Richard S. Tyler, Ph.D., spearheaded the first-ever ‘Management of the Tinnitus Patient’ conference in 1982 at the University of Iowa and still organizes them to this day. He recently gave an interview with the American Tinnitus Association (ATA) to discuss his involvement over the years with tinnitus and also how the conference began and how it’s evolved as the science of tinnitus treatments have progressed.
Interview with Dr. Tyler on last year's conference the 20th Annual Management of the Tinnitus Patient Conference Last year Dr. Tyler celebrated the 20th Anniversary of the Annual Management of the Tinnitus Patient Conference. As part of that celebration, we interviewed Dr. Tyler about how he first became involved with tinnitus research and treatment and also how the conference began. Below is that interview. We thank Dr. Tyler for his time and expertise and most of all for continuing to hold this conference for tinnitus health professionals, which in turn, helps tinnitus patients across the world get access to good care.
ATA: What first interested you in the field of audiology and in turn, tinnitus? RT: As a child I had a stutter, and I became interested in speech pathology. When I was ready for college, I applied to the speech pathology and audiology program. I didn’t make the cut. Fortunately, someone dropped out after the first two weeks of the semester and I was called and asked if I was still interested. I was admitted to the University of Western Ontario in Canada that week. Within a year I realized I was more interested in audiology. Before I knew it I was learning to become an audiologist.
I completed both my undergraduate and graduate degrees in Canada and then got a doctorate in hearing science at the University of Iowa. My first job after graduation was in England at the Institute of Hearing Research where I worked with Ross Coles, Ph.D., an audiological physician. He was a leader in audiology research and had recently completed a study on tinnitus sound therapy.
Although that first job was entirely research, we also saw patients who would come into clinic associated with the lab to be fitted for hearing aids. The benefit of this was that we were able to bring patients in for tinnitus-related projects and I began to understand how upset many of them were about their tinnitus and how little interest in the medical and audiological field there was to help these people.
During that time (over 30 years ago) we did some experiments where we presented background noise and were able to mask patients’ tinnitus. We learned that sometimes we could make the tinnitus disappear after the masker was turned off. Many patients were grateful and amazed that there was actually something to help them. I recall one patient who said that it was the first time he had not heard his tinnitus in seven years. This grown man started crying from relief and joy right in front of me - it was a captivating moment for me to appreciate the problems some of these patients really endured.
ATA: How long have you been treating tinnitus patients?
RT: I didn’t officially start seeing tinnitus patients until three years later at the Department of Otolaryngology at the University of Iowa where I pursued research on cochlear implants and also on tinnitus. I was the director of the audiology clinic too and began seeing more patients. Now we have individual and group sessions, and even a telephone counselling opportunity.
ATA: How did the first “Management of the Tinnitus Patient” conference begin and what was it like?
RT: I recall at the time talking with our otolaryngology fellow about attending a conference on the clinical treatment of tinnitus; a conference dedicated to learning how to help patients. There was none. He suggested that I do it, and I guess I must of said, “OK, we’ll give it a try…”. That’s how it started.
The first guest of honour was Dr. Ross Coles who came over from England. I also remember about that first conference - that I took Dr. Coles to Cedar Rapids to see his first-ever baseball game. The conference has always been as mall conference, but a dedicated group. The first year may have had 30-35people. There have always been a handful of people from other countries who come, including that first year. At the time, I mailed out and left brochure sat other conferences I attended. It has always been difficult to market such as mall conference. Eventually, as people became increasingly interested intreating tinnitus and through word of mouth, it grew. It’s still a relatively small conference – usually in the ballpark of 50-75 attendees - but it’s a dedicated nucleus of individuals who represent the core group of audiologists, otologists, psychologists, health professionals, manufacturers, patients and non-profit groups like ATA who are dedicated to helping the tinnitus patient.
The first two years of the conference in the mid-1980s were clearly focused on sound therapy and counseling strategies. Richard Hallam, Ph.D., a psychologist working in London published some work in 1984 and wrote a book on tinnitus based on his experience. He had developed a therapy based on the patient’s failure to habituate to their tinnitus. Dennis McFadden, Ph.D., did work for the Institute of Medicine around that same time summarizing the problem of tinnitus and what we knew about it and what we didn’t know about it.
During this same time, ATA was beginning to become the unique organization we know it as today. I met ATA’s first Executive Director, Gloria Reich, Ph.D., and subsequently Jack Vernon, Ph.D. Dr. Vernon was also an early Guest of Honor. There was a slow but growing interest in tinnitus. Dr. Coles was part of a large study in England with Jonathan Hazell, Ph.D., FACS, Hugh Cooper, Ph.D., Dai Stephens, BSc, Ph.D. and Jackie Sheldrake, RHAD, BSHAA, and in the early years focused on sound therapy treatments.
In 2002, Jane Henry, Ph.D., and Peter Wilson, Ph.D., wrote two of the best books ever in my opinion on treating tinnitus patients. Peter was also an early guest speaker. One of the most influential works on tinnitus was contributed by Dr. Hallam. He proposed a tinnitus habituation model and emphasized the neurophysiological involvement of the brain in problematic tinnitus. This model led to a focus on practical approaches to help people with problematic tinnitus.
Since those early years, I’ve focused on making sure the conferencer presents the multi-disciplinary approach necessary for treating tinnitus patients. I’ve brought in speakers who have expertise on music therapy, relaxation techniques, neurophysiology, psychiatry and clinical psychology backgrounds. This exposure is unique and needed for audiologists and otologists to learn more about helping their tinnitus patients. However, the conference is not limited to audiologists. Every year about 80 percent of the attendees are audiologists, 10 percent are psychologists, five percent physicians, and about five percent are company representatives. The conference presenters are all ‘handpicked’. It is not an ‘open’ conference where people can submit topics top resent. I want to make sure all-important areas of clinical management are covered and that I believe the presenters will provide helpful and accurate information. We also have about three to six tinnitus patients attend each year and I think they get a lot of out listening to the professionals learn, discuss and debate tinnitus treatment and research. They have specific times during the conference to share their insights and stories.
ATA: How has the conference changed over the 20 years period?
RT: One difference is the involvement of people from all around the world. I would say that now about a quarter to a third of the attendees come from different countries. Another difference is that there are a lot of new directions to treat tinnitus. Practitioners are much more sophisticated now and have their own experience before they come to the conference. Some return to the conference, to enhance their knowledge and share with their peers, or to simply learn about what’s new in the world of treating tinnitus. Increasingly, we also have companies attend who are interested in doing clinical trials but want to hear from clinical audiologists and clinical researchers and their thoughts on the most appropriate ways of running clinical trials.
We always have a Guest of Honor whom I carefully select as a world leader to bring in new concepts and summarize knowledge from a different perspective. They are asked to prepare their comprehensive review with clinicians in mind. The biggest similarity that I see is that it’s still the case that a lot of health care professionals including otologists, audiologists and psychologists who are not well trained in how to help tinnitus patients which is why we still why we get a lot of people coming to the conference every year. It’s very focused on setting up the clinic and helping them get started.
ATA: You are well known foryour clinical research and expertise. From a clinician’s perspective, is thereany avenue of research that is particularly interesting to you?
RT: I do believe within five years - maybe less -there will be a cochlear implant specifically designed for tinnitus. I’ve been saying that for about 20 years, but I think we’ve known for a long time that electrical stimulation in the region of the cochlea can turn off the tinnitus for some people.
ATA: What other activities surround the conference?
RT: We always have a barbeque at The Secrest 1883 Octagonal Barn, one of the oldest and largest round barns in the USA. I have been restoring it as a hobby for many years. People help out with the food and drinks at the barbeque, and this is a great opportunity to meet everyone. This is followed by a square dance, with lessons provided by the square dance caller.
ATA:Who are your featured guest speakers this year?
RT: This year, our guest of honour – Josef Rauschecker, Ph.D., a neuroscientist from Georgetown University, is going to discuss work he has done on tinnitus and the brain. In my opinion, this has the potential to open up new areas for research into tinnitus treatments. We’ll also include presentations from our own group at Iowa, several speakers from around the country and Europe, and invited manufacturers.
ATA: Thank you Dr. Tyler for taking time to share your experiences with us and ATA’s supporters about the University of Iowa’s Management of the Tinnitus Patient. Thank you for all you do for tinnitus patients and especially for your 20 years of dedication to providing the conference.