January 12, 2004

Listen and learn

By Eric Rangus

When the work of the Emory Tinnitus & Hyperacusis Center was profiled in a medical report on ABC’s Good Morning America in November, the reaction was swift. Center Director Pawel Jastreboff received upwards of 1,600 e-mails, and the center ran out of information packets to distribute.

Not a bad bit of publicity for an office on the second floor of the Emory Clinic whose local profile was so low that a co-worker from a department down the hall didn’t know of its existence—and she had been working in the clinic for four years.

The Emory community may not know a lot about Jastreboff, but the world sure does. He is the world’s foremost expert on the treatment of tinnitus—“ringing in the ears” to a lay person. Not only do he and his wife (and fellow professor) Margaret travel around the world to treat patients, but they also teach health care providers how to administer the groundbreaking treatment Pawel developed in the 1980s.

“Tinnitus and hyperacusis are challenging topics to study, and symptoms are difficult to treat,” said Pawel Jastreboff, professor of otolaryngology, the Warsaw native’s thick accent giving away his and his wife’s Polish ancestry.

Tinnitus is a common affliction that is referenced as far back as ancient Babylon. It affects about 17 percent of the world’s population (including approximately 44 million people in the United States).

Between 1 million and 2 million Americans have a significant problem with tinnitus that adversely affects their lives.

About 40 percent of the time tinnitus is accompanied by hyperacusis, a condition that amplifies sounds from the environment so severely that sufferers are distracted or feel pain. Symptoms of hyperacusis can be felt without tinnitus as well.

Tinnitus cannot be cured as yet, but it can be treated; however, physicians had not had much success with tinnitus until the Jastreboffs began looking for ways to combat it.

Not an easy task since many sufferers are unaware of treatment options and even clinicians can be in the dark about them. A not uncommon suggestion from health care providers to patients who complain of a ringing in the ears is to “learn to live with it.” Some people can’t, as there are documented cases of tinnitus sufferers committing suicide because of its severity.

Both Jastreboffs are dedicated to tinnitus research and treatment, but their careers didn’t start out that way. Pawel earned his first master’s degree in electronics engineering and he began his academic career as a neuroscientist (he also holds degrees in biophysics, neurophysiology and neuroscience).

Margaret, associate professor of otolaryngology, is trained as a cell biologist, specializing in cancer research (her degrees are in pharmacy, clinical biochemistry and biological sciences). Both held faculty positions in Poland until 1982, when Margaret was awarded a fellowship from the Leukemia Society of America. She was the first
Eastern European academic to earn such an honor.

“We’re here only because of her,” Pawel said. The Jastreboffs have been married for 33 years, and their ease around one another is immediately noticeable. Pavel met Margaret when she was 16 and he was writing a story for his university’s newspaper about her school’s upcoming prom—“I asked for the assignment,” said Pavel, which sent him to Margaret’s all-girls school. They married two years later.

With Margaret’s fellowship came a visiting research scientist position at the Yale University School of Medicine. She convinced Pawel, then a visiting professor at the University of Tokyo, to join her. “She didn’t want to leave the children in Poland, so she told me I had to go babysit them,” he joked.

Pawel did other things, too. He began researching an animal model for tinnitus and eventually created the neurophysiological model of the affliction. Although he spent his entire career as a researcher, not a clinician, Pawel began looking into ways to implement his theoretical work in practice. Out of that work came Tinnitus Retraining Therapy (TRT).

In lay terms, TRT retrains a patient’s brain so that it treats tinnitus similar to the way it treats noises such as the monotonous hum of a refrigerator. It’s there but no longer distracting or painful. TRT combines counseling with sound therapy using low-level sound generators patients wear either in or behind their ears.

In 1988 patients began receiving TRT, and in 1990 Jastreboff established the University of Maryland Tinnitus & Hyperacusis Center in Baltimore.

Meanwhile, Margaret was charting her own path. Like her husband, Margaret did not do clinical work; she was strictly a researcher. “It was a constant joke. I was working on an important problem,” Margaret said of her cancer research and her playful rivalry with her husband. “And he was working on some noises in the head. Who cares about that?”

“Underappreciation,” Pawel quipped quietly upon hearing his wife’s description of his work.

“Then one time, I had to go to the clinic for something,” Margaret continued. “I’m told which room he’s in, I open the door, and there is a woman who is kneeling and trying to kiss his hands.”

“That was very embarrassing,” Pawel quipped again.

“She was about 85, and she was so grateful for the help with her tinnitus,” Margaret said.

From that point on, Margaret joined Pawel in working to combat tinnitus, a path that brought them to Emory in 1999. In the last 13 years, the Jastreboffs have treated more than 2,000 patients all over the world, and that treatment, which can last more than a year, has been successful in 80 percent of cases.

Health care providers from all over the world regularly visit the center to learn how to administer TRT. Recently, the Jastreboffs hosted a couple from Italy and a nurse from Singapore; all came to Atlanta specifically for TRT training. In all, they have trained more than 1,000 people worldwide in TRT, which is practiced in 24 countries.

Patients come to the clinic from around the United States and world for help with tinnitus (Some of them high profile, like former first lady Rosalynn Carter and actor William Shatner. Shatner was so happy with his treatment that he gave the Jastreboffs a $25,000 research grant and regularly discusses their work at public appearances).

Despite their success, the Jastreboffs and the tinnitus center remain largely unknown at Emory and in the Atlanta area. Some 60 percent of the center’s patients come from out of state, and fewer than 10 patients were referred to the center by Emory health care providers last year.

Working to raise their profile at home is continuing project. The Jastreboffs don’t have a problem with that abroad since trips to eight countries in 2004 are already planned. Nothing’s new about that.

One thing that is new for Pawel is that he is a student again. Already a holder of five degrees, he is aiming for a sixth—an Executive MBA (EMBA) from the Goizueta
Business School, which he entered in the fall.

Jastreboff’s happiness is doubled by the fact son Pete, 29, is a classmate. He commutes from his home in New York for classes through Goizueta’s Modular MBA program. Father and son represent the oldest and youngest members of the EMBA Class of 2005. Daughter Ania, 27, is a medical student in Maryland. Both their children, Margaret said, have been completely Americanized; they have none of the Polish accent their parents still possess even after 22 years in this country along with naturalized citizenship.

Family is pretty much the only thing that trumps the importance of the Jastreboffs’ work. “The most rewarding part of the work is seeing the changes in patients’ everyday lives,” Margaret said. “Our goal is to make people forget about us.”
Judging by the large amount of cards and letters they receive from former patients, some of whom even name children after the doctors (more than one Paul out there has been named to honor Pawel), they still have a way to go before reaching it.