Dr. Konstantina Stankovic

And...

It's also potentially a methodological issue because, again, everything was lumped under the same umbrella.

But it is conceivable that different subtypes may respond to certain interventions.

But because we don't know how to identify these subtypes, we are lumping them all together.

So when you lump them all together and put all studies together that have ever been done and perform meta-analysis, then...

It sounds like none of them make a difference, so to the point that the American Academy of Otolaryngology Head and Neck Surgery really endorses two main interventions.

One is amplification with a hearing aid for those who need it, and two is cognitive behavioral therapy.

Those two interventions have actually shown to make a difference.

There are other things that have been tried.

Some people take things on their own.

There is anecdotal reports of potential benefit, but that hasn't panned out in large scale epidemiologic studies that have had the appropriate control group.

Exactly.

And in fact, that's what we recommend in the clinic as well.

And lots of people find it reassuring because we first have to do tinnitus.

complete and thorough evaluation, which includes examination of the ears, examination of the whole head and neck, hearing testing to make sure that there is no asymmetry or difference between the two ears.

If there is a significant asymmetry, that triggers imaging or additional testing, like auditory brainstem evoked response testing.

And imaging, it's typically MRI, and this is where we are looking for these tumors that could cause hearing loss.

They are super rare, so I don't want people to be stressing out and thinking they have that, but it's important to rule out.

So, indeed, once we find that there is...

no tumor, then we do try to reassure patients and explain that tinnitus is indeed a phantom sound produced by the brain and why it makes it.