All About Healing Tinnitus- Episode 54 with Joey Remenyi

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On this week’s episode of All About Audiology, I’m joined by special guest Joey Remenyi from Seekingbalance.com.au. Joey is an Australian Vestibular Audiologist, and author of the new book Rock Steady.

Together, we discuss the many questions and misconceptions surrounding tinnitus, and how the symptoms can be alleviatedthrough neuroplasticity.

This week on All About Audiology:

1:49 – Due to confusion amongst medical professionals regarding tinnitus, people often receive mixed messages when seeking advice. Part of Joey’s mission in writing the book Rock Steady was to have one simple easy conversation, that anyone could understand.

2:31 – Tinnitus are sounds that we hear in our inner world (body/head/ears) that no one else can hear. It’s normal for our bodies to generate healthy noise, just like the idle of a car or the hum from a fridge. All of these sounds are a sign that the body is healthy and working as it should.

4:14 – Tinnitus can begin after a benign incident, such as a common cold. These incidents sometimes trigger an awareness of noises occurring around the ear. Although noises normally come and go, with tinnitus they end up lingering.

8:19 – It is normal to feel distressed if no one has ever explained the noise to you. Although it can cause feelings of anxiety and fear, it’s important to remember that the tinnitus is harmless.

14:40 – Unwanted body sounds and sensations can harm a person’s body image and self esteem, leading to anxiety and depression. The good news is, suffering from tinnitus is reversible.

17:50 – The Rock Steady process is self paced and can take anywhere from 7 weeks to 2 years to complete. By the time a person has completed the 6 modules, they feel better both physically and emotionally.

20:43 – Joey became a neuroplasticity expert while trying to cure her own tinnitus and vertigo. After four years of trial and error, she is now able help clients achieve results much more quickly.

22:12 – Maskers teach the brain that tinnitus is bad and needs to be stopped. The brain then sees the tinnitus as being important, causing it to fire more tinnitus neural pathways.

29:19 – Neuroplasticity is your body’s ability to change your neural wiring. By changing neural pathways we change how we sense and feel the world. You can learn to change the mapping of your own inner neural system.

36:07 – Rock steady is a 6 module online program that consists of 100’s hours of online support. The book is a great resource to use in conjunction with the program. There is also a Rock Steady Facebook group, which is free to the public.

38:32 – Parents of a child who struggles with tinnitus can help by validating what the child is feeling and hearing. Speak about it in an upbeat manner, so that it doesn’t turn into something that they fear.

48:41 – Advice for students listening – Start with the book, and by learning about the power of the body to change. Avoid using phrases such as “live with it” or “accept it” when talking to clients since this can adversely affect someone’s self esteem.
48:41 – Advice for students listening – Start with the book, and by learning about the power of the body to change. Avoid using phrases such as “live with it” or “accept it” when talking to clients since this can adversely affect someone’s self esteem.

For more resources and research visit:

All About Audiology Website

www.allaboutaudiology.com

All About Audiology Facebook group https://www.facebook.com/groups/470583160143167/about

AllAbout Audiology Instagram

Allaboutaudiologypodcast

Seeking Balance International Website

Seekingbalance.com.au

Seeking Balance Facebook Group

https://www.facebook.com/seekingbalanceinternational

Mentioned in this episode:

The Rock Steady Book

The Rock Steady Program

The Rock Steady Facebook Group

Listen Next/Related Episodes:

Episode 3 – All About Hearing

Episode 35 – All About Tinnitus – with guest Dr. Kelly Dyson

Next time on All About Audiology:

Episode 55 – No Dumb Questions! – with guest Dr. Yona Saperstein

Transcript

Welcome back to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein and I’m so excited to bring you today a topic that is highly, highly requested about tinnitus, also about some vestibular things with balance. These are topics that we get lots of questions about as audiologists. A lot of people think it’s all about hearing, but our ears do a lot more than that.

So, we have a very special guest today, Joey Remenyi, from seekingbalance.com.au who is an Australian vestibular audiologist and author of her new book, “Rock Steady”. I’m so excited to talk to her all about tinnitus and vertigo and neuroplasticity and bringing it all together to make people feel stable and safe and productive and happy and all the good things.

So, welcome Joey!

Joey Remenyi: “Thank you so much. It’s just really beautiful to meet another passionate audiologist and I can hear it kind of just radiating out of you so it’s a delight to be here.”

Dr. Lilach Saperstein: “Thank you. Exactly. I felt the same way when I stumbled across your videos, specifically about tinnitus. Tinnitus is one of those things that has so many misconceptions of what causes it. Do we even really know what causes it? How do you treat something you don’t know the cause of? Then there are all those scams and all sorts of supplements that they are trying to sell you stuff. Then there are all of the maskers. Do you use noise or not use noise? It’s such a big world and you seem to have a grasp on it, and a lot of success. So, tell me everything! Hahaha. That’s a good question, hahaha.”

JR: “Before we do get started, I want the listeners to be reassured, I cover all of this in my book, my new book. And the reason I wrote the book was for everything they’re lacking. So, we get these questions, there is a lot of confusion amongst professionals, therefore there are mixed messages when people talk to various health professionals, doctors, audiologists, surgeons, neurologists. The thing is that everyone is trying to do their best and everyone is trying to be helpful and everyone’s giving the information they have but that information is all over the place. So, part of my mission in writing my book, is to have one simple, easy to understand, conversation that a neurologist will understand and the mother of a child with tinnitus will understand it. It covers that full spectrum.

So, tinnitus are sounds that we hear in our inner world. They could be in our body, in our head, in our ears and no one else can hear it. Nine out of ten people in a sound proof booth will notice the noises going on in their body. Our bodies do generate noise, healthy noise, and you can think of that as like the idle of a car or even when the fridge is running and there is a little hum. Or the washing machine in a spin cycle. This is really healthy, normal mechanical noise that if the washing machine is doing a good job, it will be making this spin cycle noise. If the washing machine is broken, it would be dead silent. So, humans are actually a little bit the same, so it’s good to rephrase things and actually generating noise, means you have moving anatomical pieces in your body that are genuinely creating a mechanical noise. As audiologists, if we really want to get geeky, we can measure them with our DPOAEs.”

LS: “I think another way to think about that is that you’re tummy gurgles when you eat and when you are digesting your food. Sometimes, that’s louder and you notice it after a big exciting meal but most of the time, you don’t pay attention to your belly noise.”

JR: “Most of the time, the people around us can’t hear it either. Occasionally, I actually use that example in my book, when a joint clicks or pops, or when we eat a big yummy Italian pasta and there’s that loud digestion, occasionally our body sound can be heard by the outer world if the vibration is strong enough. But when it comes to the run of the mill regular tinnitus, usually it is psychologically impacting someone. It’s invisible to the outer world and no one else can hear it. It’s moved beyond the mechanical noise which is where it can start as a trigger.

I don’t know what your experience is but often I’ll hear clients say it started off after I got wax cleaned out of my ears. It started after a common cold. Or it started after a knock to the head so it’s really benign incidents that are not dangerous that trigger this awareness of noises occurring around the ear. For some reason, instead of it being a normal pasta meal where the noise just comes and goes once the digestion is finished, the noise lingers forever. It’s like memory of the noise is mapped neurologically between the ear and the brain and it keeps looping.

Another example of that is that if you think about the old vinyl, playing music on an old record player, it’s kind of like it’s getting stuck on the one song and it’s just repeating. It never completes the song and it never completes the album. It just keeps jumping and skipping. That’s kind of what happens neurologically for chronic, consistent, severe, distressing, bothersome, debilitating tinnitus. This is a whole other conversation.

The good news is that vinyl skipping, that kind of memory of the sound on repeat, that neural pathway that’s firing the tinnitus sounds is completely reversible and this is what I’m helping my clients to navigate. To understand their biology, to understand the physiology of their ear and their brains, to understand neuroplasticity and to understand emotional regulation and the psychology behind why we get the stress. Why we hate it and why we associate so much fear with it. How this changes our brain chemistry and our responses in relationship to that sound and why that keeps us stuck. We end up talking about what to do about it.”

LS: “The key thing there is separating the actual tinnitus from the experience of the tinnitus. Those two things are distinct. Lots of times, people say, if I have this, that means xyz and I’m in danger and this is bad for me or this is a sign of a bad, terrible thing, which the crazy thing is that sometimes it does mean that. That’s where you are getting the mixed messages. People want to know, do I have a tumor. That’s where it goes, you know. On the other hand, no, it’s kind of a normal biological thing that happens to our ears all the time. That’s the question.”

JR: “Just for clarity, I think it’s important to recognize that even if somebody does have a tumor and that tumor is causing a change to their mechanical resting tinnitus, right, the tinnitus is totally harmless. The tinnitus will not hurt them. Tinnitus will not cause hearing loss. Tinnitus will not cause the tumor to grow. The tinnitus is like the idle of the car, so the issue there is actually identifying the tumor and talking to the surgeon to see if removal is needed. It’s not always the case and getting that medical intervention, medical opinion about the tumor, it’s really important that the tinnitus is never, ever described as the bad guy. It’s safe, it’s harmless and it’s a reflection of what’s going on in our inner world physically, mentally, emotionally and spiritually. When things are imbalanced, the sounds within our inner world change. The tinnitus is not the bad guy. It’s kind of like, if something is on fire, there is smoke. The tinnitus is the smoke, not the fire.

Healing tinnitus is about going, okay so there is an imbalance within my inner world, physically, mentally, spiritually or emotionally. Let’s get medical clearance. Let’s just do that straight up. Let the doctors tell me there is nothing to worry about. That’s the physical investigation. Then we have to say, what’s going on mentally, spiritually or emotionally for me and that’s what my rock steady process is, really giving people the tools to be the expert in that pace.”

LS: “Okay, so someone will come to you and say, even someone who is struggling and having that tinnitus handicap inventory of, I don’t know, eighty, the score that it’s the highest it can be, they can’t sleep, they can’t communicate with their friends. They are staying home and avoiding things. What do you say to the person who is coming to you and saying, what do I do? How do I deal with this? My life is so hard, I can’t focus or do anything I want to do.”

JR: “Totally. Well, first up I would say, I’ve been there. I’ve had it, I get it. Second up, I would say, you’re normal. If nobody has ever sat you down and explained to you this distressing noise to you, it’s absolutely 100% normal that you are distressed and not sleeping because that is the way a normal healthy brain responds to any unexplained threat. In that situation, the tinnitus has been categorized as a dangerous, abnormal threat. Somebody has told them it’s abnormal. Somebody has told them it’s a disease. Somebody has put fear in their mind and a natural normal, any human brain, healthy brain, will have this anxiety, fear and sleeplessness. So, it’s just like tick, tick, tick, tick, everything is coming back normal.

So, what we need to do is teach the brain that it’s a misunderstanding. The noise is harmless. The noise is neural pathways in your body between your ear and your brain, generating the perception of a sound. That sound may actually not be relevant, not be important, not be useful, not be meaningful, not being needed or required. So, we have to teach the brain that it’s not a saber-tooth tiger chasing us. It’s not a violent incident. It’s not a harmful abusive person. It’s not a really overdue bill. We have to take it out of that category of fight/flight/freeze stress. Sympathetic stress response. When we categorize the tinnitus as an awful thing that’s ruining my life, we change the brain chemistry response to it.

So, all of this education helps people start to go and say, oh okay, so my relationship to it is changing the way my brain is treating it. And the therapies in shifting that relationship which is extremely personal, there is no prescription, generic ‘you must do this kind of model of healing.’ It’s about understanding the mental landscape of the person’s world: their worries, their doubts, their fears, the dialogues going on, the voices inside someone’s head, their emotional landscapes… How are they self-regulating? Do they actually have access to joy, compassion, acceptance, kindness or are they a little bit wopt in their self-doubt of fear, anxiety, the panic and they don’t really know how to get out? So, that would be part of therapy.

Spiritually, it’s, are you going to listen to the people that told you that you are abnormal and wrong and you can’t fix this and there is no cure? Are you going to give your power away to them externally? Or are you going to come back into your body, learn about it and say my body is powerful, adaptive, amazing? It’s normal to have body sound and I can change and rewire those neural pathways and reverse the body’s sound if I learn how to do it. If I choose to do it and the spiritual place if I believe in myself to heal it.

If I don’t believe in myself to heal it, nobody else is going to believe that I can heal it either. If I don’t stop and listen to my body and what my body is telling me, nobody else on the planet is going to listen to my body and what my body is telling me. It’s my job to tune into that very personal inner world process.

My background is in yoga. So, my first discipline before audiology is yoga. We would call this svadhyaya, which is a Sanskrit term for self-study. We pause and we listen within and we learn from our sensory system delivering us information through the ears, the eyes, the skin, the taste, the tongue, etc. This is how we relate to the world.”

LS: “Yeah, that piece of self-knowledge, I think it goes across lots of religions, ideas and beliefs that people have as one of the most transcendental thing you can do, is actually be yourself and know who you are and know your body and your experience in the world, connecting to your senses. I think that one of the things you just mentioned was this idea of trusting yourself and knowing that although there are experts who are well-versed and trained and did all the years of studying of what’s available to know, you are still the expert of yourself and your experience and no one else knows how you are dealing with your life more than yourself. I think the way you described at as giving away your power, is so spot on of the difference between people who come in and say, help me understand something because you are an expert on the topic, but also, believing that they themselves have the power to do the change.”

JR: “I just want to like, I feel like this is really a tender area too, because people love an expert. Tell me what to do, Joey. Tell me how to heal. I want to learn from you Joey, in a sense they are giving me that expert power. I’m really conscious of saying, I suppose I’m an expert in the process of healing, I really get neuroplasticity. I have a huge amount of training and knowledge and this and that. That’s knowledge that I can support you with. However, I don’t know you. I don’t know what you are feeling and hearing in your body in this present moment. I don’t know what neural synapses are firing at the moment in your body. And I also don’t know what you want or the desire to feel, sense, and hear in your body, which means I don’t know which new neural synapses and connections you want to create. Only you know that stuff.

So, you’re the expert of you and your body and your inner world. I have kind of become an expert in a process, a neuroplasticity educational process. When we talk about other experts, and I’d love to hear your experience of your audiology doctorate, but when I was in the University of Melbourne, which is an extraordinary university, it’s really one of the world’s best in audiology. They barely touched upon tinnitus. We were sort of told about it briefly and we were told, some people will just have to live with it. They will just have to learn to accept it. It can be hard and they can get suicidal. But that was kind of the extent of it. We didn’t really get (more than that). Of course, we were told about masking devices, hearing aid device programs which I can talk about, but it was just super limited. We didn’t really get into any of the mental, emotional or spiritual aspects of what it means to live in a body making sounds and sensations that we don’t want. Unwanted body sounds and sensations can completely destroy a person’s body image, self-esteem and self-belief and can really lead to an anxious, depressed, isolated, panicked way of life. It’s tragic and for the listeners out there, I want you to know, it’s preventable and reversible.”

LS: “That’s a nice message of hope. Because many people really don’t ever hear that anywhere, that tinnitus is a thing that usually comes if you have hearing loss, you’ll likely have tinnitus. If you had any kind of traumatic PTSD inducing events, it will also come with tinnitus. We say, it’s the first and second thing that’s the most common thing for veterans in the VA system, it’s hearing loss and tinnitus. It’s just 80% of veterans are going to have it. That’s it. That’s the case. That’s what we do.”

JR: “Honestly, it’s all reversible and I think what’s, again going back to this kind of expert model, which in my opinion doesn’t work, is the ear, nose and throat surgeon is exceptional at understanding ear anatomy and surgical options. And if I need that information, I’m going straight to an ENT to ask those specific questions. I’m not going to ask an ENT surgeon how to get rid of my symptoms. They have no idea. It’s not their training, it’s not their specialty. They would be able to tell me if my ear anatomy is healthy or not and what to do about it, which I value. So, it’s about asking the right expert the right questions and not giving your power away to them entirely.”

LS: “I think 2020 is the year to talk about who is an expert in what field and what not. All of the sudden, everyone knows about infectious diseases, everyone’s an expert now.”

JR: “Same with neurologists. They are experts at understanding the brain. Are there any anomalies or physical disruptions or unusual occurrences going on in the brain. They will tell you and do all the right imaging and all the right contrast and they will be able to explain your brain to you in a way that nobody can, because that’s their expertise. Can they tell you how to get rid of your symptoms? No. Because that’s their training. They have no idea how neuroplasticity works, they have zero training. They are experts in diagnosis and investigation of abnormalities of neural pathways in the brain. Even if you have permanent damage to your hearing or to your inner ear pathway, you’ll use the surviving function residual pathways to recreate a new sense of norm. Does it mean you will go back to the way you were? NO! And I have a whole chapter on that in my book. We can’t turn back the clock. We can’t go back to the person we were and we don’t need to.

I want to give you hope here, because a lot of my clients come to me, and I’m the last person they see and they are in a pretty dark place. A lot of the clients I see don’t want to give up but they feel like they have tried everything, every doctor, every device, every home exercise and diet. They come to me and say, Joey, I’m going to give this neuroplasticity a go. It kind of makes sense. It’s logical and I get it and I want you to support me. So, they’ll go through the rock steady process that can take them anywhere from seven weeks to two years to go through. It’s self-paced. So, some people do it fast, some do it slowly. At the end of that process, you get six modules of daily learning, daily home practice, physical, emotional, mental and spiritual exploration of what do I need in this moment. How can I support myself in this moment so that it’s not generic? They actually choose what they need in the moment based on what they sense and feel in their inner world.

By the end of it, they come out being kinder to themselves, being more of a friend to themselves, feeling more stable, tall and strong and having more body tone because of the balance exercises. They have more emotional regulation and emotional stability, have more belief in themselves, having less worries and less doubts and having tools to move through fears. But also, which I think is equally as important and way too often overlooked, is they have the capacity to give themselves permission to experience joy and to figure out where joy lies in their life because they will have lost contact with it. Things that use to give them joy, don’t work anymore, so they have to reinvent their entire relationship to pleasure. That is a huge part of changing the brain chemistry. Can I tell you how to enjoy pleasure? No, because I don’t know you. It’s such a personal experience at an experiential pace.”

LS: “Okay, I hope the listeners heard everything that you just said because that gives me chills. When the person comes and says, ‘I hear sounds that are debilitating.’ And your outcome is, ‘well actually this will transform your whole relationship to yourself, your inner world and the way you talk to yourself, the way that you experience your humanity.’ They might just say, ‘lady, I just don’t want to hear these sounds.”

JR: “That’s also where we start, you know. I mean, I’m only human, I started off just wanting to get rid of my bodies noises and get rid of my vertigo, I didn’t want to feel this, I would have wanted anyone to fix me. Just fix me, just get rid of it. I don’t want it. And then after enough depletion and exhaustion and dead-ending and goose chasing, I began to realize actually I’m gonna have to figure this out. And I was really, really blessed because I had at this point in my life, I had over 10 years yoga practice, which means I had first hand experience to the neuroplasticity changes that people can go through and I had seen it in myself to a certain degree. I had seen it in students and colleagues. And so, I kind of understood that if you repeat things daily, your body responds with new patterns.

I had a psychology degree, I had training in cognitive behavioral therapy, acceptance and commitment therapy, neuroscience, and I had a master’s in clinical. I had the most eclectic background of studies, which was all by accident, I didn’t want to become this kind of neuroplasticity expert, it just happened by accident. And so, then I realized, you know what, I think there is a way to heal, I have no idea what it is, I have no idea what it looks like. But I’m going to start exploring through trial and error. It took me four years to figure it out for myself. And now my clients are getting results much, much quicker than I did.”

LS: “Because they have the guide. But, you know, someone being the guide is not the same as them being in charge of their healing. They’re navigating. Even the word healer, to me, seems like a complicated word.”

JR: “I consider myself as an educator. And I think the education piece is missing amongst our peers, right, amongst our audiology colleagues, amongst our medical colleagues, amongst our naturopathic. You know, we could talk forever about diets and devices and we can shift the conversation there if you like. And I can give you my theory using the philosophy of neuroplasticity as to why a lot of that doesn’t work and why it could work for some people. But why it’s just another dead end and I think people are just stabbing in the dark. What’s that term? They’re just having a go at anything. It’s blind faith and they’re just like, I’m just gonna try this low salt diet, or I’ll go off coffee or go off chocolate because it might work. There’s no logic behind it. It’s almost like an anxious panic response. And same with hearing aids and expensive devices and tinnitus programs. You know, you name it, it’s out there.”

LS: “Okay, so let’s talk about the maskers and the whole idea of distracting away from the sounds or using a fan so that there’s other sounds in the room. Is that just going down a different path where you’re kind of putting on a band-aid and then it’s going to come back when you take out the sound? Or did you actually train your ear?”

JR: “I cover this kind of in my book. I don’t think I cover the exact tinnitus analogy but funnily enough, tinnitus sounds and chronic persistent dizziness feelings like spinning or feeling nauseous or drunken hungover, however you want to describe it. Some people live like that. And it’s the same kind of dilemma as tinnitus except one expresses itself in sound and one expresses itself in a dizziness feeling. Healing pathways is the same.

So I explained this dilemma in the book, I think with the example of dizziness, which is that it doesn’t actually matter what you choose to do. It’s fine if you want to, let’s say put on some classical music to distract the tinnitus. And let’s say you love classical music, you put that music on and you enter. Your heart opens, your brain melts, and you just lose yourself in the music. You are releasing some extraordinary brain chemistry right there because it’s all connected to love and awe and beauty and presence. You do mask out the tinnitus because you’re doing something you really love, right? That could have long lasting effects that help bring the tinnitus into a joyful situation where you’re not actually getting rid of the tinnitus and you’re not avoiding the tinnitus, you’re not distracting the tinnitus, you’re actually listening to music you love. That is completely different to masking.

But if we contrast that to, alright, I’ve got to get my hearing aids in and I’ve got to put on my tinnitus program, I’m going to put on the white noise, I’m going to distract it. I’m going to try and get a noise that I don’t particularly like hearing to hearing, but it’s just better than that goddamn tinnitus or whatever, excuse me, if that’s blasphemous. But, you know, if we’re trying if there’s a fear/hatred relationship to the tinnitus, and our relationship is firing brain chemicals that release the fight/flight/freeze, sympathetic, parasympathetic nervous system, neural activity, we can’t use the neuroplasticity capacity to reverse those tinnitus pathways and actually change it with long lasting effects.

The masking machine is coming in and reminding the brain that this tinnitus is a bad guy. I spent so much money on this tinnitus device because tinnitus is a really bad thing. So, the brain is reinforcing that the tinnitus is bad and abnormal, and it needs to put a lot of energy and effort into figuring out how to get rid of it. So, to do that, it will fire more tinnitus neural pathways to help you figure it out. So, by using the mask based on fear and distraction and avoidance, we’re teaching the brain it’s important, right? And contrast that to, I don’t really care about the tinnitus but I love this classical music. It’s actually got nothing to do with the tinnitus. The brain doesn’t register the tinnitus, it just goes zoom, let’s zoom in on this music, it’s amazing. It weakens the tinnitus pathways, because they’re not emphasized as a threat, or important or abnormal. We’re just purely focused in on the music.

By default, and I do explain this in my book, by default, the neural emphasis and the neural allocation of resources is taken away from tinnitus and is diverted to those auditory music, listening and appreciation and emotional areas for taking in the classical music. So, we’re hijacking the tinnitus pathways by doing something, we’re shifting the relationship to love and joy and pleasure instead of fear and hate and avoidance and distraction. They’re completely different brain chemistry, neural activities, right?”

LS: “Yes. And I feel a big sense of synchronicity around different topics that are in my life. So, around parenting, we talk a lot about that on the show, we have a lot of parents listening. And it’s so much of how you do positive reinforcement to like, just move away from a behavior that you don’t want the child to exhibit. But the punishment, that only exacerbates it, because now you’re giving so much attention to the thing they shouldn’t have done instead of just distracting away to something else that they love to do. And we just kind of go with the flow. Like so much of everything you just said could have applied to my child who is doing inappropriate things, what do I with them, you know?”

JR: “Well, this is what my clients are saying. They’re like, Joey, this has not only helped me overcome these debilitating symptoms, which doctors said I couldn’t heal. They’re like, I’ve completely blown my mind in what I was capable of doing. And psychologists and audiologists, and physiotherapists, if the traditional medical treatments haven’t worked in the first six weeks, let’s say to six months, chances are you’ll be told there’s nothing more we can do and go live, right. And that’s nobody’s fault. That’s just where the system is at. And so, they’ll try this neuroplasticity education process, they’ll blow themselves away with how powerful their capacity to adapt is and to learn how to manipulate that system and actually use it. And yeah, they’re like, it impacts my whole life. It’s changed my relationship to my husband, it’s changed the way I parent. Some people actually changed their career. They’re like, my career was throwing me out of balance. I’ve quit my job, I’m gonna take a different track. It’s not working for me. It’s not working for my health. So, it can be really dramatic.

But coming back to the devices and diets, I just want to reinforce, it can go another way. If somebody hates classical music, right, and they’re like, oh Joey said classical music can help. And then you listen to classical music and you hate it and it’s riling you, that’s still releasing the hatred brain chemical pathways. And if you listen to classical music for the purpose of distracting tinnitus, because you hate that, it’s just another masking device that’s with a new mask on with a new face. Whereas, if somebody gets their hearing aid, and gets the amazing tinnitus channels and masking device channels in their hearing aid, and they are like, I’m freaking superhuman. This makes me better than I was. This device is like next level hybrid human. I’m bionic, I’m obsessed with this. I love it.”

LS: “I could see YouTube videos directly to my devices.”

JR: “If they love their device, because it just totally gels with their philosophy on life, with their personality, maybe it’s a childhood dream come true. Chances are they will have great success with all of the tinnitus programs and things because it’s coming from this place of awe and love and excitement. And like, I’m bionic, and it’s not like I’ve got a disability, I’m getting rid of the tinnitus. It’s like, hell yeah, give me that device. I want it. That’s fun, I’m going to tell all my friends. Exactly, I’m gonna use my Bluetooth, I’m gonna attach it to all my devices. I am winning! So, it’s about the relationship we have, not only to the noise in our body or the dizziness, but also to the strategies we implement. We want them to be evoking pleasure, excitement, enthusiasm. They want us to awaken the neuroplasticity pathways, which can only happen if we’re relaxed.

So I’m going to use an example of playing the piano. Neuroplasticity is your brain and body’s capacity to change its neural wiring. And our neural wiring is head to toe, it’s through our brain and our spinal column. It is everywhere. And the neural pathways help us to do anything that makes us not a rock basically. So, breathing, talking, listening, moving, all of it, and you know, feeling. By changing neural pathways, we change how we sense and feel the world. And often we feel stuck like oh, I’m victim to this, I don’t like this and I’m stuck because nobody else can get rid of it. The truth is, nobody else can get rid of it. But you can change the way your neural pathways are arranged. You can change the mapping of your own inner neural system if you learn how, which is the neuroplasticity education piece.

Well, that’s how the brain and body works. This neuroplasticity was about our capacity to change and adapt, we can all do it. And children are experts at it, right? Adults forget they can do it. So, if we come back to an example of neuroplasticity that’s visual, let’s say playing piano, and if we have like a gun to our head, or like we’re getting bullied, or there’s a major stressful incident and you’re at the piano and trying to learn, it’s really difficult because we blank out. We freeze. It’s really difficult to learn under that level of stress and pressure and hatred, if we hate the piano, and we hate sitting at the piano and we hate the feel of the keys under our fingers, these are barriers to learning. Because we don’t want to be there. We don’t like being there. And there’s just resistance every step of the way.

And if you contrast that to just enjoying the piano, learning from a teacher that you absolutely love, learning music that you love. Maybe you lie in bed and you dream about the piano and you visualize your fingers moving before you go to sleep at night, and the relationship is one of excitement and enthusiasm, that person is going to learn a lot more quickly. Probably practice more and feel better while they’re doing it. And their brain’s capacity to automate those piano pathways will be much faster and stronger than the person who’s learning under absolute resistance and stress and fear, right? It’s exactly the same with our tinnitus and dizziness. It’s important we don’t come up come from a place of fear and resistance.

Now what does fear and resistance look like, you might ask? Am I in fear and resistance? Well, some examples of that would be, I hate my tinnitus, get rid of it. I don’t want to hear this. It’s ruining my life. Because of my tinnitus, I can’t do X, Y, and Z. These are all examples of someone living in fear and resistance. And someone who’s not living in fear and resistance has relaxed to it and might say, you know, my sounds come and go, it’s no big deal. You know, if I do hear my body sounds come and go from time to time, I take that as a little gentle reminder that I’m out of balance somewhere, physically, mentally, emotionally, or spiritually, I use that as a little kind of reminder, a little alarm clock to take some time alone and figure out what’s out of balance. Because if I’m not listening to my body, no one’s listening to my body. So, I’m going to relax into this and learn from it. So, that’s the adaptive approach.”

LS: “Do you think that this whole process and the process outlined in your book can also apply to other chronic conditions like lower back pain is a big one that people associate with tension and stress? And, you know, lots of other things that go on in our bodies, it all applies, would you agree?”

JR: “Yeah. And you know what, this is blowing my mind because that was not my intention. Right? So, I’ve personally had vertigo and tinnitus, and I have worked with the elite best, top of the line neurologists, ear, nose and throat surgeons, psychiatrists, psychologists, physiotherapists, audiologists, you name it. And I saw these clients falling through the cracks and not getting resolution, certainly not getting healing and feeling helpless, hopeless, powerless, stuck, it was awful. So, that’s my background. It was that I was really motivated to help those people who were being failed by the system. Because of my background in neuroplasticity, neuroscience and yoga, I was like, I think I can offer an alternative, I can offer another management pathway for people who need it. I’m not saying I have the ultimate cure, I just knew I had skills that could contribute to the profession. So, I came from this very, kind of, pure background.

And then I built Rock Steady and you know, we’ve had amazing success. Our research statistics are through the roof, people are just getting the most incredible outcomes. And a lot of my clients are like, this healed my pain, you know, I used to have arthritis and chronic pain, and I used to have depression and anxiety and it’s lifted. This is where it’s like their whole lives are being affected because they are treating themselves as a whole person, not as an ear, not as a damaged problem, not as tinnitus, not as dizziness. They’re suddenly looking towards the bigger picture of who am I as a person, what are my values? What brings me joy and pleasure? And how can I explore this in real time? And how can I grow into a new version of me instead of trying to be the person I was?”

LS: “I’m speechless. Hahaha.”

JR: “So, basically, it surprised me that, you know, I was coming from such a pure, innocent kind of starting point. But because, of course, my yoga background, I was naturally looking at the whole person. So, sometimes in my therapy session, we’d be talking about sexuality and all these areas of life where the client would go, I just didn’t think we’d be talking about this in an audiology session. And I’m like, well, this is all part of who you are as a person, and this is going to impact how your ears are interpreted by your brain. And so, we need to look at all of you to give you the best chance of healing. And so, it kind of made a lot of sense to me from the beginning.

But now that I’ve seen more people and the process people go through now is largely self-study, so they don’t see me at all, there’s no email contact with me at all. It’s literally self-study. And what that means is they own being their own expert. And I love that. And in the beginning, I was like, will online resources even work? I was a bit skeptical. But you know, you have to give it a go. You don’t know unless you try your hypothesis. And sure enough, people love being able to log in at 3am. They love having access to the full plethora of tools 24/7. They are getting so much more support than they would having a session with me once a week or once a month. And they’ve got all the resources there for them to explore over and over again, in case they forget things or in case they don’t hear it quite right the first time.”

LS: “Is all of that in the workbook, as well, or this is an additional separate program?”

JR: “Yeah, good question. So, basically, my core program that I first built is called Rock Steady. And that’s a six module online program that you own for life, and it has hundreds of hours of support. It’s got videos, audios, worksheets, that’s the online program, the rock steady online program. And I have a really vibrant Rock Steady Facebook group, which is actually free to the public. So, the program people pay for, but if they want to just join the conversation, that’s free to the Rocksteady Facebook group. Out of that program came the Rock Steady book. People were like, Joey, you’ve got to write a book. You’re really onto something here. You say things differently to other people, you have to write a book.

So, it took me quite a while to write the book. So, the program came first. Through the program, I think I refined my voice, I refined my message, I was able to collect really great research statistics and data to back my message. Because people often say, well, just because it works for one person doesn’t mean it’s going to work for others. So, we tracked, in an 18 month period, we tracked about 140 people and the statistical outcomes were highly significant. It was amazing.

So, anyway, the book came second. And the book is a summary of kind of, what’s the dilemma we’re in as a global community? Why can’t the doctors fix us even though they’re trying and they are good people and they want to fix us? Why can’t they? So, it starts there, then it moves to what’s neuroplasticity? And how does it work? Why is no one teaching it to me? Then, (it goes onto) well how can I start implementing it? And the book has little chapter summaries at the end of each chapter. And a couple of home exercise suggestions ideas. They’re tiny, little snippets.

So, the book is really an educational piece. It’s great to hand out to your entire community. And also for people who are who are doing the online Rock Steady program, I think the book will be a nice little summary. Because the program’s dense, like it’s so full. And they’re quite different. The book and the program are quite different. And in order to test out my book and get a few guinea pigs to read it, I had my clients, couple of private clients, well actually about 10 private clients who were doing the online program self study and they’re taking their time to do that. And I gave them the book manuscript to read and all of them said the book was an amazing resource to support the program, so they’re quite different.”

LS: “I see. Okay, I want to ask you a question about parents who are listening to this and have a child who talks about the sounds or the tinnitus that they hear and complains and wants to avoid block parties and doesn’t want to go to school and all those things, that now as a parent, you want to help them. Or in the balance as well, children who are going through unsteadiness, dizziness, as you call it. How can parents support their kids?”

JR: “Well, first of all, validate what they’re feeling and hearing, have a smile on your face and be like, this is really curious, let’s get to know this. I’ve heard sounds in my body before too. And the reality is, most humans have heard sounds in their body and we just don’t make a big deal of it unless it’s associated with an incident that inspires fear, right? So, the kid might have noticed the sound while they got a knock to the head because someone threw a ball at them, you know? So, it’s really the context, that emotional relationship. So, what we want to do is to invite a conversation of curiosity and say, well, let’s get to know your body, how exciting. The body does indeed make sounds, it’s nothing for you to be afraid of.

If they’re really little, you know, you can start saying things like this means you’re highly sensitive, you’ve got super sonic hearing, you’re quite special. You might not want to tell people this because this is like a superpower. So, you want to kind of give it a light that allows the child to own it, and hear it and feel good about it. So, I would just say parents know their children best so find a language and a conversation that’s upbeat, uplifting, really mitigating all the fear stuff, remove all abnormal style language.”

LS: “Okay, but let’s say, it really is that their kid is banging into walls, they can’t walk in a straight line. And the parent themselves is also concerned.”

JR: “So, that would be dizziness. So, for tinnitus, it would be to have the normalization conversation and validate them. For dizziness, it’s actually very, very rare. The vestibular system is so adaptable, and it compensates so quickly. I have seen a couple of adolescent with ongoing triple pd. So, persistent, perceptual dizziness and it’s almost always related to anxiety. There are a couple of cases that are mechanical, like the wide aqueduct vestibular condition, which will need a CT scan and an ear, nose and throat surgeon to look at because that’s where one ear is actually going in and out of function. And that can mean your child is like walking into doorways, and you have to get medical clearance.

Basically, if your kid is walking into doorways constantly, and their balance doesn’t look quite right, definitely get medical clearance because that is unusual. Kids have great balance. And even if they lose balance from an infection, or some random event, or they’re not born with a fully developed ear on one side, they can ride bicycles, run, you know, they can do everything. There is so much redundancy in their system and they will quickly compensate and use their own neuroplasticity to heal. The thing that holds back the neuroplasticity is generally, anxiety. And so, what we want to do is, as a parent, to really have strategies for that emotional regulation for normalizing feeling not quite right, having ways to talk through fears.

Around the adolescent stage, as you know, most of us listeners can probably remember, there’s that inherent self doubt and questioning, what am I capable of? And where do I fit in? And if you throw some unwanted body sensations on top of that, it is pretty awful for adolescents because they’re already doubting themselves anyway when they’re like working a hundred percent normally fine. So, yeah, getting role models, getting counseling, getting great peer support, all of those things, the whole person package are going to be useful.

I’d probably say the big “no, no” if we reverse the question and say what don’t do.”

LS: “Sure.”

JR: “It’s what I see most parents doing when they come to see me. It’s like, don’t make a big deal. Don’t talk about it all the time. Don’t ask them how their dizziness is going. Don’t ask them how their tinnitus is going. Ask them how they’re going as a whole person. Don’t single out the symptoms. Because when you focus on symptoms, the brain allocates more neural power there, and more neural activity there and you get more symptoms. So, delete all symptom language, look at the whole person, find ways to enhance their self belief and their pleasure and their joy. And just have the patient, slow, motherly conversations or fatherly conversations that need to happen.

And you know, sometimes life is a bit rough. So, just be beside them through those rough, difficult, down and out feelings without over emphasizing the symptoms. The symptoms can actually be a result of feeling down and out instead of the symptoms causing the down and out. I hope that makes sense.”

LS: “Yeah. And then maybe go on and develop a hobby and put them in a class like dance or art or music. And sometimes investing in those things, like they can be very expensive. But I’ve seen that when parents are on a medical hunt, they’re in that mode. They’re going from doctor to doctor and paying for very expensive evaluations and pathologizing every encounter that they have. Now you’re missing school because we have a specialist and like they’re in that zone. Wouldn’t it be incredible if all of that resources of time and money and parental attention went towards, let’s take a day off and go for a hike. Let’s take you out of school and go to your favorite ice cream store and pick all your favorite toppings.”

JR: “I think you did nail what you said there. I think pathologizing is a good word to remember and also be careful not to, as a parent, it’s important for me not to project my anxiety on to my son. So, if I don’t understand tinnitus and vertigo and dizziness and the power of the body to heal, so I’m anxious about it. I can actually project that anxiety on a son and freak him out. But it’s actually my fear, not his. I have to be really careful about my emotional boundaries, I need to get the education so I can chill out. That’s not his job. That’s my job as a parent to not freak out about him, right? So, do the work yourself. And that could even mean, get the Rock Steady program, learn about it yourself so you get it, so that then emotionally, you’ll have the tools to not be projecting fear.

And the other piece is your kid might not know what hobbies they like. They might be like, I don’t really want to go hiking, I don’t want to go to scouts, I don’t want to play violin, I don’t, I don’t, don’t, don’t, etc…. Give them space. And say things like, just take as long as you need. Or you can have a sad day today. Give them space rather than push them and hurry them up. Obviously, you don’t want to give them forever. You don’t want them to be like 35 (years old), and still sad and doing their washing and cooking for them. But give them some transitional space to actually feel their emotions and be in a little bit of a low point. And make sure you’re not worried about them. Just smile, move around the house, do your gardening, talk them through how you’re accessing your pleasure and how you’re feeding yourself and how you’re bringing balance back to your life.

And that’s what a lot of my Rock Steady clients have said is, they now have tools to actually role model this stuff for their teenagers because they know how to be in their body and regulate their inner world. They can actually directly transfer those skills instead of their anxiety onto their children. So, really, I think it’s about role modeling. And I’ll be quiet after this but sometimes I think, children are copying us. So, if I’m freaking out about my body, and I’m like, “Oh, I’m fat” or, “Oh, I hate my skin” or “Oh, I hate my wrinkles”. If I’m saying that kind of stuff in front of my kids, the chances are that they will pick something in their body and say how they hate that because they’re copying mom. So, really notice your own language and how you talk about your body because chances are your children are kind of copying in their own way.”

LS: “I have to just give you the most adorable example for my children. Our listeners know I always bring in my little cutie, cutie anecdotes. I have three daughters that are six, four and two. And recently I got some acne on my chin that has been like ongoing and comes and goes and makes all these different colors on mommy’s face. And my daughter is like, “EMA (Hebrew for mommy), you have polka dots.” And because I have totally come into a different understanding of like, my skin is cleansing itself, it’s deleting the things that don’t need to be here. Like I had a big internal body image situation about how I’m going to view acne and makeup and all that. And then hearing her say that to me, I was like, Oh, I think the change I made got exuded somehow that there’s not even the word pimple or ouchie or boo boo like any of those other words that maybe had been in my mind about acne in the past. Now it’s just like mommy’s polka dots. It’s adorable.

I used to not go on Instagram stories like, oh, if I have (a pimple) whatever, I have something to say, forget it. There’s dots on my face, and anybody will deal with it if they care. I don’t care. Moving on.”

JR: “A hundred percent. I actually went through a phase when I first started my YouTube channel, I wouldn’t go on unless I at least had on a little bit of makeup, but I don’t wear makeup. And then it got to a point where it’s like, it’s just me, I just need to be me. And so, I made a decision like you said, just get my conversation out there, get my content out there. Because that kind of body image barrier of well, the world tells me I should be this way. So, therefore, I’m not even going to get started because I don’t really know how to use makeup.

Did you have any final questions for your listeners that I haven’t touched upon yet?”

LS: “Okay, so one more question for you would be for our other major group of listeners who are students, students of Audiology, communication disorders, speech language pathologists, teachers of the Deaf, that’s kind of who’s in our community. And I’d love to hear, because you have had all this different kinds of experience as a student in so many different fields. What advice do you have for our students listening?”

JR: “Oh, look, I mean, I think if you’re interested in this stuff to start with, read my book, I’ve just simplified this for you enormously. I think start by learning about the power of the body to change and my only other kind of, perhaps little suggestion or encouragement would be to really question whether or not you need to say things to your clients such as live with it, accept it, or there’s nothing more we could do. Really censor yourself because that can really affect somebody’s self esteem and body image and relationship to their body if an expert, a perceived expert is telling them there’s nothing to do.

I would love the new response from audiologists and psychologists and doctors to be, from my point of view, I’ve covered all bases and I’m really confident about your ear and brain, and know how powerful the ears and the brain are. And I want to encourage you to learn how you change your sensory mapping, because that’s not the peace I’m training. And that’s not what I can offer you. But I’d encourage you to explore that because you can have hope. And so, give them a pathway to move forwards instead of shutting down those explorations. Maybe you could add to that a little.”

LS: “I think that’s incredible. And so much of what goes on in the all about audiology community is that it actually isn’t all about audiology, it’s about people. And it’s about connection. And it’s about bonding with your child or being the kind of therapist or audiologist who sees your patients as a whole human. So, it is all about audiology topics. But the whole message is that we can’t just look at people for their audiogram or for their test results, because that is obviously not who we are. And we have to look at the other things.

When I heard about all the things you’re doing, I felt so connected to you bringing that holistic piece, but it’s evidence based, because now we have the evidence to say, here’s how the brain works, and all the spiritual practice of generations past, they work and now we can “prove it”. But you know, if we can do that integration in the world, and in ourselves, that is healing.”

JR: “Yeah. And by spiritual practice, I think it’s about just believing in ourselves and believing in the power within the human body. We really are incredibly powerful miracles of biology. And I think, kind of through capitalism and through patriarchal systems, we are told, listen to our parents, listen to authorities, do what your teacher says, do what the doctor says. And it’s all this external authority, external power, and that’s the brain washing every single one of us has been fed for generations. And that’s nobody’s fault. This is old, old. And so, where the spiritual pieces coming in from the ancient, this is really non religion, it’s cross cultural, it’s universal. It’s about saying, “My body is powerful. It’s up to me to learn how to harness that power. I need to learn to believe that I have billions of neurons. Not all of them are being used, some of them might be damaged. But I’ve got billions of neurons and I can kind of program how they’re mapped. If I choose to learn how, or I can stay on the couch all day crying and waiting for somebody else to fix me. We have choices.”

LS: “To learn from the earth about compensation, and about nature and cycles. And change is the game. Like, if you’re not changing, you’re dead, like you died, that’s it. I always think of a meandering river, that’s like just an image that is somewhere in my psyche that I think of all the time that it has to meander, it can’t just go straight, otherwise it would go so fast. We have to take that way and you have to go around and every time, you erode the earth a little more as you turn there. So, there you go.”

JR: “My closing words would be feeling is healing.”

LS: “Oh, I love that. Yes.”

JR: “And if we choose to feel, we choose to feel all of it. We’re not just cherry picking the joy and pleasure moments. If we choose to feel, we’re not numbing, not medicating it, distracting it, or avoiding it, if we choose to feel it means we’re letting the sensory input come in. Whether it’s anxious, whether it’s breathing, happy, whether it’s cheerful, whether it’s relaxed, whether it’s totally freaking out, we’re letting that sensory input in and we’re actually feeling it so the brain filters can use it. Feeling is healing because it means we feel the grief and we actually have something to do with it. The brain automatically processes emotions, it’s not an academic process, it’s a feeling process, it’s experiential.

And so, you know, my book really normalizes feeling and feeling all of it. Feeling human, not just feeling happy, like we’re a magazine cover star, feeling all emotions. And so, choosing to use neuroplasticity takes courage. And we need to be brave because we’re actually letting in all those feelings we’ve blocked out from previous parts of our life. And we haven’t known what to do with those feelings. And now we are learning to feel them again. As audiologists and psychologists and doctors and physiotherapists, if we haven’t done that work ourselves, if we haven’t actually stopped and done some of that inner work and a feeling work, how on earth can we help our clients if we don’t understand what that means ourselves? And this is where cognitive behavioral therapy and acceptance commitment therapy can be incredibly ineffective and completely fail if the practitioner has not actually embodied the feeling themselves. I could go on and on.”

LS: “Okay, so if you want to learn more, then head to seekingbalance.com.au/thebook to check out the book, Rock Steady. It’s on Amazon, Book Depository, etc, etc. I’m so excited and honored. Thank you so much for this conversation. Joey Remenyi from seekingbalance.com.au, if people want to reach out to you. I’m sure you have all your contact links and things but I’m just going to tell you guys, get the book. There you go.”

JR: “Yeah, thank you so much. It’s been a real pleasure. You’re a beautiful audiologist. Thank you for flying the flag so gracefully.”

Thank you all. I’m Dr. Lilach Saperstein and this is the All About Audiology podcast.