Hyperacusis TRT Protocol

I wonder if anyone could explain me this please? I would also like to ask @Dr. Nagler for his opinion:

1. If there are wearable sound generators used in TRT, what is the difference of their use between tinnitus and hyperacusis? Is it a constant volume for tinnitus and gradually rising volume for hyperacusis?

2. If there is both tinnitus and hyperacusis present, are these addressed separately in two TRT "rounds", or is it one TRT "round" where the both are addressed? But if so, what is addressed first?

Thanks!

 

If you really think you have hyperacusis I personally would be careful of any loud sounds from anything including TRT.

 

The TRT protocol for hyperacusis does not involve exposure to loud sounds.

Dr. Stephen Nagler

 

How TRT deals with Hyperacusis then?
Is this something you can explain in more details?

 

I have it. I know it may make no scene, but sounds that are not loud enough to hurt a normal person does sometimes make your condition worse. It has in mine case.

 

TRT addresses hyperacusis with its Category 3 protocol. The counseling for TRT Category 3 and the use of sound for TRT Category 3 are well-described in the literature. A google search ought to lead you right to it.

Dr. Stephen Nagler

 

I didn't say that sounds not loud enough to hurt a normal person would not aggravate hyperacusis. I said they wouldn't cause auditory damage.

Dr. Stephen Nagler

 

In TRT the counseling strategies and the use of wearable devices are dictated by TRT Category. Your TRT clinician would be in the best position to provide you with specifics.

One "round," but the hyperacusis is addressed first.

Dr. Stephen Nagler

 

thx, i initially read about it here:
http://www.tinnitus.org/

but i though there was more to it

 

There is. A lot more.

Perhaps you'll need to dig deeper. But I really do not want to be involved in a discussion of the specific protocols for each of the five TRT categories on the board.

Good luck with it.

Dr. Stephen Nagler

 

Thank you all for your answers.

 

@Dr.Nagler

Just to make sure, when you say auditory damage. Does this mean it wouldn't cause a permanent worsing of your tinnitus?

 

The premise of your question is worth considering for a moment, my friend. If you want to be "sure" about this and that, you have absolutely chosen the wrong affliction.

What I am saying is that it is highly unlikely that a noise not loud enough to cause auditory damage will cause a permanent worsening of your tinnitus.

Dr. Stephen Nagler

 

Hyperacusis (and tinnitus) is auditory damage even if you can't meassure any hearing loss. Are you following the current research?

"Charlie Liberman and Ann Hickox have examined whether noise-induced cochlear neuropathy is key to the generation of hyperacusis or tinnitus. Their recent work with animals has shown that a neuropathic noise exposure can cause immediate, permanent degeneration of the cochlear nerve despite complete threshold recovery and lack of hair cell damage."

"Liberman described how the synaptic ribbon fibers connecting hair cells to the auditory pathway can be damaged even though the hair cells survive and – more importantly – how this type of damage is typically not detectable with normal auditory tests. It is probable that some hyperacusis patients have this type of neural damage in the cochlear hair cells and such damage contributes to their hyper-responsivity to sound. "

From: http://hyperacusisresearch.org/explore-our-research/hyperacusis-research.html

What exactly are the evidence that normal sounds won't hurt us with H?

 

Well, it's hard to prove a negative, but my thinking is that hyperacusis is curable using desensitization strategies. I don't mean just treatable or manageable. I mean curable. And it's hard for me to see how a sound of, say, 80dB could cause permanent auditory damage to an individual one day but not cause any damage at all two months later - if all I did during those two months was initiate Dr. Vernon's pink noise protocol or Dr. Jastreboff's Category 3 protocol.

Dr. Stephen Nagler

 

Yeah, I get what you mean. I just find all this so confusing. After almost a year of suffering from H, I've been doing so much research on the internet and still I am confused. To me it seems like there is two camps of opinions. One who, like you and other who is from the jastreboffian school, believe that it is fixable through desensitization. The other camp does not believe this and are pretty convinced that desensitization don't work, like the people at hyperacusis research and many of us sufferers.

I mean, I don't know what to believe. Many people claim that they have been treated and even as close to cured by desensitization (TRT for example), but still no doctor or scientist can explain how and why this is. They can't explain or prove on a scientific level what the physical effect is. That really bugs me. Couldnt it be possible that Dan and Rob over at the H network, werent cured by TRT at all, and just by time and luck? But they believe that TRT cured them?

And yeah, I have fluctuations in my H so I get what you mean by a sound hurting one day, but not another day. Even though my H is always severe, those few moments when a sound that usually hurt doesnt hur gives me hope that it is fixable.
I don't know how much knowledge you have about H, since you don't have it yourself but have you ever successfully treated severe cases like mine?

 

@lapidus, it is indeed confusing. And I don't pretend to have all the answers. But before I accept research that goes against my own understanding and clinical experience, that research has to be compelling. I would consider the work you cited more along the lines of preliminary.

One of the problems is that DST (Decreased Sound Tolerance) includes more than just hyperacusis. So there is a fair bit of misdiagnosis going on.

As to your last question, the answer is yes.

Dr. Stephen Nagler

 

Can you explain these protocols in more detail?

 

That's is a very good point @Dr. Nagler .

I just realized I posted this question twice, apologies for that!! But thank you again for both comments. I agree with what @lapidus said, and I guess I was just feeling a bit of confusion as he was as well.

But that comment that you made helped give a little comfort and relief while I wait till I get into the clinic.

Ps: I will definitely make sure to give your regards to Glynnis Tidball when I get into St Pauls. It makes me glad to know that I will be getting help from someone who I am guessing you trained regarding the TRT course

 

@kmohoruk, I didn't train Glynnis. We're simply in the same field, and I respect her work.

Dr. Stephen Nagler

 

Oh Ok! My apologies Dr. Nagler. That is really great to hear then, and I look forward to hopefully meeting and working with her when it comes to my treatment.

 

Should we with T and H not be protecting our ears to a greater degree than say a person who has a healthy auditory system? There seems to be a lot of confusion as to when to protect, and also, when you might be overprotecting. I personally don't mind the pain normal sounds may cause (it hurts but I can push through it most times), my main concern is causing additional damage and a permanent worsening of T and H.

Thanks
Telis

 

No, not in my opinion. On the other hand, I have long observed the tendency for people with healthy auditory systems to underprotect!

I like Dr. Jack Vernon's rule of thumb in that regard: If you find yourself in an environment such that you must raise your own voice in order to be heard by a person standing next to you, then you should either leave or use ear protection. But that holds true for people with healthy auditory systems as well.

I myself am not a great fan of pain. I would rather see a person with hyperacusis undergo any of a number of desensitization protocols (pink noise, TRT, etc.) to normalize his or her LDLs (Loudness Discomfort Levels) so that the pain issue no longer plays into the decision process.

Hope this helps.

stephen nagler

 

Yes it does help, thank you.