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Dan, a few of weeks ago you asked if there were any tests that could establish the diagnosis of hyperacusis to the satisfaction of disability carriers (which basically means to the satisfaction of the courts.)

While there is such a test for tinnitus, I responded that I was unaware of any such "reliabilty study" for hyperacusis, but that I would check with Dr. Jack Vernon and Dr. Billy Martin during an upcoming trip to Portland.

 

Well, I forgot to ask either of them them when I had dinner with Dr. Vernon on Feb. 8 and breakfast with Dr. Martin on Feb. 9 - but I remembered when I got back to Atlanta ... so I called them a couple of days ago to get their input on this very interesting (and pertinent) question.

 

And as it turns out, while in theory the same principle could be applied to establishing the presence of hyperacusis that is used to establish the presence of tinnitus [i.e., check five (abnormal) LDL's done at ten minute intervals with no more than 2 standard deviations separating them considered to be evidence of hyperacusis as opposed to performing five tinnitus loudness matches at the tinnitus pitch done at ten minute intervals with no more than 2 standard deviations separating them considered to be evidence of the presence of tinnitus], such a test for hyperacusis is problematic for two of reasons.  First, it will not differentiate between hyperacusis and recruitment in the person with both hearing loss and sound sensitivity.  And second (more importantly) repeated LDL testing can itself theoretically cause an increase in hyperacusis - even if done carefully.

 

So, Dan, the short answer is that there is no single test analogous to tinnitus reliability testing in the hyperacusis arena.

 

The best way for a hyperacusic to establish the presence and severity of his or her auditory pathology remains a detailed letter (and if nescessary deposition/testimony) from a knowledgeable hearing healthcare professional who has taken a thorough history, done audiometric testing including recording LDL's, AND (very importantly) outlined a treatment program that the hyperacusic has diligently followed over time and failed.

 

Hope this sheds light - even if it does not help much.

 

sp

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DanMalcore

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Reply with quote  #2 

I can't tell you how much I appreciate your followup on this.  Since there is no test to validate hyperacusis to the satisfaction of disability carriers perhaps I could approach this from a different angle...

 

As you know, some individuals who come down with sudden severe hyperacusis are unable to continue employment because their work environment has a decibel level which exceeds their LDL's (loudness discomfort levels).  How does this individual get a leave of absence from their employer to pursue TRT without losing their job? 

 

Can a hearing health care professional prescribe a six month TRT treatment program that would qualify this patient for sick leave from his/her employer without losing their job? Would this prescription need to come from a physician (which could be a challenge since few physicians are knowledgeable about hyperacusis)? 

 

Talking worst case scenario.  It has often been stated that 10-15% of patients who do TRT do not significantly improve.  If this happens, after six months, might it follow that they could pursue fully disability if, as you mentioned above, their knowledgeable hearing health care professional had (taken a thorough history, done audiometric testing including recording LDL's, AND (very importantly) outlined a treatment program that the hyperacusic has diligently followed over time and failed).

 

Dan


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Dan, your question touches on a variety of issues and leads down several paths.  I'll try to summarize briefly:

 

1)  When you talk about a "leave of absence" from work to pursue treatment, I do not believe that a single standard can be applied.  First of all, the question arises as to whether the leave of absence is to be "with pay" or "without pay."  And, of course, there is the issue of how long a leave of absence will be required.  In the case of a large corporate employer, the impact of a leave with pay might not be all that big a deal.  But in the case of a small business employer, even a leave without pay could spell economic disaster ... because of the cost to the employer of the benefits (health care, etc.) that would continue while the employee is on leave.  More than that, if you postulate a four to six month leave in the small business setting, it will be hard to find a replacement who will do work of a consistently high quality - if that replacement knows that he or she will be out of a job in a few months AND that the small business would likely not be able to absorb the replacememt and move him or her into another position.  Now even though there are temp agencies that in many cases cover the benefits of temporary replacements, these problems must all be handled on an individualized basis.  So it is hard to make any blanket statements or recommend a "one-size-fits-all" strategy for hyperacusic employees to follow in regard to leave of absence.

 

2)  Regarding disability coverage, it comes in many flavors.  Some policies are "own occupation," which means that if you cannot pursue the principle duties of your own occupation, you get full benefits.  Other policies require you to be unable to work in any occupation in order to receive benefits.  And both types can be further subdivided into those provided by the employer as a benefit and those that the employee might purchase privately on his or her own.  Also - and importantly - many many folks have no disability coverage at all and must depend on the government's social security disability program.  The financial benefit from social security disability is typically lower than that of employer-provided or privately purchased policies, but social security disability does carry with it automatic qualification for Medicare health coverage regardless of age, which is a huge plus as otherwise the Medicare-eligibe age is 65.  The biggest problem with qualifying for social security disability lies in the fact that the individual must be totally disabled according to a rather strict standard - the test for total disability for social security disability is sometimes called the "night-watchman's test."  Thus, if you can sit in a quiet room, look at a series of TV monitors, and push a silent alarm if you see an intruder, then you are not considered to be disabled by the government's standard.  (There are a few exceptions such as end-stage renal disease, but you get the idea.)  And using that example, even if an individual could demonstrate severe hyperacusis to the satisfaction of the courts, he or she would likely not be considered eligible for disability benefits under social security unless there were some sort of mitigating circumstances.  I have listed all of the above "disability combinations and permutations" for the purpose of demonstrating that whether or not a hyperacusic will qualify for disability benefits - even if the hyperacusis can be established to the satisfaction of the courts - really depends on what type of disability policy we are talking about.

 

3)  Finally there is the issue you raised in mentioning of the role of TRT in hyperacusis treatment.  And I need to tell you that were I in practice today, with the technology currently available and with the understanding of hyperacusis that I have gleaned over the years (in no small part due to what I have learned from the folks on this board), I would not be treating hyperacusis with TRT unless the hyperacusic also had severe intrusive tinnitus.  In my opinion hyperacusics who do not have tinnitus - or who have relatively mild tinnitus - should be treated with pink noise delivered either through speakers in a room or through a walkman or iPod.  I firmly believe that pink noise therapy "done right" under the guidance of a knowledgeable hearing healthcare professional will be at least as effective as TRT in the treatment of hyperacusis at a third of the cost to the patient (with the clinician still making a very handsome profit - although nowhere near the profit of TRT). 

 

So I'm not sure that I answered your questions regarding disability, etc. specifically, Dan, but I do hope that I have provided some framework within which you and your readers can sort out your own answers as applied to the particular set of circumstances of the individual patient.

 

sp

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Hollis

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Reply with quote  #4 

Stringplayer wrote:

 

". . . social security disability does carry with it automatic

qualification for Medicare health coverage regardless of age,

which is a huge plus as otherwise the Medicare-eligibe age

is 65."

 

It's important to note, though, that there is a VERY

substantial lagtime between when someone is awarded

SSDI (Social Security Disability Insurance) payments and

when Medicare coverage begins. I believe it's two years. 

(It's been so long since i went  through all of this, that i

can't remember the precise time.)  If and when you do

become eligible, however, that insurance can be invaluable.

 

 


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Darcy

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Reply with quote  #5 
Quote:
Hollis wrote (in part):
It's important to note, though, that there is a VERY

substantial lagtime between when someone is awarded

SSDI (Social Security Disability Insurance) payments and

when Medicare coverage begins. I believe it's two years. 

(It's been so long since i went  through all of this, that i

can't remember the precise time.) 



The lag time is still two years, which is problematic, and advocates have been working for years to eliminate this waiting period.

Darcy
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DanMalcore

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Reply with quote  #6 

Thank you stringplayer for your response.  These specific issues rarely get talked about on this message board.  I was struck by a comment you made at the end of your post:

 

I need to tell you that were I in practice today, with the technology currently available and with the understanding of hyperacusis that I have gleaned over the years (in no small part due to what I have learned from the folks on this board), I would not be treating hyperacusis with TRT unless the hyperacusic also had severe intrusive tinnitus.  In my opinion hyperacusics who do not have tinnitus - or who have relatively mild tinnitus - should be treated with pink noise delivered either through speakers in a room or through a walkman or iPod.  I firmly believe that pink noise therapy "done right" under the guidance of a knowledgeable hearing healthcare professional will be at least as effective as TRT in the treatment of hyperacusis at a third of the cost to the patient (with the clinician still making a very handsome profit - although nowhere near the profit of TRT). 

 

TRT have been a set of initials which have echoed through the tinnitus and hyperacusis community since 1990.  They describe a treatment which is often suggested as the only hope for hyperacusis patients.  I have never seen the initials PNT (pink noise therapy) used in our world and perhaps those initials are long overdue.  Nor have I seen the initials PET (progressive ear therapy) used for hyperacusis patients who see little improvement from TRT or pink noise therapy.  PET is Rob's brainchild and I think it holds real promise for the unfortunate few who need a special approach to broadband sound. 

 

Thank you sp.

 

Dan


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Reply with quote  #7 

Dan posted [in part]:

 

[The initials TRT] describe a treatment which is often suggested as the only hope for hyperacusis patients.

 

...........

 

Only by those who know no better.

 

Dr. Vernon was recommending pink noise for the treatment of hyperacusis long before Dr. Jastreboff ever heard of the word.

 

Look, here's the deal ...

 

Dr. Pawel Jastreboff has done an incredible service to both the tinnitus and hyperacusis communities by developing the Neurophysiological Model, by developing TRT based upon that model, by successfully treating thousands of patients with tinnitus and/or hyperacusis, by publishing articles and conducting courses so that other hearing healthcare professionals could provide to their own patients, and by increasing awareness.  His role - and the role of TRT - cannot be underestimated.

 

Now as you may or may not know, the effectiveness of TRT in hyperacusis was a serendipitous finding.  Dr. Jastreboff just happened to discover that in treating those tinnitus patients who coincidentally also had abnormal LDL's with TRT, not only did the TRT facilitate habituation of tinnitus, but the patients' LDL's improved as well.  The reason for the improvement in LDL's had nothing to do with habituation - but rather with desensitization, exactly what Dr. Vernon was accomplishing with pink noise.  [And while much is made of the time-intensive "directive counseling" component of tinnitus treatment by TRT, the improvement in LDL's by desensitization in TRT has little to do with directive counseling - it just depends on the willingness of the patient to follow instructions and to get clarification and support from the TRT clinician if he or she becomes confused or frustrated.]  The big advantage of TRT in hyperacusis treatment was convenience and portability!

 

Well, with improved digital technology and the advent of the iPod generation, all that has changed in my opinion.  Pink noise can be as convenient and portable as TRT.  And I suspect that the next step in iPod will be a wireless system - whereby the iPod remains in your pocket ... and the connection to little devices worn in the ears is totally wireless!

 

But even now with wired connections in the iPod of today, I see absolutely no advantage to TRT over pink noise in treating patients who only have hyperacusis or who have hyperacusis and milder non-intrusive tinnitus - assuming that the clinician using pink noise is willing to provide the same instruction, clarification, and support as he or she would in treating hyperacusis with TRT.

 

AND, there is a huge advantage to using pink noise over TRT under those conditions - cost to the patient.  The cost of TRT runs the patient in the neighborhood of $4000.  But you can buy a brand new 2 GB Nano for around $150.  A pink noise CD runs, what, $20?  Add in a very generous $200/hr to the audiologist for, say, four hours of testing, instruction, clarification, and support - and the audiologist saves the patient over $3000 while being very fairly compensated for his or her time, effort, and expertise.  Hey, let's be real conservative in our estimation - and make it six hours at $300/hr.  You've still saved the patient $2000!!!!

 

So - like I said earlier - were I still in practice today, I would not be using TRT to treat people with a primary complaint of hyperacusis. 

 

sp

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DanMalcore

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Reply with quote  #8 

Thank you stringplayer.  The CD costs $15.00.  That includes postage to anywhere in the world.  Some have been mailed at no charge for special circumstances.

Dan


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Reply with quote  #9 

$15, huh?

 

Seems like a no-brainer to me, Dan.  Now, if you could only convince the audiologists who curretly use TRT (to treat folks with a primary complaint of hyperacusis) to use pink noise instead and settle for a paltry $200-$300/hr for their time and expertise ... you could save hyperacusis patients a boatload of money.

 

sp

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Maree

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Reply with quote  #10 
I spoke to my Audiologist about the idea of pink noise.
She felt that where you are doing desensitization for hyperacusis, environmental sound albums were just a good as pink noise.  All that was needed was that it have few tonal highs and lows, be pleasant but not particularly interesting.

I'm using a environmental sound CD, and so far so good.
Advantage of my environmental sound is that it is probably easier for the rest of my family to listen to for extended periods than pink noise.  This is a significant issue of me as I am not able to wear headphones as touching my ear is extremely painful even when I'm having a good day and my hyperacusis is only moderate).



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Maree posted:

 

I spoke to my Audiologist about the idea of pink noise.
She felt that where you are doing desensitization for hyperacusis, environmental sound albums were just a good as pink noise.  All that was needed was that it have few tonal highs and lows, be pleasant but not particularly interesting.

 

...........

 

I basically agree with your audiologist.  The main reason to consider pink noise is to be sure that the tonal highs are adequately covered and to always be in control of the volume at the various frequencies.  But by far the two most important things are that you use the system - be it pink noise or environmental music - and that you have a knowledgeable hearing healthcare professional to personally instruct you and guide you through the process.  And you, Maree, have those last two "most important" elements covered very well!

 

.........

I'm using a environmental sound CD, and so far so good.
Advantage of my environmental sound is that it is probably easier for the rest of my family to listen to for extended periods than pink noise.  This is a significant issue of me as I am not able to wear headphones as touching my ear is extremely painful even when I'm having a good day and my hyperacusis is only moderate).


.........

 

Your approach makes very good sense to me, Maree.  I love what you are doing!

 

sp

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janepm

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Reply with quote  #12 
good points guys!

after all these years, looking back, I wish that more people had promoted the use of simpler devices combined with cognitive behavioral therapy and misophonia training vs. feeling that everyone HAS to spend an inordinate amount of money doing TRT.

Now, having said that, as many of you know, I am a proponent of working with a professional and doing TRT, but that is for ME.

I know my provider, Susan Gold, made it very clear that there were much less pricier ways of doing this for my case AND that I really did not have to get the gens. However, I chose that route as I was looking, personally, for something that had a long track record and was frankly more convenient since my own case dictated listening to sound enrichment 24/7 and I move around a lot during the day.

We've come a very long way with this Board and thoughtful discussions such as what Stringplayer and Dan are having. If only the world had known all of this years ago!

And, of course, I do think every single case is different, some are more Hyperacustic than I may be. For me, it was mostly misophonia.

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Janepm posted [in part]:

 

after all these years, looking back, I wish that more people had promoted the use of simpler devices combined with cognitive behavioral therapy and misophonia training vs. feeling that everyone HAS to spend an inordinate amount of money doing TRT.

 

...........

 

Jane, I just want to clarify something, if I may, so that readers do not inadvertetly misinterpret your post:

 

Whether TRT is used for tinnitus, for hyperacusis, or for both - it does not involve cognitive behavioral therapy.  Even when TRT is used in the treatment of misophonia or phonophobia, it does not involve cognitive behavioral therapy.

 

sp 

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Maree

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Reply with quote  #14 
Stringplayer I'm interested in your views on the value of cognitive behavioral therapy in treating hyperacusis.

My pain management clinic run a 3 week full-time cognitive behavioral pain management program, designed to help reduce the distress level caused by pain.  It is a fully government funded program so would cost me nothing.  I have been accepted for the program.

I'm quite interested in participating however I have a major challenge, which is that they require people to stop taking all their pain medications for the duration.  I am not scared by pain and am happy to stop taking all my analgesics.  However if I discontinue my anti-convulsents (Pregablin aka Lyrica) my hyperacusis increased to extreme levels.

My general practitioner, neurologist and audiologist are all opposed to me stopping my Lyrica.  Not sure how much effort to put into trying to get them to reconsider.

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Maree posted:

 

Stringplayer I'm interested in your views on the value of cognitive behavioral therapy in treating hyperacusis.

 

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

 

That one's easy, Maree.  Cognitive behavioral therapy has no role at all in the treatment of hyperacusis.

 

Now that's not to say that a hyperacusic might not in some way benefit from cognitive behavioral therapy.  After all, a hyperacusic can benefit from a well-balanced diet and exercise, too!  And from reading a good book.  And from a walk in the park.  But in terms of the treatment of the actual condition itself, nope!

 

sp

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janepm

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Reply with quote  #16 
well, now, I have to respectfully disagree that CBC doesn't have a place in TRT, as I call around, EVERYONE who offers TRT now suggests this.

And I, personally have found this modality to be an essential component in my healing, as well.

I do believe that for many (and perhaps not all cases) it works hand in hand.

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janepm

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Reply with quote  #17 
Sorry, Stringplayer, I had some other things on my mind when I last posted, you ARE absolutely right that when you go to a TRT Provider, almost 100% of them do not do cognitive behavioral therapy, this falls in the ballywick of a good Pyschologist trained in CBC. But a good Provider if they deem it necessary for your particular case will suggest that CBC done alongside the TRT protocol. So yes, you are absolutely right but I did want to mention the importance of that as a possibility.

The difficulty lays, however, in finding someone trained in it. I basically googled CBC and found the organization and spoke with the Doctor who developed this protocol, then it was a matter of contacting each practioner in my generall area who did this, finding out who had an opening and who was taking new Patients, it took a couple of try's but for me, the CBC has been the largest component of my healing.

Stringplayer: by the way, have been meaning to ask you about Susan Gold, do you know if she's beginining a private practice on her own in Maryland? I have heard that Maryland will still offer TRT but I have no idea of any other news. You have a good handle on what is going on, do you know anything about all of this?

Thanks, again and sorry I didn't clarify very well!

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Reply with quote  #18 

Janepm posted:

 

Sorry, Stringplayer, I had some other things on my mind when I last posted, you ARE absolutely right that when you go to a TRT Provider, almost 100% of them do not do cognitive behavioral therapy, this falls in the ballywick of a good Pyschologist trained in CBC. But a good Provider if they deem it necessary for your particular case will suggest that CBC done alongside the TRT protocol. So yes, you are absolutely right but I did want to mention the importance of that as a possibility.

 

..........

 

If a TRT provider or anybody else does Cognitive Behavioral Therapy as part of the treatment of a tinnitus patient, it should not be considered part of TRT.  And, as I mentioned earlier, Cognitive Behavioral Therapy should not be considered a treatment for hyperacusis.

 

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

The difficulty lays, however, in finding someone trained in it. I basically googled CBC and found the organization and spoke with the Doctor who developed this protocol, then it was a matter of contacting each practioner in my generall area who did this, finding out who had an opening and who was taking new Patients, it took a couple of try's but for me, the CBC has been the largest component of my healing.

 

...........

 

Now you have me a bit confused.  I thought that many psychologists were trained in Cognitive Behavioral Therapy.

 

...........

Stringplayer: by the way, have been meaning to ask you about Susan Gold, do you know if she's beginining a private practice on her own in Maryland? I have heard that Maryland will still offer TRT but I have no idea of any other news. You have a good handle on what is going on, do you know anything about all of this?

 

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

 

Sorry, I do not know what's going on in terms of the program at the University of Maryland School of Medicine Tinnitus and Hyperacusis Center now that Susan Gold has left.  In fact, as of the last time I spoke with Susan (a couple of weeks ago), she didn't know either!

 

Regarding Susan's own future, she is seriously considering going into private practice but has not yet made a definite decision.

 

.........

Thanks, again and sorry I didn't clarify very well!

 

...........

 

Not a problem.

 

sp

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janepm

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Reply with quote  #19 
Hi Stringplayer: thanks for sharing what you know about Susan, and I don't think U of M is too forthcoming about what they are doing, most likely budget cuts.

You are correct that TRT Providers do not provide cognitive behavioral therapy, it is something, however that most if not all I've spoken with refer the Patient to. In my case, since I was working with Susan in Maryland but we live in California, I was on my own to find a Psychologist trained in this and with experience especially in medical fears and phobias. But you are absolutely correct: they do not offer it. I only found one person in California who said they offer therapy alongside but I do not know their qualifications.

When I was shopping around for a Provider awhile back, it was a bit confusing as the word "counseling" would often be used in accordance with TRT. And it's that "counseling" that is part of the TRT Protocol that many offer, however, it is in no way the cognitive behavioral therapy that is done separately from a different provider but usually alongside TRT.

Hope that makes sense and thanks again for updating us about Susan. She would be marvelous in private practice, she has a lot to give!

Take very good care Stringplayer.

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Reply with quote  #20 

Janepm posted [in part]:

 

You are correct that TRT Providers do not provide cognitive behavioral therapy, it is something, however that most if not all I've spoken with refer the Patient to.

 

...........

 

Jane, I have never had the impression that most TRT providers refer their patients for cognitive behavioral therapy in addition to TRT.  You may be right, but in my experience what you describe would by far be the exception rather than the rule.

 

sp 

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BonnieBeth

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Reply with quote  #21 

Budget cuts at the U of Maryland?  So THAT'S why they're sending me so many bills!  They need my money! 

Hi sp, great to see you are back on the board!  I do agree with Jane about CBC because I too was treated with TRT/in ear generators at Maryland.  In fact, Susan Gold had recommended CBC as an adjunct because from what I understand about this type of therapy, it's different than traditional therapy and is supposed to be shorter-term, very goal-oriented and focused, and specifically geared to treat trauma and phobia situations.  I was not able to find a CBC therapist in my immediate area, but I'm still looking.  I think it can have a place alongside TRT in that it deals with trauma situations.

 

I agree with you that the pink noise CD's are ideal for many people, and from what I've read Rob's new version is supposed to be excellent.  In my personal case, I had to go for TRT.  My hyperacusis was so bad after that MRI and for months afterward, that I couldn't even go to the mailbox at the corner without my ears splitting, and I had to quit seeing my therapist because it was agonizing to sit in a small room hearing her voice.  I wanted and needed something to take with me that I can wear in my ears, 24/7, so that I can handle outdoor sounds around me and gain back the ability to be in enclosed rooms with voices around me without cringing in pain.  For indoor use pink noise is great, and so are the sound machines including the one Rob recommended which I use when I go to sleep at night as background noise.  I assume with an ipod you can use the pink noise cd's away from home, but I don't think it's as easy.  I really wanted the convenience of generators.  In addition to the sound therapy they provide, they also help block some of the really harsh sounds on the street that I am so sensitive to. 

 

Always the best,

 

Bonnie

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janepm

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Reply with quote  #22 
Hi Bonnie: good to hear from you and glad things are going well. And I really don't know if there are budget cuts at the University, I was making more of a general comment and perhaps it could be that, I really don't know.

Have you googled Cognitive Behavioral Therapy and there's an organization that the founder has who has a list of pracitioners who do it, you are right, it's very hard.

Stringplayer: I've just called just about everyone who practices TRT here in California to locate a new person for me, and hopefully I can find someone close to me. However, each and every one of them spoke of the cbc as being an important component of this so at least out there, it's recognized as being part of TRT protocol work. You just can't get it all at one place and so Patient has to go to different people for different things.

I would not know how it is done elsewhere but that has been my experience as Bonnie's has, as well.


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Reply with quote  #23 

Jane posted:

 

Stringplayer: I've just called just about everyone who practices TRT here in California to locate a new person for me, and hopefully I can find someone close to me. However, each and every one of them spoke of the cbc as being an important component of this so at least out there, it's recognized as being part of TRT protocol work.

 

...........

 

Well it isn't according to Pawel Jastreboff and Jonathan Hazell - and I can tell you that with 100% certainty.  So there is clearly a communication disconnect somewhere along the line.

 

Best to ya!

 

sp

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myztiphyd

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Reply with quote  #24 
re: Maree's post concerning CBC.
Anytime I as a medicare/medicaid recipient of medical treatment that is "fully government funded" that is invited to "go off my medications" even for a short amount of time... I immediately see red flags.This may or may NOT be in my best interest, Because the medication I take is a "neuroleptic".. it is as if playing "Russian Roulette".
BUT... if the government can convince and save many dollars worth of medicare/medicaid expenditures.. why not?

Who knows..... and WHO hasn't showed up yet

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janepm

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Reply with quote  #25 
Stringplayer: thanks for bringing this out. very interesting, it sure isn't what we've experienced but who knows, I guess there are many ways of accomplishing the same thing.

Take care!

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Maree

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Reply with quote  #26 
I take Lyrica aka Pregablin which in Australia is not on PBS (Pharmaceutical Benefits Scheme) except for epilepsy.   So no government savings on me discontinuing meds, I pay full price for them anyway which is a huge cost.

I think the CBC people just don't really understand the nature of my illness.  There argument is stopping your pain killers can't make you sicker, just creates a situation where during the program you have significant pain levels against which to trial the new skills you are learning.
 My feeling is that stopping Lyrica makes my Hyperacusis significantly worse and that the resulting deterioration will takes many months to recover from.

I have spoken to my Audiologist and I know she agrees that I must continue to take my Lyrica.  Since seeing me she referred a couple of other Accoustic Shock Patients to my pain managment clinic.  She has had one meeting so far with the Facial Pain Consultant so far.  I will see if she is able to get them to review there position on Anti-Convulsent medications for Hyperacusis patients.
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Reply with quote  #27 

Janepm posted:

 

Stringplayer: thanks for bringing this out. very interesting, it sure isn't what we've experienced but who knows, I guess there are many ways of accomplishing the same thing.

 

...........

 

Jane, I'd like to be very clear about terminology here - because I firmly believe that most of the errors in medicine are errors of communication.

 

Here's the deal:

 

There is no such thing as "TRT including Cognitive Behavioral Therapy."  There most certainly is "TRT PLUS Cognitive Behavioral Therapy," and apparently some TRT clinicians do recommend that their patients undergo Cognitive Behavioral Therapy in addition to TRT.  But you simply cannot consider Cognitive Behavioral Therapy to be part of TRT - no matter who the clinician is - because that is not how Jastreboff and Hazell define TRT ... and they invented it!  Now TRT does most definitely have a counseling component - but that counseling component is directive ... and nobody in the field of psychology considers Cognitive Behavioral Therapy to be a form of directive counseling.  (Certainly Aaron Beck and Thomas Ellis do not see Cognitive Behavioral Therapy as "directive" - and they are to Cognitive Behavioral Therapy what Jastreboff and Hazell are to TRT!)

 

Hope this clarifies more than confuses.

 

sp

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janepm

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Reply with quote  #28 
SP: you've explained this beautifully and thanks for clarifying!

I also want to mention that for those who want to look more into cognitive behavioral therapy that there are many fine books written by the originators of cbt. While it won't suffice for a one-on-one counseling session for whatever goals the Patient wants to work on, it is a great introduction. Google also has some great sites and lists of Practitioners who do this. Not every Therapist is trained in this but it does hold much success vs. analytical therapy for making changes.

Thanks again Stringplayer and I totally agree with you on the communication thing!

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Jane
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