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Do You Hear that Ringing?
November 15, 2021

Do You Hear that Ringing?

A man is covering his ears with his hands.

Is the ringing, buzzing, chirping or humming in your ears, also known as TINNITUS (pronounced TINN-a-tus or ti-NIGHT-us), driving you to distraction? Be assured, you are not alone. An estimated 50 million Americans experience some form of tinnitus, making it one of the most common health conditions.



Megan Johnson, Au.D. and owner of Johnson Audiology, a Chattanooga-based private audiology practice, said, “Tinnitus is experienced by people in different ways. For some, tinnitus manifests itself as a ringing sound, while others experience tinnitus as a hissing, buzzing, roaring, clicking or humming. I’ve even had patients report that their tinnitus sounds like music playing directly in their ears.”

Many with tinnitus are surprised to learn that the sound they are hearing is not actually originating from the outside environment and, therefore, is not audible to anyone around them.* In a manner of speaking, tinnitus is “all in your head.” Please understand, however, that is not meant to imply that a person’s tinnitus is not “real.” It is, indeed, a very real sensation being experienced by the person with tinnitus. But why does the brain create this sound?


In 90% of cases, tinnitus is accompanied by some degree of hearing loss, even if the hearing loss is so mild as to not create significant communication difficulties. Hearing loss can happen for various reasons, but most common is exposure to various types and degrees of loud noise, even if the sounds are not constant or frequent. Think of the last time you mowed the grass or used the vacuum cleaner without wearing earplugs. Have you attended a sporting event surrounded by screaming fans? Have you been to a rock concert? Have you fired a gun? Do you work in a factory or other loud environment? Over the course of a lifetime, extended or repeated exposure to sounds at or above 85 decibels (approximately the level of a vacuum cleaner) can cause permanent damage to a person’s hearing. The damage can be in the high-frequency range of hearing, the low frequencies and/or anywhere in between. The pitch of a person’s tinnitus usually tends to be in the same frequency where there is the most hearing loss. If, for instance, a person has a high-frequency hearing loss, it is likely the person experiences their tinnitus as a sharp, high-pitched sound. That is because as the brain “searches” for sounds in that frequency and comes up empty-handed because of the hearing loss, the brain fills in the void with the ringing, buzzing, or clicking sounds. Noteworthy is that a single exposure to a sudden extremely loud noise also can cause tinnitus.


While hearing loss is thought to be the reason that most experience tinnitus, other catalysts also exist. These include sinus congestion; barometric trauma; obstructions in the ear canal; temporomandibular joint disorder, or TMJ; head or neck trauma; traumatic brain injury; some prescription and over-the-counter medications; metabolic disorders like hyperthyroidism; autoimmune disorders, such as fibromyalgia; high blood pressure; and psychiatric disorders like anxiety and depression. Tinnitus is more common in men, Caucasians, seniors, and those with significant noise exposure, such as veterans, factory workers, musicians, and hunters.


While millions have tinnitus, no two patients experience tinnitus in exactly the same way. For instance, one person’s tinnitus might come and go; for another, it might be constant. Some patients hear the ringing in one ear; some in both. The severity of a person’s tinnitus also can vary from mild to extreme. Some have a basic awareness of the ringing, but it does not affect daily life and function. However, for others, it can be debilitating. It is not uncommon for someone with severe tinnitus to experience distress, depression, anxiety, sleep disturbances, frustration, and poor concentration. For a longtime hearing aid wearer, Kimberly Haney, her tinnitus was “extremely bothersome.” She went on to describe her tinnitus: “Imagine a hot summer evening at the lake with a raucous chorus of cicadas and katydids and tree frogs calling their little hearts out. Now imagine all that noise contained between your two ears and playing on an endless loop 24/7. That describes my tinnitus. It was difficult to cope.”


So what can a person suffering from tinnitus do? Granted, since tinnitus is not a disease, but rather a symptom of an underlying condition, there is not a “cure” per se. However, these days, many options are available for managing tinnitus and thus quietening the ringing so that a sufferer can lead a more comfortable, productive life.


The first step in addressing tinnitus management is to make an appointment with a trained doctor of audiology, who will have the diagnostic tools, clinical assessments, and skills to appropriately evaluate tinnitus. As tinnitus is often a result of hearing loss, most audiologists will begin with a comprehensive audiological test to determine if a person has hearing loss and what the specific gaps in hearing are. Most important, the audiologist should subjectively evaluate the effects the tinnitus has on the person’s mental, cognitive, social, and physical well-being. All these factors will be taken into consideration when the audiologist makes treatment recommendations. Johnson said, “When Kimberly came to me for her first hearing diagnostic years ago, it was more because she thought she had hearing loss rather than with the goal of addressing her tinnitus. The tinnitus seemed an afterthought because she had been told by her doctor that nothing could be done. I assured her something could be done, and we developed a management plan that addressed her hearing loss and by extension her tinnitus.”


If the audiologist determines that hearing loss is the underlying cause of the tinnitus, hearing aids may be recommended. As the hearing aids amplify sound in the ranges where the person has hearing loss, the brain receives the sounds and no longer needs to fill in the missing frequencies with the ringing or buzzing. As a result, a person’s tinnitus often fades to a level that is no longer noticeable and/or bothersome. Bear in mind, that a person even with mild hearing loss can experience tinnitus so just because a person does not perceive they have hearing loss, the diagnostic evaluation will reveal the real story, and the audiologist may recommend hearing aids as a targeted method for reducing tinnitus. Haney said, “Hearing aids changed my life. Once I was fit with aids, and I was hearing so much better, the tinnitus quietened down to where it was a background sound in my life rather than front and center.”

Every tinnitus patient is unique in their experiences of this condition and its effect on daily living. Therefore, the recommended treatment options may vary based on how the person’s tinnitus presents itself, as well as the person’s listening needs, triggers, and lifestyle. Some management strategies may include multiple treatment options to adequately address a person’s needs. In addition to hearing aids, treatment options may include tinnitus maskers, sound generators, sound therapy, cognitive behavioral therapy, and general wellness recommendations in regards to diet, physical and social activity, and stress management.


When you make the decision to visit a hearing care provider about your tinnitus, be sure that he or she is performing a tinnitus-specific evaluation and is using subjective questionnaires to evaluate your reaction to your tinnitus. For instance, a hearing instrument specialist (HIS) at a hearing aid dispensary and even a primary care physician may not be equipped to offer the level of assessment that a doctor of audiology can provide. Oftentimes, patients will mention ringing in their ears to their primary care physician, who will refer them on to Johnson Audiology. On the other hand, audiologists have specialized training in tinnitus management. Johnson said, “Tinnitus is of special interest to me because I have seen how it can negatively affect people’s lives. I’ve also seen how much it can improve a person’s life when their tinnitus is successfully managed. That’s why we put an emphasis on tinnitus management at Johnson Audiology.” According to the American Tinnitus Association (ATA), tinnitus typically begins as an audiological, or hearing, condition. For this reason, it is best to consult providers with clinical specialties in hearing health. At Johnson Audiology, the doctors of audiology are trained to perform full-scale tinnitus assessments to create the most appropriate treatment plan tailored to a person’s individual needs.


Have you had enough of just “living with” your tinnitus? Were you told in the past, or even recently, by a medical professional that nothing can be done? Call Johnson Audiology to schedule a tinnitus evaluation today and be assessed by one of our audiologists who have specialized training in treating patients with tinnitus.


*In rare cases, a person can experience objective tinnitus that is audible to others.

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!”
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