July 5, 2007
A researcher at the University Hospital of Navarre, Madrid, Spain has recommended TRT (Tinnitus Retraining Therapy) treatment – based on the neurophysiological model – for those suffering from tinnitus.
Doctor Teresa Heitzmann points out that the aim of the treatment is to get the patient to become accustomed to the ‘noise’. To achieve this, therapeutic advice and sound therapy are used. The father of TRT is professor Pawel J. Jastreboff, who has defined tinnitus as a phantom auditory perception perceived only by the person. On applying the neurophysiological model in the university hospital, Heitzmann concluded that getting used to the tinnitus and thereby, achieving the cessation of discomfort, occurred in between 80 and 84% of patients, including, at times, a higher proportion. It is the treatment that has the highest success rate currently.
Other therapeutic methods, such as pharmacological ones, help to control the effects produced by tinnitus, such as anxiety and stress, but do not solve the problem, itself. Surgical operations have also shown to be of limited application for this disorder.
Therapeutic Advice and Sound Therapy
In working on TRT, Jastreboff showed that the central nervous system (CNS) has an elasticity and capacity for learning. The fact that tinnitus generates annoyance means that the CNS processes it as an important sound. The system can be taught to stop processing it at this level of importance and leave it at a subconscious level. This goal is achieved in two ways: therapeutic advice and sound therapy, fundamental tools in TRT.
Through therapeutic advice, the specialist gives the patient an explanation of what is happening and the cause of the discomfort being triggered, always after undertaking an assessment using questionnaires and clinical records, together with an auditory examination and study and, if deemed necessary, with complementary tests. An overall evaluation of the patient is essential.
The aim of therapeutic advice is to help to minimise the importance of the tinnitus. It involves eliminating the negative significance that makes the sound pass to a conscious level in the patient and cause discomfort. In this way, ‘disconnecting’ the limbic system is achieved and the negative emotion or reaction is eliminated little by little.
Therapeutic advice is carried out over a number of interviews between the specialist and patient. Heitzmann underscores the importance of these sessions, pointing out that, without these interviews, sound therapy will not produce results.
The second TRT tool, sound therapy, arose from the discovery that, depriving the auditory passage, designed for hearing, of sound, tends to increase the sensitivity of the ear. In such a way that, when a sound – such as a tinnitus – is produced in the passage, it captures it straight away. To avoid this phenomenon, external sound is introduced into the auditory canal, thus reducing the perception of the tinnitus at a cortical level (in order to be less conscious of what there is and distract attention away from the tinnitus by means of this external sound).
Sound therapy, thus aims at helping the patient to get used to the tinnitus, by incorporating external sound in such a way that silence is always avoided. It has various levels of application. On the one hand, all patients are advised to avoid silence at all times, using this external source of sounds. Moreover, some patients require sound generators that emit white (neutral) sound and that have to be inserted in the ears for 8 hours a day, the noise never masking the tinnitus. Other patients with auditory loss need an adaptaiton to the headphones. The application of the therapy must always adapt to the circumstances and needs of each person.
The time estimated in getting the patient accustomed to the tinnitus and the disappearance of the discomfort depends on a number of factors, such as how long the tinnitus has taken to evolve, the psychological profile of the patient, personal circumstances that and other pathologies. All these factors can contribute to the getting used to the acufeno being achieved within a year, a year and a half or two years (the average estimated period) although these times may be longer, due to the factors mentioned. Not achieving the target in this time is thus not considered a failure. To help in the process, monitoring is required involving 5-6 clinical visits over 2 years, although this can vary according to the individual.