By Ann L. Rhoten, Au.D., CCC/A
Studies suggests about 50 million people in the United States have constant tinnitus. It can be perceived as a variety of sounds, ringing, hissing, roaring, crickets, or music just to name a few. Some people perceive it in the ear and others in the head. Luckily, the majority of those people experience tinnitus but their lives are not significantly impacted by it. However, about a quarter of those 50 million people suffer or are debilitated by the tinnitus experiencing depression, loss of concentration, sleep problems and loss of enjoyment of life. Unfortunately, many people who suffer with tinnitus have been told they have to “learn to live with it” or “there is nothing you can do”. Not only is this untrue, but it enhances the feelings of hopelessness and fear by enhancing the belief that tinnitus is an incurable disease. In many cases this negative counseling from health care professionals is responsible for transforming the person from someone who experiences tinnitus to someone who suffers from tinnitus. In the past, treatment options have been limited as well as not producing any significant benefits for the person suffering from tinnitus. Although there is still no cure for tinnitus, over the last 20 years, research into the mechanisms of tinnitus and the best methods to manage it has increased dramatically. We now have options to offer the tinnitus sufferer which have been previously unavailable and due to the increase in research have been scientifically proven to be effective. Tinnitus Retraining Therapy (TRT) or habituation therapy is one of the most successful treatment and management options and has repeatedly been demonstrated to be more than 80% effective in relieving the debilitating effects of tinnitus.
The majority of people who experience tinnitus adjust to its perception without any intervention. There is no need for treatment. This process of adjusting to the constant sound in the ear or head is called habituation. We habituate to many different inputs throughout our day. For instance, most of us do not notice the hum of a refrigerator or the feel of the clothes on our backs. However for the person who suffers from tinnitus, the tinnitus signal cannot be ignored making it impossible to habituate. TRT is a treatment for tinnitus which helps those people suffering from tinnitus to recategorize it to a neutral signal. When tinnitus becomes neutral, it can be habituated.
TRT consists of two components: counseling/education and sound therapy. During counseling sessions, patients are taught about the auditory system and other systems in the brain that are relevant to the source of tinnitus and to the origin of the suffering that sometimes accompanies it. The instruction demystifies tinnitus downgrading it to a neutral signal with about as much importance as the refrigerator running. This facilitates habituation of the reaction to tinnitus. The second component, sound therapy, utilizes sounds to decrease the contrast between the tinnitus signal and the background noise. Because our senses work not on the absolute value of a stimulus but on the difference between the stimulus and background, enhancement of the level of sound coming to the ears results in a decrease in the tinnitus-related signals reaching the brain. Using sound therapy, in the correct way, can make the tinnitus seem like a candle in a lighted room as opposed to candle in a dark room. Over time, continued use of sound therapy eventually reduces the loudness of the tinnitus aiding in the habituation of its perception. Our goal is to facilitate habituation of both the tinnitus reaction and tinnitus perception. When this occurs, the tinnitus sufferer becomes just someone who experiences tinnitus.
Often people who suffer from tinnitus experience sound tolerance issues as well. Estimates suggest 40% of tinnitus sufferers also experience hyperacusis. People with hyperacusis find everyday sounds, which are not even noticed by most people, to be too loud. There are several different forms of sound tolerance issues (hyperacusis, misophonia, phonophobia) and each form must be managed in a different way. People who experience sound tolerance issues often restrict social and employment interactions sometimes living in total isolation. Similar to tinnitus, many health care professionals do not know where to refer people who experience these uncommon sound tolerance issues. Professionals trained in TRT are trained to manage both tinnitus and sound sensitivity issues.
The most common cause of tinnitus is excessive noise exposure. However, often times the cause is not known. Regardless of what may be causing the tinnitus, TRT can be successful in habituation. However, there are several conditions which cause tinnitus and sound sensitivity problems which can be medically treated. Because of this, it is very important to receive a thorough medical evaluation to rule out any treatable medical condition prior to beginning any kind of treatment and management protocol for tinnitus or sound sensitivity.
While the development of Tinnitus Retraining Therapy has been a blessing for tinnitus and sound sensitivity sufferers, there are a limited amount of medical professionals who are aware of the treatment and few medical professionals who are trained to provide the treatment. In Kentucky, there is one audiologist who is trained and certified by both the Tinnitus Retraining Therapy Association and the Tinnitus Practitioners Association. Dr. Ann Rhoten, audiologist, opened her own audiology private practice a few years ago with the intent to provide this much needed service to the people suffering from tinnitus and sound sensitivity disorders. She has people come from all over the state, Ohio, Indiana, Tennessee and West Virginia seeking her help. There really is something you can do.
Kentucky Audiology and & Tinnitus Services