Tinnitus Retraining Therapy

Ear level sound enrichment with open ear white noise generators or other neutral sounds through something other than closed ear sound buds is the only real critical aspect that has helped me. The counseling is more or less just pep talk and positive reinforcement. TRT is a 18 month program. If you do not habituate by then you get the luxury of paying $250 an hour for more pep talks.

 

I’m at about the point where I’d like to try TRT as well. The only thing holding me back, besides cost, is that there doesn’t seem to be any way to protect your hearing while wearing the noise generators. Wearing earplugs, which only further isolates your tinnitus, probably won’t help much with habituating either.

I’m just too terrified of everyday sounds to risk not wearing protection out of the house.

 

The issue is that placebo is treated like an actual, viable "treatment" leaving us progressive sufferers high and dry. Yeah I would love for my tinnitus to be stable and not spike permanently from chewing food. In fact, in my first 2 months my tinnitus was severe (could hear it over everything), but due to its stability I got over the "fight or flight" stuff that most people push in their TRT books etc rather quickly (a few weeks). I never even had the luxury of being able to mask it, but I was getting progressively better with time. Jastreboff has halted absolutely all research for 50 years because his nonsense was considered to be the only "treatment", and he constantly pushed that there will never be a cure and discouraged anyone from trying to even attempt research regarding the subject.

I don't mean to undermine anyone's suffering but if tinnitus is stable and can be masked by a fan, it shouldn't even be considered by anyone to be an issue and can be resolved with mental hocus pocus positive thinking etc, in my opinion. The fact that TRT "treatment" relies on copious amounts of time to pass just plays on people's ability to get used to things with time. I'm sick and tired of being told to do TRT when it obviously has made me worse due to it being considered a treatment for every case.

When I broke both my legs someone could have told me that slapping my leg with a carrot every day would heal me, then after a couple years I'd heal and then say that slapping the carrot is what healed me. Imo TRT is the same thing. Sure, some people when they do absolutely nothing don't get better, but doing something for mental health in mild/moderate cases is occasionally beneficial. The issue that I have with it is that it delayed any progress in any research for decades, rendering us catastrophic sufferers without anything, being told to use TRT when it had made us worse.

People can get better in 18 months without blasting their ears with white noise. Masking and sound enrichment just delays habituation and can make hyperacusis and tinnitus worse in some cases imo. It should not in my opinion be considered a "fix all" solution for most cases, especially those with hyperacusis.

 

Well that’s unfortunate. I guess my distaste for the US healthcare system has clouded my judgement on current healthcare systems in other countries. I’ll always see the healthcare of another country (preferably Nordic ones) as better by default.

 

I did not say sound therapy wasn't an important part of TRT and agree with you that it is a crucial part of the treatment but, it is not as important as the counselling. I have had TRT twice, each treatment lasted two years and believe I have sufficient knowledge and experience of it which has enabled to help people affected by tinnitus and hyperacusis.

One can be listening to sound enrichment 8 hours a day using white noise generators, a sound machine or another device to deliver sound therapy. However, treatment for tinnitus and hyperacusis first starts with the mind and positive thinking.

Good quality counselling with an audiologist/hearing therapist, helps to dispel and demystify the negative thinking that is often associated with tinnitus and hyperacusis.

Please go to my started threads and read my posts: Tinnitus and the Negative Mindset, Acquiring a Positive Mindset, The Habituation Process, How to Habituate to Tinnitus, Habituation and Tinnitus Treatments, The Complexities of Tinnitus and Hyperacusis.

Once you read these articles then you will understand how important counselling and in some cases medication are in the treatment of tinnitus, because it is an integral part of our mental and emotional wellbeing and cannot be separated from it.

Sound therapy is important and needs be delivered correctly, but it will not be effective if a person is overly stressed or depressed by tinnitus and hyperacusis. Counselling and medication (if needed) can help alleviate these symptoms.

Michael

 

Actually me too. Pretty much all Europe has universal and "socialized" healthcare. (I mean, even Italy that everyone thinks as a peasant; I went to the ER during Christmas break and they gave me an appointment with an ENT within 10 days, and despite the fact that I am not anymore member of the social insurance or whatever it is called because I live abroad, I paid nothing), France has a very well-functioning system; Sweden had one too, but now it is dangerously evolving towards something more hybrid (even though private healthcare providers are still rare here). The public sector has been mismanaged, underfunded and short-staffed for a long while, and if they do not turn the tide soon a breaking point is going to be reached in a few years...

 

Indeed, it is hard to be positive from what you have described, since tinnitus comes in many forms and intensities and no two people will experience it the same.

Hyperacusis behaves in a similar way, because no two people will experience it the same.

It all depends how a person's mental and emotional wellbeing is affected by one or both of these conditions. Some people will require counselling with an audiologist/hearing therapist and if necessary medication to help keep their mind on an even keel. Once this is addressed, the correct use of sound therapy though white noise generators can often improve the quality of a person's life.

It does take time because this is not a quick fix.

Michael

 

I'm 3 years in of hearing tinnitus over everything. Variable as can be. Super uncool, painful, and frequently challenging. The only thing I have any control over with this condition is keeping a positive attitude.

My experience is that there is no treatment at all. I even went to psychologists to share the burden and get schooled in CBT only to be told that I was already applying CBT principles and was mentally healthy, just suffering from an incurable painful condition.

There is no treatment for me; I've gone to energy healers in the West, traditional healers in Bali, audiologists, ENTs, neurologists, Lenire, hearing aids (6 months using them with sound therapy), none of them is worth spit. The only thing that works to mitigate suffering is to keep a positive attitude, chill out be as mentally and physically healthy as I can, not obsess (as much as I can), fail, pick myself up again, and soldier on. It's not the way I would have chosen to live, but the only choice I have it to stay on this plain of existence with this condition or move on. Eventually you get better at bearing the pain. If TRT, the process of it, the placebo of it helps convince people to soldier on, god bless it. If you can convince yourself that something is going to help you, if you can convince yourself that you are having a good day in spite of the phantom noises in your head awesome, if TRT can be that tool that helps you feel like you can bear it when before you didn't think you could, that's as good as tinnitus treatment gets.

 

I meant have something that emits sound in the background, at a lower level than tinnitus to help take the focus away from the tinnitus, rather than getting in-ear maskers.

 

It wasn't masked by the fan. I still heard my tinnitus. I used it in place of WNGs so that instead of being in complete silence, there was another sound.

 

I'm not sure what piqued your interest in my post but I am sensing a small bit of defensiveness. I was responding to @Uklawyer and his response which I think had you tagged in it, but it was directed toward him, not you. I am glad that you are here sharing your experiences with TRT.

 

Still not sure what you mean with this post after I had mentioned how alarming tinnitus can sound when going from sound enrichment to no sound enrichment:

 

My mistake please accept my apology. Thank you for your thoughts and the clarification.

All the best,
Michael

 

@Watasha, I said I was worried about taking a step back using sound enrichment.

You said tinnitus can sound louder when you go from sound enrichment to no sound enrichment. If that is just the contrast, and that is understood by the brain, then that is fine. But if that difference is picked up by the brain and is latched on to, then perhaps it could worsen the situation.

I had a taste of something yesterday when I played white noise for an amount of time. It was not pleasant. That would make me hesitant about using sound therapy with WNGs (plus the fact that it has, apparently, made some people worse and is generally expensive (as part of TRT)).

 

No worries, I'm thankful for all of your thoughts and time. Since we're here, what do you consider the difference between TRT and CBT if you wouldn't mind sharing?

 

Got it, makes sense. That may be one of the important pieces of the directive counseling, to reframe thoughts back to the logic and rationality. But I'm with you, at a minimum I believe that sound enrichment set below tinnitus is more helpful than not, even if it's not WNGs. I think the additional stimulus is supposes to have some neuronal effects in facilitating habituation.

 

Like TRT, CBT is a recognised treatment for tinnitus. I had a very brief spell of it in 2010 with my hearing therapist after I had TRT for two years. I think it's best you look up information online regarding CBT for tinnitus. It will give you more accurate and update information on the treatment.

Michael

 

And yet I recall reading a study that suggested that listening to unstructured white noise may cause further maladaptive plastic changes. The study recommended listening to music or sounds with full spectrum of sounds rather than listening to a selected frequency. I think I would agree with this.

Whenever I have tried wearing WNGs, I have ended up with a spike; even after working up to wearing them for longer periods. Listening to white noise as sound enrichment seems to have the same effect.

These days, I try to imagine my tinnitus is an external noise, in an attempt to trick my brain.

 

But Watasha actually asked about your opinion and experience, because you have a history with TRT counseling. And now we know that you briefly had CBT as well, so you can probably share what you think about how the two "recognised treatment for tinnitus" differ.

I am curious, have you ever thought that for you maybe just time did its thing and not TRT was the key in habituation? Research did not find significant difference between the effectiveness of TRT, standard of care and placebo.

 

You make a valid point. I do have extensive history with TRT having had the treatment twice for the full duration. My tinnitus changed in 2008, after years of habituation with it extremely low for most of the time. It changed to variable tinnitus reaching incredibly high levels of severity. According to my hearing therapist and ENT consultant, they don't see many patients with this type of tinnitus.

TRT the second time helped but it wasn't as successful as when I first had it in 1996 and finished treatment two years later. One must try to understand that variable tinnitus is a completely different kettle of fish to normal noise induced tinnitus. I have explained this in my post: Can I Habituate to Variable Tinnitus? It is on my started threads.

I had CBT for just one month and therefore, don't think I can give a fair account of the treatment or my experience with it, for it to be of value to anyone. I am not here to bash CBT or TRT and say they don't work because I believe they do and will not be discussing it further.

My advice to you and others that spend your time reading research papers that say CBT and TRT aren't effective and is a placebo, to stop it and direct your thoughts to more positive things in your life. Reading such material is a sure way for you not to make any progress with tinnitus, as it can instil a lot of negative thinking.

One Tinnitus Talk member who is a frequent poster has said, they are about to start CBT and wearing white noise generators and yet, this person has been quick to tick a "Like" when someone said CBT is a placebo.

I wish you well,
Michael

 

CBT is literally placebo. It makes people calm down with positive thinking etc. TRT is also placebo, only success is to calm people down. Which only works in cases where tinnitus is stable and doesn't get worse constantly. There are people which this doesn't work for and calling it a legitimate "treatment" is ignorant. Telling someone whose tinnitus gets 50% worse every day to "think positive" and "focus on positive things in life" is an insult.

 

Continue beating the negativity drum. I am not here to duel with you.

Goodbye.
Michael

 

That is not "continuing beating the negativity drum". That is his reality that he worsens every day from as little as whispers. To claim that he can beat this with optimism is insulting and it is a textbook case of toxic positivity. He and many other people need a cure and legitimate treatment.

Futile, I know, to "duel" about TRT, because none of us will persuade the other, but telling people who are inhumanly suffering to focus on the positive seems to be very ignorant.

 

I am entitled to my opinion and was replying to you, not to @AnthonyMcDonald. If he feels my comments were an insult, I have no control over that, but stand by what I have said.

Please excuse me as I have important matters to attend to.

Goodbye,
Michael

 

To Kriszti:

Do you know that when a wasp invades a bee's nest the bees do not directly fight it but confine it by walling it up with their wax?

This is what I have learned to do regarding Michael Leigh. He is unfortunately there but not really there at all in my conscious awareness.

It never occurs to him that by manifesting such behavior he is the worst advertisement imaginable for the so-called success of TRT; if this is what it turns you into, then I want no part of it.

The crowning irony is that by such behavior he is unwittingly revealing himself to be one of the saddest examples of how this condition can irremediably warp one's personality.

 

Listening to @Michael Leigh's advice is actually what made me considerably worse. I honestly think he is a danger to the more severe sufferers and there should be a warning before everything he posts that his advice only applies to mild/moderate cases with little or no hyperacusis.

 

@Michael Leigh, this may be an unanswerable question, but do you suppose that Tinnitus Retraining Therapy is something that could be coordinated effectively online, between patient and practitioner?

A family friend has been suffering with hyperacusis symptoms for a couple of months but has been unable to find anyone in their Eastern European home nation who offers the therapy, and feels they have exhausted every possible avenue there.

So the potential for liaising with an audiologist in another country has been discussed, but we've no idea whether this would be viable. I suppose lack of physical access to equipment would be the primary barrier, but perhaps this could be overcome somehow. Appreciate your thoughts regardless of conclusions!

 

Thank you for your enquiry. I hope that I can be of some help.

Hyperacusis and tinnitus are complex conditions and affect people in many different ways. I do not believe TRT or CBT can be successfully administered to a high quality through online consultation, because they involve in-depth counselling over many months which is best done face to face.

Since your friend has had hyperacusis for just a couple of months, it is far too soon to be starting TRT or CBT. Hyperacusis usually but not always accompanies noise induced tinnitus. Therefore, I recommend following some of the advice in my articles on tinnitus and hyperacusis.

Please go to my started threads and read the following posts: New to Tinnitus, What to Do? Tinnitus, A Personal View, Hyperacusis, As I See It, The Habituation Process, How to Habituate to Tinnitus, Will My Tinnitus Get Worse? What Is TRT and When Should It Be Started?

My advice is not to use any type of headphones, including earbuds or headsets even at low volumes.

All the best,
Michael

 

Thank you Michael, I suspected that this might be the case, but appreciate your insights and advice - will do.

 

@AMe, I disagree with both of these statements at least where it comes to CBT. CBT is merely learning and practicing techniques to modify your behavior and response. While I'm sure doing things in person is preferred, doing classes, trainings, meetings, and telemedicine online is what the whole world has been doing for the last two years, perfectly serviceable way to get CBT or training on most anything really.

In terms of waiting on CBT, if your friend has been in pain for a couple months, why wait? Working with someone who can instruct in techniques that can help decrease panic, depression, and stress responses seems like a fine thing to get going on, and it is something that may help improve quality of life right away. Other than the expense of seeing a practitioner I can't think of a single good reason why your friend shouldn't explore CBT immediately.