Tinnitus retraining therapy
The tinnitus retraining therapy is a treatment method for relief of chronic tinnitus , which was developed by Jastreboff and Hazell 1990th The therapy is less aimed at the development of the tinnitus, rather the processing of the tinnitus in the central nervous system and thus the conscious perception is the focus.
Retraining therapy is based on three pillars:
- Education and counseling of the patient about the tinnitus
- Hearing therapy with behavioral aspects, possibly also a tinnitus noiser that generates an additional noise.
- Psychotherapeutic accompaniment to make it easier to deal with the noise in the ear, supportive methods such as autogenic training and sport.
In the inner ear noises and acoustic signals are picked up. The reflexes triggered by the acoustic system are already controlled at the next level in the area of the brain stem (e.g. the escape reflex after a dog barking).
Tinnitus creates negative moods and fears on this level. This area of the brain stem is connected to higher acoustic centers and to the limbic system , which controls the human emotional world. Here, noises are perceived as pleasant or unpleasant. All of these perceptions and sensations ultimately determine a hearing impression that becomes conscious in the primary hearing center. Amazingly, these perceptions can be actively influenced, for example by suppressing or filtering out interfering noise. Getting used to constant accompanying noise is a form of habituation .
According to the theories of Hazell and Jastreboff, it is precisely this mechanism that seems to fail in tinnitus patients: it is not possible to suppress the tinnitus, rather it is perceived as causing fear, annoying and unpleasant. This draws attention to the noise in the ear and further increases the unpleasant impression.
The disorder essentially comprises the limbic system and less the actual hearing in the inner ear and in the auditory pathway . Under certain circumstances, this could also explain why previous attempts at therapy, such as medication to stimulate the blood flow, treatment with excess oxygen, infusions, etc., which were actually supposed to affect the inner ear, did not produce any satisfactory solutions, since the disturbance in higher acoustic centers remains unaffected.
The tinnitus retraining therapy builds on these considerations: It is less the actual tinnitus that is to be combated, but rather the unpleasant perception is to be reduced.
The first element of this treatment is what is known as tinnitus counseling. This is not to be understood as psychotherapy in the actual sense. Rather, the patient should be given as much information as possible about tinnitus and the neurophysiological tinnitus model in a type of lesson in order to reduce fears. In this way - according to the theories of Hazell and Jastreboff - the correct handling of tinnitus is to be initiated.
Tinnitus often occurs in connection with hearing disorders (degenerative inner ear hearing loss , old age hearing loss , noise-induced hearing loss , sudden hearing loss , Menière's disease , pop trauma ). If there is a more severe hearing disorder that should be treated with a hearing aid , devices can be used that function both as a hearing aid and that can emit broadband noise that can be used for retraining therapy.
As a second element, noise devices ( tinnitus noiser , audio stimulator , tinnitus control instrument , tinnitus masker ) are often used. For this purpose, the patient is offered a quiet, less disruptive noise with the aid of a small device similar to a hearing aid, a so-called noiser or masker . Many tinnitus patients found a stay by a murmuring, babbling brook or the use of a quietly rustling indoor fountain as a means of relieving their suffering. The patient should learn to be led out of his negative attitude to noises by consciously listening to this non-disturbing noise. The tinnitus noiser must not be set so loud that the annoying tinnitus is masked, i.e. drowned out, as otherwise the tinnitus cannot get used to or become accustomed to. This retraining therapy is based, among other things, on the idea that the patient gets used to a low noise made by the noiser and thereby learns not to perceive his own annoying noise in the ear, the tinnitus, as unpleasant. Often, on the advice of specialists, both ears are intoxicated with the noiser for up to 8 hours a day , as the hearing perception of the entire brain is to be trained on it. Such devices can be specially tailored to each patient. The success rate is around 50%. Such a process usually takes months, often more than a year.
A new approach is the compensation with the help of weak hearing aids, since the filter function of the hearing center is stimulated even better by amplifying environmental noises.
It must be noted that the benefit of the tinnitus noiser has not yet been proven. Comparative studies in which some of the patients did not use noisers found no group differences. In addition, the often inconsistent and poorly standardized application of tinnitus retraining therapy gives rise to criticism. A systematic study overview by the Cochrane Collaboration from 2010 finally came to the conclusion that no qualitatively sufficient studies exist to prove the effectiveness of the treatment. Only one randomized, controlled study indicated that tinnitus retraining was more effective than treatment with a tinnitus masker . However, this study is of low quality.
For device technology see hearing aid # Tinnitusmasker
Especially in German-speaking countries - following the guidelines of the Working Group of German-speaking Audiologists and Neurootologists (ADANO) - a variant of the tinnitus retraining therapy has been established, in which the patient is exposed to relevant psychological stress (so-called "decompensated tinnitus", see Goebel and Hiller 1998 ), in addition to the elements already described, tinnitus-centered psychotherapeutic treatment (see also cognitive behavioral therapy ) is carried out.
So far, two handbooks have been published in German-speaking countries, in which contents and materials for the design of a tinnitus-centered psychotherapeutic intervention are presented. These are “Tinnitus Coping Training” (TBT, Kröner-Herwig 1997) and “Psychological Tinnitus Therapy” (PTT, D'Amelio 2002).
Because the effectiveness of this combination therapy is no better than that of cognitive behavioral therapy alone, only the latter was recommended by the relevant medical societies for the first time in 2010 and then again in 2015.
- Tinnitus Retraining Therapy Association - List of TRT therapists worldwide
- Tinnitus Archive - Statistical Data on Tinnitus from Oregon Health & Science University
- Tinnitus information portal
- Tinnitus Research Initiative (TRI) The Tinnitus Research Initiative Foundation is dedicated to scientific research into effective treatment options for the various types of tinnitus.
- C. Hellweg, G. Lux-Wellenhof, P. Bühler: Tinnitus Retraining Therapy. Irisiana Verlag, Munich.
- B. Kroener-Herwig et al .: Retraining therapy for chronic tinnitus. A critical analysis of its status. In: Scand Audiol. 29 (2), 2000, pp. 67-78. PMID 10888343
- PJ Jastreboff: Phantom auditory perception (tinnitus): mechanisms of generation and perception. In: Neurosci Res. 1990. 8, pp. 221-254. PMID 2175858
- B. Kröner-Herwig (Ed.): Psychological treatment of chronic tinnitus. Beltz Psychologie Verlags Union, Stuttgart 1997.
- G. Goebel, W. Hiller: Tinnitus questionnaire. Hogrefe, Göttingen 1998.
- R. D'Amelio: The Psychological Tinnitus Therapy. In: W. Delb, R. D'Amelio, C. Archonti, O. Schonecke: Tinnitus. A manual for tinnitus retraining therapy. Hogrefe, Göttingen 2002, ISBN 3-8017-1379-2 , pp. 79-234.
- ↑ Phillips JS, McFerran D: Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Database Syst Rev. 2010 Mar 17; (3): CD007330. PMID 20238353
- ↑ S3 guideline tinnitus the German Society of Otorhinolaryngology, Head and Neck Surgery. In: AWMF online (as of 2015)