Tinnitus Retraining Therapy (TRT) — Financial Disclosure

[Dr. Nagler]

Question from @cullenbohannon originally posted on the Support Forum ...

Hey @Dr. Nagler ,
I hope all is well, i was wondering if there was something you could address. Obviously you are an advocate of TRT and operate a tinnitus clinic. I was wondering if you could address your financial connection to TRT?
On more then one occasion i've seen people hint that you have a financial interest in TRT and keeping the "status quo" so to speak. I wonder if addressing this wouldn't put some of the people here more at ease since we are a support board first and foremost.

I guess this issue had to come up sooner or later. I sincerely appreciate the respectful way in which you worded your inquiry.

I am going to try to answer your question thoroughly to address all concerns while at the same time trying not to run afoul of the rules of the board against advertising.

So the short answer is that I have no direct or indirect financial connection to TRT:

• I used to be Director of Tinnitus and Hyperacusis Services for one of the companies that manufactures devices used for TRT sound therapy. That was a salaried position; my compensation was not in any way connected to device sales. I do not and never did own stock or stock options in the company. I left the company last year. I receive no remuneration of any kind from the company. I receive no royalties from the sale of the devices I helped develop while I was with the company.

• I have been invited to participate in a number of Dr. Jastreboff's TRT courses in the US and abroad. I receive no financial remuneration for doing so.

• I have also delivered a number of doctoral level TRT seminars to graduate students in audiology at institutions of higher learning in the US. In every case I have donated the honoraria I have received for doing so to the scholarship funds of the universities granting the honoraria.

• TRT does involve sound therapy, but I do not sell the devices used in sound therapy and therefore do not profit from the markup on those devices. My patients are free to purchase devices from any source they care to use. I am totally financially insulated from that process and receive no financial benefit either directly or indirectly. Similarly, I am not involved in any aspect of audiological testing. My patients are free to undergo the necessary testing at any facility of their choice. As with the sale of devices, I am totally financially insulated from the testing process and profit from it neither directly nor indirectly. I do not employ any audiologists. My patients pay for my time and expertise in assessing the nature, the extent, and the impact of their auditory challenge and for helping them do something about it through the TRT counseling process when indicated.

• My clinic is set up as a for-profit company. I am the owner and sole employee. I sublet a small amount of space from an ENT practice, enabling me to keep my overhead to an absolute minimum. I draw a salary of $1 per year. 100% of the profits from my clinic are donated to research towards a cure for tinnitus as allocated by an independent entity.

In summary, I have no financial connection with TRT whatsoever, and 100% of the profits from my work go to research that if ultimately successful will result in the demise of my own clinic. The idea put forth by some that I have an interest in maintaining the status quo and in not supporting research towards a cure is both ludicrous and insulting.

I am an advocate for TRT for one reason and one reason only. And that is because TRT - done properly by knowledgeable and experienced TRT clinicians - is a highly effective treatment protocol for individuals suffering from severe intrusive tinnitus. TRT is not perfect ... but in 2015 TRT is, in my opinion, the very best thing out there. And I suspect it will continue to be the best thing out there until a true cure is found.

Dr. Stephen Nagler