Tinnitus Retraining Therapy - a Successful Treatment for Tinnitus. A Service of Maxwell, Kluger & Makaretz, ENT Associates

This can be pronounced Tin-i'- tus or Tin'-i- tus - either is correct.

Tinnitus is a ringing in the ear- one ear, both ears, or in the head. It can be a buzzing, hissing, dial tone, seashell sound or any other of many descriptions.

Tinnitus can be a symptom of an underlying medical problem. This is true in the minority of situations, but it should be evaluated with this in mind prior to any consideration of treatment. Once appropriately evaluated, treatment can be considered. Before describing this treatment let us consider the categorization of tinnitus.

Tinnitus can be intermittent - occurring only occasionally and not for long periods of time. This is not usually bothersome or concerning to the individual and probably occurs in about seventy percent (70%) of the population. We refer to this as clinically insignificant tinnitus.

On the other hand, tinnitus can be constant - always present - never allowing a moment of true "silence". It is estimated that this occurs in seventeen percent (17%) of the population. We refer to this as clinically significant tinnitus.

Seventeen percent of the population of the United States represents 45 million people - of the state of Maine some 200,000 people. Many of this group have "learned" to live with their tinnitus - but for those who are distressed by it - who would like to enjoy "silence" again -- there is now a very successful treatment known as Tinnitus Retraining Therapy (TRT).

Tinnitus Retraining Therapy (TRT) is a very simple, non-surgical approach to the problem of tinnitus. It is based on well-known anatomy and physiology and requires neither medications nor surgery.

First off, 94% of the population, if placed in a totally sound proof chamber (an anechoic chamber), would experience some degree of tinnitus, albeit very small and intermittent. This fact alone leads one to consider tinnitus as a variant of normal rather than a pathologic process. Within this 94% of the population, there are two groups of people, as mentioned above. By far the largest group is comprised of those people who experience ringing in their ears (tinnitus) very occasionally and therefore intermittently. It is generally thought that roughly 70% of the population experience ear ringing in this way. The second group is a much smaller group of people (roughly 17% of the population) who experience ear ringing all the time - on a constant basis. The real goal of tinnitus retraining therapy (TRT) is to move people from the group experiencing tinnitus constantly (the 17% group) into the group who experience tinnitus, ringing in the ears or ear ringing very infrequently but certainly intermittently and in a non-bothersome way (the 70% group). By definition this may not represent a "cure" for the tinnitus but it allows one to "live with" the tinnitus without being bothered or disabled.

In considering Tinnitus Retraining Therapy (TRT), it is important to note that most of the tinnitus referred to above, originates in the inner ear because of an abnormality of the hair cells of the cochlea. This signal, which could almost be considered a "normal" noise from the cochlea, is perceived by the two groups of people mentioned above as either extremely bothersome constant tinnitus, or by the much larger group as intermittent, non-bothersome tinnitus. Tinnitus Retraining Therapy (TRT) converts one from the bothersome group to the non-bothersome group.

A good example of the "bothersome" versus the "non-bothersome" noise is seen as we sit in our kitchens conversing on any given morning. The refrigerator will be going on and off and producing a noise which our outer ears will be receiving, but of which we are clearly unaware. This is because there is a screening mechanism within our hearing circuitry which screens out repetitive, inconsequential sounds, such as the refrigerator going on and off, the foghorn that may be blowing intermittently, the traffic that may be going by on the street, and those other, ever-present noises of which we are unaware. A "bothersome" noise, on the other hand, is experienced by the volunteer fire person who, whenever the volunteer fire whistle blows, whether it be in the middle of the day or night, will respond without fail. This is a sound that he or she is always aware of, and that is never screened out prior to his or her perceiving it. This immediate response will continue for many, many years until he or she is no longer a volunteer fire person. An individual living in the very next house, equally exposed to the same fire whistle, but who is not a volunteer fire person, will hear the fire whistle when he or she first moves to that location, but, after a few nights of getting used to it, will no longer hear it. This represents a screening mechanism in the non-volunteer fire person, screening out that sound which of course is received by the outer ear but not appreciated by the individual. Essentially the task of the Tinnitus Retraining Therapy (TRT) therapy is to convert the tinnitus sound from that heard by the volunteer fire person to that not heard by the non-volunteer fire person.

There are two parts to Tinnitus Retraining Therapy (TRT):

• The educational portion
  
  
• The Sound Treatment portion
  
  

The educational portion is an opportunity to sit for 1-2 hours with the Physician (or the Physician and the Audiologist) to discuss the mechanisms of hearing, the anatomy, the physiology, and the circuitry involved in the hearing of sound. There is a discussion of the actual collection of sound by the external ear, as well as the screening of sound by circuitry prior to the sound reaching the brain, and finally, the perception of the sound as it reaches the hearing centers of the brain. A firm understanding of these concepts is basic to the process of converting the tinnitus signal from a constant bothersome one to an intermittent, non-bothersome one.

The Sound Treatment portion, is accomplished in one of three ways:

• A program for ambient background noise
  
  
• The use of noise generators
  
  
• The use of hearing aids.
  
  

The most appropriate mode of treatment is selected for each individual situation. The basis of this portion of the Tinnitus Retraining Therapy (TRT) is the fact that our brain (Central nervous system) does not recognize the absolute volume of a given sound (tinnitus coming from the inner ear), but rather the difference between the volume of that sound and the volume of the existing background noise that our ear is receiving. In other words, if we are able to increase the level of our background sound in a comfortable way which does not block our hearing, the portion of our brain (Central nervous system) which measures the volume of the tinnitus will recognize less tinnitus. Therefore, by increasing the background noise (by any of the three methods of Sound Treatment mentioned above), our brain immediately perceives the tinnitus (ringing in the ears) as greatly reduced. The impact on the tinnitus is immediate as a result of the prescribed sound therapy. After a number of months' usage of the sound therapy, the tinnitus is converted from the constant, very bothersome signal to the intermittent, non-bothersome signal.

Let's look at the example of the refrigerator again. You have had a refrigerator for many years and, as noted, it goes on and off without your being aware of it. The refrigerator breaks down and has to be replaced. For the first 3 or 4 days you hear this new refrigerator go on and off because this is now a different signal, maybe a bit louder but certainly different, and quite bothersome. After a few days, however, it again sinks into "background noise" and is not "heard". This change in awareness comes about as a result of habituation, which is defined as the gradual adaptation to a stimulus, or to the environment. Our central nervous system, specifically that portion of our central nervous system which responds to the senses (sight, hearing, smell), is easily habituated. We refer to this as being very "plastic" - able to change or be molded. Interestingly, this aspect of our central nervous system remains very adaptable, even as we age. This process of habituation - taking advantage of the plasticity of our brains - is a large part of what is discussed in the educational portion of the Tinnitus Retraining Therapy (TRT) and implemented in the sound treatment portion of the Tinnitus Retraining Therapy (TRT).

Over the years there have been many attempts at various solutions to tinnitus, but with limited success. This current, state-of-the-art treatment (The Jastreboff Model) known as Tinnitus Retraining Therapy (TRT) has been used for approximately seven years (now 4+ years in our practice) and is proving very successful both here and around the globe.

It should also be emphasized that as effective as Tinnitus Retraining Therapy is for people with constant, bothersome tinnitus, it is not an answer to a non-problem. Anyone with tinnitus that is occasional, intermittent and non-bothersome should not consider it, once they have been fully evaluated to rule out any underlying pathology.

For more information about Tinnitus, please visit Patient Education.