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Jastreboff tinnitus retraining, noises in the ear symptoms - For You

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The main difference is that those who find tinnitus troublesome, evaluate and perceive it as a threat, or an annoyance, rather than something of little or no consequence. What happens, even in mild cases of persistent tinnitus, is that a conditioned response (reaction) is set up to the tinnitus sound. When tinnitus first emerges it is a new signal, there are no memory patterns, and no means of categorizing it.
Unfortunately, these fears may be enhanced by professional advice, or reports from others of their own, phobic reaction to tinnitus. In some patients extreme fear of tinnitus results in a phobic state developing, very similar to that of the fear of spiders, frogs, small spaces, flying etc.
Retraining the subconscious auditory system to accept tinnitus as something that occurs naturally, does not spell a lifetime of torture and despair, and is not a threat or a warning signal, can take months and occasionally even years.
While it is important to have a proper examination by an ear specialist, those professionals who themselves believe that tinnitus is an ‘ear phenomenon’ cannot help.
It is important to distinguish between the role of the ear in the EMERGENCE of tinnitus (e.g. In the last issue of our newsletter, we discussed the history and recent advances in Tinnitus Masking. The expectation was that by describing the tinnitus exactly in terms of pitch and loudness, different categories would be established and specific treatments could be applied to each category with predictable outcomes.
Approximately 75% of all the people who experience tinnitus are not affected by it and they treat tinnitus like any other sound to which they can easily habituate. The researchers found there is no difference in the acoustical characteristics of tinnitus between those who are not bothered by it and those who suffer from it! To understand how tinnitus develops, it’s helpful to understand how sound is processed in the auditory pathways. This is the basis of TRT, training the brain to habituate tinnitus sounds and classifying them to represent a neutral, insignificant signal. They placed 80 tinnitus free individuals, university members, in a sound proofed room, each for 5 minutes, asking them to report on any sounds that might be heard. As the conditioned response is part of the subconscious brain, and automatic, what you may be thinking about tinnitus at any time, (or even if you’re not thinking about it), is irrelevant to the reaction produced. Many doctors and other professionals still advise patients that there is nothing that can be done about tinnitus and that it will go on forever. Annoyance or ill ease exists, and although strong emotions may not be evoked, the limbic and autonomic systems are still being stimulated to produce aversive and intrusive emotions which reduce life quality, but most importantly to insure that tinnitus persists rather than habituates naturally. Once the tinnitus loses its sinister meaning, however loud it has been or however unpleasant it may seem, it DOES begin to diminish, and in many cases may not be heard for long periods of time. Retraining should be guided by professionals with experience in this field, forming part of a multi-disciplinary team. We are in a difficult situation where the classical training of tinnitus being due to inner ear damage is still very dominant, rather than an understanding based on the Jastreboff neurophysiological model (Jastreboff P.J. Tinnitus masking was at one time thought to be useful in that it simply made tinnitus inaudible. Most tinnitus is first heard at night in a well-soundproofed bedroom, or a quiet living room (Heller and Bergman 1953).

This issue will delve into a neurophysiological approach to reducing tinnitus symptoms called Tinnitus Retraining Therapy (TRT).
Silence actually enhances tinnitus and patients undergoing TRT are advised to avoid silence.
In these situations, tinnitus is classified as a warning signal, relating either to an bad experience (classical Pavlovian conditioning) or to negative thoughts about its meaning or outcome. Moreover, it is the reaction to tinnitus, which is creating distress, not the tinnitus itself (another difficult concept for some). This mechanism is best illustrated by the Jastreboff model in a graphical format (Figure 4).
Until proper evaluation has been undertaken of what tinnitus means, it will be regarded with understandable suspicion. These qualities of tinnitus, which make people seek help, are created outside the hearing mechanism, and therefore cannot be helped by a purely audiological or ear-related approach.
In some cases firmly held beliefs are hard to alter, particularly where there is a conviction that tinnitus is only related to ear damage which cannot be fixed (NEVER the case). However many people can be helped by understanding the Jastreboff model and applying the principles of retraining as described on our website. Despite the importance of hearing change (temporary or permanent) in triggering an emergence of tinnitus, a recent study of our tinnitus clinic patients showed there was no significant difference in hearing between the tinnitus group and normal population statistics.
In fact this proved to be counter-productive, as tinnitus, the object of the habituation exercise, must be audible for habituation to occur. Persistence of tinnitus depends not only on the meaning attached to it, but also to the contrast it creates with the auditory environment. Jastreboff developed his model of tinnitus which postulates the involvement of the limbic (emotional) and autonomic nervous systems in the perception of tinnitus. 93% reported hearing buzzing, pulsing, whistling sounds in the head or ears identical to those reported by tinnitus sufferers.
Just as the animal alerted to danger by the sound of a predator focuses solely on that sound in order to survive, so those who consider that tinnitus is a threat or warning signal are unable to do anything but listen to it.
Tinnitus may be the consequence of a mild hearing impairment rather than the other way around, but is still only twice as common with hearing impairment to normal hearing.
For people who also have co-existing or pre-existing anxiety or depression, it can take longer to change their feelings about their tinnitus. His research began with the ongoing effort at that time to describe the acoustics of tinnitus. The patient is taught the basic function of the auditory system and the brain relative to tinnitus. In any event the threatening qualities of the tinnitus are enhanced by beliefs and negative ideas about tinnitus, not any physical changes that may or may not have occurred. However maintaining this habituation is easier if tinnitus IS heard from time to time, after successful TRT. The sound generators are operated at a low enough level that the tinnitus can still be detected.
Jastreboff claims that he has treated about 1,000 patients in his clinic at Emory University in Atlanta, GA and that 80% of these have experienced significant improvement.

Although some areas of the auditory system may be more active than others, every neurone will contribute to some extent to the final perception of tinnitus. Many people complain of the loss of silence, something they previously greatly treasured and enjoyed, before tinnitus became persistent.
Finally many tinnitus sufferers are angry about the treatment, or lack of treatment, or inappropriate advice that they have received.
As a result of this and other therapy including sound therapy, the strength of the REACTION against tinnitus gradually reduces.
This enables the renewal of beliefs that tinnitus is ‘a friend’, and guards against relapse. Much better long-term results can be obtained if wide band noise is used at low intensities while the tinnitus can be heard at the same time. Everyone, especially tinnitus patients should avoid extreme silence, and retraining programmes will always use sound enrichment.
Broad band sound contains all frequencies which gently stimulate the nerve cells in the subconscious networks allowing them to be more easily reprogrammed, or habituated, to no longer notice the tinnitus. It is often feared that tinnitus will continue to spoil peace and quiet, interfere with concentration at work, quiet recreational activity and the ability to sleep at night. They may feel guilty for having submitted to treatment, which they think, is the cause of their tinnitus. Even where people do develop new negative reactions to tinnitus (which may have gone away from some years, treatment with TRT is always quicker the second time.
Fear, anger and guilt are very powerful emotions, which are intended to enhance, survival-style, conditioned reflex activity, and consequently greatly increase attention on the tinnitus.
With strong reactions the filters are constantly monitoring the tinnitus, without a reaction habituation occurs, as it does to every meaningless sound that is constantly present.
In our experience, tinnitus improves when the patient overcomes these feelings and stops dwelling on thoughts of injustice. Sadly some people think because tinnitus can return after TRT that ‘the treatment has failed’. Secondly as the auditory filters are no longer monitoring the tinnitus it is heard less often and less loud. As the goal is to get rid of tinnitus reaction – NOT tinnitus perception – provided you have achieved this, then TRT is always successful, and permanent. Of those who DO experience persistent tinnitus, population studies have shown that about 85% do not find it intrusive, disturbing or anxiety provoking (something tinnitus sufferers find very hard to believe!).
The reason for this is not so much because the quality or loudness of the tinnitus is different; in fact we have found that tinnitus is of a very similar type of sound in those who are bothered by it and those who are not. Think now how much of this treatment depends on being able to believe that tinnitus results from normal compensatory changes in the hearing mechanism. Many tinnitus patients have decreased sound tolerance and for this reason often seek very quiet environments.

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