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Rob

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Reply with quote  #1 
I developed a protocol for listening to music in a very specific way to be used as part of a strategy to improve decreased tolerance of sound.  Most people with decreased sound tolerance and some folks with tinnitus approach sound defensively.  The music protocol will help you associate sound with an activity that is pleasing and fun – and over which you have complete control.  When I spoke at length to Dr. Jastreboff a while back and discussed a protocol he uses to treat misophonia, I was struck by the similarities, as well as the differences, of our respective approaches.  I hope the protocol I’m posting here is useful for you.  

The music protocol is designed to prove to you, slowly and over time, that exposure to normal levels of sound will not hurt you.  To be effective, the protocol must be used between 40-75 minutes per session depending on the length of the CD you are using on a given day.  It is very important to listen to the music via headphones rather than thru external speakers to introduce the music as directly and consistently as possible to your auditory system. 

Each day, listen to an entire CD of your choosing through a good set of comfortable headphones attached to a Walkman or stereo system.  The only requirement about the headphones is that the music should sound pleasing to you when played through them.  You can use noise cancellation headphones, if you prefer.  Do not use the typical ear buds that come with iPods.  They are not very good.  There are commercially available ear buds with much better fidelity, but they are also far more expensive.  Do not use mp3 files, as they have degraded sound.  Use CDs, tapes, records, or files that have been downloaded in either the .wav or .aiff format.  Play any kind of music you feel like listening to, regardless of style and dynamic range, such as Beethoven, Led Zep, Radiohead, Miles Davis, or Judy Collins.  If you feel that listening to a certain style of music is too ambitious during the first couple months, and you’d prefer to listen to folk music or something calming, that is perfectly fine.  You will always have complete control and be able to lower the music any time you are uncomfortable.  

If the music hurts at any time, lower the volume. If the music still hurts, stop and play something else. The music should never be physically painful or uncomfortable to you

It is important to actively listen to the music. Don’t do some other activity at the same time to distract yourself (although it's perfectly fine to walk in a park or on a treadmill while doing the music protocol). Enjoy the music.   

Phase 1 should be used for nine weeks.  Phase 2 should be used for 18 weeks.  Phase 3 should be used for 12 weeks.

PHASE 1 (9 weeks)

Week 1 – Play an entire CD each day of the week, and set the volume so that it is at the lowest possible volume you can hear.  You will strain to hear the music, but that’s OK.  Relax and pay attention.  Remember, you can play any type of music you enjoy (e.g., folk, soul, rock, rap, classical, country, jazz). 

Week 2 – Play an entire CD each day of the week, and set the volume so that it is at the lowest possible volume you can hear.  Then, slightly increase the volume to where you can tell it is just a bit louder.  If the music feels painful at any time, lower the volume.  If you feel worried or uncomfortable, try to hang in there for a bit.  But if you continue to feel worried, slightly lower the volume.  Again, just relax, listen to the music, and enjoy it.  You are in full control at all times.

Week 3 – Play an entire CD each day of the week, and set the volume so that it is at the lowest possible volume you can hear.  Then, slightly increase the volume to where you can tell it is just a bit louder.  Then, slightly increase the volume just a bit more.

Weeks 4-9 - Play an entire CD each day of the week.  Set the volume so that it is slightly louder than the previous week.  If the music feels painful at any time, lower the volume.  If you feel worried or uncomfortable, try to hang in there for a bit.  But if you continue to feel worried, slightly lower the volume. 


PHASE 2 (18 weeks)


Week 10 – Play an entire CD each day of the week, and set the volume so that you are completely comfortable.  Relax, pay attention, and enjoy the music. 

Week 11 – Play an entire CD each day, and set the volume so that you are completely comfortable.  Then, slightly increase the volume to where you can tell it is just a bit louder.  If the music feels painful at any time, or you feel worried or uncomfortable in any way, slightly lower the volume.  As always, just relax, listen to the music, and enjoy it.  You are in full control at all times.

Week 12 – Play an entire CD each day, and set the volume so that you are completely comfortable.  Then, slightly increase the volume to where you can tell it is just a bit louder.  Then, slightly increase it just a bit more.  If the music feels painful, or you feel unsure at any time, feel free to slightly lower the volume.  As always, just relax, listen to the music, and enjoy it.  You are in full control at all times.

Week 13 – Repeat the steps used in week 10.

Week 14 – Repeat the steps used in week 11.

Week 15 – Repeat the steps used in week 12.

Week 16 – Repeat the steps used in week 10.

Week 17 – Repeat the steps used in week 11.

Week 18 – Repeat the steps used in week 12.

Week 19 – Repeat the steps used in week 10.

Week 20 – Repeat the steps used in week 11.

Week 21 – Repeat the steps used in week 12.

Week 22 – Repeat the steps used in week 10.

Week 23 – Repeat the steps used in week 11.

Week 24 – Repeat the steps used in week 12.

Week 25 – Repeat the steps used in week 10.

Week 26 – Repeat the steps used in week 11.

Week 27 – Repeat the steps used in week 12.

By now, you may find that the most comfortable volume at which you listen to music has become a little louder.  This is normal. 


PHASE 3 (12 weeks)


We’re going to add something new to the end of the protocol.  Continue to work in three-week cycles, where you repeat the steps used in week 10 during the first week of the cycle, the steps used in week 11 during the second week of the cycle, and the steps used in week 12 during the third week of the cycle.  But at the end of each session, add the following.

Week 28 - At the end of the listening session, choose one song on the CD.  Set the volume so that it is slightly uncomfortable or slightly too loud.  Then, slightly lower the volume so that the volume is loud but no longer uncomfortable.    

Week 29 - At the end of the listening session, choose two songs on the CD.  Set the volume so that it is slightly uncomfortable or slightly too loud.  Then, slightly lower the volume so that the volume is loud but no longer uncomfortable. 

Week 30 - At the end of the listening session, choose three songs on the CD.  Set the volume so that it is slightly uncomfortable or slightly too loud.  Then, slightly lower the volume so that the volume is loud but no longer uncomfortable. 

Week 31 - Repeat the steps described in week 28.

Week 32 - Repeat the steps described in week 29.

Week 33 - Repeat the steps described in week 30.

Week 34 - Repeat the steps described in week 28.

Week 35 - Repeat the steps described in week 29.

Week 36 - Repeat the steps described in week 30.

Week 37 - Repeat the steps described in week 28.

Week 38 - Repeat the steps described in week 29.

Week 39 - Repeat the steps described in week 30.

As always, you are in complete control and you can lower the volume at any time if you feel uncomfortable or afraid or if the volume is still too loud for you. 

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DrNagler

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Reply with quote  #2 
Rob, it's great to have your protocol written out step-by-step. Very helpful and much appreciated.

I have a question. Over time and with more and more experience, sometimes complicated protocols in any number of fields can be simplified (i.e., fewer steps). Have you found that to be the case with your protocol - or do you feel that the current iteration as "down to bare bones" as you can get?

Thank you.

stephen

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No bird ever soared in a calm. Adversity is what lifts us.

- David McCullough quoting Wilbur Wright
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Rob

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Reply with quote  #3 
I felt it was important to be as specific as I could, and to try to anticipate questions or concerns someone with decreased sound tolerance might have rather than generalize, simplify or condense. 

The protocol is divided into three parts.  In the first part, the baseline setting is the lowest possible volume the user can hear.  In the second part, the baseline setting is the most comfortable volume the user can hear.  In the third part, the baseline is the loudest volume the user can tolerate without being uncomfortable.  

If the user prefers, he could extend the first part to nine weeks and extend the second part to eighteen weeks before adding the third part of the protocol. 

I have used the protocol twice.  The first time I used it as described in the initial post.  The second time I used the protocol, I preferred to do the first part for nine weeks rather than three, and the second part for 18 weeks rather than nine before adding the third part. 

I hope this is helpful to anyone who wants to try it.  I think it is useful for imcreasing loudness discomfort levels, misophonia, phonophobia, and for some of the classic symptoms of acoustic shock such as ear pain, ache, aural fullness, ear pressure, tingling, and other uncomfortable or unusual symptoms associated with Tensor Tympani Syndrome.

Rob
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DrNagler

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Reply with quote  #4 
Thanks for your prompt response, Rob.

I think your protocol represents a wonderful contribution to the field.

stephen nagler

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No bird ever soared in a calm. Adversity is what lifts us.

- David McCullough quoting Wilbur Wright
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Rob

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Reply with quote  #5 
Thank you.  That is very nice to hear.  I appreciate your saying so.  

Rob
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Christian

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Reply with quote  #6 
Hello Rob,
Thank you for sharing the protocol which you describe as similar to the protocol used by Jastreboff to treat misophonia. You propose the protocol as a way to treat ear pain from TTTS (similar to Jastreboff who also seed TTTS as result of misophonia). In a different post you mention that you do not think pink noise helps against sound-related ear pain as this is not caused by hyperacusis. 
I am confused as in the recent Westcott article that you recommended about TTTS she describes TTTS as a consequence of hyperacusis and does recommend low level sound therapy with nature sounds and pink/brown noise. She explicitly states that misophonia patients do not show TTTS symptoms.
So for the patient with sound-induced ear pain it is difficult to see which of these different ways to follow.
Any comments?
Thank you,
Christian
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Rob

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Reply with quote  #7 
Very interesting points, Christian.

In my view, and in my own personal experience of ear pain and hyperacusis, the two things should be treated by taking different approaches.  I think pink noise, or any form of broadband noise, can be very helpful in treating hyperacusis.  I think ear pain should be treated with a different approach, and I would recommend the music protocol as a good approach to take to do that.  In this regard, I don't think broadband noise is helpful in treating ear pain.  

I think it is fair to say that a challenge with the tensor tympani muscle can develop as a consequence of having hyperacusis, as Ms. Westcott writes.  I agree with this.  I don't think low level broadband noise, whether pink or white, is an effective approach to treating TTTS.    

I also think the music protocol can be an effective approach to supplement the use of broadband noise when treating hyperacusis. 

Rob


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lk

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Reply with quote  #8 
Dear Christian,

I think we really don't know ...
Maybe M. Westcott , maybe Jastreboff or nobody is right ...
We do have to support all research about this because we don't know the exact mechanism about pain related soundsensivity ...


Greetings,

LK
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Johnloudb

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Reply with quote  #9 
Christian Wrote: "Hello Rob,
Thank you for sharing the protocol which you describe as similar to the protocol used by Jastreboff to treat misophonia. You propose the protocol as a way to treat ear pain from TTTS (similar to Jastreboff who also seed TTTS as result of misophonia). In a different post you mention that you do not think pink noise helps against sound-related ear pain as this is not caused by hyperacusis. 
I am confused as in the recent Westcott article that you recommended about TTTS she describes TTTS as a consequence of hyperacusis and does recommend low level sound therapy with nature sounds and pink/brown noise. She explicitly states that misophonia patients do not show TTTS symptoms.
So for the patient with sound-induced ear pain it is difficult to see which of these different ways to follow.
Any comments?
Thank you,
Christian"

I do not remember reading that statement by Westsott. But I disagree with it. I do associate TTTS with DST (decreased sound tolerance) due to misophonia. Yes, lots of opinions out there ... and I think people in general make desensitization too complicated. 

I've had TTTS and a host of other symptoms common with people who have hyperacusis and misophonia or phonophobia.

Anyway, people tend to distress and fear their symptoms, even more so when the can't find any answers from doctors. This can make things worse as people start practicing avoidance.

You just start with sounds you can tolerate like sound enrichment and pleasant sounds. Music therapy, as Rob talks about can be really helpful. It is a sound most enjoy, with increases brain plasticity and ability to adapt (habituate). Of course broadband noise can be an important part of desensitization as well, best done with help of a well trained audiologist.

And you work at gradually increasing exposure to normal everyday sounds, slowly .. exposure desensitization and cognitive behavior therapy/mindfulness. 

For those who think TTTS is not treatable and there are no answers, they are wrong!!! 

John
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Johnloudb

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Reply with quote  #10 
Christian,

I neglected to mention I have found broadband noise very helpful with ear pain and desensitization in general. Specifically the broadband noise produced by my GHI tranquil ... wearable sound generators. But Mindfulness and CBT therapy have been equally important to me.

John
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numbers

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Reply with quote  #11 
Hi Rob-

Your music protocol for treating hyperacusis is most interesting. I have had tinnitus and hyperacusis since 1988. In 1997 I traveled to Baltimore to counsel with Dr. Jastreboff about my tinnitus and hyperacusis, but mostly about my hyperacusis. I'm a category 3 T&H sufferer; i.e., my hyperacusis is my biggest problem, by far. My T is barely noticeable.

TRT gave me my life back in using Dr. Jastreboff's Viennatone Sound Generators in 1997 - 1998. I raised my sound tolerance levels very significantly over the course of 12 - 18 months. I have had some minor relapses since then but each time I would just start using my trust Viennatone Sound Generators over the course of 2 - 3 weeks and my sound tolerance would come back quickly.

My problem..... I have had another relapse and this time seems to be different. My tinnitus settled down within a few days but my hyperacusis is not bouncing back as it has in the past. Dr. Nagler recommended I take a look at your protocol because what bothers me most about this relapse, or any relapse, is that I am not able to engage in my all-time favorite hobby..... listening to music.

Of course, I am wearing my Viennatone Sound Generators again because broadband white noise is very friendly to my ears and matches my low level tinnitus so my Viennatones are a great tool for me to re-acquire my sound tolerance. Unfortunately, it can take a long time using them until my sound tolerance begins to increase.

Some questions regarding this protocol:

1. Has your music protocol worked with a majority of hyperacusis sufferers?

2. What if the music increases tinnitus levels? Then what?

3. Have you encountered anyone whose sound tolerance decreases after listening to music?

All music has some high frequency passages in it. High frequencies are the biggest problem for my ears. It is why I have never dared to start listening to music until I know my sound tolerance levels have recovered enough to listen to music without causing setbacks with my tinnitus or my hyperacusis.

Listening to my favorite music as a means to increase my tolerance of sound would be nirvana for me but my past experience tells me I don't dare until my sound tolerance has increased.

What are your thoughts on my situation?

Thanks for any help and advice you can give me.
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Rob

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Reply with quote  #12 
numbers - 

I'm sorry to hear you have had a relapse.  Do you know what caused the relapse?  Have you considered having your LDLs re-administered?  

Answers to your questions.

1.) The music protocol has been very successful for those who have stuck with it.  

2.) If (not when) there is an increase in tinnitus volume, it will be temporary.  You won't be working with music at a volume that can damage your auditory system.

3.) I have encountered folks with moderate or severe hyperacusis who feel they become more sensitive to sound after listening to music, including me, but never by listening to music in this way.  

You wrote:

All music has some high frequency passages in it. High frequencies are the biggest problem for my ears. It is why I have never dared to start listening to music until I know my sound tolerance levels have recovered enough to listen to music without causing setbacks with my tinnitus or my hyperacusis.

It is precisely because music contains a wide range of frequencies that it is ideal for improving decreased sound tolerance.  I am a fan of wearable generators, but one critique I would offer is that, by necessity, wearable generators do not emit higher-ended frequencies.  Yet, we are exposed to high frequency sound every day.  Rather than wait for your sound tolerance to sufficiently recover to where you can listen to music as you normally do, I suggest listening to music in the way I described in this thread as part of therapy.  

I also suggest that you extend the first part of the protocol to nine weeks and extend the second part to eighteen weeks before adding the third part of the protocol.  

Take it slow, take it at your own pace, and continue using the generators as part of therapy.  I strongly suggest you remove the generators during the period each day that you use the music protocol.       

Rob
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numbers

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Reply with quote  #13 
Hi Rob-

 I wanted to get back to you after I had my hearing evaluated and LDLs measured. I have done so.

I have slight hearing loss in the 4000 - 8000 range but my audiologist told me it was not enough to recommend hearing aids. As for my LDLs, they are:

Pure Tones

250: R-80 L-75
500: R-75 L-75
1000: R-75 L-70
2000: R-75 L-75
3000: R-75 L-75
4000: R-75 L-75
6000: R-80 L-75
8000: R-75 L-75

Broad Band Sound:

250: R-75 L-75
500: R-75 L-75
1000: R-70 L-70
2000: R-75 L-75
3000: R-80 L-75
4000: R-80 L-80
6000: R-80 L-75
8000: R-80 L-80

I kept my records from my hearing evaluations at Oregon Health Sciences University (Jack Vernon) in 1992 and from Dr. Jastreboff in Baltimore in 1997. I was stunned when I looked at them. My LDLs back then ranged from 65 - 75..... worse than they are now. I thought I had relapsed back to my old LDLs but I haven't. It certainly sounded like I did.

My audiologist gave me a Widex combination hearing aid and sound generator on trial to see if the amplification in the sound bands that I have some hearing loss would help my T and H. It didn't. I had the hearing aid turned off immediately..... not because I couldn't tolerate the sound but because the electronic amplification sounded really bizarre.... like I was not hearing the real sounds of the environment I was in. It was weird. I don't need it and I don't like it.

That said, there was one aspect of them I liked very well. They generate two different tones of broad band white noise. You can select which you want to listen to. With the amplification off, both tones sounded very friendly to my ears. I could change back and forth, increase and decrease volume up or down with the touch of a remote.

I can trial them for 60 days if want but I'm going to trial them for a week or two and then decide if I want to stay with my old Viennatone Sound Generators or see a trained TRT clinician that Dr. Nagler has recommended to get some modern sound generators that will give me both white noise and pink noise.

The good news..... I'm getting better. My T is way down, some days almost non-existent. I need to work on my H. I have to get my LDLs much higher.

I will be starting your sound therapy but not quite yet. Music is a very, very important part of my life and I don't want it to set me back and make me gun-shy about using it to raise my LDLs.

A question for you. As a sound engineer, and a man whose life has revolved around music, you must have encountered "listening fatigue" in your ears more than a few times. It doesn't happen very often but when I get listening fatigue, I have to stop listening and rest my ears or I know I'm headed for trouble with my T and H. If I start your music therapy and start to get listening fatigue at any point, I assume I would stop listening and start again in a day or two. Right or wrong?

Thanks for all your help. Your posts on this forum are a God-send.
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Rob

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Reply with quote  #14 
numbers - 

Thanks for sharing your LDLs.  There is no question in my mind that you can substantially improve them.  

When you decide to start the music protocol, I suggest doing the first part of the protocol for nine weeks rather than three weeks.  Each week, set the volume slightly higher than the previous week.  In week 1, set the volume to the lowest volume you can hear.  In week 2, set the volume to the lowest volume you can hear and then raise it slightly.  In Week 3, set the volume to the lowest volume you can hear and then raise it slightly and then slightly more.  Do this for nine weeks, raising the volume slightly louder each of those weeks.  

Then, proceed to the second part of the protocol, which begins on Week 4 in my original post in this thread.  Instead of following this part of the protocol for nine weeks (described as Weeks 4 thru 12 in the first post), do this part of the protocol for 18 weeks.  

After that, continue to use the second part of the protocol, but add STEPS 1 and 2 as described in the first post.

While ear fatigue is something that every hyperacusic experiences to one degree or another, particularly prior to treatment, my guess is fatigue won't be an issue when you are doing the protocol.  If you do experience fatigue when doing the protocol, lower the volume slightly but keep listening.  If you are still uncomfortable, lower the volume a little more.  

Rob          
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numbers

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Reply with quote  #15 
Thanks Rob. I'll keep you posted. I'm still working on the right sound generators right now.

My LDLs are definitely moving higher. Sounds that bothered me 10 days ago in the grocery store, post office, gas station, club my wife and I go to for dinner, etc. now don't bother me.

I don't know what is happening but I seem to be coming back as fast as I went down. What a miracle that would be to come back within a few weeks from where I was.

Anxiety was definitely a factor, perhaps THE major factor. That is way down, virtually gone.

I don't know what games my body was playing with me but maybe they were all temporary. I'll keep doing what I'm doing and see how it goes.

Thanks much for your help.
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numbers

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Reply with quote  #16 
Rob-

I have a couple questions for you regarding your experience with your music protocol.

I have read your story of how you came to have hyperacusis and your long road back to normal. Truly an amazing story and astounding comeback to normal.

You are a musician and spent many hour in a recording studio before your sudden onset of hyperacusis. You acquired tinnitus AFTER you acquired hyperacusis. We don't know the cause of hyperacusis and tinnitus but you and I are very similar in that the one constant, and crucially important element in our lives, is music. I have two questions in regard to music after you acquired hyperacusis (and before you started your music therapy) and during the time you used music to bring your sound tolerance back to normal.

1. After you acquired hyperacusis and before you started your music protocol, did the sound of music create anxiety for you?

2. When you initially started your music protocol, did the sound of music create anxiety for you?

I ask these questions because yesterday I listened to a few songs from my collection of self-recorded cassette tapes I have made over the years. I listened on my usual on-the-ear (open-air) headphones at low volume levels using my usual walkman I've used for many years. The music sounded great, the volume was low so I had no trouble listening at the volume levels, but as I listened to more than a couple songs I began to experience anxiety and I know exactly why. Even though I enjoyed the music I was listening to, and the volume was well within my sound tolerance levels, I had a fear that listening to music would 1) exacerbate my tinnitus and 2) risk reducing my LDLs.

Part of me can hardly believe this happened while another part almost expected it because the only constant element in my life when I had this relapse was my daily walks of 4-5 miles while listening to my favorite music on self-made cassette tapes using a walkman and the same on-the-ear headphones.

Did you experience any anxiety when hearing music when your hyperacusis was bad or when you first started your music therapy protocol?

Of course anxiety immediately begins to exacerbate my tinnitus. I stopped listening after a half-dozen songs and over the course of the next hour or so my anxiety came back down. Now I'm thinking I need to do your music protocol for much shorter periods of time to begin with and work up to longer periods.

This is really crazy because for most of the last 18 years since TRT raised my LDLs but before this relapse, I would listen to music at normal (not loud) listening levels for hours and it never bothered me. Now I'm wondering if I don't have an element of misophonia along with hyperacusis.

What was your experience when you started your comeback using music and what are your thoughts on what I am experiencing?

Thanks Rob.
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Rob

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Reply with quote  #17 

After you acquired hyperacusis and before you started your music protocol, did the sound of music create anxiety for you?

I didn’t begin broadband noise therapy for one year after I developed hyperacusis.  I spent part of that time seeing five doctors before I was diagnosed.  I spent the rest of the time learning about the condition and deciding how to proceed.  Music hurt to hear, and I never thought I would be able to set foot in a recording studio again.  That prospect made me so miserable, after three or four months that first year (where I didn’t listen to any music), I decided to try.  I booked a session and worked with the volume set at an incredibly low level.  I was pleasantly surprised and grateful; I thought I would be out of the studio in two minutes, but I worked for two or three hours, albeit with very small speakers (rather than the usual large speakers I was accustomed to using) and at a very low volume.  I developed the music protocol much later.  I had been doing broadband noise therapy for quite some time when I came up with it.  The purpose of the protocol was to address anxiety about sound, which I had, and ear pain I felt was associated with that anxiety.  I needed to prove to myself there was nothing to be concerned about.  The protocol helped me improve my LDLs (which were already improving with broadband noise), address my fears, and resolve the ear pain.     

When you initially started your music protocol, did the sound of music create anxiety for you?

Yes, and I headed straight for that anxiety.  That’s why I used headphones.  I wanted the sound to be right up against my ears. 

I ask these questions because yesterday I listened to a few songs from my collection of self-recorded cassette tapes I have made over the years. I listened on my usual on-the-ear (open-air) headphones at low volume levels using my usual walkman I've used for many years. The music sounded great, the volume was low so I had no trouble listening at the volume levels, but as I listened to more than a couple songs I began to experience anxiety and I know exactly why. Even though I enjoyed the music I was listening to, and the volume was well within my sound tolerance levels, I had a fear that listening to music would 1) exacerbate my tinnitus and 2) risk reducing my LDLs. 

It sounds like the delivery system you are using is exactly right.  I know what you mean and I appreciate your concerns.  It is perfectly normal to have anxiety, particularly at first.  Two suggestions come to mind.  First, when you feel anxious, lower the volume a bit and see if that helps.  If it doesn’t, lower the volume a bit more.  The protocol will help you improve your LDLs over time.  Also, you will never be working with sound at a volume that can damage your auditory system.  

Part of me can hardly believe this happened while another part almost expected it because the only constant element in my life when I had this relapse was my daily walks of 4-5 miles while listening to my favorite music on self-made cassette tapes using a walkman and the same on-the-ear headphones.

The purpose of the protocol is to pair something pleasant with sound.  You mentioned using self-made cassette tapes when doing the protocol, and that’s where my second suggestion comes in.  Since you had a relapse when listening to these tapes, I wonder if your anxiety has something to do with using the same tapes you were using when you had a relapse.  I suggest trying the music protocol with CDs from your collection and see if that makes a difference.  

Did you experience any anxiety when hearing music when your hyperacusis was bad or when you first started your music therapy protocol?

Yes.

Of course anxiety immediately begins to exacerbate my tinnitus. I stopped listening after a half-dozen songs and over the course of the next hour or so my anxiety came back down. Now I'm thinking I need to do your music protocol for much shorter periods of time to begin with and work up to longer periods.

How many weeks have you been using the protocol?  

This is really crazy because for most of the last 18 years since TRT raised my LDLs but before this relapse, I would listen to music at normal (not loud) listening levels for hours and it never bothered me. Now I'm wondering if I don't have an element of misophonia along with hyperacusis.

It sounds like you do.  The protocol can help.

Rob

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numbers

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Reply with quote  #18 
Rob-

Friday, two days ago, was my first try with the protocol. I'm in the process of doing some trial and error testing of various sound generators (other than my old Viennatones) and I thought I would wait until I had found the right sound generator for me to use with TRT. I am still waiting to get the GHI Tranquil II sound generator to trial it. Since it has both broadband white noise and pink noise, I'm hoping that will be the best sound generator for me to raise my LDLs.

I was going to just wait to start the music protocol but my curiosity about how I would react to it prompted me to try it and see what would happen. So I tried it with mixed results but I believe only due to my fear it will make my hyperacusis worse. I know in my head that is not rational. I listen to television at much higher levels than I did to my music and the sound of my television never causes anxiety. That tells me my anxiety response to the music protocol came from my limbic system, not the sound itself.

Good grief. I have gotten myself into a sorry state and TRT with sound generators has to pull me out of it.
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DrNagler

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Reply with quote  #19 
Quote:
Originally Posted by numbers
I have gotten myself into a sorry state and TRT with sound generators has to pull me out of it.

I know you are having a difficult time of it and sincerely wish you well using the sound generators.

But just to be clear in our terminology: If there is no TRT counseling to go along with the sound generators, then your using the sound generators cannot be justifiably called TRT.

They can indeed be quite effective - and hopefully that will be the case for you - but it's not TRT.

stephen nagler

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Rob

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Reply with quote  #20 
numbers -

The General Hearing Instrument Tranquil II generators are very good and will help you raise your LDLs.  

When you tried the music protocol, did you set the volume so that it is at the lowest possible volume you can hear?   

Rob
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numbers

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Reply with quote  #21 
Rob-

Close but probably not the lowest I can hear.
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Rob

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Reply with quote  #22 
numbers -

When you start the protocol for real, it is crucial to do it "by the numbers" so to speak.

The chances of having anxiety to a sound at one's threshold for hearing it are pretty slim.  The second time I used the protocol, I had all sorts of symptoms in my left ear and I wanted to make sure 1.) exposure to music would not exacerbate these symptoms and 2.) when I saw proof that listening to music at my threshold for hearing it would not worsen the symptoms, I wouldn't feel anxious. 

So, when you decide it is time to start, take it real slow.  In the first few weeks, when the volume is incredibly low, it may seem that you aren't making progress, but you are conditioning yourself to treat sound as a non-threat.  Over several weeks, as you begin to hear the music more clearly without straining to hear it, listening will slowly become a pleasant experience and the limbic involvement you mentioned will take a back seat to your enjoyment and confidence. 

Rob
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AnthonyO

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Reply with quote  #23 
ROB:

Can you speak a little bit about listening to and hearing music when NOT engaged in the daily music therapy protocol?

When travelling by car and listening to the audio system. When sitting at the home PC and maybe putting on some music then. At a friend's apartment and they have on the sound system at normal safe volumes. During these times, one would obviously be listening to music at quite different levels than what the daily protocol calls for. I have experienced all of these scenarios. In that case, would this hamper, null, confuse or sort of void the long term strategic therapy of step-by-step, incrementally raising the audio volume, if your auditory system is being exposed to varying degrees of music sound level throughout your day? I know this might be a tough question to ponder, but a very practical one, since varying levels of music that one listens to, can be found at any turn. Thanks Rob.

Anthony
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Rob

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Reply with quote  #24 
AnthonyO -

I think it's fine to go into settings where there is music playing and do the music protocol as described, in the same way that it is fine to expose one's auditory system to sound and work with broadband noise.

Rob
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TMac

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Reply with quote  #25 
Thank you so much Rob, I so appreciate your advice as I do need some hope that this will get better. I will start to apply the protocol tomorrow.
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TallDude

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Reply with quote  #26 
Hi, I'm currently reading the TRT bible (Jastreboff & Hazell).
I went from a C0/1 to C4 in about a week.
Can this method be used for C4 category?

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