Tinnitus Retraining Therapy (TRT): outcomes after one-year treatment

International journal of audiology, 2015

Assess the impact of a reduction of tinnitus intensity achieved through sound stimulation during sleep on the improvement in the patients' quality of life. Acoustic stimuli consisted of a highly customized sound that reproduced the spectral and intensity characteristics of the tinnitus in each patient. This stimulus was uploaded into a portable electronic device and delivered through customized ear buds during sleep, every night for three months. Twelve patients with subjective idiopathic chronic tinnitus were studied. Results were assessed through: (1) the measurement in dB SPL of tinnitus intensity reduction over time; (2) the results of three psychometric tests: Tinnitus handicap inventory (THI), Tinnitus reaction questionnaire (TRQ), Tinnitus functional index (TFI); and (3) a Visual analog scale (VAS) for tinnitus annoyance. After three months of treatment, we observed an average decrease in tinnitus intensity of 14.1 dB SPL (p < 0.001), implying a 62% reduction of the pe...

Psychosomatic Medicine, 2005

Background: Tinnitus seems to be associated with psychophysiological over-activation (e.g., of head and shoulder muscles). Therefore we aimed to develop and evaluate a new intervention program including a psychophysiological approach. Methods: Forty-three tinnitus sufferers were randomized to 2 groups, one receiving a psychophysiologically oriented intervention lasting 7 intervention sessions (plus 2 assessment sessions), whereas the other group waited for a comparable time period. Afterward, patients on the waiting list also received the intervention. Physiological variables were muscle activity of head and shoulders and electrodermal activity. Psychological assessments took place at pretreatment, post-treatment, and 6 months later. Follow-up data were available from 95% of participants. Major outcome variables were self-rating scales (e.g., tinnitus annoyance assessed by the Tinnitus Questionnaire), and diary data (self-control, daily time of perceiving the tinnitus). Results: On most tinnitus specific variables, patients in the treatment group improved significantly more than patients on the waiting list. Main effect sizes for tinnitus-specific variables were up to 0.89. Muscle reactivity of head muscles at the beginning predicted significant treatment effects. Conclusion: Compared with meta-analytical reviews of psychological interventions for tinnitus sufferers, the presented treatment is brief and in the upper range of effectiveness.

Trials

Background: Patients suffering from chronic, subjective tinnitus are on a quest to find a cure or any form of alleviation for their persistent complaint. Current recommended therapy forms provide psychotherapeutic interventions that are intended to train the patient how to deal with the tinnitus sound. Pharmaceutical managements are used to reduce secondary effects of the tinnitus sound such as sleep deprivation, emotional and concentration difficulties, but these treatments do not cure the tinnitus. Recent studies have shown that Tinnitus Retraining Therapy (TRT) significantly improves the quality of life for tinnitus patients. Furthermore, several studies have reported that cognitive behavioral therapy (CBT) relieves a substantial amount of distress by changing dysfunctional cognitions. However, when the tinnitus causes great interference with daily functioning, these treatment methods are not always sufficiently effective. Recent insights show that Eye Movement Desensitization Reprocessing (EMDR) is a highly effective therapy for medically unexplained symptoms such as chronic pain and phantom pain. In scientific research, tinnitus is compared to phantom limb pain. Starting from tinnitus as a phantom percept we therefore aim to demonstrate that the operating mechanisms of EMDR may also be an effective treatment method for patients with subjective tinnitus. The aim of this randomized controlled study with blind evaluator is to examine the effect of EMDR compared to CBT in chronic tinnitus patients. To our knowledge, there are no other studies that evaluate both methods simultaneously. Methods/design: A total of 166 patients with subjective, chronic, non-pulsatile tinnitus will be randomized in two treatment groups: TRT + CBT versus TRT + EMDR. The experimental group will receive the bimodal therapy TRT/EMDR and the active control group will receive the bimodal therapy TRT/CBT. Evaluations will take place at baseline before therapy, at the end of the treatment and 3 months after therapy. The score on the Tinnitus Functional Index (TFI) will be used as the primary outcome measurement. Secondary outcome measurements are the Visual Analogue Scale of Loudness (VAS), Tinnitus Questionnaire (TQ), Hospital Anxiety and Depression Scale (HADS), Hyperacusis Questionnaire (HQ), psychoacoustic measurements and event-related potentials (ERP).

Trials, 2014

Background: Subjective tinnitus is the perception of sound in the absence of a corresponding external sound for which there is no known medical etiology. For a minority of individuals with tinnitus, the condition impacts their ability to lead a normal lifestyle and is severely debilitating. There is no known cure for tinnitus, so current therapy focuses on reducing the effect of tinnitus on the patient's quality of life. Tinnitus retraining therapy (TRT) uses nonpsychiatric tinnitus-specific educational counseling and sound therapy in a habituation-based protocol to reduce the patient's tinnitus-evoked negative reaction to, and awareness of, the tinnitus, with the ultimate goal of reducing the tinnitus impact on the patient's quality of life. Some studies support the efficacy of TRT, but no trial to date has compared TRT with the current standard of care or evaluated the separate contributions of TRT counseling and sound therapy. The Tinnitus Retraining Therapy Trial (TRTT) is a randomized, double-blind, placebo-controlled, multicenter trial for individuals with intolerable tinnitus.

BMC Ear, Nose and Throat Disorders, 2008

Since the first description of tinnitus retraining therapy (TRT), clinicians have modified and customised the method of TRT in order to suit their practice and their patients. A simplified form of TRT is used at Ealing Primary Care Trust Audiology Department. Simplified TRT is different from TRT in the type and (shorter) duration of the counseling but is similar to TRT in the application of sound therapy except for patients exhibiting tinnitus with no hearing loss and no decreased sound tolerance (wearable sound generators were not mandatory or recommended here, whereas they are for TRT). The main goal of this retrospective study was to assess the efficacy of simplified TRT.

Journal of the American Academy of Audiology

Clinical management for patients complaining of severe tinnitus has improved dramatically in the last 25 years. During that period of time, various methods of treatment have been introduced and are being used with varying degrees of success. One method that has received considerable attention is tinnitus retraining therapy (TRT). This method is being practiced by hundreds of clinicians worldwide, and retrospective clinical data indicate that TRT has been effective for the majority of patients. This article provides a guide for clinicians to evaluate their patients for treatment with TRT. Included in this guide is the expanded version of the TRT initial interview and specific instructions for the clinician administering the interview.

The Journal of Rehabilitation Research and Development, 2005

Chronic tinnitus is experienced by 10%-15% of the population, of which only about 20% require clinical intervention. People requiring intervention have different levels of need, ranging from the provision of basic information to long-term, individualized treatment. We address this clinical need by outlining a five-level "progressive intervention" approach to the management of tinnitus that would provide a systematic framework for treatment by audiologists. At each level, patients must be appropriately referred-usually to otolaryngology, psychology, and/or psychiatry. Level 1 is an interview method of screening for determining if the person requires clinical intervention (and addressing basic questions). Level 2 is the provision of structured group educational counseling. If the screening determines that care is urgently required or if further help is needed following the group session(s), a tinnitus intake assessment (Level 3) should be performed. The intake assessment, wh...

Rehabilitation Psychology, 2009

Objectives: To explore the effects of a new tinnitus treatment program (tinnitus intensive therapy [TIT]) based on auditory perception principles and neural habituation. Methods: A follow-up study with measurement of treatment effects every third month over a 2-year period in which the cases were their own controls. Participants: There were 25 participants with a mean age 50.1 years (SD ϭ 16.1); 10 women (52.7 years; SD ϭ 16.8) and 15 men (48.3 years; SD ϭ 15.9). The participants were recruited from clinical population admitted to a polyclinic tinnitus treatment program in western Germany. Results: There was a significant reduction of tinnitus in the follow-up period. Mean baseline tinnitus scores (Tinnitus Fragebogen; Goebel & Hiller, 1998) at the start of the treatment were 50.9 (SD ϭ 14.5) and the final scores were 14.2 (SD ϭ 5.9). In total, the clinical improvement over the follow-up period was 72.1%. Conclusion: The TIT program showed a significant clinical treatment effect and should be tested further in a multicenter treatment project. The findings support the Jastreboff habituation model of tinnitus, but social cognitive factors should also be taken into account.

Journal of The American Academy of Audiology, 2019

Background: It is well accepted among clinicians that maskers and hearing aids combined with counseling are generally helpful to tinnitus patients, but there are few controlled studies exploring the efficacy of maskers alone to decrease the prominence of tinnitus. Purpose: We investigated the benefit of maskers for patients with chronic, bothersome tinnitus. Research Design: Crossover single-participant design, where each participant served as their own control. Study Sample: 18 adults with subjective, nonpulsatile, sensorineural tinnitus. Intervention: Participants participated in two six-week trials: one with sound therapy and one without. No counseling was provided in either group. Masking devices were fit with sounds intended to reduce the tinnitus prominence. Data Collection and Analysis: Participants rated tinnitus loudness, tinnitus annoyance, and acceptability of the background sounds using a numeric 0-100 interval scale and completed the Tinnitus Primary Functions Questionnaire (TPFQ). Results: Three participants dropped out. On the total score of the TPFQ, 5 of 15 remaining participants (33%) showed a benefit. Using a derived score based on functions showing a handicap before the study, maskers benefit was observed in the areas of sleep (five of nine), hearing (three of eight), thoughts and emotions (three of four), and concentration (four of eight). The TPFQ and annoyance data complemented each other well. Conclusions: This study demonstrates the benefit of partial masking, encouraging patients to seek help from audiologists interested in providing support for tinnitus patients.

American Journal of Audiology, 2014

Purpose To create a questionnaire focused on the primary activities impaired by tinnitus and therefore more sensitive to treatments. Method Questions were developed on (a) emotions, (b) hearing, (c) sleep, and (d) concentration. A 20-item questionnaire was administered to 158 patients. First, confirmatory factor analysis was used to select 3 questions per domain. Second, factor analysis was used to evaluate the appropriateness of the 12-item questionnaire. Results The analysis indicated that the selected questions successfully represented 4 independent domains. Scores were correlated with the Tinnitus Handicap Questionnaire ( r = .77, p < .01) and loudness ( r = .40, p < .01). The Sleep subscale correlated with the Pittsburgh Sleep Index ( r = .68, p < .01); the Emotion subscale correlated with the Beck Inventory ( r = .66, p < .01) and the Trait Anxiety questionnaire ( r = .67, p < .01). The average scores went from 51% to 38% following treatment. Conclusion The Tinn...