(1) TRT Questions; (2) TRT Testimonial

[Christian82]

Dear Dr. Nagler,

I will start TRT this week and I had some general questions in regards to the workings of TRT and my case.

I had a diving accident last summer after which I started hearing a high frequency hiss and lost my hearing above 8000 Hz.
Also I have a slight hyperacusis which I do perceive as troubling and which does not form any from of discomfort most of the time.
I did take part at the Am-101 trail placebo and the real drug but I am not sure that it had any marvellous effect.

I was wondering if you could be so kind and answer a couple questions that I have seeing that you have a lot of experience in this field.

1. Is it true that the Tinnitus becomes centred in the Brain and the actual ear has nothing todo with the Tinnitus anymore meaning if you treat the brain with TRT you can treat the Tinnitus?

2. When I first got the Tinnitus it was not that loud as it is now. All the ENT's tell me that this has todo with the psychological perception of the sound and that it is not really louder but I just perceive it as such do to the anxiety and other mental components the form a circle of responses. Would you agree?

3. Through out the day I have changes in Tinnitus loudness and noise. Also I began to develop a completely different Tinnitus sound in my left ear which I can only hear in very quiet surroundings. This Tinnitus I believe I got after a slap on the ear after which I did hear a Tinnitus sound for a second or so.which then disappeared and the new Noise appeared weeks later. The ENT's guess is that its not from the slap itself after which i did hear a Tinnitus sound for a second or so but rather has to do with the already stressed auditory system. Do you have any experience with this and you patients ?

4. I tried to place myself in to a TRT category but I can't because I do miss the expertise to do so and i was just wondering if any of the mentioned factors prevent me a from a successful TRT outcome.

5. On the program sites of the different TRT clinics I read that the outcome of TRT should be that your brain get so used to the Tinnitus that you can't really hear it unless your really search for it. Is this true from your experience?

6. I speak Dutch German and English and I searched the web in all three languages but I can't find any story from people in forums that write about their TRT therapy experience neither good or bad. Do you have any idea why I can find so much info on the Programm itself but not on patients experiences?



Thank you so much that you take the time and effort on this forum to help the people in need.


With kind regards,

Chris

 

[Dr. Nagler]

@Christian82 posted:

Dear Dr. Nagler,

I will start TRT this week and I had some general questions in regards to the workings of TRT and my case.

...............

Excellent. I hope it goes well for you.

..............

I had a diving accident last summer after which I started hearing a high frequency hiss and lost my hearing above 8000 Hz. Also I have a slight hyperacusis which I do perceive as troubling and which does not form any from of discomfort most of the time, I did take part at the Am-101 trail placebo and the real drug but I am not sure that it had any marvellous effect.

I was wondering if you could be so kind and answer a couple questions that I have seeing that you have a lot of experience in this field.

1. Is it true that the Tinnitus becomes centred in the Brain and the actual ear has nothing todo with the Tinnitus anymore meaning if you treat the brain with TRT you can treat the Tinnitus?

...............

TRT does not treat tinnitus (i.e., the sound of tinnitus) at all. TRT addresses your reaction to your tinnitus. Perhaps think of it this way. If your tinnitus did not make you feel bad in some way or another, then you would have tinnitus - but you really wouldn't care. Well, "feeling bad" is a reaction ... and if you do not react, then by definition you cannot feel bad. Not only that, if you do not react, then your tinnitus winds up occupying such a low position on your brain's priority list, that you become largely unaware of it (unless you purposely listen for it). But your tinnitus itself? Your tinnitus remains the same.

.................

2. When I first got the Tinnitus it was not that loud as it is now. All the ENT's tell me that this has todo with the psychological perception of the sound and that it is not really louder but I just perceive it as such do to the anxiety and other mental components the form a circle of responses. Would you agree?

.................

Well, if you were to take a bunch of aspirin and your tinnitus were to get louder as a result, that wouldn't be due to some sort of psychological effect, now would it? So tinnitus loudness is a complex phenomenon. To be sure, it has a lot to do with what your ENTs are calling a psychological effect (actually a neurophysiological effect rather than a psychological effect, but let's not split hairs) - but there are other factors that affect loudness as well. One of the beauties of TRT is that loudness is irrelevant in terms of treatment success.

..................

3. Through out the day I have changes in Tinnitus loudness and noise. Also I began to develop a completely different Tinnitus sound in my left ear which I can only hear in very quiet surroundings. This Tinnitus I believe I got after a slap on the ear after which I did hear a Tinnitus sound for a second or so.which then disappeared and the new Noise appeared weeks later. The ENT's guess is that its not from the slap itself after which i did hear a Tinnitus sound for a second or so but rather has to do with the already stressed auditory system. Do you have any experience with this and you patients ?

..............

Sure, lots of experience, but again that sort of thing is irrelevant in terms of TRT success rates.

................

4. I tried to place myself in to a TRT category but I can't because I do miss the expertise to do so and i was just wondering if any of the mentioned factors prevent me a from a successful TRT outcome.

.................

No, none that you have mentioned. And speaking of TRT categories, even the (dreaded) Category 4 patients tend to do well in TRT, just not as well as Categories 0 through 3.

...................

5. On the program sites of the different TRT clinics I read that the outcome of TRT should be that your brain get so used to the Tinnitus that you can't really hear it unless your really search for it. Is this true from your experience?

...............

Well, there you'd be talking about somebody who is 100% habituated, and I think that's an unrealistic expectation. Habituation is a process, not a state. I think it is much more realistic to see yourself getting to the point on the habituation continuum where you are much less aware of your tinnitus than you are now and where when you do happen to be aware of it, your tinnitus is much less bothersome to you.

....................

6. I speak Dutch German and English and I searched the web in all three languages but I can't find any story from people in forums that write about their TRT therapy experience neither good or bad. Do you have any idea why I can find so much info on the Programm itself but not on patients experiences?

................

I am fond of comparing intrusive tinnitus to being in a bottom of a rattlesnake pit. And when (thanks to TRT, for instance) you have managed to finally climb your way to safety, it is not likely that you would spend much time hanging around the reptile exhibit at the zoo. So you really do not see much in the way of detailed testimonials of TRT success on the Internet. There are a number of reports of TRT failures on the Internet - but when you begin to look into it, you generally find that these folks didn't do TRT at all - they just thought they did. (A lot of so-called "TRT Clinicians" are pretty clueless about TRT, a product of the lack of standardization and credentialing. See the fourth paragraph from the bottom at https://www.tinnitustalk.com/threads/thoughts-on-trt.7863/.)

There is one rather interesting TRT journal on the web that I can point you to, if you like. Here's the background. Some seventeen years ago I got involved in a discussion regarding the pros and cons of TRT on an unmoderated Internet newsgroup. The discussion got rather heated (as these things can go), and I decided to make an offer. I announced that I would offer TRT totally free to any one person who was randomly chosen by the participants on the newsgroup. The only stipulation was that the candidate could not post on or even follow that site during the process and that at the conclusion the candidate would return to post his or her impressions - good or bad. So around 20-25 individuals sent their usernames to a fellow in Canada whom the folks on the newsgroup knew to be impartial, and on the appointed day, he drew a name from a hat. The "winner" was announced, and the candidate and I made arrangements to start. What he decided to do, rather than deal with the newsgroup anymore, was to establish a website where he would periodically report his experiences, good and bad. Well, it turns out that his site is still accessible - the only problem is that he has not funded it in a decade or so (why bother?), so it is loaded with distracting ads. But if you can get past the ads, you might find the reports to be enlightening. See http://tinnguy.tripod.com/index-2.html.

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Thank you so much that you take the time and effort on this forum to help the people in need.

................

You are welcome.

stephen nagler