SHOW NOTES:

Does Tinnitus Cause Cognitive Decline?
===

Speaker: [00:00:00] Welcome to the Hearing Wellness Journey podcast, an exploration of determination, hope, self discovery, and triumph. We'll share the personal experiences of those that are living with hearing loss and provide a haven for their stories to show others that they are not alone in this journey. Please welcome your hosts.

Dr. Dawn Heiman: Welcome back to another episode of the Hearing Wellness Journey podcast. my name is Dr. Dawn Heiman, Dr. Stephanie Michaelides, Dr. Emily Johnson and Lindsey Doherty. And today we're gonna discuss, a question that Dr. Johnson was asked, which is.

Dr. Emily Johnson: Does having tinnitus mean that I'm going to experience cognitive decline?[00:01:00]

So that's kind of a. I don't wanna call it a buzzword in kind of the audiology and hearing loss in tinnitus community right now, is that there have been some studies done and some of that data is being misconstrued, that you know, if you have tinnitus, you are at higher risk for cognitive decline. To the point of where people are saying, because I have tinnitus, that means I'm going to get cognitive decline and it's going to happen faster.

And we are here to. Dispel any myths and answer the questions that you have about the information that's being shared. I

Dr. Dawn Heiman: feel like some of the misconstruing we'll call it is because of bad actors that are marketing and playing on people's emotions and exaggerating a little bit.

Dr. Stephanie Michaelides: Mm-hmm.

Dr. Dawn Heiman: Would you agree with that?

Mm-hmm. [00:02:00] Absolutely. Because I think there's a possibility of anything. Right? Right. But that is a big jump between tinnitus and cognition and rapid decline. So let's actually go over the facts. How about that? We'll start there and then we will bridge it and show you how it could be possible, but.

Nothing's a guarantee, number one. And just because you have a cheeseburger doesn't mean you're gonna have a stroke or a heart attack, you know? but maybe let's start with what is tinnitus? By definition, it's a symptom that something changed in your ears. And so if you have tinnitus, will you have a cognitive decline?

No. What if you're 20 years old and you have tinnius. That doesn't make sense. Okay, so let's say we have a patient and they have tinnitus. What are we thinking?

Dr. Stephanie Michaelides: Usually they have at least some kind of hearing loss, even if it's not [00:03:00] within what we test as audiologists. 'cause we test 250 to 8,000 hertz. But you hear lower than that and you hear higher than that.

So you could still have some kind of hearing loss even in the very high highest frequencies that are not part of the speech.

Dr. Emily Johnson: And we can test higher than that. We might see a little bit of change, but especially for our younger patients who have never had a baseline, even if their thresholds are technically within normal limits, that doesn't mean that they didn't have a five to 10 decibel shift of where they went from normal to normal, but it was still a change in their system.

And that's kind of where it gets hard to tell, because we're like, you're. Have normal hearing, or maybe you have just the smallest bit of hearing loss in the very, very highest frequencies. But we also don't know exactly where they started.

Dr. Dawn Heiman: And if I can say there was an assumption right there made the assumption is most people, there was a change in their hearing, [00:04:00] but not everyone with tinnitus is because.

Something changed in their ear. And that's why you need a workup. This is why you need to be tested. 'cause sometimes it's a, it's a clicking or a pitch that can change because you need to have spinal surgery. You do a thing and you hear a sound. There's a, just, this sound isn't necessarily linked to your ears.

So away someone's saying, if you have tinnitus, then you have cognitive decline is most likely untrue. So there's that, right? Let's say they do have a hearing loss, and let's say it's higher pitched way out, 12,000 hertz, 18,000 hertz. Does that mean that we are affecting the way that the brain functions?

No, probably not, because we're testing up to eight, like 250 to 8,000 hertz because that's where, Normal speech tends to occur. the sounds that we produce, that's why we're looking at that. 'cause we're looking at from a communication aspect, the upper range, is that [00:05:00] usable? Does that affect your cognition right now?

We don't know. Probably not. I'm gonna say, right? I don't know. So if you have untreated tinnitus, and it turns out you have hearing loss. Now let's go into untreated hearing loss though. What does that look like and how does that link to cognition?

Dr. Emily Johnson: Right. So the recent studies have been showing that untreated hearing loss is a top modifiable risk factor for cognitive decline, and it is a correlation, not necessarily a causation.

So having untreated hearing loss. Doesn't mean you're guaranteed cognitive decline. It's just a modifiable risk factor, which means there's something that we can do about it to reduce that risk. But [00:06:00] there's also a lot of other factors at play, including genetics that also need to be considered So. A lot of scare tactics like Dr.

Hyman mentioned earlier. It's that if you have hearing loss, well this is gonna happen to you. And that's not at all what the research is showing. It's just that correlation relationship that this is a risk factor, and maybe it's something that we do something about.

Dr. Dawn Heiman: Yeah. But I mean. There are screenings out there or questionnaires that you take for everything, right, and, and so it's wise to have a baseline, have the testing done.

if you have tinnitus and you're concerned, it's like if you have blood in your stool, you should probably go have a colonoscopy, have the screening. You know, if there are things that bad things can happen. But it doesn't mean that if you have a symptom that that's definitely [00:07:00] what it is, but why not get it tested?

Number one. Even like your vision. Even your vision, absolutely. Or any kind of screening. Just on Thursday, I asked a woman, when was the last time you had your hearing tested? She's like, she's thinking, and I'm thinking she's gonna say. Three years ago. Mm-hmm. She went to dually. She was someplace right.

And she's like thinking grade school. I'm

Dr. Emily Johnson: thinking third grade. Like, that's usually like the common response is like, I think elementary school when I'm in the cafeteria and they had me raise my hand, I'm like, mm-hmm. Oh, okay. Does it matter which hand I raise?

Dr. Dawn Heiman: No,

that's that. So if you are listening and you have tinnitus, get your hearing tested, you probably have normal hearing, but at least you have a baseline because your change in hearing. Never schedules itself. It's not like it's on the calendar for five years from now. This day your hearing will change because you are suddenly this age.

If you have a baseline, then we have something to track, especially if it's

Lindsey Doherty: a sudden change. Right? you [00:08:00] have literal data saying this, at this point in time, this is what I was experiencing. These were the other factors. was the hearing normal? Was it not? so at least going back you're not like, well, I think.

There's no question. So it is just a really good journal or track record.

Dr. Dawn Heiman: Yeah. Once you have the baseline, then let's repeat and let's keep tracking it. So let's say you have normal hearing and you have tinnitus and we have a baseline. Your hearing's normal. Two years from now, we test again. We're not just testing the pure tones, though.

We're testing your speech. Understanding ability. Mm-hmm. That's how we start to understand what's happening when you're in quiet or in a noise with speech, because

Dr. Stephanie Michaelides: that's everyone's biggest concern. Yeah. With hearing loss, it's like usually when they come and see us and we're just talking, and there's nothing else.

No competing anything in the room. It's very easy for people to follow along, but it's those no easy situations, those parties, those other things, where everyone starts noticing problems. [00:09:00]

Dr. Emily Johnson: Absolutely. And if you add tinnitus in on top of that. It's like you have to like hear through the noise for a lot of people of where it's like, yes, maybe there's some hearing loss going on, but also can your brain give a hundred percent to focusing on a conversation when you're also listening to something else all the time.

That's an invisible weight that you have to carry, and that for a lot of people is quite taxing. I think that's something that we don't always think about.

Dr. Dawn Heiman: Well, and there's so many people, we, we deal with this all the time. You know, it's when they say the average person, once they've been, I identified with a change in their hearing by a professional, it's not, I think my hearing has changed.

Dr. Stephanie Michaelides: Mm-hmm.

Dr. Dawn Heiman: Once they've been identified seven years from then, they actually maybe get treatment. So what we're most concerned about is not, let's say the pure tones never change. You do have a high frequency hearing loss if we're testing your speech, understanding abilities. [00:10:00] And we are checking in with you every couple years, which doesn't, it's not the norm, unfortunately.

Right. But I'm, you're listening. So I'm telling you, um, we're, we're testing your cognition. We're testing how well you're processing the words, processing the sounds, understanding the sounds. If you are not, understanding the words is easily just in quiet, let alone in noise. Each year we start to see that decline.

That is more of a red flag to do something about your hearing. if you have no idea where you were and where you are now, and even worse where you're going, you are not likely to do something about it and all, you just keep blaming the tinnitus. I can't hear through the tinnitus.

See a professional and then work on it. You know, like we've been fitting a lot of AirPod Pro, helping people that they're not ready yet, but we're like, we need to stimulate the brain in that region that you have a hearing loss so you don't lose it. Because the brain will just take that information.

So there's a researcher, Dr. Annu Sharma, that's at [00:11:00] University of Colorado Boulder, and they've done cortical studies and they found that it really is a use it or lose it principle. It's like if you make a dish, of food for 500 people, let's say mastaccoli or whatever, there's a lot of people in this area.

Had you ever heard of mastaccoli before you moved to Chicago? Yes. Really well, no. 'cause I'm I from this area. Oh, that's true. Okay, fine. Anyway, so people get these big dishes and like, you're gonna have a graduation party. You got a lot of food, right? And then it feels wasteful to just dump it. If people only eat enough for 300, right?

you want to give it to, a center where people can eat it and things like that, right? Your brain feels the same way if you have all this information, but then it turns out there's one region that's not using that resource. It's gonna reorganize it and put it someplace else. And usually it's in the vision, the occipital lobe will strengthen.

they've done studies where they put people in a noise pro, they're asking them to process speech, [00:12:00] and then they're watching how the brain is lighting up. And if you have untreated hearing loss, occipital lobe is lighting up when you're in background noise. And not the temporal lobe, which is where you're supposed to be processing.

Sounds and the words, right, or it's there's a combo, but it depends on how bad the hearing is. They found that depending on how old the person was and when they did the intervention, let's say there's a sudden change in hearing and then they suddenly bring it back, even 30 days give back the hearing and the brain goes back to lighting up the hearing section during speech and noise.

Plus a little bit of the vision,

Dr. Stephanie Michaelides: like we do outcome measures to show that it happens. Absolutely. Brain test. Yeah. We could bring back their ability to understand in noise and it's amazing.

Dr. Dawn Heiman: It is amazing. So the answer, I think, no tinnitus isn't gonna cause cognitive deli decline, but the tinnitus is the symptom that you are not treating the root problem.

And yes. Untreated [00:13:00] hearing loss, you have three times more likely a chance of having cognitive decline, a chance.

Dr. Stephanie Michaelides: Mm-hmm.

Dr. Dawn Heiman: There's so many people that they, they don't treat their hearing and they're fine. How many people smoke till they're 95 and they never had lung cancer?

It's baffling.

Dr. Emily Johnson: Yeah. It's just, it's something to think about. And if you're experiencing tinnitus and you're worried about cognitive decline, you're worried about all of those things, our best recommendation is to talk to somebody about it. Get that baseline, see where you're at, so that we can actually get documented information and come up with a game plan moving forward.

Because you know, for many, many years if you had tinnitus, it is well. Live with it, power through, do your best, and now we actually have solutions that can [00:14:00] be life changing for a lot of people with tinnitus and hearing loss, or even just tinnitus on its own. so if you're listening right now, whether you are a patient who is experiencing hearing loss, somebody who's just curious or another professional, like take this as a sign that you know what make that call.

Dr. Stephanie Michaelides: Mm-hmm.

Dr. Emily Johnson: Talk to somebody and go from there, because there are solutions that exist now that we did not have even five years ago.

Dr. Dawn Heiman: So where should someone start? Let's say low barrier. What's the easiest thing? If they have tinnitus and they're worried about cognitive decline, who do they start with?

Audiologists. Okay. Audiologists. Where do they just call private practice audiologists. Can they go into an ENT group? I guess it depends on your insurance or, yeah. Who's, where do you live? You can technically get tested at like a screening at a Bellone, a Miracle Ear, at a Costco. But just know that their, their [00:15:00] business model is to sell you hearing aids.

Right. And if they're a hearing is from a specialist, depending on the state, there's a good chance that they, even if they wanted to be trained on tinnitus, it is not in their scope of practice. Correct. But at least you're getting your hearing tested. But just be weary, leery. Those people that, that will offer you a free weekend, stay at a place, and you get to stay for two days or you get a free tv, if you just listen to their, their spiel mm-hmm.

You know you're gonna be sold. Right. Right. So if you don't wanna be sold, you might wanna go to just a regular. Doctor, and a group practice, an ENT practice or an audiology practice, that's not a store. 'cause if it's free, that's,

Dr. Stephanie Michaelides: yeah.

Dr. Dawn Heiman: You get nothing for free. You're paying for something somehow. they'll say, we'll just fit you with something, with a mask in it.

So it doesn't work like that.

Dr. Stephanie Michaelides: Mm-hmm.

Dr. Dawn Heiman: So let's say you get your hearing tested and they go from there. who wants to talk about like, what [00:16:00] happens? Like what are we actually looking at? How do we treat tinnitus? Just mildly. If you wanna review our protocols, like we start with video call, we ask them.

who have you seen, what have you tried? All that, you know? And then do we know? And usually they say,

Dr. Stephanie Michaelides: no one has been able to help me

Dr. Dawn Heiman: Right. So we do some screenings with them on that call.

Dr. Emily Johnson: Yes. So we'll start with a video call, which I think is again, a low barrier option.

if like video and technology's not your jam, we can do a phone call and we'll kind of talk about. Your whole tinnitus journey, when did it start? What does it sound like? One ear, both ears, middle of your head, just kind of the whole story behind what's been going on. And then after we get kind of a better picture, we'll go through a questionnaire called the tinnitus Handicap in index inventory THII, and we'll be able to [00:17:00] get a numerical value.

How much your tinnitus is handicapping or impacting your everyday life and the quality of life that you're experiencing because of your tinnitus. And I think this is important because tinnitus is so subjective, and as much as we'd love to put our ear up next to your ear, it doesn't work like that.

Here for the majority of people, unless they have objective tinnitus, we can't hear what you are hearing. this gives us a nice way to assign a number and put you in a general category of what's going on. And it asks some different questions about emotions. How do you feel about it? Situational experiences, what's your experience there?

And like your sleep, how does it impact your sleep? For some people. Not at all for other people. Keeps 'em up all night and it just gives us an insight [00:18:00] into what you're experiencing. And then based on that information we can kind of determine what treatment plans you do or don't qualify for or like what would be the best route for you.

Dr. Stephanie Michaelides: And then at that point we will schedule a diagnostic if you haven't had a hearing test before, we'll do a full diagnostic, which involves. audiological evaluation, push the button when you hear the beeps. then we'll do speech and noise testing and we actually do tinnitus pitch matching.

we can go in with our equipment to the best of limit of our technology, But we go in and at that point we can find those frequencies that you're hearing and actually validate for you. This is really loud to you. we match the pitch, and it gives our patients that validation that this is what you're hearing.

You know, we understand and we can actually then work with you to kind of help at that point with different options of where we go based on how significant the tinnitus is, you know, off the tinnitus handicap inventory, and then our diagnostic workup,

Dr. Dawn Heiman: and then there's the education portion.

Like we require that they go attend a [00:19:00] seminar that's an hour long, because like you said, let's say some people in affects their sleep, some don't. Some people are like, ah, I don't hear it. You're not sleeping well because this is interrupting your sleep. Guess who's gonna have foggy brain the next day?

Guess who can't like seem to concentrate or they're always like, you know, misremembering things and things because they're not getting great sleep. So important. Even like average sleep, but yes. So important and then just cascades into your life and it just ruins not just your day, but your. It's just a massive overwhelm other people

Dr. Stephanie Michaelides: It affects everybody.

Dr. Dawn Heiman: Nobody wants cranky pants in the house if you're not sleeping well, right? So we give tips and tricks for that to try to, make the best you can with what you have, but also recategorize the tinnitus and make it so that that brain, 'cause this podcast is about.

Cognition, brain function, anti tinnitus, If your brain is always focused on some annoying thing, it's not able [00:20:00] to be a hundred percent present for everything else going

Dr. Stephanie Michaelides: on in

Dr. Dawn Heiman: You can't learn new things. If there's something in the way, or let's say that it's, there's a hearing loss, it's in the way and you can't seem to hear through it, let's do something about that.

Like get rid of it in, you know, there's just so much that, that we could do. But it all starts with all the things before you even get into the office. And then when you do get into the office, so we have rush students, doctoral students that are in our office, and I always tell them, if you've met one patient with tinnitus, you've met one patient.

Dr. Stephanie Michaelides: Mm-hmm.

Dr. Dawn Heiman: every time I get into the booth, I find something that I wasn't expecting and I was like, sheesh. I had no idea. We make generalizations when we educate, we make generalizations when we take notes, when we're doing the history. But is it until we actually lay hands on you and start testing?

Do we find out what your needs are and then go from there?

Dr. Emily Johnson: Absolutely. And the way that I visualize tinnitus and [00:21:00] tinnius patients in my brain is a puzzle pieces. Like we have to have all of these different puzzle pieces put together to get a clearer picture of what is gonna be the best route. you can't make sweeping generalizations about, oh, this person has tinnitus.

everybody's brain is different. Everybody's experience is different. It impacts you in different ways, personality types, all of these different things, and so it's like the intake into the seminar, into the diagnostic appointment, coming up with a treatment plan.

All of these different puzzle pieces that we're putting into place to make sure that we have a complete and focused picture to get you back to the quality of life that you deserve

Dr. Stephanie Michaelides: Super important as well, like we're gonna help our patients be the experts in their own synod as well with all the actual facts.

Dr. Dawn Heiman: hole

Dr. Stephanie Michaelides: as we are.

Dr. Dawn Heiman: I also think allowing the patient to [00:22:00] educate us.

The education goes both ways. We're learning from that person. We're like, this is what works for you. This isn't, this is what, is not working for you. Oh, like, oh my gosh, that's strange. you have tinnitus at 750 hertz. What?

Dr. Stephanie Michaelides: Mm-hmm.

Dr. Dawn Heiman: You know, like finding out more about that person.

And then we have all these different treatment models depending on it. We check ourselves at the door when we come in every day or with every patient and we're not assuming anything and we're genuinely curious about what's happening and then creating that treatment protocol for them, because I think that's where, I mean, we've met how many people that are like, you're my fifth place I've been to.

Yeah, nobody listened, but like, how come no one else found this out? I'm like, and we find out it's because no one listened. Mm-hmm. Right. Huge. Yeah, so I guess we just debunked the question. We started out saying no tin and cognition are are related, and that yet tinnius and cognition [00:23:00] technically are very related.

If it is affecting your lifestyle, it's affecting your ability to hear. It's affecting your ability to learn if you are just floating along, dealing. With something that is blocking you from just doing your daily activities or even just simply sleeping. Yeah. You're, you're not going to be the person you used to be.

You're not going to be, having fun learning new stuff or watching a cool movie and things. You're gonna be a cranky person that's always just trying to get good sleep. And that affects your brain.

But, prisoners of war are sometimes given sound. Yeah. The quarrels. So they can't sleep. So they can't sleep. It's des like loud sounds, sleep deprivation, or they're like, there's sounds that are bombarding you and interrupting your life or interrupting your sleep. it takes its toll on people.

Like there's studies that have shown that the reason why we have sound barriers [00:24:00] next to the highways where there's communities that people have homes, that extra sound affects, your body.

Dr. Stephanie Michaelides: frequency sound.

Dr. Dawn Heiman: Yeah. Anything that's on, or even they say jet lag, half of it is the sound of the engines in the cabin that make it so that you're exhausted by the, by the time you, there's lighter oxygen up there, but that sound.

So if you could wear earplugs, like anytime that you can try to give yourself peace from sound is a good thing. And I know we talk about like having noise maskers and music and stuff like that, but sometimes you just need quiet. Impossible for tinnitus patients. It can be impossible at the same time.

Or if you recategorize your tinnitus or if you somehow find a treatment way that you were like canceling it out, then you could go out into nature. Right? And you could, you could do low yoga, you just sit in the grass. And if you're wearing the right devices, you can have peace, but some, but you have to have breaks.

Like one of our, current patients, I've been working with him for years, but he's a band director [00:25:00] and he says when he drives home, he doesn't turn on music. He just wants quiet, as much quiet as he can. 'cause he is just overstimulated. You don't, there's over anything is not good for your body. So if we can try to find that.

Peace for them. Yeah. Would be good. So that you sharp the next day. You're learning new things at any age,

Dr. Emily Johnson: Reduce the cognitive load that you're currently experiencing by listening to internal sounds and things like that. But an increased in cognitive load due to your tenderness does not mean that you are guaranteed cognitive decline because of it.

Anybody who is saying, oh, you have tinnitus, well that's going to lead to dementia is incorrect. That is not what the studies are showing, and I just really want our listeners to take that to heart, that, yeah, seek out [00:26:00] treatment, talk to somebody that's important to do, but not because tinnitus means that there's something wrong in your brain and it's going to lead to dementia because there are so many other factors that play into that.

We are here to take that worry and myth away and help you increase your quality of life, but not scare you into something that isn't real.

Dr. Dawn Heiman: Yes. But you know, you deserve to be at peace. You deserve to not struggle with something, but don't come rushing into a place because they had a big ad in the Chicago Tribune saying, got tinnitus. You will die of dementia if they were use the word dementia and not the phrase cognitive decline. It's a marketing tactic.

So how about next? we're gonna be talking, on the podcast about one of our [00:27:00] treatments that we do in the office that's called Linear. it's a mystery for some people how it works. Why it works. We've had a lot of success. With it. It's not for everyone, but we're gonna talk about that next time.

So tune in next time. do you guys have any parting words? Anything that you wanted to say?

Dr. Emily Johnson: Alright. If you ever read something and you're like, is that true? Just ask. We'll let you know. What's the truth and what's honest about there. And make sure that you're an educated and empowered patient is that baseline.

That's what we support.

Dr. Dawn Heiman: Get your hearing at the baseline and then get it every two years.

Speaker 3: All right. We'll see you next time. Bye. Thank you for joining us on this episode of the Hearing Wellness Journey podcast. For more information about what we do and the services we provide, please visit our website@hearingwellnessjourney.com slash podcast. Where you can find more resources based on [00:28:00] today's discussion, as well as request to be a member of our Hearing Wellness Journey community on Facebook.

That's available for our listeners exclusively on hearing wellness journey.com/podcast.