Tinnitus is the name for head noises that are often described as ringing, buzzing, whistling, etc., and it is very common. Nearly 50 million Americans suffer from this discomfort. Tinnitus may come and go, or you may be aware of a continuous sound. It can vary in pitch from a low roar to a high squeal or whine, and you may hear it in one or both ears. When the ringing is constant, it can be annoying and distracting. More than seven million people are afflicted so severely that they cannot lead normal lives.
Most of the time, the tinnitus is subjective—that is, the tinnitus is heard only by the individual. Rarely, tinnitus is “objective,” meaning that the examiner can actually listen and hear the sounds the patient hears.
Tinnitus may be caused by different parts of the hearing system.
Middle ear problems that cause hearing problems can also cause tinnitus. These include common entities such as middle ear infection and uncommon ones such as otosclerosis, which hardens the tiny ear bones or ossicles. Another, rare, cause of tinnitus from the middle ear that does not result in hearing loss is muscle spasms of one of the two tiny muscles in the ear. In this case, the tinnitus can be intermittent and at times, the examiner can also hear the sounds.
Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors such as noise damage, medications, and age) may be commonly associated with the presence of tinnitus.
One of the preventable causes of tinnitus is excessive noise exposure. In some instances of noise exposure, tinnitus can be noticed even before hearing loss develops, so it should be considered a warning sign and an indication of the need for hearing protection in noisy environments. Medications can also damage inner ear hair cells and cause tinnitus. These include both non-prescription medications such as aspirin and acetaminophen, when taken in high doses, and prescription medication including certain diuretics and antibiotics. As we age, the incidence of tinnitus increases.
Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain. These include a variety of uncommon disorders including vestibular schwannoma (acoustic neuroma) and damage from head trauma.
There are a number of non-auditory conditions and lifestyle factors that are associated with tinnitus. Medical conditions such as temporomandibular joint arthralgia (TMJ), depression, anxiety, insomnia, and muscular stress and fatigue may cause tinnitus, or can contribute to worsening of existing tinnitus.
In some cases, the cause is unknown.
Patients with tinnitus are often told that there is no medical cure or treatment for their condition. This is not entirely true. Although there may be no cure for the tinnitus, it can often be successfully managed. There are various treatments available which may give varying degrees of relief which includes Tinnitus Retraining Therapy (TRT), Cognitive therapy, Counseling, diet restrictions, Stress management and relaxation techniques. However, the TRT is considered as the most popular, successful treatment option that is being used around the world.
Tinnitus Retraining Therapy (TRT)
Tinnitus Retraining Therapy (TRT) is the most widely used form of habituation Sound Therapy around the world, and the most universally effective for most conditions and degrees of hearing loss. It was developed by neuroscientist Pawel Jastreboff, Ph.D., who published the first treatment protocols in 1990. TRT is a special form of habituation desensitization Sound Therapy, not to be confused with Masking.
TRT treatment uses specific types of Sound Generators, set in particular ways and used for specific lengths of time in conjunction with Informational and Directive Tinnitus Counseling. Counseling is necessary to explain how one can put an end to negative reaction to tinnitus, alter perception of tinnitus, and diminish and potentially end perception of significant tinnitus as problematic and unmanageable.
TRT offers tremendous relief to the greatest number of patients as long as they are willing to take the time and make the effort to learn and implement our recommendations. Recent studies have suggested that significant number of clients report a noticeable improvement in as little as 6-8 weeks. The duration of the TRT program can last between 16 – 24 months and approximately 80 percent of those who stick with the correct TRT protocol successfully habituate to tinnitus to a significant degree.
The habituation approach of TRT intends to alter the perception of tinnitus by reprogramming the auditory system and the attention processes of the brain. The first goal is to habituate to the reaction to tinnitus, return tinnitus to a level of less or no significance similar to in the past when the awareness of tinnitus was not perceived to be problematic. Tinnitus is then trained to reduce by habituation to more of a background sensation, rather than one of great significance in the foreground of perception and attention. The effect of altering the sound landscape of a sound environment with tinnitus progressively harder to find, is similar to reducing the appearance of a lighted candle in a dark room by turning up the room lights. It can be explained by a simple example such as the candle’s flame which may still glow, but it is much harder to see in a background of light rather than dark.
Through tinnitus counseling, patients are also taught how to refocus thinking and attention further and more frequently away from the tinnitus experience, which further accelerates the habituation process. Once habituation to the reactions to tinnitus is achieved, the “problem” is minimized and the process of habituation to the awareness and sensation of tinnitus altogether becomes more possible.
TRT retrains the brain to effectively recalibrate and redirect the auditory system, forming new therapeutically controlled, appropriate and acceptable neurological patterns and auditory memories of tinnitus upon which it can operate. As the retraining process continues, with repeated therapeutic sound exposure and attention control, neurons repeatedly firing together begin wiring together into increasingly stronger and more stable neurological patterns, which then becomes the new normal neurological and perceptual track. The auditory system reverts increasingly less to operating through the old neurological network patterns associated with tinnitus the way it used to be.