Tinnitus retraining therapy

Tinnitus retraining therapy is a treatment method for alleviating chronic tinnitus, which was developed in 1990 by Jastreboff and Hazell. The therapy is aimed less at the origin of tinnitus, but the processing of the tinnitus in the central nervous system and thus the conscious perception is placed at the center.

The retraining therapy is based on three pillars:

• Education and counseling the patient about the disease ( Counseling )
• Hearing therapy with behavioral aspects, may also be a tinnitus Noiser which generates a additional noise.
• Psychotherapeutic Counseling to facilitate the handling of the noise in the ear, supportive methods such as autogenic training and sports.

Basics

In the inner ear noises and acoustic signals are recorded. Already at the next level in the area of the brain stem is a control of reflexes triggered by the acoustic system instead (eg flight reflex after barking dogs ).

Tinnitus generated in this plane negative moods and fears. This area of the brain stem is associated with higher acoustic centers and with the limbic system, which controls human emotions. Here sounds are perceived as pleasant or unpleasant. All of these perceptions and sensations finally determine a sound sensation that is aware of the primary auditory cortex. Surprisingly, these perceptions can be influenced actively by about background noise can be suppressed or filtered out. The habit of constant accompanying noise is a form of habituation.

It is this mechanism seems to fail, according to the theories of Hazell and Jastreboff in tinnitus patients: It is not possible to suppress the tinnitus, but he is perceived as anxiety- triggering, disruptive and unpleasant. Thus, the attention is paid to the noise in the ear and the further amplified unpleasant impression.

The disorder comprises, in essence, the limbic system and less the actual hearing in the inner ear and in the auditory pathway. This could also explain why previous attempts at therapy, such as circulation- drugs, hyperbaric oxygen treatment, infusions, etc. that should affect the inner ear, no satisfactory solutions applied, since the disorder remain unaffected in higher acoustic centers under certain circumstances.

On these considerations is based on the Tinnitus Retraining Therapy: It should be fought less the actual tinnitus, but it is unpleasant perceptions are returned.

Elements

Advice

The first element of this treatment is called Tinnitus Counseling. By this is not psychotherapy in the strict sense to understand. Rather, as much information about tinnitus and tinnitus neurophysiological model of the patient should be given in order to reduce such fears in a kind of teaching. This is to a - according to the theories of Hazell and Jastreboff - correct management of tinnitus are initiated.

Noiser, Masker

The tinnitus often occurs in the context of hearing impairment on (degenerative hearing loss, presbycusis, noise induced hearing loss, sudden deafness, Meniere's disease, acoustic trauma ). Is there a coarser hearing impairment that should be supplied with a hearing aid, so devices can be used, which function both as a hearing aid as can a broadband noise that can be used for retraining therapy leave.

As a second element, therefore, frequently noise devices ( tinnitus Noiser, Audiostimulator, Tinnitus Control Instrument, tinnitus maskers ) are used. To this end, the patient with a soft, slightly disturbing noise is measured using a hearing aid like a small system, a so-called Noiser or Masker offered. Many tinnitus patients found a stay at a murmuring, babbling brook or the use of a soft rustling room well as relief of their suffering. The patient should learn so to be led out through conscious listening to this non-interfering noise from his negative attitude to noise. The tinnitus Noiser must not be set so loud that the disturbing tinnitus masked, so drowned out, since otherwise there can be no familiarization or habituation to the tinnitus. So this retraining therapy is based inter alia on the idea that the patient gets used to a soft sound of Noisers and thereby learns, even his own disturbing tinnitus to no longer feel the tinnitus as unpleasant. Often both ears are daily intoxicated up to 8 hours with the Noiser because the auditory perception of the whole brain to be trained on the advice of specialists. Such devices can be tailored to each patient. The success rate is about 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, as the filter function of the auditory center is even more excited by the amplification of environmental noise.

Limiting factor must be noted that the benefits of tinnitus Noiser so far could not be proven. Comparative studies in which was omitted in a subset of patients on Noiser, but could not detect any group differences. In addition, the often inconsistent and little standardized application of tinnitus retraining therapy is a cause for criticism. A systematic study overview of the Cochrane Collaboration from 2010 finally comes to the conclusion that there is no sufficient quality studies exist that demonstrate the effectiveness of the treatment. Only one randomized, controlled study to interpret that Tinnitus Retraining is more effective than treatment with a tinnitus masker. This study is, however, of low quality.

For instrumentation see # tinnitus masker hearing aid

Psychotherapeutic treatment

Especially in German-speaking countries has - the guidelines of the Association German- audiologists and Neurootologists ( ADANO ) following - a variant of the tinnitus retraining therapy established, in the case of relevant psychological stress to the patient (so-called " decompensated tinnitus ", see Goebel and Hiller 1998), in addition to the elements already described a tinnitus -centered psychotherapy (see also cognitive behavioral therapy) is performed.

So far, two manuals were published in the German-speaking world, where content and materials are set out to design a tinnitus- centered psychotherapeutic intervention. It is the " tinnitus coping training " (TBT, Kröner- Herwig 1997) and the " Psychological tinnitus therapy " (PTT, D' Amelio 2002).