Tinnitus is the topic and Dr. Kelly Breese is the expert I wanted to interview.

Tinnitus is often insidious.  It can build gradually before a person realizes they have a problem. 

Sometimes it happens suddenly. 

It comes in many forms from a minor ringing in the ears to a roaring torrent of sounds that drive the victim to distraction. 

Certified by the American Board of Audiology,  as an Audiologist and a specialist in Tinnitus Management, her videos on this important topic caught my attention and I was fortunate to have her take the time from her practice, Hearing Aids of Sarasota to sit down for this interview.

Candidates for cochlear implants often ask if a CI will help with their tinnitus. As Dr. Breese explains, the answer is maybe. While there is currently no cure for tinnitus, there are methods to help cope.

In addition to her interview, further information is found on her website hearingaidsofsarasota.com as well as her Facebook page, of the same name.

Transcript

Richard:

Cochlear Implant Basics is a site for candidates and their families and friends. If you have been told you qualify for a cochlear implant, these podcast interviews tell how receiving a cochlear implant can be a life changing experience. You will meet recipients who face a hearing loss and then hearing aids could no longer provide comprehension of speech or music. They faced growing isolation, inability to socialize or compete in the world of business. The joy of music disappeared. They explain how receiving a cochlear implant changed their lives.

Richard:

Welcome to Cochlear Implant Basics. A reminder, Cochlear Implant Basics is not sponsored by anyone nor is it offering medical advice. Please consult your own healthcare provider.

Richard:

Okay. Good morning. Would you please state your name, where you’re at and the date?

Dr. Kelly Breese:

Hi. Good morning. My name is Dr. Kelly Breese. Today is February 2nd, 2022. And I am the owner and audiologist, board certified, at Hearing Aids of Sarasota located in Siesta Key.

Richard:

Kelly, tell me a little bit about your background, why you went into audiology, where you went and so on and so forth.

Dr. Kelly Breese:

So, I was musically trained starting at nine as a percussionist, so drums, mallet instruments, marimba, vibraphone. Music has been a huge part of my life. When I started undergrad at the University of Florida, I had to do a project, and I came upon a woman named Evelyn Glennie, and she is a very well-known marimba percussionist in general, but she lost her hearing at a young age. So, she performs and she learned to train herself to play music by feeling it, so there, she would play barefoot. So, I got really interested into the hearing concept of music and it translated very well.

Dr. Kelly Breese:

And then I had a course where a professor came in at the University of Florida, the American sign language instructor, Dr. Michael Tuccelli, who has a cochlear implant. He was born deaf, but he had an implant later in life. And he really inspired me with sign language and the deaf community in bridging the gap between how audiologists in the deaf community … History is negative, and I want to be a positive change in the field.

Dr. Kelly Breese:

So basically, that really pushed me with music, translating into sound and communication, and sign language is a big part of my life. That’s how I really chose audiology. So, I went to the University of Arizona for my doctorate. And being a drummer and a musician, I didn’t always wear ear plugs, and I started getting ringing in my ears. So, I’ve personally been dealing with tinnitus, some people call it tinnitus, for, goodness, I don’t think I realized it when I first got it. But in grad school, I couldn’t process a sentence sometimes, reading a sentence because of how bothersome it was to me. So, tinnitus became an extremely interesting topic as well. So, my whole career I feel just falls around my passion of things that I’ve done.

Richard:

Yeah. That’s exactly what I’d like to talk about today because tinnitus is a major, major topic among people who get cochlear implants, whether it’s going to help them with the tinnitus. They don’t even know what tinnitus is when they first get it. So, it’s something we cover all the time.

Dr. Kelly Breese:

Yes.

Richard:

And until now, I have not had an expert, so I’m very [crosstalk 00:03:42] in talking to you this morning. Tell me a little bit about your background. You mentioned to me before that you work with cochlear implant candidates or recipients who had tinnitus. Can you give me a little bit of background about that?

Dr. Kelly Breese:

Absolutely. So previously in my training at the University of Arizona, University of Florida, my residency in Oro Valley Audiology at a private practice and some practices after I graduated, I worked a lot with cochlear implant candidacy evaluations, and we had really big discussions about pursuing a cochlear implant for the main reason of tinnitus because realistically, it’s not proven to cure tinnitus. There’s no cure for it. There are different ways we can go about treating it and trying to help you not focus on it as much, but there’s a lot of research that indicates bringing sound back to the brain can help, but that doesn’t mean a cochlear implant will stop the tinnitus. That’s a big surgery and a big risk to take if it’s just for that.

Dr. Kelly Breese:

So, I’ve had positive and negative experiences with patients with understanding and realizing that it takes time to readjust the tinnitus, retrain your brain, relearn hearing in a completely different way than our bodies usually do with a cochlear implant. Those are the more successful ones. If they’re understanding, if they’re just really hopeful it’s just going to stop it and then that’s it, that expectation is going to be a negative outcome.

Dr. Kelly Breese:

Currently in my practice, I’m just over a year as a business owner, so hopefully within this year, I’m going to be able to set up the testing and candidacy protocol, so I’m very excited to add that soon.

Richard:

This is really the center for cochlear implants because we have over 140,000 people with hearing loss just in the Tampa Bay area, which is a huge number.

Dr. Kelly Breese:

I know.

Richard:

So, you will be building your practice in that area. Can you tell me about, without mentioning names obviously, a successful cochlear implant candidate with tinnitus and an unsuccessful one? Can you elaborate a little bit more on each case?

Dr. Kelly Breese:

Sure. So, I think it really comes down to when you work with your ENT provider, the surgeon that’s going to do the surgery, and the audiologist that you get really good case history and really talk with the patient and make sure they’re aware of all the possibilities. When I had a patient who came in with wanting tinnitus to be reduced, we always do some testing, the tinnitus functional index or the tinnitus handicap inventory, things like that, she was very severe on the test. And so, before we even started the process for surgery, we started counseling on the tinnitus and understanding what causes it, how it can affect people differently, why some people have it extremely bad one day, other people, “I hear it. It doesn’t bother.”

Dr. Kelly Breese:

So really the education, starting there, is what helped prepare this patient to understand that it’s going to take some time just like an implant. I’m sure with many discussions you’ve had, relearning sound is a very difficult process, and you got to put work into it. Not only that, but the ringing in the ears is going to be a second addition to it. So, we have some more relaxation skills, and this patient was very compliant with it and understanding the ups and downs of the journey because tinnitus just doesn’t stop overnight, and it may get worse a little bit. It may come up and flare up out of nowhere. So, following the protocol of someone who’s very certified in tinnitus management, as myself, can really help understand the process and improve quality of life.

Dr. Kelly Breese:

So, in preparation after she had the activation, of course, had all the unique sound qualities, Donald Duck, Darth Vader type of speech, but we took in baby steps to implement the speech understanding process just as you have to retrain your brain to understand sound again. Well, now, we’re also going to implement the therapy relaxation and a few other soundscapes that worked for this patient specifically into it in steps. So, as we did it in increments, it was easier on her brain to relearn things, and as we were testing with those questionnaires, over a year’s time, her score went into the near normal range for tinnitus. She was saying, “If I talk about it, I know it’s there, but it’s no longer a bother in my life.”

Richard:

Well, let me ask you another question here because you’re talking about self-evaluation. You used that term. Is the questionnaire where you rate on a one to 10 or how does that evaluation work?

Dr. Kelly Breese:

So, there’s several different tinnitus questionnaires for self-evaluation. The TFI is one of the more popular ones, Tinnitus Functional Index, which is great to track, okay, how am I doing in my tinnitus retraining therapy? What number, how severe is it to me? And it looks at basically different quality of aspects of life. They ask you questions about do you have difficulties falling asleep at night? Can you focus during the day with the tinnitus? Does it make you feel tired? So basically, we’re looking at different aspects of life, and where those higher ones are, that’s then where we can create a plan, an action plan to try and break the cycle of why it’s so loud and bothersome.

Richard:

It was interesting that maybe two years ago, the local chapter of the Hearing Loss Association of America here in Sarasota, I had a speaker on Veterans Day, and she was very high up in the Veterans Administration, both for cochlear implants and tinnitus. And at that time, one of the comments struck me as very, very profound that a victim of an IED who may have lost a limb and got tinnitus from the explosion as well felt that tinnitus was worse than losing a limb. That never left me. I find tinnitus to be an amazing topic.

Dr. Kelly Breese:

It’s very, very under-discussed. There’s so much research on it. A lot of professionals or in general, people just think, “Oh, there’s nothing I can do about it.” Or if they’re being told this by a doctor or someone that they trust, it adds more distress, and then the tinnitus can become worse because it’s all about our brain. It’s about our limbic system, which is our fight or flight response, how we react to things. So that’s why some people who have the noise in their head and they notice it and they focus on it and then they get stressed that they’re hearing it, it’s this bad cycle that we have to break, and it’s different for each person.

Dr. Kelly Breese:

So, it’s very profound, and that’s why I love it because each of my patients are unique when they come in to me. There’s no same story with tinnitus at all. Our conversations in case history are very intense because we have to look at the whole person.

Richard:

That’s an interesting point because I started to lose my hearing when I was five years old from scarlet fever or the medication, I don’t know which, but I had as a child tremendous tinnitus, and I was so scared about it. I never mentioned it to my parents. It was frightening at night because the tinnitus was worse. And it wasn’t until I was well into my 20s that I read that tinnitus and the loss of hearing sometimes go hand in hand.

Dr. Kelly Breese:

Absolutely. When we lose sound, our brain goes, where is the sound that we used to get? And it starts searching and creating its own noise. They did a study in the ’90s with a bunch of college students, normal hearing, no history of noise exposure, and they put them in what’s called an anechoic chamber. So, it’s like a hearing test booth, but a lot, lot, lot more closed in, sound closed in. And they had them sitting there I think about 15, 20 minutes. And afterwards, they asked the college students, “What did you experience?” 94% of them said some form of tinnitus, some form of sound that they heard. And so, we know when someone with a normal sense, but we take that away, the brain notices that difference and starts to create its own noise. So, this is something that we know can be very well because of sound.

Richard:

It’s interesting because yesterday, my wife mentioned to me the night before she had a symptom of tinnitus for the first time in her life, and she didn’t know what it was and she described it to me. And I said, “That’s what tinnitus sounds like.” So, it can hit at any time.

Dr. Kelly Breese:

At any time.

Richard:

Peer review studies that are going on now, what kind of studies have you seen that you think would be helpful for the future?

Dr. Kelly Breese:

So, I think there needs to be more studies with how they’re approaching the case history and the holistic approach to the patient because medications can cause tinnitus, noise exposure can cause tinnitus. Sometimes it’s just genetics. Sometimes it’s hearing loss as well. You don’t have to have hearing loss to have tinnitus. So I feel like if we can have a more, I guess it would be more specific patient-based to see, okay, are we noticing if it’s noise-induced hearing loss causing tinnitus? Is there a better plan or a better method that’s improving the outcome for these types of patients or is there certain types of brain studies we can do more functional MRI testing to see if there’s more tinnitus activation based on where it could be coming from?

Richard:

Are you going to be leading those studies?

Dr. Kelly Breese:

Well, if I have some spare time, I can try and do that. I don’t know if I have that time.

Richard:

Or spare money. We’ll start with the grant money tomorrow.

Dr. Kelly Breese:

That too. That’s the bigger one.

Richard:

Tell me a little bit more about building a practice. You said you’ve only been in business for a year. I’ve noticed the TikTok videos, which I think are very, very effective. I love them.

Dr. Kelly Breese:

Thank you.

Richard:

How are you going about building your practice?

Dr. Kelly Breese:

I graduated almost seven years ago now, which is shocking. I always knew I wanted to be in private practice, but it worked out, so I was able to learn how I wanted to manage my practice and my team and grow and work with my patients. So, I’ve had my office just over a year, but it’s been an established location for almost 40 years. I’m really big into education. I think that’s one of the most important things just to start off with, and that’s even for tinnitus, just educating the public on what it is so you know you’re not going crazy, and you know this is something you don’t need to be scared of or, like you said, keep to yourself. It’s okay to talk about it. One of the most common noted things in the world.

Dr. Kelly Breese:

But my biggest thing is I’m trying to educate the public. If I can’t get it through patients and word of mouth, I’m working on my social media, and reels have now become something I’m starting too to help make it a little more exciting and interesting to keep the message there.

Richard:

That sounds fabulous. All right. Before I end this interview, because I know you have to go back to work, what would you like to tell our listeners about your practice, about the future? Do you do remote consultations?

Dr. Kelly Breese:

Yes. So, I have telehealth available. I try and keep it open to accommodate everybody. It’s HIPAA compliant. You can text our business number so that we can communicate that way. I’m really about educating the public. I’m into outreach. I’m working on doing some mobile care. I do mobile work as it is. I do some pro bono work. I try and work with some nonprofits and help the local community because that’s where my heart is, is just making sure that everyone is getting the best care and they’re not being misinformed or being treated differently. There’s a whole another topic about hearing aid pricing in that but [crosstalk 00:15:23].

Richard:

If you want to talk about hearing aids, we can because remember, when people come to any of the Facebook sites, they’re seeking information, then we do know you have to go through the nonsurgical techniques way before you can get a cochlear implant. Do you want to address that a little bit?

Dr. Kelly Breese:

Sure. So anyone who is a potential candidate for a cochlear implant, they require three months of trying a hearing aid and make sure that they’re not perceiving any benefit and they do testing for candidacy with and without a hearing aid. The hearing aids are verified using real-ear measurements, so we know that it’s addressing the hearing loss of that particular person.

Dr. Kelly Breese:

So, hearing aids are a big talk. They’ve always been a big talk, over-the-counter hearing aids, but this also goes back to education and reading the right information because a lot of consumers, they see all these mail-driven ads, newspaper ads, website ads, and it’s confusing. It’s so confusing. And I stress overlooking at some of these websites because you see information on one website, something else on another. What I always tell my patients is who is the writer of this website? Because if it’s not a verified website, if you’re not looking at research or data from like PubMed or working with a doctor who can show you this is the data behind it rather than a little quote on a page, that’s really where you need to focus to get the best education and make sure you’re getting what’s right for yourself.

Richard:

That’s exactly right because there’s so much, I don’t like to use the word misinformation. That’s not fair, but once you’ve gotten a device, whether it’s a cochlear implant or a hearing aid, you have cognitive dissonance where you have to believe what you’ve bought is the best available. So that’s where I think a lot of the confusion comes up that people make statements about what they have is the best in the world, but it may not be by virtue of the fact the data is not there.

Dr. Kelly Breese:

Exactly. I relate it to when you go to your primary and explain what’s going on, for example, if you’re diagnosed with a blood pressure issue, how many medications are there? You’re relying on your doctor to pick the proper prescription for you for that because there are tons of people with low blood pressure or high blood pressure, but they’re not all on the same exact thing. So, I translate that to, yeah, people can say they’re the latest and greatest best hearing aid, but is it for that particular individual? What are they promoting that’s the latest and greatest? So, it’s again about that research more than those ads I try and push.

Richard:

You have a lot of research ahead of you.

Dr. Kelly Breese:

I know. It’s a good thing I like to learn and continue to keep myself [crosstalk 00:18:06].

Richard:

The listeners today are going to learn an awful lot from this podcast, and I really appreciate your time, and I’m sure when we’d sign off, you’ll give me all the information for the contact, and I’ll make sure that’s posted with it.

Dr. Kelly Breese:

Absolutely. It’s my pleasure. I love speaking with you and maybe we’ll have some more topics in the future.

Richard:

I’m sure we will.