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DrNagler
 #41 
Ana, thanks for your response.  Now that I have a better idea of where you are along your "auditory odyssey" I'm going to take a bit of time to put my thoughts together (finally done with the questions!) before offering you some ideas for your consideration.

smn
DrNagler
 #42 
Ana, here are my thoughts ...

It sounds to me like you are the victim of "sensory overload" ... and the fact that your ears are ringing all the time compounds the problem.  Moreover, your hyperacusis has served to limit your access to environmental sounds, which further compounds the problem.

In situations like yours, it really helps to keep things as simple as possible.

So I would suggest the you approach the problem on only two fronts - and set the rest aside for now.

Front #1 is your hyperacusis.  Indeed, if you can improve your tolerace levels for environmental sounds, your tinnitus just might take care of itself.

Front #2 is the fact that you feel so bad about what's been going on and about what you see as a pretty bleak future.

In terms of your hyperacusis, when you see the TRT clinician for follow-up, I think you should tell him that you really want to work on using TRT to help with desensitization - so that your sound tolerance will improve.  I wouldn't worry so much about the mixing point and things like that.  You want to raise your LDL's (loudness discomfort levels) - and the trick in doing that is purposeful but gradual exposure to louder and louder sounds.  TRT is an excellent way of accomplishing that goal.  Hopefully your TRT clinician is experienced in facilitating that process.

And in terms of not feeling so bad, I have a book in mind.  It's available in paperback in most bookstores in the US, but I don't know about the bookstores in Croatia.  Or you can order it through Amazon.com.  I would really focus on the first four chapters.  They are a gold mine!!!!

Click HERE.

smn
frankie_girl
 #43 
Thanks for your thoughts, doc.
I will certainly check out the book you recommended.

Could you perhaps explain what you mean by "sensory overload"? Is it a psychological thing?

when you see the TRT clinician for follow-up, I think you should tell him that you really want to work on using TRT to help with desensitization - so that your sound tolerance will improve.

That's exactly what we agreed to do on my first visit. 


I wouldn't worry so much about the mixing point and things like that.  You want to raise your LDL's (loudness discomfort levels) - and the trick in doing that is purposeful but gradual exposure to louder and louder sounds.
Hopefully your TRT clinician is experienced in facilitating that process.

Well, I hope he is too. But since he wasn't answering my emails or phone calls, I just kept wearing the generators on the lowest volume and getting nowhere. We'll see what happens when I see him again.

And while I still have your attention, may I have the answer to your question
what is largely considered to be the single best approach to the treatment of panic attack disorder?

Thanks once again and regards.

Ana 



DrNagler
 #44 
Ana posted:

Thanks for your thoughts, doc.

.............

You are welcome.

...............

I will certainly check out the book you recommended.

................

I believe that it will help you a lot.  Think about it - if your tinnitus and hyperacusis didn't make you feel bad, you'd be a lot better off!  So this book talks in very practical terms about how to feel better.  And judging from your responses to a few of my questions, if you apply the principles ... it should make a real difference for you.

..........

Could you perhaps explain what you mean by "sensory overload"? Is it a psychological thing?

.............

Sensory overload means that you are so bombarded with various stimuli that you become overwhelmed and do not know which way to turn.

.............

"when you see the TRT clinician for follow-up, I think you should tell him that you really want to work on using TRT to help with desensitization - so that your sound tolerance will improve."

That's exactly what we agreed to do on my first visit. 


...............

Excellent

............. 

"I wouldn't worry so much about the mixing point and things like that.  You want to raise your LDL's (loudness discomfort levels) - and the trick in doing that is purposeful but gradual exposure to louder and louder sounds.
Hopefully your TRT clinician is experienced in facilitating that process."

Well, I hope he is too. But since he wasn't answering my emails or phone calls, I just kept wearing the generators on the lowest volume and getting nowhere. We'll see what happens when I see him again.

..............

Maybe you were bombarding him with too much stimulation!  Go easy.  He's human, rememember?  Consider choosing the three most important issues to you.  Write them down in the form of three questions, and try to focus only on those issues at your next visit.

.............

And while I still have your attention, may I have the answer to your question
"what is largely considered to be the single best approach to the treatment of panic attack disorder?"

..............

Well, the most common approach is pharmacological, using Xanax or similar medications to treat or even possibly prevent the panic.  But that doesn't address the cause of the attacks.  Panic attacks are responses to the way one thinks about various events in his or her life.  If over time one can learn to modify those counterproductive thought patterns, there is nothing to panic about.  That doesn't mean that there is nothing to be concerned about - concern is a realistic response to realistic thinking.  But panic attacks are distorted responses to distorted thinking.  And the treatment approach that is largely considered to be the most effective for modifying distorted thinking about the events in one's life is cognitive behavioral therapy.

Which is precisely what the Burns book is all about!

Best to ya ...

smn

Mickw
 #45 
I read through the original message and what got me was the measured loudness and the setting of the WNG's. The post was how loud screeming the t was but was covered by setting the WNG's atless than 1. I had set my WNG's between 1 abd 2 and think my t is now pretty quiet. Is this what i was told is "perception" you think its loud but in reality it isnt. Just wondered.

Mick
DrNagler
 #46 
Mick, it's a bit more complicated than that - because since tinnitus is a subjective phenomenon, it is indeed as loud as you perceive it to be.

The loudness of tinnitus is measured in two different ways.  One is in dB as determined by loudness matching in an audiology booth.  And the second is on a 1-10 scale as you perceive it.  The interesting thing is that the loudness match in dB remains fairly constant - regardless of whether you are having a "good ear day" with a 2 on that 1-10 scale or a "bad ear day" with an 9 on that 1-10 scale.

Ana's tinnitus is very soft in dB but loud as she perceives it.  There are a number of factors that enter into the "loudness as one perceives it."  We have little conscious control over those factors, but various treatment modalities (e.g., TRT, cognitive behavioral therapy) seek to address them indirectly.

smn
Mickw
 #47 
Thanks doc. My TRT clinician always said all t is a low db thing so she was right but i always thought whether that meant a lot to the person percieving it as loud. I then met a guy at the British Tinnitus Association. He described how his t had been very bad then he did TRT and his t was percieved as low. He said theres one thing he can change and thats perception. So that makes me wonder if the dude was right. CBT TRT is that what they do? Just use psychology to change the brains interpretation of what t is? Its worked for me most days to. It can be done for pain i know ive seen it but just how we all percieve thngs so different might be our make up or a thousand other factors. Weird old brain.

Mick
DrNagler
 #48 
Mick, TRT and CBT both facilitate the habituation of tinnitus.  Facilitation of habituation of tinnitus is the stated goal in TRT, and it is the implied goal of CBT.  CBT is a psychological treatment modality.  TRT is purported to be physiological, not psychological.  Habituation is the process whereby ovder time you become less aware of your tinnitus (unless purposely seeking it), and when you are aware of it, you are less annoyed by it.  Neither TRT not CBT is designed to decrease tinnitus loudness, but some feel that as the overall impact of their tinnitus decreases, it seems to be less loud to them.

smn
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