Jonathan
Hazell replies to your emails: July 2001
Hey!
My name is Jason and I'm 18 years old. Four days ago I had a firecracker
detonate close to my ear and a ringing sound emerged and to this day, is still
with me. The last few days have been rough on me. I was actually feeling sick of
my stomach worrying over whether or not I was going to have to live with this
ringing for the rest of my life. Luckily I found your website and it's helped me
tremendously! I still have the ringing but after reading
your page I am now not seeing the ringing as a threat to my life and sanity.
It's amazing how much our perception dictates how we feel and respond to
the trials we are put through. Anyways, I just wanted to thank you. I do have
one question however, I believe you when you say that the ringing is from
natural bodily causes, but how did a loud explosion enable me to perceive
it like I am now? Thanks again for your help...I now feel like living
again.
Great news! If everyone had done what you did there
wouldn't be ANY problem tinnitus about. The
answer to you question lies in the difference between emergence and
persistence of tinnitus. The sequence is
a) Firecracker experience produces temporary (protective) changes in inner ear
which result in tinnitus emergence (just like 'disco
tinnitus')
b) You become alarmed that you have damaged your ear. If this was a disco
experience it would be 'normal'.
c) You start to generate an weak aversive reaction to the sound
d) the tinnitus persists because of tuning of subconscious filters
e) you get the right information and your aversive
reaction begins to weaken
f) you don't feel so bad because your not reacting
to T as before
g) when you completely get rid of your reaction T
will gradually disappear or
only be noticed if you listen in a quiet environment (no one is encouraged to do
this!!)
h) don't forget sound enrichment. Everyone should be doing this!
I am 32 years old, I have tinnitus and often get feeling of pressure in the ear (one or other) which causes me more of a problem than the tinnitus itself. One doctor said I had Eustachian tube problems, another said it might be Ménière's disease. My hearing is normal and I don't have any vertigo. What might this be?
This could easily be due to Tensor Tympani syndrome. The original article on this condition is available in the download area (as it is now out of print). A small muscle in the middle ear is attached to the ear-drum via the malleus bone. The muscle contracts normally if the face is touched, or air is blown on the eyeball. It seems to be equivalent to the blink reflex for the eye, but now no longer useful as a protective reflex for the ear. The appendix is an example of another body part that has lost its use due to time passing. Nevertheless the muscle often does contract if we are tense and reactive (perhaps due to increased autonomic activity in tinnitus or misophonia). Sometimes it can 'flutter' like having an insect in the ear, or give a feeling of drawing the eardrum inwards (which it does!). While the symptoms can be worrying and distracting, contraction of this muscle is harmless, and a common occurrence in the general population. Worrying about it makes it worse, just like tinnitus! The symptoms always improve as the tinnitus or misophonia improves following TRT, or simply with reassurance. Eustachian tube dysfunction, common in children, is very rare in adults nowadays. It can be excluded by a simple test (impedance eudiometry). Ménière's syndrome is also very uncommon compared to tinnitus and misophonia on their own, and is often wrongly diagnosed.
Many tinnitus clinics often say
that TRT is not meant for everyone. Could you clarify what they mean by
this?
They may not understand what TRT is, or haven't been trained to do it, or they are not committing themselves. Consequently they get poor results, and excuse them by these remarks. TRT is suitable for everyone, regardless of trigger / cause. Check if the person treating you has been on a recognized training course. Patients with severe untreatable psychiatric disorders, those who do not share a common language and those involved in litigation over their tinnitus are the only exceptions in our practice.
Is
TRT benefit quicker if a person has tinnitus of only a few months duration
compared to a person having tinnitus over ten years, for whom TRT may take
very long time for relief.?
No.
All results surprisingly show no relationship to the length of time T has been
present. However severity of the aversive reaction is a factor
Have
you treated persons for tinnitus and hyperacusis who developed these problems
concurrent with the onset of encephalopathy (inflammation of the brain)?
Does such a patient present any unusual challenges or resistance to TRT?
No, not unless intellectual function has been severely compromised. Once again the main message is, TRT works regardless of the trigger or cause
I
have bi-lateral hearing loss: one ear may be affected by Autoimmune Inner
Ear Disease since 1997; the other, 19 years earlier, was a sudden
deafness, perhaps vascular. Besides
having roaring tinnitus, I often hear music. I've been told that this is
an "auditory hallucination" & have also heard of "auditory
imagery". How can I establish whether I have this condition &
what is the treatment, please? I've also read that hearing music can be
caused by a problem with the temporal lobe
.Auditory
imagery it is! (Goodwin,
P.E. Tinnitus and auditory imagery. Am.J.Otol. 2:5-9, 1980. is well
worth reading) We treat it successfully with TRT. You will not find a
lot of knowledge or support in 'mainstream ENT'
I agree that Dr Oliver Sacks had some patients with temporal lobe disorders
who were immortalized in one of his excellent books, but he went on to conclude that all cases of 'musical tinnitus' were
due to this. I've
seen hundreds of cases of auditory imagery with not one tumour!!
I
read about the Jastreboff model most days and before sleep at night, I practice
the desensitization exercises, as this is when I feel most relaxed. I can
sometimes make the tinnitus disappear.
However, we live in a quiet country house of some 8000 square feet and
it is impossible to avoid silence. I feel afraid of going into quiet rooms. I
also do a very silly thing as well - (if I haven't heard the tinnitus for a
while because I've been listening to the radio etc) I'll go into a quiet room
specifically to determine whether I can still hear the tinnitus ! Then I become
all panicky and worried about it ! I understand that my tinnitus is not
threatening to me in any way but I still have this automatic reaction. How
should I approach this ?
It
is really interesting how people do this – almost to try and frighten
themselves! It also shows that
tinnitus doesn’t have to be loud to be feared. You should equip each room with
sound enrichment devices. The fact that your are controlling your tinnitus is a
very encouraging sign. This means that temporarily at least you are able to
reduce your reactive (automatic) reaction. If you carry on with the ‘10 second
exercise’, you will gradually habituate and block, first your fear of
tinnitus, and then the perception itself will weaken. Remember that hearing
tinnitus in a very quiet room is completely normal (Heller and Bergman 1953 -
download area)
Are
you using sound enrichment continuously during the night? Also this is
the time to do the 10 second exercises
Don't wait! I hope you have been absorbing the Jastreboff model over this time from the website, and also doing the habituation exercises. However you need to check in with an audiologist or ENT, trained in TRT for 1:1 treatment
TRT like all therapies involving behavioural retraining cannot be subjected to double blind, or even blind analysis. It is impossible for the patient or researcher NOT to know what is being done, and to whom. We have compared similar treated and untreated groups over time (and shown a difference of 70%!) but this is not a controlled trial. This means that those who want TRT to fail, will always claim ' nothing is proved ' because double blind trials have not been done. TRT is only TRT if it is correctly used. Many people claim to be doing TRT but just do 'a part of it' e.g. use wearable sound devices. I am sure that Rich Tyler will make his best and most unbiased effort to show how effective TRT is compared to other treatments..
You
bet there is a good news scenario. The problem is that most user groups, and
even self help groups, are moaning clubs, giving aversive and phobic training - which
makes everyone worse. Also the information given by many
professionals is still 10 years out of date (pre Jastreboff).
Population studies show that 85% of those experiencing tinnitus, never develop, or
spontaneously habituate the aversive reaction.
Of the remaining 15%, 80% can achieve this habituation with TRT
within a year (see our results and those of our graduates).
The rest can get there, but take a little longer. The message is that, now,
no one needs to suffer indefinitely. TRT doesn’t depend on the trigger or
cause, so everyone is suitable for this treatment (see above).
Tinnitus can be aggravated by any cyclical activity
or sudden change in the brain or body including migraine. During a migraine attack there are
major changes in brain blood-flow, which can produce quite dramatic, temporary
symptoms. Most people also find
migraine unpleasant and stressful, so there are changes in the reactive
mechanism (autonomic and limbic system) which cause tinnitus distress. The majority of those who have migraine
do not have tinnitus associated with it. Also many tinnitus sufferers have
migraine which is unconnected. Both migraine and tinnitus are very common, and
common things commonly occur together without a connection. Understanding
migraine doesn't explain tinnitus, but for some people control of migraine can
help their tinnitus. TRT works whether migraine is present or not.
If you haven't investigated migraine treatment and symptom control in the last
10 years, be ready for a pleasant surprise!
I
suffer from tinnitus, my daughter has just returned from Australia after a
three-month visit. Whilst there she picked up a leaflet by Rafaele Joudry BSW
"Sound Therapy Music to Recharge your Brain". I have visited the web
site and the product seems to be very expensive, also they say you have to read
the book for the method to work. Please advise if you have heard of this method
or any independent information on this method and its viability.
Treatment with sound without supervision can make patients worse. Treatments not based on the Jastreboff model, are not recommended by us. The cost sometimes indicates the motives of those promoting such devices. Also patients need to be treated in different ways, after appropriate diagnosis (the Jastreboff Categories). Please read the information on our website, with treatment recommendations based on a scientific understanding of tinnitus mechanisms. It will cost you a local phone call!
1. I would like to know why some people with tinnitus are not bothered by it.
They do not produce an aversive conditioned response. The same thing is true for spiders, some people are aversive, some people keep them as pets
2. I understand that tinnitus is perceived by the brain as a new sound for which it has no memory pattern to match it to and therefore treats it as a threat,
No. You don't do this to every new sound you come across. only a very few. It depends on the meaning of the new sound, whether you react to it or not. The question is ' is it a friend or an unwelcome guest '. Those who are aversive to tinnitus (or spiders) find it hard to believe that the majority don't react as they do. But that's the truth!.
why then does it not affect everyone in the same way as surely everyone must have the need to match any tinnitus to a memory pattern. Also, why is tinnitus still bothersome even if you tell yourself that you are not going to let it trouble you any more?
Because once you have an aversive conditioned response in the subconscious you cannot turn it off. You cannot tell yourself to cross a road without paying attention to motor horns (ever!).
3. If TRT can train the brain to no longer be bothered by tinnitus would it ever be possible that by using TRT you could actually have a side effect such as making the brain less bothered by other sounds which are vital to survival - e.g. car horn?
No. Sounds that mean real life threats are never habituated. In TRT what you are doing is learning that you are WRONG about tinnitus. It is not a threat, simply a natural sound that the brain makes (in everyone - Heller and Bergman 1953)
4. After a programme of TRT do you know if any patients have ever had tinnitus returning in a different form (eg hissing instead of the ringing that they originally had the TRT for) for which they would then require further TRT?
Yes it has happened, on a few occasions. The subsequent tinnitus would only persist if a NEW aversive reaction were generated (new fears, new anxieties, new annoyance). The good news is that if you have once learned a skill (in this case TRT) it is much easier and more effective to apply on a second or subsequent occasion, than it would be if you were learning to do TRT from the beginning. So you simply start off, at once, applying TRT as you did before. Many people who have had the experience of tinnitus returning after successful TRT are able to do this without professional help.
I thank you in anticipation of any answers that you may be able to forward to me.
Good questions, but you don't yet fully understands the Jastreboff model. Without that knowledge TRT doesn't make sense.!!