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The presentation offers practical information on the application of auditory brainstem response (ABR) in the diagnosis of hearing loss in infants and young children.
This course series will review the latest in the clinical applications of auditory electrophysiology principles and testing, from ABR to cortical responses. This course is a compilation of questions and answers on the clinical applications of auditory electrophysiology.
The Hearing and Tinnitus Center of Dallas-Fort Worth is dedicated to minimizing the effects of hearing difficulties, whether it be hearing loss, tinnitus or sound sensitivity disorders including hyperacusis and misophonia. Misophonia is an adverse, spontaneous reaction to a specific sound or sounds which is thought to be mediated in the limbic and autonomic nervous systems. Evaluation includes a comprehensive hearing evaluation, immittance measures and Otoacoustic Emissions Evaluation, extensive history review and patient interview as well as completion of extensive questionnaires for the patient and family members.
Tinnitus, most often described as a ringing or buzzing in the ears, can be a disturbing condition that robs a person of much of the joy and tranquility of life. Misophonia and Phonophobia are defined as behavioral reactions to sounds which may or may not be physically loud, yet cause a strong physical and psychological response. The New England Tinnitius and Hyperacusis Clinic is the first center of its kind in the Northeast. All audiologists working in the New England Tinnitus and Hyperacusis Clinic are certified graduates of accredited graduate and post graduate audiology programs.
Our tinnitus clinic has effectively treated tinnitus and sound sensitivity patients with a success rate of over 80% using  TRT or tinnitus retraining therapy. Misophonia is the more challenging to treat because of an overlay of a psychological component. However, we have been effective in helping children and young adults from university students, children with autism, Downs syndrome etc. It was nasty (that’s loose audiology-speak for 110 dB or higher), and I immediately wanted to get away, but there was nowhere to go. This series is comprised of 4, 1-hour webinars that will review the fundamentals as well as provide new updates and case examples, in order to present evidence-based best practices for both new and experienced clinicians.
The course is designed for audiologists who have experience with the tests discussed (ABR, eCochG, and cortical applications), and wish to gain further understanding including special applications.
Tinnitus sufferers are often told to “just not think about the tinnitus.” Those with hyperacusis or misophonia may be misdiagnosed and mismanaged. For each patient we begin with a detailed case history and a diagnostic audiological evaluation. Hyperacusis can make even the simplest activities impossible due to the anticipation of how ordinary sounds will be perceived. This is followed by tinnitus pitch and loudness matching, loudness perception, and otoacoustic emissions tests on an as needed basis. The faint noise generated by the TRI is barely audible to the wearer and does not interfere with normal communication. Through the New England Tinnitus and Hyperacusis Clinic, tinnitus is no longer something you must learn to live with, it is something you can conquer. If they purchase a pair of hearing aids, you'll receive a $50 Stop and Shop Gift Card or a 6 month supply of hearing aid batteries! Bothersome sounds could be chewing, utensils, clicking sounds, tapping, crinkling of paper and more.

The presentation reviews current applications of electrococheography (ECochG) principles and procedures in assessment of children and adults. For others, however, the persistent sound of tinnitus can continue to be disruptive and stressful. Since then, he has held clinical and academic audiology positions at the University of Pennsylvania School of Medicine, University of Texas School of Medicine-Houston , and the School of Medicine at Vanderbilt University.Dr. While we normally consider it a rare event to see a patient experiencing hyperacusis, recent surveys suggest that the prevalence may be higher than we think. These prevalence studies, however, can be muddied, as the definition of true hyperacusis is somewhat varied. To complicate matters, we now frequently hear about other sound tolerance pathologies such as phonophobia, misophonia, and selective sound sensitivity syndrome, known as 4S. He is the author of over 120 journal articles, monographs, or book chapters, as well as the Handbook of Auditory Evoked Responses and Audiologists’ Desk Reference Volumes I and II, the Handbook of Otoacoustic Emissions and the forthcoming two volume series Handbook of Auditory Neurophysiology. His distinguished 40-year audiology career began with his days in Houston, with extended stays in following years at Vanderbilt and the University of Florida.
He also is Adjunct Professor in the Department of Audiology at Nova Southeastern University, and president of James W. The consulting corporate headquarters are located in the quaint village of St Augustine, Florida, with offices tucked away in the loft of a renovated 1907 Victorian home in historic Lincolnville, where Jay has an E800 Bekesy and a copy of CC Bunch's Clinical Audiometry at his side for constant inspiration.In this excellent article, Dr. Hall walks us through what is known about hyperacusis, and how it differs from other sound tolerance disorders. Misophonia is a distinct irritation or dislike of specific soft sounds (Jastreboff & Jastreboff, 2013). The phrase Selective Sound Sensitivity Syndrome or 4S is used by some to describe the same phenomenon, but the term misophonia now seems to be preferred among audiologists.I should add that hyperacusis, or some form of decreased sound tolerance, is more common than you might suspect. It’s a reaction to and avoidance of certain sounds that involves anticipation, anxiety, learning and conditioning.
A diagnosis of phonophobia has psychological implications for assessment and management so the term is falling out of favor among audiologists who evaluate and treat patients for hyperacusis. Assessment includes questionnaires, inventories, and special history forms in addition to hearing testing. The inventories and questionnaires provide valuable information on the nature of the patient’s decreased sound tolerance and its impact on quality of life.
Tools like the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996) are also used for patients with hyperacusis. Decreased sound tolerance, and especially hyperacusis, may be a symptom of a variety of central nervous system disorders like depression, migraine, post-traumatic stress disorder, Tay Sach’s disease, Ramsay-Hunt Syndrome, and multiple sclerosis, to name just a few. I should also point out here that hypearcusis is sometimes cited as an adverse effect of certain prescription drugs that affect the central nervous system including Effexor, Prozac, Zoloft, and others.5. A comprehensive hearing test battery must be administered including, at the very least, otoacoustic emissions, pure tone audiometry for conventional and also high frequencies (up to 20,000 Hz), and loudness discomfort levels (LDLs). The findings for otoacoustic emissions measurement and pure tone audiometry are almost always normal in patients with hyperacusis. Measurement of LDLs with pure tone and speech signals is an essential part of the diagnostic test battery for assessment of decreased sound tolerance. In an audiology clinic, it’s not uncommon to encounter patients seeking help for hyperacusis who have LDLs as low as 60 dB HL and below.

There’s no benefit to measuring these thresholds since most patients with hyperacusis have normal hearing sensitivity.
In fact, before even testing hyperacusis patients I strongly recommend that you take a minute to tell the patient that you have no plans to present any high levels of sound, and that he or she can stop any test if the sounds produce discomfort or anxiety.
Worse than that, I’ve had patients with hyperacusis who were convinced that their problem with sound tolerance was triggered when another audiologist performed acoustic reflex measurement! The management plan for patients with decreased sound tolerance is based directly on information from the history, inventories, questionnaires, and audiologic testing. A child with sensory disturbances in addition to hyperacusis, including intolerance to light and tactile stimulation, is referred to an occupational therapist for evaluation of possible sensory integration disorder. Patients taking medications that are associated with hyperacusis need to consult with their family physician or the physician prescribing the drugs. And some patients with hyperacusis benefit from consultation with a psychologist who has expertise in cognitive behavioral therapy (Andersson, 2013).11.
It’s reassuring for patients and parents to realize that decreased sound tolerance is not uncommon and that there are experts available who can make an accurate diagnosis and coordinate effective treatment for the problem. In response to their discomfort with loud sounds, patients with hyperacusis tend to reduce their exposure to environmental sound stimulation. Patients are strongly encouraged to surround themselves with soft and relaxing sound, and to progressively increase their exposure to typical everyday sounds.Counseling must include a simple review of what is known about the underlying mechanisms of hyperacusis. Patients need to understand that their reaction to loud sounds is due to activation of parts of their brain that control emotional and fear responses to sound.
Obviously, the explanation of the mechanisms of hyperacusis is given at a level that the patient can understand.
The treatment for those patients consisted entirely of counseling and sound stimulation.13. For most hyperacusis patients I begin the management process with intensive counseling and recommendations for sound enrichment.
I then recommend consultation with a psychologist, and preferably one with expertise in cognitive behavioral therapy (Andersson, 2013).14. Let’s say the list includes sounds from a vacuum cleaner, a barking dog, a child crying, thunder, a slamming door, and an ambulance siren. First of all, it’s important for the patient to control the volume of the bothersome sounds during the desensitization sessions and to gradually increase the loudness from week to week.
I first counsel extensively all patients with decreased sound tolerance, including those with misophonia.
Directive counseling explains to the patient the role of increased gain within the central nervous system and the emotional (limbic system) and fear (autonomic system) responses to sound in hyperacusis.
An appropriate treatment strategy based on an accurate assessment and diagnosis will improve quality of life for all patients with decreased sound tolerance. Adaptive plasticity of loudness induced by chronic attenuation and enhancement of the acoustic background.
20Q: What can be done for patients with hyperacusis and other forms of decreased sound tolerance.

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