What Is the TRT Protocol in Case of Relapse After a Successful TRT?

Discussion in 'Dr. Stephen Nagler (MD)' started by Air23, Mar 13, 2020.

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    1. Air23

      Air23 Member

      Tinnitus Since:
      Cause of Tinnitus:
      Dear Dr Nagler,

      May I ask you what is the TRT protocol in case of relapse after a successful TRT?

      It is currently happening to me. I started wearing the sound generators again. And reviewed the « theory ». I am currently almost constantly aware of my tinnitus again.

      My habituation of reaction is getting a bit better in the past 2-3 days (not always).

      Unfortunately the TRT specialist with whom I worked 4 years ago is currently experiencing a health issue so I cannot bother her.

      Thanks for your advice.

    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Atlanta, Georgia USA
      Tinnitus Since:
      Hello @Air23 -

      With regard to relapse it helps to keep in mind that habituation is a process rather than a state - and that rather than being a straight line with positive slope, progress in habituation tends to be more like a sine wave with overall positive slope (i.e., there are natural hills and valleys). This pattern tends to be the case whether or not one has turned to TRT to facilitate habituation.

      Keeping the above in mind, relapse should be not all that uncommon - TRT or no-TRT. So the first thing to keep in mind, I suppose, is that nothing is wrong. What you are experiencing is more a hiccough than a cataclysm, although likely it does not seem that way when you are in the midst of it. Since you have experience with TRT, ideally you should re-institute the sound therapy as previously instructed by your TRT clinician and check back in for some follow-up counseling and review. Since your clinician is not readily accessible, you have done the next best thing by reviewing the Neurophysiological Model. You might also take a look at the "Barriers to Habituation" article that I am attaching below - just to make sure you are not inadvertently getting in the way of your own progress.

      Lastly, I wouldn't worry about your tinnitus awareness. Habituation of Reaction should progress over the next few weeks or months (certainly much quicker that the first time around), and as it proceeds, you cannot help but become less and less aware of your tinnitus over time (unless you purposely seek it, of course!)

      All the best -

      Stephen M. Nagler, M.D.

      PS - I have answered @Air23's question in terms of TRT, since that is how the question was posed. In so doing, however, I do not mean to suggest that TRT is necessary to accomplish habituation of one's tinnitus. Most folks do fine without it.

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