Tinnitus Retraining Therapy Is Ineffective, Latest Study Finds

[Michael Leigh]

By the way - disagreement is not a bad thing,

I agree disagreement isn't a bad thing. In fact I'm a firm believer in voicing one's opinion but that's not what I'm referring to and you know that all to well.

All the best
Michael

 

[TibuJenkins]

Is there a reason why this needs to be so adversarial? One would think we are all in the same "team" here.

 

[Silvio Sabo]

@Michael Leigh

Where did you get your information that most people learn to habituate to it and carry on with their life doing everything they want to?

Did you manage to get hold of some nationwide statistics perhaps?

I'd love to see them.

I don't have the citations from studies or so but if you think about it logically you will come to the conclusion that most people do learn to move on. The figures are that around 10-15% of the general population experiences tinnitus of some kind. That is literally hundreds of millions of people around the world. If most of those didn't learn to move on and offed them selves or took absence from work due to illness or something similar, the world's economy would collapse. And since it hasn't the logical conclusion is that most people do in fact learn to move on.

 

[Jazzer]

@Silvio Sabo, @Michael Leigh,
@TibuJenkins,

I have to concede that you guys may well be right.
My own severity distorts my thinking at times.
I apologise to you.....x

 

[TheDanishGirl]

I don't have the citations from studies or so but if you think about it logically you will come to the conclusion that most people do learn to move on. The figures are that around 10-15% of the general population experiences tinnitus of some kind. That is literally hundreds of millions of people around the world. If most of those didn't learn to move on and offed them selves or took absence from work due to illness or something similar, the world's economy would collapse. And since it hasn't the logical conclusion is that most people do in fact learn to move on.

Just because somebody keeps going to work does not mean that they aren't suffering a great deal, though. Some really have no choice but to go to work... it's either that or starve to death.

 

[Michael Leigh]

Who are these TRT folks? They pop out of the woodwork, it's like they all have a built in alarm system as soon as the topic of TRT comes up.

I don't think anyone buys that these people are trying to help (unless that help involves the eventual promotion of TRT). These creeps seem to be willing to cut down and silence even the worst tinnitus suffers if they don't conform/believe, or even worse TRT didn't work out for them!!

These TRT promoters obviously aren't here because they care. They are here to hammer sell TRT every day (full time) until they die.

I've been here for over 5 years, from what I gather the general consensus has always been that TRT is unhelpful, now we have more evidence that confirms this, yet these same folks are at it again doing damage control as usual. Who pays these people?

HI @Telis

I know you have a lot of difficultly with tinnitus, so please forgive me when I say after reading your post it made me smile and chuckle a few times. I don't mean to be facetious for I know your situation is a serious one. I am an advocate of TRT when it is administered correctly and a person has an open mind to the treatment. Please be assured I am not being paid by anyone for writing about it.

Take care
Michael

 

[Starthrower]

I have to concede that you guys may well be right.
My own severity distorts my thinking at times.
I apologise to you.....x

Oh @Jazzer never feel you have to apologize. Leigh likes to or HAS to make public broadcasts about placing people on his ever growing ignore list. This is so juvenile. And it is done to make a person feel unworthy and less than a good person.

I think like @TibuJenkins:

Is there a reason why this needs to be so adversarial? One would think we are all in the same "team" here.

And there is a scientific study thanks to @annV:

JAMA Otolaryngol Head Neck Surg. Published online May 23, 2019. doi:10.1001/jamaoto.2019.0821

Effect of Tinnitus Retraining Therapy vs Standard of Care on Tinnitus-Related Quality of Life

Question Among patients with subjective debilitating tinnitus and audiometric normal to mild hearing loss, does treatment with tinnitus retraining therapy with conventional sound generators result in better outcomes than tinnitus retraining therapy with placebo sound generators or standard of care?

Findings In this randomized clinical trial of 151 participants with 18 months of follow-up, average tinnitus distress decreased in all 3 groups. There was no clinically meaningful difference in extent of reduction in tinnitus distress or other important end points among patients in the 3 intervention groups.

Meaning Tinnitus retraining therapy with conventional sound generators is no better than tinnitus retraining therapy with placebo generators or standard of care.

 

[Jazzer]

@Starthrower

Something I need to admit Star.
I am plagued with noise, as I know you are, though I usually cope somehow.
But having said that, there are times when the enormity of the life I have lost really hits me hard.

At the weekend I took my misus up country to see a concert by the TJ Johnson Jazz and Blues Band.
Her favourite band, and one of the bands I was trombonist for, before I had to leave because of "T."
She was sitting in the front row, lapping up the music.
I was in the back row with my ear plugs well in.

In the interval she walked down the aisle to speak to me, leaned over, and with her delightful smile said to me,
"Are you enjoying it babe?"
I lay against her chest and sobbed.
She said "Whatever is the matter baby?"

"I miss it so much."

"I know sweetheart - I know."

This thing has hit her so hard also.

I used to play Caribbean cruises in the jazz band on the QE 2, and my income for the month used to pay for both of our passages.
Now we go house sitting for people when they go away.

I know I have to be brave to form a different life, but there are times when I struggle.

Sorry to lay this on you Star,

much love

Dave x
Jazzer

 

[vermillion]

The resources that have been consumed to conduct this study, seem to be such a waste. They tried to prove the obvious. But then again thumbs up, because more of these studies eventually can help to sentence TRT to where it deserves. Death

 

[Silvio Sabo]

Just because somebody keeps going to work does not mean that they aren't suffering a great deal, though. Some really have no choice but to go to work... it's either that or starve to death.

I never said people don't suffer. Absence of suffering isn't the same thing as moving on. I suffer but I still try living my life.

 

[TheDanishGirl]

I never said people don't suffer. Absence of suffering isn't the same thing as moving on. I suffer but I still try living my life.

Oh I see. Thanks for clearing that up. I guess we apply different meaning to the phrase "moving on". For me it means that a person copes better and are generally uplifted and happier than before.

 

[Starthrower]

I know I have to be brave to form a different life, but there are times when I struggle.

Sorry to lay this on you Star,

much love

Dave x
Jazzer

@Jazzer big hug because I am the same. I guess after so many years with this I just cope also. Friends begged me to go to a weekend concert country music...I said no. I knew the loudness and the sound of the large crowds would make me miserable. Oh well...look how fortunate we are to have spouses that understand even though we try to tough it out and can see their concern in the eyes.

Sometimes I say to myself I had my days in the sun.

I think of all the people your music brought smiles to.

I never said people don't suffer. Absence of suffering isn't the same thing as moving on. I suffer but I still try living my life.

@Silvio Sabo you are like @jazzzer and myself having long term tinnitus. How long did it take you to get to this particular point? I cannot remember. I think it must have been around year four. Had a horrible incident in the second year that emotionally tore me down. So it took a while longer.

 

[Silvio Sabo]

@Jazzer big hug because I am the same. I guess after so many years with this I just cope also. Friends begged me to go to a weekend concert country music...I said no. I knew the loudness and the sound of the large crowds would make me miserable. Oh well...look how fortunate we are to have spouses that understand even though we try to tough it out and can see their concern in the eyes.

Sometimes I say to myself I had my days in the sun.

I think of all the people your music brought smiles to.


@Silvio Sabo you are like @jazzzer and myself having long term tinnitus. How long did it take you to get to this particular point? I cannot remember. I think it must have been around year four. Had a horrible incident in the second year that emotionally tore me down. So it took a while longer.

For me it's been ups and downs. When I got it back in 2006 it took me about 2-3 years to habituate. After those first couple of years I rarely thought about tinnitus for years. Yes it was always present but it didn't bother me and I could just "send it" to the back of my mind and be happy. Then in January of 2015 I had a worsening. Tinnitus got considerably louder and I also got a couple of new tones. Since then it's been a struggle. I get bad spikes from time to time from sounds that shouldn't be harmful. The worst spike I had lasted for around 5 months.

I also take anti depressants due to poor sleep and anxiety. The one I'm taking is Mirtazapine, which is a good anti depressant for people with tinnitus since tinnitus is not among it's common or uncommon side effects such as some SSRIs. Besides helping with anxiety it also puts me to sleep without building up a tolerance like sleep medications (that also can cause tinnitus!). The only problem is that it's hard to get off it and some people can gain weight from it.

 

[Juan]

Headphones in 1996.
Listening to a classical music through my HI-FI in 2008.

You gotta be kidding!!! And you call that a "noise trauma"?

I thought the standard definition of a noise trauma or noise damage was something like standing close to the speakers in a Metallica concert, or shooting guns without hearing protection, or being exposed to a pretty big explosion.

 

[Silvio Sabo]

You gotta be kidding!!! And you call that a "noise trauma"?

I thought the standard definition of a noise trauma or noise damage was something like standing close to the speakers in a Metallica concert, or shooting guns without hearing protection, or being exposed to a pretty big explosion.

Listening to music using headphones can get you up over 100 dB, depending on headphones and HiFi equipment can definitely get you over 100 dB, which is more than enough to do serious damage.

 

[attheedgeofscience]

Well... my input: title is misleading (i.e. "Tinnitus Retraining Therapy Is Ineffective, Latest Study Finds"). The study didn't conclude that TRT is ineffective – it found that TRT proper is no more effective than the two other treatment arms. It never compared TRT to doing nothing (control group). It also appears there were problems with the study itself (dropout rates and clinicians not familiar with TRT). Having said that, I am no fan of TRT, but I do want to point out the discrepancy (since no one else did and the thread is already three pages long...).

It is noteworthy, however, that not including sound therapy made no difference to the outcome of the therapy (as this part is considered instrumental to the TRT concept).

 

[Juan]

Listening to music using headphones can get you up over 100 dB, depending on headphones and HiFi equipment can definitely get you over 100 dB, which is more than enough to do serious damage.

Using headphones is something that, today, with cellphones, iPods etc most people do. And the volume depends just on your setting, it its as easy as lowering it.

Really, I have read for quite a few years about noise trauma and the usual onset is due to a one-off episode of very loud noise, well over 100 dB. That may be why some people recover from what they call "hyperacusis" and others never recover. It all depends on what caused it initially.

Personally I think that listening to headphones cannot be compared to people who got hyperacusis standing close to huge speakers at full volume during the hours that a concert lasts, which is one of the main causes quoted, or people who went clubbing, or people who were using power tools without hearing protection, or shooting, or exposed to close airplane noise. Do you think you can really compare "headphones" to a fighter plane just taking off nearby?

 

[Silvio Sabo]

Using headphones is something that, today, with cellphones, iPods etc most people do. And the volume depends just on your setting, it its as easy as lowering it.

Really, I have read for quite a few years about noise trauma and the usual onset is due to a one-off episode of very loud noise, well over 100 dB. That may be why some people recover from what they call "hyperacusis" and others never recover. It all depends on what caused it initially.

Personally I think that listening to headphones cannot be compared to people who got hyperacusis standing close to huge speakers at full volume during the hours that a concert lasts, which is one of the main causes quoted, or people who went clubbing, or people who were using power tools without hearing protection, or shooting, or exposed to close airplane noise. Do you think you can really compare "headphones" to a fighter plane just taking off nearby?

This is simply not true. Hearing usually deteriorates over time. Listening to headphones at higher volumes for hours over a longer period will have a profoundly negative effect on your hearing. This has nothing to do with what most people do or don't do. If most people jumped off of buildings it wouldn't make it less deadly. Most people who have tinnitus are older people (50+ years old), not young people. Which is due to a lifetime of smaller incidences that have accumulated and caused hearing loss and tinnitus. Which certainly does not say you can't get hearing loss and tinnitus from one single incident, which of course you absolutely can. But it's not the only way or even the most common one.

 

[Juan]

This is simply not true. Hearing usually deteriorates over time. Listening to headphones at higher volumes for hours over a longer period will have a profoundly negative effect on your hearing. This has nothing to do with what most people do or don't do. If most people jumped off of buildings it wouldn't make it less deadly. Most people who have tinnitus are older people (50+ years old), not young people. Which is due to a lifetime of smaller incidences that have accumulated and caused hearing loss and tinnitus. Which certainly does not say you can't get hearing loss and tinnitus from one single incident, which of course you absolutely can. But it's not the only way or even the most common one.

I am talking primarily about hyperacusis, which is usually triggered by a one-off episode of incredibly loud noise. In this cathegory usually do not fall the small incidents that accumulate over time, but a single incident which is very loud. If you read through these fórums you will see that the classical examples that trigger H are concerts, being close to big speakers, clubbing, noise at work (explosions, loud power tools etc)

So what I am saying is someone is advocating TRT no matter what evidence is against TRT as a possible "cure" for hyperacusis, and in the first place I seriously doubt that person has had hyperacusis at all, and even less hyperacusis caused by loud noise.

 

[Racehorse]

If TRT doesn't actually reduce the tinnitus volume, but helps people not think about it, then it's just good ol' habituation happening. Maybe TRT is just a way to help some habituate. Me personally, if I had loud tinnitus, I know I would never habituate. Mine is very mild to moderate, and it bothers me immensely. I worry it will get worse some day, so I do what I can for it not to. Pray people!!

 

[Ken219]

The resources that have been consumed to conduct this study, seem to be such a waste. They tried to prove the obvious. But then again thumbs up, because more of these studies eventually can help to sentence TRT to where it deserves. Death

It only shows people are greedy and there is a large community of junk science. But in the end we all want to believe.
'P.T. Barnum
"The public appears disposed to be amused even when they are conscious of being deceived."
"There's a sucker born every minute"

 

[Silvio Sabo]

I am talking primarily about hyperacusis, which is usually triggered by a one-off episode of incredibly loud noise. In this cathegory usually do not fall the small incidents that accumulate over time, but a single incident which is very loud. If you read through these fórums you will see that the classical examples that trigger H are concerts, being close to big speakers, clubbing, noise at work (explosions, loud power tools etc)

So what I am saying is someone is advocating TRT no matter what evidence is against TRT as a possible "cure" for hyperacusis, and in the first place I seriously doubt that person has had hyperacusis at all, and even less hyperacusis caused by loud noise.

I've never advocated TRT. I have made my stance on TRT vocal several times on this forum. I find it to be a complete waste of time and money.

 

[dayma]

I understand some members can find it frustrating how you consider your experience to be more correct than scientific studies - or the experiences of those who have not had tinnitus for 23 years.

I would also like to state that your generalization of people's tinnitus not being debilitating if they can log onto Tinnitus Talk and talk about their problems, is blatantly wrong. It might be YOUR experience, but not necessarily that of others.

We have unfortunately had several members over the years log on here, talk about their tinnitus, and then take their own lives.

If taking their own lives is not proof that they were debilitated, I do not know what else is.

Please try to understand that your opinion and experience can be utterly different from someone else.

I don't have much to add to this, but to say THANK YOU for these words!

 

[Greg Sacramento]

A Cochrane review of annV's posted study by ENTs is available, but one must pay for it. I can say that it's not worth reading. I know that Cochrane values clinical physical research and they don't often discuss mind over body theory.

This leads me to being able to post with severe anything. I'm in severe pain and I still have the same emotions and no talk by anyone is going to chance that. I do honor the love that we give each other - for me a lot is shared to and from by PM or by email.

 

[Juan]

I've never advocated TRT. I have made my stance on TRT vocal several times on this forum. I find it to be a complete waste of time and money.

I was talking about another member, the one that defines noise trauma as "headphones" and advocates TRT no matter what, even if there is scientific evidence against it.

Anyway, TRT is old enough for most people to know nowadays that it does not work.

 

[annV]

I will share now with you Craig Formby and Roberta W. Scherer's opinion / viewpoint article of the TRT study.
I will also share the full paper for your convenience.

 

[Greg Sacramento]

Type of sound heard, No.(%)
Tonal 47(95.9) 47(92.2) 47(92.2) 141(93.4)
Low-frequency noise 1(2.0) 2(3.9) 4(7.8) 7(4.6)
High-frequency noise 0 1(2.0) 0 1(0.7)

Tonal 92.2 for TRT
High frequency noise has a very low representation - so I would call the actual patient study worthless.
Even our good doctor per the doctor's corner does not often treat those with high frequency.
Also multiple sounds, thumping, pulsatile tinnitus needs representation.

 

[Ken219]

Are they still pushing TRT? How much money do you think these people made?


'Professor & Director
Margaret M. Jastreboff, Ph.D.
Associate Professor
Tinnitus & Hyperacusis Center
Department of Otolaryngology
Emory University School of Medicine

Over the years, many methods of tinnitus treatment have been introduced, but very few survived the test of time. Even now, in the year 2000, we do not have a mechanism-based method to provide a cure for tinnitus. More than a decade has passed since the introduction of the neurophysiological model of tinnitus and Tinnitus Retraining Therapy (TRT). Despite the controversies and criticism surrounding this approach, the number of patients helped is growing constantly, not only in the USA, but around the word. In fact, TRT is used successfully now in more than 20 countries.'

 

[Manny]

Are they still pushing TRT? How much money do you think these people made?


'Professor & Director
Margaret M. Jastreboff, Ph.D.
Associate Professor
Tinnitus & Hyperacusis Center
Department of Otolaryngology
Emory University School of Medicine

Over the years, many methods of tinnitus treatment have been introduced, but very few survived the test of time. Even now, in the year 2000, we do not have a mechanism-based method to provide a cure for tinnitus. More than a decade has passed since the introduction of the neurophysiological model of tinnitus and Tinnitus Retraining Therapy (TRT). Despite the controversies and criticism surrounding this approach, the number of patients helped is growing constantly, not only in the USA, but around the word. In fact, TRT is used successfully now in more than 20 countries.'

Yup, the Jastreboffs have won the Most Farcical Couple award every year for the past 200 years.

 

[Mister Muso]

Type of sound heard, No.(%)
Tonal 47(95.9) 47(92.2) 47(92.2) 141(93.4)
Low-frequency noise 1(2.0) 2(3.9) 4(7.8) 7(4.6)
High-frequency noise 0 1(2.0) 0 1(0.7)

Tonal 92.2 for TRT
High frequency noise has a very low representation - so I would call the actual patient study worthless.
Even our good doctor per the doctor's corner does not often treat those with high frequency.
Also multiple sounds, thumping, pulsatile tinnitus needs representation.

At the risk of opening up this thread again, I would hardly call that sample set representative. I don't think there is any "one size fits all" solution. For me, white noise does less to help my tonal noises than my high frequency ones. For tonal noise I use neuromodulation sounds and residual inhibition such as HushTinnitus.com. For low frequency, notched brown noise or audio books. If wearing in ear noise generators I would go for those that can play whatever sounds I choose from the above selection.