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|Tinnitus retraining therapy|
Tinnitus retraining therapy (TRT) is a form of habituation therapy designed to help people who experience tinnitus—a ringing, buzzing, hissing, or other sound heard when no external sound source is present. Two key components of TRT directly follow from the neurophysiological model of tinnitus: Directive counseling aims to help the sufferer reclassify tinnitus to a category of neutral signals,[ clarification needed ] and sound therapy weakens tinnitus-related neuronal activity.
The goal of TRT is to allow a person to manage their reaction to their tinnitus: habituating themselves to it, and restoring unaffected perception.Neither Tinnitus Retraining Therapy or any other therapy reduces or eliminates 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 partially mask the condition.A review of tinnitus retraining therapy trials indicates that it may be more effective than tinnitus masking.
Not everyone who experiences tinnitus is significantly bothered by it. [ vague ] with various psychological factors; the loudness, duration, and other characteristics of the tinnitus symptoms are secondary.[ medical citation needed ]However, some experience annoyance, anxiety, panic, loss of sleep, or difficulty concentrating. The distress of tinnitus is strongly
TRT may offer real though moderate improvement in tinnitus suffering for adults with moderate-to-severe tinnitus, in the absence of hyperacusis, significant hearing loss, or depression. [ clarification needed ], lower hearing thresholds (i.e. better hearing), high Tinnitus Handicap Inventory (THI) score, and positive attitude toward therapy.Not everyone is a good candidate for TRT. Those most likely to have a favorable outcome from TRT are those with lower loudness of tinnitus, higher pitch of tinnitus, shorter duration of tinnitus since onset,
Although no studies have [ clarification needed ], TRT has been used to treat hyperacusis, misophonia, and phonophobia.
Tinnitus may be the result of abnormal neural activity caused by discordant damage (dysfunction) of outer and inner hair cells of the cochlea.
The psychological basis for TRT is the hypothesis that the brain can change how it processes auditory stimuli. 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 parts of the nervous systems such as the limbic and autonomic nervous systems.
The full TRT program lasts 12 to 24 months and consists of an initial classification of clients for different emphasis during therapy, then a combination of directed counseling and sound therapy.
Clients are classified into five categories, numbered 0 to 4, 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 basic knowledge about the auditory system and its function, and how tinnitus and the annoyance associated with tinnitus is generated. The repetition of these points in follow-up visits helps the patient come to perceive the tinnitus signal as a non-danger.[ medical citation needed ]
The second component of TRT uses a sound generator to partially mask the tinnitus. This is done with a device similar to a hearing aid that emits a low level broadband noise so that the ear can hear both the noise and tinnitus. This is intended to acclimate the brain to reducing its emphasis on the tinnitus versus the external sound.
One study[ citation needed ] found that a full tinnitus masker was just as effective as partial masking, nullifying a key component of habituation therapy. Other review studies[ citation needed ] have found no value to the sound therapy component of TRT.
Confounding factors make it difficult to measure the efficacy of TRT: tinnitus reporting is entirely subjective, varies over time, and repeated evaluations are not consistent. Researchers note there is a large placebo component to tinnitus management.[ citation needed ] In many commercial TRT practices, there is a large proportion of dropouts; reported "success" ratios may not take these subjects into account.
There are few available studies, but most show that tinnitus naturally declines over a period of years in a large proportion of subjects surveyed, without any treatment. The annoyance of tinnitus also tends to decline over time. In some people, tinnitus spontaneously disappears.
A Cochrane review found only one sufficiently rigorous study of TRT and noted that while the study suggested benefit in the treatment of tinnitus, the study quality was not good enough to draw firm conclusions.A separate Cochrane review of sound therapy (they called it "masking"), an integral part of TRT, found no convincing evidence of the efficacy of sound therapy in the treatment of tinnitus.
A summary in The Lancet concluded that in the only good study, TRT was more effective than masking; in another study in which TRT was used as a control, TRT showed a small benefit. A study that compared cognitive behavior therapy (CBT) in combination with the counselling part of TRT versus standard care (ENT, audiologist, maskers, hearing aid) found that the specialized care had a positive effect on quality of life as well as on specific tinnitus metrics.
Tinnitus activities treatment (TAT) is a clinical adaptation of TRT that focuses on four areas: thoughts and emotions, hearing and communication, sleep, and concentration.
Progressive tinnitus management (PTM) is a five-step structured clinical protocol for management of tinnitus that may include tinnitus retraining therapy. The five steps are:
The U.S. Department of Veterans Affairs (VA) now employs PTM to help patients self-manage their tinnitus.
Cognitive behavioral therapy (CBT), the counselling part of TRT, as a generalized type of psychological and behavioral counselling, has also been used by itself in the management of tinnitus.
If tinnitus is associated with hearing loss, a tuned hearing aid that amplifies sound in the frequency range of the hearing loss (usually the high frequencies) may effectively mask tinnitus by raising the level of environmental sound, in addition to the benefit of restoring hearing.
White noise generators or environmental music may provide a background noise level that is of sufficient amplitude that it wholly or partially "masks" the tinnitus. Composite hearing aids that combine amplification and white noise generation are also available.
Numerous non-TRT methods have been suggested for the treatment or management of tinnitus.
Inflammation of the geniculate ganglion of the facial nerve is a late consequence of varicella zoster virus (VZV) known as Ramsay Hunt syndrome (RHS), commonly known as herpes zoster oticus. In regard to the frequency, less than 1% of varicella zoster infections involve the facial nerve and result in RHS. It is traditionally defined as a triad of ipsilateral facial paralysis, otalgia, and vesicles close to the ear and auditory canal. Due to its proximity to the vestibulocochlear nerve, the virus can spread and cause hearing loss, tinnitus (hearing noises that are not caused by outside sounds), and vertigo. It is common for diagnoses to be overlooked or delayed, which can raise the likelihood of long-term consequences. It is more complicated than Bell's palsy. Therapy aims to shorten its overall length, while also providing pain relief and averting any consequences.
Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spoken language, and in adults it can create difficulties with social interaction and at work. Hearing loss can be temporary or permanent. Hearing loss related to age usually affects both ears and is due to cochlear hair cell loss. In some people, particularly older people, hearing loss can result in loneliness. Deaf people usually have little to no hearing.
Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initially, but over time, both ears may become involved. Episodes generally last from 20 minutes to a few hours. The time between episodes varies. The hearing loss and ringing in the ears can become constant over time.
Tinnitus is a variety of sound that is heard when no corresponding external sound is present. Nearly everyone experiences faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearing, or is associated with other problems. The word tinnitus comes from the Latin tinnire, "to ring". In some people, it interferes with concentration, and can be associated with anxiety and depression.
A cochlear implant (CI) is a surgically implanted neuroprosthesis that provides a person who has moderate-to-profound sensorineural hearing loss with sound perception. With the help of therapy, cochlear implants may allow for improved speech understanding in both quiet and noisy environments. A CI bypasses acoustic hearing by direct electrical stimulation of the auditory nerve. Through everyday listening and auditory training, cochlear implants allow both children and adults to learn to interpret those signals as speech and sound.
Sensorineural hearing loss (SNHL) is a type of hearing loss in which the root cause lies in the inner ear or sensory organ or the vestibulocochlear nerve. SNHL accounts for about 90% of reported hearing loss. SNHL is usually permanent and can be mild, moderate, severe, profound, or total. Various other descriptors can be used depending on the shape of the audiogram, such as high frequency, low frequency, U-shaped, notched, peaked, or flat.
Hyperacusis is the increased sensitivity to sound and a low tolerance for environmental noise. Definitions of hyperacusis can vary significantly; it can refer to normal noises being perceived as: loud, annoying, painful, fear-inducing, or a combination of those, and is often categorized into four subtypes: loudness, pain, annoyance, and fear.
Unilateral hearing loss (UHL) is a type of hearing impairment where there is normal hearing in one ear and impaired hearing in the other ear.
Presbycusis, or age-related hearing loss, is the cumulative effect of aging on hearing. It is a progressive and irreversible bilateral symmetrical age-related sensorineural hearing loss resulting from degeneration of the cochlea or associated structures of the inner ear or auditory nerves. The hearing loss is most marked at higher frequencies. Hearing loss that accumulates with age but is caused by factors other than normal aging is not presbycusis, although differentiating the individual effects of distinct causes of hearing loss can be difficult.
Neurofibromatosis type II is a genetic condition that may be inherited or may arise spontaneously, and causes benign tumors of the brain, spinal cord, and peripheral nerves. The types of tumors frequently associated with NF2 include vestibular schwannomas, meningiomas, and ependymomas. The main manifestation of the condition is the development of bilateral benign brain tumors in the nerve sheath of the cranial nerve VIII, which is the "auditory-vestibular nerve" that transmits sensory information from the inner ear to the brain. Besides, other benign brain and spinal tumors occur. Symptoms depend on the presence, localisation and growth of the tumor(s), in which multiple cranial nerves can be involved. Many people with this condition also experience vision problems. Neurofibromatosis type II is caused by mutations of the "Merlin" gene, which seems to influence the form and movement of cells. The principal treatments consist of neurosurgical removal of the tumors and surgical treatment of the eye lesions. Historically the underlying disorder has not had any therapy due to the cell function caused by the genetic mutation.
Noise health effects are the physical and psychological health consequences of regular exposure to consistent elevated sound levels. Noise from traffic, in particular, is considered by the World Health Organization to be one of the worst environmental stressors for humans, second only to air pollution. Elevated workplace or environmental noise can cause hearing impairment, tinnitus, hypertension, ischemic heart disease, annoyance, and sleep disturbance. Changes in the immune system and birth defects have been also attributed to noise exposure.
Noise-induced hearing loss (NIHL) is a hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies or impaired perception of sound including sensitivity to sound or ringing in the ears. When exposure to hazards such as noise occur at work and is associated with hearing loss, it is referred to as occupational hearing loss.
Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli, or cues. These cues, known as "triggers", are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses that are not seen in most other people. Misophonia and misophonic symptoms can adversely affect the ability to achieve life goals and enjoy social situations. It was first recognized in 2001, though it is still not in the DSM-5 or any similar manual.
Diplacusis, also known as diplacusis binauralis, binauralis disharmonica or interaural pitch difference (IPD), is a hearing disorder whereby a single auditory stimulus is perceived as different pitches between ears. It is typically experienced as a secondary symptom of sensorineural hearing loss, although not all patients with sensorineural hearing loss experience diplacusis or tinnitus. The onset is usually spontaneous and can occur following an acoustic trauma, for example an explosive noise, or in the presence of an ear infection. Sufferers may experience the effect permanently, or it may resolve on its own. Diplacusis can be particularly disruptive to individuals working within fields requiring acute audition, such as musicians, sound engineers or performing artists.
Tinnitus maskers are a range of devices based on simple white noise machines used to add natural or artificial sound into a tinnitus sufferer's environment in order to mask or cover up the ringing. The noise is supplied by a sound generator, which may reside in or above the ear or be placed on a table or elsewhere in the environment. The noise is usually white noise or music, but in some cases, it may be patterned sound or specially tailored sound based on the characteristics of the person's tinnitus.
Musicians experience a number of health problems related to the practice and performance of music.
Cochlear hydrops is a condition of the inner ear involving a pathological increase of fluid affecting the cochlea. This results in swelling that can lead to hearing loss or changes in hearing perception. It is a form of endolymphatic hydrops and related to Ménière's disease. Cochlear hydrops refers to a case of inner-ear hydrops that only involves auditory symptoms and does not cause vestibular issues.
Computational audiology is a branch of audiology that employs techniques from mathematics and computer science to improve clinical treatments and scientific understanding of the auditory system. Computational audiology is closely related to computational medicine, which uses quantitative models to develop improved methods for general disease diagnosis and treatment.
Duearity is a Swedish medical technology company based in Malmö. The company specialises in hardware and software for tinnitus treatment. As of May 2021, Duearity is a public company listed on the Nasdaq First North stock exchange.
Neuromonics is a non-invasive sound therapy used to manage tinnitus. The therapy involves a customized acoustic stimulus delivered through headphones for a prescribed amount of time each day. It is typically used as part of a comprehensive tinnitus management program that includes counseling, education, and support. Neuromonics has been shown to significantly reduce the impact of tinnitus on daily life for many patients.