Tinnitus Retraining Therapy

Stink · Mar 26, 2015

undecided said: ↑

And there are some truly hilarious funds such as:

Music to Treat Tinnitus (3 Year Grant)
Richard S. Tyler, Ph.D., University of Iowa, Iowa City, IA
n/a $102,580

I mean, a hundred grand for friggin music. It'd be funny if it wasn't such a complete waste.

Be reminded that ATA is/has been directly influenced by people such as Jastreboff, Vernon, Nagler etc.
Click to expand...

tyler is a gigantic TRT supporter

FISHY...

attheedgeofscience · Mar 26, 2015

For those interested, @Dr. Nagler did an extensive comparision of TRT vs. Neuromonics some time ago:

In this review I will try to highlight the similarities and differences between Neuromonics and TRT (Tinnitus Retraining Therapy). While both approaches involve sound therapy and some form of counseling, there are, indeed, many differences between the two.

One of the most important differences lies in the fact that Neuromonics is a for-profit company; whereas TRT is a treatment. The Neuromonics company wants as many audiologists as possible to recommend Neuromonics devices to their patients as often as possible – because that is how the Neuromonics company makes a profit and keeps its stockholders happy! There is no TRT company encouraging audiologists to recommend TRT. It is true that wearable devices are often used in TRT, but the companies that manufacture such devices are hearing aid manufacturers. Income from the sale of devices that can be used in TRT typically makes up a very tiny percentage of these manufacturers' profits, whereas income from the sale of the devices used in Neuromonics makes up 100% of the company's profits. In fact, I am not aware of a single device manufacturer in the world that is promoting or advertising TRT to audiologists or to tinnitus sufferers. Contrast that with Neuromonics, where the entire focus is on promoting and advertising Neuromonics devices to audiologists and to tinnitus sufferers.

Neuromonics currently makes three different devices. Their flagship device is the Oasis, which is the unit that provides proprietary spectrally-enhanced music tailored to the user's audiogram. Neuromonics has also come up with some lesser devices, the Sanctuary and the Haven. The company refers to the Oasis as their "gold standard" device, which presumably gives the best results or else why refer to it that way? For the purposes of this discussion, then, when I talk about Neuromonics, I will be talking about the Oasis device. After all, the only reason a tinnitus sufferer would consider Neuromonics or TRT in the first place is because of the results they hope to achieve.

So let us discuss the proprietary (which basically means "secret") spectrally-enhanced music tailored to the user's audiogram that is the nuts and bolts of Neuromonics. The original concept of using spectrally-enhanced music was developed by audiologist Paul Davis while working towards his Ph.D. in audiology. Basically Neuromonics uses an algorithm that makes the music louder in the frequency ranges where your audiogram shows some hearing loss – and they mix in some "white noise" at the earlier stages of treatment. You listen to this music two to four hours a day. You do not have to concentrate on the music, but you are not supposed to drive a car or exercise when you are listening to it. Your audiologist can monitor how much you are using the device through the software platform and can also make various adjustments to the music, including whether or not to add in the white noise. You are supposed to use the device throughout the treatment period, which can be several months to a year (or possibly longer). The Neuromonics folks cite a number of internal studies that purportedly show that the proper use of their Oasis device will yield a higher success rate in a shorter period of time compared to broadband sound (like the sound used in TRT). The best truly independent study I can find was published in the Journal of the American Academy of Audiology in 2012. The investigators, Dr. Craig Newman and Dr. Sharon Sandridge are very experienced and highly respected in the audiological community. Their study, which was completed at the world-renowned Cleveland Clinic, found no therapeutic advantage to Neuromonics over broadband sound whatsoever. Specifically, in contradistinction to the company's claim, there was no difference in success rates, nor was there a difference in the time it took to achieve success. What the study did find was that Neuromonics was considerably more expensive. But let us set that particular independent study aside for a moment. To the best of my knowledge, even the Neuromonics folks have never run a controlled study demonstrating a therapeutic advantage to using their propriety spectrally-enhanced music played through an Oasis device over a similar music selection that is not altered in any way and played through an inexpensive MP3 player made to look like an Oasis device. And to be honest with you, that really bothers me – because such a study would be easy to design!

One more word about Neuromonics, and then we will turn our attention to TRT, which itself is certainly not immune to legitimate criticism. Neuromonics was first conceived of as a technology-driven approach to tinnitus habituation. TRT employs sound therapy and a one-to-one educational program called TRT counseling to facilitate habituation. (More about TRT counseling later on.) Anyway, the Neuromonics folks figured that if they could cut way down on the one-to-one educational piece and accomplish the same end, then audiologists could sell more and more devices while investing considerably less time per patient, a concept that would be extremely appealing to audiologists and, more than that, to the company's stockholders! So instead of the counseling piece, Neuromonics came up with something they referred to as bibliotherapy: They would give the patient a book to read about tinnitus, and call it counseling. The problem was that the bibliotherapy approach really did not work as well as intended. Indeed, it became readily apparent to many in the clinical community that those audiologists who had been trained and experienced in TRT counseling were having better results with Neuromonics than those who were doing the bibliotherapy – because the TRT clinicians were putting the same amount of time and effort into counseling their Neuromonics patients as they were with their TRT patients, and because they were basing much of their Neuromonics counseling on the same principles used in TRT counseling.

On to TRT, a treatment protocol devised by Dr. Pawel Jastreboff and based upon Dr. Jastreboff's Neurophysiological Model of Tinnitus, which he first described in 1990. The details of the model are not crucial to this discussion, but it is of value to understand its fundamental principle: In clinically relevant bothersome tinnitus neurological systems other than the auditory system are dominant (PJJ, 2012). The most important of these systems are the limbic system (emotion) and the autonomic nervous system ("fight-or-flight").

Where did the name "Tinnitus Retraining Therapy" come from? Consider for a moment the chair you are likely sitting in right now. You have been sitting in it for quite a while, but until I mentioned it to you, you have been unaware of the pressure of the chair against your buttocks. You might have been aware of it just as you sat down, and you are aware of it now that I am pointing it out to you, but other than that you have been unaware of it. And within a few moments I can pretty much guarantee that you will be unaware of it again – unless I draw your attention to it. One might say that the reason you are unaware of it is that you do not react to it. And the reason you do not react to it is that your brain classifies it as a neutral stimulus. The brain, even the brain at rest, is a very complex and busy organ. As such the brain must prioritize. The brain simply cannot attend to everything at once – so it places neutral stimuli way down on its priority list. What does all that have to do with tinnitus? Well, like the pressure of the chair against your buttocks, tinnitus is a stimulus. Of course, it's an internally-generated stimulus instead of an externally-generated one. And of course, there are a number of aspects of your tinnitus that make it far far different from the pressure of that chair. But in the final analysis, it is a stimulus, and if your brain can somehow be retrained to classify your tinnitus as a neutral stimulus, then you should largely cease reacting to it, and it should largely fade from your awareness unless you purposely seek it. Just like the chair. And that is where the name Tinnitus Retraining Therapy came from.

As with Neuromonics, there are a number of TRT studies available for review; however, since there is no TRT company, none of those studies is internal. And even if you throw out Dr. Jastreboff's own studies on the grounds of potential bias, the others all pretty-much conclude the same thing – a success rate in the neighborhood of 85% with success defined as a significant decrease in reaction to tinnitus (Hr) and a consequent decrease in perception of tinnitus (Hp). TRT does not claim to make tinnitus less loud. It does, however, make it less bothersome regardless of how loud it might be (i.e., you react to it less.) The implication cannot be overstated, because – due to prioritization within the brain – a decrease in awareness is an inescapable consequence of a decrease in reaction. And if you are not aware of your tinnitus (see the chair example in the above paragraph), then what does it matter how loud it is?

TRT is a very specific protocol. It starts with an evaluation during which a person's "TRT category" is identified by his or her TRT clinician. There are five distinct TRT categories, which are inconveniently numbered 0 through 4. The numbering does not reflect severity; rather it is based on the presence or absence of hyperacusis, hearing loss, and a variety of other auditory factors. Sound therapy and TRT counseling (which used to be called "directive counseling") are the two essential elements in TRT. The particular form of sound therapy as well as the specific TRT counseling strategies are dictated by the TRT category. Thus, for instance, a Category 2 patient would receive completely different sound therapy and counseling recommendations from a Category 3 patient. Regardless of TRT category, the counseling is consistent with the Neurophysiological Model of Tinnitus and involves an in-depth description of the rationale behind habituation as well as how and why the brain classifies stimuli. The counseling involves an initial session and two to four "follow-up" sessions throughout the course of treatment – generally six to twelve months. The sound therapy might involve environmental sound, hearing aids, wearable broadband sound generators, or some combination thereof as determined by the patient's TRT category. The sound generators emit a soft "shhhhh" sound, the volume of which can be adjusted by the wearer, who is carefully instructed in how to set them each morning. The end result of the instructions is that (1) the sound does not suppress the tinnitus in any way, (2) the sound is not annoying, (3) the sound does not interfere with communication, (4) the sound does not elicit the stochastic resonance phenomenon (which can actually aggravate tinnitus), and (5) within the aforementioned constraints the sound maximally facilitates habituation. The specific details of how sound therapy is employed in each TRT category and how devices are set (for the categories requiring devices) for each is well-described in a number of publications and is beyond the scope of this review. Suffice it to say that when wearable devices are used in TRT (a) they are inconspicuous, (b) they are comfortable, (c) the sound they emit is not annoying, (d) the sound they emit does not interfere with communication, and (e) within a few minutes the wearer becomes oblivious to them. The devices are worn as much as possible but for at least eight hours a day – but since the wearer quickly becomes oblivious to the devices and to the sound they emit, that is largely irrelevant. As with Neuromonics, at the conclusion of TRT the devices are no longer needed.

What is the difference is cost to the consumer between TRT and Neuromonics? Clearly there is considerable variation in this regard from clinic to clinic. But if you include the cost of evaluation, testing, counseling, all follow-up, and the device (the Oasis for Neuromonics and a pair of wearable broadband sound generators for TRT Categories 1, 3, and 4), Neuromonics generally runs along the order of $1500 to $2000 more than TRT.

Is Neuromonics more successful and quicker than TRT? The Neuromonics people would like you to think so, but the independent Cleveland Clinic study referred to earlier in this review concludes that there is no difference in either regard between the spectrally-enhanced music produced by the Oasis device and the broadband sound used in TRT.

Why is Neuromonics seemingly more popular among audiologists than TRT? Let us assume that you are a fully-trained and licensed audiologist who is interested in treating tinnitus patients.
(1) You can contact the Neuromonics company, and they will offer to provide what is essentially a turn-key operation for the tinnitus part of your audiology practice. Moreover, they will provide all of the training you need at no cost. The training does not include instruction in TRT-type counseling.
- or -
(2) Since there is no TRT company to contact, you can purchase a book on TRT and take a three-day intensive TRT course wherein in addition to sound therapy a great deal of emphasis is placed on TRT counseling. These courses (currently taught by Drs. Pawel and Margaret Jastreboff) are offered a couple of times a year in Maryland and will cost you around $2200 tuition in addition to hotel and travel.
The TRT courses include extensive instruction in counseling techniques based on the Neurophysiological Model; the Neuromonics folks tell you that their treatment approach is technology-based and requires no such counseling. The Neuromonics folks tell you that Neuromonics is quicker and more successful than TRT, but they do not tell you that the Cleveland Clinic study says otherwise. Nor do they feel any obligation to tell you that experienced tinnitus clinicians have found that Neuromonics patients do better if TRT-type counseling is included as part of the treatment. And that about sums up the answer to the question posed at the beginning of this paragraph.

On the positive side for Neuromonics, the name is trademarked. You cannot purchase a Neuromonics device from anybody other than a hearing healthcare professional who has gone through the Neuromonics training program, so there are some built-in quality controls in that when you "do" Neuromonics, you are undergoing the treatment protocol as intended by Neuromonics. Moreover all adjustments to the spectrally-enhanced music are controlled by the technology. So with Neuromonics, what you see is what you get.

With TRT, since the name is not trademarked, what you see is in many cases not what you get. And to my way of thinking, that represents an enormous problem for the tinnitus community. Anybody can call himself or herself a "TRT clinician." Moreover, since there is no credentialing or standardization in TRT, even if a clinician has read Dr. Jastreboff's book and taken his course, there is no assurance that he or she has retained the material or even understood it in the first place. Thus, not only are there many more Neuromonics clinicians than TRT clinicians, the challenge for tinnitus sufferers interested in TRT is further complicated by the aforementioned lack of credentialing and standardization. It should be noted that there is a "TRT Association" with members listed on Dr. Jastreboff's website, but Dr. Jastreboff makes a point of stating that it should not be treated as a referral list and that being a member of the TRT Association is not equivalent to certification. As I see it, at best the list should be viewed as a starting point. Moreover, I would be concerned about going to a clinician claiming to be "certified" in TRT. Such certification simply does not exist.

If I were considering TRT, I would want to know where and when the clinician actually took a TRT course. I would also want to know if he or she was using the original TRT protocol or some sort of "variation" of TRT. (Variations of TRT might or might not have merit, but they are not TRT and should not be expected to necessarily yield the same results.)

If I were considering Neuromonics, I would want to know if the treatment program was primarily based on the Oasis technology or if counseling about habituation was included (and, if so, how much?)

And while I am on the subject of questions to ask clinicians, regardless of the approach they are offering (TRT, Neuromonics, cognitive therapy, whatever), there are some very important questions prospective patients should be asking:
· What is the approach the clinician is recommending and why?
· What type of training has the clinician undergone in the use of that approach?
· How long has the clinician been using the approach?
· How many tinnitus sufferers has the clinician treated with the approach?
· What is the clinician's success rate using the approach?
· How does the clinician define and measure success?

What if after considering both TRT and Neuromonics, you have decided on TRT, but after carefully researching the matter and making a number of phone calls, you have concluded that there are no truly knowledgeable and experienced TRT clinicians in your geographical vicinity? Well, those who do a lot of TRT are often set up to do the two to four follow-up counseling sessions by telephone or Skype. Only the initial evaluation-fitting-counseling session need be done in person. Beyond that single visit there is generally no need to contemplate any traveling.

What if you are partial to the idea of listening to music as opposed to playing soft broadband sound in the background? Recall that the broadband sound used in TRT is purposely adjusted so that it is not at all annoying, and recall that within a few minutes you become unaware of it. But that said, if you have a strong preference for music and do not mind the additional cost, then Neuromonics may be the better choice for you.

Both TRT and Neuromonics are effective protocols for facilitating the habituation of tinnitus. Each has advantages and disadvantages. I hope that this review has provided the reader with some tools that will help in the decision process.

Dr. Stephen Nagler
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Source: www.tinnitustalk.com/threads/neuromonics-vs-trt-tinnitus-retraining-therapy.4288/#post-46144

svintegrity · Mar 26, 2015

@Stink It is not so much that any sound therapy would be bad for me, but that the Neuromonics CEO told me he didn't care that I was having adverse effects, and wouldn't answer my questions. He said if he refunded money to everyone having trouble with the Oasis then Neuromonics would go out of business. I said, "so you have a lot of dissatisfied customers?" He shouted me down refusing to answer any of my questions. Their business model is all about making money, and not about helping people with tinnitus, as demonstrated by the CEO yelling at me throughout the entire conversation. Not a good thing for T. If Neuromonics was definitely doing harm, there should be some recourse. Instead you just purchased a $5000 iPod. That is how they stay in business. Plus the audiologists get approximately half of the fee, so of course they are going to push it. I was told by the CFO that they sell the Oasis to the audiologists for $2540. The rest of the rake off is what the audiologist charges. The research on Neuromonics is with small sample sizes done by the company itself.

attheedgeofscience · Mar 26, 2015

linearb said: ↑

The for-profit edge of it as far as providers go, isn't nearly as lucrative as pharmaceuticals, imaging devices, and a lot of other aspects of medical culture.
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In that case, I think you better have a read of some of the proper market analysis data I have compiled for this board...

www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-%E2%80%94-efficacy-debate.7650/page-8#post-87956

www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-%E2%80%94-efficacy-debate.7650/page-9#post-88145

svintegrity · Mar 26, 2015

@attheedgeofscience Thanks for re-posting Dr. Nagler's comparison of TRT vs Neuromonics.

svintegrity · Mar 26, 2015

The dear folks at Neuromonics have no business being in any area of health care. And the company is too small for anything high finance. Even the staff audiologist told me to keep using the Oasis after I explained the adverse effects. Later I discovered her title is "national director of marketing."

111 · Mar 27, 2015

attheedgeofscience said: ↑

For those interested, @Dr. Nagler did an extensive comparision of TRT vs. Neuromonics some time ago
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Interesting info, the one below statement from him about Neuromonics is surprising, ( with lots of other statements disputing the device as well ) especially when you consider he was the vice president for clinical affairs for Neuromonics ( tinnitech ) for 2 years from 2002 - 2004, maybe his conscience got the better of him ?

One of the most important differences lies in the fact that Neuromonics is a for-profit company; whereas TRT is a treatment. The Neuromonics company wants as many audiologists as possible to recommend Neuromonics devices to their patients as often as possible – because that is how the Neuromonics company makes a profit and keeps its stockholders happy!

driven insane · Mar 27, 2015

attheedgeofscience said: ↑

I could also share a story about Team Trobalt's attempt to get help from the ATA in relation to our informal Trobalt trial, but I'd rather not.
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Why? Why are you protecting the reputations of these people?

It's obvious they want to shut down any actual chance for a cure for tinnitus so they can keep their scam (mainly of the elderly) going as long as possible. They're no better than those online scam artists spamming miracle cures. But it's worse because they maintain the illusion of being professionals who actually care about helping people and not lining their pockets.

linearb · Mar 27, 2015

attheedgeofscience said: ↑

In that case, I think you better have a read of some of the proper market analysis data I have compiled for this board...

www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-%E2%80%94-efficacy-debate.7650/page-8#post-87956

www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-%E2%80%94-efficacy-debate.7650/page-9#post-88145
Click to expand...

This is a strawman analogy; the post I was responding to had made the bizarre claim that Drs Vernon and Jasterboff are behind a conspiracy to prevent tinnitus research. Obviously, nothing in either of your posts speaks to that, so, you're trying to take me down a deeper rabbit hole than I'd intended.

However, I did read these posts, and I am not impressed. I don't see a market analysis, I see a bunch of unsubstantiated claims that LLLT is more effective than the numerous studies in to it have been, supported by some scammy practices on behalf of hearing aid companies. I have no problem accepting that hearing aid companies are just as obstructive to research contrary to their bottom line as every other for-profit industry, but they simply do not control enough raw capital for me to believe they are able to offset legitimate research interests to any significant degree. The amount of money in that entire industry is pennies in the bucket compared to pharmaceutical revenues.

At the bottom of one of these posts, you conclude

Now, if you are so pleased with your hearing aids, that's totally fine with me. But just know that you probably paid somewhat more than you had to, and that you could have gotten the same benefit from LLLT.
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As a summary this is a non-sequitor to me. People do pay a lot more than they really need to for their hearing aids as a result of all the things you enumerate -- and the same is true for most/all other durable medical equipment. But, that has nothing to do with the claim that LLLT is as effective (or at all effective). And, I didn't say anything about LLLT; I tend to stay out of those threads because I don't have a dog in that fight.

attheedgeofscience · Mar 27, 2015

driven insane said: ↑

Why? Why are you protecting the reputations of these people?
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As a general policy, I do not disclose the names of the sources I get information from or send information to (this has been true for "99%" of all the material I have supplied to this board - and I have supplied "tons"; only exception was my stem cell therapy contacts which I had to disclose since another member of TinnitusTalk was going to share his story of the same treatment i.e. it was impossible for me to keep it secret any further by that point...).

The "two key people" I am referring to from the ATA earlier on (in my post above) will remain confidential, but who they are is known to @Markku and to members of Team Awareness.

driven insane said: ↑

It's obvious they want to shut down any actual chance for a cure for tinnitus so they can keep their scam (mainly of the elderly) going as long as possible. They're no better than those online scam artists spamming miracle cures.
Click to expand...

Everyone is entitled to their opinion. Personally, I think your wording is too strong. What I will say is that the modus operandi of the ATA seems to be that they prefer to get proposals of interest submitted to them (i.e. "requests for funding" from researchers) rather than take an active leadership role in facilitating the fight for a cure. To me, that's leading-from-behind. Personally, I believe there have been missed opportunities in terms of lobbyism with the Armed Forces, the US Government, and possibly with some of the current otology pharmas. I am not going to go into details about that (and more) because - in part - of the policy of TinnitusTalk that disclosing details of private messages is not allowed. But you can pick up a couple of clues from the following publicly available posts in the "ATA petition"-thread as to why I do not consider the ATA especially effective (I will even highlight a few pieces for you and anyone else reading this):

Markku said: ↑

After correspondence with the ATA, the organization has informed me that instead of gathering signatures for a petition, it would suggest a written proposal justifying the benefits from undertaking a clinical study of Trobalt.

The background for this decision is that the ATA does usually not engage in research by itself, but prefers instead to gather research proposals from leading scientists within the field of tinnitus research.

This change would likely lighten the burden we have in front of us (as we no longer require a certain number of signatures). However, it may be required that we - the proposal owners - have to contribute financially towards the proposal. The financial burden we would have to carry needs to be clarified with the ATA.

We intend to set up a new offline workgroup with members from the TT-community. The aim will be to write a proposal and include relevant findings from our informal study along with observations from recent scientific literature. The funding "requirement" from the ATA will also need to be discussed as the outcome of any study would ideally not just benefit the TinnitusTalk community, but essentially any patient suffering from severe tinnitus, anywhere in the world.
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Dr. Nagler said: ↑

If the investigator with whom you are communicating is well-regarded and decides to do the study, by bypassing ATA you have saved yourself a year ... maybe more. Well done.

Dr. Stephen Nagler
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(The fact that the 2nd quote from Dr. Nagler was made by someone who is a former president of the ATA speaks "volumes" to me, quite frankly...).

The Tinnitus Research Initiative (TRI) on the other hand has a much more forward leaning attitude. I should also add that the BTA has been forthcoming to suggestions.

attheedgeofscience
27/MAR/2015.

Zimichael · Mar 27, 2015

attheedgeofscience said: ↑

For those interested, @Dr. Nagler did an extensive comparision of TRT vs. Neuromonics some time ago:

Source: www.tinnitustalk.com/threads/neuromonics-vs-trt-tinnitus-retraining-therapy.4288/#post-46144
Click to expand...

OK, I am going to shock the hell out of myself and maybe some others, as many of you know that I am not a fan of the author of this extensive report that ATEOS pasted into this post ref. a comparison of Nuromonics and TRT.

However, I found it a very well written discourse. Comprehensive, informative, balanced, educational, no vitriol. Plain good stuff...If that/this kind of "reporting" were the norm, I think there would be lot less conflict and a far fewer "dogfights" going on.

Just saying... Best, Zimichael

driven insane · Mar 27, 2015

attheedgeofscience said: ↑

As a general policy, I do not disclose the names of the sources I get information from or send information
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Alright then.

attheedgeofscience said: ↑

As a general policy, I do not disclose the names of the sources I get information from or send information
Click to expand...

That's easily the worst. They spend BILLIONS a year on bogus Tinnitus Retraining and "Cognitive Behavioral Therapy" and pennies on legitimate research. It' a travesty.

The ATA is standing in the way of war veterans being cured so they can make a buck. But I know enough about the Department of Veterans Affairs to know this scam probably isn't the worst going on right now.

attheedgeofscience · Mar 27, 2015

driven insane said: ↑

That's easily the worst. They spend BILLIONS a year on bogus Tinnitus Retraining and "Cognitive Behavioral Therapy" and pennies on legitimate research. It' a travesty.
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As always, you - or others - are welcome to join Team Awareness and promote the cause of tinnitus research. As it happens, I have just a ½-hour ago written a post about researchers who could use some funding - no doubt - for further proper pharmacological research:

www.tinnitustalk.com/threads/flupirtine-%E2%80%94-another-potassium-channel-opener.5642/page-3#post-102660

driven insane said: ↑

Alright then.
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I have shared what I can. If we do not within Team Trobalt respect our sources, then we risk that no one will be willing to share any information with us in the future (and that would be even worse). It's a balance.

joejunior · Mar 27, 2015

The Cochrane report has has already comprehensively demolished the arguments in support of TRT.

driven insane · Mar 27, 2015

attheedgeofscience said: ↑

I have shared what I can. If we do not within Team Trobalt respect our sources, then we risk that no one will be willing to share any information with us in the future (and that would be even worse). It's a balance.
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No, I understand. Before I wasn't aware how involved you were in things.

MarioT · Mar 28, 2015

I would like to post another question concerning TRT. It is somehow presented to me as a complex protocol while in fact (at least that is my limited understanding of it) it consist of only 3 basic components:

1. counseling, meaning someone explaining to you the neurophysiology of tinnitus.
2. Use of devices worn behind the ear and generating broad-band noise to divert attention of the patient away from the tinnitus.
3. psychological therapy including relaxation exercises etc.

@Dr. Nagler: please correct me if I am wrong. But if this is the case, I personally do not need 1.) , have already tried 2). which does not work with my T (continuous white, pink or whatever colored noise only aggravates it, no soothing effect whatsoever) and maybe, only maybe feel like 3.) might help a certain number of individuals.

What is it exactly that you do in TRT-therapy that exceeds these prementioned points? Can you give me an example of how you implement the protocol in your clinic?

Thank you in advance,

m

attheedgeofscience · Mar 28, 2015

MarioT said: ↑

What is it exactly that you do in TRT-therapy that exceeds these prementioned points? Can you give me an example of how you implement the protocol in your clinic?
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I tried to ask that once...

www.tinnitustalk.com/threads/why-trt-fails-people.6389/#post-69486

...but never really got a reply.

Nick the Swede · Mar 28, 2015

I guess this is what separetes a "good clinician" and a bad one.

@MarioT, very interesting question as it all seems a bit foggy to me

joejunior · Mar 28, 2015

I am disappointed to see that TT has effectively a shop front for TRT.

This idea that there are only a few witchdoctors around the world who can do TRT properly is a convenient excuse for when TRT doesnt work. TRT is simply a sham.

attheedgeofscience · Mar 28, 2015

MarioT said: ↑

What is it exactly that you do in TRT-therapy that exceeds these prementioned points? Can you give me an example of how you implement the protocol in your clinic?
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I am not sure you will get an answer to that - see this thread:

Dr. Nagler said: ↑

There is. A lot more.

Perhaps you'll need to dig deeper. But I really do not want to be involved in a discussion of the specific protocols for each of the five TRT categories on the board.

Good luck with it.

Dr. Stephen Nagler
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and this one...

Mpt said: ↑

Dr Nagler,

I’ve read the book and papers by Jastebroff and Hazlett, the below is my understanding of TRT, please let me know what I have right/ what I have wrong, etc.

The crux as I understand it is that through counseling aimed at informing a sufferer that the tinnitus signal isn’t harmful or representative of damage and through sound therapy (where appropriate) tinnitus can be reclassified (by both the conscious and subconscious mind) as a neutral stimulus and thus over time tinnitus distress decreases. I know the work relies heavily on subconscious neuronal networks and the brains ability through plasticity to adapt and habituate to non-threatening auditory stimuli. Let me know where I am wrong and how the Heller and Bergman experiment informed the engineer’s work.

Our conversation regarding TRT got "cut short" the other day and I really do want a substantive critique because if my understanding is wrong I would like to know as I believe many others on this forum have a similar view of the therapy.

Thanks,
Matt
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RichL · Mar 28, 2015

joejunior said: ↑

I am disappointed to see that TT has effectively a shop front for TRT.
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No it is not and this is speculation on your behalf, if you care to read through the threads you will see that TT has a fair amount of debate on this, for and against and TT do not advocate for any one special treatment, all are given equal amount of discussion good and bad!

joejunior said: ↑

This idea that there are only a few witchdoctors around the world who can do TRT properly is a convenient excuse for when TRT doesnt work. TRT is simply a sham.
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This I agree with!

1MW · Apr 7, 2015

TRT is a huge scam like all sound treatments.
It has been proved that all sound therapies does not work and can do only more damage.
Residual inhibition is not cure or improvement.
Positive results exist only in biased trials.
Its a business only for money.
T is a symptom of a problem only if you fix the problem T will stop and TRT does not fix any
ear/hearing problem.

svintegrity · Apr 7, 2015

Sound therapy definitely caused more damage in my case. I was desperate enough to try Neuromomics. Not only did it overstimulate my auditory system, it gave me severe hyperacusis. I went to a Tinnitus and Hyperacusis Clinic for treatment. When I reported the adverse effects I was having, the audiologist and the people at Neuromonics, Inc. told me to keep using it. Clearly they were only interested in the money and not the well-being of the client.

just1morething · Apr 25, 2015

I see there is a new list for TRT practitioners in 2015 for the U.S. and the rest of the world. Maybe this was posted already and for some they are not interested in this treatment. http://www.tinnitus-pjj.com/referral.html

Danny Boy · Apr 25, 2015

just1morething said: ↑

I see there is a new list for TRT practitioners in 2015 for the U.S. and the rest of the world. Maybe this was posted already and for some they are not interested in this treatment. http://www.tinnitus-pjj.com/referral.html
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They are gonna sell so many maskers...I was given one right away by my audiologist before I cured my h and reactive t. I told her I couldn't listen to white noise as my t would react to it, didn't care and gave it to me....Cost the NHS many monies for a useless device which I don't use.

svintegrity · Apr 26, 2015

Even if people are listed on the TRT practitioners website, I would express caution working with some of them. Check them out very carefully. I unfortunately did not. The person I worked with is listed on the website, and I would not recommend her to anyone. She was lazy and acted like I was bothering her when I contacted her, even though she gave me her personal e-mail address and cell phone number to e-mail and text her with questions. She said I was going to be her "new best friend." Then she was very put out with me when I emailed or texted her for help.

When I was suffering, she only offered platitudes, and nothing of substance. "Keep your chin up," etc. She was always late for appointments, and stood me up for two Skype meetings. I decided not to work with her anymore, so I cancelled one Skype meeting. She was obsessed with my only cancelled appointment. She also forwarded damaging and false health information to people who were not involved in my treatment without my written permission, which I am sure is a violation of federal law. She was only interested in the money and not with helping people. Long story short, it was a horrible experience and it cost me a small fortune. Buyer beware!

Danny Boy · Apr 26, 2015

svintegrity said: ↑

Even if people are listed on the TRT practitioners website, I would express caution working with some of them. Check them out very carefully. I unfortunately did not. The person I worked with is listed on the website, and I would not recommend her to anyone. She was lazy and acted like I was bothering her when I contacted her, even though she gave me her personal e-mail address and cell phone number to e-mail and text her with questions. She said I was going to be her "new best friend." Then she was very put out with me when I emailed or texted her for help.

When I was suffering, she only offered platitudes, and nothing of substance. "Keep your chin up," etc. She was always late for appointments, and stood me up for two Skype meetings. I decided not to work with her anymore, so I cancelled one Skype meeting. She was obsessed with my only cancelled appointment. She also forwarded damaging and false health information to people who were not involved in my treatment without my written permission, which I am sure is a violation of federal law. She was only interested in the money and not with helping people. Long story short, it was a horrible experience and it cost me a small fortune. Buyer beware!
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In the UK, TRT is free on the NHS...So sorry you have to pay....I wish the every country would have a system like the NHS.

just1morething · Apr 26, 2015

svintegrity said: ↑

She was only interested in the money and not with helping people. Long story short, it was a horrible experience and it cost me a small fortune. Buyer beware!
Click to expand...

Apparently there is some half-ass TRT practitioners out there that could be rip-off artists as well!

Dr. Nagler · Apr 26, 2015

just1morething said: ↑

Apparently there is some half-ass TRT practitioners out there that could be rip-off artists as well!
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I totally agree. That is one of the reasons I personally have such a problem with the lack of standardization and certification in TRT. In fact, you can call yourself a TRT practitioner without knowing the first thing about TRT. You don't even need to have a background in medicine or audiology to call yourself a TRT practitioner. That is why I have developed a series of questions that every tinnitus sufferer should a clinician before embarking on TRT (or any other treatment protocol for that matter):

· What is the approach the clinician is recommending and why?
· What type of training has the clinician undergone in the use of that approach?
· How long has the clinician been using the approach?
· How many tinnitus sufferers has the clinician treated with the approach?
· What is the clinician's success rate using the approach?
· How does the clinician define and measure success?

stephen nagler

svintegrity · Apr 26, 2015

@Dr. Nagler I completely agree with you. Unfortunately the person I saw actually claims to have trained with Jasterbroff. She is an AuD, and has been working with tinnitus patients since 1997 or so. She also claimed to have a high success rate, and came highly recommended. She also seemed very burned out and slovenly, but I was so desperate that I went against my intuition and decided to work with her.

I traveled 13 hours each way, with an overnight to see this practitioner on three occasions. We were going to work via Skype in between in-person appointments. She stood me up twice on Skype. She definitely cared more about her time and the money, which became obvious after the first month. I continued working with her for another month because of the time and money I had invested, before deciding to discontinue. I ended up losing a lot of money, with absolutely no return.

She would have passed your questions with flying colors, and still not be a good person with whom to work. She did not keep her word, and because she "had so much experience," she did not listen to me. Your questions are good, but the practitioner also needs to care about working with tinnitus patients, and to also realize that each person may be different. One size does not fit all. There needs to be a differential diagnosis for tinnitus.

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