What Would You Suggest If TRT Is Not Suitable?

[Cassidy]

Hi Dr. Nagler,

Thank you for taking the time to help everyone by sharing your experiences, recommendations and thoughts. Your posts have reassured me many times on days when I was feeling very low.

I just wanted to ask, as you advocate TRT for severe obtrusive tinnitus (as in your case), how would you suggest to deal with reactive tinnitus where (due to the reactive nature of the tinnitus or another reason) TRT wasn't recommended?

Many thanks for your thoughts on this,

-Cassidy

 

[Dr. Nagler]

Hi Dr. Nagler,

Thank you for taking the time to help everyone by sharing your experiences, recommendations and thoughts. Your posts have reassured me many times on days when I was feeling very low.

You are welcome. I am happy that my posts have made a difference.

I just wanted to ask, as you advocate TRT for severe obtrusive tinnitus (as in your case), how would you suggest to deal with reactive tinnitus where (due to the reactive nature of the tinnitus or another reason) TRT wasn't recommended?

I advocate TRT done right for severe intrusive tinnitus. There's a lot of bad TRT out there, and I'll discuss more about it when I finish my Neuromonics vs TRT post (see "PREPARING AN ANSWER").

Which sort of goes to the heart of your question - because I have never found a tinnitus sufferer with so-called "reactive tinnitus" for whom TRT is not suitable. The use of sound therapy might have to be tweaked a bit in severe cases, and misophonia (if present) would need to be recognized and addressed first, but most of the time with "reactive tinnitus" the issue is more with the counseling side rather than the sound therapy side. So my guess is that whoever told you that your tinnitus was not suitable for TRT probably did not have a lot of first-hand experience as a TRT clinician.

If hypothetically I were to come across a patient with severe intrusive tinnitus who absolutely could not tolerate sound therapy, I guess I'd recommend CBT - possibly with MBTSR. But first I'd want to be 100% certain I wasn't dealing with misophonia masquerading as "reactive tinnitus."

Dr. Stephen Nagler