Frequently Asked Questions

Your qualifications for the program:

What if my tinnitus tone changes throughout the day or week? Can I still participate?
Which tone (frequency) should I pick to train?
Does everyone who participates improve?
What if I complete the program, but I do not improve?
Can I continue my noisy activities (piano playing, band participation, etc.)?
Does this program help hyperacusis (UNCOMFORTABLY sensitive hearing)?
Will this training be painful?
Can poor sleep worsen tinnitus?
Use Hearing Aids or Not?
Being tired or Stressed
 
How the program works:
 
What if I do not hear 2 distinct tones in the training program?
Is this just a method of distraction & Why not just passively listen to sounds or music?
All this computer/tablet training makes my hand/arm/shoulder/neck hurt (or makes my tinnitus worse)
Avoiding Noise for Tinnitus Recovery
 
Compared to other programs:

Neuromonics
 

Common Questions right after starting or during the program:

 
Why are the tones in the program different from my tinnitus frequency?
Can I take a break for a few day from “daily” training without causing a problem?
Is training easier at different times of the day?
What is Good or Bad for Brain Health?
Tinnitus flare-up during training (and tones more difficult to distinguish)
My results are not improving anymore.
How loud can I turn up the volume without causing damage?
Is it okay to Train Multiple levels in one day?
Can Chiropractic help with tinnitus?
Should I use headphones?
 

 

My tinnitus tones change. Can I still participate?

Yes, you may participate if your tones change.
Regarding the tone to choose for the study, pick the one that is most prominent most of the time.

Choosing ONE specific frequency for your tinnitus when your tinnitus is NOT one specific sound:
This can be quite a challenge.  First, let’s answer “Why?”  We do this so that we can build a program that is targeted to the brain area that is manifesting the most dysfunction, since this is what previous research has shown to be most effective.  Ongoing research we are doing will help us determine how to be even more specific to help people even more.
For someone with “pure tone” tinnitus, choosing a single frequency is simple. For those with multiple levels of frequencies at once, changing frequencies, buzzing, hissing, swooshing, clicking, or other sounds, this can be very challenging.  Here are the guidelines for picking one specific tone:
If you have:
  • multiple tones: choose the one that is the most prominent or irritating?
  • changing tone frequencies: which one most common or most troubling to you?
  • buzzing, hissing, swooshing, clicking, or other sounds: choose the tone which is the underlying or average, sound closest to?  This is the one of the areas where we hope our research is going to give us new insight.
Eventually, we expect to match both tone and/or character of tone, but for now, do your best to pick a single tone.

Does everyone who participates improve?

Not everyone who has completed our program has improved.

As of early 2014, our first group of participants (Group 5) showed impressive improvement.
The interesting thing is that we used the LEAST effective method studied in previous research of the ADT approach, improved by our additional methods.
(“ADT”= Auditory Discrimination Therapy). Our additional methods seemed to have lead to considerably more improvement than was seen in the previous research.  Our additional improvements involve greater challenges and focused attention as the participant answers questions about the tones.   The purpose is to gradually increase the training challenge.  Research suggests that this stimulates the nerve  “map” refinement in and around the dysfunctional area of the brain.
 
Study Group #5
This % of participants Improved this much
29% of people had 10% or LESS improvement
65% of people had 27% or more improvement
 
As of early 2014, our next group of participants (Group 3) is looking even better, but it is too early to tell with certainty.
Group #3 came after #5 in our study. Group #3 used the MOST effective method studied in previous research of the ADT approach — also improved by our additional methods.
 
Study Group #3 Study Group #4
This % of participants Improved this much This % of participants Improved this much
?? ?? ?? ??
?? ?? ?? ??

But, we learned that the tones we used were irritating and that several people had dropped out of the study early, even though they felt up to 60% improvement and showed 30-40% improvement on their questionnaires (THI).  That was amazing to us, so we developed a program that was a bit more interesting and one that was more responsive to the participants’ individual lee of performance in the training.

To address irritation, we developed a program that could automatically determine when the participant was ready to skip to the next level and when they had  had reached their limit and were ready to stop to begin their maintenance program (Group #6).

To address the irritation, we developed a training program with nature sounds (Group # 7).

Study Group #6 Study Group #7
This % of participants Improved this much This % of participants Improved this much
?? ?? ?? ??
?? ?? ?? ??

Our next results will show how the MOST effective method studied in previous research of the ADT approach, improved by our additional methods.

Finally, we will combine these 2 groups, the responsive program with nature sounds.

Oh, actually, the “finally” will probably be when we crowd-fund (on KickStarter) and game version that removes the need for scrolling through pages of trainings and adds a little entertainment value to this.

What if I complete the program, but I do not improve?

Well, I will be very sad for you. Not everyone who has completed our program has improved, but we are not out of ideas for you. We encourage everyone (after the original 2014 research study) to carefully evaluate yourself for one of the other causes. We have produced a video and made it available to help you. We are also continuing to improve on a Tinnitus Risk Profile questionnaire and a trigger point self-evaluation so that we are better able to predict who will respond and how will not. As of early 2014, we are evaluating the great data provided by our research study participants. We are very hopeful about finding predictive informatin and new, better solutions.

I do not hear 2 distinct tones: The most common problem is a browser that is out of date, but it may be that you just need to reload or refresh the browser page. First, reload or refresh the page. If that doesn’t solve the problem. Update your browser. Sometimes, it may need updating even if it updates automatically. I don’t give specific update instructions, because every browser is different. With our most recent update, testing showed that it is very compatible with Safari and Chrome, but Firefox had some difficulties if it wasn’t updated to the very latest version manually. (i.e Firefox added a stray sound to the beginning). If it still doesn’t work as expected, give us a call or email, and we’ll try to help.

May I continue noisy activities? Yes, you may, but it may not be best. Of course, noisy activities usually worsens tinnitus temporarily. Naturally, you want to avoid anything that worsens your tinnitus. But, we have had people continue their activity in the band or social activities that irritate their tinnitus and still improve in the program. I would say, avoid the VERY loud noise, if you can, but continue that which you really enjoy and doesn’t cause excessive irritation.


How does your program compare to Neuromonics?

The most popular program, selling for about $5000 from audiologists, is Neuromonics (reviewed and published here:  Product Review by UCSF, & Detailed at AudiologyNOW! conference).   Comparing my program (my ADT) to theirs:

  • Neuromonics (~6-month program): avg. THI reduction of 15 points, taking approx. 6 months to complete
  • My ADT-s program(only Phase 3) (~30-day program):  avg. THI reduction of 18 points (28 points when we include only people starting with THI 38 or higher), and improving considerably more since we added all 3 phases of the program.

This is just comparing our auditory training programs to theirs.  We have since added the CBT, Healthy Brain Lifestyle, and Muscle Care Therapy for Tinnitus programs to our package, because we recognize the best results come from addressing all the causes in a customized way.


Why are the program tones different from my tinnitus? Previous research showed that training with tones outside of the tinnitus frequency resulted in the best tinnitus improvements. We have tested this approach and several others. We will continue to look for the best approach for each individual.

Is this just a method of distraction & Why not just listen to sounds or music?

I can see how this would seem to be yet another method of distraction, but harder work than the noise generators, etc. You are clearly a thinking man.
Specifically, addressing your comment: “I would think that if listening to tones on either side of my damaged nerves would correct the problem then I wouldn’t really need to identify the tone frequency, just listen to it.”
This is an excellent deduction. In fact, other approaches do use the passive (“just listen to it”) approach. They are promoted by Neuromonics and others with “notched music” approaches. The nice thing about these is that they use music. If you are going to listen, let’s have it be music, not irritating tones. The downside is that it takes 3-4 hours per day for 6-12 months. It is a very similar mechanism to what we use here, but we have added a high level of “discrimination” challenge to the process. Just as with any learning the brain does, adding a level of focus, attention, and/or discrimination challenge will speed the process dramatically and may even allow for greater levels of improvement. Consider a person trying to learn the piano by watching and listening to a person play, compared also to trying to follow along, compared to also being told which “follow-along” movements were accurate or inaccurate (feedback) .
The other approaches presently utilized are of the “passive” type. The “active” type that was researched before us used only a very small amount of “discrimination” challenge and no feedback.
So, then comes our research. We have gobs of “active” discrimination (too much for some people on the high end of the program) and immediate feedback for accuracy. The goal is to facilitate learning (brain plasticity) at a rapid rate that continues to a level that is near its maximum.
Fortunately, we have some excellent research that shows this is much more than a bright theory. Of course, my research is only beginning to have enough data to evaluate. But others’ research has demonstrated reproducible changes in brain activity networks and reduction in tinnitus severity that lasts long after the people have stopped doing the therapy. How “long” the improvement will last after the therapy stops is under investigation, but there is no question that this is much more than distraction. What we are accomplishing is rewiring brain. (For the links to the research studies, see out website where it is scattered throughout the page. – http://tinnitussynergy.com/)

Now, the challenge we are making progress toward is to make this less frustrating, less irritating (physically and on the hearing), even more effective, and maybe even a little fun, while still pushing their brain for the maximum improvement to gain the maximum results — pushing people hard, but not too hard.

All the computer training makes me hurt.

Position yourself (or the mouse, or devices) so that

  • your shoulder is relaxed down, your elbow is directly at your side,
  • your elbow is bent approx. 90 degrees,
  • your hand is not outside the plane of your body (i.e. your hand is over your thigh, not to the outside of it).
  • the center of the screen is not much below the horizontal plane of your eyes.
  • your shoulders and head are back, as if a string is gently lifting the center of your head straight up.
  • (To position yourself this way, you may need to move the keyboard, mouse, your body and/or the computer screen.)
  • (For a tablet or phone:
  • have the device at about chest level and
  • prop something behind your elbow to hold your arm/hand up to this level. (If you don’t, shoulder and neck tension will gradually worsen.)

 

Take frequent breaks to

  • stand up,
  • stretch and reach to the ceiling,
  • pull/squeeze your elbows behind your back high then low,
  • as you fully flex and extend your fingers and wrist 5 times
  • open and close your mouth / jaw several times
  • Repeat this exercise 3-5 times.
  • Repeat all this every 15-20 minutes.

 

Is training easier at different times of the day?

Yes, certainly. We are working with brain cells that need to be exercised. If they have been stressed all day (via emotional, physical, or chemical stressors), they may be a bit worn out at the end. Nevertheless, as long as you are able to train without excessive stress, you can make improvement at any time of the day.

Avoiding Noise for Tinnitus Recovery, because over-stressed ears are what cause tinnitus.

I agree, in part, with the premise and the approach.

So, first of all, I agree with part of the cause: Overstressed hearing cells are the problem. Without that, there would be no tinnitus, basically. Tinnitus is usually secondary to partial deafness/hearing loss. This is depicted in the audiogram as a dip in the graph. So far, we agree. Where we part is in explaining the mechanism of overactivity in the perception of noise (tinnitus). It seems, from the paper, that they think the tinnitus arises from overactivity of the hearing nerve receptors. They say this is analogous to the “pain” from other body parts. This is where we part. There is, in fact, increased activity in the hearing part of the brain (auditory cortex), but studies (or ferrets, at least) show that this activity is not from the hearing cells, but from the nerves that sense touch and sight. We believe it is spontaneous activity from unhealthy neurons and/or improper wiring of neurons in the brain and/or brain stem. The research is not perfect and we can’t make positive conclusions, but we can also look at the findings from chronic pain conditions, because research has shown great similarities between what happens with chronic pain states (like phantom limb pain and CRPS) and tinnitus. This pain-vs-tinnitus analogy may be very useful in gaining abetter understanding of the mechanisms. The similarities between chronic pain states and tinnitus are many, but this is the core of it:

  1. Loss of all or some stimuli to the brainstem and brain from the involved body part
  2. Not everyone gets irritating sensations after this happens
  3. For those who do get irritating sensations, we can see changes demonstrated on functional MRI in the area of the brain related to the involved body part (auditory cortex for hearing)
  4. Therapy to exercise the brain related to the involved body part results in both less irritating sensation and more normal functional MRI appearance
    • It doesn’t work for everyone and it doesn’t work perfectly

Different Recommended Solutions

Their solution is to avoid stimulating these overstressed hearing receptors, allowing them to regenerate. Our approach is to exercise the surrounding pathways to insure proper adaptation. So, why do opposite approaches seem to both work?

    • Avoidance works because the whole area is not activated (neither through accurate nor inaccurate/maladapted pathways)
      • This works with chronic pain states as well, for the most part, but it does not improve the condition, it merely avoids irritating it. Yes, resting damaged tissue allows it to heal, but resting dysfunctional neuron connections does very little.
    • Auditory exercise works, because it challenges the brain to adapt to the new hearing ability in a useful way.
I like to think of hearing like the flow of a river. Tinnitus is when the river flow is on the wrong path. Cutting off the water is helpful, but you can’t live downstream anymore, and it certainly won’t put the stream back on track. If that is the only option, so be it. But if we can reroute it to keep living a more normal life downstream, that would seem best. It will take work, but it can be done.
I think avoiding overstressed nerves is an excellent idea. Excess of anything is bad: with weightlifting, drinking water, exposure to germs, cramming for a test, drinking water, gravity, challenges in relationships. So, in physical, biochemical, and mental/emotional situation, we find that too much is bad, but too little may be just as harmful.
Knowing where to find that balance is the challenge of research and the art of application. I do not know where that balance is for you at this time.
I believe, just as in the recovery from stroke, there may be great benefit in providing a challenge immediately after the loss of function. Nevertheless, this opinion of mine is untested. I do not know.

Please understand, I cannot and have not given you medical advice. This is merely for educational purposes. You must make your decision based on your own understanding and your doctor’s advice.

Can I take a break from “daily” training?

When not to take a break: A break of a few days should not be a problem. Good question. If it were a problem, it would be indicated by your needing to return to a less difficult level of the program. You would know this if you could no longer distinguish and couldn’t improve on the tones you are training on now.

When you SHOULD take a break: Taking breaks in your training program is usually not ideal, but it may be necessary or preferred in some circumstances. It may be necessary if you have worked a very long day or you are out of internet reach. Taking a break may be preferred if there is MUCH stress, for any reason.

Good and Bad influences on Brain Health:

“Bad” influences on your brain include: stress, anxiety, poor sleep, lack of physical activity.

“Good” influences your brain include: positive attitude, good sleep, regular physical activity, brain training exercises, muscle work.

Both of these influence your brain. Physical activity, muscle work, and brain training exercises may cause a temporary increase in tinnitus, but in the long term, they are most beneficial

Tinnitus flare-up during training (and tones more difficult to distinguish):

Yes, we are getting in to the bees’ nest now, looking for the honey, or tuning the piano.

The real gains are to be made where the greatest challenge is.

Some people’s tinnitus starts to get WORSE about one third to one half the way through the training. “Worse?”, you say. Yes, this is not typical, but neither is it rare. The good news is that we have had no one report that their tinnitus stayed worse. In fact, it almost always improves to significantly better than it was before the training began. So, stick with it.

Here is how we explain it:

The brain expressing tinnitus is dysfunctionally adapted, a bit like a piano out of tune. To get it working correctly, we are using it quite a bit more, like a piano-tuner would be testing each key several times in the tuning process. At first, this sounds even worse than not tuning it at all, but as the dysfunction is tuned to proper function, the sound becomes more appropriate. In the case of tinnitus, the “appropriate” sound is quieter sound or the absence of sound.

My results are not improving anymore. When you speak of “results”, are you meaning your tinnitus severity/frequency/etc. or your ability to discriminate between tones? Either way, it is okay, for a short while.

Regarding your tinnitus not improving yet, in the early stages of the brain training, it may even get worse. That is common, and is, in our experience, always followed by improvement. Most people do not improve early in the program. Most people do improve in the latter half of the program. So, don’t give up; your persistence will almost always pay off nicely.

Regarding your ability to discriminate between tones, it is common for folks to need to repeat a level here and there. If you score less than 90%, we have you repeat that level so you can have more days training at that level. If you are unable to score 90% after repeating a level 6 or 7 times, there may be a problem with nutrition or with stress. We will usually stop after 7 days on the same level and begin the “Maintenance” program at this level or one difficult level lower.

How loud can I turn up the volume without causing damage? 

That’s a great question.  I cannot give you an exact answer, but I can give you a thorough one.
This a good site for addressing these concerns:
http://www.dangerousdecibels.org/education/information-center/noise-induced-hearing-loss/
As they state, “…at 85 dB that it can cause permanent damage after only 1 work day (8 hours).”

It appears that shorter periods of time than that should be just fine.
http://www.dangerousdecibels.org/education/information-center/decibel-exposure-time-guidelines/

Article (~30 pages in) on the mechanism of hearing loss: http://www.e-a-r.com/pdf/hearingcons/soundscape.pdf

Is it okay to Train Multiple levels in one day? If you are at a level where it is very easy (95% or greater), I think this would not be a problem. I would definitely not do more than 2 days’ assignments though.

Does this program help hyperacusis (UNCOMFORTABLY sensitive hearing)? The hypersensitivity (auditory, visual, and tactile) of many people with tinnitus people seems to be common. This was demonstrated in research with autistic people recently. This seems to usually be a neurological gating or suppression that fails. In fact, other research on partial deafness, that we are working to incorporate into brain exercises soon, has shown diminished inhibition in the auditory cortex. Basically that means, the unaltered nerve input had a built-in mechanism to dampen excess sound perception, but the partially-deaf nerve input resulted in a large loss of this dampening mechanism. That loss of dampening can be helpful when it goes right, but when there is maladaptation, this may be what causes hyperacusis. At this time, I don’t know if our training reduces the hyperacusis.

Can Chiropractic help with tinnitus? I have not had success with Tinnitus with chiropractic adjustments. This is not to say it will not help; it may. I believe that this program you are in is the most effective approach for tinnitus, statistically. That said, there are some who do not respond, because of the physiological cause of their tinnitus. We try to help you assess for other options that may help you even further. For one option, a chiropractor can be an excellent asset. We will provide a training video for self-trigger point therapy, if it is appropriate.

Will this training be painful? Oh, No, No. No pain. The sounds are a bit irritating, but control the volume and when the VERY brief sounds start…then you answer a couple questions about the sound, the play the next sound, etc.

Can poor sleep worsen tinnitus? Yes. That can make your tinnitus worse…actually that can make everything worse, or, at the very least, seem worse. I have a concise, yet thorough, educational program for getting more and better sleep that I will make available to you after this brain training program. This issue is common. Of course, your tinnitus can also make it hard to sleep. This is a cycle that feeds itself. Mental relaxation before trying to go to sleep is a key component to help break the cycle.

Use Hearing Aids or Not? Yes, you should use your hearing aids if you can.

Being tired or Stressed: Being very tired or very stressed will make it much harder to do the training. It’s just like trying to learn some vocabulary words or find your way through a maze in that tired or stressed mental condition.

Should I use headphones? Headphones are a good idea. Of course, if your headphones cause am audio feedback, that would not be good. You may be able to place the headphones on your head NEXT to your ears, just not COVERING your ears. It is possible to improve greatly with only speakers (without headphones), but this depends upon the speakers.

 

Please understand, I cannot and have not given you medical advice. This is merely for educational purposes. You must make your decision based on your own understanding and your doctor’s advice.