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DanMalcore

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Dan
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Understanding that Pawel Jastreboff has made significant contributions to  individuals suffering from hyperacusis and tinnitus I don’t understand why only two people have requested complimentary copies of the recent article in Tinnitus Today marking the 25th anniversary of TRT.  Certainly, if you have hyperacusis, tinnitus, and/or misophonia you would want to hear what he has to say – wouldn’t you?  I hope you at least take the time to read some important points he made in this article.

1)   Pawel remains skeptical about medications to cure tinnitus since the neurophysiological mechanisms involved in tinnitus perception are too intertwined with the normal function of the auditory system  

2)   Common errors in the implementation of TRT include: counseling that is too general or too abbreviated and not tailored to the patient’s educational level specific needs or background; false promises made about the perception of tinnitus going away forever; use of shortcuts in treatment without sufficient experience and understanding of TRT; inappropriate diagnosis (categorization) of patients; improper use of sound generators; too much medications that inhibits neural plasticity; running loud audiological tests for patients with DST (decreased sound tolerance); and lack of followup visits.

3)   Over the years the TRT model has not changed but its clinical implementation has.  The concept of misophonia has put more stress on retraining the subconscious part of the brain which substantially changes the sound part of the therapy.  Because of this the time required to realize improvement has shortened substantially.

4)   In the early years of TRT it took an average of one year to see improvement.  Now they may begin to see improvement in one month..

5)   The neural plasticity of the brain is essential in the habituation process for tinnitus.  Pawel’s experience found that although it is possible to achieve habituation over a longer period of time for patients using small doses of benzodiazepines (Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam) larger doses prevent habituation from occurring.

6)   Sound is more important than choosing any particular sound therapy device.  The best device depends on the specific patient.  Most tinnitus patients who have hearing loss the optimal choice is a combination of hearing aid plus sound generator in one shell. 

7)   Fixation on a device will cause a patient to be constantly reminded of their tinnitus.  Background sound enrichment is also important.

8)   The use of sound at night (not ear level devices) is recommended for the subconscious role of the brain. Typically patients use table top sound machines and/or sound pillows.  They often improve sleep quality.

9)   Formal certification of TRT is long overdue.  Pawel did not patent TRT because he was concerned it would erect barriers to clinical care and the implementation of TRT. 

10)       No method is as effective as TRT.  Cognitive behavioral therapy (CBT) does nothing for decreased sound tolerance.  TRT can help save the quality of life of patients.

11)       TRT is not yet incorporated in medical, neurology or otolaryngology residency programs.  However many audiologists have attended the Tinnitus and Hyperacusis course in Atlanta.  About 2,000 audiologists are now familiar with the basis of TRT now.

12)       Pawel plans to continue his work in this area.  Margaret Jastreboff, Ph.D. who helped Pawel devise protocols for misophonia encourages him to go easy on theory and work on implementation via language that is easy to understand.  On a lighter note Pawel says “she argues with me all the time.”


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Margy

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Reply with quote  #2 
I certainly do want to read what Pawel Jastreboff has to say! How do I get a copy of the article? I especially want to know how the TRT protocol has changed. I read his early book.
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DanMalcore

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Reply with quote  #3 
See this link:

http://www.chat-hyperacusis.net/post/american-tinnitus-association-q-a-with-pawel-jastreboff-7886895

Dan

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changes

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Reply with quote  #4 
Great concise read Dan! Thanks for the continued info and support. 
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janeygirl

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Reply with quote  #5 
Dan; thanks for this, I was thinking about Jastreboff recently and wondering if they are continuing this excellent work.

Do you know whatever happened to the University of Maryland's program, also Susan Gold, is she retired? I know she left Maryland some years ago to go elsewhere and there were some changes.

So appreciate your recap. I would only say that part of the TRT protocol since the Audiologist is not qualified in my view to do the counseling part is to also see a therapist who specializes in cognitive behavioral therapy. For me, the 3-prong approach really worked. 

Jane

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DanMalcore

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Dan
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Reply with quote  #6 
Susan Gold did retire.  She was wonderful.  To the best of my knowledge the University of Maryland no longer has a clinician trained to treat hyperacusis patients.  However, not far away, Margaret Jastreboff (Pawel's wife) is located at:

Margaret M. Jastreboff, Ph.D.

JHDF Clinic

5550 Sterrett Place, Suite 100

Columbia, Maryland 21044

443-218-4004

443-218-4007 fax

JHDF2008@gmail.com

Dan


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Aplomado

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Reply with quote  #7 
Thank you for sending me the article Dan.
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