Nov 17

Tinnitus Retraining Therapy

Virtually every non-threatening sensation in the body goes away in a certain amount of time. You feel your clothes when you first put them on, but soon after you forget that they are even there. This process is called habituation and it is an extremely important neurological function. It is also the foundation for Tinnitus Retraining Therapy.

Habituation is integral to sensation

If habituation did not take place, things that we hear, feel, see, taste, and smell would slowly drive us crazy. While most of us think about habituation as ignoring something (which it is) the process actually takes place in the nerve cells of the brain. It is not that we stop sensing things all together; it is that the brain selects which stimuli to recognize and which to ignore. If habituation did not occur, we could not sense anything at all because every stimulus would be recognized simultaneously and be drowned amongst the others. Threatening stimuli, on the other hand, do not become habituated. For the most part, any non-threatening stimulus that is constant and/or repetitive will be ignored in time. While tinnitus fits this same definition, tinnitus is often difficult to ignore. The basis of Tinnitus Retraining Therapy is to train the auditory (hearing) system to become habituated to the tinnitus sound.

Sound therapy

Imagine if a person suffering from tinnitus had a machine that produced a sound that was very similar to the tone, pitch, and frequency of the phantom sound. If the tinnitus sufferer could listen to the sound produced by that machine, constantly, in a short while one would expect the sound to be ignored by the brain. Ideally, since the sounds are presumably processed by the same hair cells and neurons (nerve cells) the tinnitus would go away as well.

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Since it is very difficult to match an individual’s tinnitus sound exactly, Tinnitus Retraining Therapy takes a slightly different approach. In general, the sound therapy component of Tinnitus Retraining Therapy employs a white noise generator. White noise has no decipherable pattern. Because the brain cannot attach significance to the white noise the tinnitus sound is lost in it, so to speak. However, unlike tinnitus itself, it is quite easy for patients to become habituated to white noise. Therefore, in theory, the tinnitus is “ignored” along with the white noise.

These sound generators can resemble hearing aids or even be combined with hearing aids. They can both provide white noise as well as amplify certain frequencies of sound. Tinnitus Retraining Therapy sound generators can resemble earphones or a stereo with speakers. The decision of which device to use depends on the patient’s regard for privacy and cost—it is not clear if one mode of sound generation is better than another. People that have increased sensitivity to sound (hyperacusis) may prefer to have a bedside device rather than a device that goes in or over the ears. The key point is that the white noise is loud enough to be audible but so loud that it causes pain or discomfort.
Directive counseling and psychotherapy

Most practitioners of Tinnitus Retraining Therapy would insist that directive counseling is an essential component of the therapeutic process. In directive therapy, the patient is taught about the how the ear hears, how sound waves are converted to mechanical and then electrical energy, and how tinnitus and deafness are often related. Through teaching, the patient develops a mastery of the symptom of tinnitus.

Recall that we are habituated to non-threatening stimuli but not threatening stimuli. Thus the strategy in directive counseling is to instruct the patient not to fear or feel threatened by the tinnitus. While this may be easy to do on a rational level, it often takes directive counseling to thoroughly pacify the mind when thinking about the tinnitus.

One hurdle to directive counseling is that tinnitus gets more pronounced the more that one thinks about it, but how does one learn about tinnitus without thinking about it? Thus some therapists have included refocusing therapy into Tinnitus Retraining Therapy. Refocusing therapy can be described roughly as taking your mind off of tinnitus. Patients are encouraged to think about enjoyable things instead of tinnitus. This is easier said than done, which is why professional therapy is usually necessary.

Some patients find that stress exacerbates the symptom of tinnitus. Therefore some therapists also add relaxation therapy to the program. This approach not only reduces general stress and stress arising from the tinnitus itself, but also improves sleep and the ability to fall asleep.

Duration of Tinnitus Retraining Therapy

Tinnitus Retraining Therapy is not always easy. The process is very involved and takes a long time to achieve maximum effect. Most patients require treatment for one to two years. Most patients enjoy relief after one year but often require an addition six months to a year to solidify the habituation and make it permanent in the brain. What is more, the white noise generator is usually used for six hours each day, which many patients find cumbersome. However if tinnitus is severe, most patients will stick to the Tinnitus Retraining Therapy because it promises to relieve the symptom permanently.

The importance of comprehensive, professional therapy

If you are considering dedicating two years to an involved treatment regimen, it is important to find a provider that has a strong, proven track record in Tinnitus Retraining Therapy. Otolaryngology and audiology clinics are a good place to start. The American Tinnitus Association may also have resources of experts in Tinnitus Retraining Therapy in your area.

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1 Comment

  1. Millicent Purchall says:

    I have tinnitus. I listen to a masking noise on my hearing aids for several hous aday. Sometimes the noise will seem to go away-for short periods,then return.
    Should I listen to the masking noise when the tinnitus is not heard,or only when the tinnitus is heard,or both.

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