Tinnitus Retraining Therapy

[lymebite]

Interesting new article that seems to say TRT should be avoided.

Unintended Consequences of White Noise Therapy for Tinnitus—Otolaryngology's Cobra Effect

JAMA Otolaryngology Head Neck Surgery
August 30, 2018

Abstract

Importance - Critical to the success of many medical therapeutics is a consideration of the brain's miraculous ability to dynamically rewire itself anatomically and neurochemically on the basis of incoming information. We argue that white noise exposure, a commonly recommended therapy for patients with tinnitus, engages these plastic processes in a way that induces maladaptive changes in the brain that degrade neurological health and compromise cognition.

Observations - The pathophysiologic mechanisms commonly associated with hearing loss and tinnitus reflect cortical dedifferentiation and widespread loss of inhibitory tone throughout the central auditory pathway. Importantly, these same changes are also induced by exposure to unstructured noise, even at nontraumatic levels in the adult nervous system. Not by coincidence, the same changes appear in age-related decline of central auditory function, suggesting that both tinnitus and white noise accelerate the aging of the brain.

Conclusions and Relevance - Noise exposure therapies offer a seductive short-term solution for relief but, in the long term, undermine the functional and structural integrity of the central auditory system and the brain more generally. Sound therapies using unstructured, random ("white") noise should be avoided as a treatment for tinnitus. Alternative therapeutics that drive positive, adaptive plastic changes are discussed.

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2697852

 

[TuxedoCat]

I had regular counselling with my Hearing Therapist and wore white noise generators daily and used a sound machine at night.

Hello @Michael Leigh

I was wondering if you think the cost effectiveness of TRT could be improved by group therapy rather than one to one with a hearing therapist.

Many thanks,
TC

 

[Michael Leigh]

I was wondering if you think the cost effectiveness of TRT could be improved by group therapy rather than one to one with a hearing therapist.

@TuxedoCat

I believe group therapy can help some people to cope better and eventually habituate to tinnitus. However, I don't think this type of therapy can match one to one counselling with a Tinnitus Therapist. I use the term Tinnitus Therapist for a specific reason. I believe a person practicing TRT with a patient has to have tinnitus themselves in order to give high quality counselling. Unless a person has tinnitus, they cannot understand it or have any idea of the emotional impact that it can have on a person. Many Hearing Therapists and Audiologists that work with Tinnitus patients also have the condition.

In reference to the post above by @lymebite the people that have written this report have no idea about TRT or tinnitus and the emotional impact that it can have on a person. When a person uses white noise generators correctly, they provide a therapeutic sound to the auditory system and brain not a "noise" as such. The level of the white noise is set below the tinnitus and therefore will not cause irritation to the user. In the case of hyperacusis which often accompanies "noise trauma". At first some people do find the white noise generators irritating and uncomfortable and they may notice a spike in the tinnitus. This is a result of the auditory system being hypersensitive due to the noise trauma. Under these circumstances, it is advisable for a person to introduce the WNGs slowly. At first wear them for just 1 or 2hrs. Then take them off for the same duration. Over a few weeks gradually build up the wearing time to 8 or 10hrs. White noise generators used correctly will help to treat hyperacusis by desensitising the auditory system.

An important part of TRT is the counselling which has nothing to do with using sound enrichment/white noise generators that I have mentioned above and will paste below.

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 is to gradually help them to 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.

When people have spoken to me over the telephone or corresponded with them by email I am told: "If I could only get my life back". "My life used to be perfect". "I keep looking at peoples ears and wondering what my life used to be like". "If I could only hear silence again".

It is for this reason I don't believe group therapy sessions can match one-to-one counselling with a Tinnitus Therapist/Hearing Therapist.

Michael

 

[JohnAdams]

My absolute faith in our Lord Jesus Christ gives me strength to continue to work and be a good family man and enjoy my life when I can.

TRT has absolutely nothing on that. Plus, it costs zero dollars.

 

[threefirefour]

@Michael Leigh you had mentioned that the treatment could cost up to $5,000, that's like for a year? Including the device they will sell?

TRT does jack for tinnitus, but from what I see, your main problem is burning ears. If you get in ear white noise generators and wear them for a few weeks, the problem should get better.

This is what TRT basically does for hyperacusis, but these are much much cheaper.

 

[Tinniger]

The wikipedia entry isn't so bad:
https://en.wikipedia.org/wiki/Tinnitus_retraining_therapy

White noise of my hearing aids seem to make my tinnitus worse/louder, - my tinnitus is very similar to white noise.
Maybe one goal of TRT is to counter tinnitus with more emotional calmness.
It's just a sound, it's just a sound, it's just a sound ... (my mantra)

 

[japongus]

In reference to the post above by @lymebite the people that have written this report have no idea about TRT or tinnitus and the emotional impact that it can have on a person. When a person uses white noise generators correctly, they provide a therapeutic sound to the auditory system and brain not a "noise" as such. The level of the white noise is set below the tinnitus and therefore will not cause irritation to the user. In the case of hyperacusis which often accompanies "noise trauma". At first some people do find the white noise generators irritating and uncomfortable and they may notice a spike in the tinnitus. This is a result of the auditory system being hypersensitive due to the noise trauma. Under these circumstances, it is advisable for a person to introduce the WNGs slowly. At first wear them for just 1 or 2hrs. Then take them off for the same duration. Over a few weeks gradually build up the wearing time to 8 or 10hrs. White noise generators used correctly will help to treat hyperacusis by desensitising the auditory system.

Spending 30 dollars to read the article to deliver another no true TRT specialist trademarked sermon with all the mental gymnastics they teach each other, priceless mate. Or maybe you didn't spend 30 bucks and you didn't read it? I know a number of H cases where 30 bucks would feed them for a week.

An important part of TRT is the counselling which has nothing to do with using sound enrichment/white noise generators that I have mentioned above and will paste below.

Michael

And the counselling part is where the ''TRT specialist'' gaslight their failures. TRT is so obviously the reason why today we have research papers that are rubbish as they're based on the systematic inability of TRT slouches at collecting data, best exemplified by how their hyperacusis questionnaire is bland rubbish that doesn't seek to differentiate types of hyperacusis, but exemplified in many other subtle ways too.

I'll just keep sitting here laughing at all the TRT gaslighting BS vendor gang backtracking to ''TRT doesn't reduce tinnitus'' when clearly my H is a direct result of having the T, as my H consists of exactly by T resonating with external sound, accompanying external sound with a vibration and a pitch of the same frequencies as my tinnitus, when for billions of years of evolution, the ear has met external sound with silence and hence weightlessness as it should do. Read those words carefully, and you'll realize how damaging the blank slate TRT community is to T, and especially to H. How obvious it is that TRT gangs feed off mild cases that haven't had further acoustic shocks yet, to deliver sermons to the crowd, which mostly consists of healthy people looking to claim that there is nothing wrong.

 

[TuxedoCat]

I believe group therapy can help some people to cope better and eventually habituate to tinnitus. However, I don't think this type of therapy can match one to one counselling with a Tinnitus Therapist.

Thank you @Michael Leigh. I appreciate the time you take to share your insights based on experience with tinnitus and helping others.

 

[japongus]

Nothing funny about my response to you @Michael Leigh, no need for a smarmy ''Funny'' response.

1. TRT have literally backtracked to ''we just help you adapt, we don't decrease your tinnitus'', as shown in this thread. That is, when heaps of evidence were thrown at them that something measurable, tinnitus loudness, wasn't being improved, they retreated to something harder to measure, ''discomfort'', which TRT can more easily falsify by coaching their patients to tick better boxes post counselling session.

2. Some of us have differentiated types of T and types of H. Sudden vibratory H that resonates to the precise tone of the underlying T is one of these types, and its mere description is total anathema to TRT therapeutic nihilists. It's a type of H/T that has appeared a few times on the forums, with most of the members sharing the same type of H with the same type of vibratory low frequency underlying T. It's a taboo for you TRT folk to comprehened the existence of this process as it breaks your claim that you help T and H without having to decrease the T. It's easy to understand why the research is so terrible in T and H, it's because TRT therapists mess up the huge sets of data only they have access to, because they're ingrained TRT therapeutic nihilism into every step of their ''treatment''.

 

[Michael Leigh]

Thank you @Michael Leigh. I appreciate the time you take to share your insights based on experience with tinnitus and helping others.

You are most welcome @TuxedoCat Thank you for your kind comments.
All the best
Michael

 

[JohnAdams]

Nothing funny about my response to you @Michael Leigh, no need for a smarmy ''Funny'' response.

1. TRT have literally backtracked to ''we just help you adapt, we don't decrease your tinnitus'', as shown in this thread. That is, when heaps of evidence were thrown at them that something measurable, tinnitus loudness, wasn't being improved, they retreated to something harder to measure, ''discomfort'', which TRT can more easily falsify by coaching their patients to tick better boxes post counselling session.

2. Some of us have differentiated types of T and types of H. Sudden vibratory H that resonates to the precise tone of the underlying T is one of these types, and its mere description is total anathema to TRT therapeutic nihilists. It's a type of H/T that has appeared a few times on the forums, with most of the members sharing the same type of H with the same type of vibratory low frequency underlying T. It's a taboo for you TRT folk to comprehened the existence of this process as it breaks your claim that you help T and H without having to decrease the T. It's easy to understand why the research is so terrible in T and H, it's because TRT therapists mess up the huge sets of data only they have access to, because they're ingrained TRT therapeutic nihilism into every step of their ''treatment''.

Imagine if we went to paralyzed people and told them we could help their paralysis and we just wiggled their feet around and told them to get over it. Then gave them a bill for $5000. That's my view of TRT.

 

[Johan_L]

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2697852

Here available with the full article https://www.brainhq.com/sites/default/files/pdfs/media-kits/whitenoise/journal.pdf

 

[1000]

HI @1000

I live in the UK. When I had TRT under my health system which is the NHS it was free. I know this treatment is expensive and probably would have had difficulty paying for it privately at the time. The purpose of my posts to to convey to people the benefits of TRT when it is administered properly as in my case. I had regular counselling with my Hearing Therapist and wore white noise generators daily and used a sound machine at night.

TRT is not enough on it's own. A person has to adopt a positive outlook to life. This means reinforcing positive thinking and doing everthing possible to get their life back on track. It takes time and effort. Some people what to habituate to tinnitus without doing anything at all. Therefore, they will see no progress.

All the best
Michael

Imagine if we went to paralyzed people and told them we could help their paralysis and we just wiggled their feet around and told them to get over it. Then gave them a bill for $5000. That's my view of TRT.

I don't believe in counseling....but TRT practitioners are the expert on desensitized the ear with sound therapy?

 

[JohnAdams]

I don't believe in counseling....but TRT practitioners are the expert on desensitized the ear with sound therapy?

I dont think so. I dont think they have a clue and need to step out of the way. They have nothing new to add to the community. Sounds may retrain the brain. There are already free TRT sounds all over YouTube, for free. There should be zero dollars going into this field of science. It is stuck in the dark ages.

What I want to see is an initiative to comprehensively comb nature for substances that can replicate the effects of progenitor cell activators that are being investigated pharmaceutical corporations right now.

@Contrast has provided ample evidence that tinnitus doesnt happen from bent cochlear cilia and that it is from the brain/auditory system/dorsal cochlear nucleus, that is missing input. For those that understand microcontroller programming I'm saying that it is the difference between getting input from polling and interrupts, that hearing isnt like interrupts, it is like polling. At least maybe some forms of tinnitus, like mine.

 

[1000]

I dont think so. I dont think they have a clue and need to step out of the way. They have nothing new to add to the community. Sounds may retrain the brain. There are already free TRT sounds all over YouTube, for free. There should be zero dollars going into this field of science. It is stuck in the dark ages.

I know if the only issue is tinnitus.

I see but if there's a grade of hyperacusis maybe an extra help of someone who can guide you step by step? How about if there's hearing loss?

Habituation to tinnitus can only be the time but as more intrusive it is habituation won't be a reality just surviving suffering.

Anyone here from the US that is doing TRT now?

 

[Michael Leigh]

I don't believe in counseling....but TRT practitioners are the expert on desensitized the ear with sound therapy?

You are entitled to your opinion on counselling and so is @JohnAdams on TRT . I find it strange that the two of you are so quick to dismiss treatments that do help a lot of people with tinnitus that you both know nothing about. When this condition is severe it can be very debilitating and affect a person's mental well being profoundly and to the point where they might want to end their life because of the misery that they are in. Counselling with someone that understands this condition can go a long way in helping a person afflicted with it, look at their life differently and in time more positively.

 

[1000]

You are entitled to your opinion on counselling and so is @JohnAdams on TRT . I find it strange that the two of you are so quick to dismiss treatments that do help a lot of people with tinnitus that you both know nothing about. When this condition is severe it can be very debilitating and affect a person's mental well being profoundly and to the point where they might want to end their life because of the misery that they are in. Counselling with someone that understands this condition can go a long way in helping a person afflicted with it, look at their life differently and in time more positively.

@Michael Leigh I'm saying I have never believed in counseling not against TRT. I'm even searching for a specialist that can help me with sound therapy. Either that or a bullet.

 

[Michael Leigh]

@Michael Leigh I'm saying I have never believed in counseling not against TRT. I'm even searching for a specialist that can help me with sound therapy. Either that or a bullet.

I know what you said and when I replied to your quote that is what I was addressing. I assure you that you are wrong about counselling, although you are entitled to your opinion. Choose your words carefully because they may come back to bite you in later life. Counselling can be very helpful. I have counselled quite a few people with tinnitus and continue to do so.

Michael

 

[1000]

I know what you said and when I replied to your quote that is what I was addressing. I assure you that you are wrong about counselling, although you are entitled to your opinion. Choose your words carefully because they may come back to bite you in later life. Counselling can be very helpful. I have counselled quite a few people with tinnitus and continue to do so.

Michael

@Michael Leigh understand what you've said. Like I said I have more issues than a high pitch sound tormenting on every side of the head.

 

[Michael Leigh]

@Michael Leigh understand what you've said. Like I said I have more issues than a high pitch sound tormenting on every side of the head.

It is probably a good idea to talk to your doctor and if antidepressant is suggested I think you take it to help with any anxiety that you have. Tinnitus and hyperacusis can wear a person down considerably when they are severe, no matter how positive and upbeat a person tries to be. We all have our limitations to how much we can handle.

Talk to someone and get some help.
Michael

 

[1000]

It is probably a good idea to talk to your doctor and if antidepressant is suggested I think you take it to help with any anxiety that you have. Tinnitus and hyperacusis can wear a person down considerably when they are severe, no matter how positive and upbeat a person tries to be. We all have our limitations to how much we can handle.

Talk to someone and get some help.
Michael

I'm on amitriptyline....but still I barely sleep. The trauma caused me TMJD.

 

[JohnAdams]

You are entitled to your opinion on counselling and so is @JohnAdams on TRT . I find it strange that the two of you are so quick to dismiss treatments that do help a lot of people with tinnitus that you both know nothing about. When this condition is severe it can be very debilitating and affect a person's mental well being profoundly and to the point where they might want to end their life because of the misery that they are in. Counselling with someone that understands this condition can go a long way in helping a person afflicted with it, look at their life differently and in time more positively.

but you're acting as if there is no possibility that TRT is just like the other pseudo-scientific tinnitus treatments out there, that people claim has helped them significantly. you may point to the research that is available regarding its efficacy, but there are people on this site that have posted evidence from other lines of research that would lead to a conclusion that TRT is counterproductive, maybe even harmful. and there is evidence to suggest that there are conflicts of interest between the organizations that conduct TRT research and the individuals that make a living off of it. what say you that?

 

[JohnAdams]

Choose your words carefully because they may come back to bite you in later life.

Which words? Explain what you mean by that.

 

[Michael Leigh]

what say you that?

I will be more than happy to enlighten you on a few things as I see them. I have had tinnitus for 22 years and I have had TRT treatment twice within this time. I have had good results with it, contrary to what some people say in this forum that haven't tried TRT and say that it doesn't work. I understand their reasons and some feel justified in condemning it. But I want to talk facts here. The main reason some people are against it is due to the high cost of the treatment and I understand that.

Michael

 

[Michael Leigh]

Same goes for you.

I always do....

 

[JohnAdams]

The main reason some people are against it is due to the high cost

Uh no. I can very easily afford it.
Also, there is no need for it to cost so much in the first place.

 

[1000]

Uh no. I can very easily afford it.
Also, there is no need for it to cost so much in the first place.

How much it cost?

 

[JohnAdams]

How much it cost?

too much

 

[1000]

too much

but it also depends on the time, like if I can afford 6 or 12 month's... Or the white noise generators are too expensive?

 

[japongus]

You are entitled to your opinion on counselling and so is @JohnAdams on TRT . I find it strange that the two of you are so quick to dismiss treatments that do help a lot of people with tinnitus that you both know nothing about. When this condition is severe it can be very debilitating and affect a person's mental well being profoundly and to the point where they might want to end their life because of the misery that they are in. Counselling with someone that understands this condition can go a long way in helping a person afflicted with it, look at their life differently and in time more positively.

So if you think you have the authority to explain to all of us what TRT does for severe cases, explain to me what type of tinnitus you had and what type of hyperacusis you had. Was it sudden vibratory hyperacusis and vibratory tinnitus, or was it pain hyperacusis. Tell me all about how you were able to reduce the sudden vibratory hyperacusis WITHOUT having to reduce the vibratory tinnitus. HINT: you won't be able to, and you'll try to deflect and stall.