Dan's Corner, aka Ask Danik

[jazz]

@dan- this is not related to TRT but I got T from banging my head really hard on a concrete wall which was stupid mistake. Any idea why a concussion bring on T . my hearing tests and OAE were normal. Thanks

Actually, a small percentage of people do get tinnitus from a TBI (traumatic brain injury). I have a relative who got tinnitus when his brother dropped an ax on his head! (They were building a tree house.) In his case, the tinnitus was permanent. But you're still early so there's a good chance it will go away!

 

[LadyDi]

Awesome post, @awbw8. Important reading for those you trying to sort through all the craziness of some recent threads.

 

[dan]

Pycnogenol is also a good one.

 

[dan]

I must respectfully disagre, DIY trt, if done by the book, is just as good as 1 on 1 TRT.
There is nothing that you can't read on your own that is not covered in the 3 hour TRT session.
TRT involves directive counceling, its not regular counceling - being a therapist isn't a requirement.

 

[awbw8]

Hi @dan, I'm glad the dialogue exists. I agree that just getting the "how it works" info can be done in a book. I'm just saying that's not "TRT" as it seems to be defined - there is no DIY TRT, because it seems to say it requires that bi-lateral counseling aspect, you can't do that alone, so it's a contradiction in terms. I think who provides the directive counseling matters, not that the person need be a psychologist. Even here you are explaining it to people, and I truly do not say this to be at all combative, but the way you are sharing your knowledge of TRT here is perhaps not the easiest to comprehend (for me and others apparently) though you do, presumably, have said knowledge.

I am curious about what another poster asked, and I do not ask it to be confrontational, just curious. What is your full experience/story with TRT?

 

[Telis]

Just want to say...great thread @dan

Putting your time, experience and knowledge forward to help others is very generous.

Telis.

 

[Sen]

Where is the best place to park your boat in Florida?

 

[dan]

I'm just saying that's not "TRT" as it seems to be defined - there is no DIY TRT, because it seems to say it requires that bi-lateral counseling aspect

So basically it comes down to the psychological impact that having a knowledgeable figure drill you on the model of tinnitus rather than just trying to self absorb the material. I'd say that yes, for a lot of people they would need the guidance of a clinician. But I'm saying its not impossible to achieve TRT on your own.
Its like hypnosis vs self hypnosis.

 

[dan]

Just want to say...great thread @dan

Putting your time, experience and knowledge forward to help others is very generous.

Telis.

Oh thanks Telis!
Dr.Nagler would probably accuse me of blasphemy lol.

 

[dan]

I am curious about what another poster asked, and I do not ask it to be confrontational, just curious. What is your full experience/story with TRT?

I've been to the Canadian Tinnitus and Hyperacusis Centere
http://www.canadiantinn.com/
I did the 4 hour first day session which included 1 hour of audiology and 3 hours of counceling.
I can tell you that my experience there was exactly as @Martin69 's experience in the German tinnitus clinic - almost word for word.
I would say with 100% certainty, that reading the Jastreboff Neurophysiological Model book of tinnitus, will give you a huge amount of education as opposed to what you'd get from the trt session.
Actually my trt experience was worse than Martin's German clinic.
My clinician simply told me she'd get me the sound generators and I would just set my own volume as I see fit - as long as its below the tinnitus level.
I was interested in her success rates and the only examples she could give me was of some patients with mild tinnitus as compared to some of the tinnitus we have here on this board.
One guy was able to use imagery to pretend his tinnitus was a hot radiator heater hissing away softly at night, allowing him to get his sleep back.
When I asked if she had any patients with tinnitus that sounded like a swarm of bees, she said she has 1 patient who is still suffering after 2 years.
At least she was honest with me.

 

[awbw8]

awbw8 said: ↑
I'm just saying that's not "TRT" as it seems to be defined - there is no DIY TRT, because it seems to say it requires that bi-lateral counseling aspect
So basically it comes down to the psychological impact that having a knowledgeable figure drill you on the model of tinnitus rather than just trying to self absorb the material. I'd say that yes, for a lot of people they would need the guidance of a clinician. But I'm saying its not impossible to achieve TRT on your own.
Its like hypnosis vs self hypnosis.



@dan I'm all tuckered out with this subject I'm afraid, others will draw their own opinions. Thank you for sharing your time, story, time and opinions though. That's the good stuff of TT.

Take care & be well

 

[MattK]

@dan why do you think TRT wouldn't work for you?

 

[dan]

@dan why do you think TRT wouldn't work for you?

Because I'm a category 4 patient.
If you read the Jastreboff book on Implementing the N.M., you will find that he says it is extremely difficult to treat these patients.

 

[Street Spirit]

I've been to the Canadian Tinnitus and Hyperacusis Centere
http://www.canadiantinn.com/
I did the 4 hour first day session which included 1 hour of audiology and 3 hours of counceling.
I can tell you that my experience there was exactly as @Martin69 's experience in the German tinnitus clinic - almost word for word.
I would say with 100% certainty, that reading the Jastreboff Neurophysiological Model book of tinnitus, will give you a huge amount of education as opposed to what you'd get from the trt session.
Actually my trt experience was worse than Martin's German clinic.
My clinician simply told me she'd get me the sound generators and I would just set my own volume as I see fit - as long as its below the tinnitus level.
I was interested in her success rates and the only examples she could give me was of some patients with mild tinnitus as compared to some of the tinnitus we have here on this board.
One guy was able to use imagery to pretend his tinnitus was a hot radiator heater hissing away softly at night, allowing him to get his sleep back.
When I asked if she had any patients with tinnitus that sounded like a swarm of bees, she said she has 1 patient who is still suffering after 2 years.
At least she was honest with me.

Is this the Canadian T and H Centre that is located in the back room of a podiatry clinic?

 

[Street Spirit]

P.S. Great avatar!

 

[dan]

Is this the Canadian T and H Centre that is located in the back room of a podiatry clinic?

Yes! How did you know, have you been there ? lol

Honestly when I first arrived there I couldn't figure out for the life of me where tha heck the entrance was lol. I thought I had the wrong address.
I was not very impressed as I was led back thru the podiatry clinic into a small room of total silence where my tinnitus went insane, with archaic audiology equipment.
Probably this was not real TRT.

 

[Street Spirit]

hahaha. .had a friend who went and had same experience as you! Yea we laughed about it for quite awhile. ." Canadian Hyperacusis and Tinnitus Cent...er Room!"

 

[MattK]

Because I'm a category 4 patient.
If you read the Jastreboff book on Implementing the N.M., you will find that he says it is extremely difficult to treat these patients.

I'm sorry to hear that Dan. I hope that you have found something that works, or will find something soon.

 

[dan]

yeah thanks,
i think TRT is great if you're a 0-3 patient!

Excerpt from the TRT book:

Table.
Criteria for determining TRT patient categorization.

Patient Category


Criteria
0

Tinnitus a minimal problem
1

Tinnitus a significant problem
Hearing loss not a significant subjective problem
2

Hearing loss a significant subjective problem
Tinnitus a significant problem
3

Hyperacusis a significant problem
Hearing difficulties irrelevant
Tinnitus irrelevant
4-Tinnitus

Prolonged tinnitus exacerbation caused by sound
Hearing difficulties irrelevant
4-Hyperacusis

Prolonged exacerbation of hyperacusis caused by sound
Hearing difficulties irrelevant
Tinnitus irrelevant


Category 1 patients require extended treatment for their tinnitus condition but do not require the use of hearing aids. They are fitted with wearable ear-level sound generators and counseled repeatedly, usually over a period of 1 to 2 years. Category 2 patients also require extended treatment for their tinnitus condition, but in addition, they report significant hearing difficulties. They receive the same treatment as for Category 1 patients except that they are fitted with either hearing aids or ear-level combination devices that incorporate both hearing aids and sound generators. Category 3 patients have the primary problem of hyperacusis and are treated for this condition with a specific TRT protocol that involves use of wearable sound generators or combination instruments. Category 4 patients are relatively uncommon and suffer from a condition in which their tinnitus or their hyperacusis is significantly worsened because of exposure to certain types of sounds. Category 4 patients are the most difficult to treat successfully [21,23].

Proper patient categorization requires the clinician to clearly understand the patient's subjective difficulties with each of the conditions of tinnitus, reduced sound tolerance, and hearing loss. Completion of the TRT initial interview will provide this information. The treatment approach will vary according to category; thus, accurate placement of patients into these categories is critical to provide proper treatment.

 

[MattK]

@dan, thanks for that explanation. I guess based on that, I would be a category 1 patient. Have you tried anything that works, medication or supplements? I have heard good things about Alpha Lipoic Acid and Pycnogenol. And of course, many on here have reported good things about retigabine, but the problem there would be convincing a doctor to prescribe it.

 

[dan]

For anybody who is interested in buying tinnitus ear devices.
I found this awesome link explaining the procedure of programming ear sound devices. I think Dr.Jastreboff recommends these devices as well.
In my opinion, if you go to a tinnitus clinic and they tell you to choose any device and "set it yourself at a comfortable volume below your tinnitus" is a huge rip-off! You are paying $$$$ to the clinic for the fitting of the devices, and this means they must first do a loudness match of your tinnitus then do a MML (minimum maksing level) test. Then they have to program the devices and try to avoid stochastic resonance, they keep track of the settings if you have hyperacusis, and so on.
These resound devices also have a cool feature whereby they adjust the output according to the environmental sound level.
http://www.gnresound.com/~/media/Do...loads/ReSound LiveTS Whitepaper.ashx?la=en-US

 

[jss]

@dan

Could you give me an example of stochastic resonance? like what would a symptom be? I have my generators slightly below my tinnitus so I can hear both but the generators don't mask the sound but its kind of scary since I can hear my T loud and clear and generators are in the background but not too intrusive.

Thanks

 

[valeri]

According to this scale I'm in category 1.
So this is not considered complicated?!
Now, I wish I live in Atlanta and could go to a proper TRT professional and be done with this mess of a life
And I'm serious when I say that I would do TRT, never said I wouldn't, but too bad I don't live anywhere near a good professional.

 

[dan]

@dan

Could you give me an example of stochastic resonance? like what would a symptom be? I have my generators slightly below my tinnitus so I can hear both but the generators don't mask the sound but its kind of scary since I can hear my T loud and clear and generators are in the background but not too intrusive.

Thanks

You would need to know to what dBspl are your generators set to.
Anything below 15dB is in the stochastic resonance range.

due to stochastic resonance, by adding low
level external noise paradoxical enhancement of the
tinnitus signal occurs. A weak tinnitus signal, which
could not be detected in silence, can be observed by
adding external noise. Additionally, the tinnitus
signal which has been detected in silence will
undergo enhancement. Consequently, tinnitus per-
ception could be enhanced by adding low levels of
sound, such as in case of using sound generators set
at the threshold of hearing or just slightly above the
threshold. This will in turn make habituation more
difficult

 

[dan]

According to this scale I'm in category 1.
So this is not considered complicated?!
Now, I wish I live in Atlanta and could go to a proper TRT professional and be done with this mess of a life
And I'm serious when I say that I would do TRT, never said I wouldn't, but too bad I don't live anywhere near a good professional.

I recall Dr.Nagler recommending, Myriam Westcott, to one member.
http://www.tinnitus.com.au/trtcontacts.htm

 

[valeri]

Yes, she was recommended to me too, but upon two consultations I'm still where I am

And yes, I also went to this guy Ron Kendall, here is SA, he said I need to stop monitoring and get my tinnitus under control before he would even consider doing TRT with me!
WTF?

@dan
This is what I'm taking about, it's not that TRT is not helpful, but finding somebody who will help you is equal to winning the lottery. Therefore, we tinnitus sufferers need more of a universal approach (which I understand may not be easy) to help the vast number of sufferers, without hitting one brick wall to another.
This is the concept Dr Nagler has difficulty either believing or understanding.

 

[jss]

You would need to know to what dBspl are your generators set to.
Anything below 15dB is in the stochastic resonance range.

due to stochastic resonance, by adding low
level external noise paradoxical enhancement of the
tinnitus signal occurs. A weak tinnitus signal, which
could not be detected in silence, can be observed by
adding external noise. Additionally, the tinnitus
signal which has been detected in silence will
undergo enhancement. Consequently, tinnitus per-
ception could be enhanced by adding low levels of
sound, such as in case of using sound generators set
at the threshold of hearing or just slightly above the
threshold. This will in turn make habituation more
difficult

So In theory if I had a weak tinnitus signal and I had to perhaps consciously try to find the generators signal (thus it being a bit low) this would actually put more strain on my brain to find the signal therefore actually enhancing my real tinnitus tone? I guess Im category 2 with slight hyperacusis.

 

[dan]

So In theory if I had a weak tinnitus signal and I had to perhaps consciously try to find the generators signal (thus it being a bit low) this would actually put more strain on my brain to find the signal therefore actually enhancing my real tinnitus tone? I guess Im category 2 with slight hyperacusis.

That is correct. Also as I understand Jastreboff paper is that every patient is different and stochastic effect varies from person to person.

 

[dan]

I'd also say that if you need to consciously look for the generator sound upon setting your device, then it is too low. But then again human perception is deceiving - that's why clinicians use the computer software. TRT is an exact science, which requires tweaking. Its not simply slapping on noise gens and Bob's your uncle - that's why you pay the big $$$.

 

[Christian78]

danik hel i cant find u on skype. what do u think about failure of autifony?