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Issue 28.pmd

Life with tinnitus
The greatest challenge for most people is that tinnitus is thereall the time. Other symptoms may come and go, or can be There you are, quietly going about your business, when controlled with medication, giving a sense of power, but with suddenly, out of nowhere, a loud, hissing sound appears.
tinnitus, it does what it likes, and you are powerless against it.
You look around to see where it is coming from. It's not theradio, and there isn't a street cleaner outside. After a minute When health practitioners tell someone there is nothing they or so, it dawns upon you that the noise is coming from inside can do, they make things worse. Just saying this can help to turn an already irritating symptom into a potentiallydevastating nightmare. I have treated dozens of people whose You move your head around frantically to see if that has any tinnitus became far worse after being told there was nothing effect. Then you try rubbing your ears, lying down, doing some they could do. This is not true.
exercise, but nothing you do seems to help. It'll soon go, youthink, but as you sit down and try to read a book it's impossible How craniosacral therapy helped me
to concentrate, as you cannot stop noticing the sound.
My main motive for setting up a research project on how By the time you go to bed, it's driving you mad and seems craniosacral therapy helps tinnitus, is to stop health worse than ever. You lie there waiting to drift off to sleep, but practitioners telling people there is nothing they can do an hour later you're still there, eyes wide open. The more you get irritated, the louder it seems, and the louder it gets themore you react.
The purpose of this article is to share with you some ofthe success stories I have had treating over 200 people with When you get to the GP you are desperate. Not only are tinnitus with CST and, equally important, some of the mistakes you exhausted from dreadful nights, but you also feel trapped I have made.
and frightened, because, for no apparent reason whatsoever,the one thing we all take for granted, peace and quiet, has I used to experience severe tinnitus myself. By that I mean I couldn't hear the phone because the tinnitus drowned out thering. Now, thanks to CST, my tinnitus is so irrelevant I have to The doctor says that you have tinnitus, which apparently is an concentrate hard to find it again. My reaction to treatment at awkward condition that you cannot really do anything about.
the time was so positive that I decided to take up CST as aprofession.
‘Learn to live with it,' he says with an apologetic smile, ‘andtry to relax'.
The key to undoing tinnitus is learning how to let go, andspecifically letting go of overwhelm/trauma lurking ‘Relax!? How can I with a party going on right inside my head?!' unprocessed in the nervous system.
The doctor's forehead becomes furrowed as he adds, ‘Maybe It was a course of regular treatment over a year or so that you should have an MRI scan to check there aren't any gradually improved my tinnitus, rather than sudden, miraculous changes during or immediately after any session.
However I was extremely lucky because my own tinnitus ‘What sort of problems?' you snap, more abruptly than you changed within minutes of the first treatment, which was would have liked.
enough to spur me on and take a course of treatments. However, ‘Oh don't worry about it. Nothing more than a few routine with most people, helping tinnitus is a slow, gradual process working with chronic patterns deep inside. Nowadays I makeit very clear to people that it is very unlikely to be a quick fix.
As you leave the surgery, you feel devastated. It really lookslike you might have to put up with this for a while because it Why tinnitus is such a challenge
seems from what the doctor said that there is no hope at all.
for craniosacral therapists
Tinnitus often starts like this. People report hearing sounds Sometimes, treating tinnitus is like walking a tightrope across like roaring engines, chirping crickets, or tinkling glass. One a deep chasm of change, simmering in craniosacral motion poor woman described her noise like a brass band playing below. That tightrope will probably be taut and fragile, where very badly, all day and all night inside her head. She hadn't you, perched carefully on your fulcrum must balance. Progress slept properly for six years. She seemed suicidal.
comes from maintaining that balance as safely and in as The sad fact is that every year people do in fact kill themselves much stillness, as possible. Yet there is an overwhelming because they cannot stand the disturbance any more. The need to acknowledge the great turmoil beneath, waiting to effects of tinnitus should never be underestimated and, as a burst through.
therapist, it is very important to be compassionate about the This turmoil is very important and will probably be made amount of suffering it causes, especially considering that this abundantly clear to you, but the last thing you or the person on nervous disorder is rarely taken seriously, and is often treated the couch needs, is to fall head-long into it and stir it up, or appallingly by health practitioners.
activate it. This may cause an eruption.
Julian Cowan Hill
In my own treatments, when I released shock or was unwound, If helping tinnitus is all about letting go, the bad news is that my sympathetic nervous system became highly activated and letting go does not come easily to people with tinnitus. The my tinnitus went berserk. An eruption of change sent reactions body tends to hold tension/emotional conflict deep inside and cascading through my body, and sometimes took weeks to settle.
so a lot of control is needed to function normally. This in turn But then, I was a CST student and I knew what a healing crisis leads to being very cerebral and horribly out of touch with was, and could put it down to being part of the process. I had what is going on below the neck.
plenty of people to ask why I was feeling the way I was.
However, someone who is deeply disturbed by tinnitus may Typically, people with tinnitus live in a permanent state of be alone, with little support, and will often find releases and sympathetic arousal, and therefore tend to be very driven, reactive and restless. They spend most of their lives racingaround in their heads and often don't want to feel how locked Recovery needs much change in the system, and yet it is up or blocked they are. Even more challenging is the number precisely change that is likely to activate the system and disturb of people deeply in parasympathetic shock where they literally the tinnitus. Here is the tinnitus paradox.
cannot feel much of their body at all.
As a practitioner I quickly stopped working with tissues and I'll never forget taking the case history of a multi-millionaire.
all their emotional issues with unwinding as I found it far too He had narrowly escaped three serious car crashes. He was activating and counter-productive. Rather than focusing on chairman of a large international corporation. In his spare the swirling whirlpools, electrical storms, hot buzzy feelings time he dabbled with some companies he owned for fun. Every or cold emptiness, I found that looking for the deeper stillness morning he took many drugs. He'd remarried so many times from the long-tide helped make changes less activating and a whole page probably carried his name in the phone book.
more manageable.
‘What do you do to relax,' I asked him, curiously.
When someone comes to me with devastating tinnitus, I ‘I sleep on the plane,' he replied with a tight smile. I didn't actually feel it is unethical to get involved in highly activating pursue that line of questioning any more. Suddenly, without processes: working with the CRI, unwinding, talking about any warning, his head went into a frenzy of shaking.
overwhelming issues, etc. when they are in such a state of ‘Are you alright?' I asked.
nervous overwhelm. You need to be in the right place on thattightrope, not too close, with plenty of space all around it, and ‘Oh fine thanks,' he replied. He held his arms down to stop with all your own support to balance you.
them from trembling visibly.
As most people with tinnitus have long since forgotten how tobe calm, and how to switch off, the best thing we can do is help them rediscover this at the deepest possible level, in the long-tide or below. I find tuning in to a person's craniosacral motionor CRI often makes tinnitus worse, especially if you are sitting irritated, the louder there, holding into patterns and looking for releases.
It is the long-term improvements that count and I encourage clients not to cling on to immediate improvements or changesin their tinnitus. Things will probably go up and down in theshort-term and start to improve overall very gradually.
I tried to get him to explain how his body felt, but he couldn't.
I asked him if he could feel the couch, but he didn't really The first stage in getting over tinnitus is becoming less irritated understand what I meant. When I took up contact, I don't by it. If the noise seems quieter, that's great, but when it stops think he was anywhere near his body. Even if I had been sitting being so annoying this is a sure step to a more long-term on an extra-comfortable practitioner's fulcrum a million miles away, I don't think we would have established much contact.
The ‘tinnitus personality'
This is an extreme example, but most people with tinnitus Ihave met have been live wires, who are disconnected from Clear patterns emerge when you treat many people with their bodies. They seem incapable of switching off and getting tinnitus. The most startling for me was that less than 20% of out of their heads. Even a seemingly placid gardener will spend those who responded to an article I wrote actually came back all day in the garden worrying about where to put their for a second session. Other therapists have also found that magnolias tomorrow.
many of their clients with tinnitus didn't follow through witha course of treatment.
Symptoms appear in very clear patterns too, often surfacing afew months after a divorce, moving house, bereavement, an I want to explain some of the common patterns that I have operation, being promoted etc. Anything that overstimulates found in many of the people I have seen.
you over a prolonged period of time is enough to triggertinnitus.
One of the fight or flight responses turns the sensitivity of our feel highly stressed. This takes fifteen minutes at least once senses up to full volume. Not only do our pupils dilate so that we see more, but our auditory cortex turns up its internal • noticing what they can feel in their feet, for example sensitivity so that we become aware of the slightest noise.
Sounds are heightened because we are in emergency mode • clenching and then relaxing that part of the body and normally we don't even notice a creaking floorboard, • feeling if anything has changed unless it's important. A person with tinnitus has becomehypersensitive so that they end up hearing things, that other Then they move onto the next muscle group, working their people wouldn't detect. If this irritates them or makes them awareness through the body. The aim is to learn to focus on anxious, their system then registers this noise as a threat, and how they are feeling. This is a very simple but powerful locks onto it, monitoring its every movement.
technique that gradually helps them divert the focus out oftheir heads and back into their body. It gives them something The lives of people with tinnitus have filled them with tangible and specific to do the next time they find themselves adrenaline, noradrenaline and cortisol. There are books feeling distressed. Some people have benefited enormously describing the ‘tinnitus personality' as oversensitive, reactive, from this technique alone, and have learnt how to calm down overambitious, restless, aggressive, anxious, controlling etc.
their nervous system and tinnitus. (Send me your e-mail These are all behavioural patterns that emerge in fight or address if you want a copy of this exercise.) Please note that flight mode.
tinnitus often takes days if not weeks to calm down, and it isuseful to help people understand the need not to expect too Ask them when they last had a day of doing nothing and the much too soon. Even though I consider myself as an expert at answer will probably be, ‘Can't remember!' calming my own tinnitus down, after a highly activating processlike skiing, drinking lots of wine, or going on a driving holiday, How can we help?
it still takes me a good week to bring it back to a minor level.
Research carried out in 1953 by Heller and Bergman foundthat 94% of happy, healthy participants, when placed in a Considerations for case history taking
totally silent room, developed tinnitus. They discovered that I have found the following points really useful when taking a silence actually brings on the stress response in the body, tinnitus case history: causing our ears to listen out more and more acutely untilthey hear something. If there isn't any noise outside, you end 1. Obvious as it sounds, I find out what was going on in the
up generating or amplifying audible stimuli. This was a major background when their tinnitus started. People often say revelation, showing that silence can cause tinnitus.
they first noticed symptoms after they had a cold, during aflight or after having their ears syringed. I am always So first of all, tell people with tinnitus to avoid silence like the suspicious of this as it is rarely enough to trigger tinnitus by plague. It will make them become more aware of their tinnitus itself. Far more likely is that long-term stress caused by a and consequently they will find it harder to focus elsewhere. If divorce, a court case, or unprocessed shock from an accident they already have tinnitus, silence will most likely make it fifteen years ago etc. has left the system over-stimulated worse. Ideally they should allow their ears to rest with and hypersensitive, and that syringing etc. was merely the something to monitor by leaving the window open or the final straw that tipped the balance.
radio on, etc. If their tinnitus is severe, they may have to 2. I ask them to clench their teeth and see if this changes the
leave the radio on quite loud, or invest in a masker - a white noise. If it does, as is often the case, this gives you a clear noise generator.
indication where the structural stresses lie, and you might Secondly I tell people that tinnitus is often a benign condition want to check out the mandibular muscles which often act that self-corrects itself as soon as the nervous system gets used like a volume control button by holding the whole temporal to it and stops registering it as a threat. I explain that everyone area rigid. Hypertonus in the lateral pterygoid muscles gets tinnitus after a loud concert, or if they are left in total often causes problems. This can often be detected when the silence for long enough, and that many people go through tinnitus person can influence the noise by moving their jaw stressful periods of their lives when they start to experience tinnitus in the background.
Have them press their cheekbones, pull-down on their I explain that they are maintaining the tinnitus pattern because heads, push their chin in towards their neck, twist their their nervous system is overwhelmed, and that the best way to heads to either side. All these often have a radical effect on help clear the tinnitus pattern is to learn to relax the body, let the noise, and can really help show you which structures go and switch off. I add that craniosacral therapy will act as a are linked into the tinnitus stress points. It is also good for guide to help them feel what they need to let go of.
showing people that it is not a fixed condition! I then give them a relaxation/body-awareness building 3. I ask about dental/orthodontic work. Dental trauma is a
exercise1 to do every day, and every time they cannot sleep, or common cause of tinnitus, along with malocclusion, andTMJ problems.
4. I ask if they have had an anæsthetic. A common side effect
some of the mechanisms behind overwhelm and what locks of anaesthesia is tinnitus. I discovered this on the Embase2 people into this state.
and Medline3 websites. I typed in tinnitus and anæsthesia I found this approach extremely useful in helping tinnitus. It and was amazed to find dozens of abstracts showing stories became clear that most of the people I was working with were of people recalling a deafening noise as they went under, deeply overwhelmed, and that they needed help building up etc. This programme is brilliant for accessing information.
their resources. Helping them consciously get in touch with (When I released anæsthetic shock, my own tinnitusworsened considerably for weeks, and then improved their strengths, and actively creating a deep sense of safetyseemed essential for easing them out of this state, into a much dramatically over the next few months.) more fluid and dynamic one.
5. Most importantly, I find out how badly tinnitus is disrupting
In fact, I would say getting in touch with what feels comfortable their life. It is pretty serious if it is disturbing their sleep. In or OK is an important milestone for many people with tinnitus, severe cases be aware that the simple question, ‘What isyour tinnitus like?' can quickly lead to tears and emotional and can be a real challenge. It is only when people are able tobreak things down into more manageable chunks, that they flooding. This can be very activating in itself, and can make can let go of their tight clutch on control and start freeing-up.
the tinnitus seem worse. If the person is in a bad state, I I found that people quickly started to get in touch again, and usually start by focusing on their strengths, support discovered that they could feel much more than they realised.
networks, and positive bodily sensations before askingspecifically about how their experience of tinnitus is.
How I learnt the hard way
Talking about relaxation techniques and tinnitus groupscan help establish a feeling of hope, comfort and support.
Severe tinnitus is a very serious condition, often needingcounselling, medical intervention, and psychiatric care. In Specific approaches that help tinnitus
these cases I have always encouraged a support network withtheir GP, counsellors, the helpline, help groups, and other Peter Levine's book on shock and trauma, Waking the Tiger, and Franklyn Sills's shock and trauma course helps clarify Photo: Kate Steane Invariably one of the first questions you will be asked is if A few days later she called at 9.30pm to say it had got much craniosacral therapy can make it worse. This puts you in an worse again. We decided to leave more time before the next extremely difficult situation because the answer is yes! Like session to allow things to settle. After about six sessions over 4 any other symptom, before it starts to subside long-term, months she said that ever since she came for her first session, tinnitus can often change quality, seem louder, or become more her tinnitus had been much worse, and laid the blame squarely on me and cranial work.
A person whose life has been devastated by noise will find this In retrospect I realised that I was not able to be neutral as a possibility unbearable. If they are worrying about cranial work therapist. I had lowered my price having taken pity on her making their tinnitus worse before you even start, then it is and her financial situation, and got too involved in the process, important to be very clear about this from the beginning. I sure that I could help her. I was in too deep, and did not have usually explain that sometimes it can get worse before it gets the space, clarity and neutrality to work without being biased better. However, if the person is clearly distressed by this, I by what was actually quite an emotional pull. I knew what she feel it is not advisable to treat them at all, and would then was going through.
focus on relaxation techniques.
After lengthy discussions with my supervisor, it became clear If they are very keen to continue, I suggest they think about it that perhaps she was clinging on to the hope that what for a while, try out the relaxation techniques and then get back happened to me would happen to her. I also started to suspect to me. Unfortunately, this in itself gives out a negative message that maybe her pattern was to seek sympathy from everyone and can cause further activation. I am lucky because I can by involving them in her suffering. I asked her why she wanted always talk about my own very positive experience with cranial to continue if it had apparently made her worse. ‘Well it does work and tinnitus to keep things balanced.
seem to get better every time, but then…' I learnt the hard way. One woman came to me with chronic My feeling is that, when she got home, and was surrounded by tinnitus and hyperacusis (pain caused by sound). She had her normal world, she then started to notice her tinnitus again.
seen several specialists, taken various drugs (including However, when she found it again, it seemed louder than ever benzodiazepine and amitriptyline that some websites claim because she was in a quieter state.
make tinnitus worse) and had spent years in counselling. In My mistake was to give her high expectations that her tinnitus the second session I took up contact and the treatment seemed would improve. And yet being positive with her and allowing to go well. We touched the long-tide and sometimes experienced her system to move towards a deeper state of calm was probably gentle mid-tide changes that seemed manageable to her.
what her system needed most to come out of the tinnitus cycle.
She left feeling calm and was less bothered by the noises.
This experience taught me that people are responsible for A week later the phone rang and for half an hour she explained their own health, and that we therapists are merely offering in tears how it was better for a couple of days and then became the possibility for change and experiencing things differently.
worse than ever. ‘It's never been this bad!' she sobbed, My own need to fix people had taken me into an uncomfortable explaining how she hadn't slept, and detailed every inch of place where I was setting myself up to be blamed.
her suffering. Finally she asked, ‘Your tinnitus got better withCST. Do you think it will help mine?'‘It helped mine enormously. Maybe it will help yours, maybe other things will change first, but I cannot say anything forsure'. I replied.
act[s] as a guide Because she was suffering the whole time, she decided tocontinue with treatment, as the hope of any improvement wasimportant to her and my own history was proof that it Different people people require different responses - for the people who are looking for a quick fix, I have learnt to say thatmaybe the tinnitus will be the last symptom to change.
We did the next treatment without any contact on the body. Istood at varying distances around the couch and worked with I find that it is much better to show people that the less her sense of comfort. If she felt any discomfort, I would move discomfort and resistance they have in their lives, the less further away from the couch until her system settled. We talked likely they are to experience tinnitus, and other symptoms. I a lot about how important it was to be open about whether she would say that over 60% of those that have continued withtreatment have stopped worrying about it so much, and feel was really comfortable or not, and how it was OK for her to askme to move further away. By the end of the treatment she was their tinnitus has improved.
extremely calm, and said she felt like having a deep sleep.
Those that have improved have successfully learnt to focus on She seemed to be happy, and for the first time, was not their bodies again. They have become able to give a chattering incessantly, but just being quiet. I felt the whole commentary on what they are feeling, whereas before they session had been a really important breakthrough.
seemed locked away in their cerebral cortex, out of touch.
Specialised tinnitus support
However, I have come up against a brick wall. I do notunderstand why some people go through life-changing changes If they (or you) need to find out more there is a great deal of with CST, whereas others just get a minor sense of relaxation, support available. This can really ease feelings of isolation never to come back again. If I could be specific about the sort of and hopelessness: person best suited to CST, then I could create a realistic sample • RNID Tinnitus Helpline - 10.00am - 3pm
group for the project. I was surprised to find that it is valid to Tel: 0808 808 6666 - excellent general advice choose a specific sample group for research purposes, working with people that respond well to CST. This would produce far Jonathan Hazell's comprehensive website explains more useful results than selecting an arbitrary group of people everything you ever needed to know about tinnitus, with where half may not even respond to cranial contact.
positive and constructive advice on how to help it. It's quite I would be interested to know if anyone has any ideas on why long and detailed, but very well designed. He's a leading or whether certain people are better suited to CST than others.
figure in the field and was very positive about my suggestion Just as I have started to categorise the tinnitus personality, can to do a research project on tinnitus and cranial work. (He we do the same with people who benefit from CST? Is it about also has craniosacral therapy himself!) being spiritually aware, physically in touch, or being an old • British Tinnitus Association - Tel: 0800 0180527
soul? Is it purely to do with the ability of the therapist? Perhaps They publish Quiet the tinnitus magazine that carries the you think everybody responds well to CST? I have asked latest news, with details of local tinnitus groups that organise several therapists from the most experienced to the beginners talks and get-togethers.
like myself, and am still none the wiser.  over 60%… feel their 1. For details of the relaxation exercise or any comments
tinnitus has improved re people's suitability to CST contact:
jcowanhill@pavilion.co.uk
To research or not?
I still believe that craniosacral therapy is one of the best
therapies around for clearing overwhelm out of the nervoussystem, which is the chief cause of tinnitus.
Some of the research was done in the extensiveRNID library 330-332 Gray's Inn Road, London WC1 I have been working on producing a research project to try and tel: 020 7915 1553 email: rnidlib@ucl.ac.uk - it's an prove this. My aim is to stop health practitioners doing so excellent library and the librarians are very well- much damage by telling people there is nothing they can do informed and helpful.
about tinnitus.
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Source: http://www.craniosacral.co.uk/articles/tinitus.pdf

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‘Bio Piracy' — A Discussion of Some Important Cases The article discusses the issue of large pharmaceutical companies patenting bio-resources that have been traditionally used by the indigenous people of a land. Bio piracy is the appropriation of the to traditional knowledge,2 some of the an ancient Sanskrit text and a paper knowledge and genetic resources of

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UNIVERSITÀ DEGLI STUDI DI UDINE DIPARTIMENTO DI SCIENZE MEDICHE E BIOLOGICHE Corso di Studi in Infermieristica IMPATTO DELLA TERAPIA DIURETICA DOMICILIARE SULLA QUALITÀ DI VITA DEI PAZIENTI CON SCOMPENSO CARDIACO Relatore Laureanda Dott. Stefano Fabris Angelica Moro Anno Accademico 2012 - 2013