Tinnitus Retraining Therapy

This may be a shot in the dark, but I was wondering if anyone out there is aware of a reputable TRT program in Orange County, CA? Maybe even in Los Angeles? It would be ideal to have a little bit of feedback from fellow patients before looking into/investing in any kind of treatment. Anything would be welcome. Thank you.

 

@Dr. Nagler should be able to help you. But I did find a link for TRT at the University of San Francisco. It's not close, but if you call they might be able to direct you to someone nearby.

http://www.ucsfhealth.org/conditions/tinnitus/treatment.html

From their website:

Auditory Habituation or Tinnitus Retraining Therapy
These techniques consist of two main components — directive counseling and low level sound generators.

• Directive counseling provides intensive, individualized education regarding the causes and effects of tinnitus on the ear, the brain, and the coping mechanism.
• Low-level sound generators produce broadband noise via hearing aid type devices at a soft enough level so that the brain perceives both the noise and the tinnitus. Eventually, the brain may relearn a pattern that will de-emphasize the importance of the tinnitus. These devices also may be helpful in desensitizing patients who are overly sensitive to sound.

 

This is the one tinnitus site that I've found to be more useful than any other (apart from Tinnitus Talk, of course!). There is an audio file of a TRT counselling session that you can download, along with accompanying diagrams. It's hard going to listen to -I find the voice rather monotonous - but I found it's worth taking the time.

http://www.tinnitus.org/counselling_session.html

 

Will TRT work on multi tonal tinnitus?

 

Yes.

TRT focuses on reaction, not on the tinnitus signal itself.

Stephen Nagler

 

Thanks for the response Dr.Nagler.

 

Maybe you should consider TRT? That's what I did, anyway.

smn

 

Absolutely. I plan on it. I have the gens, I now just need a good clinician.

 

What kind of wearable devices do you have?

Stephen Nagler

 

Will TRT work only if you have T in one ear Dr. Nagler?

 

One ear, both ears, in the head, single tone, multiple tone, pulsatile, non-pulsatile, fluctuating, constant, etc., etc. It doesn't matter, because TRT addresses reaction.

So everybody get ready to eat whatever you want!

smn

 

I've been reading the book on TRT (not cheap at $60) and enjoying learning more about the theory about how tinnitus is created. I have a few questions:

1) I haven't read much yet about Neuromonics, but it seems to be based on the same concept as TRT...that the brain needs to be retrained regarding tinnitus. Is this correct? What are the similarities and differences between neuromonics and TRT?

2) I went to what I think is the "official" TRT site (http://www.tinnitus-pjj.com/) but it seems to be out of date. Does this mean TRT is outdated? Has it advanced into something better or new?

3) How does one find a TRT practitioner that is legit? Are practitioners certified in TRT?

 

Hey tony check out @Dr. Nagler section in the Dr's corner. He posted an answer about your first question.

 

https://www.tinnitustalk.com/threads/neuromonics-vs-trt.4288/

 

Thanks, that link pretty much answered my questions. Do these discussion boards allow us to "promote" it to some kind of FAQ?

So, there is no certification of TRT clinicians. That's a bit worrying since I can ask doctors the questions he suggested, but will never really know if I got the "right" doctor. Fortunately, the TRT website lists a doctor in my area, so I will give him a try.

The only question I really have is why isn't the TRT website a bit more updated. I have programmed websites and would offer to update it for free to make it look a lot less dated!

 

So if TRT improves your reaction to T, I assume TRT will improve your sleep also? That is, your brain will listen to the T while sleeping and view it as a neutral sound. What are your thoughts Dr. Nagler? Thank you.

 

Unfortunately TRT doesn't work for everyone. Some say that food makes no difference and people with tinnitus who have tested foods at length and know that nothing they have done, ie. adding new foods or avoiding certain ingredients, has reduced the volume or given them silence, are justified in stating that changing their diet made no difference for them. But the key here is 'for them'. They are not justified in stating that it would make no difference for others.

It is thought that there are many, many reasons for T onset and even just by reading Tinnitus Talk it is obvious that T varies from person to person. Some have it continuously and some, like me, have T that comes and goes away completely. Different causes, different symptoms and different reactions to food and medicines.

After reading many issues of the British Tinnitus Association's 'Quiet' magazine I found that they basically only advocated TRT and masking/hearing aids as forms of 'self help'. I found their articles and stories depressing and so contacted them with the revelation that, for some people, controlling diet can control tinnitus (for 95% of the time). They dismissed this as it was 'unproven'. Surely they, and all of us, should be listening to people who have tinnitus and have managed to control it?

I realise that advising people who have recently aquired T to 'watch what they eat' may be a bad idea (although I wish that someone had advised me back in those frightening first few months) as it can then increase their anxiety, but, for those of us who are no longer in constant panic mode, it's a worthwhile thing to try.

Over two years of tinnitus for me has included more than a year of documenting every food ingredient that made the volume louder. It's a complex business because my tinnitus has changed dramatically a few times and with those changes came different effects from food. But my god it was worth it. Avoiding those foods has made life wonderful again.

 

Dear Dr.Nagler,

I like your explaination of TRT in this and other threads. Kindly allow my questions as follows:

1.if T becomes so loud that it supress the daily talk/surrounding noise/etc all the time,will the person still be able not to react ,and be indifferent in front of it?

2.It seems TRT is a bit like turning to a hypnosis/psychology specialist.Only if I find a capable TRT specialist and he/she 'matches' me,then I may get relief. As there is no objective clear standard/regulation in TRT,and many uncapable doctors can still earn a lot of money through it without any consequences to be responsible of .Right?

3.From your experience,in the long history what is the situation of the majority of severe tinnitus sufferers(esp. many old people whose hearing is poor and tinnitus is loud)? most of them are habituated without big trouble,or using mask/device/etc to go on life,or whatelse ?Thank you.

Jacob

 

The questions will give you a good feel for whether or not you are in capable, knowledgeable, and experienced hands.

Please keep in mind that except for the first visit TRT can be done long distance (e.g., via phone or Skype). So geography really is not as much of a barrier as it may seem. A couple of months ago I saw a TRT patient from Hawaii - that's 4500 miles from Atlanta.

It's also important that the clinician be able to recognize when TRT is not indicated. For instance earlier this week I saw a charming gentleman from another state (who actually found me on this board!) As it turns out he had a lot of questions and was harboring a few misconceptions - but he didn't need TRT at all.

Updating the site is not a priority for Dr. Jastreboff as long as the information is accurate, which it is.

Stephen Nagler

 

Better stated, TRT facilitates the attenuation of your reaction to tinnitus.

Only if your sleep problem is due to your tinnitus.

Stephen Nagler

 

@Jacob_zjm posted:

Kindly allow my questions as follows:

1.if T becomes so loud that it supress the daily talk/surrounding noise/etc all the time,will the person still be able not to react ,and be indifferent in front of it?

.................

It's not quite as simple as that. If you cannot hear what is being said to you over your tinnitus, then you likely need hearing aids and would be treated as a TRT Category 2 patient.

...................

2.It seems TRT is a bit like turning to a hypnosis/psychology specialist.Only if I find a capable TRT specialist and he/she 'matches' me,then I may get relief.

.....................

I'm not sure what you mean by "matches" you. Clearly you need to be able to effectively communicate with each other, if that's what you're referring to.

.......................

As there is no objective clear standard/regulation in TRT,and many uncapable doctors can still earn a lot of money through it without any consequences to be responsible of .Right?

......................

Right. Except that there really isn't much money in TRT. There's much much more profit to be made dispensing hearing aids - with a lot less time and hassle.

Anyway, I wrote about TRT over on the Doctors' Corner so folks would have a basic understanding of the pros and cons.

................

3.From your experience,in the long history what is the situation of the majority of severe tinnitus sufferers(esp. many old people whose hearing is poor and tinnitus is loud)? most of them are habituated without big trouble,or using mask/device/etc to go on life,or whatelse?

....................

Some habituate to their satisfaction over time. Some don't. I personally have had three patients who suffered terribly from severe intrusive tinnitus for more than twenty years, but who within one year of starting TRT were doing great!

Stephen Nagler

 

Right. TRT's success rate is only 85%.

The British Tinnitus Association takes no official position on any treatments. And TRT is not in any way "self help."

Stephen Nagler

 

@Dr. Nagler they are from the company amplisound

 

Seriously, they should be fine for your purposes. All the best with it.

smn

 

Thank you for confirming that I was correct in saying that TRT doesn't work for everyone.

This may well be their 'official' stance. I can only reiterate that their magazine is full of articles about TRT and masking and that they told me that they had no intention of letting their readers know that some people with tinnitus find that changing their diet improved their tinnitus dramatically.

A little pedantic don't you think? A major part of TRT is learning about the mechanisms of tinnitus (demystification) and I choose to define that as 'self help'.

(BTW - I've posted this reply as you specifically replied to my previous post but I'm not here to argue. I respect any opinions you may have but I won't be continuing to reply to this stem of the discussion.)

 

A major part of being treated for gonorrhea is walking into the doctor's office to get a penicillin shot, so using your argument I'll choose to define that as 'self help' as well. You don't walk into the doctor's office, you don't get the shot!

smn

 

Dear Dr.Nagler.

Many thanks for your detailed reply. The essence to win over T that I learnt from all your former threads is TRT + 'I don't care'. Now I just realized TRT is also aimed to build the ability of 'I don't care'. It is really cool if we finally have this ability,as naturally our hearing will become poor and T become louder with time goes by. So,my only thinking is, TRT may not be the only way to realize 'I don't care',we can achieve this by the power of psychology,philosophy,pypnosis,etc right? as for TRT,we may run the risk of finding a 'wrong' doctor. We may try different ways to develop this super ability,which may also help us to face other difficulties in life besides T.

Best Regards
Jacob

 

It is possible with TRT that the tinnitus goes away or it is always still there but people just habituate to it? I was wondering if you do eventually habituate to it, maybe the brain stops sending the false signals? Is that a possible outcome?

 

Even though our hearing deteriorates over time, tinnitus tends not to become louder - because (thankfully) the brain overcompensates. Thast phenomenon has nothing to do with TRT.

TRT is a predictable way to facilitate habituation, but it is not the only way.

Stephen Nagler

 

TRT facilitates habituation of tinnitus.

If you ever achieve the lasting state wherein you cannot detect tinnitus upon purposely trying to hear it, that would be a cure. TRT is not a cure.

Stephen Nagler