Tinnitus and hyperacusis – an interview with Jan L. Mayes

Cary: This is episode seven of Soundproofist. My name is Cary.

Cary: Today we’re going to talk about tinnitus, also known as TINnnitus, which is when you hear ringing or buzzing in your ears–and its relationship to noise and resources for coping with it. I’m talking today to Jan L Mayes, who’s the author of a new book called “Tinnitus Toolbox, Hyperacusis Handbook.” Thank you for joining us today. Jan.

Jan L Mayes: Thank you for inviting me.

Cary: Can you tell me about your background and how you became an audiologist?

Jan L Mayes: Well, I started off trying to decide whether to be a journalist or a speech language pathologist. And then I was in a really bad car accident that caused sudden onset tinnitus or tinnitus.  I say, TINnitus, but maybe that’s Canadian. There’s not right or wrong either way. And so when I went to see the doctors and your specialists, they told me nothing could be done, which was upsetting. And they also told me that it wasn’t from the accident. So I was 21 years old. I didn’t have tinnitus before the accident and I had severe tinnitus after, and it made me really mad. And since I was already in the speech language pathology program, I had already taken a lot of the courses for audiology. So I switched. Because I thought that I would be on the front lines of finding out what treatments or science or anything new — where something could be done. And there wasn’t anything for quite…for many, many years. So it was always kind of a challenge for myself personally, but also professionally to try to have some hope for people who were coming in and had distress. But until about — probably the late 1990s, that’s really when treatments and approaches started to arrive in the clinic that audiologists could use for non-medical management and help people cope better because there isn’t any cure. At least not yet.

Cary: Right. That was one of the things I wanted to talk about. As you noted in your book, there is no cure for tinnitus, but there are coping tools. And this is what your book seems to be mostly about: coping tools. But you did say that another topic that you cover in your book, that hyperacusis can be reversed with therapy.

Jan L Mayes: Yes.

Cary: So what kind of therapy?

Jan L Mayes: It’s the same types of therapy for both. Tinnitus is where you’re hearing extra sounds that aren’t coming from the outside environment and they believe it’s hyper activity in the hearing system. And hyperacusis is also from hearing system hyperactivity, where people are hearing sounds actually louder than they really are to other people. And so sounds can be painful or uncomfortable. So, the approaches are using sound therapy or kind of quiet, comfortable sound to help reduce the hyperactivity. There’s mental techniques and strategies like cognitive behavioral therapy, which is often ignored. And you know, kind of the usual –eat healthy, just get regular exercise. Even if that’s just going for a walk or enjoying nature if you can. And it’s not too noisy. But it’s challenging because people are still being told nothing can be done.

Cary: So for example, if you have both conditions, when there is sound, it’s too loud or some sounds are too loud. And when it’s quiet you’re still hearing something with the tinnitus. Because when there is no sound, this sound is still being generated inside of your hearing system. Is that correct?

Jan L Mayes: Exactly.

Cary: Is it common for people to have both of these conditions?

Jan L Mayes: Yes. 30 to 40% of people who are mainly concerned about their tinnitus also have hyperacusis. And about 86% of people with hyperacusis as their main concern also have tinnitus. As far as curing hyperacusis, it does depend how severe it is to start. Because just from my experience, people with very severe hyperacusis too. You know, there’s cases where people have ended up locked in soundproof basements. They can’t even brush their teeth with a toothbrush because that sound is too loud for them. And so they can certainly get better and they can get to the point where they can start going outside again. And you know, living a more regular life with being exposed to regular daily sound, but it’s pretty hard to go from that point to sound isn’t bothersome at all. They’re usually always is a little bit of sensitivity that’s still there.

Cary: And another one, which is it called misophonia.

Jan L Mayes: Yes.

Cary: Where people are — just certain sounds I guess — really have an impact on people and make them angry at times. Like, like a throat clearing or — I don’t know what they all were. But that’s not related though necessarily to these other issues.

Jan L Mayes: It is actually. There’s a … Doctor Jastreboff is one. He’s a neuroscientist and he was the one who invented tinnitus retraining therapy, which is only one approach. There’s many others. But he was one of the first people to divide the different categories into tinnitus and then decreased sound tolerance. And within decreased sound tolerance, you have the hyperacusis. So sound is painful. You have the misophonia, where people really dislike or hate certain sounds and phonophobia where people are afraid of sounds or even the thought that the sound might be there. So for example, if I see somebody with an air horn when I’m out and about at some type of community event, I run. Because I’m terrified –and they haven’t set it off. But I’m terrified to hear that sound. Misophonia tends to be a big problem for children and teenagers in school because a lot of the time it’s just — you know — maybe someone’s chewing gum in class or people are tapping on their phones or devices in class and that’s enough to really trigger the misophonia.

Jan L Mayes: So when I see news articles about school districts banning phones and devices in class, that’s a really good thing for a lot of children. Because they’re not going to come out and say, “you’re chewing your gum too loud” or “you’re tapping too loud on your phone.” And it is a big distraction. They can’t focus on learning. Some kids actually drop out because they just can’t handle it and people don’t understand it. If they do try to say anything, yeah, it can be really challenging.

Cary: I’m wondering what inspired you to write this book?

Jan L Mayes: Well, I had written an earlier book in 2010. Because I thought I was just tired of people coming in and saying, well, nothing can be done. And then they’re surprised that there were so many things that could be done. But since I wrote that book — and the medical science and hearing health science –it usually takes about five to 10 years for new things to really get out there and, and be known about.

Jan L Mayes: And so after I published the first book, there was all this new information coming out. And I still kept having people, including family doctors and ear specialists and people who have it saying “nothing can be done.” And you know, sometimes there are stories where people have committed suicide or people are having severe mental health issues, like anxiety and depression. And there is hope that people can learn to manage better. There’s been big tech changes with digital tech. So say compared to the 1980s — when mine started — I would say nothing could be done back then. But now there’s digital tech — there’s digital sound quality that’s very good. That used to be a problem in the past, because with the static and analog sound quality people with tinnitus and hyperacusis tend to be — you know, they want good sound quality. We don’t want distortion, we don’t want, you know, things that don’t sound good.

Jan L Mayes: And so they’d refuse to wear analog devices and I don’t blame them. You know, now there’s digital devices, there’s new treatments, there’s new science. And the other side of it was we’ve learned a lot about noise damage to hearing. Because when I learned about noise damage, I was taught that the inner ear or the Cochlea, that’s where the damage started. And that’s actually not true at all. It starts with the hearing nerves and the damage to the inner ears actually happens much later after a lot of distortion and other damage has already happened.

Cary: It sounds like the people have no — if they’re damaging their hearing nerves first — then they have less of a sense that the damage is taking place. Is that right?

Jan L Mayes: Well that’s the thing. It’s still painless and it causes distortion. So it kind of made sense for the audiology community. Because we’ve always had people who come in their hearing tests are normal, so everything looks normal. But they’re saying, “I can’t hear, I can’t understand when I go out to the coffee shop or if I go out, you know, with a group of friends and I’m trying to have a conversation, I can’t understand what people are saying.” And now the thought is that because there’s so much noise in our daily lives between community noise and work noise, that there’s this hidden hearing loss happening that causes all distortion for speech and music. And especially in background noise. And so that could be part of what’s happening with a lot of people who look like their hearing’s normal. But it’s really not.

Cary: Somewhere. I saw an article, which really resonated with me. Because I tend to, when I’m talking on my cell phone or listening to music or listen to anything on my cell phone, I use in-ear earbuds. And some article came out recently that said these are the hearing patients of the future. And I thought, you know, that might be true. I mean I turn the volume down a lot more because those earbuds, they seal out everything else. So you’re just piping in just the sound with no outside sounds. But at the same time you don’t know if it’s still not too loud and you might be damaging your hearing. Because you have, I think you had mentioned somewhere that it’s the outer ear actually has a function and you’re bypassing your outer ear I think by sticking these earbuds in your ears. Isn’t that right?

Jan L Mayes: As far as the earbuds go, there have been studies done comparing all the different types of earbuds like the stock earbuds. And the ones that fit a little more deeply and maybe the noise-cancellation and headphones as well. And they found that if the volume is less than 50%, it doesn’t matter what you’re using, it’s going to be safe listening no matter how long you listen. The problem is that there’s no regulations on consumer products. And so, for example, there’s manufacturers that are selling personal listing headphones for kids that they advertise as safe, and they don’t limit noise at all. So the parents have this false sense that, “oh, I’m protecting my children,” which is of course good. And if they actually really want to know which headphones are safe, there’s a website you have to go to. And I make the analogy of airbags in cars. That you know, as consumers we shouldn’t have to go somewhere to find out what works as claimed or what doesn’t when it’s damaging children’s hearing.

Cary: Right. Or to get in the car accident before you find out if your airbag works well or not.

Jan L Mayes: Exactly. Yeah. Like, “oh that wasn’t regulated. And guess what? Your airbags don’t work.” The World Health Organization does have recommended manufacturer guidelines for sound limiting for personal listening, but it’s not mandatory. It’s just a guideline. So unless governments actually say to the manufacturers, “this is what we’re going to require,” that they all have to meet these standards. And then we wouldn’t even have to worry about the 50% or lower volume, you know, they would be safe no matter how loud people were listening. So there’s things like that as a society, I guess people might want to think about. I don’t think it’s fair to children that we’re not protecting them. I think that governments have some responsibility there. Because they’re growing up and having damaged hearing and also damaged health from the community noise because it’s the levels. They’re also way over the World Health Organization recommended limits and as noise control isn’t mandatory in regulations. So what seems to keep happening is that the airports have their noise maps and governments have their noise maps, and so they’re all measuring the noise and everyone’s “oh yes, the noise is too high” and nobody has to do anything about it.

Cary: Apparently not. No. And in fact, I think the number of different noise-making…not just equipment…but this noise-making in general in our environment is on the increase. And this is just my own perception. You mentioned, I think in your book, and this is one of my pet peeves is leaf blowers. You know, the gas-powered ones are horrendous. Motorcycles… construction going on. And another thing that I think is also been happening — and just maybe even in the last 10 years or so — is that the recording volumes of music have gone up.

Jan L Mayes: Apple products…there’s a setting inside where you can set an equalizer. And so it looks at the source sound and equalizes them and you don’t get that soft to loud. That was a pet peeve of mine that I would be listening to my iTunes and one song that’s older is quiet and the next one’s blaring. But once I figured out that equalizer setting, that wasn’t a problem anymore. And I could pick a volume and it stayed pretty consistent. You know, I like watching old movies and old shows and I’m always struck by how someone will be at a bar and they’re having a conversation and there’s no background music playing and even no soundtrack playing. Or I just saw one that was, it was kind of an old show and so everyone would get together, they were dancing and singing and it was all acoustic. And I thought, you know, I think that we’ve lost a little bit of that, of how enjoyable it is just to have acoustic music instead of always having it be amplified. And I don’t think anybody’s checks the settings. So say for restaurants or malls or nightclubs or, I mean that clubs are a bit different because people are expecting it to be loud. But I think sometimes people just crank it to wherever they think is okay.

Cary: And, I think when people started to play music in restaurants, it was ambient sort of music, it’s just so that it’s not total silence, sort of this underlayment of sort of dinner appropriate music. And then it turned into… Whatever is the latest pop song, you know, played at a volume that is better for dance.

Jan L Mayes: All they need is like a little bit of tape or something on the dial to say “don’t turn it past… This.” Usually below 65 would be nice if that for people walking around, below 60 is even better. I guess people don’t stop to think about those things where sometimes it’s just an easy fix of, you know, let’s pick volumes that aren’t going to aggravate people or hurt people’s hearing or communication.

Cary: You know, I was going to a French-speaking group and there’s different Meetups and things where you can practice speaking the language. And so there was one group that was meeting in a cafe. And the problem I had with that was while I might strain sometimes to hear someone when I’m speaking English with people, it was an entirely different thing when I was trying to understand a language that wasn’t my native language in a noisy background environment. I really had a really hard time with it. The extra energy required to hear them, understand them in another language, and process all that and respond to them was too much for me. And I actually stopped going. Background noise really starts to become sort of the foreground noise, and the person talking to you suddenly is just one noise out of a mass of noises, and it’s hard to sort that out

Jan L Mayes: And yeah, and that’s where the quiet communication needs come in. ‘Cause it’s in a few studies lately where they’ve found that people with tinnitus, even with normal hearing do not do as well with background noise as people who don’t have tinnitus. And it is for exactly what you’re describing with understanding a different language and in a noisy place. Because it takes you a bit more time to process it, and they think possibly with the tinnitus that it is a bit of a divided-attention thing. So part of your brain is focusing on tinnitus. You have no control over, that’s your brain is doing that. And so you don’t have as much brain resources left over for when noise is added in as well. If you’re having a quiet conversation, that’s fine. You can focus even though your attention is divided between the other voice and your tinnitus.

Jan L Mayes: But once you add the noise in, that’s one more factor. Maybe it’s a different language. That’s another factor. So there’s, there’s so many different things that tie into communication. But the more unnecessary extra noise there is, the harder it is. And imagine if you have hearing loss or tinnitus or that on top, it’s that much more exhausting, which is why a lot of people with hearing issues are very isolated because they don’t want to go into those situations. And I can’t, you know, you can’t blame them.

Cary: That’s right.

Jan L Mayes: But it doesn’t have to be that loud. You know what I mean? Cause I mean, I’m going to metal concerts and you know, I still go to really loud events, but I protect my hearing. I think the thing that upsets me is when I go places where it doesn’t have to be like that. And the easy option is to turn the volume down.

Cary: And I’ve started carrying insertable filtered earplugs with me on my key chain for specifically for these types of situations. So these silicone inserts like Eargasm. But there’s several other brands, you know, you put them in and there’s this little filter. So a little bit of sound is conversation is still coming in, but it’s not as loud. It’s reducing the loudness.

Jan L Mayes: They’re perfect.

Cary: Yeah, they are actually.

Jan L Mayes: And I think, you know, there’s a bit of debate of whether, you know, some people think the music should be turned off completely, but then in a restaurant or a cafe, like you say, a little bit of noise is nice because then you don’t, or a little bit of music. Because then you don’t feel like people are eavesdropping. It’s just makes a nice ambiance, and you maybe feel like you have a bit more privacy versus the background music is that much louder and then you can’t have a conversation anymore.

Cary: Right.

Jan L Mayes: Yeah. I wish everybody, I wish everyone had a pair with them either on a key chain. I mean they’re supposed to be 12 and up for children because children aren’t supposed to wear earplugs unless they’re prescribed and fit by a audiologist or hearing healthcare professional.

Jan L Mayes: People are often out and about. And then it’s like, “oh, this is louder than I thought that it was going to be.” If I had my little filtered earplugs, I could pop them in. And they’re comfortable and you can still hear to communicate much better than say the old style foam or formable-type earplugs that block out all sound. And they don’t let the voices and the sounds that you really want to hear come through.

Cary: Yes.

Jan L Mayes: Everybody, it needs to have more hearing protection handy because if you don’t have it with you, you’re not going to use it. Here in Vancouver, I always measure anytime I go anywhere and the transit is always above the levels safe for hearing health, even when the cars are about half empty. So that’s not even full rush hour. And, that’s something where it would be good to wear filtered earplugs, but the real solution is to control the noise at the source because they could.

Cary: Well in all cases it would be great if they would control the noise at the source. And we don’t want to let them off the hook by saying, well everyone will just wear earplugs all the time either.

Jan L Mayes: That’s exactly it.

Cary: What should someone do — first steps — to get a proper evaluation and diagnosis of a potential hearing issue?

Jan L Mayes: Well if it’s something that’s sudden onset, like if you had a sudden onset hearing loss or sudden onset tinnitus that is or hyperacusis, that’s more of an emergency type situation. Sudden onset hearing loss definitely should go to the emergency department because sometimes there are treatments that can help bring hearing back if, but only if it’s within a certain window of opportunity. Otherwise seeing the family doctor for a referral, and the audiologists are the main provider. So audiologists are the ones who would be doing the evaluation. And I’m talking about coping strategies if any are needed. Because a lot of people, once they get basic information, that’s all they need to know. They don’t really need anything else. But if they do need something more because of distress, then audiologists are the best care provider to let them know what’s available in their community. And you know, what options that they might want to go forward with, whether that’s the audiologist or not, you know, it might be something they could do for self help. That might be something the audiologist could guide them on. It really depends on the individual.

Cary: Yeah. And more than likely in some healthcare situations, you’d probably have to start first with your general practitioner, depending on your healthcare plan. Probably less of an issue for you in Canada. But here maybe.

Jan L Mayes: No, you have to start … yeah, you can’t get anywhere without a referral.

Cary: Okay. So it’s not like just sit down and get on the Internet and look up an audiologist and just go. Maybe you could do that.

Jan L Mayes: If it was private practice, yes. And some of them, like in Canada…like it’s depending on your age, the family doctor usually needs to do the referral. And if you’re getting treatment for tinnitus or hyperacusis a lot at the time we want to make sure the person has seen a ear, nose and throat specialist or an ENT. Because sometimes there can be something medical going on, and that still needs to be treated and needs to be addressed. And the person, you just want to rule out anything that could be medically treated. But the, the problem that comes in for a lot of people, and I think this is — I don’t think it’s any one country — is that especially if it’s noise-induced or a traumatic type of thing. Where, say, someone went and saw fireworks and now they have tinnitus or hyperacusis or you know, something happened, and now they’re noticing it.

Jan L Mayes: If they go in, if you go and see your family doctor, which is what you’re supposed to do, it usually takes a long time on a waiting list before you get to see that your specialist or the audiologist. And you really want to be able to see an audiologist within a three-month timeframe after it starts. If it’s a sudden-onset starting type thing — because that’s when the treatment can be most effective. So that’s kind of a problem with the healthcare system that people don’t always get to see the audiologist as early as they could because of just wait lists and healthcare costs and all of that. But if people have had tinnitus or hyperacusis for a really long time, it’s still good to get evaluated and see what types of coping tools. Because by the time coping tools came out, say in the 1990s, like I was talking about earlier, I thought, well, “maybe it’s too late for me” because I’d had it since the 1980s.

Cary: Right, and you had a sudden onset, it sounds like. Your situation. Yeah.

Jan L Mayes: And scientists didn’t. Back then they were like, well, you know, the longer you’ve had it, the longer it will take to notice any difference. But there was also, maybe it won’t — maybe there is a time limit, that it’s too late and you won’t be able to cope any better. But I didn’t find that to be true at all. And I haven’t found that true for anybody that I’ve met that ….you know, even if it’s been 10 years, 20 years, however long. If people are interested in really trying coping strategies or approaches and sticking with them for at least three months, you can end up doing a lot better.

Cary: Doesn’t this happen often? Not with a sudden onset, but just sort of a gradual thing where maybe nobody you don’t notice at first that is starting to happen and then all of a sudden you start noticing like, “Huh, do I hear kind of a … ringing?”

Jan L Mayes: And most people — I think about 80% of people it’s not distressing. You know? It’s like, “oh well yeah, there’s that sound” and they carry on and everything is fine. And then there’s that other 20% of people where it is distressing, and it’s affecting their daily life. And that’s where it’s important to know that there are things that people can do to cope better, whether they are mildly distressed or whether they have really severe distress. There are lots of options.

Cary: I think a lot of people, especially older musicians are finding that they have this condition. You know, certainly like when you’re talking about the eighties versus now, or the nineties versus now. It’s certainly, you know, people of the big stadium rock era. A lot of them now are having hearing issues. I think a couple of years ago Huey Lewis had to stop touring and other people have talked about this situation. But I think also now DJs, because deejaying is really kind of the dominant music scene. So I don’t think a lot of DJs were wearing hearing protection for awhile. They will put headphones on so they could monitor what they were doing and mixing on stage. But I don’t know if they were wearing hearing protection. So you know, I’ve seen that there were some deejays who are way younger than the musicians I was just talking about who are already having issues. And it’s probably very distressing to them. And it is interesting that you can still actually hear pretty well but you have tinnitus at the same time. You know, you can hear.

Jan L Mayes: Yeah, definitely DJs and you know, even in bars and nightclubs, the wait staff and the bartenders. And the bouncers not as much because they tend to be either near the door or just outside the door so they have that little bit of distance. But it’s definitely loud enough to cause hearing damage. But those are situations where it’s hard cause DJs are probably self employed. But if they’re not, the employers should be making sure they have the proper hearing protection. And with DJs that would be like a combination in-ear monitor. Plus sound reduction. The last time I went to a concert I noticed a lot of people had their foam earplugs. They weren’t inserted properly, they were kind of hanging out of their ear canals like cigarette filters. But at least they were trying.

Cary: Yeah, they had the idea right.

Jan L Mayes: But the problem is again, if the solid earplugs, without any filter — you can’t communicate and those jobs are communication. So if, if they had filtered earplugs, that would be really helpful. But you need to start using them when your hearing is still normal. Because once you have some hearing loss, it’s harder to use hearing protection because you know, the hearing protection is adding hearing loss on top of what you already have. So it is harder for people who’ve been in an industry longer to find something that’s going to work more easily for them for hearing protection as far as filtered ones. But filtered is, yeah, like I had my filtered ones on at the concert I was at — and I think I saw three other people there out of about a thousand people who had filtered earplugs.

Jan L Mayes: And I just thought, you know, everyone — where are your earplugs?

Cary: That’s scary.

Jan L Mayes: Well and the other thing, and this is a very big issue, but if there was universal hearing health care. Like I tried to imagine what if hearing protection was covered for everybody at the same way that sunglasses can be covered under healthcare? If people have the right coverage, if everybody was eligible for basic hearing protection, that doesn’t mean everybody would get it through the healthcare system. But at least then everybody would have equal opportunity to protect their ears and protect their hearing health and maybe raise awareness more. Because hearing loss — there’s so many health problems associated with with it, from cardiovascular disease, diabetes, dementia higher risks — and those are all really high healthcare costs for those conditions. And if hearing protection could even prevent 10 or 15% of those from the group of people that are having it from noise exposure, that’s a big — the savings would be more than the cost of the universal hearing protection.

Cary: One of the things you said in your book was that you mentioned a number that scientists say that 33% of people who wear something to protect their ears aren’t getting the right kind of protection because it doesn’t fit properly. So how do you know that it’s fitting properly?

Jan L Mayes: For ear plugs, it has to be sealed, kind of like swim goggles. So for foam ear plugs, after I put them in, you have to roll them up super, super small. And it’s a bit harder for people with smaller ear canals, so children or teens and women. And then once they’re in, I hold my finger to let them expand and then I tug a little bit. And if they just come out, they’re not sealed. If they’ve actually sealed, you’ll feel — it’s almost like when you have one of those little cups that you put on a window to stick something to a window. There’s just that little bit of a seal there. So then you know, they’re sealed. And also your voice should sound a little bit different. So you can kind of do a little vocal test for custom molded.

Jan L Mayes: They should fit because they’ve been custom molded to your ear. The filtered ones, they should also. You should feel that bit of a seal around the edges that if you tug very, very gently that they’re seated in there because noise will leak just like water. So you have to make sure that there’s nothing that will let the noise through. And with ear muffs, again, they’re the easiest to fit, but you can’t have a braid, you can’t have your cord of your iPod running underneath the cup. It has to be just sealed nicely to your head without any gaps. And that’s where some people have a head shape where they can’t use ear muffs.

Cary: Or it hurts after a while or something.

Jan L Mayes: Yeah, exactly.

Cary: Yeah. If you wear earrings, it’s uncomfortable to have something pressing your ears against your head.

Jan L Mayes: Yeah. And if the earrings were there, that’s a leak, right. So…

Cary: Oh, you’re right. Actually, unless they fit inside of the cup.

Jan L Mayes: They’d have to be inside. And there are lots of ones where you can actually plug the music directly into the ear muff. And there’s some of earplugs that come that way too. So you’re not hurting the hearing protection by listening to music at work. You can do it safely. And, but another thing that I’ve seen parents do, and it just makes me cringe is they’ll be getting earmuffs put on their kids and they’ll be like, stretch, stretch, stretch out the band. And then pop it on. It’s like you can’t stretch the bands out. You have to keep things the way they were manufactured because …

Cary: Otherwise it’s too loose.

Jan L Mayes: And when people have hearing loss, you can also get amplifiers built into the earmuffs. That was one of the most rewarding things I used to find at work because people would come in with work-related hearing loss. And they couldn’t hear their coworkers, they couldn’t hear equipment sounds that they needed to hear. And so they would try these earmuffs that you just, they work off a battery so you just turned them up, turn them on. It’s like having a safe hearing aid inside the hearing protection and their eyes would just light up. Cause like, “oh, I’m going to be able to hear, even though I’m in a noisy environment at work and it’s still going to protect my hearing.” Again, I think it’s just more awareness, more letting people know about their options. Even for people that have some hearing loss or have other issues going on that maybe needs something a little different than the average person.

Cary: Yeah, good point. One of the things you said — which I really appreciate — in your book was you can still see with sunglasses. You should still be able to hear what you need to by wearing hearing protection. And I thought that analogy was really great. It’s yeah, when you put sunglasses on, you’re not like in a completely blackened environment and can’t see anymore. And the same with hearing protection.

Jan L Mayes: Yeah. You should still be able to hear what you want to hear, whether that’s music or voices. And yeah, it’s not taking away all of your hearing. You’re still going to be able to hear what’s going on around you.

Cary: Is there anything else you wanted to cover about your book or about messages to listeners who have more questions about tinnitus?

Jan L Mayes: Um, well, I, I think that everything that you’re doing is really important. The topics that you’re discussing and like you say, there are different groups and people that are trying to share the information about tinnitus and hyperacusis and hearing health and noise. Because even though a lot of tinnitus and hyperacusis isn’t preventable, there’s a lot that is. And you know, I always feel if there’s anything that I could do to stop someone from getting it in the first place, then the book has done what I hoped that it would do. And I guess, and I just hope that people are interested in learning some of the science with it too, because it’s hard to talk about these things without talking about science. And talking about noise levels and that type of thing. And it might seem a bit complicated at first, but I really believe that anybody can learn about noise if they’re interested and learn about tinnitus and hyperacusis and how to protect their hearing health and how to use coping strategies.

Cary: Yes, I think so too. And I, and I think that just putting this book out there, it’s available also as a Kindle edition and I know it’s for sale on Amazon.

Jan L Mayes: Yeah. And Barnes and Noble, Kobo, it’s also on some subscription services. So it’s on Scribd, Playster and I can’t remember the other one. But it’s also available through library services, so Baker and Taylor, Biblioteca. And there’s another one as well. So if people are interested for their local library to get it, they can certainly request it because — a lot of people, that’s the type of thing that you want to find at the library. It’s something that’s helpful. And you know, I want it to be accessible for people for free as well as for people that might want to have it in their own book collection. So it’s available — the paperback is only available at Amazon because I can’t find anywhere else to print it. But the ebook is at the different bookstores.

Cary: How can people learn more about your work or contact you. Through your website or…?

Jan L Mayes: Through my website is probably the best choice. I’m also going to be doing some more volunteer work for the Right to Quiet Society who, um, are working to have noise abatement and control in our communities and to help protect people’s health. But I have information on that at my website as it goes along. And I’m also thinking of maybe doing some education modules on some of the noise issues that I couldn’t really get into in my book that were more noise than tinnitus/hyperacusis. And I also have Twitter: @janlmayes. So that ‘s a good way too, but probably my website is the best first stop.

Cary: And that is Mayes, M. A. Y. E. S.

Jan L Mayes: Yes. it’s Jan….. yeah, janlmayes.com

Cary: Great. Well, thank you for joining me on the Soundproofist podcast today. It’s been wonderful talking to you. And I hope more people get out there and read your book.

Jan L Mayes: Yeah, thank you very much.

Cary: You can find the “Tinnitus Toolbox, Hyperacusis Handbook” by Jan L. Mayes on Amazon. And if you have any questions or comments about this episode, send me a note through soundproofist.com. Thanks for listening.