@pytajnick
Since you have asked me politely I will try to answer your question and this is my personal opinion as someone that has had TRT twice, the full treatment and not a scaled down version of it. I also speak as someone that has had tinnitus for many years and consider myself a veteran of the condition and knowledgeable on tinnitus and hyperacusis that were caused by
"exposure to loud noise" . There are many people in this forum that understand tinnitus & hyperacusis and the way these conditions can affect a person emotionally, their mental wellbeing and day to day living just as well as I can. I am always looking to learn more because no one knows it all. Therefore, I readily accept advice from fellow veterans, those seasoned to tinnitus and newbies alike.
The TRT book written by Professor Jastreboff is a reference book meant for Hearing Therapists and Audiologists that want to practice the TRT treatment with tinnitus patients. It explains all about causes of tinnitus and hyperacusis and the treatment for these conditions using the TRT protocol. It explains about phonophobia and misophonia and the way these four conditions can affect a patient. It cannot teach a person tinnitus counselling although it does give guidance and suggestion on the subject. The actual counselling skills, has to come from the Hearing Therapist or Audiologist training and personal experience. By this I mean the following: For a Hearing Therapist or Audiologist that practices the TRT treatment with a tinnitus patient or even does counselling with such a patient, for best results they need to have personal experience of tinnitus. It is not unusual to find Hearing Therapist and Audiologists that work with tinnitus patients, were either born with tinnitus or acquired it at some time in their life.
It is for this reason most ENT doctors know very little about tinnitus. They know about the anatomy of the ear and can treat it medically or surgically. However, understanding tinnitus requires a different set of skill. ENT doctors are physicians not counsellors.
As I have already mentioned on this thread. Tinnitus comes in many forms and intensities and no two people experience it the same. Many people habituate to tinnitus within the first 6 to 18 months of onset. This doesn't always require having treatment at a tinnitus clinic. A person that has difficulty coping with tinnitus may need one to one counselling with a therapist and this is something that they cannot do themselves. Life can be very problematic. Often people do not have just tinnitus to cope with. They may have other medical conditions a people they deal with in their personal lives. All this can have an affect on the tinnitus.
So what is TRT and when should it be started?
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 problems. I think a period of six months should elapse before starting a long-term treatment such as TRT.
Michael