What Happens in TRT Sessions?

Someone recently asked me: What happens in TRT sessions?

I feel this question deserves an appropriate answer but I’m unable to do that in a few sentences so please bare with me. Whenever I mention TRT and the benefits that a person with tinnitus is likely to get from it, someone says to me: The treatment cost a lot of money and many can't afford it. One person even had the effrontery to ask me not to mention TRT in any of my posts because of its cost. Then I was asked if I’m an audiologist trying to promote my TRT business through tinnitus talk. For the record, I am not an audiologist nor do I work in the medical field.

It is unfortunate that many things in this world are only obtainable if a person is able to pay for them and this is especially sad when it includes healthcare. I was fortunate to have TRT treatment twice and live in the UK where we do not pay for our healthcare. However, TRT is not available at many UK hospitals - although there are usually alternative treatments and devices such as hearing aids and white noise generators that are given free that help tinnitus patients.

I believe the reason TRT is not more readily available here is due to its cost and the duration of the treatment. Therefore, if people in the UK want to try TRT and it's unavailable at a hospital where they live and they are unable to travel the distance to a hospital were it is available; their other option is a private tinnitus clinic which again cost a lot of money and will be comparable to other countries across the world.

If a person is referred to a hearing therapist for TRT (tinnitus retraining therapy) and they also have hyperaucusis (sensitivity to sound) that often accompanies exposure to loud noise, it will also be treated. TRT or tinnitus retraining therapy is exactly what it implies. It is a retraining of the mind or the way a person thinks about their tinnitus and the impact that it has on their life. In my opinion, ninety percent of how a person is able to cope and overcome tinnitus is in the mind and this is why tinnitus counseling is so important when the condition is severe.

A person’s emotions can be seriously affected and their ability to carry out everyday tasks. Things such as going to work, relaxing or to go for a leisurely walk can become very difficult. It can put immense pressure on a person’s relationship with their partner and friends because one feels no one understands what they are going through. Through regular counselling sessions with a Hearing Therapist trained in TRT, the patient learns not to look at their tinnitus as non-life threatening nor to be constantly afraid of it and to be monitoring every little change in its perception.

The Hearing Therapist does this in a controlled and precise manner so that the patient feels relaxed and not pressured. Over time the negative thinking that is often associated with tinnitus and hyperacusis is gradually dispelled and demystified. Therefore, it must be stressed and understood, this treatment takes time and is something that cannot be rushed.

The second part of the treatment requires the patient to wear two white noise generators for up to ten hours a day. They are first put on in the morning and the white noise set to just below the tinnitus, and then left alone. It can be tempting to turn up the volume when out on the street as traffic noise can make it difficult to hear them. Please don’t do this. Constantly adjusting the wngs volume will delay the habituation process. Over time the brain habituates to the white noise generators and pushes the tinnitus further into the background where it becomes less noticeable. This cannot be successfully achieved if the wngs is repeatedly adjusted throughout the day.

While the auditory system is being treated with white noise it is gradually being desensitised and treating the hyperacusis. White noise generators should not be used when going to sleep at night. When retiring one should use a sound machine by the bedside and the volume adjusted to a level just below the tinnitus. The sound machine should be set to play throughout the night until morning and this provides the brain and auditory system with sound enrichment.

To complete a course of TRT takes approximately twelve to twenty four months and in some cases longer. The duration of each counseling session is left to the discretion of the Hearing Therapist. Typically, these can last up to one hour or more. The amount of appointments required will be different for each patient, but it is quality rather than the quantity of the counseling that really matters.

There are a few misconceptions about TRT and the way it is administered that some people misunderstand which I want to address. If a patient is given one white noise generator to wear this is not TRT. When two wngs are issued and no tinnitus counseling is offered on a regular basis, it is not TRT. I am not saying that a patient will not gain any benefit from the above treatments; I only want to state they do not follow the proper Tinnitus retraining therapy protocol.

Michael

 

Hi. I have just started TRT treatment. I have had these hearing aid type things for a week now. And of course it's all being handled by my Audiospecialist. The thing is they said they had to tread the hyperacusis first and then the tinnitus.

The first two days I had no problem having them on, and I even experienced some relif. But as the days went on I stupidly turned up the volume of the noise machine. At first it made no difference in my tinnitus and seemed fine.

But a couple of days later it's gone completely insane, the hyperacusis has gone worse, the "reactive tinnitus" has gone worse and my tinnitus has gone way louder than before.

It's only been almost two months since it all started.

And before I got these things I actually started feeling better and all the tings seemed to get better.

But now it's like I'm back where I started all because I started using these things.

Did you experience something like this when you first started using these?

 

@Soren Fogh

If it's only been two months since your tinnitus started, it is far too soon for you to be starting TRT and wearing white noise generators. Please read a piece of text below taken from my post: What is TRT and when should it be started: I have included the link to this article.
https://www.tinnitustalk.com/threads/what-is-trt-and-when-should-it-be-started.19024/

When should TRT be implemented or started?

The following is based on my own opinion and therefore is not professional medical advice. The onset of tinnitus can be quite an emotional roller coaster for a lot of people, and I believe a person needs time for this to settle. Many people habituate within the first 6 months to one year of the onset of tinnitus without any treatment. If a person just has tinnitus without any additional symptoms, such as dizziness, deafness or balance problems. I think a period of six months should elapse before starting a long-term treatment such as TRT.

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White noise generators must be used correctly otherwise they can irritate the ear and make the tinnitus worse. I do not agree with what your Audiologist has advised in treating the hyperacusis first. I do know some healthcare professionals prefer this method but I think it can cause problems. Some advise the patient to gradually increase the volume of the white noise generators in an attempt to treat the hyperacusis by desensitization. I think this approach can be too abrupt and cause irritation and make the tinnitus and hyperacusis spike.

I have had TRT twice. On both occasions my Hearing Therapists advised me to use the traditional method of treatment using white noise generators. Putting them on in the morning and setting the white noise slightly below the tinnitus and then left alone. Some people need time to get used to white noise generators as their ears maybe sensitive. In this case: wearing them for 1 or 2hrs to begin with and taking them off for the same duration can be helpful. Over a few weeks gradually building up the wearing time until 8 to 10hrs is achieved.

As I have said: If you have only had tinnitus for 2 months or so then in my opinion, it is far too early to be starting TRT and wearing white noise generators as mentioned in my article.

All the best
Michael

 

I had no problems wearing white noise generators and never experienced what you describe. I still wear white noise generators whenever I feel the need. The problems you are experiencing is mainly due to starting this treatment to soon, if you've only had tinnitus for 2 months.

Michael

 

TRT costs 10 thousand dollars in USA

 

Not everywhere in the U.S. Pricing would depend on the WNGs, the audiologist and your insurance coverage.

 

I thought it was more in the region of $3000-$5000

In either case, it’s still way too expensive for what it is.

 

In Canada depending on where you go it’s about $3,000 for the devices, and then a little bit more for the follow up appointments.

 

That’s the range I found in the U.S. With insurance, my cost would have been considerably less.

 

I’m 3 weeks in to TRT after 37 years of tinnitus... I love it... still having spikes etc & they do take getting used to, what’s weird is when you scratch your head it sounds like crumpling up a crisp bag...
Sometimes my own voice sounds weird too...

I wouldn’t say tinnitus has got better but I’m definitely distracted especially in bed it’s lovely...

I’m doing CBT privately & practice mindfulness.

Also I’ve given up alcohol. I think this helps with anxiety. Hangovers are poo.