Music Therapy (Heidelberg Model) as an Early Intervention to Prevent Chronification of Tinnitus

[metro]

Music therapy as an early intervention to prevent chronification of tinnitus.

Abstract
In the present study a music therapeutic intervention according to the 'Heidelberg Model' was evaluated as a complementary treatment option for patients with acute tinnitus whom medical treatment only brought minimal or no improvement. The central question was if music therapy in an early phase of tinnitus was able to reduce tinnitus symptoms and to prevent them from becoming chronical.

23 patients with acute tinnitus (6-12 weeks) were included in this study and took part in our manualized short term music therapeutic treatment which lasted ten consecutive 50-minutes sessions of individualized therapy.

Tinnitus severity and individual tinnitus related distress were assessed by the Tinnitus Beeinträchtigungs-Fragebogen (i.e. Tinnitus Impairment Questionnaire, TBF-12) at baseline, start of treatment, and end of treatment.

Score changes in TBF-12 from start to end of the treatment showed significant improvements in tinnitus impairment. This indicates that this music therapy approach applied in an initial stage of tinnitus can make an important contribution towards preventing tinnitus from becoming a chronic condition

 

[Craig in Cali]

I've read multiple articles on this therapy, but can't figure out exactly what the protocol is?

 

[Champ]

That's a hell of a conclusion to jump to, that because people report being less impaired by the tinnitus, that somehow that fact "indicates that this music therapy approach applied in an initial stage of tinnitus can make an important contribution towards preventing tinnitus from becoming a chronic condition."

Sounds like conjecture to me. Are brain scans included in this study?

 

[mintblue]

I have no scientific evidence to provide but I've noticed an overall lessening in my tinnitus in conjunction with increasing my exposure to louder sound levels. Sometimes I'll go to a concert with a ton of bass and despite wearing earplugs will have slightly elevated tinnitus for a day or two after. Then it actually becomes less intrusive than before the concert. I am pretty sure my tinnitus became bad because I went from so much loudness to none at all nearly overnight. Having found a balance now I can say my tinnitus is at a level that would be acceptable and undetected by most people. I'd even dare say it's gone, because it's no longer intrusive to my life. I produce music, go to concerts, and listen to music in the car every day with no discernible problems in my ear.

Important notes: I don't have significant hearing loss of any kind. I'm busier than I've ever been before doing something that's important to me. It's amazing how many problems in our society stem from a lack of purpose.

 

[Antje]

Stumbled upon some scientific research on the Heidelberg Music Therapy method practiced in Germany.
It all sounds very promising but I haven't really seen anybody speak about it on fora like these.

Does anyone have any experience with the Heidelberg Sound Therapy method?

Really looking forward to hear your experiences!

Selection of research:
http://www.tinnitusjournal.com/arti...tment-outline-and-psychometric-evaluation.pdf

http://journal.frontiersin.org/article/10.3389/fnins.2015.00049/full

 

[Sannoliver1]

Has anybody tried this method? Does anyone know of a practioner?? Please help.

 

[Samir]

I've read multiple articles on this therapy, but can't figure out exactly what the protocol is?

Could it be this "Heidelberg Model"? It's also called "Heidelberg Model of Music Therapy for Chronic Tinnitus". Heidelberg is a town in Germany.

The use of music therapy in otology has emerged to a main field of research and expertise at the German Center of Music Therapy Research (Deutsches Zentrum für Musiktherapieforschung DZM e.V.) Heidelberg

https://www.researchgate.net/public..._Heidelberg_Model_of_Music_Therapy_in_otology

They started recruiting people for this therapy in 2004 for a study. That was the first broad use of it I guess. The details about the method can be found here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443887/

I guess it's really down to the behavioral and structural changes of the neurons. Which reminds me of this:

https://www.tinnitustalk.com/thread...n-change-the-way-nerve-cells-are-wired.20506/

But if music therapy can reverse these neural changes without restoring the input, that I do not know. Who does really? Only time will tell.

 

[The Red Viper]

Sounds like smoke and mirrors to me...

 

[Kekistan]

Could it be this "Heidelberg Model"? It's also called "Heidelberg Model of Music Therapy for Chronic Tinnitus". Heidelberg is a town in Germany.



They started recruiting people for this therapy in 2004 for a study. That was the first broad use of it I guess. The details about the method can be found here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443887/

I guess it's really down to the behavioral and structural changes of the neurons. Which reminds me of this:

https://www.tinnitustalk.com/thread...n-change-the-way-nerve-cells-are-wired.20506/

But if music therapy can reverse these neural changes without restoring the input, that I do not know. Who does really? Only time will tell.

Can you do it by yourself if your tinnitus is new and have nothing to lose?

 

[Samir]

@Kekistan,

This is not something you can do on your own. The best would be to visit the ENT clinic at the university hospital of Heidelberg. They will know what to do and how to do it. Some private ENT doctors in Germany might also be able to offer you this therapy.

 

[gerhei]

Hello guys,

TL;DR Heidelberg Mudel of Music Therapy is currently probably the most effective way to treat acute and chronic tinnitus (I don't know whether that holds for somatosensory tinnitus as well).

Due to my own tinnitus and my geographical closeness to the city of Heidelberg I researched the topic for myself. Far from being a specialist, I think that I understand some mechanisms that make this therapy effective. The effectiveness was the therapy was indicated by the AWMF ("Working Group of the Scientific Medical Societies e.V.") that publishes the guideline for treating chronic tinnitus (its effectively an authoritative guideline that every otolaryngologist should follow). In the guideline it states:

"Active music therapy is carried out under the guidance of a music therapist. Argstatter et al. (2007 [11], 2008 [12], 2010 [13], 2012 [14, 15]) and Grapp et al. (2013 [63]) published studies on active music therapy. This is a music therapy standardized by means of manualization of nine 50-minute sessions five consecutive days in a row. A recently published (Argstatter et al, 2014 [16]) controlled, pseudorandomized study shows a first evidence. In comparison to counseling, which led to a 33% improvement in TQ scores (Göbel-Hiller's tinnitus question inventory), music therapy achieved a score improvement of 66% (OR 4.34 with a CI of2.33-8.09). In methodological terms, we can speak of a moderately validated therapy programme, the effectiveness of which should be reproduced at least by a further study of another centre or a multicentre study."​

The guideline was published in February 2015. A few days before the publication the study "Cortical reorganization in recent-onset tinnitus patients by the Heidelberg Model of Music Therapy" was published. The study was also mentioned by another poster in the thread. The study investigates why the therapy is effective on a neuronal level. The summary/abstract reads as follows:

"This therapy is a compact and fast application of nine consecutive 50-min sessions of individualized therapy implemented over 1 week. Clinical improvement and long-term effects over several years have previously been published. However, the underlying neural basis of the therapy's success has not yet been explored. [...] Before and after the study week, high-resolution MRT scans were obtained for each subject. Assessment by repeated measures design for several groups (Two-Way ANOVA) revealed structural gray matter (GM) increase in TG compared to PTC, comprising clusters in precuneus, medial superior frontal areas, and in the auditory cortex. [...] In line with recent findings on the crucial role of the auditory cortex in maintaining tinnitus-related distress, a causative relation between the therapy-related GM alterations in auditory areas and the long-lasting therapy effects can be assumed."​

Although the study focuses on patients with recent tinnitus, the "German Center for Music Therapy Research" (DZM) which developed and carries out the therapy, treats patients with both chronic and acute tinnitus. In a personal phone call I had with the center I was unofficially told that, although the success rate of the therapy is statistically the highest for those with recent tinnitus (about 80% of patients have a significant improvement), the success rate for chronic tinnitus is still about 70%. I don't remember anymore exactly where I read it but it was indicated that the remaining 20-30% of patients who were not treated successfully had no good results because they also suffered from untreated hearing loss and should have first corrected that hearing loss with hearing aids before proceeding with the therapy. This effectively implies that the therapy is suited for almost everybody.

I am waiting for the update of the guideline in February 2020 and their evaluation of the above mentioned study.

Methods

By humming melodies, counseling and some other components the therapy changes the brain structure in the auditory cortex in a short period of time. Neighboring regions of the overactive parts of the auditory cortex that compensate for missing signals due to damaged hair cells and other sources of false signal processing are "reprogrammed" effectively.

A short video which is already older (unfortunately only in German):



Best regards

 

[MattS]

Hello guys,

TL;DR Heidelberg Mudel of Music Therapy is currently probably the most effective way to treat acute and chronic tinnitus (I don't know whether that holds for somatosensory tinnitus as well).

Due to my own tinnitus and my geographical closeness to the city of Heidelberg I researched the topic for myself. Far from being a specialist, I think that I understand some mechanisms that make this therapy effective. The effectiveness was the therapy was indicated by the AWMF ("Working Group of the Scientific Medical Societies e.V.") that publishes the guideline for treating chronic tinnitus (its effectively an authoritative guideline that every otolaryngologist should follow). In the guideline it states:

"Active music therapy is carried out under the guidance of a music therapist. Argstatter et al. (2007 [11], 2008 [12], 2010 [13], 2012 [14, 15]) and Grapp et al. (2013 [63]) published studies on active music therapy. This is a music therapy standardized by means of manualization of nine 50-minute sessions five consecutive days in a row. A recently published (Argstatter et al, 2014 [16]) controlled, pseudorandomized study shows a first evidence. In comparison to counseling, which led to a 33% improvement in TQ scores (Göbel-Hiller's tinnitus question inventory), music therapy achieved a score improvement of 66% (OR 4.34 with a CI of2.33-8.09). In methodological terms, we can speak of a moderately validated therapy programme, the effectiveness of which should be reproduced at least by a further study of another centre or a multicentre study."​

The guideline was published in February 2015. A few days before the publication the study "Cortical reorganization in recent-onset tinnitus patients by the Heidelberg Model of Music Therapy" was published. The study was also mentioned by another poster in the thread. The study investigates why the therapy is effective on a neuronal level. The summary/abstract reads as follows:

"This therapy is a compact and fast application of nine consecutive 50-min sessions of individualized therapy implemented over 1 week. Clinical improvement and long-term effects over several years have previously been published. However, the underlying neural basis of the therapy's success has not yet been explored. [...] Before and after the study week, high-resolution MRT scans were obtained for each subject. Assessment by repeated measures design for several groups (Two-Way ANOVA) revealed structural gray matter (GM) increase in TG compared to PTC, comprising clusters in precuneus, medial superior frontal areas, and in the auditory cortex. [...] In line with recent findings on the crucial role of the auditory cortex in maintaining tinnitus-related distress, a causative relation between the therapy-related GM alterations in auditory areas and the long-lasting therapy effects can be assumed."​

Although the study focuses on patients with recent tinnitus, the "German Center for Music Therapy Research" (DZM) which developed and carries out the therapy, treats patients with both chronic and acute tinnitus. In a personal phone call I had with the center I was unofficially told that, although the success rate of the therapy is statistically the highest for those with recent tinnitus (about 80% of patients have a significant improvement), the success rate for chronic tinnitus is still about 70%. I don't remember anymore exactly where I read it but it was indicated that the remaining 20-30% of patients who were not treated successfully had no good results because they also suffered from untreated hearing loss and should have first corrected that hearing loss with hearing aids before proceeding with the therapy. This effectively implies that the therapy is suited for almost everybody.

I am waiting for the update of the guideline in February 2020 and their evaluation of the above mentioned study.

Methods

By humming melodies, counseling and some other components the therapy changes the brain structure in the auditory cortex in a short period of time. Neighboring regions of the overactive parts of the auditory cortex that compensate for missing signals due to damaged hair cells and other sources of false signal processing are "reprogrammed" effectively.

A short video which is already older (unfortunately only in German):



Best regards

@gerhei - would you happen to have a copy of the treatment protocol in English? Some of the summarized features of the treatment make some sense - are in line with some of the things I've been considering, experimenting with. But the articles don't actual provide the treatment protocol - just a summary, and a citation to a German article from 2008.

 

[hans01]

I have no scientific evidence to provide but I've noticed an overall lessening in my tinnitus in conjunction with increasing my exposure to louder sound levels. Sometimes I'll go to a concert with a ton of bass and despite wearing earplugs will have slightly elevated tinnitus for a day or two after. Then it actually becomes less intrusive than before the concert. I am pretty sure my tinnitus became bad because I went from so much loudness to none at all nearly overnight. Having found a balance now I can say my tinnitus is at a level that would be acceptable and undetected by most people. I'd even dare say it's gone, because it's no longer intrusive to my life. I produce music, go to concerts, and listen to music in the car every day with no discernible problems in my ear.

I also noticed that my T is worse if I stay too much time in silent rooms and better when I listen to music at higher levels. Maybe the silence isn't that good after all ...

 

[Auron]

Maybe the silence isn't that good after all ...

Silence doesn't affect my T.If anything it helps.Quite mysterious,T is.

 

[Johan001]

Hi all,

Does anyone have experience with this therapy?