Tinnitus and oversensitivity to sound are common and hitherto incurable, distressing conditions that affect a substantial number of the population. Pawel Jastreboff's discovery of the mechanisms by which tinnitus and decreased sound tolerance occur has led to a new and effective treatment called Tinnitus Retraining Therapy (TRT). Audiologists, ENT specialists, psychologists and counsellors around the world currently practise this technique, with very high success rates. TRT, the treatment developed by the authors from the model, has already proved to be the most effective and most widely practised worldwide. This book presents a definitive description and justification for the Jastreboff neurophysiological model of tinnitus, outlining the essentials of TRT, reviewing the research literature justifying their claims, and providing an expert critique of other therapeutic practices.
Author(s): Pawel J. Jastreboff, Jonathan W. P. Hazell
Year: 2004
Language: English
Pages: 290
Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Preface......Page 13
1.1.1 Commonly used definitions of tinnitus......Page 17
1.1.2 Tinnitus as a phantom perception......Page 19
1.1.3 Justification of proposed definition......Page 20
1.2 Categories of phantom auditory perception......Page 23
1.3 Other phantom perceptions......Page 24
1.5 Processing of sounds within the brain......Page 25
1.6 Tinnitus duration and epidemiology......Page 26
1.8 Components of decreased sound tolerance......Page 27
1.9 Involvement of hearing loss in tinnitus......Page 30
1.10 Summary......Page 31
2.1 Development of the neurophysiological model of tinnitus......Page 32
2.2.1 Tinnitus perception as a by-product of a compensatory action by the auditory system......Page 39
2.2.2 Discordant dysfunction theory of tinnitus production......Page 42
2.4 Relationship of tinnitus to hearing loss......Page 48
2.6 Natural habituation......Page 49
2.7 The process by which tinnitus becomes a problem......Page 50
2.7.1 Selective perception......Page 53
2.7.2 Suppression of positive emotions......Page 54
2.7.3 Sleep impairment......Page 55
2.8.1 Main systems involved in the model......Page 57
2.8.2 Conditioned reflexes......Page 59
2.8.3 Effect of negative reinforcement......Page 60
2.8.4 Feedback loops......Page 61
2.8.5 Irrelevance of the strength of the tinnitus signal......Page 63
2.8.6 Decreased sound tolerance......Page 64
2.9 Mechanism of tinnitus habituation and the neurophysiological basis for TRT......Page 68
2.10 A clinical approach to induce habituation of tinnitus......Page 71
2.10.1 TRT counseling......Page 72
2.10.2 Sound therapy......Page 74
2.11 Summary of the model......Page 76
3.1 Outline of tinnitus retraining therapy......Page 79
3.1.2 Sound therapy......Page 80
3.2 Initial visit and evaluation......Page 81
3.2.1 Initial interview and taking a history......Page 82
3.2.2 Audiological evaluation......Page 88
3.2.3 Medical evaluation......Page 92
3.3.1 Basis for classifying tinnitus......Page 96
3.3.2 Categories of treatment......Page 98
3.3.3 Allocation of patients to categories......Page 100
3.4 Counseling (retraining) sessions: common features......Page 101
3.4.2 Specific aspects of general counseling related to decreased sound tolerance......Page 122
3.4.3 General factors modifying tinnitus retraining counseling......Page 124
3.4.4 Common issues for sound therapy......Page 127
3.4.5 Sound enrichment in hearing loss......Page 130
3.5.1 Selecting optimal sound......Page 131
3.5.2 Wearable sound generators......Page 134
3.6.1 Category 0: mild or recent symptoms......Page 137
3.6.2 Category 1: tinnitus alone (high impact)......Page 138
3.6.3 Category 2: tinnitus and subjectively significant hearing loss without hyperacusis......Page 140
3.6.4 Category 3: hyperacusis without prolonged enhancement from sound exposure......Page 144
3.6.5 Category 4: prolonged worsening of symptoms by sound exposure......Page 147
3.7.1 Methodology of follow up contacts......Page 149
3.7.2 Potential factors related to a failure......Page 152
3.7.3 Closing the treatment......Page 156
3.8 Minimal requirements necessary to perform TRT......Page 158
3.8.2 Treatment......Page 159
3.8.3 Follow-up......Page 160
4.1 Introduction......Page 161
4.2 Methods of data collection......Page 162
4.4 Technical aspects of measurement......Page 163
4.5 Specific criteria for scoring the significance of individual improvement......Page 164
4.6 Placebo effect and spontaneous recovery......Page 166
4.7.1 Baltimore......Page 167
4.7.2 Atlanta......Page 172
4.7.3 London......Page 178
4.8 Why we believe our data are valid......Page 184
4.9 Conclusions......Page 185
5.1 Avoidance of silence......Page 187
5.2 Provision of sound enrichment......Page 188
5.4 Avoidance of negative counseling......Page 189
5.6 Identification of subjects with predisposition to tinnitus......Page 190
5.7 Basic principles of prevention......Page 191
6 Critical overview of selected tinnitus treatments......Page 193
6.1 Medications......Page 197
6.1.1 Drugs used for tinnitus treatment......Page 199
6.1.2 Drugs and substances that might cause tinnitus......Page 210
6.1.3 Summary for applicability of medications......Page 212
6.2 Surgical approaches for neurotological problems......Page 213
6.2.1 Ablative surgery to eradicate tinnitus......Page 214
6.2.2 Vestibular schwannoma......Page 215
6.2.4 Perilymphatic fistula......Page 217
6.2.6 Otosclerosis......Page 218
6.2.7 Meniere's syndrome......Page 219
6.2.8 Auditory nerve compression......Page 220
6.3 Treatment of medical conditions associated with tinnitus and hyperacusis......Page 221
6.4 Masking......Page 224
6.5 Hearing aids......Page 227
6.6 Psychological treatments......Page 228
6.7 Electrical stimulation......Page 230
6.8 Alternative therapies......Page 234
6.8.3 Homeopathy......Page 235
6.8.7 Hyperbaric oxygen......Page 236
6.8.11 Alternative treatments for hyperacusis: ear protection, pink noise, auditory integration......Page 237
6.9 Conclusions......Page 238
7 General conclusions and future directions......Page 239
Appendix 1: interview forms......Page 244
Appendix 2: representative examples used in counseling......Page 247
Glossary......Page 249
References......Page 259
Index......Page 284
