Interview with Richard S. Tyler, Ph.D.

Topic: Tinnitus Virtual Conference on AudiologyOnline, May 17 - 21, 2010 and University of Iowa Tinnitus Conference, September 17 - 18, 2010

Rich Tyler

CAROLYN SMAKA: Dr. Tyler, thanks for your time today. I'm sure professionals reading this interview are familiar with your expertise, but can you please tell me about your background and your current role at the University of Iowa?

RICHARD TYLER: Sure. I trained as a clinical audiologist at the University of Western Ontario in Canada and I did my Ph.D. in psychoacoustics at the University of Iowa. I worked for the Medical Research Council in England for three years and have been at the University of Iowa ever since. I have a joint appointment primarily in the Department of Otolaryngology Head and Neck Surgery and a secondary appointment in the Department of Communication Sciences and Disorders. I conduct research mainly on cochlear implants and tinnitus, and also have a tinnitus clinic at the University. In addition, I've been running the annual tinnitus conference here now for a number of years.

SMAKA: We are honored to have the opportunity to work with you for the upcoming Tinnitus Virtual Conference on AudiologyOnline that's happening May 17 - May 21, 2010. Can you tell us about the presenters and topics you have planned?

TYLER: Yes, I tried to select topics for practicing clinicians to get a broad view of different approaches and different conceptual frameworks that would be important to starting your own tinnitus clinic and providing a good treatment strategy. I also contacted people from other countries as well to bring in a variety of expertise.

The first presenter on Monday, May 17, will be James Kaltenbach. He's a neurophysiologist and has been a guest of honor at one of our tinnitus conferences here in Iowa City. He's going to discuss the neurobiology of tinnitus. He'll explain the different models, causes and how tinnitus is likely coded in the cochlea, in the brainstem and in the brain. He has wonderful slides and a great presentation for how the auditory system works. This is helpful both for the clinician to understand what's going on, and a lot of this information can also be modified and explained to the patient, depending upon their level of expertise and interest in understanding the neurobiology of tinnitus.

SMAKA: It sounds fascinating. Sounds like a great way to start the week as it kind of lays the foundation for what comes afterwards.

TYLER: The second presenter is Dr. Claudia Coelho and she's an otologist who practices in Brazil. I'm fortunate that she also comes up to Iowa once or twice a year to help with research projects. Claudia will be talking about the medical evaluation and the medical treatments that are offered or not offered for tinnitus patients. I think it's very important to understand the perspective of the medical practice and what they have to offer. It's important for us to know what they're looking for when a patient comes to them and says, "I have this terrible ringing. What can you do about it?"

Claudia is quite knowledgeable about the clinical options for tinnitus. She'll review what she does in the evaluation of tinnitus patients and also the kinds of medications and complementary treatments such as dietary supplements that she sometimes explores with her tinnitus patients.

SMAKA: I noticed in her bio that she's a medical physician as well as has a Ph.D. Interesting background.

TYLER: That's correct. She did her Ph.D. on tinnitus and hyperacusis in children and I suppose she might be able to comment on that as well.

SMAKA: Sounds great!

TYLER: On Wednesday, your listeners are stuck with me. I'll be reviewing a wide variety of counseling and sound therapy options some of which we've developed here over the past 20 years at the University of Iowa that we now call Tinnitus Activities Treatment. It focuses on the four major categories of problems that people have from their tinnitus: thoughts and emotions, hearing, sleep and concentration.

I'll also be reviewing some of the options that patients have for wearing different kinds of sound therapy devices and as most of these patients also have hearing loss, when to consider hearing aids and what options to consider.

SMAKA: Excellent. What is on the agenda for Thursday?

TYLER: On Thursday, we'll have Dr. Christina Stocking from Buffalo. Dr. Stocking is a practicing audiologist who runs a clinic, and she'll present a very practical talk about setting up a tinnitus clinic. She had to set up her clinic in Buffalo many years ago now and has lots of experience in the practical issues of what to have in place, what sort of handouts to have, how to evaluate the patients when they come in, and many other issues. She'll talk a little bit about using group therapy, reimbursement, and more. After you're comfortable with understanding tinnitus and what options you want to provide, the last step is to figure out how to bring it to action so you can actually see patients and have a productive, easy flowing and profitable clinic. Christina's definitely an expert in this area.

SMAKA: I like how the program for the week builds from tinnitus' underpinnings through practical aspects of providing treatment.

TYLER: Exactly. Friday there'll be a panel discussion with some of the presenters. I'll be there too and we'll review some of the more important aspects of evaluating and understanding tinnitus and providing a clinical service to the patients that need our help. We'll also take questions from attendees.

SMAKA: What a great opportunity for participants to be able to ask questions and participate in the discussion with renowned experts. Thanks for that overview and more importantly, thank you for inviting these experts for what is a very well-rounded five hours of continuing education in tinnitus. I should mention that all class times are from 12pm - 1pm EST (9am - 10am Pacific), and all presentations will be available as recorded courses for folks who can't make the live seminars.

Dr. Tyler, what's planned for the upcoming tinnitus conference at the University of Iowa that you are chairing?



The 18th Annual Conference on the Management of the Tinnitus Patient will be held September 17th - 18t, 2010h. More information can be found at www.uihealthcare.com/depts/med/otolaryngology/conferences/index.html

TYLER: Our guest of honor this year is a psychologist named Gerhard Andersson from Sweden. Gerhard has done a number of studies to try and understand the basic psychological problems that tinnitus patients experience, including their distress and the way that tinnitus affects their lifestyles, the lifestyles of their spouses, and their social situation in general. He's also set up some very smart Internet tools for helping and assessing tinnitus.

This year our conference starts on Friday, September 17th, and runs through the evening of Saturday, September 18th. We always have an opening reception on Thursday evening and a barbecue and square dance in a round barn on Friday evening. Square dance lessons are provided, and it's always a good time.

SMAKA: The faculty looks like they cover very diverse areas of expertise.

TYLER: Yes. In addition to Dr. Andersson, we have otologist Carol Bauer who will be presenting about different aspects of medications and her research on changing the loudness of tinnitus with sound therapy.

Tom Brozoski, Ph.D., will also be presenting. He's an animal neurophysiologist and has done some very interesting work in animal models and the use of medications to try and change tinnitus in the animals. He'll be talking about neurotransmitters and changing tinnitus and how that can be examined using magnetic resonance spectroscopy.

Christina Stocking will be talking about setting up a tinnitus clinic, as I described, but in much more detail.

We have a new speaker this year, Bev Klug, who will be talking about Mindfulness-based Stress Reduction. She works here at the University of Iowa and sees tinnitus patients as part of her practice as a Licensed Marriage and Family Therapist.

Matt Howard, a neurosurgeon, will be discussing his experience stimulating the brain for tinnitus. Our psychiatrist Catherine Woodman who works at the VA here and sees a lot of distressed tinnitus patients will also present. The neurotologist who works in our clinic, Marlan Hansen, will review workups that he does for his tinnitus patients and the kind of treatments he offers.

Finally, Shelley Witt will present. Shelly is an audiologist who works with me here at the clinic seeing tinnitus patients. She will go through the kinds of activities, treatments and programs that we use with our patients. We have a series of pictures that are available for free download on the Internet, and Shelley will review them and discuss how they can be used and modified to fit the needs of individual patients.

We also have presentations from a variety of people from the industry talking about the devices they have to offer including GN Resound, General Hearing Instruments, Neuromonics and Widex.

SMAKA: It sounds like it covers such a broad spectrum;it would be relevant for all audiologists. Regardless of the practice setting or specialty, most audiologists see patients with tinnitus. Does the conference attract attendees from other disciplines as well?

TYLER: Yes, it's very interesting. While the conference is geared for clinicians, we always try and have some new and different areas of research and emerging topics. For example, we had a music therapist here a few years ago. The mindfulness aspect is new this year.

Typically it's a small meeting, between 40 and 50 people. Usually about three quarters are clinical audiologists. There may also be attendees from companies who are interested in starting trials with a new product, such as a drug or an electrical stimulation approach, and they come here with quite a different perspective. There are also usually three or four physicians from around the world, one or two psychologists and occasionally a nurse or two. So it's quite a wide variety of people from different backgrounds that are interested in tinnitus. As you know, at this time there is no cure to make tinnitus completely go away so there are lots of different opportunities to help patients. This conference is focused on practical things that you can do to make a difference, while also trying to reach out and explore new conceptual areas to at least keep us thinking on the forefront.

SMAKA: For more information about the conference, where should we direct readers?

TYLER: They can visit the website, www.uihealthcare.com/depts/med/otolaryngology/conferences/index.html. If you don't have the URL handy, you can find the website by typing "Iowa tinnitus conference" into your search engine.

SMAKA: Your tinnitus clinic website also looks like a great tinnitus resource, both for professionals and for patients.

TYLER: There is a lot of information and tools available there. There are several questionnaires, pictures for use in treatment as I mentioned earlier, and helpful suggestions for patients, among other information. In addition to using the URL, you can get to the website simply by typing "Iowa tinnitus" into any search engine.

SMAKA: Well, I've got a million tinnitus questions for you, but I'll save those for one of the upcoming conferences. Thanks, Dr. Tyler.

TYLER: Thank you.