Question for @Dr. Nagler about Hyperacusis

[cullenbohannon]

@Dr. Nagler

Hello I have a question regarding hyperacusis. Im not entirely sure what it is because so many people say different things on this site. As i understand it with H normal sounds will be louder, and if i have pain and my ear muscles contract that is not necessarily related to H? I hope that makes sense. I don't feel like i hear things louder but my ears are a bit sensitive or at least the muscles contract which causes pain, could this be due to anxiety related to my ears? Thanks very much for all your help!

 

[cullenbohannon]

One thing i want to add, i am actually experiencing weird things with my eye as well. Like it will close really tightly when i see something pop up on tv. Almost the same feeling i get in my ears when the ears contract. I think they are connected somehow because when i close my eyes with some force it aggravates the ear as well. TIA

 

[Dr. Nagler]

Hi @cullenbohannon -

So this issue is likely more difficult than it needs to be - because the experts define hyperacusis differently. Dr. Tyler looks at it one way. Dr. Jastreboff looks at it another. Dr. Vernon saw it a third way. And on and on.

Most, I think, will agree that hyperacusis is a form of sound sensitivity (or "decreased sound tolerance") wherein sounds that are well-tolerated by others sound uncomfortably loud. Well, no. That's not right. Tyler calls what I'm referring to above as "loudness hyperacusis" - and goes on to define other forms of hyperacusis. The confusion is enough to make your ears ring!

OK. So most folks see hyperacusis purely as a loudness thing. And the proper treatment involves some form of desensitization, using exposure to very gradual purposeful sounds of increasing intensity over time in a carefully controlled manner.

The feeling of pain and contracting of the ear muscles that you describe - especially when (as in your case) loudness is not the issue - is not hyperacusis. At least it doesn't sound like hyperacusis to me.

My recommendation would be for you to be evaluated at a clinic or center where they are familiar with the diagnosis and treatment of various forms of sound sensitivity (hyperacusis is but one) as well as the diagnosis and treatment of tonic tensor tympani syndrome and stapedius muscle spasm, either of which can (along with misophonia) produce the types of symptoms you describe.

Hope this helps more than confuses.

Stephen Nagler

 

[cullenbohannon]

@Dr. Nagler thank you for the reply. I live in the scranton Pennsylvania area. Not far from philly. Is there any where you might recommend.

Hi @cullenbohannon -

So this issue is likely more difficult than it needs to be - because the experts define hyperacusis differently. Dr. Tyler looks at it one way. Dr. Jastreboff looks at it another. Dr. Vernon saw it a third way. And on and on.

Most, I think, will agree that hyperacusis is a form of sound sensitivity (or "decreased sound tolerance") wherein sounds that are well-tolerated by others sound uncomfortably loud. Well, no. That's not right. Tyler calls what I'm referring to above as "loudness hyperacusis" - and goes on to define other forms of hyperacusis. The confusion is enough to make your ears ring!

OK. So most folks see hyperacusis purely as a loudness thing. And the proper treatment involves some form of desensitization, using exposure to very gradual purposeful sounds of increasing intensity over time in a carefully controlled manner.

The feeling of pain and contracting of the ear muscles that you describe - especially when (as in your case) loudness is not the issue - is not hyperacusis. At least it doesn't sound like hyperacusis to me.

My recommendation would be for you to be evaluated at a clinic or center where they are familiar with the diagnosis and treatment of various forms of sound sensitivity (hyperacusis is but one) as well as the diagnosis and treatment of tonic tensor tympani syndrome and stapedius muscle spasm, either of which can (along with misophonia) produce the types of symptoms you describe.

Hope this helps more than confuses.

Stephen Nagler

 

[Dr. Nagler]

@cullenbohannon, you might start with Dr. Gail Brenner in Philly. Dr. Brenner is an audiologist with a lot of experience in the area of sound sensitivity and who by coincidence is very good friends with Myriam Westcott in Melbourne, who has done a lot of work in the area of TTTS. So for Dr. Brenner to run your case by a TTTS expert halfway around the world will take but a quick e-mail among old friends.

Stephen Nagler

 

[Grace]

@cullenbohannon, you might start with Dr. Gail Brenner in Philly. Dr. Brenner is an audiologist with a lot of experience in the area of sound sensitivity and who by coincidence is very good friends with Myriam Westcott in Melbourne, who has done a lot of work in the area of TTTS. So for Dr. Brenner to run your case by a TTTS expert halfway around the world will take but a quick e-mail among old friends.

Stephen Nagler

Wow, i live in the philadelphia area and when i was looking for audiologists in the area dr brenner popped up, but chose to see another one instead. Ill keep that name in mind incase i
Ever have to see another doctor!

 

[tyty]

Dr. Nagler, I spoke with you on the phone a few months ago and considered trying to fly down to see you for evaluation, I did actually did find an audiologist here who I am working with now that says she knows you and that she uses your method of TRT Therapy. The audiologist name is Carol Lambert, she is probably in her 60's and she is located at Hillcrest Medical Bldg in Tulsa, OK. I just finished a series of extensive hearing test and so far two therapy sessions of with her and now waiting for all the results to be compiled. It sounds like she is looking at using a hearing device/ masking device combination. Is there a certain brand of hearing/masking devices you can recommend? I am going back next week to look at the Sharkey brand? I just would appreciate any input you can give me bc insurance pays nothing for any of this so I want to be careful about this huge investment. I appreciate hearing back from you and for all you do for other T sufferers. If all else fails I am flying to Atlanta for appt with you! Thanks!!

 

[attheedgeofscience]

Dr. Nagler, I spoke with you on the phone a few months ago and considered trying to fly down to see you for evaluation, I did actually did find an audiologist here who I am working with now that says she knows you and that she uses your method of TRT Therapy. The audiologist name is Carol Lambert, she is probably in her 60's and she is located at Hillcrest Medical Bldg in Tulsa, OK. I just finished a series of extensive hearing test and so far two therapy sessions of with her and now waiting for all the results to be compiled. It sounds like she is looking at using a hearing device/ masking device combination. Is there a certain brand of hearing/masking devices you can recommend? I am going back next week to look at the Sharkey brand? I just would appreciate any input you can give me bc insurance pays nothing for any of this so I want to be careful about this huge investment. I appreciate hearing back from you and for all you do for other T sufferers. If all else fails I am flying to Atlanta for appt with you! Thanks!!

Unless you quote or tag it like this @Dr. Nagler then he might not see it. (This is an old thread after all...)

 

[Dr. Nagler]

@tyty, there are a number of different manufacturers that make devices appropriate for TRT. The choice of device and manufacturer depends on a variety of factors - TRT category, degree of hyperacusis (if any), and severity of hearing loss (if any) among them. Without detailed knowledge of your case, something that is clearly beyond the scope of this board, I would hesitate to make such a recommendation.

Dr. Stephen Nagler

 

[tyty]

@Dr. Nagler thank you for your quick response, if my audiologist sends you all her findings would you possibly be at that time willing make some recommendations. Also, if there are more test you prefer you could let me know and I can get more information. Carol Lambert is who I am using and she uses your same methods you have designed and implemented, supposedly she trained under you? When I spoke to you on the phone you did say there were a few people that you had trained but did not know for certain where all of then were practicing, maybe I just got lucky and found on of them?
I can always call your office and get fax info or you can private message me your fax or email. I can also send a medical release from myself as well to allow us to communicate. I do understand your time is valued and I am willing to pay consult fee for our time. If this sounds reasonable please let me know. Thanks and have a wonderful rest of the weekend. I do have a friend in Altanta now if you prefer I fly there, just trying to make sure I invest my money wisely and if it take me flying there with all this information I can, just hoping to keep in local if possible.
Thank you for serving on this panel.

 

[Dr. Nagler]

@tyty, for years I have served as a resource for other healthcare professionals in the field when they need help with challenging cases. But generally it is the clinician who makes that determination. I think it would be a little awkward for you to make that sort of request of Carol Lambert yourself; it sort of implies that you do not have all that much faith in her.

That said, if Carol Lambert wishes to discuss your case with me, she is free to get in touch with me if she desires.

FWIW, Carol Lambert may be the greatest thing since sliced bread, but I have never heard of her. If she has told you that I participated in her tinnitus training, she has me confused with somebody else. But like I said, she might be totally wonderful.

Here are some questions you might want to pose to her.

· What is the approach she is recommending and why?
· What type of training has she undergone in the use of that approach?
· How long has she been using the approach?
· How many tinnitus sufferers has she treated with the approach?
· What is her success rate using the approach?
· How does she define and measure success?

These are the sorts of questions I feel everybody ought of be asking embarking upon a course of treatment.

All the best -

Dr. Stephen Nagler

 

[tyty]

@Dr. Nagler, thank your for your information, I will be meeting with her in a couple of weeks for our third meeting. I will for sure ask her the list of questions. I do find it strange that she would claim to have trained under you yet you have never heard of her. I am not certain how I feel about her at this point. I was just excited about her because I was assuming that she would be following all your protocols, and that was my main reason for choosing her. I am going to take that list of questions with me along with a few more. Thank you so much.

 

[Dr. Nagler]

@Dr. Nagler, thank your for your information, I will be meeting with her in a couple of weeks for our third meeting. I will for sure ask her the list of questions. I do find it strange that she would claim to have trained under you yet you have never heard of her. I am not certain how I feel about her at this point. I was just excited about her because I was assuming that she would be following all your protocols, and that was my main reason for choosing her. I am going to take that list of questions with me along with a few more. Thank you so much.

The protocols I use for TRT are Dr. Jastreboff's protocols, not mine. Perhaps she took Dr. Jastreboff's course. On a number of occasions I have given presentations as part of his course. Maybe that's the connection. Regardless, I do think the questions are important, and I'm glad you'll be asking them.

All the best -

Dr. Stephen Nagler

 

[tyty]

@Dr. Nagler I think you are exactly correct! She did take that course, because she said she uses the Jastreboff method, most likely that was when she met you. She may have been under a different name at that time. I certainly understand you can't remember all who take your seminars, but you can be for certain they remember you. I am following your advice. I hope to have good updates to report to the forum.

Truly appreciate your time.

 

[Liuzn]

Dr.Nager i experience buzzing in my ears when driving or when walking which i suspect is from power outlets like powerlines an such, it seems that certain electrical frequencies send my ears buzzing is that H? I have no problems with everyday sounds...refrigerator noises are abit more noticable but that could be due to my anxiousness.....ill add that this doesnt happen all the time but sometimes....i need some advice idk what this is

 

[Dr. Nagler]

Dr.Nager i experience buzzing in my ears when driving or when walking which i suspect is from power outlets like powerlines an such, it seems that certain electrical frequencies send my ears buzzing is that H? I have no problems with everyday sounds...refrigerator noises are abit more noticable but that could be due to my anxiousness.....ill add that this doesnt happen all the time but sometimes....i need some advice idk what this is

Hi @Liuzn -

Hyperacusis is discomfort due to the loudness of sounds. Sounds that are generally well-tolerated by the population at large are uncomfortably loud to the hyperacusic.

I'm not sure what to make of the sensation you describe except to say that it is not hyperacusis. I suspect that it may be a form of tinnitus that is aggravated in certain environments - but that's really only a hunch. Why don't you contact the fine folks at the Australian Tinnitus Association, NSW and see if they can give you the names of a few audiologists in your area with tinnitus expertise.

Sorry I couldn't be of more help.

Dr. Stephen Nagler

 

[Liuzn]

Thank so much for your quick reply, i have a appointment with a ENT who specailises in T so hopefully they can help