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Michael2133

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 #1 
Dr. Nagler -

I was curious as to the difference between over the ear sound generators and general sound enrichment from natural fountains or table top devices. Is there anything magical/special that sound generators provide other than the convenience factor of constant, more stable consistent sound to both ears (which I'm sure is preferable)? Additionally, are there guidelines for environmental enrichment similar to guidelines for over the ear generators? I am assuming that "set it and forget it" is simply an instruction as to prevent thinking about tinnitus anymore than necessary.

Additionally, what exactly is proposed to be happening with sound enrichment in the habituation process at a neuronal level? My understanding is that sound reduces the strength of the signal by reducing the contrast between tinnitus and environmental sound. Is that all there is to it, i.e. does TRT simply set the stage to better facilitate a process that in many cases wants to occur without intervention? For example, if I were to be constantly thinking about my tinnitus is habituation of reaction occurring in the background? Or is progress being made only in those instances where I momentarily forget about tinnitus? I'm sure some sort of new neuronal pathways are being formed during habituation but I guess I don't fully understand what is occurring and how sound is playing a role. (This is all with the understanding that counseling is taking place to re-frame the signal to a more neutral stimulus).

Thank you for your time and generosity.
Dr. Nagler

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 #2 
Thank you for your very good question, Michael.

The answer really depends on what it is that you are trying to accomplish with your sound therapy.

On a very basic level sound can mask or partially mask the tinnitus, thereby providing some immediate relief. And in that regard, whether or not you use wearable devices or environmental sources really makes very little difference.

Specifically with respect top TRT, a lot more is going on.

First, as you suggest, sound decreases contrast - the idea being that a candle in a pitch black room looks much brighter than does the same candle with the lights on at a comfortable level, even though the candle puts out the same amount of watts under both circumstances. So the use of a constant level of sound introduced via wearable devices re-set each morning at a comfortable intensity that blends with (but does not mask) your tinnitus can, in effect, make your tinnitus less "bright" and consequently easier to habituate.

But more important than that is the element of associative conditioning. Are you familiar with that concept?

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Michael2133

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 #3 
I am not. I believe I saw Hazell mention it but only in passing which in large part led me to this line of questioning as I felt like I may be missing something in my understanding.
Dr. Nagler

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 #4 
I don't believe I ever saw Mr. Hazell discuss associative conditioning, but basically if you were to describe the sound used in TRT without mimicking it, you might say that it is uninteresting, non-threatening, boring, and readily habituated. Contrast that with the way your brain views your tinnitus, which might be described as the polar opposite. In TRT each morning you set your devices so that the sound they emit blends with your tinnitus but does not mask it so that your brain associates one with the other on a very powerful subconscious level. [There are some other constraints in setting the devices, but that's the basic idea.] And, over time, your brain begins to view your tinnitus as a sound that is uninteresting, non-threatening, boring, and readily habituated.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Michael2133

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 #5 
So is the same process occurring in those who habituate with sound enrichment alone? Or is this a different mechanism of habituation? It's evident to me that sound enrichment should be of a specific variety with similar acoustical properties as the devices (non-attention seeking, bland, readily habituating (i.e. nature sounds)). I've often wondered if my time spent commuting would be better spent with less talk radio and perhaps something more bland like a babbling brook (as long as I don't feel like I'm really losing anything by switching, which would give the sound too much importance)?

I also believe I read that plasticity is reduced by silence and that changes in the auditory system can only occur when it's being stimulated with sound, which implies that sound (and I'm assuming the wider band the better) is an almost necessary component to habituation. Is that correct?

Lastly, I am to understand that one cannot simply ignore their tinnitus in order to retrain the aversive conditioned response. Like many, I have the habit of "checking" it. If habituation is occurring at the sub-conscience level, then checking it would be more of a quality of life issue than say impeding habituation?

Long story short, at the end of the day (absent devices) enrich my environment with neutral sound so that I can still hear the tinnitus, and go on with living and let the sub-conscience do its thing over time?

Many thanks!
Dr. Nagler

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 #6 
Quote:
So is the same process occurring in those who habituate with sound enrichment alone? Or is this a different mechanism of habituation?

Not sure I understand. Habituation of tinnitus is a decrease in reaction to one's tinnitus over time. It happens naturally unless something is standing in its way. Sound therapy can be helpful. It can also be counterproductive.

Quote:
It's evident to me that sound enrichment should be of a specific variety with similar acoustical properties as the devices (non-attention seeking, bland, readily habituating (i.e. nature sounds)).

What is evident to you isn't all that evident to me. Seems to me this topic is deserving of an in-depth back and forth discussion, something that goes beyond the type of thing that can be readily accomplished on a board such as this.

Quote:
I've often wondered if my time spent commuting would be better spent with less talk radio and perhaps something more bland like a babbling brook (as long as I don't feel like I'm really losing anything by switching, which would give the sound too much importance)? 

Do you ever wonder if maybe you are trying too hard? Like I said earlier, habituation is a natural process.

Quote:
I also believe I read that plasticity is reduced by silence and that changes in the auditory system can only occur when it's being stimulated with sound, which implies that sound (and I'm assuming the wider band the better) is an almost necessary component to habituation. Is that correct?

The auditory system is always being stimulated by sound unless you are in a sound-isolated chamber. I mean, if you go to a room in your home that you consider to be fairly quiet and measure the decibel level in that room, I suspect it will be in the neighborhood of 40dB. So there's sound everywhere! But to your question, people who are deaf can habituate their tinnitus. So no, sound is not a necessary component to habituation.

Quote:
Lastly, I am to understand that one cannot simply ignore their tinnitus in order to retrain the aversive conditioned response. Like many, I have the habit of "checking" it. If habituation is occurring at the sub-conscience level, then checking it would be more of a quality of life issue than say impeding habituation? 

Complex issue, but habituation has both subconscious and conscious components. One thing to understand, though, is that it has nothing to do with "ignoring" tinnitus. Ignoring tinnitus is an active process. Habituation is passive.

Quote:
Long story short, at the end of the day (absent devices) enrich my environment with neutral sound so that I can still hear the tinnitus, and go on with living and let the sub-conscience do its thing over time?

Long story short is that the most important thing anybody can do as far as habituation goes is get out of the way

In my opinion, anyway.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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