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August 15, 2003


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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