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Readers Email

Letters from readers 2013, with replies by Jonathan Hazell


Questions and Answers December 2013


I have read the information on your website and found it all very helpful and
encouraging, so thank you for that. My question is; in your experience of
dealing with people with tinnitus, would you say that it is more difficult to
‘habituate’ to a low frequency tinnitus sound (such as a buzzing/humming) than
the classic high pitch ‘ringing’ which I believe we all experience at some point in
our lives? Or is it generally irrelevant what the type of sound heard is and it is
purely based on each persons ‘reaction’ to the sound and perceived loudness? I
have a mild high-pitch ringing in both ears that I have fully ‘habituated’ to and
which never bothers me at all. However, I also experience a low frequency
buzzing/humming in my right ear, which is very bothersome to me and which I
believe I have never been able to ‘habituate’ to. I perceive this tinnitus as very
loud in the absence of sound but it is quite easily ‘masked’ by everyday noises,
which is great, but perhaps maybe why I have never been able to fully accept it.
I feel that this noise interferes with most of my quiet time activities and since
being diagnosed with it three and a half years ago (directly as a result of ear
syringing), I have never been able to sleep without the aid of a fan in the
bedroom at night.

Absolutely not. We researched the results of TRT against all the possible
parameters of tinnitus experience, and the only consistent factors were related to
negative beliefs about the meaning of tinnitus, and compliance with tinnitus
retraining programmes. It makes no difference what characteristics, length of
time, trigger or onset events or indeed anything you can think of that might
measure tinnitus, will affect the outcome of TRT. That is because ALL that matters
is your reaction to tinnitus (aversive conditioned response). You make it your
enemy, and the brain is absolutely right to monitor it and dislike it. You make it
your friend and you will only hear it when you wish and without displeasure.
Sound enrichment is recommended 24/7, and indeed also for those who DON’T
have tinnitus. Silence in nature means a predator. Tinnitus after ear syringing is
very common. If patients are warned of this then they will not develop an
aversive conditioned response and the tinnitus will not persist.




Very short: born 1962; noise trauma in 1984; tinnitus getting louder in 90’s;
hyperacusis starting after 2000; my tinnitus is now about 50dB; ldl around 80 dB.
The last year I have a new outburst of tinnitus every 5 days. In the morning at
round 7 I wake up with severe tinnitus (can’t hear the off-station radio anymore
which I use for background noise). Then it takes days to gradually get softer. On
day 5 It’s okay. But the next day everything starts all over again. It’s impossible
to have a job or have a social live. I do relaxing exercises every day and I am fully
aware that the tinnitus is not threatening and “only” the sound of my brain. Still
it’s very hard to live with. Question: What can I do to make this 5 day cyclus go
away? Have you ever heard of it before?

Very short answer! It is linked to a 3-5 day limbic emotional cycle described in our
book – extremely common. Look again at the graphic of Jastreboff’s model.




Hello, I was advised from a member of the hyperacusis message board to
contact you . it will be a great help if you could give me some direction. My case
is not usual; in May 2010 i was attacked at the street (no brain injury, just strong
shock) and 2 weeks later i developed strong hyperacusis as well as
hypersensetivity to vision. Not only bright light lamps but to the world lights in
general. the colours are strong , vivid and bright exactly as in my hearing but
with vision. This state “hyperacusis” and “hypervision” produces in me a
constant state of hyper-vigilance and anxiety. i was treated by many
antidepressants, neuro-feedback , psychological help with sero improvement. I
became isolated and i stay in my room 95% of the time .
i do not have many of the characteristic of PTSD like flashbacks, avoidance of
trauma places and so on . Iam 27 male , living totally isolated. The man in this
hyperacusis forum told me that desensitization of sound in trt can help to
reduce the vision sensitivity because there is strong connection between
auditory and vision systems. It clear that in my case something wrong in the
perception and it affects hearing and sight.
I am now thinking of in extreme measures that will remove surgically my
amygdala in order to disconnect the sensory input from the limbic system that
produces the anxiety.

Global hypersensitivity following an attack/injury is very common, and we have
seen many patients like you.
TRT certainly will help the hyperacusis (this is the thing it does best!) and following
the exercises (see website left column) is important. Apply these to all your over
sensitivities, but remember don’t try to work too fast. ‘Flooding’ doesn’t work!
CBT and relaxation helps to reduce the limbic input. I would strongly advise you
not to have any brain surgery. You could end up with serious complications and
be no better. Retraining is what all phobic/hypersensitivity states are about.
While the reactions to your experience are in a sense appropriate survival reflexes,
in your case they have just been too strong, possibly because of previous anxiety
states. The TRT and related approaches, do work, but you have to be patient. Just
trying to shield yourself from the objects of your dislike will make things worse,
and simply reinforce the threat that your brain perceives.





I was so glad to have found your website. I was recently diagnosed with
hyperacusis and tinnitus by an audiologist here in Raleigh, NC, USA. Until 6
years ago, I was a completely normal, healthy white female who had worked as
a nurse for 30+ years. I suddenly developed a rare condition called
neurosarcoidosis. Initially, extreme sensitivity was one of my symptoms but my
neurologist dismissed it. I didn’t even know there was a name for it. Recently,
the sensitivity returned but much worse than before. A fellow neurosarcoidosis
sufferer mentioned “hyperacusis” so I made an appt with an audiologist. A
diagnosis of hyperacusis and tinnitus was made last week. The audiologist also
mentioned in her report that the cause might be due to granulomas along the
auditory pathway.Have you ever heard of this? (My initial MRI’s did show non-
caseating granulomas in the temporal region of my brain as well as other
sections) Interestingly, I developed photophobia about 6 wks before the
hyperacusis. All of this has occurred as my neurologist has decreased the med
which I’ve been taking for the past 4 years to treat the neurosarcoidosis. Do you
know of anything that might link these symptoms together to lend a clue to the
underlying cause? Everything seems to have a neurological connection to me.
The audiologist whom I saw is fitting me with “musicians’ ear pieces” which, as I
understand it, will filter out the noxious sound frequencies. However, after
reading articles on your site, I’m wondering if this is going to be
counterproductive. Is my understanding correct? Would the noise therapy be a
better option. If, indeed, there is a neurological connection between by eyes,
ears and neurosarcoidosis who might be able to recognize that and provide an
appropriate treatment. (My neurologist is not interested in anything other than
my brain and just dismisses my complaints with “I don’t know anything about
that” but he doesn’t suggest where else I can go either)

Thank you for any thoughts you might have and for any help you might provide,
No I have never seen a case so I can’t comment medically, although someone
may have written something in the medical literature; try and google it.
Photophobia is very common in association with hyperacusis. It is a
manifestation of ‘global’ hypersensitivity. You brain is manifesting a ‘fight and
flight’ response, which doesn’t seem unreasonable given your medical problem.
However it doesn’t help YOU! Sound therapy, and look at the exercises on our
web, are designed to help reduce sensitivity in any sensory system when applied.
If it IS the neurological problem that is directly affecting cranial nerves, then TRT
may be less effective, but it could still help. Nothing to loose!
I understand and believe the Jasterboff model, so how do you explain the fact
that my tinnitus is always worse when I wake in the morning? I’ve had many
days that were ‘silent’, only to awaken to loud tinnitus (which can lead to a bad
day depending on my reaction). Certainly my emotional state didn’t change
while I was asleep. Thanks for your reply
Threatening sounds are always amplified by the brain on waking – they might
have been what woke us (survival strategy). In the case of tinnitus the meaning
has been wrongly attributed. Once tinnitus is your friend (end point of TRT) this
will no longer happen


Sorry to bother you. I have tried to understand all that is on the website. My
tinnitus started after I went unilaterally deaf suddenly (due to a virus) just over
3 months ago. The deafness was more or less overnight. It is in my right ear (as is
the tinnitus.)
I am still waiting for a hearing aid (which my Audiologist has but can’t fit for
another week or more, as she is away – a torture! I can’t wait to hear in stereo
again!) Will TRT work without a hearing aid?
I have read that in order for TRT to work BOTH ears need to be matched, as far as
hearing levels are concerned. How is this possible? My right ear will NEVER be
equal to my left ear now, even with a hearing aid… # well we do our best to
achieve this, but it is not the be all and end all..I have also read that the hearing
aid itself will make the tinnitus much better. Is this the case? Is the cause of my
tinnitus the fact that the brain-sounds (or background sounds) are now so much
louder, compared to the external sounds, than my ear is used to that they seem
to be a threat (to my subconscious, anyway..)? Is raising the level of the external
sounds in my right ear, via hearing aids (to rebalance them with the internal
sounds) the key to my recovery? And does this mean it can’t REALLY GET GOING
until I have my hearing aid fitted? Or is my right ear just desperate to hear
something and so is focusing on the internal sounds, now that they are (more or
less) all it has?


# there is a lot you can do with sound enrichment 24/7, the
exercises (see web) and learning the Jastreboff model Lastly (and possibly most
importantly) I live in the countryside (in the proper sticks!) and due to my job, I
spend a lot of time outdoors, where it is very quiet. This focuses my
concentration on the tinnitus and makes it seem louder. I read that in TRT
silence is to be avoided. I find that an MP3 player helps massively with this but,
due to the one-sided deafness it is most definitely not well balanced. I hear it
much more in my good ear (obviously)Is this bad? Also, sometimes I only wear
the earphones in the bad ear, so that I can hear music and tinnitus in there and
can focus on the music instead of the tinnitus (usually just the bass as the
hearing is quite bad.) I do this so I can hear my girlfriend with my good ear and
not have a loud tinnitus in my other ear. Should I be doing this? Is is masking or
sound enrichment? Will it aid or hinder my recovery? I have to walk the dogs,
for example. Should I just put up with the ringing until hearing aid time?
Once I have a hearing aid, headphones will be more balanced for my hearing. Is
this the time headphones are recommended? Or should I go outdoors without
headphones (will the sounds of nature be enough for my sound-starved ear?)
#don’t get too hung up on sound therapy. The most important thing is to work
towards making tinnitus your friend (the endpoint of TRT) and that is a mental
exercise based on knowledge I have been told that if my GP had referred me to
an ENT specialist sooner, my hearing would have been saved. This fills me with
anger towards my GP and makes my deafness (and tinnitus) seem very unjust to
me. This feeling of unjustness won’t go away soon as my own logic makes me
consciously aware that the incompetence of others has cost me dearly. Is this
sense of injustice what is fuelling my anxiety towards my tinnitus? Will I have to
let this go to recover? Should I take legal action in order to satisfy my injustice or
is this prolonging my anger? Sorry – quite a complex issue I suppose. # there is no
scientific basis for this. Treatment of sudden nerve deafness is empirical, and
there is still no good study that shows that it is any better than doing nothing #
PS, I read Oliver Sacks’ “Man who thought his wife was a hat” a long time ago.
Very interesting! #a great man, and a gifted writer – he taught me neurology as a
medical student at the Middlesex hospital in Londonbefore moving to the US!




Thankyou for the information. I have the book that you and Jastreboff wrote but my anxiety and depression have been so bad Im not able to concentrate. Now that the Clonazepam has made me feel better I will get to grips with it and learn the Model properly. I have seen the flow diagram of it and understand the anxiety loop but I havent read about the filters.

There is one big stumbling block with me fully taking on board the Model. I dont know if you will have the time and patience to help me with this but I hope so. What I dont understand is how the Model fits in with neuronal hyperactivity in the auditory cortex. As I understand it the brain is tonotopically mapped and when input goes missing from some frequencies due to hearing loss then those neurons which are not receiving stimulus anymore go crazy and hyperactive and its this which we hear. How does this fit in with the Model? How can reducing anxiety stop these hyperactive neurons as they still wont be receiving sound stimulus. Thats my big problem which trying to get to grips with the JST Model.


No. Benzodiazepam tranquilizers work (and have been shown to do so in placebo trials) because they reduce limbic system anxiety. This in turn, affects the filters and cognitive function identified in every picture of the Jastreboff model. Everyone experiences ‘worse’ tinnitus when they are anxious, and indeed we showed that anxiety linked events were the commonest trigger for the onset of tinnitus. Those ‘arrows’ go both ways
The problem with tranquilizers and particularly clonazepam is that they are simply sweeping the anxiety problems under the carpet. They are also highly addictive, so when you try to withdraw them (which must always been done with extreme slowness) you get an exacerbation of anxiety and therefore tinnitus. The only effective way to deal with anxiety is by psychologically based methods, cognitive therapy etc. You may need a psychologist to help or you might do it on your own (better). Again the approach involves essentially the same principles as our model. You have to face the objects of your dislike without reacting (desensitisation).




Jan 2013
I am a tinnitus sufferer. I first noticed tinnitus eight years ago and habituated 100%. Recently (two months ago) after a stressful event I noticed tinnitus again. I have been doing everything which is suggested on the BTA website. Recently I came across your website about TRT at tinnitus .org Your website made me feel much better about my tinnitus and I support your theories whole heartedly. I am beginning to habituate again. There were times when it hasn’t been easy but I’m a ‘glass half full’ kind of girl and I believe I can habituate 100% again, especially as I now have a much clearer understanding of tinnitus.
My question is I notice on the website there are emails dating back to 2006. I wondered if the website is still actively monitored. There are lots of people who would benefit from your website and book and I promote both on the BTA Forum. Please will you consider updating your website with more recent correspondence from other sufferers..


Culpa mea! Yes I do monitor it and I reply to every writer addressed to help at least once. However… I have not been good at updating the selected letters, and your jolt in my ageing back has prompted me to action. In retirement I have a number of other almost full time activities. In fact I would dearly love to make the whole website look ‘modern’ . The website has nearly 1 million visitors now, and the book Jastreboff and I wrote, still sells well (about 900 a year!) #




Hi I had a bad fall a year ago and a resultant concussion. With the concussion came sound and light sensitivity. I am almost better but am still sensitive to sharp or loud or electronic sounds and very often have very bad ringing in my ears and at times even pain. Is this tinnitus? Can it be dealt with? Any thoughts?


Hyperacusis (see website) and multi -sensory hypersensitivity after head injury are quite common. Apart from the direct effect of brain concussion on processing this represents a response from the brain in general to be more aware of potential threats – a survival strategy. Increased anxiety about this response will potentiate it! The other changes are reversed by regrowth of neurones and plasticity (learning). Let it be and all will be well


Hey, i have a mild tinnitus as long i can remember, only hear it when i sleep. I have a new problem, sometimes at certain frequencies or pitch i hear a whistling, almost human like, it started in one ear when people spoke. I hear it now over music, tv, outside noise, loud places bars etc. Its like my ears or brain mimics and makes whistling sounds, never hear it in quiet places. What is this?. I have jaw problems and uses teeth protection. I am diagnosed with Anxiety. Is this a mental illness? This scares me a lot gives my anxiety attacks. Plz help, worried soul from Sweden.



No it is not a mental illness, although you obviously need help with anxiety – psychologists are better than drugs, and there is a lot of self-help. You do experience tinnitus and this response to sounds, as opposed to hearing it in the quiet is quite common. Please read the articles on our website, and do the exercises (left hand column) they are very good for anxiety too. Knowledge about what tinnitus is ( a normal compensatory phenomenon and not a disease) is essential. #






According to our local TRT specialist a person who belongs to category 4 can evolve to catergory 3 or even after a while to category 1 or 0. Is this correct?






I was wondering, if a person had relatively OK “tinnitus” for a long while but it slowly got worse, even though there was no obvious physical cause or noise exposure or anything, is it ever possible to get back to where the tinnitus was quieter? I am and have been anxious about tinnitus for years but can never tell if increases/exacerbations are due to some physical change that will never get better or if it’s psychological and I have hope of going back to the way it was. Just wondering if there’s any kind of rule of thumb or something to figuring out if a change in tinnitus is physical/permanent or psychological/stress etc and reversible.



Revisit the Jastreboff model! The only thing that makes tinnitus ‘worse’ is your reaction to it, and that is based on a) what you think is happening (‘dreadfulising’) and b) your mood state which influences tinnitus through the model (look at the diagrams). Your reaction (AVERSIVE CONDITIONED RESPONSE) to tinnitus is what governs it, and the effect it has on you. This is what TRT reverses. Loudness is immaterial and indeed some of our worst affected patients had tinnitus they could hardly hear except in a very quiet room. Read the website, and the book, learn that tinnitus is a naturally occurring phenomenon in everyone, and only when phobias and dislike takes over do you get into trouble. There is NO physical change relating to tinnitus alone. Do the exercises on the web regularly and use sound enrichment 24/7 according to the instructions. #





I am deaf in my left ear from birth and I’m 24 years old. I suffer with tinnitus in my right ear and head sound. I get told I should be wearing 2 WNG’s to habituate; you also mention this on your website about it not being one sided. What are my options? Does this mean a life of suffering because of the hearing loss and making habituation harder? Thank you.


No, you have never had ANY hearing in your left ear; there would be no point in a WNG on that side. As far as you brain is concerned hearing input is right only (and this works very well as you know! ) Simply follow the TRT rules about learning the model, and doing the exercises on our website, and using sound enrichment (at night too). You have exactly the same chances of success as everyone else. That is excellent if you do TRT properly!



Briefly, I am a male, 78 years old and a former patient of yours. My tinnitus started in 1988. I first saw you in 2000. TRT was very successful. I saw you again in 2004 after a ‘relapse’. After that visit (until the beginning of this year) . I went through a very good period for some 8 years; only about 3 or 4 brief periods of annoying tinnitus. These lasted no more than a week or two and were dealt with easily using TRT. This year I had 3 annoying periods which again I dealt with as before. But about 3 months ago I had another ‘relapse’ and I am unable to deal with it. Indeed it seems louder than before. I am a firm believer in the model, understand what tinnitus is and realize and accept that my distress is caused by my reaction to it. I saw Jaqueline Sheldrake recently and she suggested it may have been triggered by my straining to hear (I have hearing aids) and she tweaked the aids and cleaned them. This is why I am seeking your help as I would have come to see you if you were still in practice. I play your tapes to me which are very reassuring but are not doing the trick this time. Can you reassure me that (as you have told me in the past) TRT always works and advise me on the steps I should now take, even though those steps are well known to me. My disappointment is that although on some days the tinnitus does reduce to a mere whisper, which to me is heaven and it becomes a friend again, the following day I will awake to sounds as loud as ever.


Well I think this last sentence has the clue. You are still judging your response to TRT by how loud your tinnitus is on certain days. ‘Quiet’ days are OK. Well, the loudness of tinnitus is not important , only your reaction to it. In fact it is your reaction +/- your fluctuation in your mood state, that makes it louder and more noticeable rather than the other way around. TRT will always be the answer, and the more practice you have had using it, the better the results. Try doing the exercises on the website (button on the left) on a regular basis.




Have you ever heard of someone getting episodes of LOUD tinnitus just out of the blue periodically. They last a few seconds and then fade away. These scare the ***** out of me! I’ve long been afraid of tinnitus and hear different noises in my ears but I know it’s just anxiety and intense fixation. I’m seeing a psychologist for this and countless other somatic fixations and hangups. But these bloody episodes are totally different. They’re an extremely loud sound that comes on unexpectedly. The only clue I have about them is that sometimes they’re accompanied by a muscle seizure like feeling in my head or face. But not all the time. I don’t recall ever having these before I became so terrified of tinnitus generally.



Transient tonal tinnitus is 100% universal. Absolutely everyone experiences it sometime or other. Try asking people in the street! They are part of the normal ‘calibration system’ of the auditory system. Naturally if you try hard to develop a phobia about them, it will be a self-fulfilling prophesy. I beg you to read and learn the Jastreboff model so you can lose you irrational fears. Knowledge is the way. The problem is not tinnitus, or your hearing, it is your phobic anxiety state, possibly rooted in childhood experiences and which has to be sorted out by you and your psychologist. The path to enlightenment is one only you can travel. It is also worth remembering that British psychologists have shown that repeated reassurance doesn’t help and can actually make anxiety worse. So the answer has to come from within you. #




I found your article ‘things that go bump in the night’ on the website! Can it just be that my case is an increased muscle activity in reaction to the tinnitus? I hope so. Is the reason that i experience this increased muscle activity only in one ear then, in accordance with your reaction to my question why i experience tinnitus only in one ear, that it is the brains best guess of the location of the tinnitus??



Absolutely right! Well done. ‘If I hear it, it must be something to do with the ear’ It’s sometimes a bit alarming to realise that all our perceptions of ourselves and our world happen at the brain cortex, and are ‘the brain’s best guess’, sitting as it does in total silence and darkness. Sometimes it does a poor job at interpreting the very complex sensory input! #





If tinnitus patients’ tinnitus is little different from the “tinnitus” heard by subjects in the Heller Bergmann experiment, then why can’t every tinnitus patient who undergoes TRT get back to the state the Heller and Bergmann subjects were in when they exited the soundproof booth. Those people didn’t hear tinnitus before and presumably didn’t hear it after they left the booth. Yet, tinnitus patients, even one’s who successfully habituate, often claim they still hear their tinnitus all the time. Is it just that the Heller Bergmann subjects had very quiet tinnitus and most tinnitus patients have very loud tinnitus? Otherwise why doesn’t the noise effectively disappear after successful habituation like it did when the people came out of the booth? What’s the difference?



I recollect that the descriptions by the H&B normal subjects were identical to descriptions by tinnitus sufferers. The characteristics and loudness of tinnitus have absolutely no meaning in terms of whether they are a problem. (Wish I had 10p for the times I’ve said that!). I think the persistence of tinnitus in those who were previously sufferers is due to a learning process. Once you have ‘taught’ your auditory filters to pick up internally generated sound, you can do it any time you like. Same is true of sounds in the environment like the fridge. Again, my conversations with Mo Bergman revealed that sadly they never followed up their subjects. Maybe some of the ‘normals’ could hear T afterwards, but were not aversive. #





Have T now for 1 month (loud ringing), no hearing loss. I borrowed a sound generator from a audiologist = pink noise (looks like small hearing aid) which I put around and in my right ear. Is it correct to have it only for 1 ear, just want to know before I buy because very costly, Siemens R 6 300 South African Rands ! And is pink noise successful ? SSSSHHHH NOISE. Thank you (so many websites, don’t know what to believe.



Never one ear while hearing in both – better to stick with environmental sound enrichment. Correct Retraining needs to balance, not unbalance auditory input. This is not correct TRT. Broad band noise is what you are aiming for, the spectrum is limited mostly by the device construction and ear canal. Please read the info on the site about TRT and sound enrichment è 22/10/2012






Hi, after reading your fascinating material via the website i believe i have a better understanding of how tinnitus develops and how to adopt it rather than fear it,i will continue to read at length.My question is as a rock drummer for fourty years ear damage has been assesed and of course tinnitus for 6-7 years BUT i have it loud and high 7000 hz for 10 – 11 days then overnight it will diminish to tolerable for 5-6 days,this cycle repeats continuously.Conversly i have gone on stage with tinnitus and left without it. can you tell me more. I start tonight by removing earplugs and learning non reaction .Many thanks.



The secret is in the Jastreboff Model
Look at at the connection in the diagram
between perception and emotional centres.
As everyone has cyclical activity in the
limbic and autonomic systems ‘ups and down’
tinnitus perception (the threat) will be
more noticeable in the down periods.
Exposure to noise can produce an effect in some people
called residual inhibition. It was once thought it might be
a treatment, but of course it isn’t!
Keep up the good work – learning model, exercises
sound enrichment.





I have been told by ENT that no cause can be found from CT scan and MRI for the PT I have had for one year now. A couple of questions are:
1. Why does it get louder as I turn my head to the left, or up and back compressing my neck?
2. Why do I get a loud “squeal” in my right ear when I raise my right arm and simultaneously tilt my head a little to the right? The sound stops immediately upon straightening up to a normal posture. One day I got a loud squeal (also in the right ear) when stretching my neck and jaw a little to put an earring in my right ear, giving me a huge fright.

I couldn’t find anything in your book about posture having an effect on T. Thank you for any advice.



Download – ‘Things that go bump in the night’
Tinnitus and somatosounds are a continuum. Anyone who has ‘trained’ himself to listen to the ‘music of the brain’ is very adept at hearing the not insignificant sound (usually habituated as with tinnitus) of normal brain circulation. Cerebral blood flow changes with posture as does the sound generated by any blood vessel. The head is a very noisy place! Interestingly I have been able to hear these sounds since childhood – long before I knew I was going to be an ear surgeon! ‘Neural’ tinnitus can be altered by somato-sensory input see book page 206 and references therefrom. Very common experience. As with all tinnitus the perception is made stronger the more you react





Hello, I am greatly appreciative of your website. I have had Tinnitus for 5 weeks now. I too was full of anxiety in the beginning. But after reading all about Tinnitus and my reactions to it, I have reached the point of it just being irritating. I hear it , but am not scared of it.



This change in your experience of tinnitus is a measure of the habituation that has already occurred – but more work to do#





My question(s) is:

I am a mailman, I work outside. Is being outside enough sound enrichment, or should I be wearing an MP3 with white noise or nature sounds? I do sleep with house fan running all night.

Is it likely that I’ll habituate on my own, with or without some kind of one on one therapy, or will I need to go through TRT?

Is constantly monitoring your Tinnitus a hinderence to habituation? Because it’s really tough put it out of my mind



Everything hangs on what you believe tinnitus is. That’s why learning the Jastreboff model is essential. This teaches the modern scientific view that tinnitus is the result of natural universal compensatory mechanisms in the central auditory system. The triggers (such as some high frequency
hearing loss, or a stress event – shared by everyone) are irrelevant. Only if you develop an aversive reaction is there a problem. Once tinnitus is you friend and not an unwelcome guest – that is the end of it.
Download the ‘demo’ and illustrations, maybe buy the book: There is no shortcut for learning (and believing) the complex way in which our brain deals with the sounds it hears.Constant monitoring is what the brain does to all signals regarded as threatening. You can’t expect that to stop until you change the meaning of the sound.Read the download on environmental sound enrichment to answer your other question.






Is TRT benefit quicker if a person has tinnitus of only a few months duration compared to a person having tinnitus over ten years, for whom TRT may take very long time for relief.?



No. All results surprisingly show no relationship to the length of time T has been present. However severity of the aversive reaction is a factor.





Have you treated persons for tinnitus and hyperacusis who developed these problems concurrent with the onset of encephalopathy (inflammation of the brain)? Does such a patient present any unusual challenges or resistance to TRT?



No, not unless intellectual function has been severely compromised. Once again the main message is, TRT works regardless of the trigger or cause





I have bi-lateral hearing loss: one ear may be affected by Autoimmune Inner Ear Disease since 1997; the other, 19 years earlier, was a sudden deafness, perhaps vascular. Besides having roaring tinnitus, I often hear music. I’ve been told that this is an “auditory hallucination” & have also heard of “auditory imagery”. How can I establish whether I have this condition & what is the treatment, please? I’ve also read that hearing music can be caused by a problem with the temporal lobe



.Auditory imagery it is! (Goodwin, P.E. Tinnitus and auditory imagery. Am.J.Otol. 2:5-9, 1980. download from this site ) We treat it successfully with TRT. You will not find a lot of knowledge or support in ‘mainstream ENT’ I agree that Dr Oliver Sacks had some patients with temporal lobe disorders who were immortalized in one of his excellent books, but he went on to conclude that all cases of ‘musical tinnitus’ were due to this. I’ve seen hundreds of cases of auditory imagery with not one tumour!! In the majority of cases the main problem is a hearing loss which has not been satisfactorily helped or rehabilitated. The perception of music seems to be the result of ‘auditory memory leakage’ into the perceptual areas of the auditory cortex. Normally this requires a signal from outside (via the ear) to trigger he experience, but in Auditory Imagery this is happening in the absence of stimulus, perhaps because of hearing impairment. The brain is just desperate to hear something – so it tries old memories!






I read about the Jastreboff model most days and before sleep at night, I practice the desensitization exercises, as this is when I feel most relaxed. I can sometimes make the tinnitus disappear. However, we live in a quiet country house of some 8000 square feet and it is impossible to avoid silence. I feel afraid of going into quiet rooms. I also do a very silly thing as well – (if I haven’t heard the tinnitus for a while because I’ve been listening to the radio etc) I’ll go into a quiet room specifically to determine whether I can still hear the tinnitus ! Then I become all panicky and worried about it ! I understand that my tinnitus is not threatening to me in any way but I still have this automatic reaction. How should I approach this ?



It is really interesting how people do this – almost to try and frighten themselves! It also shows that tinnitus doesn’t have to be loud to be feared. You should equip each room with sound enrichment devices. The fact that your are controlling your tinnitus is a very encouraging sign. This means that temporarily at least you are able to reduce your reactive (automatic) reaction. If you carry on with the ‘10 second exercise’, you will gradually habituate and block, first your fear of tinnitus, and then the perception itself will weaken. Remember that hearing tinnitus in a very quiet room is completely normal (Heller and Bergman 1953 – download area)





I am really struggling badly with my sleep, I seem to get maybe 2-3 hrs a night if I am lucky, and end up awake with T from 3am – 6:30 when I get up.
Are you using sound enrichment continuously during the night? Also this is the time to do the 10 second exercises
I have one more question if you have the time – I have had tinnitus for 6 weeks now, at what point should I stop thinking that I will spontaneously habituate and need to seek that TRT treatment.



Don’t wait! I hope you have been absorbing the Jastreboff model over this time from the website, and also doing the habituation exercises. However you need to check in with an audiologist or ENT, trained in TRT for 1:1 treatment






Why is it that a lot of persons believe that the necessary controlled studies have not been done for TRT. The American Tinnitus Association has funded a research on the effectiveness of TRT, a study which is being done by Dr. Richard Tyler. Why should there be apprehensions on this?



TRT like all therapies involving behavioural retraining cannot be subjected to double blind, or even blind analysis. It is impossible for the patient or researcher NOT to know what is being done, and to whom. We have compared similar treated and untreated groups over time (and shown a difference of 70%!) but this is not a controlled trial. This means that those who want TRT to fail, will always claim ‘ nothing is proved ‘ because double blind trials have not been done. TRT is only TRT if it is correctly used. Many people claim to be doing TRT but just do ‘a part of it’ e.g. use wearable sound devices. I am sure that Rich Tyler will make his best and most unbiased effort to show how effective TRT is compared to other treatments..





Is there a good news scenario for tinnitus? What percentage of cases go away on their own and in what time frame? Does it usually just fade away or do you get periods of relief?



You bet there is a good news scenario. The problem is that most user groups, and even self help groups, are moaning clubs, giving aversive and phobic training – which makes everyone worse. Also the information given by many professionals is still 10 years out of date (pre Jastreboff). Population studies show that 85% of those experiencing tinnitus, never develop, or spontaneously habituate the aversive reaction. Of the remaining 15%, 80% can achieve this habituation with TRT within a year (see our results and those of our graduates). The rest can get there, but take a little longer. The message is that, now, no one needs to suffer indefinitely. TRT doesn’t depend on the trigger or cause, so everyone is suitable for this treatment (see above).






I have two problems: tinnitus and migraines. Recently, I did some research on the internet and found that migraines are quite often associated with tinnitus. On tinnitus sites, I seem to see little or no discussion of this association. Sometimes tinnitus, along with dizziness, is simply viewed as a symptom of a migraine headache on migraine. What gives?



Tinnitus can be aggravated by any cyclical activity or sudden change in the brain or body including migraine. During a migraine attack there are major changes in brain blood-flow, which can produce quite dramatic, temporary symptoms. Most people also find migraine unpleasant and stressful, so there are changes in the reactive mechanism (autonomic and limbic system) which cause tinnitus distress. The majority of those who have migraine do not have tinnitus associated with it. Also many tinnitus sufferers have migraine which is unconnected. Both migraine and tinnitus are very common, and common things commonly occur together without a connection. Understanding migraine doesn’t explain tinnitus, but for some people control of migraine can help their tinnitus. TRT works whether migraine is present or not. If you haven’t investigated migraine treatment and symptom control in the last 10 years, be ready for a pleasant surprise!






I suffer from tinnitus, my daughter has just returned from Australia after a three-month visit. Whilst there she picked up a leaflet by Rafaele Joudry BSW “Sound Therapy Music to Recharge your Brain”. I have visited the web site and the product seems to be very expensive, also they say you have to read the book for the method to work. Please advise if you have heard of this method or any independent information on this method and its viability.



Treatment with sound without supervision can make patients worse. Treatments not based on the Jastreboff model, are not recommended by us. The cost sometimes indicates the motives of those promoting such devices. Also patients need to be treated in different ways, after appropriate diagnosis (the Jastreboff Categories). Please read the information on our website, with treatment recommendations based on a scientific understanding of tinnitus mechanisms.






Can you help me please again!? I have a white noise generator, have you any advice with regards to its usage, I have it for two months now, when will I know that I will not need to use it any more? At the moment I need it a bit less on the weekends and then end up having to turn it up on Monday mornings! Is it best to use it all day every day at a low level, I tend to not to use it at night time at all.



You can only get help from this device if it is properly fitted by someone trained in TRT who tells you exactly what to do. It sounds as if you are not using it for habituation, but for symptom relief, which is not the aim in TRT. The device is only a part of TRT and cannot work on its own (except for masking – which we do not recommend). If you only have one device you also are not being treated properly. For tinnitus, sound generators are set at a level indicated by your audiologist and not readjusted during the day. For hyperacusis the techniques are different. Don’t forget sound enrichment at night.






I am enquiring about any information or help you may be able to give my Father. If necessary we would be prepared to book a consultancy if you think it is appropriate. My Father is 78 years of age, is in general good health, albeit a bit of a self confessed worrier and has had run of the mill Tinnitus constantly for 17years. Since Christmas he has started to experience explosive and roaring noises which start just as he is about to drop off to sleep.



This is a very common scenario. The conscious brain is ‘shutting down’ at the point of going to sleep. Many electrical changes occur at this time, and these are often heard as a changing form of tinnitus. These sounds may be frightening but they are completely harmless.






If I read your notes correctly, the main factor that differentiates an individual with tinnitus from the normal population is that the brain of the tinnitus patient has “locked onto” the tinnitus activity – that is, his brain has “decided” that this is an important signal that must be monitored. The “TRT” protocol is designed to retrain the brain to ignore the signal.



Not exactly. The difference is that ‘sufferers’ have an aversive conditioned (Pavlovian style) reflex response to the sound their auditory system naturally generates. TRT is designed to remove / retrain the aversive conditioned response. You cannot do this by ignoring your tinnitus.






I have been reading the items on your website with interest and would welcome your answers to the following questions if possible.
1. I would like to know why some people with tinnitus are not bothered by it.
They do not produce an aversive conditioned response. The same thing is true for spiders, some people are aversive, some people keep them as pets
2. I understand that tinnitus is perceived by the brain as a new sound for which it has no memory pattern to match it to and therefore treats it as a threat,



No. You don’t do this to every new sound you come across. only a very few. It depends on the meaning of the new sound, whether you react to it or not. The question is ‘ is it a friend or an unwelcome guest ‘. Those who are aversive to tinnitus (or spiders) find it hard to believe that the majority don’t react as they do. But that’s the truth!.



why then does it not affect everyone in the same way as surely everyone must have the need to match any tinnitus to a memory pattern. Also, why is tinnitus still bothersome even if you tell yourself that you are not going to let it trouble you any more?



Because once you have an aversive conditioned response in the subconscious you cannot turn it off. You cannot tell yourself to cross a road without paying attention to motor horns (ever!).



3. If TRT can train the brain to no longer be bothered by tinnitus would it ever be possible that by using TRT you could actually have a side effect such as making the brain less bothered by other sounds which are vital to survival – e.g. car horn?



No. Sounds that mean real life threats are never habituated. In TRT what you are doing is learning that you are WRONG about tinnitus. It is not a threat, simply a natural sound that the brain makes (in everyone – Heller and Bergman 1953)



4. After a programme of TRT do you know if any patients have ever had tinnitus returning in a different form (eg hissing instead of the ringing that they originally had the TRT for) for which they would then require further TRT?



Yes it has happened, on a few occasions. The subsequent tinnitus would only persist if a NEW aversive reaction were generated (new fears, new anxieties, new annoyance). The good news is that if you have once learned a skill (in this case TRT) it is much easier and more effective to apply on a second or subsequent occasion, than it would be if you were learning to do TRT from the beginning. So you simply start off, at once, applying TRT as you did before. Many people who have had the experience of tinnitus returning after successful TRT are able to do this without professional he