Tinnitus Retraining Therapy

[erik]

Hey Leah... did I see you say in an earlier post that Cleveland Clinic was near you? I would definitely take a look there. Make sure wherever you go that they have a strong counseling protocol, other support staff with knowledge about tinnitus. And check out the training of the audiologist who will be working with you; I don't think its too complicated to get certified through Neuromonics, which I sense is all that's required to sell the product. I have waited extra months to get into the Miami program because the first one that qualified me was part of a large ENT practice, and I didn't think they had the experience or staffing to handle it properly. They were just looking for a way to bring in extra money.

Good point LadyDi. Many places offer these devices like Neuromonics and Soundcure without any counseling which is why perhaps so many people have bad results with these devices. You need to have both components to be successful with TRT. I am surprised that the makers of these devices especially at the high costs, don't mandate that their providers offer the counseling portion of it as part of the treatment before they allow them to sell their devices.

 

[Leah]

Thanks Lady Di & Erik for the information. I have an apt with a Cleveland Clinic Psychiatrist but not until 10-18.
The Clinic has a T support group that has this doc and various professionals available. There is a 6 month waiting list.
I am attempting to find out who these professionals are and get into them privately, 6 months is a long time to do nothing. Please explain why counseling is important to the success of this treatment. So glad I have all of you here for help/

 

[LadyDi]

As I understand it, the counselors talk with you about how you are adjusting to the sound, give suggestions on strategies you can try to habituated, etc. It may be a lot like using cognitive behavioral therapy for anxiety. They on just give you the device and occasionally adjust it. I'll know more when talk to them next month. Believe @ShootingStar on here was trying it, too?

 

[Karl]

I read something in Jastreboff and Hazell's book "Tinnitus Retraining Therapy", where they say that people who use hearing aids take longer to habituate. This has always confused me.

I have been using hearing aids to suppress my tinnitus. Recently somebody on this website sent me a personal message saying that they have habituated, and tinnitus no longer bothers them. So, the question is, does that mean he can no longer hear tinnitus?

I mean, do you have to hear tinnitus to habituate, so hearing aids will delay habituation? Then, after habituation, you no longer hear it??? Or does this mean that after habituation, you are no longer concerned about it???

This is all very confusing, ...isn't it?

 

[Markku]

I read something in Jastreboff and Hazell's book "Tinnitus Retraining Therapy", where they say that people who use hearing aids take longer to habituate. This has always confused me.

I have been using hearing aids to suppress my tinnitus. Recently somebody on this sight wrote me that they have habituated, and tinnitus does not bother them. So, the question is, does that mean he can no longer hear tinnitus?

I mean, do you have to hear tinnitus to habituate? Then, after habituation, you no longer hear it??? Or does this mean that after habituation, you are no longer concerned about it???

This is all very confusing, ...isn't it?

Habituation of reaction and perception [ http://tinnitus.org/tinnitus.html ]

The presence of any continuous stimulus results in a process called habituation, whereby the individual responds less and less to the stimulus, as long as it does not have any special significance. Think of moving house, from the quietness of the countryside, to live by a busy road. At first the traffic sounds are disliked, and appear very loud. As this reaction diminishes with time (habituation of reaction) there is an automatic reduction in the perception of traffic sounds (habituation of perception). The final stage of habituation is when the signal is no longer detected, and cortical neurones are unresponsive.

It seems the final stage is supposed to be where you no longer detect the signal (/tinnitus?).

What percentage reaches that stage, I don't know. I've always considered habituation to be where you no longer react to tinnitus, but can still hear it. If I couldn't hear my tinnitus, I wouldn't call it habituation but being completely resolved.

 

[Karl]

....

It seems the final stage is supposed to be where you no longer detect the signal (/tinnitus?).

What percentage reaches that stage, I don't know. I've always considered habituation to be where you no longer react to tinnitus, but can still hear it. If I couldn't hear my tinnitus, I wouldn't call it habituation but being completely resolved.

Yes, this is a fine point: "No longer detect" versus "no longer react". I have also considered habituation to be the "no longer react" definition.

If we read Jastreboff's nice little neuorphysiological diagrams, he shows a literal disconnect between conscious thoughts and the tinnitus loop acting at a lower conscious level. Then he goes on to say things, "If tinnitus reappears..." (blah, blah, blah). It's like, it it gone , but it can reappear and get fixed again. (Why the hell are these guys so cryptic? It drives me crazy!)

But if we also read the Thomas Coleman's "Tinnitus Miracle" (only $50, by the way), he says that after a person habituates, tinnitus is still there, but it is no longer a concern..like living next to a train yard. Based on that, I've always gone for the " no longer react" definition.

It just seems hard to grasp that it can go away. But, hey, I'll take that option. This is giving me much more to look forward to.

 

[Mark Washington]

Habituation is when you no longer tune into the tinnitus. The tinnitus is there but you are no longer bothered by it.

If you live by an airport people tend to get used to planes constantly flying over their house. The loud sounds of planes do not generate a response in the brain. The person that lives by an airport will not even wake up at night to the planes constantly roaring. If I, who do not live by an airport happen to move by an airport, i might be bothered by the planes constantly roaring by. I might even want to move out because I am bothered by the planes.

Someone else who just moves in by the airport might not be bothered by the roaring of planes where as I am (when we both are currently in our new houses by the airport). I might need TRT or Airplane Getting Used to Habituation where as they (i.e. the new person who moved into a house by the airport and the person whose already there and used to the sounds of the airport) would not need TRT or airplane roar habituation.

Just as a friendly gesture of pure hope. I do have a really good friend who has had tinnitus since he was 10. He tells me that he has no clew that he has tinnitus. He is so used to tinnitus that the sound is just as much as apart of him as his eyes are brown. He told me that when he dies he will miss tinnitus becauses that sound is apart of him. It took him till he turned 18 to fully get used to tinnitus. Its constantly ringing but he has no clew that it is there. AS his heart beats his tinnitus rings. As his It is possible for anyone to be able to fully get used to tinnitus.

PUt it this way another one of my friends who has tinnitus I think recently ruined his ears again or upped the volume. He went out to a really loud place or concert or something. I asked him why did you go out when you know you have tinnitus. HE told me that he totally forgot that past 5 years that he had tinnitus. Now he has TINNITUS Again.

It is the case that one can make tinnitus a nosie of the background or a noise that one might miss when they are dead. Both my friends have never had TRT and habituated it on their own.

 

[Dr. Nagler]

Habituation is when you no longer tune into the tinnitus. The tinnitus is there but you are no longer bothered by it.

I agree.

In short, habituation is when you no longer care.

Stephen Nagler

 

[Claire43013]

I've been looking into TRT, but my problem with it is this; 80% of people naturally habituate to T, and TRT has an 80% success rate. What if the success rate is just people who would have habituated on their own in due time? TRT proponents say treatment may last up to 1-2 years. That's how long it takes to habituate, on the high end!

 

[Dr. Nagler]

I've been looking into TRT, but my problem with it is this; 80% of people naturally habituate to T, and TRT has an 80% success rate. What if the success rate is just people who would have habituated on their own in due time? TRT proponents say treatment may last up to 1-2 years. That's how long it takes to habituate, on the high end!

Claire, there is really no way to tell in advance if any given person will habituate on his or her own (i.e., without TRT) within a couple of years after onset of tinnitus.

But I am aware of one interesting study from a clinic where they looked at their "TRT successes" and checked to see how long those individuals had been suffering from tinnitus before starting TRT that was ultimately successful. One would think that if these folks would have succeeded on their own, the average time would have been two to three years. Turns out that the average in this particular study was 10.5 years. That's 10.5 years of suffering with tinnitus prior to starting TRT that was ultimately successful within another 12 to 18 months. Three patients actually had been suffering for more than 20 years prior to succeeding in TRT.

Now granted, that's one uncontrolled retrospective study from one clinic - but it's something to think about.

Stephen Nagler

 

[Claire43013]

Claire, there is really no way to tell in advance if any given person will habituate on his or her own (i.e., without TRT) within a couple of years after onset of tinnitus.

But I am aware of one interesting study from a clinic where they looked at their "TRT successes" and checked to see how long those individuals had been suffering from tinnitus before starting TRT that was ultimately successful. One would think that if these folks would have succeeded on their own, the average time would have been two to three years. Turns out that the average in this particular study was 10.5 years. That's 10.5 years of suffering with tinnitus prior to starting TRT that was ultimately successful within another 12 to 18 months. Three patients actually had been suffering for more than 20 years prior to succeeding in TRT.

Now granted, that's one uncontrolled retrospective study from one clinic - but it's something to think about.

Stephen Nagler

That's a good point. If the AM-101 study doesn't pan out for me I think I'm going to try the TRT approach. If anything, maybe it will help me to habituate faster.

 

[RocketJSquirrel]

TRT is certainly worth a try; after all, it costs virtually nothing and won't hurt you in any way.

I tried self-administering it a couple of years ago. I bought and read Jastreboff's TRT book. Regardless of how well you understand the neurophysiological model, the method itself is easy to administer. I played nature sounds like crickets or raindrops in my ears all the time - literally 24/7 - at a volume just lower than my tinnitus. During the day, I used an iPod with earbuds. At night, I used SleepPhones.

After about 6 months of this, I experienced two 15-minute periods of silence, where I suddenly realized I wasn't hearing the T. But the effect didn't last, much to my disappointment, and I gave it up.

But remember, we're all different. It might work for you.

 

[Claire43013]

They said it works best if you do it with a counselor. I think it's probably difficult to do it on your own because it also involves a change of thought process and patterns. The music and sounds is only part of the therapy. If you can afford it, maybe you could hire a counselor who specializes in it.

 

[Dr. Nagler]

They said it works best if you do it with a counselor.

If you don't do it with a trained TRT clinician, then is isn't TRT at all!

What Rocket did in Post #59 wasn't TRT. There is no such thing as "self-administered TRT."

sp

 

[Mark McDill]

They said it works best if you do it with a counselor. I think it's probably difficult to do it on your own because it also involves a change of thought process and patterns. The music and sounds is only part of the therapy. If you can afford it, maybe you could hire a counselor who specializes in it.

Claire
I'd like to say I habituated on my own (because I never sought out nor paid an official TRT counselor, I just have my H.A.s with W.N.); but my audiologist is very much like a counselor (a very unique individual indeed). Although he never took me through a predefined/systematic process he did 'hold my hand' and he kept me on track (with my anxiety issues). It's those blasted anxiety issues ; get those under control and you are on your way. Over time the brain adjusts (heals) and you habituate; although I'm the type that can stress about my stress levels! That being said, there can be a lot of value in having a counselor (someone to see you through, help you get there -- that's a big deal, worth pursuing)

@RocketJSquirrel is right when he says there is no need to understand the T model (ears, nerves, cortex, et al); however, I find it fascinating so I read about it anyways; and I like to hear about new approaches to potential cures.

BTW: how have you been doing? AM-101? Praying for you.

Mark

 

[Dr. Nagler]

Claire
I'd like to say I habituated on my own ...

Many people do habituate on their own. And I think it's great.

My issue here in this TRT thread - my only issue in this TRT thread - is that if people are going to say that TRT didn't work for them, it would be real nice if they had actually done TRT.

sp

 

[Piper the great]

I think these forums have people who have yet comes to terms with their T. B/C there are millions and millions of people world wide who have, and don't feel a need to come to these forums.. just a thought of mine..

 

[Dr. Nagler]

I think these forums have people who have yet comes to terms with their T. B/C there are millions and millions of people world wide who have, and don't feel a need to come to these forums.. just a thought of mine..

I tend to agree.

In fact, when I give presentations at various tinnitus support groups across the US, I have a slide that I introduce by referring to it as the URL for very best tinnitus support site on the web:

www.IveDoneGreatWithMyTinnitusAndHeresHowIDidIt.com

... and then I go on to observe that unfortunately that site does not exist.

That said. over the past twenty years or so I've seen and participated on a whole lot on Internet tinnitus sites - and I have never come across a better one than this one, both from the standpoint of the respect the participants generally show each other and from the even-handed way it is moderated.

The only problem here - and it is a problem common to all tinnitus sites - is that with all the information available, newbies (and some vets as well) can have considerable difficulty separating out the good information from the bad information, since good or bad it all tends to make sense. I mean, I think I'm a fairly bright guy, but if I went to a Japanese culture site for information about Japanese culture, I wouldn't have a clue as to whether what I was reading was actually correct. Just something to keep in mind with the incredible volume of tinnitus information available on this wonderful site.

sp

 

[RocketJSquirrel]

They said it works best if you do it with a counselor. I think it's probably difficult to do it on your own because it also involves a change of thought process and patterns. The music and sounds is only part of the therapy. If you can afford it, maybe you could hire a counselor who specializes in it.

You're right. The process does specify counseling. But trained TRT practitioners are scarce. The closest one to me is over 350 miles away, according to the official list.

I believe that the part of TRT which is supposed to be supported by a counselor can be self-taught. There's nothing complicated about it, and all the information is in the TRT book. It's largely taking a positive, optimistic attitude.

 

[Dr. Nagler]

You're right. The process does specify counseling. But trained TRT practitioners are scarce. The closest one to me is over 350 miles away, according to the official list.

I believe that the part of TRT which is supposed to be supported by a counselor can be self-taught. There's nothing complicated about it, and all the information is in the TRT book. It's largely taking a positive, optimistic attitude.

Rocket, I do not wish to belabor the point - but TRT has absolutely nothing to do with taking a positive, optimistic attitude. As a matter of fact, when I did TRT myself I had a negative pessimistic attitude. I never thought it would work and spent a good bit of time thinking very unhealthy thoughts. I had suicidal ideations, the whole bit. Thankfully I did not act on them - but I sure as hell thought about it. What TRT does require is a willingness to follow the protocol and an experienced and knowledgeable TRT clinician to take you through it. Mine was Dr. Jastreboff, who at the time was in Baltimore, 675 miles away from my home in Atlanta.

sp

 

[dan]

That's a good point. If the AM-101 study doesn't pan out for me I think I'm going to try the TRT approach. If anything, maybe it will help me to habituate faster.

Actually Im not holding my breath for Am101, my bets are on Aut00063.

 

[just1morething]

Actually Im not holding my breath for Am101, my bets are on Aut00063.

Yeah, What's the point of injecting your ears if the noise is coming from your damn brain? http://www.autifony.com/view-article.asp?ID=1
Research shows that tinnitus arises within the central nervous system, and may be caused by increased neural activity in regions of central auditory pathway. Thus treatments for tinnitus need to focus targets within the brain, and not the cochlea.

 

[Martin69]

Yeah, What's the point of injecting your ears if the noise is coming from your damn brain? http://www.autifony.com/view-article.asp?ID=1
Research shows that tinnitus arises within the central nervous system, and may be caused by increased neural activity in regions of central auditory pathway. Thus treatments for tinnitus need to focus targets within the brain, and not the cochlea.

Thought the same.

My T was introduced by stress. I don't think that my hair cells were suddenly damaged. The stimulus started in the brain and has been there since. So I doubt doing something with my ears will have any impact.

 

[Naseeb ali]

enhanced huge surge high-energy you're right you know but I did have energy and I had action more than I'm used to and this is where take advantage of it now I ate lunch and I was absolutely not hungry I'm hand by hand a mean I was hungry basically emotionally I did now I need but I kept thinking okay and I get into this morning emotions I can drop it I had eat yeah I'm not hungry Pure Nitro Max but this is not about how I feel at this moment this is about my body my body needs food and also if I'm Donna exercise what am Saigon actually I thought that I can't issue nose clean up bad company into my system and it worked goat happy or good PR so i win a ATM and lunch and dhow we get me in that part about 400 calories on our I consider very burned actual I 400 anyway because I knew I want to Seton the treadmill

 

[dan]

Hey I got a great idea people!
Lets all try TRT and 85% of tinnitustalk will recover from tinnitus! lets make this a group trial.
Imagine 8+/10 people on this board should be able to hear their tinnitus only when searching for it after therapy (im assuming nobody has or is doing proper TRT yet on here)
So what are we waiting for? Why suffer one more day than we need to?

 

[Magpie]

RocketJSquirrel wrote:
TRT is certainly worth a try; after all, it costs virtually nothing and won't hurt you in any way.

I tried self-administering it a couple of years ago. I bought and read Jastreboff's TRT book. Regardless of how well you understand the neurophysiological model, the method itself is easy to administer. I played nature sounds like crickets or raindrops in my ears all the time - literally 24/7 - at a volume just lower than my tinnitus. During the day, I used an iPod with earbuds. At night, I used SleepPhones.

After about 6 months of this, I experienced two 15-minute periods of silence, where I suddenly realized I wasn't hearing the T. But the effect didn't last, much to my disappointment, and I gave it up.

But remember, we're all different. It might work for you.

Here's the way I see it. TRT costs around $3000 or more depending on where you are and who you see. Neuromonics also costs anywhere from $4000 to $5500 depending on where you live. Neither is cheap IMO and if you intend doing either then you have to be dedicated and do them exactly as the clinician instructs you to. In the case of TRT wearing wng's is recommended for 8 hours a day last time I checked. Now that was an impossibility for me aside from the fact that I thought the cost was pretty steep. The other thing that I was chuffed about was that when I checked the websites of TRT practitioners I often read words to the effect that I would not hear my tinnitus any longer after I had finished the treatment i.e. I would be cured. Now I knew this was false so my confidence in those who claimed that was non existent and I also doubted TRT in it's entirety. Even to this day there is false information on Jonothan Hazells website and to my knowledge he retired some time ago. I think that if you are well informed about tinnitus, don't fear it, have a strategy to get through the bad days and set you on the road to habituation then the odds of you being successful are very good.

 

[mick]

I think these forums have people who have yet comes to terms with their T. B/C there are millions and millions of people world wide who have, and don't feel a need to come to these forums.. just a thought of mine..

I think the simple answer to your comment is that people are physically different, and the volume or intensity of T varies from person to person for physical and biological reasons . The phrase "coming to terms" suggest the degree of discomfort or life disruption a person experiences from T is entirely a psychological one. I largely disagree with that and posit that some people adjust easily, or barely experience negative repercussions of their T because their T is not as bad as that of people who do not adjust easily. An analogy would be if someone dropped a heavy weight your foot would the amount of pain you feel or damage done have more to do with how well you came to terms with the injury, or with how heavy the weight was? My opinion is that it would be the latter.

 

[dan]

RocketJSquirrel wrote:
TRT is certainly worth a try; after all, it costs virtually nothing and won't hurt you in any way.

I tried self-administering it a couple of years ago. I bought and read Jastreboff's TRT book. Regardless of how well you understand the neurophysiological model, the method itself is easy to administer. I played nature sounds like crickets or raindrops in my ears all the time - literally 24/7 - at a volume just lower than my tinnitus. During the day, I used an iPod with earbuds. At night, I used SleepPhones.

After about 6 months of this, I experienced two 15-minute periods of silence, where I suddenly realized I wasn't hearing the T. But the effect didn't last, much to my disappointment, and I gave it up.

But remember, we're all different. It might work for you.

Here's the way I see it. TRT costs around $3000 or more depending on where you are and who you see. Neuromonics also costs anywhere from $4000 to $5500 depending on where you live. Neither is cheap IMO and if you intend doing either then you have to be dedicated and do them exactly as the clinician instructs you to. In the case of TRT wearing wng's is recommended for 8 hours a day last time I checked. Now that was an impossibility for me aside from the fact that I thought the cost was pretty steep. The other thing that I was chuffed about was that when I checked the websites of TRT practitioners I often read words to the effect that I would not hear my tinnitus any longer after I had finished the treatment i.e. I would be cured. Now I knew this was false so my confidence in those who claimed that was non existent and I also doubted TRT in it's entirety. Even to this day there is false information on Jonothan Hazells website and to my knowledge he retired some time ago. I think that if you are well informed about tinnitus, don't fear it, have a strategy to get through the bad days and set you on the road to habituation then the odds of you being successful are very good.

Self-administering TRT is not TRT. If you did TRT with a professional, you would not give up after 6 months just as you had improvement, this is where the counceling comes in- TRT takes generally up to 18 months.

You would not hear your tinnitus because you would not be aware of it. This is called habituation of perception.
Habituation of reaction is the stage before this, when you hear it but don`t care. This allows your brain to stop hearing it.
You still have tinnitus but you don't care!

So what are you waiting for?

 

[cullenbohannon]

Stay classy dan.

Self-administering TRT is not TRT. If you did TRT with a professional, you would not give up after 6 months just as you had improvement, this is where the counceling comes in- TRT takes generally up to 18 months.

You would not hear your tinnitus because you would not be aware of it. This is called habituation of perception.
Habituation of reaction is the stage before this, when you hear it but don`t care. This allows your brain to stop hearing it.
You still have tinnitus but you don't care!

So what are you waiting for?

 

[Dr. Nagler]

I think that if you are well informed about tinnitus, don't fear it, have a strategy to get through the bad days and set you on the road to habituation then the odds of you being successful are very good.

I agree. Well said.

sp