Tinnitus retraining therapy

Tinnitus retraining therapy is a form of habituation therapy designed to help people who experience tinnitus, a ringing, buzzing, hissing, or other sound in the ears when no external sound is present. Two key components of TRT directly follow from the neurophysiological model of tinnitus. One of these principles includes directive counseling aimed at reclassification of tinnitus to a category of neutral signals, while the other includes sound therapy which is aimed at weakening tinnitus related neuronal activity. Tinnitus retraining therapy is a form of habituation therapy designed to help people who experience tinnitus, a ringing, buzzing, hissing, or other sound in the ears when no external sound is present. Two key components of TRT directly follow from the neurophysiological model of tinnitus. One of these principles includes directive counseling aimed at reclassification of tinnitus to a category of neutral signals, while the other includes sound therapy which is aimed at weakening tinnitus related neuronal activity. The goal of TRT is management of the reaction to tinnitus, thereby allowing habituation to begin and return to previous levels of perception There is no evidence that Tinnitus Retraining Therapy or any other therapy can reduce or eliminate tinnitus. An alternative to TRT is tinnitus masking, the use of noise, music or other environmental sounds to obscure or mask the tinnitus. Hearing aids can provide a partial masking effect for the condition. Results from a review of tinnitus retraining therapy trials indicate that it may be a more effective treatment than tinnitus masking. Not everyone who experiences tinnitus is significantly bothered by it. However, some of the problems caused by tinnitus include annoyance, anxiety, panic, and loss of sleep and/or concentration. The distress of tinnitus is strongly associated with various psychological factors; loudness, duration and other characteristics of the tinnitus are secondary. TRT may offer real although moderate improvement in tinnitus suffering for adults with moderate-to-severe tinnitus, in the absence of hyperacusis, significant hearing loss and/or depression. Not everyone is a good candidate for TRT. Factors associated with suitability for TRT and predisposing for favorable outcome are: lower loudness of tinnitus, higher pitch of tinnitus, shorter duration of tinnitus since onset, recognition of tinnitus attenuation by sound generator, lower hearing thresholds (i.e. better hearing), high Tinnitus Handicap Inventory (THI) score, and positive attitude toward therapy. Despite the fact that there haven't been any recent studies which concluded in its optimal treatment, tinnitus retraining therapy has been applied to treating hyperacusis, misophonia, and phonophobia. It has been proposed that tinnitus is caused by mechanisms that generate abnormal neural activity, specifically one mechanism called discordant damage (dysfunction) of outer and inner hair cells of the cochlea. The psychological basis for TRT stems from the fact that the brain exhibits a high level of plasticity. In turn, this allows it to adjust to any sensory signals as long as they do not lead to negative effects. TRT is imputed to work by interfering with the neural activity causing the tinnitus at its source, in order to prevent it from spreading to other nervous systems such as the limbic and autonomic nervous systems. Clients are classified into 5 categories. These categories are numbered 0 to 4, and based on whether or not the patient has tinnitus with hearing loss, tinnitus with no hearing loss, tinnitus with hearing loss and hyperacusis, and tinnitus with hearing loss and hyperacusis for an extended amount of time. The first component of TRT, directive counseling, may change the way tinnitus is perceived. The patient is taught the basic knowledge about the auditory system and its function, the mechanism of tinnitus generation and the annoyance associated with tinnitus. The repetition of these points in the follow-up visits helps the patient to perceive the signal as a non-danger.