The TRT method in practice

Abstract

Tinnitus retraining therapy is one approach by which habituation to tinnitus and hyperacusis can be induced. It is logically based on the neurophysiological model described by Jastreboff (1990) [1]. Considering the complexity of tinnitus and hyperacusis, it is logical and straightforward, both in treating the patient, and in teaching the technique to health care professionals. The key problem with persistent tinnitus and hyperacusis is an aversive conditioned reflex response, similar to that evoked by security issues, or threats to wellbeing. For as long as this response to internal neuronal activity (in tinnitus) or external sounds (in hyperacusis) is established in the subconscious, it continues to evoke unpleasant alteration of limbic and autonomic function, whenever the signal is detected. Habituation to continuous meaningless sounds occurs rapidly, but does not occur where the sound has a negative, invasive, or threatening message. The goal of TRT is to habituate or block completely any reaction of the limbic or autonomic nervous system to tinnitus, or, in hyperacusis, to sound in the environment, which is causing annoyance. The technique requires a specific approach in which tinnitus and hyperacusis is first categorised, and an individual programme of retraining on a one-to-one basis is designed for each patient, dependent on 5 different treatment categories. All treatments involve directive counselling/teaching, training in sound enrichment of the environment and avoidance of silence. Some categories involve the use of instruments (either noise generators or hearing aids), fitted and used in the specific context of the neurophysiological model. The vital component for both professionals and patients is a complete understanding of the model.