitus, so linear is what wecall.
Like the system.
It was built by a companycalled Neuromod and it came out
of Ireland.
2015, 2016, they started doingtrials.
Ironically, I was on my belatedhoneymoon in Ireland, was

(31:54):
looking at a newspaper, snappeda picture of a call for people
to complete a tinnitus trial.
That was actually the lineardevice.

This is all full circle, Dr Tarvin.

I was live in Ireland and the founder came
to my office.
Dr Ross O'Neill came to myoffice and I showed it to him
and he was like yeah, that wasLanier.
So I claimed to be the firstAmerican that knew Lanier
existed, anyway.
So, yes, so it got FDA approved.
So it's been around for, let'ssay, seven years now on working

(32:28):
on people in Europe.
It's been FDA approved inAmerica since March of 2023.
So we're over two years of itbeing on patients in America.
It's taken off.
More and more providers havebeen educated, credentialed and
approved to provide it, but it'sstill specialty.
The Neuromod team is stilltrying to be very intentional

(32:49):
and making sure that they'reworking with clinicians that are
already aware and knowledgeableabout tinnitus.
So linear is a tool, linear isnot the tool.

Sure , If that makes sense which I
truly do appreciate.

I think that's extremely valuable
because it's not a standalonedevice, but it is the first FDA
approved treatment for tinnitusspecifically, and so it got de
novo approval from the FDA,which is very, very hard to
acquire.
It went through a bunch ofclinical trials and now it has
published real world evidencedata as well.
And what it does is it takestwo modes of input, so bimodal,

(33:26):
that's, tactile stimulation onthe tongue coupled with auditory
stimulation via headphones, andthere were a bunch of smart
people that did a bunch of stuffand created protocols and
tested them and refined them andtested them again and refined
them and found that in theclinical trials it was over 70%
and some of the real world datait's showing over 90% effective

(33:46):
at reducing tinnitus severity.

Wow .

You look at severity as being measured by
a questionnaire and somebodytakes it before they start
treatment and then they take itthroughout treatment.
We see clinically significancedeclines in how their tinnitus
is impacting them acrossdifferent modalities and that's
what's defined as clinicallysignificant.
That doesn't mean that peopledon't ever hear their tinnitus
again.
That doesn't mean that itmagically is cured or goes away.
But if you were experiencingpain and you would say that your

(34:17):
pain was an eight out of 10,and you could do something that
the pain would go down to a fourout of 10, you'd probably be
pretty grateful.

Oh , yeah, absolutely.

If you had floaters in your eyes and your
thermologist said we can't everget rid of them completely, but
we can get rid of 70% of them,you'd be like that's worth it.
And that's kind of how we haveto think about Lanier.
There are some people who havecrazy, amazing results Like they
truly are, like I don't hear mytinnitus anymore, and they

(34:48):
would tell you it was a cure forthem.
And then you have people on theother end of the spectrum that
don't get a benefit at allbecause it's a medical device
and nothing is a hundred percentright.
We take medications all thetime that are not a hundred
percent effective, but it's areally strong, effective,
valuable tool.
It's a pretty easy ask to how touse it and it can be very

(35:11):
effective at reducing theseverity of people's tinnitus.
And yes, I use it in my clinic.
It is not for everybody.
Nothing is but for the peoplethat it's right for holy cow.
It's pretty awesome.
Like I'm really glad to have itas a tool, because there are
people who are like I don't havea hearing problem.
Or you could tell me untilyou're blue in the face that I
have a hearing problem but I'mnot doing anything about it,

(35:32):
tinnitus is my problem, and nowwe can say, okay, I can meet you
where you are.

Right , which is absolutely brilliant,
and so you have Twillo, thecompanion app and then as a
linear provider for consumerstuned in right now.
Dr Tarvin, if they do presentwith tinnitus and they go to a
linear provider cause, you needto be certified as a linear
provider.
Is this something that's donein the office, that they go home

(35:58):
to do?
What does that process looklike?

So you are fit in the office with the
device, so it does need to becalibrated program, do you need
a proper education on how toutilize it and then, with your
provider, you will havefollow-up care over the months.
But you actually do thetreatment at home or not in the
office, and it's a veryenjoyable experience for most
people.
What you're hearing is kind ofa wide variety of noises and

(36:24):
sounds and I kind of tell peopleit sounds kind of like spa
sounds at times, and then whatyou're feeling on your tongue is
very a gentle stimulation.
It is using electrical pulsesbut you are not being shocked.
I'm like if you've ever had aself-surgery, I'm like it's less
aggressive than that at times,and so it's an enjoyable

(36:44):
experience.
And again, one of the thingsthat I look for when I'm seeing
is somebody a candidate forlinear as a treatment is are
they willing to use it?
Does their lifestyle allow themto make time to use it?
What is their mindset or theirattitude towards it?
So it's not just what's theirhearing loss and how bad is
their tinnitus, there's a lotthat goes into it and that's

(37:06):
stuff that a lot of mycolleagues that are also linear
providers have learned on thehearing aid side, on the
tinnitus side, on even equipmentthat we use in our offices,
right, it takes time to vet thatstuff and then you kind of
figure out I do that on thatperson, I don't do that on that
person.

(37:26):
You know, you learn, you'reprofessional, and that's one of
the benefits of being a doctor,and profession in audiology is
that you make decisions for yourpatients.
That's what a doctor does, andso you know whether it is sound
therapy without hearing aids,sound therapy with hearing aids,
just mental health techniques,linear, a combination of all of

(37:46):
these things.
That's something that we'rehelping our patients decide upon
.
And again, I like it with thatteam approach.
When patients say, just tell mewhat to do, I don't love it
Right, cause I'm like I can'twant it more than you.
It has to be a joint effort.

You could buy the gym membership,
but if you're not going to goyou're not going to see results.
You could buy whatever appyou're trying to do, whether
it's lose weight or, you know,manage your tinnitus but if
you're not utilizing that toolyou're not going to see results
Exactly.
And attitude matters, yeah, notonly in life but in hearing
healthcare as well, because ittakes a patient.

(38:21):
There's studies that say sevenyears to visit a hearing care
professional, others will say 10years.
Either way, if you're waitingseven to 10 years to address
your hearing loss, when thatpatient comes through the door
they more or less.
You have to understand thepsychology of the hearing
impaired and that to me, drTarvin, when I was practicing
full time, was you're not reallydealing with hearing loss and

(38:43):
ears as much as you are theperson in front of you and the
brain between their ears,because it's all psychology and
the foundation that you and yourhusband have built that on with
Twillo is incredible.
I want to deep dive a littlebit into misinformation and
myths, because you could go ontothe 13th page of Google which,

(39:04):
like probably no one ever goeson.
Like what are some of thesecommon myths around tinnitus?
I know you've heard them.
You know caffeine,riboflavonoids, even the idea
that tinnitus causes dementia,yeah, what's the?
truth here.

Yeah, the good news is that a lot of the
myths out there are myths.
A lot of the stuff out there isnot actually true, because a
lot of it's pretty hopeless andpretty yucky and ugly, and
misery loves company.
So if somebody did something ortried something and it didn't
work for them or they're like,oh, that's snake oil, you know,

(39:41):
you have to take it with a grainof salt because misery loves
company.
But I will say there are somethings that are pretty often
recommended or even prescribedthat we know are not really
effectively on placebo, butthey're so widely, it's so
common, that we just accept itas that must be true.
One of those is theriboflavonoids, and I looked

(40:03):
into this because I had learnedpretty early on that they were
very placebo.
But placebo is sometimes goodright, as long as something's
not harming you and itpotentially could impact you.
It's not a high risk, it's notoverly expensive.
Maybe it's worth it to try.
But the idea behind theriboflavonoids is that or the
bioflavonoids, riboflavonoidbeing one of them, is that it

(40:24):
can increase circulation in theinner ear, which would be a
healthier inner ear.
Blood flow is pretty criticalbecause the inner ear has the
second smallest microvascularstructures in the body second to
the lungs.
So you need good blood flow,you need those nutrients to go
into those cellular structuresand helping fatty deposits and
all these other things thatcould be really good for you.

(40:45):
It's a supplement, right?
Supplements are notprescriptive and supplements are
often not regulated by the FDA.
You can give it a try If ithelps you.
Cool If it doesn't no skin offyour back right?
There's a lot of stuff aboutdon't drink caffeine, caffeine
being like coffee soda.
There's even caffeine inchocolate.
That has been shown to be amyth.

(41:08):
So that came out of someunreplicable studies a while ago
that talked about caffeine andtinnitus like caffeine being a
trigger for tinnitus.
But I will say it's globally amyth.
For an individual it might betrue.
If somebody's metabolism isvery sensitive to stimulants
coffee being a stimulant you mayfind that you have an increase

(41:29):
in your tinnitus perception oryou're more aware of it if
you've absorbed any caffeine, ormaybe a higher amount than is
best for you.
You can say the same thingabout alcohol, I mean, but that
is we know that to be true.
Alcohol, stress, somerecreational drugs we know that
can be a trigger for tinnitusperception.
That's not a myth.
It just to the degree at whichit impacts somebody.

(41:52):
The greatest, most disturbingmyth that patients are coming
into my office repeating is thattinnitus causes dementia.
Because that's really scary,like the idea of that is really
really scary.
And if I was perceivingsomething that I didn't feel
like I had control over and Ifelt like, or I read that it was
a warning sign for somethingthat I surely don't want to

(42:12):
happen to me, I would feelpretty crummy.
And I think I found the rootsource of that, which is like
one article, but the media wentcrazy with it.
And then the media went crazywith it.
People read stuff.
They believe it to be factual,then other people post it and

(42:32):
then it gets on social media andthen it gets put you know, and
if too much stuff happens, thenyou get the like with AI
thinking that's real data, right, but if you Google, does
tinnitus correlate with dementiaor it does, it's just tinnitus
a cause of dementia.
Google will tell you now.
So we're in a good place there.
I'm glad for that.
But yeah, that is not true.

(42:53):
Now what is true?
Untreated hearing loss is arisk, a significant risk for
dementia, especially if somebodywas already at a higher
likelihood of developingdementia for other reasons.
So if somebody is at increasedrisk of dementia and they also
have untreated hearing loss now,they're at a further increased
risk of dementia.
But tinnitus is a symptom.

(43:14):
It is not a disease, so you canhave feelings about it.
You cannot like your.
Tinnitus is a symptom.
It is not a disease, so you canhave feelings about it.
You cannot like your tinnitus.
It can disturb you, it cancause other things from a mental
health perspective and anemotional health perspective,
but it is a symptom, so itcannot cause something
physiological to happen withinyour body.

Dr Tarvin, counseling intake
holistic care.
As hearing care professionals,we find that one of the most
undervalued parts of tinnituscare is the counseling.
So we're talking aboutmanagement and you've actually
duplicated yourself with Twillo,but why is it so critical to
really hear the patient's story?

I think the biggest thing is that when
we can share our story withsomebody who that we entrust
with information that we'reseeking and they're receiving,
you actually have like mirrorneurons and you can actually

(44:21):
share through facial expressionsand facial language and you can
actually bond with other people, and that is extremely powerful
.
It could have a feeling ofsafety.
I have patients that will comein I would say 50% of tinnitus
patients.
They're coming in for tinnituscare, tinnitus appointment
information.
50% of them do not leave withany type of costly treatment

(44:45):
plan.
They just need to be heard,validated, respected.
They need to know that there isa plan or there does not need
to be a plan right For themspecifically, and it's the time,
it's the counseling, it's theeducation, it's that bond or
that sharing of information thatwas therapeutic for them.

(45:06):
And without that right, justthat constant spiral of is this
a sign of a brain tumor?
And what does this mean?
And if this would get out ofthe way, I'd be able to hear
better.
So it's the stupid tinnitus,and that's why I can't hear my
grandchild, or that's why Ican't hear my son in the back
seat.
You know it's like, unlessyou're given corrected
information and told like you'regood or you're not, then the

(45:27):
brain can take over and we haveautomatic negative thoughts and
that could feed down the spiralof a lot of despair.

And so that time, with a specialist
to tell you what is, or whatisn't is invaluable, it just the
word there I feel like to me islike synchronicity, and to be
able to find that in a providerthe patient has to just feel
like such a relief of oh my gosh, you listened to me the fact
that half of your patientsroughly are leaving your clinic
without costly treatment, butthe fact that they were able to

(46:01):
just share with you how they'refeeling and you give them the
strategies and managementtechniques to manage their
tinnitus, that's really powerful.
Now, on the flip side, manypatients have been told just
live with it.
Those messages are incrediblyinvalidating.
How do you help patientsreframe that experience?

(46:22):
Because maybe you had a patientcome to you who went to another
provider who wasn't trained intinnitus management, and then
they come to you.
How do you help them reframethat?

Well, I let them vent because some of
them are very angry that they'vebeen told that or that their
care has been delayed becausethey were maybe just brushed
away.
I let them vent because some ofthem are very angry that
they've been told that or thattheir care has been delayed, you
know cause they were maybe justbrushed away.
I let them vent if they need tovent, and then I kind of speak
back what they're saying to meand get a feel for well, is this
impacting you as much as youthink it is or not?
Right, and then go through thewhole trajectory of like how
we're going to help take care ofthat person.

(46:53):
But I definitely like tovalidate the feeling that was
unhelpful, that that informationis less than helpful and that
we want to make a change andthat we want the medical schools
and the PA schools and thenursing schools and continuing
education for people who'vealready graduated and other

(47:14):
peripheral healthcare providersto start learning that you don't
have to know it, but you haveto refer to a specialist.
I'm an audiologist.
Audiologists are the doctors ofvestibular care, balanced care.
I am not a vestibularaudiologist, right?
I will refer to my colleaguesthat specialize in that.
That I trust in my communitybecause they're going to serve
that person a lot better than Iam.

(47:35):
But I know enough informationto refer or ask enough questions
to be able to get their ballrolling right For the next
person that's going to take careof them.
So it's okay to not know andit's okay to admit that you
don't know right, but then youhave a responsibility as that
person's provider in that momentto figure out well, what does
this person need?
And if I can't give it to them,then I need to have a resource,

(47:57):
have a toolkit of people thatcan help them.

There are 44 million Americans who
present with hearing loss.
And then there's 26 millionAmericans who present with
normal hearing on an audiogrambut struggle in noisy situations
and what I'm getting at here.
There's a lot of people withhearing loss and there's not
that many hearing careprofessionals.
And then you have the internet.
Consumers are getting all thisinformation, so we wanted to sit

(48:25):
down together and talk aboutthis and share real, true
educational material abouttinnitus.
So thank you so much for yourtime about tinnitus.
So thank you so much for yourtime.
I'd love to hear one of yourfavorite success stories from a
tinnitus patient that you'vehelped.
Now I know there's hundreds,but is there one that like

(48:45):
really sticks out to you?
That's like wow, you went homethat day and you shared this
story with your husband.

So there are two, two really positive
stories that stick out to me.
One of them was a really coolexercise in the opposite of
placebo.
So I had a patient that was aphysician and she had come to me
with moderately bothersometinnitus, was willing to do, you
know, kind of be open-minded todifferent options, was already

(49:14):
on the right track with, like,her physical health.
Her emotional health was prettyintact, but she was still
really impacted by her tinnitusperception and I had recommended
Lanier as a treatment optionfor her because she really did
not have any treatable hearingloss.
That was also not relevant forher and so we had talked about
Lanier.
We did a telehealth appointmentand we had talked about Lanier

(49:35):
as a treatment, a telehealthappointment and we had talked
about Lanier as a treatmentoption and then she opted to
move forward with it and on her.
Two weeks into her treatment Ihad a phone call with her and
she told me that she had spokenwith her cousin, who was a very
respected either researcher orphysician but in the
neuroscience space and kind ofhad poo-pooed some of the data

(49:56):
and just wasn't really vibingwith this idea and I got really
nervous for this patient becauseI was like, oh no, is this
going to bias you, right?
Somebody that you love and youcare about is like saying what
you're doing is nonsense and Iwould be biased by that.
That would definitely put doubtin my mind, right?
And she was like, oh, I don'treally know.

(50:17):
She was actually one of thepatients who moved through her
linear treatment so quickly.
She didn't need her treatmentanymore after 10 weeks and we
normally tell patients thattheir linear treatment is going
to be between three and sixmonths to expect that and she
had gotten so much benefit by 10weeks that she was going on a
trip, an international trip, andshe didn't even take her
treatment with her because shewas in such a good space and

(50:40):
that was.
I was so happy for her.
But it was also reallyinteresting experience for me.
That you know cause.
Some people will say certainthings are placebo, and I will
acknowledge that some things areplacebo, right, not everything,
but some things are.
But when you have somebodyactively trying to tell you
against something and you stillget a benefit from it, well,
that's the opposite of placebo,which is pretty cool, right?

(51:02):
So that was really cool for herand really cool for me.

And I will say it's like when
you're researching, let's say, atelevision for like 20 hours
and you're set on the Sony andyour best friend says don't get
the Sony, get the LG.

It's like, and your best friend says don't
get the Sony, get the LG.
It's like it's out the window.
Yeah, first world crumblingproblems, you know Absolutely,
but it's true.
Like I was buying a car, I hadresearched Toyota and then I get
to the place and I drive aNissan and I love it.
I'm crying in the cardealership because this is
breaking up by everything Ithought I wanted Totally Like,
totally Okay.

(51:37):
And then another tinnituspatient that's coming to mind
that was a really awesome storywas that we had been working
together for many, many yearsand every time he would come in
he was.
These are two linear stories,just because they're profound
stories, not just because oflinear.
Please understand, there'sother people that get benefit

(51:57):
without linear too, but yeah,and this is not a Lanier
sponsored episode at all.

I don't even need to tell them.

I was talking about them, but it's
just about the power oflistening to your patient and
being open-minded to the kind ofpivoting right.
So he had been coming to mewith a mild hearing loss that
over time was getting moreprogressive but really did not.
That was not his main problemand we had fit him many, many
years ago with hearing aids andhe wore them very, very reliably

(52:26):
and he did get a benefit fromthem.
But every time he came in hewas still like my tennis is
really bothering me, my tennisis really bothering me.
And we had talked about mentalhealth strategies and tools and
this was a person who was justlike unwilling to do certain
things Right, and so we bothkind of at times felt like we
were beating our heads againstthe wall, even though I was
trying to pull out all my socks.
And then Lanier enters themarket as an option and his wife

(52:48):
was one of the first people Icalled and she was super excited
about it.
And then he was coming in andhe got a lot of success from
doing that treatment, that bcoming in, and he got a lot of
success from doing thattreatment at bimodal
neuromodulation and then he wasno longer using it.
He no longer needed to use it.
And then he was coming in andhe was still wearing his hearing
aids and he would never bringup a sentence and I was so used
to this being like the maintopic of our conversation.

(53:10):
And then he's coming in and I'mlike how are you?
And he's like great.
And I'm like that's all youhave to say.

He's like yeah, Is there any more?

Is there any more, anything else you
haven't brought up yet?
And I look at his wife and I'mlike how's it going?

And she's like don't even bring it
up.
Don't bring up the word becausethen he's going to hear it.

Yeah, we're good, we're good.
And so it was really twodifferent perspectives Of
somebody who was really, reallybothered by their tinnitus, and
we made progress, and somebodywho was bothered by it but not
as much, and we made progress.
And then there's yes, you'reright, there are plenty of other
stories and I don't want it tosound magical, right, like when
somebody is experiencingsomething chronically, not
everybody gets what they want.

Right .

And that's also part of my responsibility.

Right Is to work that work walk that
journey through it with thosepeople too and setting those
realistic expectations.
So, dr Tarvin, in closing let'sclose with professional and
consumer takeaways.
So for audiologists or hearinginstrument specialists,
especially those hearinginstrument specialists in states

(54:12):
where they can specialize intinnitus management, where they
can specialize in tinnitusmanagement, what is your biggest
piece of advice?

I would say my biggest piece of advice
is care.
If you truly care about theperson that's in front of you
and if you truly care aboutlearning more and growing within
your profession or within aspecialty, then do it with care
and you will help people just bythat, because that will drive

(54:41):
so many decisions that you make.
And then, from my consumerperspective, I think I want
people to know that it's okay toarm yourself with knowledge and
information, it's okay to readthings online, but if you have
gotten to a point where you'rein a state of any degree of
distress because of tinnitus orhearing loss or a combination of

(55:03):
those two, it's time to seekprofessional care.
And if your level of distressis one of which it's really
starting to impact your qualityof life, then you're going to
want to seek a specialist fortinnitus, if that's the main
cause of the problem.

And I just have to ask, if we have
providers that tune in to theHearing Matters podcast, if
they're interested in offeringTwillo as a tinnitus management
tool for their patients, who canthey contact and how can they
learn more about that?

Yeah, thank you.
So we are trying to make it asaffordable as possible.
So we actually have it as a webapp, so it's not like you can
go to the Apple store or theGoogle Play store to find it.
It's actually we can keep it ata lower cost for providers and
users at that users currently atthat option.
So if you go to the websitetwilloappcom, t-w-i-l-l-o appcom

(56:03):
, you can see information aboutit and then you can actually
contact us directly on there andour team my husband will be in
contact to kind of get the ballrolling and get the professional
side of the portal hooked upand go through all of the
details.

But it's very easy to use, Awesome,
Excellent, Well, and, inclosing, congratulations on just
everything and truly thank youso much for all that you do for
our industry as it relates toadvocacy, tinnitus management,
hearing healthcare, truetrailblazer.
Thank you so much.
And you know, Dr Tarvin, thankyou for reminding us that
tinnitus management it's notjust about masking a sound, but

(56:42):
it's about restoring control,validating patients and doing
right by those who arestruggling.
So thank you for yourdedication and passion.

Thank you and your patients and community
really do appreciate it.
Thank you so much for your timetoday.

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Tinnitus Management with Dr. Alexandra Tarvin | Elevate Audiology

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Tinnitus Management with Dr. Alexandra Tarvin | Elevate Audiology