The Cause of Internet and TV Addiction?
Hyperacusis/Tinnitus Retraining Therapy
"So far, the most promising therapy for hyperacusis involves listening to pink noise at barely audible levels for a disciplined period of time each day.
This protocol is called Tinnitus Retraining Therapy and was developed by Dr. Pawel Jastreboff and Dr. Jonathan Hazell through the University of Maryland in Baltimore.
To ease the demand for this treatment, the University of Maryland has been certifying hearing professionals throughout the world to help administer this treatment. People with hyperacusis have a terribly difficult time traveling due to the sounds of car or air travel.
Current treatments recommended by experts in the field suggest the opposite approach as AIT (see hyperacute hearing). It is suggested that instead of filtering out sensitive frequencies (as is done in AIT), that we retrain our ears by listening to all frequencies through the use of white noise (as is done in TRT). White noise is the FM static you hear on a radio frequency that contains no radio station (detained FM station). This FM white noise contains all the frequencies the human ear can hear - including the ones we are sensitive to.
The theory suggests that we can desensitize our ears to all frequencies (white noise) thereby allowing our ears to return to more normal sound tolerances.This is accomplished by using a masking device (similar in appearance to a hearing aid) called the viennetone AM/ti, or listening to white noise tapes (or a compact disc - CD). Although this therapy is not a cure, it can help significantly in reestablishing tolerances to sound. More information on this therapy will be discussed later in this supplement."
"The University of Maryland, under the direction of Dr. Pawel Jastreboff and Dr. Jonathan Hazell, has developed a therapy for individuals with hyperacusis that is very promising. By being fitted with a special ear appliance called the viennetone AM/ti (sound generator) the patient is told to listen to a specific sound called white noise for a disciplined period of time each day. Those in the network who have been through this therapy have realized improvement of 10% - 80%. Although this is not a cure, it can be a wonderful help. No one has gotten worse from this therapy, but there are many in the network that have had no desire to undergo the therapy."
"When we talk about retraining, this is not simply an abstract learning exercise. In the subconscious part of the brain concerned with hearing, beyond the inner ear, but before the act of conscious perception of sound takes place, subconscious filters, networks of nerve cells (neuronal networks) are programmed to pick up signals on a 'need to hear' basis."
"Why, then, might TRT fail in some cases to cure, fail in some cases to adequately treat (if not cure), or for that matter fail to even modestly treat hyperacusis?
· (1) For reasons currently being studied, but not yet well-understood, hyperacusis in individuals with Lyme Disease (and potentially those with various other infectious disorders affecting the central nervous system) do not seem to respond as well to retraining methodology.
· (2) People with severe underlying psychiatric disorders tend to respond suboptimally. People with reactive depression, however, a condition not infrequently seen in tinnitus and hyperacusis, seem to respond as well as anyone else - especially when the depression is addressed by a therapist willing to work with the TRT clinician.
· (3) People with pending medical-legal action do less well with TRT. This phenomenon, which is observed more with tinnitus than with hyperacusis, is felt to be unrelated to possible malingering or potential secondary gain. Rather it has to do with the seemingly endless flow of paperwork and monthly justification required by the legal/insurance industry in such cases, paperwork (not to mention interviews) which by its nature causes something we wish to be less of an issue (tinnitus/hyperacusis) ... to be all that more of an issue.
· (4) People with severe hyperacusis who for whatever reason are unable at some point in their treatment to make that all-important leap to embrace the concept that their condition does not represent a lowered threshold for damage, but rather a lowered threshold for discomfort can in many ways be their own worst enemies when it comes to TRT.
· (5) Various psychopharmacological agents at least theoretically have the potential to inhibit neuronal plasticity and thereby delay (or remotely prevent) TRT success.
· (6) The most common cause for treatment failure lies in the crucial element of 'directive counseling' - see below.
· (7) There are in all probability additional factors in treatment failure, which have not yet been identified."
"Directive counseling for people affected by hyperacusis, whether or not there is also a component of tinnitus, is typically very intensive - especially if the hyperacusis is severe. The counseling involves a detailed individualized explanation of the central nervous system mechanisms involved with hyperacusis and the role these mechanisms play in the auditory pathway. This detailed explanation often must be re-introduced at intervals - as greater understanding is achieved. The counseling involves tailoring the use of background neutral sound to the specific circumstances of each hyperacusis sufferer. It involves guidelines about gradual exposure to those environmental sounds which heretofore might have caused discomfort, but which represent no danger. And it involves frequent (often weekly at first - in person or by telephone) "tweaking" of the program as thresholds begin to change and as the inevitable challenges arise. These challenges - frustration, fear, impatience, temporary setbacks, miscommunication - are the factors which most frequently result in totally unnecessary abandonment of treatment before it has had a chance to be successful. Counseling must come from a knowledgeable yet compassionate source. It must be conducted according to the guidelines of TRT as described by Dr. Jastreboff and Mr. Hazell, and the individual doing the counseling must be thoroughly versed in the principles of TRT. He or she must also be willing to be reasonably accessible between scheduled appointments, and the patient must be willing to avail himself or herself of that accessibility, to follow through on recommendations, and not to prematurely discontinue the program."