Tinnitus Retraining Therapy

For those who are interested in TRT, there is some additional recent-ish literature (in the absence of Tyler's lack of publications):

• www.ncbi.nlm.nih.gov/pubmed/25862626
  
• www.ncbi.nlm.nih.gov/pubmed/22609540
  
• www.ncbi.nlm.nih.gov/pubmed/25756459

For those interested in the full-text copy, I can perhaps lend a hand...

 

He's generally a toxic person IMHO. Try not to take what he says to heart.

 

Thanks. I saw him throw other users under the bus and blocking them for exactly this kind of thing. And he calls me immature

 

Indeed, you can be immature at times @threefirefour but also quite humorous too. I hope you didn't mind my little joke on ignoring you. I have ignored some people but you're safe for now so please behave.....

 

Wow you actually scared me a bit, and that's pretty hard. One joke deserves another I guess. I went through some of your articles and I thought one of them was actually helpful with hyperacusis. Thanks for not blocking me

 

You're not so bad and part of me missed you when you weren't around for a while....lol

 

Did you get a night splint from a dentist?? The sick thing with me is when I first got the night splint the T went away for a day or two completely and the splint loosened and the T came back. Got the splint tightened again and NO T for 2 days, then the T came back as the splint got loosened. Then tightened the splint and still have the T again. The right side of the splint is a little tighter then the left, my neck has gotten worse and weaker, I'm thinking of doing physical therapy on my neck, I already have it on my jaw. The neck could be the stem of the issue though and like I said its gotten worse and lost about 20% each way movement.

Also threefirefour, what do you do for your neck/tmj bc those 2 were the culprit of my T. How bad is your T? Like I said my T is prob just a notched the loudness of the avg T person, its more annoying then anything.

What does your neck feel like??

Also does the jaw/neck have to be exactly in the same "slot" or the way it was before for the T for the T to go away?

 

I don't have a splint yet, but my tinnitus reduces heavily when I shift my whole jaw to the left. I can hear my tinnitus in a library sometimes. It's reduces a lot overtime.

My neck aches every now and then.

Yeah I think it needs to be in the same slot.

 

Are there any reading materials about do it yourself tinnitus retraining therapy? Hopefully online? I'm hesitant to buy a book, and certainly can't afford it any other way. I feel like I keep pulling up the same crap. I've been doing CBT, but I'm curious to see the difference of it to TRT.

 

Observation on effect of retraining therapy in patients with chronic tinnitus
[Article in Chinese]
Zhao D1, Jiang ZG.
Author information
1Department of Otology,Qinhuangdao First Hospital, Qinhuangdao, 066000, China.
Abstract
Objective:To analyze the curative effect of tinnitus retraining therapy on patients with chronic decompensated tinnitus and to explore an effective method to treat patients with chronic decompensated tinnitus.Method:Thirty patients were treated for tinnitus retraining therapy for 12 months. The content of retraining therapy includes: tinnitus counseling,low intensity natural sound therapy, shift attention, and relaxation training.Result:The severity of tinnitus was compared in grading before treatment and after 12 months treatment: 56.7%(17/30) of grade Ⅲ before treatment, 36.7%(11/30) of grade Ⅳ and 6.7% (2/30) of grade Ⅴ;16.7%(5/30) of grade Ⅰ after treatment, 60.0% (18/30) of grade Ⅱ,16.7%(5/30) of grade Ⅲ,6.7% (2/30) of grade Ⅳ, where compensatory tinnitu was 76.7%(23/30), and decompensated tinnitus was 23.3%(7/30). The composition ratio of 30 subjects compensated tinnitus and decompensated tinnitus before and after treatment has significant changes, with statistical differences(P<0.01). The mean score of tinnitus severity before treatment was 14.40±2.60 in 30 subjects and 9.00±2.82 after treatment in assessment scale. There was a significant difference between the both groups(P<0.01).Conclusion:Tinnitus retraining therapy is an effective treatment of chronic decompensated tinnitus.

KEYWORDS:
decompensation; retraining therapy; tinnitus

https://www.ncbi.nlm.nih.gov/pubmed/29798140

I wondered what "chronic decompensated tinnitus" meant and found this article:

Psychosomatic stress factors in compensated and decompensated tinnitus
[Article in German]
Stobik C1, Weber RK, Münte TF, Frommer J.
Author information
1Westerwaldklinik Waldbreitbach, Schwerpunktklinik für Neurologie und Neurologische Psychosomatik.
Abstract
AIMS:
In modern medical practice, chronic decompensated tinnitus is defined as a complex psychosomatic process in which mental and social factors are considered to have a determining effect on the patient's subjective response to the impairment of otological or other somatic functions attributed to tinnitus. What is still largely unknown is the interaction of the individual factors and their impact on the patient's ability to cope with tinnitus. The impact of psycho-social and somatic factors on the subjective experience of patients with compensated and decompensated tinnitus is evaluated.

PATIENTS AND METHODS:
53 patients with chronic tinnitus were divided into two groups, compensated and decompensated, on the basis of their subjective experience of the disorder, established according to the tinnitus questionnaire published by Goebel and Hiller. Self-assessment instruments and a survey of symptoms of somatic stress disorders were used to compare the two groups in terms of differences in the patients' mental and psycho-social behaviour, in their strategies for coping with tinnitus and in the incidence of co-morbidity.

RESULTS:
The patients with decompensated tinnitus suffered from more pronounced mental and social disabilities, were more prone to depression and used less effective techniques to cope with their illness. The principal difference between the two groups, however, appeared to lie in a significantly higher degree of somatic multi-morbidity, where a particularly strong correlation was found between tinnitus and the incidence of cardiovascular diseases and hypacusis. 81 percent of the total sample of patients suffered from impaired hearing. Patients with decompensated tinnitus experienced greater communication difficulties as a result of their auditory impairment.

CONCLUSIONS:
In the diagnosis and therapy of tinnitus, in addition to psychic and psycho-social aspects greater attention ought to be paid to somatic factors, influencing the patient's ability to cope with the disorder.

https://www.ncbi.nlm.nih.gov/pubmed/12886492

 

@Frédéric Decompensated tinnitus is the most severe form of tinnitus and is mostly severe high pitched somatic tinnitus with hearing loss and often heart disease. Ones in this small group have interference in the brain's hearing system. This type of tinnitus activates the temporal lobe and auditory complex. Sufferers must include physical and medical treatments such as heart medications and muscle therapy. I have membership in this group.

 

@Frédéric - Thanks for digging out and posting these studies, but the TRT study doesn't seem to have a control group to check against. We know that T "generally gets better on its own with time", and so without a control group we cannot really determine the efficacy of the treatment.

 

I like how most studies with TRT show it losing to less of itself lol. There was a study done on TRT that actually had a control group. It showed it was successful for hyperacusis, but did not fare well against other treatments with tinnitus.

 

So now I assume that anyone that still opposes TRT and Pawel Jastreboff's ideology is going to be put in the category of pseudoscience quacks.

Quit looking at things so complicated, TRT isn't doing anything that reduces tinnitus, or reverses hearing loss. The faulty neuroplasticity and hyper fusiform cell activity in the audiotory brain that causes tinnitus is still the same. The damage and death to the hair cells in the cochlea still exist.

The only thing that is being accomplished is desensitize and separation the emotional brain and auditory brain.
I never said this doesn't work, maybe @threefirefour has but I am clearly aware that "not giving a damn" can work in some
people that being said others would appreciate real help with actual scientist solving the biology/neurological riddle of tinnitus and SNHL instead of Jastreboff's doctrines living to see the light of day holding back real research. Using the same logic as TRT I can desensitize my emotional brain not to care about anything and become an emotionless robot, however that seems like a extremely poor excuse of treatment.

Mark my words, once something *coughs Susan Shore and the University of Michigan signal timing device for tinnitus becomes available to reduce the actual volume of tinnitus, TRT will be viewed as complete useless garbage.

 

Michael, what is the specific purpose of the white noise generators worn as part of TRT? Is it to promote habituation? I have a family friend who says wearing these dramatically brought down the noise of his actual tinnitus from very loud to mild (rather than promoting habituation as I actually understand it).

 

Please ask me this question a little more politely @Agrajag364 and I will gladly give you the information you request.
All the best
Michael

 

This whole thread from beginning to end is something else. The more I read about TRT, the more I see it as a completely outdated “treatment” there is no money in a cure and all that........

@Agrajag364 you did ask politely, Maybe ask somebody else who is less rude.

 

I don't think the way I asked was rude Michael. Normally I might include the word please but I don't think that leaving it out was rude in this instance in a quickfire discussion as on these threads. Please do share the info, if you know, but if you don't know it's totally fine!

Have I offended someone in some kind of strange habituation versus actual noise reduction debate thing?

 

John- I am having something that was described as trt in Glasgow though the counselling bit is limited. Both the Queen Elizabeth and Gartnavel offer this service via audiology

 

@Agrajag364

Well said and thank you.

White noise generators formally known as maskers serve two purposes. They can as you say, promote habituation when used as part of TRT and also desensitise the auditory system when hyperacusis is present. They can also be used to aid habituation without having TRT treatment. If they are not used correctly they can make tinnitus and hyperacusis worse.

Please read the text below taken from a post that I wrote a while back.
Michael
__________________________________________

There are some people that do not understand what proper TRT is. Therefore, I will explain for those that do not know.
1. Wearing one white noise generator alone with or without regular tinnitus counselling is not TRT
2, Wearing 2 white noise generators without tinnitus counselling is not TRT
I am not saying that a person who wears 1 or 2 white noise generators without tinnitus counselling won't gain any benefit because some people do. I am saying it doesn't follow the proper Tinnitus Retraining Therapy
protocol.

TRT, CBT are not a cure for tinnitus and will not work for everyone the same as any other treatment. However, if someone is going to try TRT and they are paying for this treatment then they want to know what they are getting is right.
In my opinion, I don't believe a person that is new to tinnitus should try TRT. Leave it for around 6 months preferably a little longer. Many people habituate to tinnitus within this time naturally without any treatment.
In the early stages of tinnitus, many people feel like they're riding an emotional rollercoaster. This takes time to settle. For anyone that is going to be paying for TRT and wants to know they are getting the correct treatment it is as follows. Anything less that a clinic offers you then I suggest, giving them a wide berth and go elsewhere.
Proper TRT treatment requires a person to wear two white noise generators and to be having regular counselling sessions with a Hearing Therapist. The treatment lasts from 12 to 24 months.

What happens in TRT treatment?
The Hearing Therapist talks to a patient in a controlled and precise manner so that the patient feels relaxed and not pressured. Over time the negative thinking that is often associated with tinnitus and hyperacusis is gradually dispelled and demystified. Therefore, it must be stressed and understood, this treatment takes time and is something that cannot be rushed.
The second part of the treatment requires the patient to wear two white noise generators for up to ten hours a day. They are first put on in the morning and the white noise set to just below the tinnitus, and then left alone. It can be tempting to turn up the volume when out on the street as traffic noise can make it difficult to hear them. Please don’t do this. Constantly adjusting the wngs volume will delay the habituation process. Over time the brain habituates to the white noise generators and pushes the tinnitus further into the background where it becomes less noticeable. This cannot be successfully achieved if the wngs is repeatedly adjusted throughout the day.
While the auditory system is being treated with white noise it is gradually being desensitised and treating the hyperacusis. White noise generators should not be used when going to sleep at night. When retiring one should use a sound machine by the bedside and the volume adjusted to a level just below the tinnitus. The sound machine should be set to play throughout the night until morning and this provides the brain and auditory system with sound enrichment.

 

@Agrajag364

White noise generators can lower the tinnitus volume over time. Habituation to tinnitus affects people differently. In many cases when a person habituates the tinnitus is reduced in volume.

The habituation process.

Habituation is frequently talked about in tinnitus forums and probably comes in at second place to the popular question: when will a cure be found? It seems some people have become quite taken with this word and believe it is the most important thing to strive for when dealing with this condition. Everyone wants to habituate as soon as possible and carry on living their life doing everything that they want to and putting tinnitus firmly behind them.

I can honestly say that I see nothing wrong with that, but wanting something in the speed that we would like it isn’t always achievable, especially with something like tinnitus. A few people that have had tinnitus for a while, have contacted me to discuss just that. They have concerns about the length of time it’s taking to habituate. Similarly, I have heard from those new to this condition that want the habitation process to start as quickly as possible. Both groups tell me they are doing all the right things but it seems patience is giving way to despondency and despair and some are starting to believe habituation might never happen for them.

It is of little comfort to these people when they hear family and friends say, tinnitus is just a minor irritant and something that can easily be ignored. Occasionally, it might be intrusive but this is never more than temporary and they are still able to carry on with their life unperturbed. I often sense the frustration a person is under when they are relaying this to me. Whether I’m talking to them on the telephone, private messenger or answering an email. It is then that I’m often asked: why is it that the habituation process doesn’t seem to be happening for them?

Answering such a question isn’t easy because there is no single answer that I can provide but I will say this. Tinnitus is a common condition that comes in many forms and intensities and no two people experience it the same. It can be very troublesome especially in the early stages of onset, but gradually this gives way and the condition settles down and in time many manage to cope with it when it’s mild or moderate. Sometimes this may involve treatment via a hearing therapist or a person achieves this naturally without being referred to a clinic.

It should be noted that tinnitus can be a complex condition, depending on how loud and intrusive it is for the individual? So what I’ve just outlined won’t apply to everyone. There are other factors that also come into play. A person’s make-up or rather their outlook on life. Whether they are positive or negative thinking can help or delay the habitation process. In addition to this, stress and anxiety are often associated with tinnitus and a person might be taking medication such as an antidepressant to help cope with it. There are a myriad of scenarios that I could relay to you on how tinnitus can affect someone’s quality of life, their well-being and the habituation process. For now I will say this:

When a person habituates to tinnitus it means they are able cope with it but this doesn’t mean they will never hear it. Although some people habituate to a level where the tinnitus is rarely heard or stays at a very low level. Whether the tinnitus is silent for periods of time or remains low, mild, moderate or is occasionally intrusive, it doesn’t really matter, because it all means the same thing. When habituation is reached a person will know, because whatever the level it will not bother you. However, like everything there are exceptions and tinnitus is no different. I believe there are some limitations to habituation. As I have previously said the condition comes in many forms and intensities. Some people have variable tinnitus that can fluctuate from silent, mild, moderate and severe. When it is loud and intrusive (severe) and this level is sustained for long periods it can become very debilitating and a person might have to take medication to cope with it, which is usually supplied by their doctor. This level of sustained intrusiveness shouldn’t be confused with a tinnitus spike, which usually returns to baseline within a short period of time.

I want to say that I believe habituation is achievable for most people with time. In some instances a person might need the professional help of a Hearing Therapist or Audiologist, as there are a variety of treatment options available to help one in the habituation process. One should also try to be realistic. There are some people that will accept nothing less than a complete cure from their tinnitus and this is unfortunate, because they could waste a lot of time being miserable.

I have corresponded with people that have said, their tinnitus is very low and is only heard occasionally or in a quiet room, at night for instance. Yet these people are not satisfied because they want a complete cure and will deliberately seek out quiet surroundings to monitor their tinnitus, checking to see if it has increased or not. It’s as if they have become obsessed with this condition and to the point where is starts to affect their relationship with those that are close to them, and I don’t think this is healthy.

In summing up I want to say one last thing. Those that are having treatment with a Hearing Therapist, Audiologist, or finding that their tinnitus is becoming less intrusive and they are in the habituation process. Try not to read negative posts or associate with negative thinking people who are not in the same place that you are, as their beliefs can prevent your advancement, if you are not careful.

I wish you well
Michael

 

If you want to waste your money I can PM you my Paypal

I say your money because I hope to God thats not taxpayer money.

 

I wouldn't have bothered with trt, not being super excited about the idea of habitation, without knowing my family friend and at least one other person online had a reduction in the actual volume rather than habituation. And mine has come down slightly in volume since I started with the maskers. Habituation as described by my boyfriend is more after years of having t he hears it only when he thinks about it. His brain has tuned it out like a fridge noise. Actual volume reduction is like when i go outside now and can't hear it on many days-irrespective of whether I think of it-and mine was LOUD at the start. Not all of that is the masker but I think those days are more common now. I also sometimes use the heating aid setting even though my hearing is normal. But it turns out the counselling was no more than relaxation advice.

The audiologist said as Michael did that the purpose is to get The brain to "push the noise into the background". I asked her whether that was habituation or a reduction in the volume. She said it was quite difficult to tell as often people would just say it was quieter. She said that sometimes they would come and give the Maskers back as the tinnitus had disappeared. She said this didn't happen in the majority of cases but it happened at times

So I don't want to spoil a good hobby of being sarky on the internet but sometimes things aren't so black and white as you think.

@Michael Leigh, many thanks for copying your post on habituation and trt. It's nice for you to be appreciated, I'm sure, so have you thought of self publishing your thoughts as a book on tinnitus?

 

@Agrajag364

For what it is worth (probably not very much), my guess is that your family friend and the other person online had reductions in their tinnitus volume that were going to happen anyway, and it was just coincidental that it happened during TRT. Just a personal guess as a patient though, nothing more.

I offer this guess without any particular knowledge, beyond having read many papers on TRT and I personally did TRT under the supervision of Pawel Jastreboff. So I have some personal experience as a patient, including long discussions / counseling sessions with Dr. Jastreboff. To the best of my knowledge, I do not recall even anecdotal evidence that TRT can reduce tinnitus volume. It is more about partial masking and habituation.

For me personally, TRT ended up doing the opposite - it INCREASED my tinnitus and hyperacusis. So if I could go back in time I wish I would have not done TRT. But TRT seems to help many people so it is difficult to know how to proceed.

 

WE WANT A CURE!

 

>"it's not what you think at all"
> describes exactly what I think it is

Don't worry you didn't spoil my hobby of being "sarky" on the internet.

 

So i describe something apparently that's helped me and others reduce the actual volume and to you this is bad and a waste of money. Where's the logic in that? Lol I don't think you even have tinnitus. It's the effects not process I said may not be so black and white as you think.

 

It's possible, but in the case of the older family friend, it was a dramatic and rapid reduction in volume soon after he started the maskers. Of course that's anecdotal but this is an Internet forum. It's appropriate to share anecdotal information. I used to work in scientific research and I still believe that. the quality of medical research is often so bad that often anecdotal information isn't useless

Really sorry yours got louder, that was a big concern for me in trying this too. I started off using the maskers for a very short time and built it up. I still don't do it for more than a few hours a day. It is worth saying it may well be the hearing aid that has helped my case even though I have normal hearing. And that is after I take it off as well. But in my case any improvement has been much less marked than the other cases i found


It is an outrage there are not better treatments for tinnitus. But pretty much any disorder of the brain is very badly understood right now. Pharma has thrown a whopping amount of money at Alzheimer's for example with no success. One day there will be treatments for tinnitus I am sure, but right now it's not alone in having barely any treatment

i'm lucky enough to have multiple health problems with no good standard treatment.

I'm beginning to see that others who had an actual reduction in volume might have left this forum pronto. Which is cheering.

 

Thank you for your kind words @Agrajag364

I wrote a 13,000 word book/article Tinnitus A Personal View https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/ after quite a few people encouraged me to do so. It was a difficult process for I had never done anything like this before and my tinnitus gave me a lot of trouble whilst writing it. I have a very severe and unusual form of tinnitus according to my ENT consultant and Hearing Therapist, for they haven't met any patients with my type of tinnitus. It took me 4 years to habituate the 2nd time. It ranges from complete silence, mild, moderate, severe and can reach extreme severe levels, requiring me to take clonazepam to calm it down as nothing else will work.

Therefore, under these conditions, I won't be attempting to write a longer book. Although, I will be starting a project soon, which involves writing about tinnitus and hope I will be able to complete it.

I hope your tinnitus continues to improve.
All the best
Michael

 

Really? I don't have tinnitus? Pray tell why do you think that?

And I'm sorry, but I doubt his volume reduced as a result of TRT. Everything's I've seen written about TRT suggests that it has no effect on volume or in some cases makes it worse.