The logo for johnson audiology is green and white.
Is the Ringing in Your Ears Affecting Your Mental and Emotional Well-Being?
November 15, 2021

Is the Ringing in Your Ears Affecting Your Mental and Emotional Well-Being?

A silhouette of a woman 's head with gears coming out of it.

You can find help and hope!

As a doctor of audiology for more than 15 years, Dr. Whitney Smith, with Johnson Audiology, has helped thousands of people address hearing loss. “Assisting people to re-engage and re-connect with their lives through improved hearing is not just my job; it’s my life’s work and so rewarding,” she says. “Hands-down, though, giving my patients access to new rehabilitation options for tinnitus is one of the highlights of my audiology career. I now have evidenced-based tools and techniques to offer for quietening the ringing.”


For some people, ringing in the ears, or tinnitus, is a mild bother. For others, it can be debilitating, impacting their mental and emotional health by causing profound anxiety, depression, sleeplessness, anger issues, even thoughts of suicide. “One patient described her tinnitus as being locked in a small room with a million tree frogs calling in her ears 24-hours a day. She felt like a prisoner in her own body because she could not escape the noise,” Dr. Smith says.


Subjective tinnitus, which is the most common type, is a self-perceived sound that manifests for people as ringing, roaring, buzzing, chirping—even musical notes--in the ears. The condition likely dates to the earliest human civilizations. In the last 20 to 30 years, however, tinnitus has emerged as an acknowledged serious public health issue, affecting approximately 50 million Americans. More than two million people report tinnitus so severe it disrupts daily living and function.


“While tinnitus can have a variety of causes, the number one culprit is hearing loss,” Dr. Smith says. When a person’s hearing is damaged from loud and/or repetitive noises, permanent hearing loss often results and usually occurs in specific frequencies. Dr. Smith offered these examples: “For instance, a dentist may experience the occupational hazard of losing hearing in the high frequencies because of the damage done to hearing from the repeated whine of a high-powered dental drill. A factory worker, on the other hand, may lose low frequency hearing from exposure to the constant low decibel drone of cooling fans or machinery in the workplace.” When certain frequencies within a person’s hearing spectrum are damaged, sounds in those frequencies go unheard. For example, lose your high frequency hearing, and sounds like birdsong or young children’s voices become undetectable. As the brain searches for input in those missing frequencies and comes up empty-handed, the brain will “fill in the gaps” with the ringing, roaring, or buzzing that is tinnitus.


Dr. Smith draws this connection: “The increase in reported tinnitus is not surprising. We live in a much noisier world than at earlier times in human history. Damage to hearing is on the rise so, by default, tinnitus is also on the rise.”


As the incidence and severity of tinnitus continue to put a heavier burden on more and more people, additional resources have been devoted to research to better understand the condition. Dr. Smith says that this should lead to increased awareness for those struggling with tinnitus as well as a deeper understanding by the healthcare providers supporting them. Dr. Smith mentions, “It’s certainly time that happens. Historically, when a person broached the subject of tinnitus with his or her doctor, they were often told, ‘Well, you just have to learn to live with it.’ When a patient gets the brush-off with a trivializing comment like that, it is so detrimental. That person may not have the courage to bring up their tinnitus struggles again for years, if ever, continuing to suffer in ‘noisy silence’ from the cumulative effects of the unresolved mental and emotional health issues the disorder can bring on. I implore healthcare providers to remove verbiage from their provider-to-patient vocabulary that dismisses a person’s tinnitus.”


Guidelines released in March 2020 from the National Institute for Health and Care Excellence (NICE), entitled Tinnitus: Assessment and Management, may well be a factor in turning that tide. Many health care and social care professionals are beginning to use the advice NICE offers on supporting people presenting with tinnitus as well as the recommendations on when to refer a person to a qualified specialist for assessment and management.


Obvious choices for tinnitus management referral are to audiologists and otolaryngologists, the health care field’s most qualified professionals for issues dealing with disorders of the ear and hearing. “I encourage people with tinnitus to seek out these professionals and to ask if they have specialized training and experience in working with those with tinnitus. Even in these specialties, there can be varying degrees of expertise, knowledge and responsiveness.”


Dr. Smith has embraced tinnitus as a specialty within her specialty, having a solid knowledge base in tinnitus management coupled with true compassion for people and a dogged desire to help. She recently attained a new certification through the National Council for Behavioral Health, having completed coursework in Adult Mental Health First Aid. She explains that the purpose of mental health first aid is not to diagnose mental health issues. Rather, she has learned techniques for first response. She explains, “When someone comes to me because of tinnitus, and they are experiencing a mental health crisis because of it, I can provide initial help and begin to map a plan for long term management and care.”


Dr. Smith says many people do not even associate their struggle with tinnitus as putting them at risk for mental and emotional health issues. “I seek to learn more about how each individual experiences his or her tinnitus. It is unique for each person and can present in a myriad of ways,” she says. How does it sound to that individual? Ringing? Roaring? Buzzing? Is it constant or does it come and go? Is it in one ear or both? Does it make you feel stressed, anxious, depressed, desperate, irritable, hopeless? Does it cause sleeplessness, tiredness, poor appetite? Do you have dental and jaw issues like a temporomandibular joint (TMJ) disorder? Have you identified triggers that set off or magnify your tinnitus like caffeine, nicotine, or alcohol use? “The more honest and open patients are with me, the more I am able to help,” she says.


Dr. Smith says that treatment and management for tinnitus can include a host of options tailored to the person. “Some are in my wheelhouse as an audiologist, such as sound therapies like masking and habituation as well as fitting a person with hearing aids to restore lost sound frequencies. Restore sound where you have hearing loss, and the brain no longer needs to fill in the silence with the ringing, roaring, and buzzing. About seven out of ten patients will notice a subjective decrease in their tinnitus just by treating their hearing loss,” she explains.


Tinnitus therapy is not limited to these options, however. “That’s why I am committed to a team approach when I work with patients on tinnitus management. I am networking with various professionals who I can refer to. For instance, I have a behavioral therapist with training in tinnitus who I refer patients to and a dentist who specializes in TMJ. I hope to add to that list with providers like a chiropractor, neurologist and others,” Dr. Smith comments.


She mentions that getting to the bottom of specific triggers for a person’s tinnitus and employing the appropriate lifestyle changes can make a huge difference. “I had a patient recently who was taking a prescribed medication that was exacerbating her tinnitus. She worked with her general health care provider to simply change the time of day she was taking that medication, and her tinnitus faded.” For those with triggers like caffeine, sodium, nicotine, and alcohol, reducing intake or abstaining from those substances can help.


For those with tinnitus tied to stress, techniques like relaxation and mindfulness therapy can be gamechangers. Dr. Smith says. “Interestingly, the same parts of your brain that are activated in the fight or flight response—your autonomic nervous system—also light up when a person is experiencing tinnitus. It begins to have a cascading effect because once the tinnitus is forefront in your mind that heightened state of anxiety builds on itself.” She continues, “The mind is a powerful tool, though. Using brain mechanics, many have learned to control tinnitus rather than it running roughshod through their lives. That’s why I’ve become such a proponent for cognitive behavioral therapy as a recommendation for many patients with tinnitus.”


Dr. Smith also mentions that mobile phone apps, like the one the hearing aid manufacturer Widex offers, are especially useful tools. “The Widex Zen app is free to download and offers a combination of sound therapy options, relaxation and meditation exercises as well as practical guidance, right there on your phone,” she says.


Another product on the market is My Butterfly Pillow. This comfortable, hypoallergenic pillow includes adaptive Bluetooth technology so you can listen to white noise, relaxation sounds, audiobooks, even television directly through the pillow via Night Owl Speakers. Plus, you will not disturb your sleeping partner.


Dr. Smith shares: “I have had the pleasure of helping many of my patients learn to successfully manage their tinnitus. I had a patient whose tinnitus was having such a profound effect on her, she had withdrawn from life, stopped working, etc. Now that she has addressed her tinnitus with various management techniques, she has a renewed hope. She has gone back to her career, back to interacting with family and friends. She’s a ray of golden sunshine.”


If you are experiencing tinnitus, whether mildly bothersome or life-altering, contact Johnson Audiology today for a tinnitus evaluation and get on the road to managing your tinnitus.

Cochlear implantation: A game changer for Chattanooga native, Chipper Gocke

March 6, 2025
Chipper Gocke, 28, has had many poignant moments in the last six weeks since his cochlear implant surgery. “A workmate commented recently that my speaking voice is the appropriate volume now. Not being able to hear myself, I probably often talked too loud before. It seems like a small thing, but it is a way to be more normalized in my professional and other settings.” His mother, Amy Gocke, also has noticed the changes. “Chipper has never called me on the phone before. With his profound lifelong hearing loss and even using powerful hearing aids, he simply couldn’t communicate by phone. Now I look forward to his calls every day after he gets off work.” These daily experiences that people often take for granted—communicating with a workmate or calling a family member to say hello—are now possible for Chipper because of his cochlear implant. Hearing loss has been a part of Chipper’s life since he was a small child. Chipper’s father, Ted Gocke, relates, “From the time he was 18 months old, Chipper had ear infections that had us in and out of the hospital. That led to tubes in his ears and the diagnosis that he had a significant hearing loss.” As a youngster, Chipper received early intervention services before he even reached school age. He also got established with local audiologist, Darnell Scafe, and they reconnected recently when Chipper sought out Darnell for hearing health care services as an adult. Darnell, who joined the Johnson Audiology team in 2018, says, “I remember Chipper as a sweet little boy who didn’t let his hearing loss slow him down. It’s wonderful to get to know the fine, capable young man he has grown into.” Last year, Darnell encouraged Chipper to consider a cochlear implant, and she referred him to Johnson Audiology’s Cochlear Implant Program Director, Dr. Hannah Dearth. Dr. Dearth then was able to complete cochlear implant candidacy testing. In November of last year, Chipper’s surgery was performed at Murfreesboro Medical Clinic (MMC) in Middle Tennessee by an otolaryngologist (ENT). A native of Chattanooga, Chipper traveled for the initial surgery since there is not currently an ENT in Chattanooga who performs CI surgeries. However, Chipper then had his cochlear implant activated at Johnson Audiology (JA) by Dr. Dearth in early January. Also, there to celebrate activation day was Darnell. “It felt like a full circle moment when Dr. Dearth activated Chipper’s cochlear implant, and he began to have those first sound perceptions.” Dr. Dearth explains, “People often wonder how a hearing aid and a cochlear implant are different. Cochlear implants are designed for patients whose hearing aids are no longer assisting them in understanding in both quiet and noisy environments. A hearing aid is designed to provide amplification for speech sounds that are unintelligible without said amplification. Cochlear implants are a surgical option for those who are no longer able to achieve meaningful understanding with a traditional hearing aid. Hearing aids rely on the ear’s natural pathway for hearing to accomplish this and so may not work well for someone with severe damage to the inner ear. A cochlear implant, on the other hand, bypasses the damaged parts of the ear by stimulating the auditory nerve directly with a mild electrical current that sends the sound signal to the brain.” Chipper is committed to his own success with his cochlear implant and in addition to listening to the speech of those around him, he is also tuning in to podcasts and audiobooks that give him even more speech exposure. Dr. Dearth says that is a huge factor in any patient’s ability to thrive with the device. “The patients who are committed to the aural rehabilitation as prescribed experience faster progress and higher success rates long term.” Chipper will continue regular follow-up appointments for the rest of his life to maintain successful progress with his CI. He gets emotional talking about the social isolation that can be a common side effect of profound hearing loss and, also, mentions the spatial awareness that better hearing offers. “Being able to pinpoint sound and localize stimuli from both sides of the head has positive effects for living a safe life,” Dr. Dearth says. Dr. Megan Johnson, audiologist, founder, and owner of JA, says, “Johnson Audiology has provided support for cochlear implant patients since 2017 with care offered through the practice’s location on Lee Highway in the East Brainerd area. After implantation, every other part of a CI patient’s hearing journey can be accomplished at Johnson Audiology—from initial activation to routine mapping.”  Chipper and his parents encourage people to explore the possibility of cochlear implants since it can make such a difference in a person’s daily life and function. Johnson Audiology is accepting new patients who currently wear hearing aids but would like to pursue cochlear implant candidacy as well as those who already have a cochlear implant. Call Johnson Audiology at 423.556.7185 or visit www.johnsonaudiology.com/schedule for more information or to schedule an appointment.

Untreated hearing loss is changing your brain

By Jan Hollingsworth • May 16, 2024
Research reveals that hearing loss actually rewires your neural pathways Your Amazing Brain Your brain is an amazing organ! This wrinkly, reddish-pink mass weighs about the same as your two-slice toaster, tipping the scales at about three pounds. Acting as a master control center, your brain enables every thought, breath, eye blink, heartbeat, movement—everything—that happens in your body. Rivaling the world’s most powerful supercomputer, your brain can download, process, and react in milliseconds to the tidal wave of information coming from your eyes, skin, nose, tongue, and ears. Neuroplasticity and Your Sense of Hearing Researchers have discovered that the human nervous system—made up of the brain, spinal cord, and a complex network of nerves—has incredible capacity to modify itself, both in function and physical structure. This is called neural plasticity . Dr. Megan Johnson, audiologist and owner of Johnson Audiology explains, “Neural plasticity is going gangbusters in a child’s brain as the child develops and matures into adulthood. Based on years of brain research, we also know that the adult brain is far from being fixed. It, too, changes and adapts when you learn new information or skills or as a response to stress, hormonal fluctuations, drug interactions, injury, and much more.” Dr. Johnson also relates that “your brain displays neuroplasticity when you experience hearing loss.” By measuring brain waves using an electroencephalograph, or EEG, scientists have studied how the brain of a person with hearing loss functions compared to a person with normal hearing. The results are both fascinating and sobering as studies reveal that, in those with hearing loss, the portion of the brain devoted to hearing becomes reorganized. This can be true even with early-stage, mild hearing loss, and the process happens quickly, often in months rather than years. The Hearing Center of Your Brain and Beyond What is actually happening when this takes place? Your brain has a right and a left hemisphere and six major lobes. Think of your frontal lobe as your brain’s boss, where executive functions like decision making, emotion and impulse control, and planning occur. Your temporal lobe, which contains the auditory cortex, is doing the heavy lifting when it comes to interpreting sounds and assigning those sounds meaning. The temporal lobe processes speech and language, and it is where initial learning of new information takes place, which is the first step for logging that information into memory. Dr. Johnson goes on to relate, “When the delicate infrastructure of your ear has become damaged through noise exposure, infection, etc. leading to hearing loss, your auditory cortex cries out to your frontal lobe, saying ‘Help! Help! I’m not receiving any sound to process, so I feel lost.’ The frontal lobe ‘boss’ jumps to attention, and your occipital lobe, responsible for processing vision and touch, takes over the areas in which hearing is normally processed. In other words, your other senses seek to compensate for the deficit due to the loss of your sense of hearing.” Amazing, right? So, where’s the rub? Picture a car assembly line; each worker has an assigned task. One day, the worker who installs the windshields is absent, and the worker who attaches the rearview mirrors is assigned double duty, and a duty that was not part of job training. It is easy to see how the worker left juggling both jobs is compromised, and a car might slip through minus a rear view mirror. Similarly, the areas of your brain that are being taxed to make up for a lack of hearing are overloaded and less able to do their assigned responsibilities. “This explains why so many of my patients with hearing loss relate feeling exhausted and frustrated after a big family gathering—where multiple talkers and sounds must be interpreted—rather than happy and invigorated by the experience. We call this listening fatigue ,” states Dr. Johnson. Additionally, when left untreated long enough, researchers point to the brain’s reorganization due to hearing loss as a significant correlation with dementia. Hearing Technology and Your Brain “But here's the great news!” Dr. Johnson says. When a person is fit with hearing aids or a cochlear implant and sound is restored, the brain has the ability to adjust back—partially or completely—to proper function. How swiftly that happens often depends on how long the hearing loss went untreated and is why she encourages patients to treat hearing loss sooner rather than later. “Here is what I tell patients who are downplaying the importance of hearing: If you won’t treat your hearing loss for the sake of your ears, do it for your brain!”
Share by: