Frequently Asked Questions About Tinnitus

Clearing the Air: Tinnitus FAQ – Your Top Questions Answered

What is the medical definition of tinnitus?

  • Tinnitus is a phantom sound heard in the ears or head.

Is there a cure for tinnitus?

  • We are happy to give you the most straightforward answer we can to the question, “Can tinnitus be cured?”.
  • Answer: No.
  • But there is also no cure for heart disease, diabetes, cancer, and many, if not most, chronic medical conditions afflicting older adults.
  • The real question to ask is, “Can tinnitus be effectively treated?”
  • Answer: HECK YES! Using our proven treatment program, we can effectively reduce tinnitus in nearly 90% of patients!
  • We certainly like those odds. In addition to reducing tinnitus, treatment also improves concentration, sleep and reduces overall stress and anxiety.

How long will it take for my tinnitus to reduce?

  • Treating tinnitus can take time. We have had some patients notice immediate relief (within minutes!), whereas some patients can take 6-18 months.
  • As a rule of thumb, early detection and treatment increase your chances of noticing a quicker reduction in tinnitus. (Or, on the flip side, the longer you have had the tinnitus, the longer it may take to reduce it!).
  • But it will depend on several factors, including how long you have had your tinnitus. For example, if you have had bothersome tinnitus for over 30 years, we wouldn’t anticipate it taking minutes to fix. Instead, you may be one of the patients who need 30, 60, or 90+ days to notice a marked reduction in the ringing. It is important you know this before you start treatment, so you have the right expectations.

Is there a proven way to reduce tinnitus?

  • Yes. The most effective and proven treatment for tinnitus is to stimulate the brain with sound to reduce activity in the neural networks that create the phantom perception of sound.
  • Perhaps you have been told by some to deal with it and sleep with a fan on to ignore it. Even worse, you may have been told there is nothing that can be done for you!’.
  • The approach to treating tinnitus is very logical; if you activate the damaged nerves that connect the ear to the brain, the ‘central gain’ causing the ringing will decrease, ergo you will perceive less tinnitus.
  • This prescriptive technology used to directly treat tinnitus is both FDA-regulated and effective in nearly 90% of patients. Recent reports that investigated the impact of treatment on sleep, concentration, work, and when hearing others in a conversation have all noted dramatic reductions in the impact of tinnitus on everyday life.

When treating my tinnitus, should I still worry about my ‘tinnitus triggers’?

  • For many patients undergoing treatment, the ringing can be virtually undetectable until a ‘trigger’ ramps up the volume of the tinnitus. Be sure to avoid or protect your ears from the most common triggers for tinnitus, including loud noise (concerts, electric tools, lawnmower, etc.), alcohol, caffeine, nicotine, NSAIDS (ibuprofen, aspirin, etc.,) and stress.

Does acupuncture work to reduce tinnitus?

  • Currently, there is no conclusive research to confirm whether acupuncture can effectively alleviate tinnitus symptoms. However, since there are no indications that it could exacerbate tinnitus, you might be inclined to give it a try.
  • Acupuncture is a safe practice that may also help to ease other issues and correct imbalances that may be associated with tinnitus, including:
    • Temporomandibular Joint Disorders (TMJ)
    • Hypertension
    • Chronic Neck Pain

Do I need tinnitus retraining therapy (TRT) for my tinnitus?

  • Tinnitus retraining therapy is a form of indirect treatment for tinnitus and may be considered to supplement direct treatment. The benefits of TRT can vary from patient to patient, and minimal peer-reviewed data supports the effectiveness of TRT.

But my doctor said there is nothing that can be done about my tinnitus.

  • Most patients that come to see us say, ‘But my doctor told me there is nothing that can be done about the sounds in my ears’, and sometimes we wish we had kinder words, but often blurt out ‘hogwash!’.
  • What upsets us the most about this statement is that when addressed properly with the right treatment program and the right prescriptive technology, nearly 90% of patients can expect a reduction in their experience with tinnitus. This means less noise while you sleep, less noise when you work, less noise when you focus, less noise when spending time with others and less noise while living a more fulfilling life.

Is tinnitus harmful?

  • YES!
  • Think of tinnitus as your internal warning alarm telling you something is wrong. If you didn’t have tinnitus and now do – something has gone awry! The most common cause of tinnitus is a progressive degeneration of the neural system connecting the ears to the brain. Deficits in this neural network can impact memory/mental health, increase your risk of dementia, and raise your chances of a traumatic fall.
  • In addition, untreated tinnitus can impact your emotional, physical, social, economic, and cognitive health.

Will my tinnitus cause hearing loss?

  • For most people with tinnitus, it is the result of the same neural degeneration that causes us difficulty hearing. Thus, we often tell our patients that hearing loss is tinnitus, and tinnitus is hearing loss.

How long will my tinnitus last?

  • Here’s our equivocal answer: if you don’t treat your tinnitus, it will get worse. And if you properly treat your tinnitus, the odds are in your favor (90%) that you will notice a marked reduction in your tinnitus, and you will likely have less tinnitus.

Is tinnitus a disability?

  • While the right treatment can help you to live an active life without the constant interference of tinnitus, extreme cases can be disabling.

Can earwax cause tinnitus?

  • Yes! A blockage of earwax can cause tinnitus. However, if the tinnitus persists once the wax is removed, that may indicate you have underlying tinnitus that was only made louder by the presence of earwax. There are many options to safely remove wax; consult with your local healthcare provider.

Can tinnitus be prevented?

  • This is a tough one – that has both a yes and no answer!
  • Given the most common cause of tinnitus is due to aging, tinnitus in most people is not avoidable if you live long enough. The underlying cause of tinnitus can start in the 4th to 5th decade of life and become noticeable shortly after that.
  • In many people, there are additional external factors that make their tinnitus worse, including excessive noise exposure, stress, poor diet, lack of sleep, and anxiety.

Can I treat my tinnitus with surgery?

  • Many patients that are desperate to reduce their tinnitus will ask if cutting or severing the hearing nerve will eliminate their tinnitus.  This permanent, deafness-producing procedure is not a dependable means of reducing tinnitus.  In fact, the surgical destruction of a person’s hearing nerve can often leave tinnitus as the only sound heard (like ‘Phantom Limb’).

What are my odds with tinnitus and medication?

  • Put bluntly – there are currently NO FDA-approved drugs specifically for treating tinnitus. However, there are pharmacological options to address the stress, anxiety, and depression that are caused by (and can sometimes exacerbate) tinnitus.

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CBD and Further Reducing Your Tinnitus

Unlocking Serenity: CBD’s Potential in Quieting Tinnitus

Please note – In considering this article, please keep in mind that you must first directly treat your tinnitus, and then you may consider supplementing your treatment with CBD to reduce anxiety even further, depression, stress, insomnia, etc., associated with your tinnitus.

In the past ten years, the impact of Cannabidiol (CBD)on health has been extensively studied. The health benefits of CBD can include reduced anxiety, marked reductions in chronic pain and less tinnitus!

Visit our website, www.salushearing.com, to explore a wealth of resources and solutions for tinnitus relief and support.

What is CBD?

Cannabidiol is derived directly from the hemp plant but does not cause a “high” by itself and does not exhibit any effects indicative of abuse or dependence. It is legal in all 50 states and available in many stores and online. CBD comes in many forms, including capsules, vapes, extracts, oils, patches, and topical creams.

Research on CBD and Tinnitus

Researchers have found two cannabinoid receptors in the brain, also known as CB1 and CB2, that act in response to the presence of CBD. Developing studies have shown that these receptors may well play a role in hearing and balance. So, the question remains: does CBD help with hearing conditions such as tinnitus? At this point, rigorous studies to definitively answer this question are not currently available. However, it would be a disservice to ignore the testimonials of patients who have used it to reduce their experience with tinnitus.

There is some indication that CBD may improve stress levels, which obviously is an issue for those with chronic tinnitus. It is important to note that everybody reacts differently, as no two people are the same. Most have stated that CBD helps with stress and falling asleep, two of the biggest concerns of dealing with chronic tinnitus.

Is CBD safe to use for tinnitus?

According to WHO (World Health Organization), CBD is safe to use with limited side effects in rare cases (weight loss or gain, diarrhea, fatigue). Talk to your doctor before trying CBD, as it may interact with some other medications you are taking.

Once you have decided to try using CBD, be sure to do your research to ensure that you are buying a high-quality product. It is suggested to start with oil for its higher bioavailability and production of fuller-body effects.

So, how can you find a quality CBD product?

Below is a quick guide on ‘What to look for when purchasing CBD’:

  • Search for third-party testing on the label. A quality CBD product will come with what is known as a COA, which you can read before buying. The COA will verify that everything that is on the label is truthful and accurate relative to the CBD content and THC content. The COA will also tell you whether the product you are buying has passed the necessary tests for contaminants.
  • Once you’ve done that, scan the ingredients. All CBD products should contain hemp oil and hemp extract. It would be ideal to choose a CBD product that contains organic ingredients.
  • Ensure that the CBD brand you’re considering clearly specifies the origin of its hemp cultivation and provides detailed information about its manufacturing procedures.
  • Check the reviews! Take a good look at the company’s customer reviews. Also, as of the writing of this article, we have it on good word that Amazon prohibits the sale of CBD on their site. So, if you find something on Amazon, it is most likely not CBD.

The ultimate takeaway here is that while there is no direct scientific evidence to support the use of CBD for tinnitus, it is known to help deal with the side effects of that constant ringing in your ears. Explore our comprehensive website to find relief from tinnitus and regaining peace of mind. www.salushearing.com.

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Melatonin and Further Reducing Your Tinnitus

Unlocking the Power of Melatonin: A Path to Quieter Nights and Reduced Tinnitus

Please note – the information in this article is meant to supplement (add to) your direct treatment of tinnitus, not be a substitute for treatment.

For more information on treating your tinnitus, please visit www.salushearing.com.

Melatonin is a hormone that plays a crucial role in regulating the sleep-wake cycle and is commonly used as a dietary supplement to help with sleep disorders or jet lag. While melatonin is not a direct treatment for tinnitus, there have been several studies and reports suggesting that it may have an impact on tinnitus. The underlying mechanism of how melatonin can reduce tinnitus is not known; however, it’s logical to assume that improved sleep and a well-rested brain, including the limbic (emotional) system, would lead to reduced stress and, consequently, a decrease in tinnitus.

Tinnitus can be particularly bothersome for people, especially at night, and lead to sleep deprivation. Melatonin may break this vicious cycle of tinnitus: less sleep, more tinnitus, even less sleep, even louder tinnitus, etc. Melatonin may help people with tinnitus by improving their sleep quality and making it easier for them to fall asleep, which in turn can reduce the perceived severity of tinnitus during the day.

Melatonin also has the potential to reduce anxiety and stress – which is a significant trigger for tinnitus. The calming effect of this supplement may help reduce these psychological factors, potentially leading to a decrease in tinnitus-related distress.

It’s important to note that melatonin is not a cure for tinnitus but is a viable option to help supplement treatment and even further drive down the ringing.

At least 20% of people with untreated tinnitus complain about how it impacts their sleep. A lack of sleep can have a devastating impact on your body, your heart, and your brain. Thus, melatonin and healthy sleep may do more for you than reduce your tinnitus!

The Significance of Sleep in Aging

Sleep is a fundamental biological process that becomes increasingly important as individuals age. Quality sleep is crucial for physical, mental, and emotional well-being, and it plays a significant role in maintaining overall health and vitality. Unfortunately, many older adults experience sleep disturbances, which can negatively impact their daily lives and overall health.

Cognitive Health, Sleep, and Melatonin 

The Link Between Sleep and Cognitive Function

Sleep is essential for cognitive function and memory consolidation. During deep sleep stages, the brain processes and stores information acquired throughout the day, promoting optimal cognitive performance. Sleep disturbances, such as insomnia or fragmented sleep, can impair cognitive function and memory.

The short-term cognitive impacts of poor sleep include:

  • Excessive Sleepiness
  • Poor Attention Span
  • Reduced Adaptability
  • Reduced Emotional Capacity
  • Impaired Judgment

The long-term cognitive impacts of poor sleep include:

  • Impaired Memory
  • Increased Risk of Alzheimer’s Disease

Melatonin as a Potential Protective Factor

Melatonin’s role in promoting healthy sleep patterns may have implications for cognitive health in older adults. Some studies have explored the potential neuroprotective effects of melatonin, suggesting that it could help mitigate the risk of cognitive decline and dementia by improving sleep quality and supporting brain health.

Melatonin’s Effects on Tinnitus-Related Sleep Disturbances

Research on melatonin’s impact on tinnitus-related sleep issues has been studied for over 20 years, and many reports suggest that melatonin may help individuals with tinnitus experience more restful sleep by reducing the psychological distress associated with the condition.

Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. Considering its minimal side effects, melatonin should be a part of the physician’s armamentarium in the treatment of tinnitus.”

~Rosenberg et al., Journal of Laryngoscope, 1989

Combining Sleep Hygiene Practices with Melatonin

To maximize the benefits of melatonin supplementation, individuals should also adopt good sleep hygiene practices. These practices include:

  • maintaining a consistent sleep schedule
  • creating a comfortable sleep environment
  • avoiding stimulants such as caffeine and electronics before bedtime.

Enhancing the quality of life for older adults includes sleeping well for mental and cognitive health. Older adults must consider their physical, mental, emotional, and social needs. Personalized care and attention are essential for promoting well-being and happiness as they age.

Discover valuable insights and support for managing your tinnitus by visiting our website today at www.salushearing.com.

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How To Avoid Triggering Your Tinnitus

Mastering Tinnitus Management: Avoiding Triggers

Tinnitus, even when being properly treated, can be triggered, or exacerbated by a variety of factors. Let’s take this chapter to review some of the more common triggers that you can (hopefully) avoid to reduce your experience of tinnitus even further. These triggers are broken into three categories: chemical, physical, and mental!

Chemical Triggers

MedicationsMany medications can aggravate tinnitus; however, please do not stop taking any medications before speaking with your doctor and pharmacist (phew – now we can’t get sued!). Your doctor may explore different medication alternatives that could potentially not aggravate your tinnitus.

Alcohol: Drinking alcohol can impact your blood pressure – which, in turn, can worsen your tinnitus. In addition, over time, alcohol can impair your cognitive performance and potentially increase your risk of cognitive decline.

Tobacco Products: No matter how long we spend scouring the internet and scientific journals, we’ve yet to come up with anything good that smoking does for you. But you already know that. But did you know that the nicotine found in cigarettes, vaping and chewing tobacco can increase tinnitus symptoms? Nicotine can elevate blood pressure and narrow blood vessels, thus decreasing the amount of oxygen traveling to the ears and brain — both increasing the experience of tinnitus! If you have tinnitus and are a nicotine user, you just found another great reason to quit! Oh, and let us not forget that smoking increases your risk of developing dementia significantly.

Caffeine: Please know, as coffee lovers, it pains us to write about this. Sadly, caffeine (often found in coffee, tea, soda, energy drinks and supplements) can raise blood pressure and trigger tinnitus. We’ve met many patients over the years who don’t realize the strong connection between caffeine and tinnitus and notice near-instant relief from tinnitus once they cut back on the Joe!

Refined Sugars: Over the years, we’ve had many patients tell us they notice a spike in their tinnitus after eating sugary foods. And there is science to back this up. One research report found that nearly 90% of people with tinnitus had too much insulin in their blood (aka hyperinsulinemia). Insulin’s job is to open cells and allow sugar to enter. When blood sugar levels rise, insulin is released to move sugar from the bloodstream into cells to avoid the sugar damaging tissue in veins, arteries, and nerves. Untreated high blood sugar levels can also damage the nerve that controls how the brain interprets sound and may cause tinnitus. Avoid overindulging in sweets to keep your blood sugar in check and your tinnitus symptoms under control.

Salt: While sodium is one of the body’s most important chemical substances, like everything in life, too much can be a bad thing! If you have tinnitus, you must monitor your salt intake. Salt can increase blood pressure, which may then drive up the ringing. If you believe this is one of your triggers, be sure to read nutrition labels for salt content.

Physical Triggers

Loud NoisesLoud noises are not only a root cause of tinnitus but can also be a serious trigger and cause tinnitus to flare up.  Loud noise, even at levels not considered ‘damaging’, can cause tinnitus to intensify for hours, perhaps even days. People with pre-existing tinnitus must wear hearing protection in all situations where loud noises may be present. For example, using hearing protection when at concerts, using tools, mowing the lawn, going to weddings, sporting events, loud restaurants, etc.  When using headphones or earbuds to enjoy music, always make sure to never go over 70% on the volume dial.

EarwaxAlthough earwax is suitable for your ears by providing lubrication and protection from dirt and bugs, too much wax can be a bad thing. If earwax accumulates and becomes impacted (a solid wall of wax), it can reduce your ability to hear and ramp up your tinnitus. If you think you have too much earwax, ask your hearing healthcare provider to remove it and ask for tips on how to stop it from becoming an issue. Oh, and never use a Q-tip inside your ear canal – all you are doing is pushing the wax further down the ear canal and causing it to build up and eventually become a problem.

CongestionAllergies, colds, ear infections and sinus infections can cause congestion, which can worsen tinnitus. If congestion triggers your tinnitus, be sure to ask your doctor about options for reducing the congestion.

Blood PressureTinnitus can be triggered by either low or high blood pressure. Remember – what’s good for your heart is good for your ears and your brain! If you notice your tinnitus comes and goes with spikes or decreases in your blood pressure, talk to your heart doctor about how to best manage this.

Stress Triggers

Sleep ProblemsTinnitus and sleep have a very unhealthy relationship. Many patients complain that they can’t sleep because of their tinnitus, and a lack of sleep only causes the tinnitus to be much worse. To help avoid this vicious cycle, you may try homeopathic remedies for sleep, including relaxation exercises and natural supplements (Melatonin). For many patients, introducing an external noise, i.e., a sound machine, leaving the TV on at night, etc., can help drown out the tinnitus and help you fall asleep.

Nervous TensionMental and emotional strain can make most things in life worse, including tinnitus. Although this is easier said than done – avoiding stress and developing stress-relieving habits can decrease the effect that stress has on your tinnitus. For many people, regular exercise, relaxing hobbies, counseling, deep breathing, meditation, and massage can reduce stress and help drive down the experience of tinnitus.

Anxiety and DepressionThere is a long history of published research that indicates people with a history of anxiety and depression suffer more with their tinnitus (compared to people with no history of mental illness). Many coping mechanisms exist and are outside the scope of this book. Talk to your doctor and hearing healthcare provider to find a mental health specialist in your area who specializes in helping patients manage anxiety, depression, and tinnitus. Keep in mind that some medicines prescribed to treat anxiety and depression may worsen the tinnitus.

Unlock a world of better hearing and improved quality of life!

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Treating Tinnitus and Reducing Your Risk of a Traumatic Fall

Silencing Tinnitus, Securing Balance, Preventing Traumatic Falls

Did you know that tinnitus and significant hearing loss dramatically increase your risk of a traumatic fall? 

Falls are the #1 cause of injury-related deaths, lead to hospitalization, and can lead to the loss of independence. Falls are often associated with declines in physical, emotional, social, economic, and cognitive health.  While falling can result from a variety of reasons – diabetic neuropathy, orthostatic hypotension (the dizzy feeling you get when you stand too quickly!), decline in physical fitness, impaired vision, medications, accidents, etc., – tinnitus and hearing loss are significant contributors to a person’s risk of falling.

A fall can threaten one’s safety and independence and generate enormous economic and personal expenses. It is estimated that a fall can cost a family, on average, nearly $30,000 per incident. And, unfortunately, those who fall nearly double their risk of falling again. Perhaps one of the saddest realities of falls is that most adults who fall are later forced to leave their homes.

There is significant evidence to suggest that treating tinnitus and hearing loss can help reduce the risk of falling in older adults. The relationship between tinnitus, hearing loss and falls is multifaceted, but simply put, being able to hear everything around you can help you avoid a disastrous fall. Even the softest sounds in the world around us (i.e., footsteps, creaking floors, or the change of surface below our feet) help your brain understand your position in the world and keep up upright.

Treating your tinnitus and hearing loss and restimulating the ear-to-brain connections can help in several ways, including enhancing your ability to hear and understand sounds in your environment, improving auditory awareness and reducing the risk of accidents due to miscommunication or misunderstanding. Furthermore, treatment can help individuals better localize sounds and understand the direction from which sounds are coming, thus reducing the risk of tripping, or losing balance in situations where auditory cues are essential for safety. Improved awareness of environmental sounds like approaching vehicles and alarms allows for quicker and more appropriate reactions to potential hazards.

Additionally, by promoting social engagement and reducing isolation, treating your tinnitus and hearing loss enables you to remain active, preventing physical deconditioning and falls. Some studies even suggest that treatment leads to improvements in balance and gait, further reducing the risk of falls, especially in older adults.

Interestingly, some of the newest prescriptive technology used to treat tinnitus and hearing loss has fall detection technology embedded in it. Using built-in 3D sensors and AI, the technology you use to reduce your tinnitus and treat your hearing loss can detect when the user falls and alert friends and family. Many consider this new technology superior to traditional fall detectors worn around the neck or wrist. Fall detectors worn at ear level and linked to head movement are naturally less prone to mistake daily activities for falls than the devices worn on other parts of the body.

Here are some steps you can take to minimize the risk of falling:

  1. Exercise regularly.
  2. Make your home safer by removing tripping hazards.
  3. Discuss medications with your doctor that may make you dizzy or affect your balance.
  4. Have regular vision checks.
  5. Wear appropriate footwear.
  6. Stay hydrated. Dehydration often leads to weakness and dizziness.
  7. Maintain a balanced diet. Proper nutrition leads to bone and muscle strength.
  8. Use canes, walkers, or wheelchairs if necessary for mobility.
  9. Consider a personal alert system or medical alert bracelet.
  10. Know your limitations.
  11. Stay mentally active.
  12. Be mindful of your environment.
  13. Participate in a fall prevention program.
  14. TREAT YOUR HEARING LOSS!

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Treating Your Tinnitus & Reducing Your Risk of Dementia

Silencing Tinnitus: A Sound Strategy for Dementia Prevention

In 2017, the European Dementia Commission put forth the first in its series of ‘the holy grail’ on the state of dementia. This report, published in the Lancet (FYI – the Lancet is among the oldest, most respected, and most widely read medical journals in the world) and recently updated in 2020, lays out the ‘How To’ of preventing dementia.

To summarize, the 2020 Lancet report (Dementia Prevention, Intervention and Care) has two major findings:

  • 40% of all cases of dementia are considered preventable.
  • 12 (simple) modifiable factors can help prevent dementia.

Each of the 12 modifiable lifestyle factors is scientifically backed and can dramatically reduce your risk of developing cognitive decline and dementia.

Not surprising to us, but surprising to most in both the medical and non-medical fields, is that the early treatment of hearing loss and tinnitus is #1 on the list of modifiable factors! Below is a list of all 12 modifiable factors – with most of the attention focused on the links of tinnitus, hearing loss and dementia.

NOTE – the 12 items below are listed IN ORDER of percentage chance of avoiding dementia if this risk is eliminated:

  1. Treat Your Tinnitus & Hearing Loss – The early medical treatment of hearing loss and tinnitus is the #1 modifiable lifestyle factor for reducing the risk of dementia. Several studies have shown a correlation between untreated hearing loss and cognitive decline, including dementia. While the exact mechanisms behind this link are not fully understood, the correlation between increased risk of cognitive decline and dementia is undeniable.
    • There are three strong theories on why untreated tinnitus and hearing loss can increase your chances of cognitive decline and dementia.
    • Tinnitus and hearing loss impacts over 48 million people in the U.S. (nearly 1.5 billion people worldwide) and is listed by the Department of Health and Human Services as the 3rd most common chronic disorder affecting today’s older adults.
    • Unfortunately, for most of us, age-related hearing loss is inevitable, impacting nearly 50% of seniors between the ages of 60-70, almost 2/3 of people between the ages of 70-80, and nearly 80% of individuals over the age of 80. Age-related hearing loss is characterized as a progressive degenerative disorder that impacts neural connections and functions throughout the brain.
    • This chronic medical condition can have a significant impact on several key brain areas, including memory, emotion, hearing, decision-making, speech, and language portions. Several key research studies have pointed to the potential links between hearing loss and dementia, including the groundbreaking work from Dr. Lin and his colleagues at Johns Hopkins Medical Center that indicates hearing loss can increase the risk of dementia by 200-500%.
    • The links between tinnitus, hearing loss and cognitive decline are detailed below:
      • Social Isolation: The impact of reduced social and physical activity. Withdrawal from social situations is common in individuals with hearing loss. Many studies cite feelings of embarrassment, fear of making mistakes in conversations, and feeling like you are not part of the conversation as the common rationale for individuals with hearing impairment to separate themselves from family, friends, and community. This retreat from social activity has even been found in individuals with a mild degree of hearing loss. In addition, individuals with hearing loss are less likely to engage in physical activity. Both increased social isolation and reduced physical activity are strong risk factors for the development of dementia.
        • Note – Both social isolation and the ensuing depression are major risk factors for the development of dementia, and both increase as we age. Being a lifelong learner and staying active is important to maintain a healthy, active brain and can also reduce your risk of cognitive decline and dementia. Some studies have shown that social activities, larger social networks, and a history of social contact are associated with better cognitive function and reduced risk for cognitive decline.
      • Cerebral Atrophy (aka Brain Shrinkage): The association of a shrinking brain, resulting from the loss of neurons, with dementia, has been long documented. Even people with MCI (Mild Cognitive Impairment) show signs of cerebral atrophy. In recent years, scientific studies using advanced brain imaging techniques (including fMRI – Functional Magnetic Resonance Imaging) have demonstrated that hearing impairment is associated with accelerated brain atrophy throughout the entire brain.
      • Cognitive Overload (i.e., Working Your Brain Too Hard to Hear): Tinnitus and hearing loss are not normal, and neither is the excess strain that it puts on your brain. While hearing loss may be more common as we age, tinnitus and hearing loss must be treated. With hearing loss, the brain is constantly on ‘overload,’ trying to fill in the missing pieces and follow the conversation. Increased cognitive load is considered a risk factor for developing dementia. Cognitive load, as measured by pupillometry, is a measurement of how hard your brain is working to follow a conversation. Recent research has found that individuals who treat their hearing loss do not work as hard to listen (i.e., have a reduced cognitive load) and have as much as a 20% increase in memory recall when following a conversation.
  2. Increased Education: Your mother was right – stay in school and never stop learning. Education level has been found to have a significant impact on the risk of developing dementia. Research has consistently shown that individuals with higher levels of education tend to have a reduced risk of developing dementia compared to those with lower levels of education. Here’s how education level is related to dementia:
    • Cognitive Reserve: One of the leading theories explaining the relationship between education and dementia is the concept of cognitive reserve. Cognitive reserve refers to the brain’s ability to withstand damage and function effectively despite neurological changes. Higher education is thought to contribute to cognitive reserve in several ways:
    • Education typically involves mental stimulation and learning, which can enhance cognitive abilities and create a reserve of brainpower.
    • Educated individuals often engage in complex mental tasks throughout their lives, which may help their brains adapt to challenges and function efficiently, even in the presence of brain changes associated with dementia.
  3. Stop Smoking: If the threats of lung cancer and emphysema are not enough to get you to stop smoking, perhaps ending up without dementia will. Smoking has been identified as a significant risk factor for the development of dementia, particularly Alzheimer’s disease and vascular dementia. Research has consistently shown a link between smoking and an increased risk of cognitive decline and dementia. Several factors contribute to smoking and cognitive impairment, including:
    • Vascular Damage: Smoking is a major contributor to vascular diseases, including atherosclerosis (hardening and narrowing of the arteries) and hypertension (high blood pressure). These conditions can lead to reduced blood flow to the brain, depriving it of essential oxygen and nutrients. Such vascular damage is a known risk factor for vascular dementia, which is caused by impaired blood flow to the brain.
    • Inflammation: Smoking promotes inflammation throughout the body, including in the brain. Chronic inflammation is believed to play a role in the development of Alzheimer’s disease and other neurodegenerative conditions.
    • Oxidative Stress: Smoking generates oxidative stress in the body, which can damage cells, including brain cells. This oxidative damage is associated with the development and progression of dementia.
    • Amyloid Plaque Accumulation: Smoking may contribute to the accumulation of beta-amyloid plaques in the brain. These protein deposits are a hallmark of Alzheimer’s disease.
    • Interaction with Other Risk Factors: Smoking can interact with other risk factors for dementia, such as high cholesterol and diabetes, further increasing the risk of cognitive decline.
    • Accelerated Brain Aging: Smoking has been linked to accelerated brain aging, which is associated with cognitive decline and an increased risk of dementia.
  4. Depression: Addressing depression in older age is critically important for cognitive health, and living a life with less ringing and healthy hearing goes a long way to reducing depression. Depression and dementia are two distinct but interconnected health conditions, and they can often co-occur or influence each other in complex ways. Here are some important points to understand about the relationship between depression and dementia:
    • Coexistence of Depression and Dementia: Depression and dementia can coexist in the same individual. In some cases, depression may be a symptom of dementia, especially in the early stages when individuals may be aware of their cognitive decline. This is known as “depressive pseudodementia.” Conversely, individuals with a history of depression may be at a higher risk of developing dementia later in life.
    • Depression as a Risk Factor for Dementia: Several studies have suggested that late-life depression may be a risk factor for the development of dementia, particularly Alzheimer’s disease. The exact mechanisms linking depression and dementia are not fully understood, but chronic inflammation, vascular changes, and stress-related changes in the brain are some of the proposed pathways.
    • Symptoms and Overlapping Features: Depression and dementia can share certain symptoms, such as memory problems, difficulty concentrating, and changes in mood and behavior. This overlap in symptoms can make it challenging to differentiate between the two conditions, especially in older adults. Healthcare professionals must conduct thorough assessments to determine whether symptoms are due to depression, dementia, or a combination of both.
  5. Social Isolation: Tinnitus and hearing loss often lead to profound isolation among many patients. Social isolation and loneliness have been associated with an increased risk of developing dementia and can also exacerbate cognitive decline in individuals already living with dementia. The links of social isolation and dementia include:
    • Reduced Cognitive Stimulation: Social interactions provide cognitive stimulation through conversations, problem-solving, and engagement with others. When individuals are socially isolated, they may experience a lack of mental stimulation, which can contribute to cognitive decline.
    • Mental Health Impact: Loneliness and social isolation are linked to depression and anxiety, both of which can negatively affect cognitive function. Chronic stress associated with loneliness may also contribute to cognitive decline.
    • Physical Health Impact: Social isolation can lead to a sedentary lifestyle and poor health behaviors, such as a lack of exercise and unhealthy eating habits. These factors can increase the risk of conditions like obesity, diabetes, and hypertension, which are known risk factors for dementia.
    • Neurobiological Effects: Loneliness and social isolation have been associated with changes in the brain, including increased inflammation and alterations in stress-related hormone levels. These changes may contribute to cognitive impairment and increase the risk of dementia.
    • Medication Adherence: Social isolation can make it challenging for individuals to manage their healthcare, including taking medications as prescribed. Poor medication adherence can lead to the progression of underlying health conditions that increase dementia risk.
    • Lack of Social Support: A solid social support system can provide emotional and practical support, which can reduce stress and help individuals cope with life’s challenges. Social isolation can result in a lack of this support, potentially leading to increased stress and anxiety.
  6. Traumatic Brain Injury (TBI): While most TBIs are the result of an accident, preventative measures should always be taken to reduce the incidence of TBI, as it can be a significant risk factor for the development of various cognitive impairments, including dementia. While not everyone who experiences TBI will develop dementia, there is evidence to suggest that TBIs, particularly moderate to severe ones, can increase the risk of dementia in the future. Several factors contribute to the connections between head injury and dementia, including:
    • Types of TBIs: TBIs can range from mild (e.g., concussions) to severe, with varying degrees of cognitive and physical impairment. Moderate to severe TBIs, which involve more significant damage to the brain, are more strongly associated with an increased risk of dementia.
    • Increased Risk: Many research studies have indicated a link between moderate to severe traumatic brain injuries (TBIs) and an increased likelihood of developing dementia, specifically Alzheimer’s disease and various types of neurodegenerative dementia. The risk appears to be highest in the years immediately following the TBI.
    • Mechanisms: The exact mechanisms by which TBIs increase the risk of dementia are not fully understood, but several factors may contribute:
      • Neuroinflammation: TBI can trigger an inflammatory response in the brain, which may lead to chronic inflammation and neurodegenerative processes.
      • Tau Protein Accumulation: TBIs can result in the abnormal accumulation of tau protein in the brain, a hallmark of Alzheimer’s disease.
      • Axonal Injury: Damage to axons (nerve fibers) in the brain can disrupt communication between brain regions, potentially contributing to cognitive impairment.
      • Vascular Changes: TBIs can also lead to changes in blood vessels in the brain, increasing the risk of vascular dementia.
      • Cumulative Effect: Multiple TBIs, even if they are mild, can have a cumulative effect on the brain and may further increase the risk of cognitive impairment and dementia.
  7. Physical Inactivity: People with tinnitus and hearing loss do less physical activity. This has been shown time and time again in research and is likely the result of increased social isolation in older adults with hearing loss. Physical inactivity is a well-established risk factor for the development of dementia. Regular physical activity is associated with various health benefits, including improved cardiovascular health, reduced inflammation, better blood flow to the brain, and enhanced brain plasticity. Here’s how physical inactivity is related to dementia:
    • Cardiovascular Health: Physical inactivity can lead to conditions such as hypertension (high blood pressure), obesity, and diabetes, all of which are risk factors for vascular dementia. Vascular dementia is caused by reduced blood flow to the brain due to vascular problems, and physical activity can help maintain a healthy cardiovascular system.
    • Brain Health: Exercise has a positive impact on brain health. It can stimulate the release of neurotrophic factors, which support the growth and maintenance of neurons (brain cells). Regular physical activity can also enhance cognitive function and improve memory.
    • Reduction of Alzheimer’s Risk: Alzheimer’s disease, the most common form of dementia, is characterized by the accumulation of beta-amyloid plaques and tau tangles in the brain. Physical activity has been linked to a lower risk of developing Alzheimer’s disease and a reduced rate of cognitive decline.
    • Stress Reduction: Physical activity is known to reduce stress and improve mood. Chronic stress and depression are associated with an increased risk of cognitive decline and dementia. Exercise can help mitigate these risk factors.
    • Blood Flow to the BrainWhat’s good for the heart is good for the mind! Exercise promotes better blood flow to the brain, ensuring that it receives the oxygen and nutrients it needs to function optimally. Reduced blood flow can contribute to cognitive impairment.
    • Neuroplasticity: Physical activity can enhance neuroplasticity, the brain’s ability to reorganize and adapt by forming new neural connections. This can be particularly important in protecting against age-related cognitive decline.
    • Social Engagement: Some forms of physical activity, such as group sports or classes, also involve social engagement. Maintaining an active social life can have a protective effect against dementia.
    • Healthy Lifestyle: Regular physical activity is often part of a healthy lifestyle that includes a balanced diet, not smoking, and moderate alcohol consumption, all of which can contribute to a lower risk of dementia.
  8. Hypertension: If it’s good for the heart, it’s good for the mind!  Cardiac conditions compromise blood flow to nearly all major organs, including the brain and the ear. Love yourself and take care of your heart.
    • Hypertension, or high blood pressure, is a known risk factor for the development of dementia, particularly vascular dementia, and Alzheimer’s disease. There is a strong association between hypertension and cognitive decline, and here’s how hypertension is related to dementia:
      • Vascular Damage: Hypertension can cause damage to blood vessels throughout the body, including those in the brain. Over time, high blood pressure can lead to atherosclerosis (narrowing and hardening of the arteries), which reduces blood flow to the brain. This reduced blood flow can result in small strokes or micro-infarctions that damage brain tissue, increasing the risk of vascular dementia.
      • Impact on Brain Structure: Long-term high blood pressure has been associated with structural changes in the brain, such as white matter lesions and brain atrophy. These changes are often seen in individuals with dementia.
      • Amyloid Accumulation: Hypertension may also contribute to the accumulation of beta-amyloid plaques in the brain, a hallmark of Alzheimer’s disease.
      • Midlife Hypertension: Hypertension in midlife (around ages 40-64) appears to be particularly relevant to dementia risk. Controlling blood pressure during midlife may have a protective effect on cognitive function later in life.
      • Interaction with Other Risk Factors: Hypertension often coexists with other risk factors for dementia, such as diabetes, high cholesterol, and obesity. The combination of these factors can increase the risk of cognitive decline.
  9. Air Pollution: This was recently added to the list as air pollution might act via vascular and/or respiratory mechanisms and reduce proper blood and oxygen flow to the brain. There is growing evidence to suggest that air pollution, especially fine particulate matter, and other pollutants, may be associated with an increased risk of dementia. While more research is needed to establish a definitive causal link, several studies have found significant correlations between exposure to air pollution and cognitive decline, including the development of dementia. Here’s how air pollution is related to dementia:
    • Inflammation and Oxidative Stress: Air pollution, especially fine particulate matter and toxic chemicals can enter the bloodstream and reach the brain. Once in the brain, these pollutants can cause inflammation and oxidative stress, which are processes implicated in the development of neurodegenerative diseases, including dementia.
    • Blood-Brain Barrier Disruption: Air pollution can impair the integrity of the blood-brain barrier, a protective barrier that regulates the passage of substances between the bloodstream and the brain. This disruption may allow harmful substances to enter the brain more easily.
    • Vascular Effects: Air pollution is a well-known risk factor for cardiovascular diseases, including hypertension and atherosclerosis. These conditions can reduce blood flow to the brain, increasing the risk of vascular dementia, which is caused by reduced blood flow to brain tissue.
    • Brain Structure and Function: Some studies have shown that long-term exposure to air pollution is associated with structural changes in the brain, such as smaller brain volume and white matter damage. These changes are often seen in individuals with dementia.
  10. Diabetes: While diabetes and dementia are two distinct health conditions, insulin levels play a vital role in how the brain operates. Some even theorize that dementia is a ‘type 3 diabetes’. Several studies suggest that the brains of people with Alzheimer’s disease are in a ‘diabetic state’, partly due to the decrease and insensitivity to insulin. People with diabetes are at least twice as likely to experience dementia. Several mechanisms contribute to the correlation between diabetes and dementia, including:
    • Increased Risk: Several studies have shown that individuals with diabetes, especially type 2 diabetes, have an increased risk of developing dementia, including Alzheimer’s disease, vascular dementia, and other types of cognitive impairment.
    • Vascular Factors: Diabetes can lead to various vascular changes and complications, including atherosclerosis (narrowing and hardening of the arteries) and hypertension (high blood pressure). These vascular problems can reduce blood flow to the brain, increasing the risk of vascular dementia.
    • Insulin Resistance: Insulin resistance is a hallmark of type 2 diabetes, and it can also affect the brain. Some research suggests that insulin resistance in the brain may contribute to Alzheimer’s disease by impairing brain cell function and the clearance of toxic beta-amyloid proteins.
    • Blood Sugar Control: Poorly controlled diabetes can result in high blood sugar levels, which may have a negative impact on brain health. High blood sugar can cause inflammation and oxidative stress in the brain, both of which are associated with cognitive decline.
    • Hypoglycemia: Episodes of hypoglycemia (low blood sugar) can occur in individuals with diabetes, especially if they are using medications like insulin or sulfonylureas. Severe hypoglycemia can lead to cognitive deficits and, in some cases, may increase the risk of dementia.
    • Interaction with Other Risk Factors: Diabetes often coexists with other risk factors for dementia, such as hypertension, obesity, and high cholesterol. The combination of these risk factors can increase the risk of cognitive impairment.
  11. Obesity: Being overweight is an emerging concern when it comes to dementia. The rates of increased BMI in older adults are growing and may be contributing to cognitive decline.  Obesity is a significant risk factor for the development of dementia, including Alzheimer’s disease. The relationship between obesity and dementia is complex, but several mechanisms and factors contribute to this association, including:
    • Inflammation: Obesity is characterized by chronic inflammation in the body, including the brain. Inflammation is believed to play a role in the development and progression of neurodegenerative diseases, such as Alzheimer’s disease.
    • Insulin Resistance: Obesity is often accompanied by insulin resistance, a condition where the body’s cells do not respond properly to insulin. Insulin resistance has been linked to impaired brain function and an increased risk of cognitive decline.
    • Vascular Changes: Obesity is a risk factor for cardiovascular diseases, including hypertension (high blood pressure) and atherosclerosis (hardening and narrowing of the arteries). These conditions can reduce blood flow to the brain, potentially leading to vascular dementia.
    • Metabolic Factors: Obesity is associated with metabolic disturbances, such as abnormal lipid profiles and elevated levels of triglycerides and cholesterol. These metabolic factors can contribute to cognitive impairment.
    • Hormonal Changes: Obesity can lead to hormonal imbalances, including elevated levels of certain hormones like leptin and insulin, which may affect brain health.\
    • Sleep Apnea: Obesity is a risk factor for sleep apnea, a condition characterized by interrupted breathing during sleep. Sleep apnea has been associated with cognitive deficits and an increased risk of dementia.
    • Amyloid Plaque Accumulation: Some studies suggest that obesity may be associated with increased production and accumulation of beta-amyloid plaques in the brain, which are a hallmark of Alzheimer’s disease.
    • Physical Inactivity: Obesity often coincides with physical inactivity, which is also an independent risk factor for dementia. Regular physical activity is essential for maintaining cognitive health.
    • Psychosocial Factors: Obesity can lead to psychosocial factors such as depression and low self-esteem, which can contribute to cognitive decline and dementia.
  12. Alcohol Intake: Like most things we enjoy in life, moderation is key. Consuming less than 21 units of alcohol per week (the equivalent of 2 bottles of wine per week) can help to reduce the risk of cognitive decline and dementia as we age. The relationship between alcohol consumption and dementia is complex and varies depending on the amount and pattern of alcohol use. Below offers some insight into how alcohol can impact the brain and increase the risk of cognitive decline and dementia:
    • Excessive Alcohol Consumption: Chronic heavy alcohol use is a well-established risk factor for dementia. Excessive alcohol intake can lead to a range of neurological and cognitive problems, including alcohol-related dementia (often referred to as alcohol use disorder-related dementia or alcohol-induced neurocognitive disorder). Impairments in memory, executive function, and overall cognitive ability characterize this type of dementia.
    • Brain Damage: Prolonged heavy drinking can result in structural and functional brain damage, including the shrinkage of brain regions crucial for memory and cognition. This brain damage can lead to cognitive deficits and contribute to the development of dementia.
    • Wernicke-Korsakoff Syndrome: Chronic alcohol use can lead to Wernicke-Korsakoff syndrome, a condition characterized by severe memory problems, confusion, and hallucinations. This syndrome can significantly impact cognitive function.
    • Alcohol-Related Neurotoxicity: Alcohol has neurotoxic effects on the brain and can lead to the death of brain cells, particularly in regions critical for memory and cognitive function.
    • Interaction with Other Risk Factors: Excessive alcohol consumption often coexists with other risk factors for dementia, such as hypertension, liver disease, and nutritional deficiencies. These comorbid conditions can further increase the risk of cognitive impairment.

Take the next step:

The Truth About Medical Treatment of Tinnitus & Hearing Loss

Unraveling the Mystery: Exploring Tinnitus and Hearing Loss Treatments

Like ice cream that is sold in many places with many flavors, sometimes knowing where to treat your tinnitus and hearing loss and what type of technology is best for your cognitive needs, can leave people feeling confused and indecisive. Frankly, it is overwhelming.

Let’s start with the most important question: where do I go to start the process of addressing my tinnitus (and hearing loss)?

Go to www.salushearing.com to get started!

Like everything in life, there are ‘bad apples in every orchard’. When a hearing healthcare provider offers an inexpertly applied, standardized solution, it tends to be cheaper than the fees of a specialist who offers custom prescribed treatment plans. When it comes to treating tinnitus (and nearly all medical conditions) cheaper, it usually implies there is economic pressure to cut corners and compromise care.

The medical treatment provided for tinnitus and hearing loss has permanent, lifelong, and life-impacting consequences. This concerns your health, including your risk of dementia, risk of falls, your ability to feel accepted and socialize with others, and your career longevity.

When possible, you always want to choose an audiologist or hearing specialist that focuses on the medical treatment of tinnitus and hearing loss.

Second, you may be asking: how do I know if my hearing healthcare provider is an audiologist or hearing specialist?

It is a great question and a critical one to ask as you seek treatment for your hearing loss and/or tinnitus. Accredited hearing healthcare practices and certified tinnitus specialists can be found online at www.salushearing.com. You can find an approved specialist in your area who focuses on providing the right medical treatment for your tinnitus, hearing, and cognitive needs.

Finally, most people will wonder: “how do I know which technology I should use to treat my hearing loss”?

This question does not have a simple answer. Just as we are all different, so too is it true that all patients who experience tinnitus and hearing loss are different. Genetics, noise exposure, medications, medical history, and co-morbid disorders (i.e., diabetes, cardiovascular disease, cancer, etc.) all play a role in your tinnitus and hearing loss. Thus, there is no ‘one answer’ to this question. But there are guidelines that you must follow and should be sure to review with your hearing healthcare specialist.

First – the correct medical recommendation never considers age or cost. A thorough evaluation that determines the cause of your tinnitus and its impact on cognitive function is the gold standard in hearing healthcare. Accept nothing less.

Second – traditional hearing aids suck. I hope you will excuse our being so blunt, but it had to be said! Because we spend every waking minute of every day with every patient working to provide the medical treatment of tinnitus and hearing loss, sometimes we can’t help but be offended by traditional hearing aids that do nothing but burn a hole in your pocket. These types of devices make sounds louder – and anybody with tinnitus will tell you – the last thing they need is to be overwhelmed with sound that will likely trigger their tinnitus! Like everything in life, when it comes to traditional hearing aids – you get what you pay for!

Third – always ask if the technology you are being recommended is custom-prescribed to address your tinnitus, your hearing loss, and your cognitive needs. In recent years, with the advances in AI and brain-computer interface (BCI) technology, treating tinnitus and hearing loss has never been easier and more satisfying for the patient.

“In hearing healthcare, the gold standard isn’t just a measure of excellence; it’s the symphony of sound quality, compassion, and expertise that harmonizes to create a world where every voice is heard, and every life is enriched.”

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Direct vs. Indirect Treatment of Tinnitus

Direct Intervention vs. Indirect Approaches: Tackling Tinnitus Head-On

If you talk to your primary care physician, ask your friends and neighbors, or dare to search the internet, you will come across a never-ending sea of options for treating tinnitus. You will find everything from white-noise generators to acupuncture.

For the most up to date information on tinnitus, please visit www.salushearing.com.

Regardless of the exact treatment, all tinnitus treatments fall into one of two categories: Direct or Indirect Treatment.

Direct and Indirect treatment are terms often used in the context of healthcare and therapy to describe different approaches to addressing a patient’s condition or symptoms. The primary difference between these two approaches is how they target the actual underlying pathology. While Direct treatment involves directly addressing the underlying cause or symptoms of a condition, Indirect treatment focuses on addressing symptoms or triggers associated with a condition rather than directly targeting the underlying cause.

The underlying cause of tinnitus in the vast majority of patients (over 90%) is the progressive breakdown of the neural integrity of the ear-to-brain connections. Thus, Direct treatment of this condition would be to focus on neural preservation by stimulating remaining neurons and slowing the progression of the pathology.

Direct Treatment for Tinnitus

Today’s prescriptive hearing treatment technology employs advanced techniques to directly stimulate the brain and compensate for missing neural signals, while also mitigating the ‘central gain’ related to the perception of tinnitus. This method of direct treatment can be achieved through modern technology that utilizes artificial intelligence (AI) to present sound to the brain through acoustic or electric means.

  1. Prescriptive Technology with AI: Using modern technology, we can offer patients cutting-edge treatment that enhances signal processing and tailors auditory input to an individual’s specific needs. This new technology can analyze incoming auditory activity and adjust the stimulation parameters to optimize sound perception. This approach aims to mimic the brain’s natural processing of sound, thus addressing the issue of central gain, which is the brain’s tendency to amplify weak auditory signals. In the AAO-HNS report, it was noted that this form of treatment had a “preponderance of benefit” with no significant risks or harms.
  2. Cochlear Implants: Cochlear implants are surgically implanted devices that bypass damaged receptor hair cells in the inner ear and directly stimulate the auditory nerve with electrical impulses. They consist of an external microphone and speech processor that capture sounds, convert them into electrical signals, and transmit them to an implanted electrode array. This direct stimulation helps individuals with hearing loss receive auditory input that would otherwise be compromised.
    • Currently, cochlear implant surgery is reserved only for those patients with tinnitus who have significant hearing loss and do not receive any benefit from prescriptive technology. What’s even more worrisome is that certain reports indicate that tinnitus worsened after cochlear implant surgery in 10-15% of patients.
    • Perhaps the most controversial form of direct treatment for tinnitus is surgical removal of the auditory nerve. The AAO-HNS does not recommend this procedure for several reasons highlighted below.
  3. Surgical Removal of the Auditory Nerve: Surgery to sever the auditory nerve as a treatment for tinnitus is a relatively uncommon and highly invasive procedure. Severing the auditory nerve is typically considered a last resort when all other treatments have failed, and the tinnitus is severely impacting a person’s quality of life.

There are some key points to consider regarding this procedure:

  • High Risk – Severing the auditory nerve is a high-risk procedure that is likely to result in permanent hearing loss. It is usually reserved for extreme cases of tinnitus where other treatments, such as direct treatment, and/or cognitive-behavioral therapy, have not been effective.
  • Unpredictable Outcomes: The effectiveness of the surgery in relieving tinnitus can vary from person to person. Some individuals may experience relief from the tinnitus, while others may not experience any improvement or may even have worsened symptoms.
  • Hearing Loss: Since the auditory nerve carries signals from the inner ear to the brain, severing it will result in complete hearing loss in the affected ear. This procedure is usually only considered for individuals who have already experienced significant hearing loss in that ear.
  • Balance Issues: Severing the auditory nerve can also affect balance because it is closely connected to the vestibular system, which helps control balance. Post-surgery balance issues are common, and rehabilitation may be necessary.
  • Risks and Complications: Like any surgery, there are risks and potential complications associated with severing the auditory nerve, including infection, cerebrospinal fluid leakage, and injury to nearby structures.

Indirect Treatment for Tinnitus

Many Indirect treatment options for tinnitus exist. While some of these treatments can serve to enhance the impact of Direct treatment, many of them have limited or no scientific backing.

  1. Sound Therapy: Often, ‘sound therapy’ will be recommended to patients. This entails using an external sound generator to help them mask or ignore the phantom sounds in their head. For instance, they can use a fan, a white noise generator, or a sound-generating app on their smartphone while attempting to sleep. Some available noise generators can even be worn at ear level (and appear to look like a traditional hearing aid). The goal of this indirect treatment is to make the tinnitus less noticeable or bothersome. The AAO-HNS considers this indirect treatment a viable option but warns against promoting false hope to patients by offering this intervention with uncertain efficiency.
  2. Counseling and Education: Educating a patient on their medical condition must always be a part of the therapeutic process. Tinnitus counseling focuses on educating individuals about their condition, helping them understand the underlying causes, and teaching coping strategies to reduce anxiety and stress associated with tinnitus. The AAO-HNS notes that education has a preponderance of benefit over harm and values the role of education in counseling patients.
  3. Cognitive-Behavioral Therapy (CBT) (aka ‘talk therapy’) is a common approach within counseling to address the emotional impact of tinnitus. CBT is a widely recommended and very effective form of psychotherapy that focuses on addressing and changing negative thought patterns and behaviors to improve mental health and well-being. CBT is based on the idea that our thoughts, feelings, and behaviors are interconnected, and by identifying and modifying unhealthy thought patterns and behaviors, individuals can experience significant improvements in their psychological and emotional functioning. Clinicians are encouraged to recommend CBT to patients experiencing persistent and bothersome tinnitus.
  4. Tinnitus Retraining Therapy (TRT): TRT is a form of Indirect therapy that combines counseling and sound therapy. It aims to desensitize individuals to the tinnitus sound, reducing its perceived loudness and distress. TRT often involves wearing hearing devices that emit low-level noise to habituate the brain to the tinnitus sound. Much conflict surrounds the efficacy of TRT, including a history of poorly designed studies and a recent report in the Journal of the American Medical Association (JAMA), which found no outcome difference in the group with vs. without TRT.
  5. Medications: Some medications may be prescribed to alleviate the symptoms of tinnitus, especially if an underlying medical condition is contributing to it. However, there is no single medication that consistently works for tinnitus, and their effectiveness varies from person to person. The consensus of the AAO-HNS is not to recommend medication for the specific treatment of tinnitus.
    • In some cases, medications may be prescribed to help manage tinnitus-related conditions, such as anxiety or depression. The medications might include antidepressants (to help with the emotional distress that tinnitus can cause), anxiolytics (anti-anxiety drugs to reduce the anxiety associated with tinnitus), and hearing loss medications (to improve blood flow to the inner ear).
  6. Lifestyle Changes: Making lifestyle changes can indirectly help manage tinnitus. Reducing exposure to loud noises, managing stress, regular exercise, and avoiding excessive caffeine and alcohol consumption can all have a positive impact on tinnitus symptoms. Often, your hearing healthcare provider will ask you to keep a ‘log’ of daily activities to help uncover triggers that can worsen the experience with tinnitus.
  7. Herbal Supplements: There are many unfounded claims about herbal supplements and treating tinnitus. Below are two lists of supplements: one with evidence of decreasing the experience of tinnitus and the other with no scientific validity.
    • Herbal Supplements with Strong Evidence to Decrease Tinnitus
      • Vitamin B12: A deficiency in Vitamin B12 has been associated with deficits in neural function throughout the brain, especially in older individuals. If you have a Vitamin B12 deficiency, supplementation is recommended for many reasons, including enhanced cognitive performance and the potential to reduce tinnitus.
      • Melatonin: A high level of scientific data exists to corroborate the notion that melatonin can reduce the experience of tinnitus. Although the mechanism is not well understood, it stands to reason that increased sleep can reduce the stress and anxiety related to tinnitus and, therefore, decrease the experience of tinnitus.
    • Herbal Supplements with Limited Evidence to Decrease Tinnitus
      • Ginkgo Biloba: Ginkgo Biloba is an herbal supplement that has been suggested to improve blood flow to the inner ear. To date, no scientific studies exist to back up these claims.
      • Zinc: Zinc deficiency has been linked to tinnitus in some cases; thus, it stands to reason that zinc supplementation may be helpful if you have a deficiency. The jury is out on this supplement.
      • Magnesium: Magnesium is involved in nerve function and has been studied for its potential role in reducing tinnitus symptoms, particularly in cases related to noise-induced hearing loss.
      • Coenzyme Q10 (CoQ10): CoQ10 is an antioxidant that may help improve circulation and reduce oxidative stress in the inner ear. Some people have reported a reduction in tinnitus symptoms when taking CoQ10.
      • Omega-3 Fatty Acids: Omega-3 fatty acids, found in fish oil supplements, have anti-inflammatory properties, and may support overall ear health.
  8. Acupuncture: Acupuncture is an alternative Eastern medicine practice that involves inserting thin needles into specific points on the body to stimulate various physiological responses. Acupuncture may vary from person to person, depending on the specific cause of their tinnitus. When performed by a trained and licensed practitioner, acupuncture is considered safe and can be very effective. Limited data exists to support any claim that acupuncture can reduce the experience of tinnitus.

As a rule, when it comes to treatment options for tinnitus, the more salacious and outrageous the claim is, the less likely it is to be true! Also, any marketing that claims the treatment of tinnitus is quick and easy (i.e., take this pill, and your tinnitus will go away) is generally suspect.

Take the next step:

How to Find a Successful Tinnitus Treatment Practitioner

Unlocking Relief: Navigating the Search for a Tinnitus Treatment Specialist

Why is this important? Afterall, according to the internet, you might be able to just take a magic pill, stand on your head for 3 minutes, or press warm bread up against your ears. Or you can find a medical professional to use evidence-based science to effectively reduce your tinnitus.

For accurate information on the treatment of tinnitus, please stop by and visit us at www.salushearing.com.

What are some good clues to select a great hearing healthcare practitioner to treat your tinnitus?

We have two: One, she/he is busy. Two, her/his practice is busy.

When you see a really, really, busy practice there are probably a whole lot of patient referrals. Let’s face it – nobody enthusiastically refers if they feel they were lied to or treated badly, sold something they did not need, and put their prescription technology in their underwear draw.

Our offices are very busy. While we do some minimal marketing, most of our patients find us through word of mouth and direct referrals from their physicians. Our practices are built on ethics and earned trust.

The other clue: the treatment for your tinnitus is not cheap.

The fees for our tinnitus treatment program are calculated to allow for “Cadillac + Care” in every respect. From the detailed 7-Step Cognitive Screening and Diagnostic Process to the proven tinnitus treatment program we have developed, we will never compromise on your treatment.

If we were you, we would worry if we could find a specialist that is a lot cheaper anywhere else. If you do find one, know this: behind closed doors they are probably asking, “can we do this cheaper?”. Is that the question you want discussed by your care team at every step of your treatment process?

There is both a science and art to treating tinnitus. Our healthcare team of specialists are all highly trained to produce state-of-the-art outcomes, nothing less. The specialist truly makes a difference.

The Top Ten Things You Should Know Before Choosing Who Will Treat Your Tinnitus.

This is something you want to be sure about. We have just suggested one big consideration: a highly successful practice. Here are ten more:

  1. Are they specialists?
    • Tools have never created the skill. They’re simply a conduit teamed with education, talent, experience, and knowledge. The tools used to treat tinnitus have never made the specialist, but when the best tools are in the hands of the best specialists, magic happens.
    • All hearing healthcare specialists that treat tinnitus should be licensed by the state in which they practice.
    • To be a part of this network, a hearing healthcare specialist must be thoroughly trained and tested to demonstrate their knowledge of the auditory system, clinical skills, and judgment.  In addition to finding a local specialist, you might consider a specialist who understands the hearing and brain connection as ‘treating hearing loss’ was recently named the single most modifiable risk factor for the prevention of the mind-robbing disease of dementia.
      • Signs of a specialist:
      • Certified Tinnitus Specialist
      • Incorporates Cognitive Screenings into Testing Protocols
      • Offers Comprehensive Hearing and Cognitive Treatment Programs, Not Just Traditional Hearing Aids
      • Treatment Programs Include Ongoing Brain Training Exercises
      • Treatment Technology Is Updated Over Time, Without Additional Fees!
  2. Do they have a medical office (or a sales office)?
    • For years, the profession of hearing healthcare and audiology has received a bad reputation for its focus on the sale of traditional hearing aids by former used-car salesmen.  In the audiology world it is not hard to open a shop on a shoestring budget and call yourself a ‘hearing aid specialist’.
    • When determining your family’s next tinnitus and hearing healthcare specialist, we recommend you understand the treatment philosophy and purpose of the founder or specialist.  Take the time to research his/her office, treatment team, website, location, and online testimonials and reviews.  During your research, be on the lookout for a stand-alone location or a medical setting that was founded many years ago and has helped thousands of individuals in your community.
    • Medical-based offices will focus on the signs and symptoms of hearing loss and tinnitus, the detrimental impact of untreated and undertreated health conditions.  You will notice that medical-based offices include many free reports, books, videos, and educational opportunities to learn more about you or a loved ones’ condition.  Remember, the educated patient is the best patient.
  3. Do they think brain health first? 
    • It might seem strange and go against everything you were taught in pre-school, but we don’t ‘hear’ with our ears.  The ears are just a receptor of sound, which is then transferred to our auditory nerve, and finally into our brain, where the speech understanding and cognitive process of deciphering sounds into words takes place.  And the brain is where your tinnitus is.
    • Dr. Keith Darrow, as a neuroscientist who has worked in the lab for over a decade and seen up close how the system works, states that this comes naturally to him, but to many hearing specialists without formal training or membership in a community like the Excellence In Audiology network, it is often overlooked.
    • While words like dementia, cognitive decline, cognitive overload, progressive degenerative disorders, and auditory system damage might seem scary, rest assured a hearing specialist and his/her team who thinks ‘Brain Health First’ will undoubtedly be using these words when discussing your hearing and tinnitus symptoms with you.  If your specialist is not using these words, or is focused on things like lifestyle charts, Bluetooth, rechargeable batteries and TV adapters, you will know they are thinking ‘hearing aids first’ and not ‘Brain Health First’.
    • Some Questions to Ask Before You Commit:
      1. What cognitive screening protocols do you use in your office?
        • Answers should include: “Cognivue,” “Word Recognition Testing,” and “Speech in Noise Testing.” 
      2. Does your tinnitus treatment plan include new prescriptive treatment technology?
        • Answers should include  HECK YES! We only use the best, most up-to-date proven prescriptive technology to treat tinnitus and hearing loss.
    • By the way, if you hear words like ‘test-drive’ or ‘demo’ or ‘we can talk about options to treat your tinnitus when you come in’… RUN AWAY AS FAST AS YOU CAN!
  4. Do they provide pre-appointment education? 
    • Most traditional hearing aid sales offices will be in a hurry to get you right in for a “FREE Hearing Test”.  This is so they have the first chance to ‘sell’ you on their traditional hearing aid.
    • Our recommendation is to find a medical-based office that specializes in the medical treatment of tinnitus, hearing loss and associated cognitive decline. Period.
    • Some items we recommend requesting prior to your appointment:
      • seven to fourteen-day delay before your appointment to review all materials sent to you
      • a book or publication by the practice owner or founder
      • any online presentations or educational materials available
      • a detailed account of what is included in their comprehensive treatment program
      • the cost of their all-inclusive monthly treatment plan
      • what to expect during your first appointment.
    • It won’t take you long to differentiate which office is focused on providing you with education and conversation as opposed to those looking to get you in as soon as possible.
  5. Do they offer guarantees? If so, what are they? 
    • No matter where you decide to treat your tinnitus, ultimately you are beginning a relationship with them; a relationship based upon a significant investment of both time and money to solve you or a loved ones’ tinnitus and hearing loss problem.  As with any relationship, it should be based upon trust and a guarantee that you will experience the expected outcome you are looking for.
    • The most common attempt at a guarantee in the field of hearing healthcare and audiology is a “traditional hearing aid return period.”  This is NOT a guarantee, this is a law required by every hearing healthcare specialist who is selling a traditional hearing aid widget.
    • When we speak of a ‘guarantee’, we are referring to the commitment of the founder or owner, or hearing healthcare specialist you choose.
      • Do they guarantee your ability to hear will be restored to its full potential?
      • Do they guarantee if you are unhappy at any point during the adaptation period you will part ways as friends and not spend a single penny for treatment received so far?
      • Do they guarantee your hearing and tinnitus treatment is fully covered with no additional fees during your treatment program?
      • Do they guarantee that if at any time during your four-year treatment plan if your hearing loss or tinnitus progressives severely enough that it requires a new prescription you will get that new prescription without increased monthly fees?
      • Do they guarantee that your monthly cost of treatment will never increase due to rising costs or inflation?
    • Now those are guarantees!
  6. Are they using science-based testing and prescriptive treatment technology?
    • The diagnosis of tinnitus differs a great deal from years past.  With the evolution of computer-designed technologies, hearing specialists with the proper equipment will be able to diagnose, treat, and improve your experience with tinnitus, your hearing, and your cognitive functions more accurately.
    • Modern technologies that should be used by a hearing specialist include:
      • Speech in Noise Testing to determine your ability to hear in noise.
      • Cognitive Screening with Cognivue Equipment
      • New prescriptive treatment technology that has artificial intelligence which focuses on restoring stimulation to the auditory system; improving hearing and reducing tinnitus.
      • Pre-and post-treatment testing to prove your results both in the testing booth and in background noise.
      • Audioscan Verfit2 Real-Ear Measurements to objectively measure the benefit of your new treatment.
      • Live-Speech Mapping to verify you are hearing all parts of the spoken language.
      • BrainHQ Brain Training Program for ongoing memory and processing speed improvements.
  7. Do they offer a comprehensive treatment membership? 
    • Long gone are the days of spending thousands of dollars up front to treat tinnitus with traditional hearing aids; just don’t do it!
    • Tinnitus and hearing loss are the third most common chronic conditions affecting seniors in our communities. Like any major medical condition, the treatment of tinnitus, hearing loss, and the associated cognitive impacts are not a one-and-done purchase of a sound generator, but rather an ongoing monthly medical treatment.  When you are searching for a hearing healthcare specialist to treat your tinnitus, we recommend you find one who has a monthly treatment program or membership that allows you to begin treatment without investing thousands of dollars on day one.
    • An all-inclusive tinnitus treatment membership should consist of everything you need to properly treat your hearing and tinnitus, including:
      1. your prescribed hearing technology
      2. any supplies, accessories, or batteries you’ll need
      3. coverage for loss or damage at a low deductible
      4. all your office visits and annual evaluations
      5. yearly cognitive/dementia risk screenings
      6. and other various benefits:
        • early access to events
        • birthday gifts
        • special new release education materials
        • supplements
        • BrainHQ
      7. A price lock guarantee so you don’t have to worry about price increases in the future.
  8. Do you get a direct phone number for 24/7 support or questions? 
    • Tinnitus is something that can plague you 24/7, and so you should have access to your treatment team via a 24/7 support line.
    • Each time a patient embarks on the journey of reducing their tinnitus and improving hearing, there is an adaptation period for the patient.  This period can take up to 60 days (perhaps longer for the most difficult cases of tinnitus) and is unique to each patient.  Whether you or your loved one have a simple question, or need reassurance, your hearing healthcare specialist should give you a direct number to a patient experience coordinator just in case.
    • In addition to the complex hearing and cognitive changes that will happen as we begin restoring the stimulation to your auditory system, there can be moments of minor irritation or discomfort like wearing a new pair of shoes or prescription eyeglasses.  Whatever question or concern you have, don’t hesitate to ask!
    • A medical-based hearing healthcare specialist will provide you with the means for direct support, as well as an established new treatment plan consisting of three to four appointments during the first 45-60 days of treatment.  You should plan to visit your specialist four times per year for ongoing maintenance, re-evaluations, and prescription updates in addition to any fun or interactive patient events they may offer.
    • Remember, you should not have to pay additional fees or costs for this direct phone number, visits, patient events or ongoing hearing healthcare.  It should be included in your comprehensive monthly treatment plan.
  9. Do they make you feel special and comfortable? 
    • Regardless of whether you are reading this report for your own tinnitus, for a spouse, or another family member, you are the most important part of the healthcare practice.
    • The best hearing healthcare specialists, practices, and teams would be wise to remember that without the patient, they would not have careers.  As Dr. Darrow has traveled the country speaking, educating, and working with private practices, he continues to teach based upon the principles of Disney Magic, the Ritz Carlton Gold Standard, and the empathy found at the Cleveland Clinic.
    • When you walk into your new hearing healthcare specialist’s office, you should be made to feel comfortable and welcome.  Empathy, compassion, and understanding is very important to the healing process.
    • Here are some things we recommend you should receive:
      • pre-appointment information
      • welcome gift
      • a great look, feel, and smell to the office
      • a big thank you
      • treat or drink
      • walked to your treatment room
      • They should get to know you – the person.
      • understand your symptoms and desired outcome
      • a fond farewell to return.
    • If you’d like the feedback of others prior to booking an appointment, try visiting their online views or video testimonials to learn more about what to expect at your appointment.
  10. Do they have a great reputation? 
    • “Trust; But Verify!”
    • When it comes to choosing a tinnitus specialist, we prefer no other phrase.
    • With the internet today, it is extremely easy to pull up ratings, reviews, and testimonials from other patients.  Simply go to Google, Facebook, HealthyHearing, or Yelp and search for audiology reviews in your town.  We would recommend choosing the hearing healthcare specialist with the most reviews at the highest rating.  This gives us comfort in knowing that they are busy enough to get the most reviews, and great enough to earn that high 5-star reputation.
    • In addition, with the growth of YouTube, many practices now have a YouTube channel full of real-life patients on video giving their own personal testimonials about the hearing healthcare specialists and office.  So, remember, trust that your research has fulfilled the first nine questions of this report, but don’t hesitate to verify with real patient review, testimonials, and references.
    • And never be shy about asking for references- and go directly to the source!  You have the right to call any hearing healthcare specialist and ask for a list of references who may be patients and/or local physicians who have volunteered to help advise other patients as they first enter the world of hearing loss and tinnitus treatment.
    • Okay, we know we said the list was only ten, but this last one is really important to consider!
  11. Will they make treatment affordable for us? 
    • We realize that we were only supposed to list the ‘The Top Ten Things You Should Know Before Choosing Who Will Treat Your Tinnitus’, but we couldn’t leave out some tips on making sure your choice of hearing healthcare specialist never allows a treatment decision to become a financial decision. 
    • Once you are comfortable knowing the answers to the Top-10 questions and have chosen a hearing healthcare specialist to treat you, your spouse, or your loved one, the next question is typically:
    • “Is this comprehensive treatment plan affordable?” 
    • When it comes to affordability, there was no greater pain in our years as clinicians than having to turn a patient away due to their financial situation.  Thankfully our new treatment membership programs allow us to treat nearly every patient by reducing costs to a low, monthly, affordable payment. Your local clinic will always offer an affordable membership plan to ensure that you don’t have to make a treatment decision, or possibly compromise treatment, because of finances.
    • Benefits of Membership Based Hearing Healthcare:
      • avoid the large upfront cost
      • low monthly membership plans for the medical treatment of tinnitus and hearing loss
      • all-inclusive coverage for your hearing and tinnitus treatment needs

And remember, treating your hearing loss is the #1 way to help to treat your tinnitus. Please learn more at www.salushearing.com.

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Why Does Tinnitus Make It Difficult to Hear in Noisy Restaurants?

Lost in a Sea of Sound: How Tinnitus Amplifies Restaurant Noise

As if the ringing weren’t enough to deal with, many people with tinnitus also complain that it is challenging for them to follow a conversation in background noise. This interruption in the ability to socialize and easily communicate can be devastating to the person and their loved ones. Unfortunately, when someone is not able to follow along with what family and loved ones are saying at the dinner table, too many people default to ‘then why bother even being there’.

The feelings of isolation, depression, fear, loneliness, embarrassment, frustration, and anxiety that are associated with tinnitus and hearing loss are real and are very well documented. Perhaps you only need to look in the mirror or at a loved one to realize how real these emotions are. The ability to follow a conversation when multiple people are speaking or with other competing sounds (when the TV is on in the background, running water from the sink) is a natural cognitive (brain) ability that we take for granted until it begins to break down and interfere with communication with others. As we age, for many in their 40s and 50s, subtle changes in the ears yield significant differences in the ability to hear in these ‘complex’ listening environments, including noisy restaurants, etc. Most often, this difficulty is noticed long before the official diagnosis of hearing loss.

Hear the difference – schedule your appointment now at www.salushearing.com.

The Breakdown

Tiny ‘hair cells’ in our ears that process sound and connect our ears to the brain become damaged and die off with age, and they do not come back. As a result, our ears will have difficulty noticing fine differences in sounds. For example, the subtle differences between the ‘s’ and ‘sh’ sounds become undetectable to the listener, making words like ‘see’ and ‘she’ harder to understand and distinguish. This difficulty with clarity is why so many people with early tinnitus and hearing loss say, ‘can you repeat that?’ and not, ‘can you please say that louder?’. Clarity and volume are not the same, and the loss of clarity impacts your life 5-10 years before you need sounds to be louder. This is one of the first signs that tinnitus is also impacting your ability to hear.

Downstream

Once the vast neural network that connects the ears to the brain becomes damaged, the unseen changes in the brain can be devastating. A recent report from Johns Hopkins found that people with hearing loss and tinnitus can also have significant cerebral atrophy. They noted that people could lose up to 40% of their total brain volume – and the only common factor in the research subjects was damage to the auditory system. While this may seem odd, it makes a lot more sense when you consider that we hear with our brains, not our ears! This damage to the brain can become progressively worse with age if left untreated.

Cerebral atrophy is a hallmark feature of dementia; thus, tinnitus and hearing loss are closely tied to a person’s future risk of developing cognitive decline and dementia.

Listening to others is otherwise effortless when we live without tinnitus and with normal hearing. However, when living with tinnitus – the ability to hear in complex listening environments (such as noisy restaurants), will require significant effort and tax the brain. The brain has four unique hearing capabilities, including:

  • Localization – the ability to determine where sounds are coming from.
  • Recognition – the ability to recognize words and understand conversation.
  • Focus – tuning in to what is important (somebody speaking to you), especially in noisy rooms or restaurants.
  • Separation – segregating out what you want to hear from what you don’t want to hear.

Each of these tasks relies on a vast and robust neural network of information coming from the ears. Thus, each of these is negatively affected when tinnitus and hearing loss wreak havoc on the ear-to-brain neural networks.

With tinnitus and hearing loss, the damage to your ears and brain is not reversible; however, with treatment, the goal is to slow down the progression of the disorder and preserve neural integrity.

The medical treatment of tinnitus and hearing loss is custom prescribed to address the needs of each patient by restoring clarity, supporting the four cognitive tasks mentioned above, allowing them to maintain high-quality communication with others – even in the noisiest restaurants – reduce the risk of cognitive decline and reduce tinnitus.

Hear the World Anew! Schedule Your Appointment Consultation Today at  www.salushearing.com.

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