Dr. Jastreboff and Loudness ...

[Lisa88]

Lisa, I only recommend clinicians I personally know and for whom I can vouch unconditionally. The person I really like in the Bay Area is Malvina Levy. Malvina is not a fan of TRT at all, but she would absolutely be my first choice nonetheless. Recall that in Post #8 I was writing about various brands of cars that can get you to your destination. Malvina doesn't do TRT, but she will get you to your destination safely and with compassion. And in the end it's the getting there that counts nonetheless, yes?

Stephen Nagler

Stephen Nagler, I can't believe it. She is my audiologist, and leads a wonderful support group for t out here. She is an amazing person. Thanks so much! I am being tested by her first week of April. Might go the Neuromonics route, although my most annoying frequencies of t fall below the lowest frequency the audiologist can input for that program. Hopefully, she will evaluate and let me know though. Thanks, Stephen Nagler. This has made me so happy! I will send you her regards

 

[Isabella 123]

I live in the DC area and have not been able to find anyone to help me with TRT. I'm just starting on this journey and the first ENT I saw was, to put it mildly, not helpful. I'm not sure I even understand what TRT is, but I certainly don't want to go this alone, as you put it.

 

[Dr. Nagler]

I live in the DC area and have not been able to find anyone to help me with TRT. I'm just starting on this journey and the first ENT I saw was, to put it mildly, not helpful. I'm not sure I even understand what TRT is, but I certainly don't want to go this alone, as you put it.

I'd consider Gail Brenner in Philly.

Like Paula Schwartz (Post #30), she can do the follow-up long distance.

Folks, I have a lot of very good friends in the tinnitus clinician community across the US and abroad. I can see that continuing to make such recommendations on the board has the potential for offending some of those friends - so I think I'm going to hold off on making further referrals on the board.

The point is ... there are some very fine tinnitus clinicians around (both TRT and non-TRT), and there are some real doozies as well. So in looking for somebody to assist you on your journey, it's important to do your due diligence. Ask good questions. Listen carefully. And resist the urge to get into the first shiny car that comes along; it might have a rusted-out undercarriage.

Best to all -

Stephen Nagler

 

[Mclovin]

Hi sp.

Thank you for you answer! I know about Anne-mette, and have been at her clinic once about 2 years ago. Back then I didn't have much money, due to losing my job when T hit, so I couldn't afford more treatment at the time. I will consider contacting her again, and make a new appointment. This will be my first priority, and maybe I'll look into TRT in UK later on if I need it.

Again, I'm really grateful for the help you provide. You are invaluable, and always encourage me with your posts and reply's. It's good to see you here on TT also, you can do magic here with your wisdom.

Kenneth

 

[Dr. Nagler]

It's good to see you here on TT also, you can do magic here with your wisdom.

Thanks Mom!!!!



Stephen Nagler

 

[Mclovin]

Just trying to be nice....

 

[Dr. Nagler]

... and I sincerely appreciate it.

All the best -

Stephen Nagler

 

[jazz]

In practical terms, since habituation is a process rather than a state, the best a person with intrusive tinnitus can do is largely habituate it, which means that you might for whatever reason become aware of it every once in a while when you are not purposely listening for it, but even then while it might briefly distract you, it causes you no distress.
Stephen Nagler

Hi @Dr. Nagler ,

I've enjoyed reading your posts on TRT. It might help people if you explained the difference between "habituation of reaction" and "habituation of perception." I do understand the difference, but many here probably do not. It is useful to know, for example, that the former must be achieved before the latter, etc. (I could go on, but you're the expert and I think the distinction will clarify rather than obfuscate.

jazz

 

[Dr. Nagler]

@jazz, I really dislike the terms "habituation of reaction" and "habituation of perception" because strictly in a scientific sense habituation is 100% about reaction and has nothing to do with perception. That said, Dr, Jastreboff coined the two terms in describing what happens in TRT ... and you asked a TRT question. So I am going to explain the terms specifically as used in TRT.

The simplest way to look at habituation of reaction (or "Hr") is a decrease in the degree to which you react to your tinnitus over time. It is important to understand that Hr is a process. The farther along Hr proceeds, the less bothersome your tinnitus is and the less distress it causes you. It is also important to understand that we are not talking about your tinnitus being less loud or less pitchy. We are talking about your reacting less to your tinnitus regardless of how loud or pitchy it might be.

Now the brain is very "busy" organ. Even when you are at rest, your brain is very busy. And in order to function effectively, your brain must prioritize; it simply cannot attend to all the stimuli it encounters at any given time throughout the day. That's why - until I mention it - you have been unaware of the pressure that the chair you are sitting in right now has been exerting against your buttocks, and it is why within a few moments you will be unaware of it again ... unless you check. So the brain puts stimuli to which you react less way down on its list of priorities. Dr. Jastreboff calls this process habituation of perception (or "Hp").

The whole idea here is that the less you react to your tinnitus over time (Hr), the less you will perceive it over time (Hp) unless you purposely check. And again, this phenomenon holds true regardless of how loud or pitchy your tinnitus might be. That is why, for instance, a person can have a cuckoo clock in the house or a gtrandfather clock in the house but only rarely be aware of the sounds they make. Or why somebody can live near railroad tracks yet largely be unaware of the trains.

It is not true that (as you suggest in your post) Hr must be "achieved" before Hp can be achieved. They are processes and not states. The less one reacts to his or her tinnitus over time, the less one will tend to perceive it - unless he or she purposely checks.

Hope this helps more than confuses.

Stephen Nagler

 

[Bobo]

Dr. Nagler-

Any recommendations for the Washington, DC, area? Great posts! Thanks.

Greg

 

[Dr. Nagler]

Dr. Nagler-
Any recommendations for the Washington, DC, area?

See Posts #32 and #33.

Stephen Nagler