Ph.D. Audiologist Explains Tinnitus Best Practices & Resound Relief App – Jack Scott – #05

Jack Scott is a tinnitus professor and former clinical audiologist at Northwestern University in Chicago, Illinois, United States. He discusses best practices for tinnitus and the ReSound Relief app for tinnitus.

Jack Scott, PhD
There is more information than there ever has been for patients with tinnitus. Every person’s tinnitus is different in the impact on that person’s life. The impact on their overall well being as well as their relationships is different for everyone. And I say this as somebody who has tinnitus, and understands the impact that it can have and how it can fluctuate from day to day from hour to hour.

Ben Thompson, AuD
Everyone welcome. This is Ben Thompson here with the pure tinnitus video podcast series. This is podcast episode number five. We are here with Jack Scott who is a PhD audiologist and jack earned his PhD at the University of Texas Dallas at a well known hearing, hearing and balance and tinnitus center in Texas. He has served as a clinical audiologist and a clinical faculty and lecturer at Northwestern University in Chicago, Illinois. So he has experience at some of the most renowned centers for hearing loss, hearing aids and tinnitus treatments in the United States. And he’s here with us to share some of what he has learned along the way.

Jack Scott, PhD
I am a lecturer at Northwestern University. I teach a graduate level course in tinnitus to the Doctor of Audiology students there and previous well I shouldn’t say Previous to that, but I’ve also been a clinical faculty member at Northwestern prior to joining GN hearing in their research and development. And so it is true that we’ve had to take the course online. It is seminar course and the course that I teach covers tinnitus. It covers found tolerance issues and more specifically, it kind of digs into the way to be able to determine if someone has a what’s called a tinnitus handicap. That is if tinnitus is impacting their overall quality of life, through questionnaires and counseling. They also learn about different aspects of 10 inches, what can exacerbate tinnitus, what causes tinnitus, as well as some of the sound therapies and therapeutic processes out there for tinnitus. So we cover both the medical which is surgical pharmaceutical components of tinnitus, remediation and tinnitus relief, as well as the non medical components those that may apply more towards the audiologist, such as the implementation application of hearing aids, for sound enrichment, in addition, the use of sound therapy either through some sort of bedside device that makes a bad noise or the use of hearing aids, that may have some sort of sound generator within it, or other additional apps that are available on the market to be able to provide support for patients with tinnitus. As part of my course as well. I also invite a cognitive behavioral therapist to come in to speak to the audiology students about that aspect. So more of the psychological components, tinnitus and some of the psychological therapies that can be applied for tinnitus patients, in addition to the the use of amplification and sound enrichment component.

Ben Thompson, AuD
Thanks so much. Now, as we know, tinnitus care is not only hearing aids, but it’s it’s a huge important part of it. What are the main takeaways that you want your students to leave your courses as they go into the field into the clinics working with patients who come with tinnitus, and may or may not have a hearing loss? What are those important points that you want to make sure are being communicated to the patients?

Jack Scott, PhD
I think I think what you’re saying is spot on. I mean, there are patients out there with tinnitus that don’t have hearing loss. And so one of the more important points that we point out is, you know, how do we quantify the impact of tinnitus. On that patient, we also discuss ways of measuring the tinnitus as well. And then focusing on some of those therapeutic sides. So the psychological abuse of cognitive behavioral therapy, the use of sound in Richmond, what I really want the students to take away from, from the course more specifically, is that they are known to tinnitus patients that are exactly the like, exactly like I should say, every person, every person’s tinnitus is different in the impact of the hypnosis on that person’s life. Their overall well being as well as their relationships is different for everyone. And I say this as somebody who has tinnitus, and understands the impact that it can have and how it can fluctuate from day to day from hour to hour. And so, while we do do psychological or I should say, handicap assessments through questionnaires, realizing that this are merely snapshots of that person’s life. And it’s important to over to understand the overall Gestalt of the patient. And really dig into the counseling aspect, and learn what truly can drive this person status, what things they found to be able to benefit them with their tinnitus, and understand the overall implications of it.

Ben Thompson, AuD
Thank you, Jack. Guys. We’re here with jack Scott, who’s PhD audiologist, who earned his PhD at UT Dallas in Texas, and now as a clinical faculty and lecturer at Northwestern University in Chicago. So in the United States, those are two well known institutions that have a high quality standard for for research and for clinical practice in audiology and tinnitus care. So jack, in your years working, and being involved with tinnitus research and working in clinics, what have you seen over the years, you know, I’m a millennial audiologists myself, so I’m more new into this into this game. And there’s people out there who are looking for help, there seems to be these new treatment that come up every now and then neuromodulation, to me was one that seemed promising, but is now losing interest. What have you seen with the trends over the last 10 or 15 years?

Jack Scott, PhD
Well, it’s probably a little bit more than that for based on my age and my clinical practice. But I think one of the things that’s really exciting within the world of Audiology and what’s really beneficial for tinnitus patients, is that we do have this evolution of therapeutics that are available both medical and non medical. And when I first started practicing in clinical audiology, we were very limited on the use of tinnitus, maskers, either for patients with or without hearing loss. More specifically for patients with hearing loss, it was one or the other, either you were amplification or you were attendances Master, but you can have both, and where now we have both the combination of tendances, masters and amplification. And then also at the time, open ear hearing aids were relatively new in coming on the market. And these are devices that actually could be used for patient that don’t have a hearing loss, but actually can now wear your your level devices with minimal application or no amplification, and then be able to take advantage of some of these sound generators that are available within amplification or through streaming apps. Also, I think the availability of the smartphone right, just the apps themselves, one of the as we’re going through some of the regulatory documentation at the company, one of the things that I’ve been involved in is looking at sort of the number of apps that are available for patients with tinnitus, or patients who suffer from tinnitus, and what’s available out there. So it seems like there is more information than there ever has been for patients with tinnitus, saying that, obviously too much information, it’s sometimes a bad thing. And so I think the most important thing is to look for information that is backed up by science, or as you were talking about, then, with regard to neuromodulation. There’s a variety of other options that are available out there that I sort of communicate with my students or my students and I, I say communicate through some of the research readings that we have looking at some of the different options that are that are available for for tinnitus patients, whether that be some sort of medical, you know, going through FDA approvals, such as the Vegas nerve stimulation in conjunction with auditory stimulation tried to result in neuroplasticity or reorganization so that distended tinnitus is not as durable. In addition, the use of some of the different types of sound therapy that are available. And so there’s a lot of research is still being done finding out what is the best sound therapy for tinnitus. And as I tell my students, whenever we’re going to find that silver bullet is going to help everybody, but the fact that we do have a lot of the options of different types of sound therapy available, whether it be wind noise, air noise, water noise, or even just white noise for some patients. You know, we have a lot of flexibility for the patients and it’s also available out there.

Ben Thompson, AuD
Yeah, Jack touched on some important points and to be honest, in my experience, working with people and communicating with people who have tinnitus from all over the world. The first thing, there’s so much information out there and it’s easy to get distracted to follow something that seems like it’s going to be a cure or an easy fix, only to then have unfortunately wasted a lot of time and being read led down the wrong path. Now the second thing Brought up, I wanted to touch on his sound therapy being that it seems so simple. And it’s not the immediate cure that some people are seeking. But it is one of the most evidence based long term approaches. And I’m referring to progressive tinnitus management from the United States military veterans research, how using some constant or nearly constant low level background noise has a positive effect long term. That message is fairly simple, but there’s so much noise on the internet. So how can we get our What do you think? How can we get our patients to really focus on what’s been proven and try to reduce the distractions?

Jack Scott, PhD
First and foremost, I think it boils down to education. One of the first documents that I have my audiology students tree is a clinical practice guideline in tinnitus that was put out by the American Academy of otolaryngology head Neck Surgery back in 2014. And this is really good document because in addition to positions of laryngologist, and also involved audiologist, who did scientific literature reviews to look at what types of therapies and what types of interventions, I should say as well, were beneficial for patients. They looked at randomized controlled trials, they looked at single case studies and determine is something recommended is something optional, or is something concrete and gated. And so for example, one of the things that’s always recommended for a patient that has tinnitus, first and foremost is a hearing assessment just that we can get a sort of general sense of what their hearing looks like, because there’s such a strong relationship between hearing loss and tinnitus. One of the things which is kind of interesting. That is, you know, is optional, was the use of acupuncture for tinnitus patients, given the research that’s out there. In addition to sound therapy as being an optional component. Cognitive behavioral therapy was definitely something that was recommended by by the clinical practice guidelines. And again, this put out in 2014, so about six years ago, and I know that since 2014, there has been some additional literature and research that’s come out showing the additional benefits of sound therapy put out by Dr. Henry’s group. Within the Veterans Administration, as you mentioned, for example, progressive tinnitus management, as well as research put out by Dr. Richard Tyler’s group at the University of Iowa. And so I think I think it’s about education. And one of the other documents that I had one of my my, my students read as well, is the use of sort of herbal therapies. And if there’s any really strong evidence, because one of the things that I know, when I was practicing that comes up was, you know, patients would ask me, should I take this herbal therapy to be able to help my tinnitus and as it stands now, there’s no strong evidence, showing that herbal therapies do provide a benefit for patients with tenants that we always strongly recommend for you take any sort of herbal therapy, to contact your physician, to have a conversation with them about other medications that you’re taking to make sure that anything within the herbal therapy, if you are considered taking it does not interact with any of your current medication.

Ben Thompson, AuD
Yeah, that’s important, I find that these alternative treatments that show some promise, they typically have a grain of truth to them, and then a lot of gray area. So it is known that diet and overall health and wellness in the body and what we eat our exercise our stress level, that impacts our body’s response to tinnitus. So that is true. The gray area is can certain herbal supplements or vitamins that are out of balance, can those be the main reason to improve tinnitus? So I think that I see this in a lot of a lot of different treatment alternatives or even therapies. there’s typically a grain of truth but a lot of gray area. Is that what you found as well?

Jack Scott, PhD
I think that’s exactly true. I mean, not to, not to focus too much on the herbal herbal therapy aspect. But, you know, they’re, you know, one of the one of the components, many of the herbal therapies is think organ COVID biloba, and so there while there may be research out there, you know, showing that there might be some benefit for patients with tinnitus. There’s not real strong, randomized control trials showing benefit with zinc or with gingko biloba. And yet, you know, people will latch on to a little bit of the science that is out there and then make broad strokes as far as you know, something being beneficial.

Ben Thompson, AuD
So what’s what what’s your recommendation for someone with tinnitus? who finds one research article with a relative and they don’t they don’t have a PhD background or a doctorate or a scientific background to be able to analyze the validity. What’s your advice to someone who finds a one research study that seems to have a promising treatment result? portunities? How can they validate that? How can they make sure that’s coming from a good reliable source?

Jack Scott, PhD
You know, I think first and foremost, you know, either have a conversation with your physician or with your audiologist about the article. These are specialists in the realm of tinnitus, more specifically otolaryngologist or your audiologist. And the other thing is to look at professional organization what the recommendations are. So the American Academy of Audiology, for example, is one the American Speech and Hearing, Speech, Language and Hearing Association. As far as the audiology is concerned, again, the American Academy of otolaryngology these companies, federal organizations will typically have statements about some of the recommendations or some of the information out there on tinnitus. So first and foremost, I would say go to the experts to have these discussions or to look to the experts, professional organization website, to glean more information. It’s very, it’s very difficult to look at articles sometimes and be able to determine, you know, based on the results, and the the end, you know, do they have enough power to show a benefit? So I think it’s I think it’s just talking to the experts and having a conversation with them.

Ben Thompson, AuD
That’s good advice. So now let’s talk about the experts some of whom you’ve been a part of developing their understanding as you have been lecturer professor to them. So how much did the average audiologist know about tinnitus? And I say this because it’s very common for someone with tinnitus to go to their audiologist or their primary doctor or their end doctor and feel that that doctor hasn’t shared that they know much about tinnitus. So what do you think? How much do these different specialists actually know about the full treatment, the full management of tinnitus?

Jack Scott, PhD
And I think I think within from my experience within the realm of Audiology, I think audiologist are trying to gain more information on tinnitus. I mean, definitely. I, you know, speaking as an inner one for myself, when I was going through my graduate program 20 years ago, tinnitus was very lightly covered. But then again, we didn’t have I mean, while there was research out there, you know, there’s been a lot of research just in the past 20 years, and I think it is that area, that audiologists see that they can potentially have an impact on the overall well being of their patients with tinnitus. Because the connection between hearing loss and tinnitus is I I can tell from the presentations, I do the number of people that attend those presentations on to basically, there is a thirst out there within the profession, to learn more about tinnitus, and knowing from my course and, you know, what is required in the class that I teach that the, the university can still maintain accreditation, and what’s required within the realm of images that the students are getting a great breadth of information and tentative. Now, you know, nothing. You know, as with any graduate program, you know, additional training is needed when you when you graduate, you can’t teach them everything about everything, unfortunately, but at least there’s a strong foundation to understand how to glean more information and look for more information. So, you know, I think it’s, I think it is that area, in audiology, where people want to learn more about it. And I think audiologist, I think one of the great things about us is that we’re a very ethical profession. And so, you know, speaking for myself, I know, if someone approached me about a topic area that I wasn’t very comfortable with. I would refer that person to a friend of mine in the profession was a specialist. You know, rather than trying to lead them down a path that was correct, you know, we need to do the ethical thing and be able to refer patients to those audiologists that do do the additional training to do additional learning to be become a specialist within tinnitus. Yeah. Thank you.

Ben Thompson, AuD
That’s definitely important. And part of our collective mission is to have more resources that are evidence based. So people who either go to their doctor or look online can can save themselves time and stress living with bothersome tinnitus and instead have a trusted path to continue forward with some confidence of where they got that plan from. So what do you think is the most compelling research that supports trying hearing aids for tinnitus relief?

Jack Scott, PhD
Even in the past five to 10 years, there’s been quite a finite number of studies that have come out showing benefit, searchable 2010 showed that patients with tinnitus and hearing loss who were amplification actually showed improvement in their tinnitus handicap over those patients that did not wear amplification. In addition, there was a Dr. Henry article that came out in 2017, that showed that patients with hearing loss and tinnitus did better with a hearing aid and a sound generator than just a hearing aid alone. And so I think it’s again, going back to the idea that the hearing aids are now not just amplification devices, but hearing systems. So I know from our company, you know, putting a lot of functionality in the GN resound, hearing aids to be able to help tenants with patients. You know, it’s not just the application of sound, but also these incorporation of sound generators, in connection or in, in cooperation with your audiologist going through one of these tentative therapy programs.

Ben Thompson, AuD
Just as we are trying to educate the consumers based on the research, there’s also manufacturers of devices who are trying to produce technology that can use their research to support patients as well. You work for one of the major hearing aid manufacturers in the in the country in the US and in the world. Would you be able to comment on how your group and hearing aid manufacturers in general, are using evidence to support devices for tinnitus?

Jack Scott, PhD
Oh, yeah, I mean, it’s, you know, as technology improved, we’re able to implement and apply different types of sound therapy with our hearing aid. So as a company at gn, the research guides our research and development in many cases. So for example, when our hearing aids first started out, I should say, when we first implemented the use of sound therapy within our within our hearing aids about two years ago, it was more at a very basic level at about, and what I mean by that is providing a white noise, which covers many if not all the frequencies or pitches. But then as literature came out, showing that in some cases, white noise wasn’t the most preferred noise for patients with tinnitus. Actually more water noise era noise when noise, then we were able to actually implement and put those sounds within our amplification within our hearing aids. So that patients had the opportunity to be able to select what sound therapy or what sound quality worked best for them as far as their tinnitus. And going back to the point that you made, it’s not just found that there was but maybe the overall quality of sound that reduces the stress in that given moment to make the tinnitus thing not as as noticeable for them. Speaking for myself, I know that I incorporate some of our tendances tinnitus therapies. So for example, the tinnitus resound relief apps, basically, it has a variety of different types of sounds that the patient can be able to use or the person suffering from tinnitus can be able to use to be able to bring down their overall stress level, hopefully, mask the tinnitus, in some cases, potentially mask it out, if not actually provide just a little bit more noise in the environment to make the tinnitus seem not as perceptible. In addition, we also have components that involve meditation to incorporate relaxation, as well as some image therapy as well. When that I’m thinking of specifically, is it shows the video or boring firing, you can listen to the roaring fire in the background. And it can have a soothing effect, which is kind of interesting, because just recently I learned and you know, as this app is probably being developed, that watching a fire can actually reduce someone’s blood pressure. And I say, you know, a fire like but within our app, you know, watching sort of a fire in your backyard and your fire pit can actually produce someone’s blood pressure.

Ben Thompson, AuD
Very helpful. That is the most common app that’s recommended for tinnitus relief. It is free, it is called resound relief, you can find it on Google Play, or on the Apple Store. Now, question for you guys internally, maybe you know this, maybe you don’t? Do you track the user data and the preferences for all of the adjustments through the app? Because, as you said, we’re trying to figure out what sounds help tinnitus the most, it sounds like you guys have a huge amount of potential data through that app.

Jack Scott, PhD
Potentially. And that’s, that’s probably above my paygrade at this level, as far as that kind of data. But I think one of the things that we are trying to do as a company is to provide into focus on those resources that really help the patient. Oh, I know that, you know, I think we’re trying to glean more information, potentially, to be able to help drive some of this. And I know, through some of the literature reviews that I do, you know, looking at some of the information out there to be able to help drive some of the the research that’s coming out. So yeah, you know, hopefully, it’s out there, again, probably above my paygrade at this point, but there’s a lot of data. So hopefully, something’s being thought about at the higher level.

Ben Thompson, AuD
Amazing. And yeah, I just pull up the app here on my phone, you can see that there’s some basically different kinds of sounds, and you can click the different sounds. And then it plays. It plays the sound so cool stuff. And what I learned, which I didn’t realize was that you don’t need hearing aids to use the app. And you don’t even need resound hearing aids to use the app to any any device that streams Bluetooth. You can listen to relaxing sounds and a large library of them. That is really beneficial. So thank you guys for putting that together.

Jack Scott, PhD
Of course.

Ben Thompson, AuD
Last question here. We’re in the end of 2020 as a group as a hearing aid manufacturer, and as someone who teaches tinnitus coursework, would you like to comment on any kind of market trends or research trends for the next few years in tinnitus, hearing loss or hearing aids?

Jack Scott, PhD
I think that the biggest thing that we’ve sort of seen is this idea of personalization. And I think giving the patient as much flexibility as possible, is kind of key. So for example, within our hearing aids, we have something called within the genome resound hearing aid we have something called the tinnitus sound generator. And so this is the feature or function within the hearing aid that allows the the audiologist or hearing care professional to turn on the function to be able to provide sound therapy. And so once the audiologist or hearing care professional actually turns that on within the fitting software for the hearing aid, then the patient has the flexibility within our smart 3d app to be able to pick whatever sound they want. But even though your ACP may, may turn on white noise for you in office, you as a patient have the ability to pick a different sound that you may prefer in a given moment, or also to adjust the level of that of that sound therapy in a given moment as well. So I think I think the key is personalization, individualization, so, making the hearing aids work best for that patient in that given in that given moment in time to help her resolve a relief provides some relief to the tinnitus.

Ben Thompson, AuD
Thank you and I can attest I have a patient a client that I work with who is a musician who developed tinnitus after decades of loud music, and he has a hearing loss and he has very loud tinnitus. And he shared that using the hearing aid with a sound generator a soothing sound for him that it is very useful when his tinnitus spikes and he he seems to be losing control over keeping his concentration and his focus and his energy when the tinnitus is so loud. So having something on his ear that he can be around other people, not distract them with a noise but listen to it in his ear is is huge for him a really big improvement in quality of life. So just to bring in a real story about how this technology is helping people. That is that is something that comes up quite often. All right, so Jack, how can individuals find your work or find the work of your group?

Jack Scott, PhD
You know, I think a simple Google search will find Resound hearing aids, we’ll, we’ll bring you to our website. And then from there, you can learn more about sort of our tinnitus solutions that are available. In addition, as you mentioned, we have the the resound relief app that’s available in the Apple store or in the Google Store online to be able to download it to their phone to play around with it. And so this is a great tool to be able to, to to learn about some other recommendations for tinnitus relief, such as meditation, relaxation, as well as the sound therapies that are available. And it also does have a kind of a little hearing test in there as well. And determine if you need to, to be seen by an audiologist for a more advanced diagnostic hearing assessment.

Ben Thompson, AuD
Thank you so much, guys. This is jack Scott, PhD audiologist, and current senior audiologist at the GN Resound group, previous faculty and lecturer at Northwestern University in Chicago. And thank you so much for joining us.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson is an audiologist in California and founder of Pure Tinnitus. Dr. Thompson has a comprehensive knowledge of tinnitus management. He completed his residency at University of California at San Francisco (UCSF) and is a past board member of the California Academy of Audiology. Via telehealth, Dr. Thompson provides services to patients with hearing loss and tinnitus.

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