But please read these articles carefully and critically first!
Long article: download recommended
Just reading your advice on tinnitus seems to have reduced my ear noise by 50 percent and I am less worried about it . Is there any cd or tape package that would enable me to train myself at home as my visit to an ENT consultant for help and advice proved unsatisfactory I have only had tinnitus for about 15 months.
I am so please to read this! Many people have had similar experiences. The article is a simple form of retraining in itself!
I have read the revised website and the diagrams were very helpful. I now understand that
persistent tinnitus depends on a conditioned response in the subconscious part of the
brain and TRT aims to break that response. I also understand what you mean by "music
of the brain" its the sound evoked by the background electrical activity in every
living cell in the hearing pathways( until now I found this very confusing).I do have
three specific questions:
(i)In your e-mail of 29/9/97 you said "The WNGS are SECONDARY ..."What are WNGS?
white noise generators, previously called maskers
(ii)Could please you clarify the role of the conscious mind in breaking the conditioned
response.
learning real meaning of T
believing Jastreboff model
listening to T
not reacting to it, reducing dislike, trying to encourage 'friendship'
all on a daily and increasing basis
(iii)Do the hair cells in the cochlea produce background electrical activity?
yes, healthy hair cells are part of the
auditory orchestra
Once again, thank you for your previous advice, it has been most helpful and reassuring.
Just over a month after my tinnitus came on I now feel that it has established itself,
however this does not give me any huge concern, as I feel in a much better condition to
cope with it. This is because the hyperacusis, which disturbed me more, is now
considerably less unbearable. I believe that this is so for two reasons:-
1. The initial shock has now subsided and the panic cycle triggered by certain noises has
lessened.
2. I have forced myself to confront those noises which distressed me the most (sudden,
loud noise and high-pitched electronic noise) within as safe environments as possible, and
in doing so have regained a lot of confidence in my ability to cope with day to day
sounds. I am concerned about achieving the correct balance between being over-cautious and
over-ambitious in the future, and would welcome your advice as to how I can gauge this.
Specifically, I would like any advice as to how long it should be before I consider
returning to work (I work in a busy office with 18 'phones in it). I appreciate that I am
not your patient and that medical ethics probably require you to refer me back to my GP.
However, my recent contact has been highly unsympathetic and her comments have indicated
an almost total lack of understanding of my problem. Therefore any general
guidelines/reference material would be most appreciated. Thank you for your time spent
helping me, it is very much appreciated.
General quidelines are, when you feel up to it, and noise isn't triggering
exacerbations of tinnitus. Work with the TRT approach and gradually introduce more sound
into your environment. The problems of unsympathetic professional help are very
widespread. Hopefully wider information about the Jastreboff model of tinnitus will lead
to a less dismissive attitude evntually.
I have been suffering from persistent tinnitus in my left ear since January this year.
Tests carried out at the Alexandra hospital in Manchester have shown that this is
associated with a slight loss of hearing in a narrow band at about 6kHz. At the end of
June, I obtained a white noise generator from Withington Hospital in Manchester, which I
am using below the noise level of my tinnitus, as was suggested by my audiologist, rather
than as a masker. I was still under the impression however that although the white noise
generator MIGHT decrease my awareness of tinnitus over time, there was little or no chance
of it ever being eliminated. I was therefore greatly encouraged when I read in your web
pages that complete elimination of the tinnitus (you quote a 20% success rate) is a real
possibility, and a significant improvement almost certain (90%). However, you point out:
"Although using white noise on its own can give some temporary relief from tinnitus
discomfort, unless it is combined with the retraining approach, there is very little
chance of permanent relief. Information and teaching and demystification about tinnitus
and tinnitus mechanisms are the most vital parts of the therapy."
Is it therefore true that if I undergo a more thorough TRT, then I will greatly increase
my chances of experiencing habituation? I have gained much information from your articles
on the web and from talking with my audiologist, but is there more to it than that?
Looks like you've done it! Important not to plug, makes things far
worse. Desensitise with WNGS. under proper supervision with local help.
Use advice on website too
At 15:49 02/10/97 +0000, you wrote: I have just read the web page on this subject and
suspect that I may suffer from either phonophobia or hyperacusis as I find noises in my
open plan office that do not bother anyone else hard to bear. I have had to resort to
finding either a spare side room to work in or using foam ear plugs. How should I go about
seeking a formal diagnosis? Thanks,
You've made the diagnosis! See our explanation on the web pages. Plugging
makes things worse. Desensitization is the answer, but it must be approached
gradually.
Dear Dr. Hazell, I am extremely pleased to have found your tinnitus pages. I feel
reassured since reading them. It all makes good sense to me. Since reading about your
research, and retraining therapy, in a newspaper a while ago, I have been rather less
concerned about my tinnitus, although I still don't feel that great about it. Still, I
have stopped worrying so much, and consequently it no longer bothers me as much. I have
asked my doctor to refer me for retraining therapy to the clinic at St. George's Hospital
in Tooting. However, as we are in Streatham, my doctor apparently does not 'have an
account' with this hospital, which is annoying. I am pursuing it however, and expect I
will get there in the end.
Thanks for you vote of confidence! People in the UK are having difficulty
with health-care, which is being rationed in this way. Continue insisting on a
correct referral. Eventually more hospitals will be providing the service.
Dear Dr Hazell, Thank you for your very kind reply, on reflection certainly the phobic
state applies exactly to my first experience of tinnitus when I started being bothered by
it after a concert I attended very shortly after having a breakdown. Certainly I have been
terrified of loud sound ever since and the current increase in loudness judging from the
model would be due to that great fear. The tinnitus did diminish temporarily for 24hrs
during which I was greatly relieved but it has returned again louder - probably sparked
off by stress. At least I understand what is going on now and that gives me great hope. I
have the opportunity to regularly fly to London, if I wanted to receive treatment there
who or where would you recommend I go? Many thanks
Im sending you details of local services. Understanding and 'demystification'
of tinnitus is the first most important step in TRT.
Thank you very much for referring me to your article and to prof. Jastreboff's work, this
makes a lot more sense than anything else I've read. At the moment I am waiting for
appointments for stress counselling and diet, however I don't really believe that they
will be of any considerable benefit to me. Could you tell me where my local/closest
tinnitus retraining therapy centre is that my GP can refer me to, without going outside
the NHS. Thank you once again for your time.
There isn't anyone really close to you at present, but working with the information
on these pages can help you a great deal. Stress counselling is useful in
learning how to control 'autonomic' or body reaction to tinnitus, but permanent
changes in tinnitus annoyance and awareness only come through retraining.
I am 40 years old and have had severe tinnitus since I was 25. I do have a high pitch
hearing loss and have hearing aids for that, but I only wear mainly the left one, when the
tinnitus becomes unbearable.
Straining to hear with unaided deafness promotes tinnitus. One aid, which
makes hearing asymmetrical is also bad for tinnitus. The auditory system
works best when there is symmetry. It seems that it is worsening with time and I have
concerns for my "golden" years. I am considering the retraining therapy offered
here in the states at the University of Maryland with Dr. Jastreboff more every day! I say
that with reservation because I am aware that I will have to wear both hearing aids for
maybe two years every day. That alone causes me distress (exacerbating my tinnitus!)
because they are quite uncomfortable.
most likely cause: badly fitted or wrong aids, or no proper instruction. This
is something that the Maryland Tinnitus and Hyperacusis Centre will sort out
first.
I am married with no children and really have no one that I can relate to on this
subject. People who don't have this condition cannot possibly perceive what I experience
and that's perfectly understandable. In light of that I would love to communicate with
people who do know where I'm coming from and who have developed a positive way of life for
themselves. This kind of encouragement is vital for tinnitus sufferers. There are times
when I'm in quite a lot of "pain" and could use the support from someone
knowing. I'm not looking for sympathy, I'm looking for compassionate encouragement. I do
hope you or someone you know might be able to direct me to support groups either online,
via telephone or group meetings in my local area of Miami, Florida,U.S.A.
Centres practising retraining therapy do understand the problems of tinnitus
distress. However TRT is not just about support and sympathy, that is what is
offered by 'coping strategies'. Retraining actually produces changes in the part of the
brain concerned with enhancing, or amplifying tinnitus signals. This results in a
gradual reduction of annoyance from tinnitus, and eventually less awareness too
(habituation of reaction followed by habituation of perception).
Hello Dr. Hazell Thank you so much for your prompt response from yesterday. There's one
thing I'm confused of: What's the difference between a Masker and White Noise treatment ?
I know a masker is supposed to mask (away ?) your tinnitus (during time).
Our first attempts to help tinnitus in the 70s, pioneered by Prof Jack Vernon
in Portland, involved 'masking' Tinnitus. If you couldn't hear tinnitus because
the masking noise drowned it, it didn't distress you. However, not being able to hear
tinnitus stopped the process of habituation (a gradual reduction of annoyance and
perception of tinnitus).
Also only 40% of people could actually achieve masking, and it only worked
while you were doing it. Also many found the masking noise was so loud as to be
intrusive, or even interfere with hearing. In TRT we need to hear our tinnitus in
order to retrain to it, but white noise therapy (or sound enrichment) reduces the
impact at a stage when it is impossible to bear. Sound therapy also helps to
speed up the changes we are trying to promote in subcortical auditory pathways
(called increasing plasticity). The instruments we used for masking are similar,
often identical to the white noise generators. Its only the way they are used
that is different.
I appreciate if you could help me again with some practical advice on my tinnitus. I last
contacted you in December of 1996. Since then, and after carefully reading all of the
Tinnitus WEB articles - which I strongly trust in - I've had quite a long, peaceful period
with my Tinnitus since then (Dec. 96).
> hurrah!! That's great.
> There have been some ups and downs but I basically have learnt to cope with it,
accepting its presence. My basic belief is that once you get to CONTROL something - as
dreadful as it can be - rather than 'it' has control of you - you're in good shape. I'm
not I've learnt to 'master' my tinnitus but I've learnt to accept its existence. However,
for the last 2 weeks there has been a new factor in my tinnitus - it has to do with
'squeaky' noises (high-frequency). Hearing such a high frequency tone sometimes gives me
an immediate irritation (or discomfort). I'd like to pinpoint though that if this sound
keeps repeating itself - I have no problem with it - it's just the initial sound that
causes me discomfort, as if the ear is somewhat tuned to hear the next occurrences of this
sound without any actual problem, whereas the initial sound is 'kind of a surprise'. Is
this something to be defined as 'Hyperacusis' ?
absolutely, and those who have, or have had tinnitus are more likely to
experience this. Remember mild hyperacusis (e.g. chalk on blackboard) is
cultural!
If so - and even if ain't so - what's the best way to cope with this irritation ? In other
words, is there a way for me to do something to NOT being irritated by these noises ? I
know I shouldn't be plugging my years to avoid these sounds, and that's precisely what I'm
doing, i.e. even though some sound causes me a discomfort, I'm not running away from it
but continue to listen ! Is this something that supposes to help ?
similar technique as tinnitus. Face the object or your irritation and remain calm
and unruffled. Reaffirm that the sound cannot harm you, the discomfort is your
reaction to it, it based on fear. Gradual reduction in your anxiety about the
MEANING of the sound results in habituation taking place. This usually has to be
combined with sound therapy from white noise generators, under appropriate
supervision. Plugging must be gradually and carefully abandoned.
At 11:53 21/08/97 +0000, you wrote: I'm rather surprised that there is no acknowledgement
of the possibility of the inner ear being the source of an actual signal.
You missed it!! ANY neuronal component (active nerve cell) in the auditory system
can (and probably does in each case) contribute to the phantom perception we call
tinnitus. In Meniere's disease the cochlear component may be more important. But it
doesn't matter what the source of the signal is or what caused it's initial
emergence, TRT works just the same.
The gist of what is presented on your web site is that there is no particular physical
malady or malfunction of the inner ear. This is contrary to an article published in
Scientific American several years ago where researchers simply stuck a sensitive
microphone in tinnitus sufferers' ears and detected a very well defined signal emanating
from the inner ear.
Lynn Penner's work in Washington on spontaneous acoustic emissions shows that
they have little to do with the majority of cases of problem tinnitus. These emissions
are most common in children where tinnitus is rare (though definitely can occur)
and mostly absent in those over 45 years of age which is where most of our
tinnitus patients are.
Being a tinnitus sufferer for 16 years now, I would appreciate more comprehensive
discussions on the topic. It strikes me that it would be very easy for you to confirm the
above research. If, indeed, there is something to it, then a physical solution seems more
appropriate than "retraining therapy". At any rate, I am glad to see something
on the WWW to review. Thanks.
Well we chased the 'physical solution' for nearly 15 years without any
results!
I read in a local paper that there is a significant percentage of severe tinnitus
sufferers who eventually commit suicide. Is this accurate? Are there statistics? What
percentage of tinnitus sufferers are predisposed to clinical depression?
It's the other way around. Tinnitus is often a symptom of long standing severe
depression, which can unfortunately sometime result in suicide. Although tinnitus
can make depression worse, it never results on its own in suicide. There are studies
supporting this. Many people feel suicidal from time to time about many things
(including tinnitus) but few if any, of them would actually be at risk. Most of
the press reports have been sensation seeking and inaccurate .
After reading your web-page I have a better understanding of this "ringing" in
my ears. I have been to my GP and he seems to think there is nothing wrong. I thought I
had a brain tumour in the back of my head, at the base of my scalp. The noise seems louder
when my neck hurts. However, I now think because my neck hurts it stresses me more and the
noise gets louder. The ringing started when I started taking Zoloft for menopause
symptoms. I thought it was a side effect of the drug. Anyway, I stopped taking it due to
other side effects, but the noise stayed. The noise is almost gone when I first wake up in
the morning, but gets louder off and on during the day. I am now sure it is due to stress.
Thank you for your information. I am much relieved.
You have made a correct analysis of the situation and got better as a result.
Well done!
At 10:10 17/09/97 +0000, you wrote: My hearing was tested 1 yr ago and showed some loss of
hearing at higher frequencies and my tinnitus was moderate. Since then the tinnitus is
somewhat worse and I will have my hearing tested again soon. Is my high frequency loss
related to my tinnitus or vice versa?
Although tinnitus is about twice as common in hearing impairment, it is not
really the cause. As many people have tinnitus with normal hearing, as have total
deafness and no tinnitus! Neither does tinnitus 'mask' hearing causing deafness,
although it often seems like that to people with loud tinnitus, and a hearing
loss due to natural ageing.
I heard your talk to Dr Swain on Australian radio recently with great interest, as this
phenomenon has (tinnitus) occurred to me in recent months. It may be connected to the fact
that I retired last Sept.
most likely, many people are ill prepared for this trauma!!
However I noted that experiments were done on mice using aspirin to induce tinnitus. I
take Cardiprin for angina which of course is aspirin-based. Do you think this may be a
causative factor? Would be interested in your comments. Thanks in any case for a very
informative and reassuring talk
No I don't. You were taking it well before the tinnitus started. Small doses
used to stop blood clotting don't affect the ear adversely.
I recently suffered a severe case of tinnitus. I was unhappy with the treatment I received
and decided to find out more for myself, so I accessed the tinnitus t-FAQ. I am now
utterly convinced that I have had a low-level Tinnitus since I had an ear infection in
1979.
Yes, but so what? It wasn't a problem then, was it? Ask what made it a
problem. The ability to HEAR T is universal...see the Heller and Bergman
experiment. the problem is the aversive conditioned response to it. This
can be reversed by retraining.
I received audiometric testing at the time, unfortunately, the results are not on my
records and the child health department have now shredded their notes. However, since
adulthood, and going to noisy pubs, gigs etc., I have suffered from panic attacks in these
environments, specifically associated with the number of different noises, as well as the
volume. The most extreme example of which has had me almost punching my way through the
crowd. This is only one of many reasons why I now believe that I have "coped"
with tinnitus for so long. I am also exceptionally emotional, I cannot remember a day when
I have not either been reduced to tears or reduced myself to tears in some way, most days
this happens more than once. It is as though I cannot stop myself, once I start crying I
then calm myself down again, however, the feeling will reoccur until I feel that I have
sufficiently resolved whatever has made me emotional (it can happen equally if I am happy
or sad). I now see that this is a possible indication of tinnitus. I have approached you
as you specifically mention the direct effect between cochlear and emotional response in
the brain.
Could you :-
a. Confirm that this is not all in my head, and that I am not going mad.
with pleasure!! you are not going mad, but yes it is in your head, and so are
your ears!. The point is tinnitus is a real perception, but generated in the auditory
pathways as a result of 'faulty processing' or 'over compensation' by the auditory system..
b. Consider me for referral to your clinic, subject to my health authority agreeing the
funding.
Sure, speak to your GP
Can TRT be helpful even with noise induced hearing loss(NIHL)???
TRT works regardless of trigger or reason of tinnitus
I have worked around jet aircraft for the past seventeen years and of late my Tinnitus has
been getting the better of me. I feel as if I need to do something now. I have
moderate-bad NIHL for which I attribute my Tinnitus to. Can you please provide any helpful
information?
The majority of those with NIHL do not have troublesome tinnitus, so the
cause of this is due to way you think about it / evaluate it
My current ENT specialist is trying me on Tegretol 100mg but that appears not to be
helping. After reading your article TINNITUS PERCEPTION, HABITUATION AND RETRAINING
THERAPY i feel we are barking up the wrong tree with drug therapy. I have booked an
appointment with an Audiologist, is there any special questions that I need to be asking
them? Thank you for trying to make things better for us sufferers.
I'm glad the articles made sense. If your audiologist knows about TRT, or if
you take copies of these articles, you could discuss your tinnitus management and
hearing loss with him/her.
I have what appears to be temporary tinnitus in one ear from being near a gun being fired.
My doctor gave me frightening advice that if it did not start to get better in three days
it was probably permanent.
I hope you both understand the importance of negative counselling in
establishing tinnitus as a continuing experience. This kind of advice is what starts the
anxiety and sets up the aversive conditioned response, just like training someone
to respond to the sound of a motor horn when they cross the road.
I have had tinnitus for five years and it consists of about 8 different sounds. I enjoyed
reading the article on habituation..the concept makes sense and it is actually an
"attitude" oriented idea in which the tinnitus is no longer an enemy.
You're absolutely right, but its difficult for people to take on board when
they have just started experiencing loud and frightening tinnitus.
You wrote that you have been doing research for 22 years. Im sure you get asked this a
lot, and i shall ask again..if, in the future, something which is actually a
"cure" is found, what area so you think it will come from....surgical, with
lasers, or drug wise? I am really curious about getting into an area of the body that
small and delicate, although i have noticed that eye surgery, which is just as complex,
has had some great strides recently.
If you understand / believe that the main problem is a conditioned behavioural
response to a weak natural signal, coming from the brain, there is always going
to be a need for a behaviourally based approach to treating tinnitus. That's what
TRT is. It is not to say that medical and surgical treatment may not be indicated
in some cases in addition to TRT, or that we will find drugs, and other
therapies, which will speed it up. However changing beliefs about tinnitus is the central
part of TRT, and I can't see how drugs or surgery can do that.
Thanks for continuing the research.
I had been noticing a hearing loss--or thought perhaps that I wasn't hearing as well as I
should. I went to the Dr. (specialist) yesterday and discovered I did have hearing
loss--unknown causes. They kept asking me if I had any ringing or sounds in my ears. I
wasn't sure what they meant until I got home and later that evening read an article on
tinnitus in the local paper. I was shocked to find out that everyone didn't have the
background type noises that I have in my head. I think I've had it for a long time and am
already adjusted to it. No problem sleeping or anything. Is there anything I need to watch
out for?
PLEASE don't!!! Nothing is worse or more guaranteed to give you a problem
that concentrating and monitoring this natural background sound. The ability to
hear background noise in the ears or head is universal (see Heller and Bergman
1953 reference on my site) The large majority of people who have developed
anxieties, or even phobias about tinnitus, have got this from listening to
negative counselling from professionals and others who don't know what the real
mechanism is.
Many thanks for accepting my telephone call from Cape Town. The `home page` answered
several questions. I would, however, appreciate a reply to the following additional
questions, please.
Brief history:
1 Age 50
2 Tinnitus for 6 weeks, in left ear
3 Consulted with GP and ENT specialist
4 Audiologist report indicates drop in high frequency
5 Awaiting `white sound` masker/ noise generator
6 Sleeping tablets for nocturnal peace taken
7 Anti-depressant tablets have also been prescribed
Questions:
a) Touching left temple exacerbates problem. Is this indicative of anything?
happens to 99% of those with tinnitus. Many trivial activities can evoke small
changes in PERCEPTION. (Not only of tinnitus)
b) Is tinnitus cause of `4` or result of it?
associated with it. There is only a 2 times increase in likelihood of
developing tinnitus, but the hearing loss (probably normal for your age anyhow) is
irrelevant. This means 70% of those with your HF hearing loss DON'T have tinnitus
c) Problem developed after changing to new TV set (6 hours of daily viewing) could this be
cause of problem?
I don't think you really believe this, specially after reading the articles. This
is part of the process of looking for 'physical causes' . As many people with tinnitus
('aversive reflex response to brain music') get aversive to external sound
('hyperacusis') many environmental sounds may change / aggravate the PERCEPTION of
tinnitus. The point is that it is all entirely harmless, just like spiders in
aracnophobia.
d) Could consulting with a neurologist help?
Only if you need reassurance about worries of neurological disease. Neurologists
generally don't undertake treatment of tinnitus.
Thank you again
I read your articles with much interest. What they say is totally different than what I
have been told over the years. that is to say the ear specialists seemed to think it was
from an inner ear problem maybe a virus--Never could pin it down One ear specialist blew
my eustachian tubes open twice, another one put ice- water in my ears to cause a spinning
sensation, another gave me diuretics, etc. Never any help. It started while I was sitting
in a lawn chair one day in July 1959 and never has stopped. Sometimes it will be a little
quieter and other times very loud. If I get nervous it will become louder it seems. Of
course quiet rooms are out. I have to have a radio or tv on in order to go to sleep, or
the ringing will drive me crazy! It is a very fine high pitched ringing and believe it or
not it pulses to the beat of my heart. I can count my pulse rate by counting the ringing.
When it first started, my hearing was very sensitive to high pitches. If a bus put on its
brakes and there was a high squeal, I would have to cover my ears. Over the years I
believe that my sensitivity to high pitches has become less pronounced. I have just
learned to live with it and never mention it to anyone as they look at me as if I was a
little "odd" to be hearing head noises. I will say that about a week or two
before this started in 1959, I had been taking swimming lessons at an indoor pool. I had
been learning to dive and apparently dove into the water and made a sharp upward curve. At
that point I seemed to hear a crack and when I broke the surface, everything looked like I
was looking through gray smoke. I swam to the edge of the pool and hung onto the side till
it cleared.... it took just a short while till my vision was clear. A week or two later is
when the ringing started. Maybe this incident is purely coincidental. I'll never know. In
any event, thank you so very much for putting my mind at rest that there is another cause
other than an inner ear problem. It is nice to know after all these years of wondering. I
am 65 years old now and it really does not matter, I am so used to the sound. I honestly
do not believe there are any physicians in this part of the U.S. who believe in your
theory.....at least I have not heard of any in Florida. My thanks to you for these
informative articles.
Amplification of 'the music of the brain' and the creation of an aversive
response to it is the problem. Naturally what the 'specialists' have
told you made this reaction worse, rather than better. As the aversive response
is something akin to a survival reflex, you cannot (unfortunately!) expect a
sudden extinction of it. Otherwise we could suddenly ignore the sound of
a motor car horn when we cross the road! However, gradual RETRAINING about the
real meaning of tinnitus, will do this. The experience you describe is
of gradual automatic habituation, particularly of the reaction to tinnitus. It
has taken a long time however, and retraining can speed this up enormously.
I was given a TV set recently which seems to have a bad transformer which emits a
very high-pitched noise ... very much like a combination of a sizzle and a squealing.
Anyhow, it leaves me with a residual ringing in my ears for several days afterward.
(1) Have I permanently damaged my ears?
absolutely NOT. but wrong belief about this can lead to continued symptoms
(2) Is the TV set harmful to my hearing?
if it was they could not be sold. There is nothing special or different about
your ears, only the way in which your brain is currently processing sound
information
(3) Is there a correlation between the TV set's "noise" and tinnitus?
5 frequently. This is because aversive reflex responding to one sound will
produce an aversive response to another SIMILAR sound. It doesn't matter if its
the TV on the one hand, and the brain's music on the other.
PLEASE comment so at least I'll know what to do about the TV set!! Many thanks,
At 16:28 08/08/97 +0000, you wrote: Hi, I have just finished reading (very carefully) your
article on hyperacusis. It seems as though hyperacusis is partially a psychological
disorder (?)
I don't like the word 'psychological' I think 'auditory processing disorder' better
describes it. It depends what you think psychological means. Certainly
it isn't just an 'ear' problem. But some people think the word 'psychological' is
a bit abusive, as if one ought to be able to 'snap out of it'.
My friend is GREATLY disturbed by noise of all kinds. He wears earplugs all of the time
and if he goes without them he feels his heart pounding and seems to become very stressed.
He can not maintain concentration when he is studying even if the only noise is whispering
; he seems to have no selective hearing. He says that all noises disturb him both mentally
and physically. He states that even as a child he could not tolerate noise and in school
would take his desk outside the classroom to complete his work in quiet.
this sounds like a fairly well developed phonophobic state. He does need
help, TRT is just the thing! Try working with the web articles. They really
explain more of what you need to know.
We have been wondering about his problem for some time. Could the shape of the external
ear influence his perception of sound?
no this is really on the wrong track
His external ears lack the " hooked " part; on the top of the external ear the
part which folds forward toward the face , exterior to the flat cartilaginous section. If
you have time to respond to this it would be appreciated.
The external part, or pinna, does have a function in collecting sound and
helping with directional hearing (as well as being decorative).
However it has nothing to do with tinnitus or hyperacusis, which is 'beyond the innner
ear'
At 16:27 08/08/97 +0000, you wrote: Hello: I have read your web article on
hypersensitivity of hearing and find it fascinating. I am 61 years old and have always had
an intense, terrified, avoidance reflex to certain sounds, in my case explosive sounds but
not necessarily harmfully loud ones. Fireworks and Champagne corks produce the same
response. I do not mind sounds similar to these such as thunder, jet planes, demolition
equipment, etc. It's as if the sound has to have certain specific elements, unidentified
at present, to affect me. I have always assumed I have a phobia, but after all these years
of every kind of phobia therapy imaginable, with no (or very little) effect, I think maybe
phobia treatment is not the answer. Your article comes very close to describing my case,
but it is not exact, as you can see; I do not respond this way to all sounds. And
desensitization has not worked.
I have made an appointment with a doctor for two weeks from today because recently I have
been told that perhaps I have a hearing problem instead of a phobia. I'm hoping the doctor
can refer me to someone who can help. In preparation, I am trying to learn about
alternative (to phobia) theories. I'd appreciate any additional information you can send
that might help me and the doctor sort through this. Thanks.
Tinnitus is a word describing a sensation of sound coming from inside, just
like pain or cold describes what you feel. So you can't ask someone
else! It is not a diagnosis, nor is it generally associated with distress (read
the Heller and Bergman paper - ref on the site). I think you need to read the
articles more carefully (and more frequently) to be completely familiar with what
they say..this is part of the treatment, actually the most important part.
One you understand that tinnitus is a normal phenomenon and not a disease,
you will avoid becoming phobic about it. The text books simply describe the
experiences of the minority group who take that path!
At 09:05 10/07/97 +0000, you wrote: I have been aware of a constant hissing in my right
ear whenever it is quiet for approximately seven months, it would seem to have become
slightly louder over that period. I have not been aware of any particular anxiety,
depression, etc. as a result of the noise and seem to be able to hear normally. I am
concerned to establish whether this is tinnitus or could have some other origin. I first
became aware of the problem shortly after undergoing a hip replacement operation. I found
your article on the net extremely helpful and would like to establish whether this is
tinnitus and whether I need to take any action. glad you liked it! I think
you are beginning to see the importance of other external factors in the emergence of
tinnitus. The persistance of tinnitus results from the negative beliefs that stem from our
misunderstanding of the tinnitus mechanism
At 18:16 01/07/97 +0000, you wrote: Very, very interesting article. I've was recently
exposed to a high level (175+ dec.) which has resulted in louder tinnitus for me. I've
never heard of the new information you have in your article. I was recently told by an
audiologist that the ringing was due to nerve damage. Where can I find treatment, that you
propose, in the Seattle Washington, USA, area?
I have been searching for some answers to an unusual (as I understand)
tinnitus/hyperacusis problem for the past year. Your article Hypersensitivity of Hearing
has been the most relevant information I have come across yet. I hope that with your
specialized knowledge you might be able to help me where the audiologists, ENT's, and
physicians I have consulted have not. I have tinnitus in my right ear that sounds like
rushing water. The unusual thing is that it only occurs as a response to outside sound. It
first occurred when I was practising my violin, and then gradually (over 3 years) occurred
more frequently until the sound of my own voice was enough to trigger it. As soon as the
outside sound stops the tinnitus dies away as well. When I was reading the part in your
article about recruitment and "sounds above 80 db not only uncomfortable but liable
to produce distortion" I was very excited because it was the first reference to what
I am experiencing. Do you think it is possible that I do not really have tinnitus, but the
sounds I am hearing are a distortion of incoming sound?
this is a very common problem specially with musicians; the same subcortical
filters which cause tinnitus and hyperacusis are used for learning 'automatic
playing'
I have very slight hearing loss in that ear but I am interested in your theory that it may
not be permanent damage to the cochlea that causes hypersensitivity but rather a
processing error somewhere in my perception of sound. If this is the case I am interested
in the possibilities of retraining therapy. I appreciate your time in reading this and
hope you can send me a response. I am a classical violinist, 27 years old, desperately
seeking answers as my life and career are in the balance.
we have a long list of successful musicians who have returned to work Whatever
you do don't give up your career until you've been through retraining.
At 08:07 16/06/97 +0000, you wrote: Dear Dr. Hazell, Congratulations on an excellent web
page. Hyperacusis is a problem I encounter infrequently in my practice but with enough
regularity to appreciated your contribution to the subject. I am curious to know the
procedures used to verify the patient's complaint of hyperacusis. Using traditional
audiological test batteries, I have not been successful.
Rock concerts are specifically mentioned in the web pages. Ringing tinnitus
is extremely common after concerts, but disappears in everyone after 2 to 24
hours, provided you haven't 'got the wind up' Fear that you have done damage
to the ear creates a conditioned response which makes the hearing cortex monitor
its own internal sounds. It is essential to understand that the music of the
brain is harmless. This is quite separate from the understanding that
repeated exposure to over loud noise will eventually reduce hearing (with OR
without tinnitus), so care should be taken.
At 14:12 11/06/97 +0000, you wrote: Hello !!! I`m 23 years old and live in Norway. I have
been playing drums for about 15 years (though almost always with ear protection), and I
now find myself in a position where I have to avoid any loud sounds because of my
tinnitus. I have read a lot about tinnitus, but can`t seem to find answers on diagnosis or
treatment possibilities for my kind of situation. I know that I got it from being a
musician, my hearing nerves being over-exposed to loud sounds. I`m in perfect shape
besides the tinnitus, I even have perfect hearing on all different ranges. So I am very
interested to hear if there is any way I can get rid of the problem, or at least reduce
the effect of it. My doctor, the ear-specialist, told me to just avoid any sounds over 40
db, to prevent it getting any worse for as long as possible(!!). I have tried several ways
to approach my life as a Tinnitus affected person, and I`m now using a musicians ear plug
in my left ear (which is the most damaged one), and a little bit of cotton in the other
ear. This makes me able to keep the Tinnitus down at it`s normal acceptable volume in my
everyday. I get to hear the sound while i wear this though, but I don`t mind as long as I
know what happens if I don`t. I know from experience that the volume increases when I`m
exposed to loud noises as going to the disco, or a concert (with very good silicone plugs
though), or if I don`t wear anything`at all in normal situations like the sound of
traffic, washing the dishes, watching TV at normal volume etc. It really doesn`t seem like
my ears can stand anything before the level increases. This gets back to the normal state
after using the plugs all the time for a while. So therefore I have made my decision to
wear them always. My worries lies about the future. I`m really scared if I`m going to have
a large problem later in life, so in a way it already is. So I hope you could be so nice
to try and give me some advice, suggestions and information based upon what I have told
you about my situation. I have read several places that there is help, like surgery,
hypnosis etc. I have even read about a revolutionary new surgery method to deal with the
problem for good. It was an article in a highly respectable scientist magazine in Norway,
called " Illustrert Vitenskap". The plot was that during researches in the USA,
they had used a brain scanner they use to locate epileptic attacks with on epileptic
patients, to locate the place in the brain the ringing manifested itself. And then using
laser surgery to remove it, and it was a success. I haven`t heard about this method since.
So I`m willing to do what takes to improve my condition. I would be ever so grateful if
you could give me some answers, because my specialist here in Norway gives me no hope
whatsoever of getting better, but I don`t believe him.
It such a shame the advice you have been given is so wide of the mark, and
has only made you more anxious. Proper ear protection while playing loud music
can allow a career in pop music, without fear of deafness or tinnitus. 40dB is a
ridiculously low value, quieter than normal speech! The information
about brain scanners and zapping the area of activity is fictitious too. TRT does
it without any expensive or dangerous surgical treatment.
I read your article with interest. I have had tinnitus in the left ear for over ten years.
In 1998 I had an acoustic neuroma removed which rendered that same ear completely deaf.
Would retraining therapy be likely to assist in this situation?
yes, we have shown it works well in cases of total unilateral hearing loss especially
when combined with a CROS hearing aid system. This device takes sound from the
deaf side to the hearing ear, and often fools the brain! consult your audiologist
about this. Acoustic neuroma is very rare, but causes enormous anxiety in many
patients being investigated. Remember at least half those with acoustic neuroma
have no tinnitus, or no change in tinnitus after surgery.
I am 57 years old. Two years ago the speaker in my church had feedback that was extremely
painful to me and after that my ears rang for a long time. Then things got better, but I
noticed that I had a slightly increased sensitivity of hearing. Then the speaker had
feedback two more times about six months apart. Each time my sensitivity got worse. Now
birds chirping bother me.
Your paper has convinced me that:
Normal sounds cannot hurt me.
I can be trained to tolerate normal sounds.
It may take six months.
I probably don't have damage to my cochlea.
I don't need ear plugs, except for loud sounds.
Since I live in Kentucky can I train myself by just taking my plugs out and gradually
learn to accept normal sounds or do I have to go through a long extensive therapy to bring
myself back to normal? I doubt that you need it! I think you're half way there already!
Good luck!
It's really interesting how, once people understand the mechanism of tinnitus, they can
work out the treatment, almost by themselves.
Finding your clearly written documents on the internet was like a breath of fresh air for
my wife after a visit to a conventional specialist who left her with such gems as,
"It might be there the rest of your life." Fortunately she's only had a problem
for a few weeks, so approaching it with a new attitude will be a great help. Thanks again.
I'm delighted they were helpful. Tinnitus distress is so often created by the
people who ought to be helping! As one of the helpers, I feel very bad about
people who have this unnecessary experience
I have not fully read this article yet, but before I read the print out I just made, I
must tell you this page is excellent! I am enormously thankful that someone has taken the
time not only to research and write on the issue but has put it on the web for someone
like me who has questions to be less in the dark, as well as have the tenaciousness to
break from the mainstream in places where they feel those theories are outdated. thank
you,
and thank you for your feed back, info is really what patients need! I have
some ideas for some TRT 'excercises' and Ill put them up soon
At 17:20 08/05/97 +0000, you wrote: I was reading the information on Tinnitus Retraining
Therapy. It good to see an approach that helps people with their problem of Tinnitus. If
you would be so kind as to explain something I read that may seem not to agree with each
other.
You sited an experiment that cause tinnitus in people who listen at a sound at a low noise
level. The tinnitus noise generators are set at a low noise level below the tinnitus
sound. Is there a conflict here?
No. Sound enrichment by WNGs, or FM radio or anything, AVOIDS the Heller and Bergman
effect. That's why we recommend it! The contrast between extreme silence and tinnitus is
avoided. Auditory systems work on contrast and change of signal. As noise generators are
very constant (unlike an outside noise source that changes with head movement)
they are often more effective.
Would it hurt to listen to a FM radio set between stations at a low sitting to aid in
sleeping? Any additional information would be most helpful and appreciated.
just fine! no need to listen, the auditory system gets the message
subconsciously, even during sleep.
Your theories on tinnitus emergence/persistence/distress are extremely well presented.
Pawel Jastreboff's! not mine
However, they appear to be based on a model of normal tinnitus emergence which we have all
experienced at some time or rather (eg. in a quiet room or after loud noise, etc) which
goes away after a period of time. The difficulty comes in applying this model to someone
who suddenly jumps from a normal tinnitus experience to a severe tinnitus experience,
which may or may not be linked to a specific event. Whilst many would accept that 'low
level' tinnitus is something many people will experience at various times, or if they
listen for it, persistent 'high level' tinnitus is a totally different experience which
does not fit the Heller and Bergman 'experiment'. Surely, this can not be considered
normal auditory function? Is it possible to experience aberrant sound which deviates
significantly from that which may be considered 'normal'?
high level is not just 'perceptual loudness', its principally the increase in
distress caused by tinnitus. This relates to the emotion response from outside
the auditory system. The subjects in the Heller and Bergman experiment heard exactly the
same sounds as tinnitus sufferers
TRT seems to be based upon resetting 'filters' (neurologically speaking) so that they do
not transmit tinnitus messages to the hearing cortex. This would seem quite feasible in
cases where the tinnitus generation is within 'normal' limits or due to normal ear
function. However, does this theory hold true for those who's tinnitus generation far
exceeds normal limits?
this is just a very common expression of belief failure...well it could work
for someone who was moderately affected, but not for me...I'm so much worse!
We only see the very worst patients which are referred from all over the
world and the results we are describing are on these patients. Not at all people
who are 'mildy' affected by tinnitus. It works for all of them. The 'normal'
people you describe often don't need formal TRT, just one session of information.
You indicate that Pawel Jastreboff has discovered the 'mechanisms' of tinnitus. In general
this would appear to relate to 'weak' electrical signals coming from the inner ear or
brain. There is a strong suggestion that the signal generation is weak in all cases of
tinnitus and part of the natural mechanism of the auditory system. Is this true and what
evidence do you have to support this view? Are you saying that the tinnitus generator is
always weak and it is neurological conditioning (opening of filters due to tinnitus
distress) which makes the tinnitus perception louder? If so, I can see some difficulty
convincing those (myself included) that the sudden onset and persistence of very loud and
intractable tinnitus is no different from 'normal' tinnitus experience by many people from
time to time. You're right there is often considerable difficulty, that's why TRT
has to be performed by well trained, knowledgeable professionals who can take the
time that is needed. Once you believe in the existence of a 'volume control' in
the central auditory pathways (think of response to your own name in a nearby
conversation) then it is a small step to consider that the nob can be turned
quickly or slowly.
We do have experimental evidence that the tinnitus source is extrememly weak, indeed very
difficult to detect even with sensitive equipment
In summary, I find your views on this subject most encouraging and offering hope for the
future. I will certainly be promulgating your information to our members and to the
various associations we have with the medical area. Hopefully, you will be able to respond
to the above questions and I look forward to further developments in TRT.
Hi, your research sounds excellent, and your theories make a great deal of sense to me. I
was hoping you could answer my questions. I'm 27, an audiologist has pronounced my hearing
normal. I have played music in loud bands since I was 16, but have been wearing some sort
of hearing protection since I was 18(too often just cotton, but in the last 5 years actual
ear plugs. I've noticed tinnitus off and on since I was 13, but it wasn't a problem until
last year. I stopped playing loud music and now play moderate level music(easy to shout
over and be understood).
QUESTIONS:
1)My concern is that the tinnitus will get louder with increased music exposure, will it?
Even though I wear hearing protection. Your research seems to say no, but so many others
say yes.
No reason why it should, if you protect against further noise damage. T can get better
during this period with retraining
2)Will an untuned FM radio work as a low level white noise generator? I'd like to try your
retraining method, and a white noise generator seemed a key factor.
Yes it can help. Main thing is to avoid silence, but do not use noise that
will intrude. Sound therapy is NOT the key factor, but the second most important
element after demystification.
3)Will hypnotherapy help in the retraining process?
It may well speed it up, but will needs proper execution. We are looking into
this presently.
I am 50 years old and recently notice a ringing/static type noise when I am in a quiet
room or at night in bed. After reading your article, I have this novice theory. Three
months ago we had a border in the house that I didn't trust and his coming and going at
odd hours had me listening for strange noises. I think the anxiety and intense listening
could have aggravated my situation. It is only a minor concern at this time.
You're not a novice at all! Its an excellent example of how the auditory
system tunes in when we are looking for danger. Relax, and stop worrying about
it!
Greetings and salutations. I have a couple questions obviously, however they may have been
answered in the frequently asked questions part but I missed it.
First of all I have a constant ring in my ears and have dealt with it the last four or so
years that I have been aware of it. I've seen a doctor and have been officially diagnosed
with tinnitus. He showed on a frequency chart where my hearing has a dip in it. If you
follow my description. Question.
1) If your new description of what tinnitus is and its causes then explain why when I am
exposed to loud noises my ring in my ears nearly doubles?
Loud noise does temporarily exacerbate tinnitus in some people. It usually
means you need TRT in a recognised centre.
2) Does it also mean that I will become hard of hearing more premature than otherwise?
No there's no evidence for this. Our tinnitus patients have the same hearing profile
as the normal population (pulished work)
At 09:16 14/10/96 +0000, you wrote: Dear Dr Hazell, I did reread the article you suggested
and I do understand this possible hypersensitivity The other sensitive area I wanted to
repot was 8 year ago I began PROZAC and it was very successful treating my dizziness and I
can't remember if I still had the tinnitus when I began the therapy. I went off one for
about 15 days 5 years ago and started getting the dizziness and possibly the tinnitus
back. Another time I switched MDS again and again had problems and went back on Prozac.
This time I went off for one month and went on Wellbutrin. 4 weeks into it I woke up in a
panic because of a silent strobe light fire alarm going off in my hotel room. I began to
panic and hear the buzzing noises again. I have started Prozac again and I am praying that
it will again help me to desensitise. Right now I have extreme Anxiety and depression. I
have suffered from depression, Anxiety and OCD. Any thought would help a great deal
The way to look at things is that tinnitus is just a barometer of your
emotional state. As you get more threatened by events so the tinnitus gets
louder. Taking Prozac, other antidepressants and tranquillizers essentially just
sweeps your lifetime of problems and anxieties under the carpet, for a while. You
need serious long term help from a proper counsellor or psychiatrist to sort
these out first. Often blaming the tinnitus is like shooting the messenger who
is the bearer of bad tidings. I know Im not offering you a simple solution to
your problems, because there isn't one, but try and recognise what is the cart,
and what is the horse. Good luck!