What Is TRT and When Should It Be Started?

Discussion in 'Support' started by Michael Leigh, Dec 14, 2016.

    1. Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      What is TRT and when should it be started?

      I have talked about TRT in many of my posts. One tinnitus talk member recently told me that I have mentioned it no less than twenty five times. He went on to ask, am I an Audiologist promoting my practice in this forum purely for business purposes? Another member was quite disgruntled and told me to stop mentioning it because where he lives the treatment is expensive and can’t afford it. It just goes to show one never knows what is going on behind the scenes when you think no one is watching.

      I understand and empathise with people that are unable to afford this treatment or any other to help one’s health but don’t feel this is a good enough reason for me to stop mention it when I believe it can help, having had TRT twice in the 20 years that I’ve had tinnitus. I am not an Audiologist. I just consider myself like many others at tinnitus talk, who want to help people that are having a difficult time coping with this condition, as I was once helped many years go when I first got tinnitus.

      Some people have been sending me private messages asking if TRT cures tinnitus? A member mentioned having two sessions with their Audiologist and was shown some slides, and told that anxiety can make tinnitus louder. Understandably this person wasn’t sure if this was TRT, and then asked if it’s something they could do on their own? As I have mentioned I have had TRT twice and I also have the Tinnitus Retraining Therapy book, written by Professor Pawel Jasterboff and Jonathon Hazell. It is available at Amazon should anyone wish to purchase it.

      It is the reference book that Hearing Therapists and Audiologists follow when practicing TRT with their tinnitus patients. There are two parts to the treatment. Counselling and sound therapy. Sound therapy is supplied by wearing two white noise generators and then using a “sound machine “ at night by the bedside for sound enrichment. If hyperacusis is present the sound therapy will also treat it. Throughout the TRT book there is no mention that this treatment cures tinnitus. TRT or Tinnitus Retraining Therapy, is what it implies: Through regular counselling sessions there is a gradual retraining of the way a person thinks about tinnitus and to treat it as non life threatening.

      At first the therapist discusses with the patient how the tinnitus makes them feel and how it has impacted on their life. Often people say they have lost interest in the things they once liked doing, which is perfectly understandable. The main goal here is to gradually help them look at life differently and with a more positive outlook. Over time the negative thinking that is often associated with tinnitus and hyperacusis is gradually dispelled and demystified.

      The Hearing Therapist does this in a controlled and precise manner so that the patient feels relaxed and not pressured. In many instances the tinnitus is gradually pushed further into the background making it less prominent. Therefore, it must be stressed and understood, this treatment takes time. To complete a course of TRT takes approximately twelve to twenty four months and in some cases longer. The duration of each counselling 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 counselling that really matters.

      There are a few misconceptions about this treatment 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 counselling 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.

      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 problelems. I think a period of six months should elapse before starting a long-term treatment such as TRT.

      Michael
       
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    2. Marie79

      Marie79 Member

      Location:
      USA
      Tinnitus Since:
      2/1/16
      Cause of Tinnitus:
      Ear infection
      haha was this me??
       
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    3. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      @Marie79 I was refering to you Marie but didn't want to mention your name. I'm pleased that you are not upset that I included your experience in my post.
      Michael
       
    4. Marie79

      Marie79 Member

      Location:
      USA
      Tinnitus Since:
      2/1/16
      Cause of Tinnitus:
      Ear infection
      oh no not at all!! :) reference me anytime I won't get upset.
       
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    5. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      Thanks @Marie79
       
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    6. Jason E

      Jason E Member

      Location:
      Melbourne
      Tinnitus Since:
      10/2018
      Cause of Tinnitus:
      Slap to right ear
      This is exactly the information I was looking for so thank you very much for sharing, I have been trying to find somewhere that actually practices this modality in Melbourne Australia but with little luck, I am going to continue searching and hope that I can find a reputable clinic.
       
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    7. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      I wish you every success in your search and thank you for the kind words.

      All the best
      Michael
       
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    8. JacquelineG
      Thinking

      JacquelineG Member

      Tinnitus Since:
      2010
      Cause of Tinnitus:
      Acoustic trauma
      Hello Michael,

      I bought two outside the ear Bluetooth ear hooks ($10 each) that I can play white or pink noise, but I've only been using one on the ear I have the most tinnitus on.

      Questions:
      1) Should I use both ear hooks at the same time and put the noise just below the level of my tinnitus?
      2) Is using these ear hooks the same as the sound generators that cost thousands? I can hear the noise fine right outside my ear.
      3) How long each day should I wear them?
      4) Is white noise better than pink noise or is it subjective?

      Any guidance is much appreciated.
       
    9. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      HI @JacquelineG

      I am just writing to say, I will either answer your question here or by PM tomorrow as I have to leave now.
      Take care

      Michael
       
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    10. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      HI @JacquelineG

      I have no experience of the Bluetooth ear hooks that you speak of so I am unable to comment on them. I use White noise generators that are used to treat tinnitus and hyperacusis.

      Whether a person has tinnitus or tinnitus with hyperacusis and wants to use white noise generators. It is best to be under the care of a Hearing Therapist or Audiologist that specialises in tinnitus and hyperacusis management as counselling may need to be involved. Using white noise generators alone without counselling a person may not get the full benefit using this form of sound therapy. Tinnitus can be complex to treat and if hyperacusis is present more so. It is not just a simple case of wearing white noise generators alone with the belief that this is all that's required.

      My white noise generators also have pink noise and I can select between the two. To be honest I do not notice a lot of difference between them. My opinion on this is: Pink noise sounds slightly softer but not to any significant degree.

      My advice is to contact a Hearing Therapist or Audiologist that specialises in Tinnitus and knows about using white noise generators for treatment.

      Hope this helps.
      All the best

      Michael
       
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    11. JacquelineG
      Thinking

      JacquelineG Member

      Tinnitus Since:
      2010
      Cause of Tinnitus:
      Acoustic trauma
      Hi Michael,

      Thank you for your response. I had completely habituated since my acoustic trauma 9 years ago and a recent MRI put me back to square one with T in addition to having some H and ear pain which has gotten better.

      My T has been sky high for two days now, and I am at my wits end. Using some headphones that go on the ear right now with some white noise from a phone app and it seems to help mask it.

      Can you please let me know which white noise generators you use and recommend and how much they were? I want to spend my limited budget wisely.

      I do have an Audiologist that I'm going to see in January, the same one I saw 9 years ago, but here in Miami, I don't know of any "Hearing Therapists". Do Audiologists provide counseling or are they just out to sell you things? Or are you referring to therapy to a psychologist that is familiar with CBT?
       
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    12. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      HI @JacquelineG

      It is your choice whatever you want to do. Playing white noise through headphones is not a good idea as it can cause the tinnitus to increase. White noise through headphones is not the same as using dedicated white noise generators that are designed for this purpose. I have written posts on this which I will paste below. If you decide to continue with using headphones, make sure that you do not mask the tinnitus. In other words, the white noise must be set at a level that is below the tinnitus.

      I use Oticon Behind the ear white noise generators that were supplied by the NHS which is the UK healthcare system. I bought two in-ear white noise generators privately. MM10 These a bullet shaped and the smallest WNGs available. They fit in the ear canal and are very discrete. I bought them from Puretone . net The company makes other white noise generators: http://www.puretoneretail.net/mm10.html http://www.puretoneretail.net/tinnitus.html

      I live in the UK so don't know what Audiologists in you part of the world provide. If an Audiologist is just interested in selling you hearing aids then I advise you to give them a wide berth. If they are only interested in selling you white noise generators then my advice is to do the same. You need to be properly assessed and enquire if the Audiologist provides counselling. This can be part of TRT or CBT.

      Preferably you need to see a Hearing Therapist or Audiologist that specialises in the treatment of tinnitus and hyperacusis. In my opinion, and I stress it's just my opinion, the Audiologist or Hearing Therapist should have tinnitus too in order to give good counselling. Unless the health professional providing counselling has tinnitus I do not believe it will be counselling of high quality. Unless a person has tinnitus they have no real in-depth understanding of the condition. How it affects a person's mental and emotional wellbeing.

      Hope this helps and wish you the best of luck
      If I can be of any further help please ask or PM me.

      Michael
       
    13. JacquelineG
      Thinking

      JacquelineG Member

      Tinnitus Since:
      2010
      Cause of Tinnitus:
      Acoustic trauma
      Hi Micheal,

      Thank you again for your feedback. I founded the former Miami Tinnitus Educational Support Group several years back and had all sorts of doctors, ENTs, audiologists, CBT psychologist, dietician, meditation, acupuncturist, etc. speak at the meetings and I have not found anyone in South Florida that is a "Hearing Therapist." I did have one psychologist who is familiar with CBT and had tinnitus for just a couple of weeks, but she doesn't take my health insurance and charges $150-200 a session. Only the rich can afford that on a continuous basis. The Oticon and Audibel A4 which is a similar BTE run from $3,000-$4,000 US each. Again, not covered by insurance. It's unbelievable that Tinnitus is only recognized as a disability for our veterans and not civilians. This is a great injustice, but that's a whole other subject. Thank you for your advice as always.
       
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    14. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      HI @JacquelineG

      I have talked to various people with tinnitus from other countries and treatment for it can differ quite a lot to what is available in the UK under the NHS healthcare. Although I have been under the care of Hearing Therapists and Audiologists throughout the 23 years I have had tinnitus, people from overseas have told me they have been treated by Audiologists that specialise in tinnitus but have no knowledge of Hearing Therapists.

      I have had TRT twice under the NHS and saw a Hearing Therapist for counselling as part of the treatment, she was born with tinnitus. She has supplied me with white noise generators and sees patients with hearing difficulties and other problems with the auditory system.

      The Audiologist I currently have, has supplied me with BTE (Behind the ear) white noise generators which had to be setup on a computer when I was been fitted. If a fault develops with them then it's the Audiologist that I contact for repair or replacement. Audiologists also supply hearing aids and carry out hearing tests in addition to other things. Some Audiologists in the UK also do the role of a Hearing Therapist and I assume this is what happens in other countries.

      Take care
      Michael
       
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    15. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      Many people think TRT is garbage, and expensive garbage at that.
       
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    16. linearb
      Psychedelic

      linearb Member Benefactor Hall of Fame

      Location:
      temporarily banished from this plane of existence.
      Tinnitus Since:
      1999
      Cause of Tinnitus:
      karma
      it doesn't have to be; there's nothing magic about the TRT ear level noise generators, besides their slim profile./

      I have gotten sales audiologists at two different tinnitus clinics to tell me to my face that WNGs don't do anything I can't do with high quality earbuds. My favorite response was

      Just lol lady, I don't need to spend $5000 to cater to what you think is "socially acceptable". I live in the fucking woods. I interact with humans only on my own terms, if I was using earbuds for WN and someone thought it was rude, well, that'd be their problem, right?

      I do think some significant amount of people benefit from CBT techniques, and there can be some advantages to learning this from someone who has at least worked with a chunk of other tinnitus patients.

      All that said, yes, in 2019 Jasterboff's ideas and the cult of personality which still cling to them look sillier by the day. I personally do not want to discount Jastreboff's contributions to the field, any more than I discount JJ Thompson's contributions to atomic science. Ultimately, the model of the atom which Thompson proposed was found to be incomplete and inaccurate, but he was still thinking about these things in a new and unusual way. I will give Jastreboff the same credit, and also point out that the best evidence-based ways we can rebut or disprove some of Jastreboff's ideas, are based on imaging studies and tech which did not exist when Jastreboff did his seminal work.

      Did he turn into an old dude who was still too enamored of his old ideas to keep up with a changing world? Probably, but that describes like 75% of aging affluent intellectuals I've ever known. I'm probably headed there myself, get the fuck off my lawn, punks
       
    17. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      I agree but isn't TRT paired with psychotherapy from shrinks? I am finding that sound therapy is helpful, namely the R. David Case demon noises. The noise sensitivity in my right ear that was really bothering me is gone from listening to it.
       
    18. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Cause of Tinnitus:
      Noise induced
      Indeed, Think is the operative word. Most of the people that think this way are those that have never tried TRT or CBT. People that I have corresponded with over the years have told me they have had TRT and CBT and it didn't work. When I have enquired further into what their treatment entailed, it is of no surprise to learn, what they believed was TRT or CBT was nothing of the sort.

      I have explained at length in my opening post above and numerous posts in this forum, that TRT must be administered correctly in order for it to work, the same applies with CBT. In addition to this, if a person starts these treatments or any other tinnitus treatment, with the mindset that the tinnitus will be cured or has negative beliefs from the outset, that no benefit will be gained from these treatments, then they will make zero improvement.

      In addtion to the above a person has to try and help themselves by reinforcing positive thinking. This means staying away from tinnitus forums and not discussing the tinnitus treatment in them. Engaging in things they like to do. Counselling and wearing white noise generators cannot do everything. Positive mental attitude needs to be learnt and instilled.

      Whilst you are entitled to voice your opinion anyone having tinnitus treatments sees a statement such as yours or engages with people with a negative mindset about tinnitus treatments, can do serious harm as it can instill a belief that whatever treatment they try their tinnitus will not improve. It is for this reason anyone having tinnitus treatment: Whether counselling, sound therapy, medication or a combination of all three, my advice is to stay away from tinnitus forums.

      Michael
       
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    19. Tybs

      Tybs Member

      Tinnitus Since:
      04/2019
      Cause of Tinnitus:
      Fall from stairs
      IMO the general concepts behind TRT are useful, but I also think that certain elements are overvalued or at least misunderstood. Let's say that a sound is a result of a nerve under constant pressure: the correct treatment in this case would involve helping to set the nerve free, not to just mentally suppress the generated sound. Once someone proclaims that TRT is the treatment to go for with all the T patients without even examining the origin, then my support is gone.

      TRT itself is fine, but at least check whether the main issue can be located first.
       
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    20. linearb
      Psychedelic

      linearb Member Benefactor Hall of Fame

      Location:
      temporarily banished from this plane of existence.
      Tinnitus Since:
      1999
      Cause of Tinnitus:
      karma
      yes, it is, but the "psychotherapy" is just CBT. "Shrink" to me implies psychiatrist; I have a different set of problems with psychiatrists than I do with psychologists, and I think CBT is real and useful however you learn it.

      A few years ago I wanted to get into guitar, so I took paid lessons. Practically, for a beginner, there was little I could not have just learned on youtube, but the structure of working with a provider was helpful. I think CBT can be similar.

      This doesn't mean there are not people capable of learning and utilizing all these techniques for free. I am someone who by personality benefits from interacting with others.
       
    21. Phat Tuna

      Phat Tuna Member

      Tinnitus Since:
      03/2019
      Cause of Tinnitus:
      Hygienist
      Can TRT fix dysacusis / sound distortions?
       

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