Tinnitus and Mental Health: Insights from Dr. Megan Johnson

November 16, 2021
A silhouette of a woman 's head with gears coming out of it.

As a doctor of audiology for more than 20 years, Dr. Megan Johnson, audiologist and owner of Johnson Audiology, and her hand-picked team of 12 other audiologists have 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 our patients access to new rehabilitation options for tinnitus is one of the highlights of my audiology career."


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. Johnson 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. Johnson 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. Johnson 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. Johnson 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. Johnson 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. Johnson 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. Johnson says many people do not even associate their struggle with tinnitus as putting them at risk for mental and emotional health issues. “Our audiologists at Johnson Audiology seek to learn more about how each individual experiences 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, the more we are able to help,” she says. 


Dr. Johnson says that treatment and management for tinnitus can include a host of options tailored to the person. “Some are in our wheelhouse as audiologists, 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. “A multi-disciplinary approach is often the best. For instance, a behavioral therapist with training in tinnitus management can help a person learn techniques for minimizing the mental and emotional toll of tinnitus. A dentist may be of help for someone whose tinnitus is triggered by jaw issues, like TMJ,” Dr. Johnson 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 game changers. Dr. Johnson 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 tactics like cognitive behavioral therapy are a great recommendation for many patients with tinnitus.” 


Dr. Johnson 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. 


Dr. Johnson shares: “At Johnson Audiology, we have had the pleasure of helping many 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 and is interacting with family and friends again.” 


If you are experiencing tinnitus, whether mildly bothersome or life-altering, call Johnson Audiology today for a tinnitus evaluation and get on the road to managing your tinnitus or make an appointment using our online scheduler.

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The restaurant was loud. Music played in the background, conversations filled the room and Karen Marcus was seated with a group of coworkers. For much of her life, this was exactly the kind of setting that made communication difficult. But this time, something remarkable happened: Karen could understand the person sitting across the table. “That just blew my mind,” she recalled. It may sound like an ordinary conversation, but for Karen, it represented something much bigger. She was not trying to piece together fragments of sentences or repeatedly asking someone to start over. She was simply sitting at the table, following the conversation and being part of the moment. A Lifetime of Working to Hear Karen was born with hearing loss. As she grew older, her hearing continued to decline, making conversations increasingly difficult. Social situations could leave her feeling uneasy before they even began. She might have to ask “What?” again and again, misunderstand what someone said or miss the conversation completely. “It was frustrating and embarrassing, even though it shouldn’t be,” Karen said. Her family and coworkers understood her hearing loss and tried to help by facing her when they spoke so she could read their lips. That support mattered, but communication still required effort. A restaurant, meeting or group conversation could quickly become overwhelming. Karen wanted to hear more clearly, but she also wanted something deeper: the confidence to participate without constantly worrying about what she might miss. Discovering What Was Possible Karen eventually received a cochlear implant and a compatible hearing aid. Before her implant was activated, she read about the experiences of other cochlear implant recipients and joined several online support groups. She wanted to understand what the process might be like and what she could realistically expect. Once her implant was activated, those possibilities began to become real. “Seeing those expectations come to realization, it has just been an amazing journey,” she said. The change became especially clear during that evening at the restaurant. Surrounded by music and competing voices, Karen could understand someone seated across the table—one of the most challenging listening situations for many people with hearing loss. Karen is careful not to describe the result as perfect hearing. Instead, she measures it against what life sounded like before. “I’m not going to exaggerate and say that it’s perfect,” she said. “But based on what it was before and what it is now, it’s light-years ahead.” Better Hearing in Everyday Life The difference extends beyond one memorable conversation. Karen can stream cellphone calls directly into her hearing devices, making it easier to understand the person on the other end. Television audio can also stream to her devices, helping her follow programs without struggling to catch every word. For conferences, presentations and other situations when a speaker may be farther away, Karen uses a Roger assistive listening device. During one tour, the guide clipped the Roger microphone to their collar. Even from approximately 20 feet away, Karen could hear the guide without difficulty. These features are not simply conveniences. They help Karen stay involved in her work, enjoy everyday activities, and communicate with greater confidence. “My new hearing devices have really helped with my confidence because I can hear so much better,” she said. “Overall, I just feel more normal, if you will.” A Team Celebrating Every Step Technology has played an important role in Karen’s progress, but so has the care surrounding it. Karen describes Dr. Hannah Dearth and Dr. Katie Brown as encouraging, patient, and kind throughout her cochlear implant journey. As her hearing improved, they celebrated each new milestone alongside her. “When I got my cochlear implant, every time I made progress, they were cheerleading me on,” she said. She also remembers what happened after she purchased a new iPhone and could not get it working properly with her hearing devices. The Johnson Audiology team initially emailed instructions, but when Karen still had difficulty, they invited her to come into the office. Christian, a Johnson Audiology, audiology assistant, patiently reviewed the settings on her phone and made sure everything was connected correctly. “He didn’t make this Boomer feel silly that I was needing all this technical help,” Karen said. That experience reflects what Karen values most about the team: she never feels rushed or dismissed. “They always answer all of my questions and make me feel like I am their one and only patient for the entire day,” she said. More Than Hearing Better Karen’s journey has not been about achieving perfect hearing. It has been about discovering how much more may be possible with the right combination of technology, professional care and continued support. For Karen, progress sounds like a phone call streaming clearly into her hearing devices. It sounds like a tour guide speaking from 20 feet away. It sounds like music playing in a busy restaurant—and still being able to understand the person across the table. Most of all, it feels like greater confidence and a renewed ability to participate in the personal and professional moments that matter to her. “I feel so fortunate to have been connected with Johnson Audiology,” Karen said. “Everything has been so wonderful on this journey to better hearing.” Karen will soon share more of her experience in an upcoming Johnson Audiology patient testimonial video. Watch for the opportunity to hear her story in her own words.