April 2004 – Feature Article
Effective Treatment for Tinnitus is Available
By Jody A. Jedlicka, AuD, Doctor of Audiology
Michael, a professional musician, has had tinnitus for years, but it wasn’t until about seven or eight months ago that he became very aware of it. He reports, “It made perfect sense that I would be the sufferer of such a malady. After all, I am a professional musician, with heavy education and live performance on percussion, drums, pianos (loud electric ones) electric and acoustic guitars – anything I could play that would make music, mostly loud music. Good drummers joke about their hearing loss and the justification of the volume we play our drums. If it’s too loud, your too old!” After becoming very aware of his tinnitus, he states, “My biggest fear was that I would never be able to escape my own mind and this “loud” noise. ‘Will it get worse?’ was the next fear, and finally there really is nothing anybody can do about all this…” That was when Michael decided to learn everything he could about his condition and Tinnitus Retraining Therapy (TRT).
Tinnitus Affects Millions
It is estimated that 44 million people in the United States experience tinnitus, a buzzing, ringing or other noise heard by a person in the absence of an external sound source. Of this 44 million, approximately 10 million suffer from their tinnitus. They are aware of it most of their day, it’s presence is annoying to them, it begins to interfere with their ability to concentrate, it can interfere with sleep, and in some cases can deprive the sufferer of their life enjoyment.
Interestingly, research has shown that the frequency, loudness and sound quality of the tinnitus signal itself is much the same in patients who merely experience it and those who suffer from it.
Treatment Helps Patients Cope
Traditionally, patients with tinnitus have been told that they would have to “learn to live with it,” but in 1988, Pawel Jastreboff, PhD, ScD; developed a neurophysiological model of tinnitus and a treatment technique known as TRT. Use of this technique was initiated that same year in London, England by Dr. Jonathan Hazell and audiologist Jacque Sheldrake and it was noted almost immediately that patients were responding better than with any other treatment available. Dr. Jastreboff began treating tinnitus patients in the U.S. at the University of Maryland where he established the University of Maryland Tinnitus and Hyperacusis Center. He continues his work at Emory University in Atlanta.
The Neurophysiological Model of Tinnitus recognizes that the tinnitus signal itself plays only a secondary role in problematic tinnitus. Rather, reactions of certain brain systems, specifically the limbic system (responsible for emotional responses) and the autonomic nervous system (responsible for ‘fight or flight’) are the primary players.
How Treatment Works
TRT consists of a combination of direct patient counseling designed to teach the patient about tinnitus and the role of the brain systems in the reaction to tinnitus. This helps to ‘demystify’ tinnitus making it a less threatening stimulus and therefore not something that needs constant monitoring. The second part of the regimen is sound therapy using sound generators or environmental sounds to make the signal less obvious. These two parts done in conjunction with a trained practitioner allow the patient to reclassify their tinnitus as a “non-threatening” signal no longer requiring attention. The tinnitus signal becomes like the sound of your refrigerator that makes noise, but you only hear it when you are paying attention to it. Thus, the signal remains, but goes unnoticed by the patient unless they choose to focus on it. They are able to habituate response to the signal and with time, they will begin to habituate detection of the signal, too.
Patients Report Significant Relief
Approximately 80% of patients report significant relief from tinnitus after undergoing TRT. Some relief is reported after initial treatment and continues to develop over the course of treatment. Average length of treatment is 18 months.
Although there are several medical conditions that may cause tinnitus, the etiology of the patient’s tinnitus is irrelevant with this technique. In addition, TRT has been found effective in adults and children.
A version of this therapy technique also has been found to be effective for patients with hyperacusis, or an oversensitivity to sounds.
Michael states that as a result of TRT, he was able to start understanding the mechanics of the auditory system and how his conscious and subconscious mind were working, just like they were supposed to, rather in response to the wrong signal. He used nature sounds and a fan to ‘enrich his sound environment’ in order to make his awareness of the tinnitus less intense. He says, thanks to TRT “I’m truly one of the lucky ones…(my tinnitus) is there if I concentrate on it and at the end of a very stressful day, I will hear my tinnitus and smile and say ‘Well kid, you never quit do you? It’s you and I again’…but guess what?…and this is the miracle… it soon disappears and if it takes a few more minutes to wait for it to disappear. It’s like, so what?”
Dr. Jastreboff, the developer of TRT practices his own protocol on patients at the Emory Tinnitus and Hyperacusis Center in Atlanta, GA. In an effort to bring the most effecive treatment available for tinnitus patients to the rest of the world, he has trained approximately 600 professionals world-wide in his method. To find a practitioner who is trained in TRT, contact the Wisconsin Speech-Language and Hearing Association at www.wisha.org or (800) 545-0640.
Jody Jedlicka, AuD, Doctor of Audiology currently treats tinnitus patients using TRT at her private practice audiology clinic, About Better Care Audiology, in Appleton, WI.