Cutting out the noise

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An annoying ringing in the ears is a symptom that has prompted many people to visit a health-care provider. Constant noise such as ringing in the ears, or even whistling, buzzing, chirping, humming, roaring or shrieking are symptoms of a condition called tinnitus. It is the perception of sound that originates in the head as opposed to sound coming from a source in the person’s environment.

Tinnitus is a common condition often detected in people who have been exposed to extremely loud noise. According to the Hearing Health Foundation website, tinnitus is the leading service-related disability among veterans at the U.S. Department of Veterans Affairs (VA) Medical Centers. In 2017, there were 1.79 million disability compensation recipients for tinnitus, and 1.16 million compensation recipients for hearing loss. Members of both civilian and military sectors, especially those working in high-noise occupations and conditions encompassing the music industry, factory workers, miners and construction crews are susceptible to this disorder that can range from slightly annoying to incapacitating. In military members, those having experienced post-blast trauma can also have trouble understanding speech, while scoring normally on hearing tests.

Dr. Libba McMillan, associate professor at the Auburn University School of Nursing, has both a personal and professional interest in helping patients increase their quality of life following diagnosis of this condition. Additionally, McMillan has a passion for equipping health-care providers in understanding their vital role in getting the patient the help needed—such as determining when referrals to audiologists are necessary, obtaining further diagnostics (MRI), knowledge of resources available and techniques to assist with patient management of the bothersome symptoms.

“Training in tinnitus management is either non-existent, inconsistent or minimal across all health-care disciplines,” said McMillan. “Clinicians are ill-prepared to offer evidence-based tinnitus service.”

As the spouse of a retired Air Force F-16 and A-10 fighter pilot, McMillan understands firsthand the debilitating effect of tinnitus. “It was personal for me,” said McMillan. “Last year, my husband suffered a host of psychological and physical symptoms related to the severe, intrusive condition of tinnitus, and expressed frustration in the lack of options provided by the medical community. The unabated noise prevented him from having a high quality of life." A nurse educator and a practicing nurse since graduating from Auburn’s School of Nursing in 1983, McMillan sought out resources to help her husband. “I started searching for information that could help his condition; if not a cure, at least a way to manage the symptoms,” added McMillan.

Her diligent research and passion to find solutions to help her spouse led to a life-changing conversation with the leading researcher in tinnitus, Dr. James Henry, senior research career scientist at the Veterans Affairs Office of Rehabilitation Research and Development in Portland, Oregon. Henry invited McMillan to collaborate on creating a “toolkit” for multidisciplinary health care professionals to understand and function in their roles to help veterans manage tinnitus. Their article, recently published in the Journal for Nurse Practitioners, discusses this multidisciplinary approach to tinnitus care. The article includes a case study of a veteran with tinnitus and follows the patient through diagnosis and treatment; it also includes strategies for understanding the patient’s perspective.

“The patient’s journey begins with the need for accurate information about the realities of tinnitus management from health-care  providers,” she added.

Determined to bring awareness of the condition to health-care providers, she organized a conference, held in March 2020, that included vital information for caregivers, patients, health-care providers and those researching the process of managing and providing tinnitus care.

In addition to research with tinnitus, McMillan also has presented work at international nursing research conventions with Dr. Joy DeBellis. This research centers on a pilot study in a collaborative partnership with the Alabama chapter of the American Legion, one of the oldest Veterans Service Organizations (VSO) in the country. McMillan and DeBellis’ study examined the role of sleep on the quality of life and health among veterans.
During the evaluation of the veteran populations in their pilot study, McMillan and DeBellis discovered that tinnitus symptoms were highly correlated with sleep difficulties.

“Including tinnitus management strategies with sleep hygiene interventions could help alleviate the insomnia symptoms,” added McMillan.

"It is an honor and privilege to work with our veterans, military and family members. Their bravery, courage and sacrifice for the country secured our nation’s freedom. It is important for us as citizens and health-care providers to help improve the quality of their life,” said McMillan. “Being able to help patients and their families experience and enjoy the best health possible—at any life stage—is why being a nurse for the past 37 years has been such a joy and a privilege.”

Auburn University is a nationally ranked land grant institution recognized for its commitment to world-class scholarship, interdisciplinary research with an elite, top-tier Carnegie R1 classification and an undergraduate education experience second to none. Auburn is home to more than 30,000 students, and its faculty and research partners collaborate to develop and deliver meaningful scholarship, science and technology-based advancements that meet pressing regional, national and global needs. Auburn's commitment to active student engagement, professional success and public/private partnership drives a growing reputation for outreach and extension that delivers broad economic, health and societal impact. Auburn's mission to educate, discover and collaborate drives its expanding impact on the world.