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numbers

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 #1 
Hi Dr. Nagler:

I have had tinnitus and hyperacusis since June 3, 1988. I found Dr. Jastreboff in 1997 and traveled to his Tinnitus and Hyperacusis Clinic in Baltimore. By 1997 hyperacusis was a bigger problem than my tinnitus. TRT gave me my life back. Using the Viennatone Sound Generators for up to 18 hours a day, I habituated to my tinnitus but, most importantly to me, they raised my LDLs by 20 - 25 db. I could once again listen to the music I love and go to restaurants and shopping stores that I could not previously tolerate.

I have had a relapse over the last few weeks and I really don't know why or how it happened. I only know it has happened. I have had relapses before but they were always after exposure to sound that was too loud for too long. I would then start wearing my trusty Viennatone Sound Generators and within a couple weeks my LDLs would bounce back to their prior levels. This time is different. This was not caused by exposure to too loud sound, it just happened. I suspect anxiety was an element but I have controlled my anxiety for the last 17 years while having minimal problems with tinnitus and hyperacusis. I can't say that as I type this.

I will take whatever steps I need to take to get back to where I was just a month ago. My question to you is this.... I know from browsing this forum that you went through TRT in 1994 - 1995 so you would have used the same Viennatone Sound Generators I used in 1997 and still use from time to time.

Technology used in TRT has advanced a lot over the past 20 years. In your opinion, are the Viennatone Sound Generators as effective as modern over-the-ear sound generators for raising my sound tolerance level?

Thank you for your consideration and your generosity with your time and advice.
Dr. Nagler

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 #2 
Quote:
Originally Posted by numbers
Hi Dr. Nagler:

I have had tinnitus and hyperacusis since June 3, 1988. I found Dr. Jastreboff in 1997 and traveled to his Tinnitus and Hyperacusis Clinic in Baltimore. By 1997 hyperacusis was a bigger problem than my tinnitus. TRT gave me my life back. Using the Viennatone Sound Generators for up to 18 hours a day, I habituated to my tinnitus but, most importantly to me, they raised my LDLs by 20 - 25 db. I could once again listen to the music I love and go to restaurants and shopping stores that I could not previously tolerate.

I have had a relapse over the last few weeks and I really don't know why or how it happened. I only know it has happened. I have had relapses before but they were always after exposure to sound that was too loud for too long. I would then start wearing my trusty Viennatone Sound Generators and within a couple weeks my LDLs would bounce back to their prior levels. This time is different. This was not caused by exposure to too loud sound, it just happened. I suspect anxiety was an element but I have controlled my anxiety for the last 17 years while having minimal problems with tinnitus and hyperacusis. I can't say that as I type this.

I will take whatever steps I need to take to get back to where I was just a month ago. My question to you is this.... I know from browsing this forum that you went through TRT in 1994 - 1995 so you would have used the same Viennatone Sound Generators I used in 1997 and still use from time to time.

I remember my Viennatones very well. Yes, indeed.

Quote:
Technology used in TRT has advanced a lot over the past 20 years. In your opinion, are the Viennatone Sound Generators as effective as modern over-the-ear sound generators for raising my sound tolerance level?

Well the technology has improved for sure. The units most commonly used for TRT Category 3 patients (i.e., those whose primary problem is hyperacusis rather than tinnitus) these days are the GHI Tranquil Simplicity OTE devices, which are considerably smaller, lighter, and more comfortable than the Viennatones. The circuitry has come a long way as well. But all that said, in my opinion the technological improvements have not resulted in a clinically significant improvement in outcomes. So assuming that your Viennatones are still working properly, I personally do not think I'd spend the money on the newer technology. Just continue doing what you are doing, and I bet that over time things will begin to settle back down for you.

I do have one other thought - something you can do in addition to wearing your Viennatones. You cannot do it at the same time you are wearing them (the Viennatones are just too big and clunky), but you can certainly take them out each day long enough to add this into the mix. Anyway, as you may know, I am in general not a huge fan of Internet tinnitus and hyperacusis support sites. It's not that you can't find good information on those sites; you certainly can. Rather, it's that for every piece of good information, there are ten pieces of bad information. And since by and large all the information - the good and the bad - makes sense, how is one to know??!! Well, there's a wonderful exception in the name of a fellow who posts under the nick "Rob" on the hyperacusis board. Rob is not a hearing healthcare professional, but I really believe he has missed his true calling there. I have found Rob's postings to be insightful and almost always spot-on. Turns out that he has come up with a music protocol for all forms of decreased sound tolerance (hyperacusis, misophonia, etc.) that I believe has great potential. You can find it at the link below. Perhaps consider giving it a shot ...

Rob's Music Protocol

Quote:
Thank you for your consideration and your generosity with your time and advice.

You are most welcome.

Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC

__________________

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
numbers

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 #3 
Dr. Nagler-

Thanks for your response on the Viennatone Sound Generators.

I read your post on Neuromonics vs TRT. Very informative.

Are you familiar with SoundCure?

From what I have read about it, it is tailored to each individuals tinnitus sound but uses a habituation sound that is at about half the volume of the tinnitus level.

Half the volume.... that is exactly what Dr. Jastreboff told me about TRT back in 1997..... turn the volume on the Viennatones up only until you can hear the white noise, not loud enough to mask the tinnitus. The theory being that you can't habituate to something you can't hear. The SoundCure technology appears to be based on TRT but tailors the sound to each individual's tinnitus sound.

I'm wondering if you are familiar with it and, if so, is it effective in raising sound tolerance levels for hyperacusis sufferers as well as for tinnitus habituation.

Thanks for any information you can give me.
Dr. Nagler

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 #4 
Quote:
Originally Posted by numbers
Are you familiar with SoundCure?

Yes. And right off the bat I can tell you that one should be skeptical, very skeptical, of a company that uses "Cure" in its name - when it doesn't cure anything!

Quote:
From what I have read about it, it is tailored to each individuals tinnitus sound but uses a habituation sound that is at about half the volume of the tinnitus level.

My understanding is that SoundCure is not a habituation protocol at all. I believe that it is more akin to tinnitus suppression like a masker, but using "S-Tones" rather that broadband sound. Theoretically the S-Tones do not have to be played at the same volume as broadband sounds, but either way the effect does not last.

Quote:
Half the volume.... that is exactly what Dr. Jastreboff told me about TRT back in 1997..... turn the volume on the Viennatones up only until you can hear the white noise, not loud enough to mask the tinnitus.

If you set the Viennatones as you describe - at the point where you can just hear the white noise - you run the risk of actually inhibiting habituation through the stochastic resonance effect. I think you may be a bit confused regarding setting the devices, but that's understandable since it was almost twenty years ago that you were instructed in that regard.

Quote:
The theory being that you can't habituate to something you can't hear.

That's right - but there's a huge difference between setting devices at or just below the "mixing point" and setting them so that you can just barely hear them.

Quote:
The SoundCure technology appears to be based on TRT but tailors the sound to each individual's tinnitus sound.

SoundCure is in no way "based" on TRT. Indeed, it is about the farthest thing from it!

Quote:
I'm wondering if you are familiar with it and, if so, is it effective in raising sound tolerance levels for hyperacusis sufferers as well as for tinnitus habituation.

As I understand it, SoundCure is not purported to be effective in hyperacusis. Nor, as I mentioned earlier, has it ever been shown to facilitate the habituation of tinnitus. Temporary tinnitus suppression and tinnitus habituation are two different things entirely.

Having read through both of your posts again, I think you would likely be best off being re-evaluated by a clinician who is knowledgeable and experienced in tinnitus and hyperacusis. The clinician could then review suitable effective protocols with you based upon the outcome of that evaluation. He or she could also assess the output your Viennatones to be sure that time had not exacted too great a toll on those wonderful old devices.

All the best -

Dr. Stephen Nagler

__________________

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
numbers

Member
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Posts: 4
 #5 
Dr. Nagler-

Thanks for your help with Viennatone settings. I think you're right. I need a hearing evaluation by one of the best.

I live in North Dakota. Is Dr. Paula Schwartz in Edina, MN still one of your recommended audiologists for a hearing evaluation and sound therapy?

Thanks for your help.
Dr. Nagler

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Registered:
Posts: 1,764
 #6 
Quote:
Originally Posted by numbers
I live in North Dakota. Is Dr. Paula Schwartz in Edina, MN still one of your recommended audiologists for a hearing evaluation and sound therapy?

Yes.

Dr. Stephen Nagler

__________________

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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Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.