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As many of you know, the Neuromonics company (based in Australia) has developed a protocol that involves spectrally enhanced music (music that is adjusted in accordance with your audiogram so that - in essence - it sounds to each individual listening to it as the composer meant it to sound) for use in the facilitation of habituation of tinnitus.  The idea is that instead of being played just below the "mixing point" as in the case of the broad band sound used in TRT (which therefore never masks the tinnitus), in the Neuromonics protocol (also called "ADP") the volume fluctuations in the music (due to dynamics - forte, pianissimo, crescendo, etc.) as well as the pitch changes serve to repeatedly mask and unmask the tinnitus.  The reason for the spectral enhancement is that typically a person's tinnitus frequencies are in the region of the frequencies of hearing loss.  Thus, without the spectral enhancement in order for the tinnitus (located as noted above) to be intermittently masked, the overall volume of the music would have to be set at a level that would be uncomfortably loud for frequencies where the person being treated has more normal hearing thresholds.  Preliminary data indicate that ADP may well facilitate habituation of tinnitus more quickly and with a higher rate of success than in the case of TRT.  I personally believe that the theory has merit and that the data are promising.  ADP is priced in the neighborhood of $4000US, and it seems to me to be a legitimate option in the tinnitus treatment arsenal.



The question now arises - since TRT has been shown to be effective not only in the facilitation of habituation of tinnitus, but also in the desensitization of hyperacusis, why not use ADP for the treatment of hyperacusis as well?  And the answer is that there is no reason I can think of that ADP would not work in that regard.  But if you go back to my description of "spectrally enhanced music," there is absolutely no reason to believe that ADP would be any more effective than an ordinary music CD in the case of hyperacusis (as opposed to tinnitus).  Nor are there any data at all suggesting that it would!



The difference for the hyperacusis patient, of course, is that while ADP costs in the neighborhood of $4000, a music CD costs less than $20.



Incredible as it may seem, a very few audiologists have actually gone so far as to offer ADP to their patients with hyperacusis.  In the absence of any reason whatsoever to believe it would be more effective in that regard than a $20 music CD, one has to wonder. 



sp

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janepm

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Reply with quote  #2 
Hi Stringplayer: thanks for explaining this so well. I had been hearing about it and in my recent calling to all the various Audiologists in California, I was very surprised to learn that many are now doing this training and some offering both this as well as Jastreboff-based TRT.

I don't know where I read it but somewhere sometime recently, someone might have said that it wasn't as effective for Hyperacusis as it was Tinnitus BUT that it definitely worked a lot faster than TRT for Tinnitus.

As far as the money, well, for those who do the TRT and buy generators like I did, it sounds like a deal, actually, I spent more than that last year for both.

I think I will stay with the TRT as that is what I started BUT I think it's wonderful to see so many other ways, including a $20 CD that works. So encouraging!

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Jane posted:

 

Hi Stringplayer: thanks for explaining this so well.

 

........

 

You are welcome, Jane.

 

.........

 

I had been hearing about it and in my recent calling to all the various Audiologists in California, I was very surprised to learn that many are now doing this training and some offering both this as well as Jastreboff-based TRT.

 

..........

 

Well, I am not at all surprised that some audiologists are offering the Neuromonics program as well as TRT for tinnitus.  That makes good sense and is completely ethical.  But are you saying that they are offering the Neuromonics program for hyperacusis?  I do find that pretty hard to believe.  Why in the world would they do such a thing without first recommending that the patient try a simple music CD and maybe charging the patient a hundred bucks or so for the time it takes to counsel the patient in its use!  Seems a whole lot more cost effective than $4000 for the Neuromonics program, doesn't it?

 

...........

I don't know where I read it but somewhere sometime recently, someone might have said that it wasn't as effective for Hyperacusis as it was Tinnitus BUT that it definitely worked a lot faster than TRT for Tinnitus.

 

..........

 

There have been no studies specifically looking at the effectiveness of the Neuromonics protocol in hyperacusis.  There has been some soft indirect anecdotal evidence on hyperacusis that fell out of one of the studies looking at tinnitus - but (as I mentioned earlier) there is no reason to believe that in hyperacusis the Neuromonics protocol would be any more effective than using a suitable unaltered music CD (along with proper instruction).  So why an audiologist would not try the latter approach first and literally save the patient thousands of dollars is totally beyond me. 

 

sp

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janepm

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Reply with quote  #4 
Hi SP: thanks for clarifying, obviously my memory is a bit fuzzy on this one.

It seems to me there is probably a lot of money in this trainig for those who have gone through the training, could be one reason why they aren't suggesting other alternatives.

Ten years ago, I found the same thing with the "fairly new" TRT, people were hard-pressed to tell me about other ways of doing things until I talked with Jastreboff himself and he suggested I try the "stream" setting on a tabletop. It worked for a long time but in my case, it was apparent I needed the full TRT protocol which necessitated working with someone other than myself.

You have far more experience in all of this than I do, however and thanks again. Say hello to Atlanta for me, it's been a long time since I've visited my hometown.

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Jane posted:

[i]It seems to me there is probably a lot of money in this trainig for those who have gone through the training, could be one reason why they aren't suggesting other alternatives.

..........

Ya think?

So let me get this right.  Joe has hyperacusis, and he puts his faith in a "professional" - maybe somebody his doctor recommends, maybe somebody he finds in the Yellow Pages, maybe somebody whose name pops up in a Google search or an Internet message board, ... whatever.  But instead of recommending a $20 CD and charging Joe a couple of hundred bucks for the time it takes to explain how to use it in the treatment of hyperacusis, the "professional" recommends a program that costs several thousand dollars that has not ever been shown to be more effective than the CD.

I mean, even in the absence of a study I could maybe see it if there was some reasonable physiological basis for believing that spectrally enhanced music would be better than music that is not spectrally enhanced for desensitization of patients with hyperacusis ... but there isn't!

sp

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janepm

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Reply with quote  #6 
Hi SP: Yep!
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Jane posted:

 

Yep!

 

........

 

Well, I firmly believe that Neuromonics has a legitimate place in the treatment of tinnitus, but I really wish there were some way to warn folks with sound sensitivity about "professionals" who recommend it for hyperacusis.

 

I mean, sure it will work for hyperacusis.  Just like you can buy a Rolls Royce to drive to work.  But a Chevy will get you there just as quickly and dependably.

 

The people in Australia who developed the Neuromonics tinnitus program are really wonderful.  I know them all personally.  They are honest and highly ethical.

 

But those "professionals" who would recommend Neuromonics for the treatment of hyperacusis?  You have but to read Jane's and my posts above in this thread to get an idea of what's really going on in that regard.

 

sp

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janepm

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Reply with quote  #8 
Another "Yep SP, well-said!


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Maree

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Reply with quote  #9 
I recently saw an Australian audiologist with who specialises in Hyperacusis her approach to sound theraphy was providing the following:

-  a list of appropriate music that I could purchase via music stores, mainly enviromental sounds. 
- a page on setting sound volumnes
- a couple of pages on varies available music source devices (eg pillow speakers)
- lots of handouts on tinitus/hyperacusis and use of sound theraphy for these.

She stressed to start with sound sources that were at a distance from me and gradually move them closer, up to a point where I could wear a headset hanging around my neck. But that I must NOT put anything on or in my ears.

She told me she thought it was something I was capable of doing on my own and suggested I give it a try and email or visit her again if I thought I needed any more help.

Two weeks in and results are promising with a CD I purchased of rain sounds.
Today she rang me to check on progress and to remind me to let her know how I get on.

From your comments above sounds like this low tech, low cost option, isn't a bad one to explore.

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DanMalcore

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Reply with quote  #10 

-  a list of appropriate music that I could purchase via music stores, mainly environmental sounds. 
- a page on setting sound volumes
- a couple of pages on varies available music source devices (eg pillow speakers)
- lots of handouts on tinnitus/hyperacusis and use of sound therapy for these.


Maree, thanks for your input.  Could you give some examples of the appropriate music she recommended?  What did she say about setting sound volumes?  Does your audiologist have a website?  I look forward to hearing more from you.

Dan

 


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Maree posted:

 

From your comments above sounds like this low tech, low cost option, isn't a bad one to explore.

 

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

 

It is if you are an audiologist who puts dollars ahead of what's in the patient's best interest.

 

Fortunately for you, Maree, you found an audiologist who doesn't just talk the talk, but who actually walks the talk. 

 

I would really love to hear an audiologist who is offering Neuromonics to his or her hyperacusis patients explain how he or she can possibly justify doing so outside a formal funded prospective study.

 

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 STEPHEN SAYS:

 

I would really love to hear an audiologist who is offering Neuromonics to his or her hyperacusis patients explain how he or she can possibly justify doing so outside a formal funded prospective study.

 

sp---SEE BELOW

 

---Maybe you should contact some of the THIRTY THREE Clinics in the United States where audiologists are currently using NM to help patients who have the condition of hyperacusis. 

 

In my case, it is not the treatment of first choice, but it certainly is an option for people who have never been able to succeed with the use of Pink Noise, Drugs, Psycho therapy, Hypnotherapy, Counseling, and even Retraining Therapy using broadband sounds via devices.

 

There are aspects to NM that are unique in the design of the processor to match the patient's audiologic air and bone conducted thresholds, including the fact that the processor can produce much higher fq sounds that are specifically programmed for those areas.

 

Anyone can imagine what is going on or speculate about an idea.  It is very easy to fantasize about how something might work. Someone can make up or imagine many possibilities or assign intentions.

 

However, it is a very different picture in the clinical setting where data is being accumulated and compiled over time using laboratory testing and in addition, compiling data from many different clinical settings. Then we can see something closer to reality.

 

The report from Maree is a perfect example of what should happen with the initial stages of attempting to find help in recovery from hyperacusis.  Any audiologist should be able to conduct themselves in precisely that manner, based on their training in their doctoral programs, and course on T & H are very much standard parts of that training, unlike the old days when it was only a tiny part if even mentioned. Actually every MD in this country should be able to discuss generally the condition of hyperacusis or tinnitus, and know where to steer patients (the ATA) or to the local doctor of audiology.

 

For the people, though, who CANNOT improve using music and CDs and stopping excessive earplug use, then we all know there has been Dr. Jastreboff's Tinnitus Retraining Therapy which has been clearly shown to be very effective in many cases, although not all (5-15 percent fail) benefit.  As a matter of fact, Dr. J's therapy approach for hyperacusis was the very first one that was widely available, and he and Margaret Jastreboff, PhD, and Susan Gold, audiologist, are literally completely responsible for bringing awareness of hyperacusis to the medical community as a neuro-physiological condition that could be improved.  Much of the medical community still believes hyperacusis is a psychological or emotional disturbance!

 

And now we have also Neuromonics, authored by another very well respected and regarded brilliant scientist, and it has only recently come here to the US.  And for some people, with hyperacusis, it might be worth trying. 

 

The company is very clear about a free 30 day trial, full refund.  All audiologists, 33 of us, signed that agreement and follow their protocol precisely.  If it does not help you, you can return the unit without penalty. I am not sure if that has been said here.

 

Since I brought the discussion here, earlier, I would like to add that I did contact my six closest audiology colleagues across the country and inquired specifically about the use of the program for hyperacusis.  This is not a formal funded (that is the land of the PhD not the clinical audiologist) report, but every single one said they were using NM for hyperacusis.  Every single one.  These are well known clinics in larger cities, and I implicitly trust these professionals and their word. 

 

I cannot fathom why this situation would be so hard to comprehend:  medical research moves on, things are invented, initial trials are completed, the knowledge moves into the community via carefully trained well educated professionals, and then the citizens try it.  The results flow back into the researchers' hands and minds as time passes, and more trials are held or the focus expands.......and conclusions are drawn.

 

That seems like a normal process to me.  Consider how many medications that were approved the FDA for a single purpose later found their way into so many other perfect applications!  (of course there are a few disasters, too).  But who would have though aspirin, a simple derivative from the willow that relieves pain, would have turned out to be a strong part of a healthy heart management program.

 

I would encourage you to keep an open mind with regard to new programs.  If you want to learn more about Neuromonics, visit their own website at http://www.neuromonics.com

 

MJ

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Reply with quote  #13 

This is a quote taken from Maree's Audiologist's website which was very nice btw, and referred to in another post about her visit: Hyperacusis "Therapy Practical self-management strategies to assist hyperacusis desensitisation and reduce auditory hypervigilance, personalised to suit each person's individual coping style, are developed. Sound enrichment and low level sound therapy are required as part of the desensitisation process. This may involve the fitting of wearable sound generators providing low volume neutral sound or the fitting of hearing aids set up to act as electronic filters."

Hey, look, that sounds like TRT! And sound generators!  And basic Audiology 101, hearing sensitivity = highly compressed anti-hearing aids! Whoa! 

 

Uh oh, looks like those greedy audiologists are out there again, pushing their wares!

 

: )

 

Dang it, 9000 audiologists cannot be all wrong about this.....guess what, sound therapy of many types appears to work to help people with hyperacusis! 

 

But NOT ALL.  There are some very severe cases of hyperacusis that are very resistant to recovery.

 

MJ

 

I am going off to work now!  

 

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Reply with quote  #14 

Marsha posted:

 

I would encourage you [sp] to keep an open mind with regard to new programs.

 

........

 

I am quite familiar with Neuromonics, thank you.

 

I have read all of the studies and have discussed them in detail on several occasions with Dr. Paul Davis, who developed the program.  I even visited Dr. Davis's lab in Australia, where I observed him with a number of his patients at various stages of treatment.  I have met with the people who developed the hardware.  I helped design some of the study protocols from way back when "Neuromonics" was "Tinni-Tech."  I know the members of the board of directors of the company and have even met the principle investors.  And I have reviewed the Neuromonics website thoroughly on a number of occasions as it has undergone its various transformations.

 

And I believe that Neuromonics is a legitimate treatment option today in the management of tinnitus.

 

But I am here to tell you that ANY audiologist who is offering Neuromonics as treatment for hyperacusis outside of a formal funded prospective study is ripping off his or her patients every bit as much as the lasertherapy scammers are unless that audiologist has personally applied to that patient a treatment program similar to that used in the Neuromonics protocol but using an iPod or a walkman-like device playing couple of $20 music CD's that are not spectrally enhanced.

 

sp

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Marsha continues:

 

Dang it, 9000 audiologists cannot be all wrong about this.....guess what, sound therapy of many types appears to work to help people with hyperacusis!

 

.........

 

Nobody is taking issue with the 9000 audiologists who believe that sound therapy can help in hyperacusis - and you know it.

 

My issue is with those (hopefully) very very few audiologists who would suggest one particular $4000-$5000 treatment program to his or her hyperacusis patients without first personally supervising a trial applying the same basic principles in that program but without all the expensive equipment and spectrally-enhanced music.

 

sp

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LynnMcLaren

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Reply with quote  #16 

Hi Maree, ((( Smiles )))

Thats what I did.. To be able to work at all with what I used..

I had to use a portable non stereo player.. Turn off the DBBS..

 

And I kept it on the carpeted floor in the spare room I stayed in to

be away from others.. Inaudible to others..

 

As nobody else could hear it playing but me at one time..

My husband even put his ear right up to it too..

Thats the way I had to start off and in time I guess I did what

you could call move it closer as I eventually place it on tables and then

counter top in the surrounding areas of what ever room I was in like

the kitchen , family room ect....

 

Over time.. It was a gradual building up for me.. And I never did put the

sound in my ears but moved on instead to other forms of sound therapies

around  "in the home "..

 

I think that this can be a good way to go for thoses expecially..

ones who are really badly hyperacustic at the time and need to start somewhere..

Anywhere... Ones that may not be able to venture out..

 

What you wrote... At a distance playing in the room.. It can work

overtime...

 

Just doing something with the goal of building up your ears overtime to do more.

 

For alot of people...... Sound therapy seems to work in helping improveing their tolerances overtime if followed through with..

 

I had alot to overcome as in my T was Bad.. My H was Bad.. And then of

course I had the ear spasming problems too.. So with all I had back then..

It seems to have worked out well for me.. Except what I do have left over

which is nothing compared to all that...

 

Good Luck To You...  ((( Smiles ))))

 

Maree wrote...

 

Quote:
She stressed to start with sound sources that were at a distance from me and gradually move them closer, up to a point where I could wear a headset hanging around my neck. But that I must NOT put anything on or in my ears.

 

     


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LynnMcLaren

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Reply with quote  #17 

Hi Marsha, (((( Smiles )))

 

I was reading what you wrote about and I was interested in this here...

So their are certain areas where a higher frequency may be more healing

as programmed for those areas..

 

Whats audiologic air and bone conduction thresholds..

When I had symptoms of hyperacusis.

 

I had lots of bone conduction of sounds.. Is that a bone conduction threshold..

Or is that in the middle ear bone levers..  So in the healing process..

Higher frequencies lets say at a low'er level of sound can be

healing in what way.. That they have found in Neuromonics..

 

And that is a high'er frequency lower level to soft level..

of stimulation over time ??

 

I know that higher frequencies are hard on the hyperacusis ear to

listen to or contend with.. It can be like the worst of sounds..

To listen too... Depending on ones H... 

 

And music and alot of sounds in life that hyperacustic people have..

to retrain or relearn or build their tolerance back up to overtime..

 

Like music, water , voices, sound machines ect..

I mean.. I had a hard to time with the sharpness within music and voices

and water and silverware ect.. at one time..

At certain times in my H worse then other times..

 

Dr Vernon told me at one time to listen in a time frame to voices that sounded very cutting and sharp and loud to my ears..

It would have been easy to say I just can't do it..

I just couldn't..  

 

And I did tell him so... that it just wouldn't work out..

I can't do that.. But he was so insistent back then and so positive

over it all..

 

I thought he was not understanding my dilemma of what I just couldn't

tolerate or do at one time yet... How bad it really was... 

 

It was pretty bad to subject myself to that even in limited

time frames.. It hurt to hear.. Caused reactions in my ears ect...

 

And music therapy I had the problem with hearing the sharpness..

of high frequencies in that as well when I was trying..

to learn to tolerate it again..

Starting at a very very low level of sound..

 

It was never easy. And sounded and felt totally awfull to do..   

Haveing some higher frequencies sound within sounds to contend with..

Just cut right through my ears... Like a knive.. At one time..

 

But lots learn to do just that again.. Be able to tolerate thoses

sounds again in life...  

 

I've read up alot about the sounds in life we all listen to on the web 

on many different sites and posted alot of that on the frequencies

and a human voice thread.. 

 

So.. What I'm interested in is about the benefit to maybe a lower level

very low volume level /barely audible level of stimulation of thoses circuits.

 

Overtime.....

And maybe one could do that right away with like with music..

 

I couldn't listen to music at all at one time and I couldn't really bear it

much either...

when starting off trying too when I was still very hyperacustic..

But I had a goal.. And just stuck with it for years..

 

But depending on where they were at with their H... 

 

I'm just interested in the research of what they have found to be helpfull in

the way of doing just that.. Lets say with Neuromonics..

 

For those that decide to try it and follow through with it..

It's just interesting to me what's going on with what their doing..

Who knows maybe something new will come out of all that research..

I'm for choice and progress of any new therapy..

That may work for some.. or for whoever it does... 

 

Marsha Wrote..     

 

 

Quote:

There are aspects to NM that are unique in the design of the processor to match the patient's audiologic air and bone conducted thresholds, including the fact that the processor can produce much higher fq sounds that are specifically programmed for those areas 


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Maree

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Reply with quote  #18 
In response to Dan's queries above:
Music Recommendations:
  • Ken Davis, Sounds of Nature series
  • CD's  from Listening Earth company website link
Sound Setting:
1. Find volume level where you start to her it, increase volume until you can hear without straining.
2. Slighly increase volume until starts to mix with external sounds you find difficult to tolerate.
3. If this volume is annoying or uncomfortable over longer period of time, reduce the volume slightly. 

Better to have sound present for longer periods at lower volume levels than the reverse.

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LynnMcLaren

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Reply with quote  #19 

Hi Maree, (((( Smiles ))))

 

I think so too...

Sometimes people need it playing at a very low level to work with any

sounds at all.. Then you could build up that way to doing it in a longer timeframe... then trying to do that with louder spurts..

 

Maree wrote...  

 

Quote:
Better to have sound present for longer periods at lower volume levels than the reverse.


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Maree

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Reply with quote  #20 
Also for Dan - my audiologist's website:

http://www.dineenandwestcott.com.au/hyperacusis.php

In a sign of how difficult it is to get sent to the right person with hyperacusis, after 12 months where I have seen 2 neurologists, 2 ENT specialists, 1 TMJ specialist, 2 pain management specialists.  I found Myriam myself on the web,  amusingly her practice is 5 min drive from my home.  When I spoke to her I  discovered: we share a doctor, she knows my TMJ specialist very well.


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LynnMcLaren

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Reply with quote  #21 

Hi Maree, (((( Smiles )))

Interesting site.. I'll check it all out later.....

Thanks... 


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Reply with quote  #22 

Marsha posted:

 

In my case, [Neuromonics] is not the treatment of first choice, but it certainly is an option for people who have never been able to succeed with the use of Pink Noise, Drugs, Psycho therapy, Hypnotherapy, Counseling, and even Retraining Therapy using broadband sounds via devices.

 

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

 

I have a Yes or No question for you, Marsha:

 

Before you recommend that a person with hyperacusis invest $4000 to $5000 in Neuromonics, do you recommend that the patient purchase a couple of plain old ordinary music CD's that have a wide frequency range and then personally take the patient step by step through counseling as you would in Neuromonics? 

 

I mean, given that there are absolutely no studies showing that for the treatment of hyperacusis the Neuromonics spectrally enhanced music is any more effective than the same music not spectrally enhanced, I cannot see why you wouldn't go the less expensive route and save that patient several thousand dollars. 

 

After all, you keep telling us about the immeasurable value of the kind smile and the reasuring touch of the truly caring and knowledgeable clinician.  So why not use it with a $20 CD instead of a $4000-$5000 treatment program?

 

So please do go back to my "Yes or No" question at the start of this post.  Yes.  Or No.  And if not, why not?

 

sp

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myztiphyd

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Reply with quote  #23 
You know sp...that is truly an incredible and wonderful idea! You are a patient advocate in that sense and I appreciate your integrity.Consumers/patients/clients/human beings are too often fleeced.
Having said that...I don't think I need to remind anyone that morale on this board is at an all time low. Although debating, discussing, challenging, etc is perfectly in order...character assassination and snarky remarks are not.Stop it.It makes you all appear as sub-professional. More like the north ends of south bound horses.It does nothing to further your cause.Perhaps these remarks could be saved for private messages..because they ultimately cause HARM.Uhmm.. yeah.. "First Do No Harm?"
Please.
Thank you

D.

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Reply with quote  #24 

STEPHEN ASKS:

 

Before you recommend that a person with hyperacusis invest $4000 to $5000 in Neuromonics, do you recommend that the patient purchase a couple of plain old ordinary music CD's that have a wide frequency range and then personally take the patient step by step through counseling as you would in Neuromonics? 

 

----This is a yes answer but it does show a tremendous lack of knowledge about the NM program as there is no 'counseling' in the sense that takes place in TRT.  Seriously, there is no extensive directive education in the NM process when compared to TRT. 

 

Stephen, I do not how to write more clearly but I will try again:

 

1) the individuals who come here for T and H are long past the point of the music cds, the vast majority of them

 

2) the ones who have severe hyperacusis have already tried many other treatments without success

 

3) there is a 30 day free trial that NM company insists on for everyone

 

So the answer is yes.  I don't know about wide range music CDs.  I prefer fans, fishtanks and fountains, and a generally active ambient noise environment.  That includes music and nature sound cds.  There are a bazillion choices.  I also like books on tape. I am not really a sophisticate about wide-range stereo systems or iPods although I have one that I have never used.  BTW, I also like Celtic music, it is my favorite.

 

MJ

 

 

 

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myztiphyd

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Reply with quote  #25 
Oh, goody More of the same.Have you considered some "reality TV" fodder.. perhaps "The Great Ethics Challenge"?
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Reply with quote  #26 

Ha!

 

I have no idea what that is, I don't watch TV but I think I would enjoy one of those survivor type shows give or take the fact that I don't like large bugs.

 

Tell me, what is the secret to happiness?

 

Is it really doughnuts?

 

I hope it is Pad Thai!

 

Even so, point well taken, I am off again to explore my week end and enjoy a break and play for a while.

 

: )

 

No more fodder, I promise.

 

MJ

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LynnMcLaren

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Reply with quote  #27 

Oh, ((((( Smiles )))))

 

I must of missed something as well...

I don't think I'm going to get my question answered...

At this point.. But I guess I'll stay tuned..

When things calm down some...

 

Everybody have a good holiday weekend..

I'll be mostly off with Kids to care for..

It'll be one busy weekend as it's 3 days for me....

Like everybody else... 

 

 

 


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Reply with quote  #28 

Marsha posts:

 

----This is a yes answer but it does show a tremendous lack of knowledge about the NM program as there is no 'counseling' in the sense that takes place in TRT.  Seriously, there is no extensive directive education in the NM process when compared to TRT.

 

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

 

There most certainly is counseling in Neuromonics in the sense that the term "counseling" is used by the audiological community when fitting hearing aids, for instance.

 

In Neuromonics what subsititutes for directive counseling as the term is used in TRT is something Dr. Paul Davis, who developed the protocol, terms "bibliotherary," which basically means book instruction.

 

You are right in the sense that there is nowhere near the amount of time devoted to one-on-one counseling in Neuromonics as there is in TRT.

 

..........

 

1) the individuals who come here for T and H are long past the point of the music cds, the vast majority of them

 

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

 

Not without your personal instruction, reassurance, and encouragement they haven't.  They try Neuromonics for hyperacusis because they trust you.  Simple as that.  If you suggested pink noise or a music CD and took the time to instruct them, reassure them, and encourage them, they'd go for it.  And with patience, instruction, reassurance, and encouragement they'd get better.

 

...........

 

2) the ones who have severe hyperacusis have already tried many other treatments without success

 

...........

 

Not without your personal instruction, reassurance, and encouragement they haven't.  They try Neuromonics for hyperacusis because they trust you.  Simple as that.  If you suggested pink noise or a music CD and took the time to instruct them, reassure them, and encourage them, they'd go for it. 

 

...........

 

3) there is a 30 day free trial that NM company insists on for everyone

 

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

 

All the Neuromonics data point to the fact that at 30 days there is rarely, if any, appreciable improvement.  The 30 day free trial is merely for the patient to find out if the approach and technology are as acceptable in practice as they are in theory.  Plus don't forget there's that hefty "restocking" fee that y'all charge.

 

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

 

So the answer is yes.  I don't know about wide range music CDs.  I prefer fans, fishtanks and fountains, and a generally active ambient noise environment.  That includes music and nature sound cds.  There are a bazillion choices.  I also like books on tape. I am not really a sophisticate about wide-range stereo systems or iPods although I have one that I have never used.

 

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

 

You don't know about the use of wide-range stereo systems or iPods in the treatment of hyperacusis?  Why not?

 

sp

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Reply with quote  #29 

Stephen:

 

I am also confused why you keep lumping NM with lazer stuff.  You must be aware of the fundamental differences between Dr. Paul Davis and this light-lazer thing.

 

Do you really know what you are stating in that last post? Although I feel sure that you are an excellent cancer surgeon, no doubt really, you are not an audiologist. And so I do not really think you do know.  I think you are guessing.

 

Ok, look, figure it out.  First off you have the pricing wrong.  You do.  Ask your friends if they will tell you.

 

Secondly you make it sound like there is some hidden fee for NM.  There isn't.  All the funds are returned. All.  100 percent.  No restocking fee, I think that is a retail term anyway, audiologists do not re-stock.  Also the company sets the fees.  True there.  They tell us what we are to charge.  Strongly suggest might be more of the word.  They want uniformity. They want coherent similar testing and tracking and fitting.  This is not TRT.  This is a very well designed and managed company.

 

Thirdly, your time management is way off:  let me tell you about the average NM patient and see what you find out from this illumination. Keep in mind, please, again, that I have now only SIX patients.

 

Phone call:  usually at least 30 minutes to talk over the situation. Often several calls.  During those calls is when I try to discover, have they tried cds? TRT? Drugs? Who is referring them?  Why?

 

Medical records review: 10-15 minutes for simple cases, more for complex ones, can be up to 1-2 hours

 

Initial Evaluation:  90-180 minutes

includes 5-7 test procedures and case history, and again, in many situations, here is the time to say, well you could do Pink Noise, you could try Ambient Sound Sculpting at home and work, how bad is it, what have you tried, alright, here are all the options.

 

BUT if they decide, ok, I want to try the NM system, and I agree with them, then.....

 

First Fitting:  60-90 minutes

 

Week 1 phone follow up:  15-30 minutes

Week 2 phone follow up: same

(weeks 3-7, short follow ups on the phone) 60 min

 

Week 8:  Switch to Phase II  60 minutes, includes retesting in the booth

 

Estimate 4-6 contacts over the next four months, about 15-30 minutes each

 

Week 24-28 Return to clinic for final evaluation, consult, includes booth testing, etc.  60 minutes

 

That makes about 9-16 hours per patient over a six month period.  That might be an average patient, others will call nearly every day or every week, or come in for more frequent visits.  Some will not complete in the prescribed period and we simply carry on as needed. 

 

The price of the NM is actually less than a decent set of hearing aids at this point, and generates a far smaller 'profit' as you call it for the audiologist, which is why 99 percent of audiologists in private practice prefer to fit h. aids.  Ask anyone here who has looked at hearing aids, they run about $6000 for a really good pair.

 

As to your idea of using an hourly rate, we have talked that over during many years now and I must remind you that there is NO consult code for an 'office' visit with an audiologist at this point, due partly to the AMA stranglehold on the codes in the country, but with the advent of the AuD as the entry level point for audiologists (In August 2007 knock on wood and hard work, I will be Dr. Johnson at last) I am pretty sure that is going to change.  And at that point, yes, I think we will find ourselves able to charge hourly fees for consults for various needs.


Sorry about the bold stuff.  This format puzzles me and sometimes it looks bold when I write but then is tiny when it comes on the board, and vice versa.

 

Stephen, I enjoyed debate team in both high school and in college.  Probably should have been a lawyer but glad I chose this profession instead.  I hope the people who read these messages can glean some information that is useful for their situation.

 

However, I think I should concentrate on contributing to the threads now and give it a rest.


What do you say?

 

MJ

 

 

 

 

 

 

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Reply with quote  #30 

Marsha posted:

 

The price of the NM is actually less than a decent set of hearing aids at this point, and generates a far smaller 'profit' as you call it for the audiologist, which is why 99 percent of audiologists in private practice prefer to fit h. aids.  Ask anyone here who has looked at hearing aids, they run about $6000 for a really good pair.

 

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

 

Right.  And the mark-up on those hearing aids is around 100% - just like in Neuromonics.

 

I'm not saying that you don't deserve to make a profit, Marsha.  You most certainly do.  I'm just wondering how to justify recommending a Neuromonics spectrally-enhanced music CD for the treatment of hyperacusis at some $4000-$5000 when there is no evidence that for hyperacusis it is any better than a regular music CD that you can get for $20.  You still haven't answered that question. 

 

 

sp

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dylan

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Reply with quote  #31 

Several adjustments have been made to the posts in this thread.  Content about the salaries of clinicians is inappropriate.  In our view it is unprofessional and discourages clinicians from posting here.  It can change this forum from a message board to a battling arena or blood bath.  As one poster stated, it can also effect the morale of the participants of a message board.  That is a valid point.  We will not let that happen.  If posters want to discuss the advantages or disadvantages of a particular treatment that is one thing.  If posters want to discuss the price difference between treatments, that is even permissible.  But to chastise one for the wages they receive or the annual income a clinician makes is not allowed.  We are tired of babysitting threads about laser and neuromonics.  Any postings which discuss wages or involve a personal attack will be deleted in their entirety, even if part of the post was acceptable.  The final step would be to ban the offending poster.  Sufficient warnings have been made here.  Participants are better served if the merits or faults of a treatment are discussed.  No matter what topic is discussed on any message board, the thing people are most interested in is whether something works or doesn't work.  That is always the bottom line.  That is where the interest must be.

 

This post will not be deleted. 

 

dylan

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Reply with quote  #32 

Dylan posted:

 

Participants are better served if the merits or faults of a treatment are discussed.  No matter what topic is discussed on any message board, the thing people are most interested in is whether something works or doesn't work.

 

..........

 

I fully agree with you, Dylan.

 

But here we have a treatment using a "spectrally-enhanced" music CD costing a hyperacusis patient $4000-$5000 that has never been shown to be more effective in the treatment of hyperacusis than a well-selected ordinary $20 music CD provided that an experienced audiologist personally takes the time to instruct, reassure, and enourage the patient in the use of that $20 music CD.  (Or for that matter in the use of the Network's $20 pink noise CD!)  So add in a fair hourly rate for the few hours it takes the audiologist to instruct, reassure, and encourage ... and you still have a huge disparity.  All I am asking for is some sort of justification - and worded in that manner I think it is a very fair question that is highly relevant to the auditory, emotional, and financial well-being of the readership of this board.

 

sp

 

........

 

It is not appropriate for you to 'add in an hourly rate' then speculate on what a clinician might charge.  That must stop.  Step one is DOES IT WORK!  That is always the most important point. 

 

dylan

 

.........

 

If you read what I just wrote you will see that I was very careful not to speculate on what a clinician might charge.

 

sp


Suggesting any clinician's hourly rate or compensation has caused stress in this thread.

 

dylan


Now, regarding "step one" as you call it, it might be helpful to the readership to be very clear that while Neuromonics has been shown to be effective for tinnitus, there are absolutely no studies that have formally addressed its efficacy in hyperacusis.  Those audiologists who are offering Neuromonics in the treatment of hyperacusis are doing it because they think it might work.  And what I am saying is that there is absolutely no reason to believe that for hyperacusis Neuromonics wouldf be any more effective than a carefully-chosen $20 music CD if that CD is used properly under the guidance of an experienced audiologist.

 

sp


We have no problem with that message.  Suggesting they are doing it because they think it might work is an acceptable approach.  One must keep in mind however that when you say you think they do it because it might work, it may be more a matter of YOU think THEY think - after all, you are not them.  This is conjecture and when you are painting a picture about other professionals you are in dangerous territory. 

 

dylan

 

 

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Reply with quote  #33 

The most puzzling thing is, I do not have any patients using NM that fit that category.

 

Up to this point, the patients come with T and H. Or  just T.

 

So who is it you think is this happening to?

 

MJ

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Reply with quote  #34 

Marsha posted:

 

The most puzzling thing is, I do not have any patients using NM that fit that category.

 

Up to this point, the patients come with T and H. Or  just T.

 

So who is it you think is this happening to?

 

.........

 

Above in this thread you speak of 33 clinics in the US where Neuromonics is used to treat hyperacusis.

 

Regarding your own clinic practice, we all know from Heller & Bergman that almost everybody has at least some degree of tinnitus.  Are you saying that in the cases of those patients who have hyperacusis and are being treated in your clinic with Neuromonics, their primary complaint is tinnitus and they just happened to have a little sound sensitivity?  If that is the case, I think Neuromonics is totally justifiable.  But if their primary complaint is hyperacusis (this is, after all, a hyperacusis board), ... my concerns remain. 

 

sp

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Reply with quote  #35 

Voila!

 

Remember, this thread began when I said that two patients had tried NM and one was noted at 8 weeks to have significantly improved his LDLs.

 

All of the patients who have to me so far, have tinnitus as the primary complaint.

 

I must apologize if I was not clear in the beginning if it seemed that I suggested that NM might become the primary choice for hyperacusis treatment, then, based on that single case.  I was simply speculating on the effect of the therapy and its promise for the future.  But again, it should not be a primary treatment, we agree on that.

 

So no one that I know is using NM as a primary treatment for hyperacusis.  Certainly NM is not promoting it as such.

 

Hope this clears up the mystery, then. Now I finally have a better idea of what was creating the issue.

 

MJ

 

 

 

 

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DanMalcore

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Reply with quote  #36 

Maree

Thanks for your response.  Is there a specific CD your audiologist recommended from the Sounds of Nature series?  Did your audiologist diagnose you with hyperacusis?  Thank you...

Dan


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Maree

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Reply with quote  #37 
Diagnosis: Tonic Tensor Tympani Syndrome, she felt my symptoms were consistent with having an Accoustic Shock Injury.
She took case history details but did not perform any hearing or sound sensitivity tests due to the severe neuropathic pain problems I have.

And no she didn't recommend a particular CD.  I was fotunate enough to be able to go to a bookshop and eliminate ones I found to demanding (too many birds mainly).

I purchased Ken Davis Early Morning in the Rainforest & Rain in the Forest from  the Nature sounds of Australia series.  I find the Rain in the Forest CD particularly good. The rain sound builds up slowly and the sound has a nice consistency to it.

After a couple of weeks of listening to this, I can use the washing machine and drier while in the house if I put the Rain CD on at the same time.

Main points my audiologist made: sound should not have to many highs and lows, be pleasant and comforting but not so interesting or enjoyable that you will want to focus on it. 
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