Tinnitus Retraining Therapy Is Ineffective, Latest Study Finds

JAMA Otolaryngol Head Neck Surg. Published online May 23, 2019. doi:10.1001/jamaoto.2019.0821
Effect of Tinnitus Retraining Therapy vs Standard of Care on Tinnitus-Related Quality of Life

Question Among patients with subjective debilitating tinnitus and audiometric normal to mild hearing loss, does treatment with tinnitus retraining therapy with conventional sound generators result in better outcomes than tinnitus retraining therapy with placebo sound generators or standard of care?

Findings In this randomized clinical trial of 151 participants with 18 months of follow-up, average tinnitus distress decreased in all 3 groups. There was no clinically meaningful difference in extent of reduction in tinnitus distress or other important end points among patients in the 3 intervention groups.

Meaning Tinnitus retraining therapy with conventional sound generators is no better than tinnitus retraining therapy with placebo generators or standard of care.

 

Great News! Reading now.

 

How many years did this study take to complete, and how much money did they spend on it? Why did it take this long to say it is junk science?

 

The study is saying TRT is tied with just normal sound therapy. Nothing special about Jastreboff's model compared to normal sound therapy.

Why are you so happy to defend the status quo? TRT obviously has bias too considering how audiologists are more then happy to prescribe it because it comes with hearing aids. Seriously that's why audiologists love TRT so much because they profit from the hearing aid aspect.

 

AnnV back at it again with quality content.

 

Years ago I couldn't afford TRT. I was able to do some CBT and after about 14-18 months I had habituated. I am not happy or defending the status quo. I have prayed for a good treatment or cure everyday for 30 years.

To me TRT is a scam.

 

It took 20 years to do this trial with 130 patients? Kind of ridiculous!

TRT never made much sense to me. When my tinnitus was much worse, I craved silence, and the idea of playing continuous sound into them really was making me think it would make things worse if anything. Once I was able to get a full complement of earplugs to match the situation (variety of foam, silicone and musician), along with a set of muffs, and some experience on what I should - and should not- protect from, things ended up getting a whole lot better over months.

The problem in doing a study like this is at least some of the patients get better once the additional noise damage stops - with or without the TRT. The other problem is the audiologists make a lot more profit from hearing aids that play the white noise than recommending a foam plug, or even custom made ear plugs. Bet at least some audiologists persist in prescribing this therapy.

 

For TRT to have received patient funding from government and insurance companies in some countries around the world, it must have shown efficacy somewhere. How?!

 

TRT is not a scam. It works. I have had two noise traumas in twenty three years and have had the treatment twice. Not a scaled down version of it. This involved wearing two white noise generators and having regular counselling with a Hearing Therapist. I also used a "sound machine" each night by my bedside for sound enrichment. Each course of treatment lasted 2 years.

Contrary to what some people believe, hyperacusis can be cured using white noise generators as mine has for over 20 years. I am not saying in every case but with treatment it is often reduced. I had very severe hyperacusis. My tinnitus reduced significantly after my first TRT treatment but got worse in 2008 when I had a second noise trauma. This resulted in having TRT for the second time and did have some success with it under the NHS. It has become more difficult to have this treatment under the NHS but it is still practiced at the hospital that I have been attending as an out-patient for the past twenty three years. Usually a person complaining of tinnitus will be able to get some form of treatment and it is totally free of cost at point of delivery. This being: Tests, medication, counselling, hearing aids, white noise generators, TRT & CBT where available etc.

I cannot speak for the medical care, practices and treatment for tinnitus in other countries but I am immensely thankful for the treatment, dedication that my Hearing Therapist, Audiologist and ENT consultant have given me throughout the years and especially, when I had the most difficult and traumatic 4 years habituating to tinnitus for the second time. From 2008 to 2012. When I felt myself slipping into depression with tinnitus because of the relentless noise I had to live with. I felt reassured when my ENT consultant said: I will never give up on treating you and kept to her word.

The NHS is not perfect and has it's problems and like any large organisation nothing runs smoothly all the time. The strange thing is, the press and news media hardly ever want to say what our health system does right. The thousands of people that are successfully treated in GP surgeries, walk-in clinics, out-patient departments and operations in hospital 24/7.

Michael

PS: Anyone reading this post that wants a slanging match about how unsuccessful TRT is will get no response. Equally, anyone having an axe to grind about the NHS will get the same treatment - no pun intended.

https://www.tinnitustalk.com/threads/what-is-trt-and-when-should-it-be-started.19024/

https://www.tinnitustalk.com/threads/what-happens-in-trt-sessions.18195/

https://www.tinnitustalk.com/threads/trt-as-i-see-it.19555/

 

I actually had a bit of TRT and it kind of helped, I'll fully admit, I just think one of the huge glaring issues (especially in my case) is that there weren't actually any qualified "TRT" specialists in Australia. So instead of just being able to get a pair of WNGs I was expected to fork out 6 grand for a pair of hearing aids. Which was just obscene when comparing them to the amount of help they provide.

 

@Liam_Cairns

You have raised some interesting points that I would like to address and hopefully, put to rest some of the misconceptions surrounding TRT.

I have corresponded and counselled people with tinnitus for some time. Some of these people have told me, they were in the process of having TRT or had the treatment with various degrees of success or none at all. After enquiring further I have learnt quite a few things. What some of these people believe to be TRT is not it at all. For TRT to work it has to be administered correctly and follows a strict protocol. Please take note of the following:

1. If a patient is fitted with two white noise generators and doesn't have regular counselling with a Hearing Therapist or Audiologist trained in tinnitus and hyperacusis management, this is not TRT.

2. When a person is fitted with one white noise generator with or without regular counselling this is not TRT

3. When a person is just having a few counselling sessions with a Hearing Therapist or Audiologist this is not TRT.

I am not saying that a person will not find any relieve having the above or other elements of TRT but they do not follow or adhere to the proper Tinnitus Retraining Therapy protocol.

For TRT to work a patient has to be fitted with two white noise generators not hearing aids .Regular counselling has to be provided and with a Hearing Therapist or Audiologist trained in tinnitus and hyperacusis management & treatment. Counselling is a vital part of this treatment as it helps remove and demystify the negative thinking that many people have with the onset of tinnitus. Depending on the severity of the tinnitus counselling may need to be involved and long term. It is a gradual retraining of the mind. Over time the patient learns not to see tinnitus as a threat; gradually the brain pushes the tinnitus further into the background. This is not a quick fix as there are a lot of factors involved. This treatment can take up to 2 years.

If a patient goes into TRT or any other tinnitus treatment with the mindset that nothing but a complete cure from tinnitus is acceptable then it is unlikely to work. TRT is not a cure. Similarly, there are some new treatments on the horizon that a lot of people are excited about and believe they will be the silver bullet for tinnitus. I have my doubts. I am not saying they cannot help reduce the intensity of tinnitus for some people but again, there are many that want a complete cure from this condition and nothing else will be acceptable. Therefore, I believe even when tinnitus might be reduced, some people will not be satisfied and will need counselling with therapist trained in tinnitus management.

I have explored this further in the links in my post above.

Michael

 

Take a group of new tinnitus patients, give them a THI test, then test them 3 months later or 6 months later. 90% will have improved, so you can introduce any bullshit therapy or device and make it look like it gets results.

 

I'm enrolled with TRT on the NHS, and I have seen two therapists.

- Both said not to use sound enrichment as it would make the Tinnitus worse, and that I had to listen to the Tinnitus to get used to it.
- Both said the use of WNGs is no longer recommended, and I had to insist before they would prescribe them.
- Both can only see me once every two months for an hour.

I want TRT to work - we all want it to work I'm sure! - but unless I've been really unfortunate in my area, the TRT provided on the NHS is quite terrible. I wonder if it's changed quite a bit since you had it Michael? Because they seem to be offering quite different advice to the advice you received, and getting regular appointments is an impossibility.

I'm considering going private to see if that is better but I can't really afford it, and it would be a complete waste of money if it was the same as on the NHS.

 

Yeah I was receiving regular counseling along with it, the guy was really good and very realistic, it was about learning to cope and not about a cure.

But sadly there are just no WNG makers in Australia anymore. That was told to me by about 5 different audiologists all from different organizations. Hence the use of hearing aids. But also I will say one of audiologists said that while he technically was using "TRT" he openly admitted that he was not trained by Pawel Jastreboff.

So I went looking for someone truly trained in TRT but it turns out literally no one in Australia is.

Which raises some serious questions because if it was the most effective way of treating tinnitus why would not a single person in the entirety of a country be trained in it?

 

With all due respect, I am utterly baffled by your comment that "gradually the brain pushes the tinnitus further into the backround." Is this equivalent to actual tinnitus reduction? Or just another habituation method?

 

The tinnitus loudness is not supposed to change through TRT (though supposedly it does go down for some) but they claim the brain will tune it out (habituation). Obviously, we know that not everyone can learn to tune out their tinnitus. One of the many reasons why TRT can do more harm than good by spreading these misconceptions. Thankfully, not every therapist offering TRT/CBT for tinnitus does promote those misconceptions but too many do.

 

You have asked a good question and with respect and for that I will answer your question as I see it. Tinnitus is largely affected by our mental and emotional wellbeing. Many people new to this condition become stressed and anxious by it due to the amount of focus the brain puts on it. Depending on how loud and intrusive the tinnitus is, will often depend how long it will take for a person to habituate. I have covered habituation and the habituation process in many of my articles which can be found on my "started threads".

Tinnitus reduction in many ways is similar to habitation because the brain learns to accept it and no-longer see it as a threat. For example, moving house to a location where one is living near a busy train station or motorway/expressway . At first the brain focuses on these sounds having not been used to hearing the increase in environmental noise. At first a person might have difficulty sleeping. However, gradually overtime the brain becomes used to them and no-longer sees the sounds as a threat so pushes them into the background as unimportant and becoming less noticeable - reduction or habitation. The sounds are still present by no longer so noticeable.

Habituating to tinnitus is real and does work but a lot depends on a person's mindset: chiefly it is their mental and emotional wellbeing towards the tinnitus and their expectations. Some people want a complete cure from tinnitus and nothing else is acceptable. With this in mind it can be difficult to come to terms with tinnitus. Please click on the links below where I explain habituation and the importance of having and acquiring a positive mindset.

Michael

https://www.tinnitustalk.com/threads/tinnitus-and-the-negative-mindset.23705/

https://www.tinnitustalk.com/threads/acquiring-a-positive-mindset.23969/

 

What did you expose yourself to?

 

HI @Tanni

Wanting TRT or another other tinnitus treatment to work is the right attitude. Secondly, it doesn't matter what treatment a person has for tinnitus, it has to be backed-up and reinforced with positive thinking as the treatment cannot do it all. By positive thinking, this means to engage in things that you like to do and one has to make a conscious effort in doing this. Whether it's a hobby going out spending time with friends or family one has to try and participate in doing things that are positive. I am not saying never to feel negative about tinnitus but everything has to be kept in balance.

When you start TRT I strongly advise you to keep away from tinnitus forums. Reading negative posts about tinnitus treatments being ineffective can have a detrimental impact on your recovery and habituation. Reading posts and corresponding with people that have a negative mindset towards tinnitus can do the same.

I do not agree with the advice you have been given that sound enrichment will make tinnitus worse. It helps plain and simple. I have discussed this at length in many of my posts on TRT which can be found on my "Started threads" TRT treatment is expensive and where it is available in the UK under the NHS, it has been modified to their requirement. Please accept whatever treatment that is offered to you.

In many countries medical insurance will not pay for TRT or any other tinnitus treatment, so a person has to pay for treatment out of their own pocket. It is quite sad things are this way.

Take care and wish you all the best
Michael

 

Headphones in 1996.
Listening to a classical music through my HI-FI in 2008.

 

Mate, there's literal scientific evidence against it now. Give up.

 

Surprised the hoard hasn't backlashed with propaganda yet tbh. Took a full day for them to arrive.

 

I haven't corresponded with you in a while. I will keep this brief and will not be commenting further. Science has nothing to do with habituating to tinnitus and its treatment.

Take care
Michael

 

Yeah you too, nice to see you again.

No, but it does have everything to do if it determines whether or not TRT is effective.

 

'You can lead a carpenter to water but you can't make him drink'

 

So you’re saying I can show you the evidence but you still not accept it?

 

Ding dong the witch is dead.

 

Yep even if Pawel Jastreboff came out and said it's ineffective, Michael Leigh would still be promoting it.

 

Tell me about it