How do you treat tinnitus?
The most frequently used treatment is Tinnitus Retraining Therapy. Other names, such as habituation therapy and the Jastreboff method, refer to the same thing. This treatment plan involves an extensive audiological evaluation, several counseling sessions, the use of external sound, and for most patients, the use of sound generators. It does not involve any surgery or drugs.
What does Tinnitus Retraining Therapy mean?
The goal is to retrain the subconscious parts of the brain to ignore the sound of your tinnitus and to achieve the stage in which you are not aware of nor annoyed by your tinnitus.
Do you provide a medical evaluation?
No, since I have found that almost all of our patients have already been evaluated, often several times. When a medical evaluation is appropriate, I will refer you either to your primary care physician or to one of the specialists I work with.
Are there any side effects of the treatment?
No. That’s one of the key advantages of a strictly audiological therapy.
What kind of audiological tests are performed? Will they hurt my ears?
The tests include an audiogram and several specific tests which will allow me to evaluate whether you have tinnitus and/or hyperacusis, and to what degree. The tests begin with low levels of sound. Some will gradually get louder. When I do these tests, you will be aware of the rate at which they get louder, and will always have the option to stop that particular test. None of these tests will be painful. You will always be in control.
What if I don’t have tinnitus when I’m tested?
It will not influence the probability of success with tinnitus retraining therapy.
I recently had audiological tests done. Do they have to be repeated?
Almost all tests must be done during your first visit. Equipment calibrations vary slightly, and test instructions may significantly affect test outcome. You and I need these factors to be constant as we track your progress through the treatment period. There are also specific tests which are not routinely performed in other places. Having said that, if you have had a diagnostic audiological evaluation, performed by a certified or licensed audiologist, within the past three or four months, a portion of that examination might not need to be repeated. There are also a small number of minor tests that will not need to be performed if you have had certain diagnostic evaluations done.
Is the counseling a form of psychotherapy or biofeedback?
No. The counseling will provide you with information about the causes and factors involved in your tinnitus and/or hyperacusis, and explain to you how retraining therapy works. It will also teach you how to control your tinnitus. It is a unique form of counseling not available from other disciplines. The counseling is fundamental to success.
I may include several elements of cognitive therapy along with the directive counseling. How much, and to what depth, varies from patient to patient. Keep in mind that this Center’s therapy is provided by an audiologist, one who specializes in the evaluation and rehabilitation of the hearing system, rather than by a psychologist.
What is the role of external sound?
External sound from radios, TV’s, stereos, etc. is used at a low level, not to cover, or mask, your tinnitus, but to help bring about changes in your subconscious hearing system. It reduces the contrast between your tinnitus and your acoustic environment, and tends to distract you from the sound of your tinnitus.
What are the sound generators and what do they look like?
The sound generators are housed in hearing aid cases that are worn usually in, or sometimes behind, both ears. They can be worn with glasses. They will not interfere with your work or with talking on the telephone.
A photograph is available at the General Hearing Instruments web site by clicking on “Open Ear Devices.”
Can’t I just buy the devices?
While the devices speed up the process of retraining, how they are used is critical, and varies from patient to patient. Dr. Jastreboff reports an 80% improvement rate for the combination of sound therapy and counseling, but only an 18% success rate for sound therapy alone. Similar results have been reported by Dr. Jonathan Hazell in London. If used incorrectly, the sound generators can actually worsen your condition. Much of the counseling involves teaching you how to use the sound generators correctly and effectively.
Do I really need the devices?
Not everybody needs the devices. After the audiological evaluation, I will give you my recommendations, and you can choose your treatment. Almost half of my patients do not need, or choose not, to purchase the devices. On the other hand, clinical experience has shown that for many patients, not using the devices significantly reduces the long-term success rate.
I am using hearing aids. How can I use other devices?
Depending on the type of hearing aids, it is possible that I can work with your hearing aids and you will not need any other devices. We are also working with two manufacturers of combination instruments, which have both sound-generator and hearing aid circuits.
I tried maskers without effect. Isn’t this the same thing?
This treatment is very different from masking. Although in some cases masking can provide tinnitus relief by making it inaudible, once the masker is removed, the tinnitus returns, and the level of sound required to mask the tinnitus may be annoying or uncomfortable.
Tinnitus retraining therapy has an entirely different goal. We use the sound generators at a very soft level that mixes with or is below the level of your tinnitus. The objective is to make you feel more comfortable and to remove the emotional response to your tinnitus. Ultimately the objective is to remove the perception of your tinnitus.
Does that mean you don’t use masking therapy?
No. I’m supportive of masking, which has worked reasonable well for large numbers of people. During your evaluation, I will discuss the advantages and disadvantages of every proven tinnitus therapy.
I am taking some medication. Will I be able to continue?
In general, if you are taking medication for any reason other than for your tinnitus, you will be able to continue taking the medication. If necessary, we will work closely with your physician to help answer any questions about your medications.
How long does the treatment take?
Up to 18 to 24 months. Most patients who carefully follow the protocol and grasp and apply the concepts presented during the counseling sessions see at least some improvement within six to twelve months.
Will I be cured of my tinnitus or of my hyperacusis?
When the therapy is successful, you will no longer be bothered or annoyed by your tinnitus. However, if you listen for your tinnitus, you will hear it. If you have hyperacusis, it is reasonable to hope that day-to-day sounds no longer bother you. This is why we refer to Tinnitus Retraining Therapy, or to habituation therapy, as a treatment, not a cure.
What is the guarantee that I will get better?
There is, unfortunately, no guarantee, but clinical experience in a number of clinics, ours included, indicate that from 70 to 85% of patients (depending upon when patients are counted and how “success” is measured) have reported significant improvement.
How frequently do I need to return to the Center?
The typical follow-up schedule is one visit every two weeks for the first two months, one at 12 weeks, and then every 6 months until graduation. If you are going to obtain the sound generators, plan on another one-hour visit two weeks after the first evaluation session. For patients who live far away and/or who do not want to take time off work, the early follow-up visits are often done by telephone, or occasionally by email.
Is the treatment covered by insurance?
Check with your insurance. If you email a request for an information package, the package will contain insurance codes and the Center’s fees.
A few insurers cover part of the evaluation, and occasionally, the devices. The large majority of insurances do not. Medicare does not cover any costs. We have sometimes had success getting Worker’s Compensation programs to cover the program for established claims.
Insurance reimbursement rates are generally inadequate to pay for the costs associated with providing tinnitus therapy. For this reason, the Center does not bill insurance, Medicare included.This Center has dropped participation in the Medicare program.
The frequent effect of trying to get insurance to pay for tinnitus therapy is the loss of critical therapy time.
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