Interview with Merideth Eldridge International Audiology Trainer, SeboTek, Tulsa, Oklahoma
Beck: Good Morning Merideth, thanks for joining me today.
Eldridge: Hi Doug. Thanks for the invitation.
Beck: Merideth, I know you've had an interesting hearing health background, and, you've done lots of work with tinnitus patients. Would you please tell me a little about your formal education, training and current position?
Eldridge: Sure. I graduated, can I just say, many years ago, with a master's degree in audiology from the University of Nebraska at Lincoln. I've held many positions since that time, including educational and medical settings as well as audiology private practice. I worked with a hearing aid manufacturer for 8 years as sales manager with a special interest in tinnitus products. Prior to that, I had a very interesting job with an FM sports communication company developing a product that would allow individual and group communications between coaches and athletes. My new responsibility at SeboTek, as the International Audiology Trainer is to provide training and audiology support to our international distributors for SeboTek products and their applications.
Beck: Thanks Merideth. Although it's a little off topic, you have such a wealth of experience with tinnitus and hyperacusis, that I'd like to explore tinnitus and amplification issues with you. What can you tell me a about the tinnitus products you've worked with?
Eldridge: The products I worked with primarily were noise generators used for tinnitus and hyperacusis rehabilitation with patients that had normal or near normal hearing and the tinnitus and/or hyperacusis severely impacted their lives. Most often they were used with Tinnitus Retraining Therapy (TRT) but could be used for masking as well. Both approaches use a combination of sound therapy and counseling
Beck: So you used the product for tinnitus patients and hyperacusic patients?
Eldridge: Yes, particularly if the patient had no amplifiable hearing loss. For the majority of tinnitus patients with hearing loss and mild bothersome complaints, amplification, like with the SeboTek PAC, can be extremely beneficial. One thing that is really interesting is that some patients with severe tinnitus complaints have lower than normal loudness discomfort levels or some degree of hyperacusis. Hyperacusis should always be addressed first in those situations using constant low level noise. I highly recommend testing frequency specific loudness discomfort levels (LDL's) with patients with loudness complaints and all tinnitus patients. Many times, when their discomfort levels improve, tinnitus is not as much as an issue and they are ready to focus on their hearing loss.
Beck: So you're advocating measuring frequency specific LDLs before starting a rehabilitative program with tinnitus patients?
Eldridge: Exactly. Sometimes when working with tinnitus patients, professionals may not think about LDL's. Many tinnitus patients do not directly report issues with loudness discomfort and/or hearing loss because the tinnitus is so bothersome. Patients really need to tested, to determine if they have tinnitus or hyperacusis only, with hearing loss, or, all three! It is also important to get information about the degree of negative impact the condition has on the quality of their life. This gives the clinician the ability to determine the effectiveness of the treatment.
Beck: Merideth, what about the time involved? How long does a typical TRT patient undergo desensitization before seeing quantitative positive results?
Eldridge: That varies. As you know, TRT is a combination of sound therapy and counseling. With the sound therapy portion of the treatment, improvements in LDL's usually occur fairly quickly, within months. For tinnitus habituation to occur it usually takes one to two years. Fortunately, many times, the "perceived" loudness of the tinnitus is diminished immediately, as it is in masking.
Beck: I know this next question is out of step with the previous discussion, but I think many of us, myself included, have tried to use hearing aids as maskers for tinnitus patients, and in doing so, I have witnessed some successes. I've thought that if the patient has hearing loss, and if they have tinnitus, why not use the hearing aid to present non-tinnitus sounds while improving their hearing too? Can you tell me your thoughts on that?
Eldridge: Abosultely, for those patients with hearing loss, I think amplification can be very effective for relief of tinnitus. Tinnitus is a perception, so increasing environmental sound will reduce the perception of tinnitus. I think we've all seen examples of this in our own tinnitus patients, and so for many patients that are not severely bothered, that remains an excellent option. Amplification can also be used in TRT, an .habituation approach, as long as there is environmental sound for the hearing aid to amplify on a constant basis. However, for hyperacusis treatment, a desensitization approach using low level broad band noise is most effective.
Beck: I agree. So for tinnitus patients, hearing aid amplification is potentially a viable option, but not really a great option for hyperacusis patients?
Eldridge: Yes, that's my opinion. For those patients with hearing loss and tinnitus that is not debilitating, amplification can be an effective option. Many patients that have severe hyperacusis do not have hearing loss, so, of course amplification would not be indicated for them.
Beck: OK, that makes sense to me. And again, to be clear, masking with traditional hearing aid amplification is a reasonable approach for selected tinnitus patients?
Eldridge: Yes, as long as there is sound in the environment to amplify. Remember, amplified silence is still silence and the important thing with both masking and TRT is to avoid silence.
Beck: And I guess it could be an advantage to have a "noisy noise" floor in the hearing aid circuit, while trying to mask tinnitus?
Eldridge: That's funny! Most hearing aid circuit noise is quickly habituated because it is non-important acoustic stimuli. Sound of any kind, works in favor of the tinnitus patient!
Beck: OK Merideth, this is wonderful, and I really do appreciate your time. Can you just tell me about insertion loss and tinnitus before you run?
Eldridge: I think your getting to the issue that with significant insertion loss, tinnitus tends to be exacerbated?
Eldridge: It is the reason open fittings have traditionally been recommended. As you can imagine, this is somewhat intriguing to me! There are several advantages to the unique design of SeboTek's PAC which lend itself to the most effective amplification system for use with tinnitus patients! We know that the deep canal seal allows us to provide more effective high frequency amplification without feedback or occlusion and the wide bandwidth enables us to deliver broadband acoustic stimuli. We are currently conducting research to determine the degree of insertion loss and the effect this has for tinnitus patients. The preliminary findings are very encouraging!
Beck: Wow -- that would be fantastic. Please keep me posted on these developments Merideth, and thanks again for your time.
Eldridge: My pleasure, Doug. Thank you, too.
Tinnitus Retraining Therapy - Implementing the Neurophysiological Model
Jastreboff, P. and Hazell J., Cambridge University Press 2004
Tyler, R.S., Singular Publishing Group 2000
Journal of the American Academy of Audiology: Special Issue: Tinnitus
Vol. 13, No. 10, Nov/Dec 2002
For more information on SeboTek, visit www.sebotek.com