TRT How? Please Advise Me

Discussion in 'Dr. Stephen Nagler (MD)' started by Robb, Mar 24, 2015.

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    1. Robb
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      Robb Member Benefactor

      Tinnitus Since:
      Dear Dr. Nagler,
      (Here my post as agreed on moved from other TRT topic).

      I am now having T for 1,5 years after a slap on my ear, resulted in a perforated eardrum.
      My T after the event has gone down to a more bearable level. I tried AM-101 and had at least two single injections of it in second round. However my T is still present and might is a bit more annoying present from time to time and I feel i want to start TRT. As I am afraid the T level will become more and more intrusive over time.

      You have any case examples of outcome in similar patient cases after such accident?

      What can you recommend me?

      Just simply;
      - what kind of device or type of TRT should I start? As I my T seems to be at a broadband white noise tone of 16,5kHZ which seems according to guys not treatable with their solution. What kind of treatment should i do else?

      - if i go sleep at the moment i have no masking device, should i use masking devices? (will this slow process of T moving/settling in brain?)

      - is it necessary for me to keep at day background noises? (will this slow process of T moving/settling in brain?)

      I remember you have advised me a while ago the contact Miss Sheldrake. I still need to go - contact her - as at the time I was afraid of flying with my ears in relation to T.


    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Atlanta, Georgia USA
      Tinnitus Since:
      Hi Robb -

      Thank you for moving your question over here to the Doctors' Corner. Your inquiry raises a very important point, and I did not want it to get lost deep within the midst of a thread.

      As I have written elsewhere (see, TRT is a well-defined protocol that employs a combination of counseling and sound therapy. The counseling is more properly called "TRT counseling" to distinguish it from the type of counseling used, for instance, in psychotherapy. TRT counseling is basically a one-to-one bi-directional educational process with the flow of the counseling dependent on one's individual circumstances and TRT Category. There are five TRT Categories, inconveniently numbered 0, 1, 2, 3, and 4. Not only is the TRT counseling dictated by the TRT Category, but so is the type of sound therapy.

      So were you to go to a knowledgeable and experienced TRT clinician, the first thing he or she would do would be to evaluate you and determine your TRT Category. As I read your post, Robb, it seems to me that you have tinnitus that resulted from acoustic trauma, that you are actually doing fairly well with it (although from time to time it does get annoying), and that your real concern is that over time it will become more and more intrusive. That likely puts you in TRT Category 0. And the counseling protocol for TRT Category 0 is an hour or two of TRT counseling during which the Neurophysiological Model of Tinnitus would be carefully reviewed with you as it applies to your particular situation and concerns. The sound therapy protocol for Category 0 involves instruction in the proper use of environmental sound to decrease contrast. No wearable devices are needed for TRT Category 0 patients. They would be overkill and an unnecessary expense in your case.

      Regarding your question about sleeping, Category 0 patients are instructed not to try to purposely mask their tinnitus at night, but rather just to use a tabletop device or Sleep Pillow Sound System to provide a constant level of gentle background sound to decrease contrast and take the edge off.

      The question about daytime background noise would be addressed by your TRT clinician in terms of the sound therapy component and your personal daily routine, but in any event as a Category 0 patient (assuming I am right about your TRT Category) you would not need to purchase wearable devices.

      You mention Jacqui Sheldrake in your post. She would be an excellent person to guide you through the above. Also, I might be wrong about your TRT Category; I have not evaluated you, and I am just trying to give an educated guess based upon what you wrote. Here again, Jacqui Sheldrake would be a wonderful person to do your evaluation and give you more definitive recommendations.

      stephen nagler
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