Tinnitus Management and Treatment
What Is TRT?
Suffering from a "ringing in the ears" sounds benign enough on the scale of medical problems, but tinnitus and related hearing disorders that affect millions of Americans can become so severe that they lead not only to decreased life quality but to anxiety, panic, depression and social isolation.
Ringing in the ears," or tinnitus, is a common hearing disorder that is generated internally. Hyperacusis is a condition that amplifies sounds from the environment, causing distraction and pain. Both tinnitus and hyperacusis can vary in degree from mild symptoms that can be easily controlled, to symptoms that cause extreme pain and discomfort. Both afflict people of all ages, all over the world. Symptoms can occur alone or simultaneously, and the longer the symptoms go untreated, the more intrusive they can become. As many as 40 million Americans experience symptoms all the time, and it is believed those symptoms are significant enough to affect quality of life in one to two million of them.
There is no cure for tinnitus, but many sufferers may be interested to know that there is a treatment approach that was developed and tested throughout the 1980's and finally put into clinical practice in the early 1990's. "Even though tinnitus and hyperacusis are each classified as a symptom and not a disease, they do require treatment," says Pawel Jastreboff, PhD, ScD, professor in the Department of Otolaryngology at Emory University School of Medicine, and director of the Emory Tinnitus and Hyperacusis Center. According to Dr. Jastreboff, "both tinnitus and hyperacusis may affect attention, work, sleep and sociability. These disorders can cause serious psychological as well as physical dysfunction that can devastate a patient's life."
Tinnitus Retraining Therapy (TRT) was developed by Dr. Pawel Jastreboff and Dr. Jonathan Hazell in the 1980s. Dr. Jastreboff is a neurophysiologist who has conducted research at universities such as Yale, U. of Maryland, and at this time, he is located at Emory University in Atlanta, Georgia.
More than two decades ago, Dr. Jastreboff and his wife Margaret, an associate professor of otolaryngology, combined their backgrounds in neurophysiology, neuroscience, electroacoustics, biophysics, biochemistry and pharmacology to study how the brain processes information within the auditory pathways. Dr. Jastreboff's work lead to the conclusion that by retraining the brain to habituate, or ignore certain noises, patients could eventually be free from the annoying symptoms. The method of treatment based on these principles is known today as Tinnitus Retraining Therapy (TRT).
TRT is based on a new clinical approach for the treatment of tinnitus that results in significant improvement for more than 80% of the patients treated.
Tinnitus Retraining Therapy (TRT) uses a combination of sound therapy and directive counseling to assist in overcoming the bothersome effects of tinnitus, thus making the patient no longer aware of their tinnitus, except when they focus their attention on it, and even then tinnitus is no longer annoying. Hyperacusis is a decreased tolerance to sound and can be a serious and frustrating problem.
Tinnitus Retraining Therapy can also be used in the treatment of Hyperacusis to totally or partially restore normal levels of sound sensitivity.
The goal of TRT is to retrain the patient's brain so that they learn how to treat tinnitus and hyperacusis the way they treat the sound of a refrigerator in their kitchen; a sound which they normally are not aware of but when they do hear it, it is not bothersome. TRT helps people recover from tinnitus by using the very basic theory of brain plasticity. The human brain is capable of increasing or decreasing the amount of attention paid to various external and internal stimulation. This increase or decrease happens on a subconscious level in the brain, in a physical location of the central nervous system that also caretakes essential body functions such as heart rate, sleep cycles, emotional feelings of well being or distress, hormone productions, and other important, unconscious regulatory functions.
When a symptom like ear noise happens, such as tinnitus, this subconscious brain response can be called into action. If the person feels alarm or concern related to the tinnitus, then deep seated areas of the brain, including the limbic system and the autonomous nervous system, can start a sequence of events that evolve into a serious problem. Negative emotions and negative conscious reactions can become firmly attached to benign symptoms, like tinnitus.
TRT should always consist of two components: counseling and sound therapy usually with the use of sound generators. Because of the complexities involved, it is extremely important that the course of treatment is conducted by specialists who are appropriately trained.
Patients who have been thoroughly tested and diagnosed will begin therapy with a counseling session in which the diagnosis and treatment progression is explained. The patient learns to understand the mechanisms of hearing and basis of the brain function. Specifics of sound therapy, including potential use of variety of instruments such as tabletop sound generators and/or wearable sound generators, hearing aids, or devices consisting of a sound generator combined with hearing aid. Once the patients understand the mechanisms of hearing, principles of tinnitus perception, and reasons why tinnitus is creating problems, then they are instructed to follow a specific regimen of sound therapy. Significant improvement occurs typically after about three months, with further improvement noted in six months to a year.