Tinnitus Retraining Therapy

Australian and New Zealand Journal of Audiology, 2002

The main objective of Tinnitus Retraining Therapy (TRT) is habituation of activation of the autonomic nervous system, evoked by signals present in the auditory pathways. Sound therapy aims at decreasing the strength of these signals. The same systems in the brain are involved in tinnitus and decreased sound tolerance, and the same basic neurophysiological mechanisms are utilised for decreasing the tinnitusrelated neuronal activity and, in case of hyperacusis, abnormally enhanced activity induced by external sounds. The similarity of TRT treatment between tinnitus and misophonia is even closer, as in both situations the goal is to achieve extinction of functional connections between the auditory and the limbic and autonomic nervous systems. The increased gain within the auditory pathways that are presumably responsible for hyperacusis could enhance the tinnitus signal, thus it is possible to expect coexistence of tinnitus and hyperacusis, and the predisposition of hyperacusis patients to develop tinnitus. As such, for some patients tinnitus and hyperacusis may be considered the double manifestation of the same internal phenomenon.

Revista Neurociências, 2021

Introduction. Tinnitus is a subjective perception of sound in the absence of an external acoustic stimulus. It has negative behavioral feelings associated, e.g., depression, insomnia, difficulty of concentration, anxiety, irritability, and panic. The feelings impact negatively on the social and economic life of individuals. Empirical data suggest that disorders in the auditory cortex and its neural pathways give rise to abnormal spontaneous activations associated with tinnitus. Understanding the causes remains challenging. However, the current hypothesis suggests that clusters of neural networks and subnetworks are involved in tinnitus generation. Central dynamic neuroplasticity induced by a peripheral loss of auditory input can cause tinnitus noise. To date, there is no widespread consensus about the most effective therapy for treating tinnitus. Objective. To reflect on two tinnitus therapies: Tinnitus Retraining Therapy (TRT) and Transcranial Magnetic Stimulation (TMS). Method. A narrative review. Explicit and systematic criteria were not adopted in searching for the theoretical framework. Results. TMS is promising compared to TRT because TMS acts on tinnitus neural mechanisms. TRT is effective on a behavioral level since it relieves mild and moderate tinnitus' negative feelings. Conclusion. TRT does not advance on the neural source, but only on the tinnitus perception. TMS acts directly on the neural causes. Both therapies have limitations and can work for some patients. However, the effect of TMS seems more efficient, although transient.

Frontiers in Neuroscience, 2016

Frontiers in Systems Neuroscience, 2012

The Open Neuroimaging Journal, 2020

Tinnitus is a hearing disorder that causes ringing, buzzing or hissing sensation to the patient's auditory senses. It has become a very common complaint over the years affecting around 7-8% of the human population all over the world. The disorder causes the patients to feel irritable, annoyed, depressed, and distressed. As a result, it obstructs their sense of relaxation, enjoyment, and even their sleep-thus forcing them to avoid any social gatherings. There has been a substantial amount of work that has been carried out pertinent to this disorder. This paper reviews existing research and work done regarding Tinnitus effects, causes, and diagnosis. The numerous ways in which Tinnitus could affect an individual have been depicted. From the plethora of probable causes of this disorder, the most conceivable ones are highlighted. Moreover, this paper documents and reviews the attempts at treating Tinnitus, relevant engineering breakthroughs, and the various ways in which Tinnitus noise is suppressedsuch as Tinnitus Retraining Therapy, Neuromodulation, and Signal processing approach. The manuscripts highlight the pros and cons of these methods. Over 45 research articles and other reliable internet medical sources were reviewed and these pieces of work were contrasted. These findings should help in understanding both-the disorder, as well as the situation of the patients suffering from it. Through this manuscript, an attempt was made to spread awareness about the mysterious disorder.

Frontiers in Neuroscience, 2018

Tinnitus is the conscious perception of a sound without a corresponding external acoustic stimulus, usually described as a phantom perception. One of the major challenges for tinnitus research is to understand the pathophysiological mechanisms triggering and maintaining the symptoms, especially for subjective chronic tinnitus. Our objective was to synthesize the published literature in order to provide a comprehensive update on theoretical and experimental advances and to identify further research and clinical directions. We performed literature searches in three electronic databases, complemented by scanning reference lists from relevant reviews in our included records, citation searching of the included articles using Web of Science, and manual searching of the last 6 months of principal otology journals. One-hundred and thirtytwo records were included in the review and the information related to peripheral and central mechanisms of tinnitus pathophysiology was collected in order to update on theories and models. A narrative synthesis examined the main themes arising from this information. Tinnitus pathophysiology is complex and multifactorial, involving the auditory and non-auditory systems. Recent theories assume the necessary involvement of extra-auditory brain regions for tinnitus to reach consciousness. Tinnitus engages multiple active dynamic and overlapping networks. We conclude that advancing knowledge concerning the origin and maintenance of specific tinnitus subtypes origin and maintenance mechanisms is of paramount importance for identifying adequate treatment.

The International Tinnitus Journal, 2012

Introduction: Serotonin seems to play a central role in tinnitus. The intensity dependence of auditory evoked potential (IDAP) is considered an index of central serotonergic activity in the auditory cortex. The higher the steepness of the N1/P2 component amplitude-stimulus function slope (N1/P2 ASF slope as calculated by IDAP), the lower the central serotonergic activity. Similarly, the N1 amplitude-stimulus function slope (N1 ASF slope) was investigated. Auditory brainstem responses (ABR) examine the auditory system functionality from the periphery and through the brainstem, where serotonergic projections have been identified. Objectives: Assessing whether tinnitus perception neurotransmitters activity inbalance could be investigated by an electrophysiological approach. Materials and Methods: Ten normoacousic tinnitus patients and 14 healthy controls were included in the study. Subjects underwent EEG (IDAP) recording, ABR recording and psychometric questionnaires administration. Results: N1/P2 ASF slope and N1ASF slope tended to have a greater steepness in patients. N1ASF slope was significantly correlated with ABR wave V and interpeak III-V latencies in patients. ABR wave V and interpeak III-V latencies were significantly longer in patients than in controls. Conclusion: N1/P2 ASF slope, N1 ASF slope and ABR components appear to be useful electrophysiologic methods to study possible functional alterations related to the serotonergic activity.

2012

Tinnitus is an auditory phantom sensation (ringing of the ears) experienced when no external sound is present. Most but not all cases are associated with hearing loss induced by noise exposure or aging. Neuroscience research has begun to reveal how tinnitus is generated by the brain when hearing loss occurs, and to suggest new avenues for management and prevention of tinnitus following hearing injuries. Downregulation of intracortical inhibition induced by damage to the cochlea or to auditory projection pathways highlights neural processes that underlie the sensation of phantom sound.

Acta Clinica Croatica, 2003

SUMMARY – Tinnitus is an abnormal noise in the ear. About six percent of the general population suffer from what they consider to be ‘severe’ tinnitus. Tinnitus can come and go, or be continuous. It can sound like a low roar, or a high-pitched ring. Tinnitus may be bilateral or unilateral. The causes of tinnitus are various, e.g., inner ear injury, 8 th nerve lesion, injury of the brainstem, and rarely of the brain. There also are many extracranial causes of tinnitus. Upon making the diagnosis of tinnitus, medical therapy may occasionally help lessen the noise even though the cause has not been identified. Current therapy for tinnitus, so-called tinnitus retraining therapy, first includes learning about what does actually cause the tinnitus. This process is called habituation of reaction. Tinnitus then becomes quieter for long period of time and may eventually disappear, or becomes part of the background ‘sound of silence’ (habituation of perception). In some cases, changes in the i...

Tinnitus-the perception of sound in the absence of an actual external sound-represents a symptom of an underlying condition rather than a single disease. Several theories have been proposed to explain the mechanisms underlying tinnitus. Tinnitus generators are theoretically located in the auditory pathway, and such generators and various mechanisms occurring in the peripheral auditory system have been explained in terms of spontaneous otoacoustic emissions, edge theory, and discordant theory. Those present in the central auditory system have been explained in terms of the dorsal cochlear nucleus, the auditory plasticity theory, the crosstalk theory, the somatosensory system, and the limbic and autonomic nervous systems. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus.