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Emory Center Helps Hyperacusis and Tinnitus Patients With A Unique
Retraining Therapy
ATLANTA Suffering from a "ringing in the ears" sounds benign enough
on the scale of medical problems, but tinnitus and related hearing disorders
that affect millions of Americans can become so severe that they lead
not only to decreased life quality but to anxiety, panic, depression
and social isolation.
As long ago as the time of ancient Babylon, medical writings described
these problems. "Ringing in the ears," or tinnitus, is a common hearing
disorder that is generated internally. Hyperacusis is a condition that
amplifies sounds from the environment, causing distraction and pain.
Both tinnitus and hyperacusis can vary in degree from mild symptoms
that can be easily controlled, to symptoms that cause extreme pain and
discomfort. Both afflict people of all ages, all over the world. Symptoms
can occur alone or simultaneously, and the longer the symptoms go untreated,
the more intrusive they can become. As many as 40 million Americans
experience symptoms all the time, and it is believed those symptoms
are significant enough to affect quality of life in one to two million
of them.
There is no cure for tinnitus, but many sufferers may be interested
to know that there is a treatment approach that was developed and tested
throughout the 1980's and finally put into clinical practice in the
early 1990's. "Even though tinnitus and hyperacusis are each classified
as a symptom and not a disease, they do require treatment," says Pawel
Jastreboff, PhD, ScD, professor in the Department of Otolaryngology
at Emory University School of Medicine, and director of the Emory Tinnitus
and Hyperacusis Center. "Both tinnitus and hyperacusis may affect attention,
work, sleep and sociability. These disorders can cause serious psychological
as well as physical dysfunction that can devastate a patient's life."
More than two decades ago, Dr. Jasterboff and his wife Margaret, an
associate professor of otolaryngology, combined their backgrounds in
neurophysiology, neuroscience, electroacoustics, biophysics, biochemistry
and pharmacology to study how the brain processes information within
the auditory pathways. Dr. Jastreboff's work lead to the conclusion
that by retraining the brain to habituate, or ignore certain noises,
patients could eventually be free from the annoying symptoms. The method
of treatment based on these principles is known today as Tinnitus Retraining
Therapy (TRT).
"Our goal is to retrain the patient's brain so that they learn how to
treat tinnitus and hyperacusis the way they treat the sound of a refrigerator
in their kitchen; a sound which they normally are not aware of but when
they do hear it, it is not bothersome," explains Dr. Jastreboff. "This
method retrains the reflexes involving the connections between the auditory
and the limbic and autonomic nervous systems, and retrains the subconscious
part of the auditory pathway to block the tinnitus signal."
TRT should always consist of two components: counseling and sound therapy
usually with the use of sound generators. Because of the complexities
involved, it is extremely important that the course of treatment is
conducted by specialists who are appropriately trained.
Patients who have been thoroughly tested and diagnosed will begin therapy
with a counseling session in which the diagnosis and treatment progression
is explained. The patient learns to understand the mechanisms of hearing
and basis of the brain function. Specifics of sound therapy, including
potential use of variety of instruments such as tabletop sound generators
and/or wearable sound generators, hearing aids, or devices consisting
of a sound generator combined with hearing aid. Once the patients understand
the mechanisms of hearing, principles of tinnitus perception, and reasons
why tinnitus is creating problems, then they are instructed to follow
a specific regimen of sound therapy. Significant improvement occurs
typically after about three months, with further improvement noted in
six months to a year.
"Tinnitus and hyperacusis are challenging topics to study and symptoms
are difficult to treat. Many questions remain unanswered," says Dr.
Jastreboff. "We are constantly striving to improve our approach to tinnitus
and hyperacusis and refine our research and understanding of the neurophysiology
of the symptoms with the ultimate goal of eventually finding a true
cure." In the last 13 years, more than 2000 patients have been treated
by the Jastreboffs from all corners of the world, including many countries,
e.g., Canada, Korea, Switzerland, and Brazil. Of those 2000 patients,
80% have been successfully treated. None of the patients who were successfully
treated have had recurrence.
When the Drs. Jastreboff are not traveling around the world training
other specialists about TRT, they are conducting more studies. Currently
they are co-investigators for a study involving brain imaging which
has been supported by a grant from the Tinnitus Consortium. They also
continue to look at various aspects of the mechanisms of tinnitus and
the effectiveness of TRT. In addition to their work, other centers have
major grants funding tinnitus research which are being finalized, including
grants from the NIH. Patients can get more information on the Emory
Tinnitus and Hyperacusis Center by calling 404/778-3109.
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