Tinnitus is a phantom auditory perception that is not related to an external sound stimulation. People can hear ringing, buzzing, hissing and other sounds. Tinnitus and DST seem to be caused by enhanced auditory nerve stimulation as a result of hearing loss, loud sounds, emotional reactions and overall emotional status, stress, general health or specific medical conditions. Decreased Sound Tolerance is an abnormal sensitivity to sounds that may not necessarily be loud. It consists of Hyperacusis, which is a negative reaction to a sound depending on its physical characteristic and Misophonia, which occurs when a person has a strong reaction to a sound with a specific pattern or meaning, for example chewing.
Tinnitus is a common problem affecting 10-17% of the population however 1 out of 200 adults have bothersome tinnitus.
Generally, people who have Tinnitus are told that nothing can be done or they have to live with it. Medication may be prescribed with little or no effect on the tinnitus itself. Although there is no cure for tinnitus, mainly owing to the fact that it is a symptom, its perception and associated negative emotions can be reduced and in many cases removed. There are various therapies that can help to relieve the emotional aspects mainly Cognitive Behavioural Therapy, Meditation and /or Mindfulness.
Tinnitus Retraining therapy was developed by Powel J. Jastreboff, Ph.D,Sc.d., M.B.A, and has been used for 30 years to treat over 2500 people who had bothersome tinnitus or DST. Now it is being used in over 30 different countries by professionals who follow a specialised training course.
Tinnitus Retraining Therapy (TRT)
TRT is based on the Neurophysiological model of Tinnitus and is focused on removing responses that are caused by Tinnitus. This habituation will eventually stop the reaction of the brain to unwanted sounds.
TRT therapy consists of
- Educational Counselling
- Sound Therapy
There will be an initial intensive evaluation and several follow up appointments that can last 9—18months. This therapy is also efficient in treating Hyperacusis and Misophonia and has an 80% success rate.
During the Counselling you will learn about
- Mechanisms or tinnitus, Hyperacusis and misophonia.
- How to control tinnitus
- How to relief Hyperacusis/Misophonia
- How to use background sounds to facilitate rehabilitation.
As part of sound therapy many times it will be possible to use sound devices that you may already have, however, it might be necessary to use ear level sound generators and in case of a hearing impairment one may need to use amplification devices combined with sound generators. These will be set up accurately using evidence based recommendations to be able to enhance the habituation process.
Tips and Things to Avoid
- If you have Tinnitus, Hyperacusis or Misophonia do not stay in a quiet environment. Always have an enriched sound background.
- Stress will increase tinnitus due to increased neural stimulation.
- Benzodiazepines will delay habituation.
- Tinnitus may not allow you to sleep however it does not have an impact on the during of sleep. This will depend on your sleep cycle and ability to go back to sleep if you wake up in the middle of the night.
- Diet, Caffeine, Alcohol, Smoking, Street Drugs and medication can have tinnitus as a side effect.
- Avoid Masking tinnitus or else the habituation process will not work properly.
- Use ear protection wisely but do not over protect your ears, it can increase DST. You need a certain level of noise for Auditory Toughening as the brain needs to hear.
- Be careful of misleading information on the internet some comments can be quite stressful and therefore increase tinnitus perception.
- Be realistic, a lot of patience is needed to treat Tinnitus and DST. Even if tinnitus is not bothersome you will still hear it but that is ok.
- If you have hearing loss do something to improve your hearing and tinnitus perception may decrease.
References for TRT
Jastreboff, P.J., Phantom auditory perception [tinnitus]: Mechanisms of generation and perception, Neuroscience Research, 1990; 8:221-254)
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TRT Programme
The TRT programme is being conducted by Dr Andrew Sciberras M.Sc, Au.D ,who has been trained to do this by Pavel J Jastreboff in person. Dr A Sciberras has been working in the field of Audiology for over 20 years and has specialized in tinnitus in 2018. He has also attended a course in CBT specifically for tinnitus however TRT will be the therapy of choice.
- Information Session / Initial Interview : 45- 60 mins
- Audiological Evaluation, Interpretation of results: 60-120mins
- Counselling session : 45-60mins
- Fitting of Devices if needed :45-60mins
- Follow – up Sessions. At 1,3,6,9,12 and 18 months as needed. 45-60 mins
- Fees are calculated on a pro rata basis at €60 /hour. With a minimum fee of €50
- Extra cost may be incurred if Ear level devices are needed or combination devices. Various prices are available depending on the technology level required.
Find us
Loud & Clear Professional Audiology Services
No 30A,
Gzira Rd,
Gzira,
Malta,
GZR1313