"TRT" Fails Once Again ...

Discussion in 'Support' started by Dr. Nagler, Apr 21, 2015.

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    1. Dr. Nagler

      Dr. Nagler Member

      Atlanta, Georgia USA
      Tinnitus Since:
      Hi All -

      I would like to point you to an interesting exchange within another thread. Well, at least I think it is interesting!

      @Valentina posted:

      My personal experience with TRT therapy didn't help me neither with my T nor with my H. I have done the TRT for four months, expecially at night while sleeping, but I haven't reached any positive result. It's very subjective though, so it's worth to try it because maybe your brain will collaborate!

      I responded:

      Valentina, I am so sorry to hear that TRT didn't help you. You know, as a TRT clinician when somebody posts that TRT didn't help, I like to try to figure out why. It helps me be a better clinician, and sometimes it can help the person for whom TRT didn't work as well.

      So when I read your post, three questions came to mind:

      (1) You say that you were doing TRT "especially at night while sleeping." Can you tell us exactly what you were doing while sleeping that you are calling TRT?

      (2) During the four months that you were doing TRT, how many formal one-to-one TRT counseling sessions did you have with your TRT clinician? Or were you just doing the sound therapy part of TRT?

      (3) TRT is a protocol that can take 8-12 months to be effective. You say that you were doing TRT for four months and it didn't help. How can you come to any conclusion about an 8-12 month protocol after four months?

      Thanks -

      stephen nagler

      Valentina responded:

      Good afternoon Doctor Nagler, thank you for your comment :) I didn't expect it!

      The San Raffaele hospital, located in Milan, Italy, is well known because of one team of doctors, in charge of Dr. Umberto Veronesi, specialized for the cure of breast cancer. During one of my periodical visits, I met a doctor who suggested me a TRT sound therapy, after he has heard me talking about my tinnitus.

      (1) I used a sound equipement called sound ball which generates white noises and similar sounds, able to enrich the sound I have in my head, untill the brain gets habituated. I have been told that at night, while sleeping, the therapy effects are much more effective.

      (2) Only once, at the beginning, when the doctor teached me how to use the sound ball and when.

      (3) I decided to stop this therapy because my tinnitus was increasing considerably. After only a month my T's volume was almost doubled. The doctor told me that it could have happened so I didn't stop, but I was full of fear. When my T, from static became pulsatile and enriched itself with more hisses, I was really not brave enough to continue. So I gave up and, after a couple of weeks, my T went back to normal.

      I have probably used the TRT acronym in the wrong way, I'm sorry.

      My best regards Dr. Nagler

      I responded:

      You are kind, Valentina, but there is absolutely nothing to apologize for. You were told you were doing TRT, so quite naturally you thought you were doing TRT. And since what you thought was TRT was not working for you, you said that TRT was not working for you. The fact that it was not really TRT in the first place never dawned on you. Why would it??!!

      I wish you well, Valentina. And here's to quiet days ahead for all.

      stephen nagler


      So unfortunately this problem comes up all too often in the tinnitus community. Mr. Jones believes he is doing TRT because he is told he is doing TRT, and he has no reason to doubt the person who told him he is doing TRT. But what Mr. Jones believes is TRT is not TRT at all. So when Mr. Jones does not improve, he quite naturally assumes that TRT did not work for him.

      The difficulty, which in my opinion is huge, is that there is no standardization or credentialing in TRT. I have discussed this issue in a number of other posts and will not go into it at this time. But one of the reasons TRT has a lukewarm reputation on the Internet is that so many people truly think they are doing TRT, but whatever it is that they are doing ... it isn't TRT.

      Now please don't get me wrong. There are other challenges with TRT, but that's a big one.

      stephen nagler
    2. LifesABeach

      LifesABeach Member

      Tinnitus Since:
      Cause of Tinnitus:
      Wish I knew
      I found Dr. Nagler's post #2 from this thread https://www.tinnitustalk.com/threads/trt.7823/ads/trt.7823/ useful when thinking about researching TRT options in my area:

      "One of the problems with TRT is that the name is not trademarked - so with many clinicians claiming to offer TRT, what you see is not necessarily what you get. And to my way of thinking, that represents an enormous challenge 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. 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.)

      Here are some important questions that I would pose to any tinnitus clinician regardless of the treatment approach he or she is offering to you:
      · 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 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 evaluation-fitting-counseling session need be done in person. Beyond that initial single visit there is generally no need to contemplate any traveling."

    3. kmohoruk

      kmohoruk Member

      Tinnitus Since:
      Cause of Tinnitus:
      Loud Noise, Ear Infection, TMJ
      Thats what happened with me. I thought the first time around I was doing TRT - turns out I wasn't and the audiologist was just a tyrant.

      Now I am trying TRT again with another audiologist who is much more understanding. So far the devices that I have been using are a better fit for me, and have already helped me with my TMJ issues as I am much more relaxed and not paying attention to my T as much as it doesn't really seem to eat at me as much. :)
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