| Present general overview of counseling for reduced sound tolerance. |
| Review participant's pretreatment audiometric results. |
| Review participant's pretreatment loudness discomfort levels (LDLs) and reduced dynamic range (DR) for pure tones. |
| Present treatment goals of improved sound tolerance, an expanded DR for loudness (illustrated with a case example), and an enhanced ability to use appropriate amplification. |
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Component 2: Overview of Auditory Anatomy and Neurophysiology
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| Explain anatomy and physiology of auditory system. |
| Describe outer, middle, and inner ear components (relate to sensorineural hearing loss). |
| Explain that people hear at the brain (auditory system acts as a transformer). |
| Describe structure and function of inner and outer hair cells with reference to sound tolerance. |
| Explain afferent/efferent neural control of peripheral auditory gain. |
| Explain that if auditory input is reduced, then the brain will “turn up the gain” in an attempt to enhance the input. |
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Component 3: Overview of Central Auditory Gain Control Mechanisms
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| Explain how the brain handles the input from the peripheral auditory system. |
| Describe subcortical areas: monitoring and filtering roles. |
| Discuss cortical areas and perception. |
| Explain central auditory gain and its role in modulation of loudness perception. |
| Discuss the Jastreboff model and the misophonic response. |
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Component 4: Role of Sound Therapy
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| Explain the use of low-level sound therapy as a tool to “turn down the gain” within the auditory pathways. Show again examples of positive treatment effects achieved with treatment approach. |
| Emphasize the importance of a sound-enriched environment in regulating the auditory gain mechanism. |
| Avoid silence. Keep a low level of neutral sound on at all times, day and night. Examples are a fan, computer, sound machine, nature tapes, humidifier, or fountain set at low volume. |
| Use appropriate noise protection, but not overprotection. |
