Tinnitus Retraining Therapy (TRT) has a success rate greater than 80% in substantially improving tinnitus perception and annoyance: Sheldrake(1996); Bartnik, (1999); Heitzman (1999); Herraiz, (1999); Jastreboff (2001); Mc Kinney (1999). That is, patients often report that their tinnitus ceases to be an issue in their lives. This approach employs the temporary use of soft sound, often in the form of broad band “white noise” generators purposely set at a volume that does not mask the tinnitus. The contrast between the tinnitus signal and environmental sounds is thereby decreased, thus facilitating habituation to the tinnitus signal. Habituation means that the subconscious mind is passively retrained to filter out and not respond to the tinnitus signal the same way the subconscious mind naturally filters out the meaningless sound of a refrigerator or a computer fan.
Neuromonics uses the neurophysiologic model as its basis, but holds that most patients who suffer from tinnitus have some degrees of hearing loss between 250-16000 Hz. Therefore, there is lack of stimulation perceived by the brain. This causes the central auditory nervous system to develop a compensatory action to offset this loss of stimulation. The Result is an artificial gain the central auditory nervous system that is perceived by the brain as sound. Accordingly, if we use a highly sophisticated algorithm to compensate this loss of sound to the brain, we can re-train the brain into reducing the artificial gain which will reduce patient’s annoyance and in turn the volume of the tinnitus (known as minimum masking level). This calls for a very detail evaluation of auditory system, including high frequency audiometry, tinnitus pitch measurement, and tinnitus matching, loudness discomfort levels, and residual inhibition. If sleeping is affected due to tinnitus, Neuromonics can be a significant help since patients can wear the device to bed.
Masking tinnitus involves partially or completely covering up the tinnitus sounds with other sounds from an external source. In fact, masking raises the threshold of the perception of tinnitus when an external source is presented. In clinical settings, masking is accomplished through the use of wearable noise generators (maskers) or “tinnitus instruments”, which are wearable units that function both as a hearing aid and masker. Currently, the Widex Mind hearing aid is the only highly advanced tinnitus instrument that can combine noise, music, and amplification to accomplish masking. The Jazz-duo from General Hearing Instrument and Amplisound open system are also other choices, but do not produce music as a medium. Dr. Jack Vernon and his colleagues at the Oregon Hearing Research Center in Portland introduced the principles and concepts behind masking which helped improve the quality of life for literally millions of tinnitus suffers.
Cognitive Behavioral Therapy (CBT) – The way one thinks about his/her tinnitus determines how he/she feels about it. When we modify the response by changing the distorted thought processes commonly associated with tinnitus, patient’s emotions toward tinnitus change. This in turn makes the patient notice the annoyance of the tinnitus less than before. Most treatments use CBT in one way or other. We modify CBT to address each patient’s need. In some cases, patients need to use some form of sound therapy along with CBT.