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  • Tinnitus Home Page
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  • Untitled Document
    Home Misophonia Origin of TRT Outline of TRT TRT Association Further Reading Training Courses Contact Us

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  • Tinnitus Home Page
    generation and perception Neurosci Res 221 254 1990 and based on it a new clinical approach have created a totally new treatment for tinnitus that results in significant improvement for more that 80 of the patients treated at our center Jastreboff P J Gray W C Gold S L Neurophysiological approach to tinnitus patients Am J Otology 17 236 240 1996 This method Tinnitus Retraining Therapy TRT uses a combination

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  • EMORY TINNITUS & HYPERACUSIS CENTER PERSONNEL

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  • Tinnitus Home Page
    collaboration with Jonathan and Jacqui TRT has been refined over the years both in Baltimore and in London and undergoes continuous modifications aimed at shortening its duration and enhancing the effectiveness I am frequently asked what is the essence of TRT In a few words TRT is a method aimed at habituating of reactions of the body induced by tinnitus and habituation of perception of the tinnitus signal itself Our goal is to retrain the patients brain so they treat tinnitus similar to the way they treat the sound of a refrigerator in their kitchen which they are normally not aware of and when they do hear the sound it is not bothersome The method retrains reflexes involving connections of the auditory with the limbic and autonomic nervous systems and retrains the subconscious part of the auditory pathway to block the tinnitus signal TRT always consists of two components intensive one on one directive counseling and sound therapy most frequently with the use of sound generators which emit low level of broad band noise following a specific habituation protocol Tinnitus should never be masked in TRT because one can never habituate signal one cannot detect All of us in London and Baltimore become very excited seeing such the positive treatment outcomes Satisfied patients created a growing demand for the popularization of TRT Jonathan has started to incorporate some information about TRT in Dr Coles and his Nottingham Tinnitus Course since 1992 TRT received recognition in Europe very quickly and Jonathan and Jacqui were helpful in establishing many clinics across the continent In the past two years we have offered three courses aiming specifically at teaching TRT at the University of Maryland in Baltimore and about 80 people have thus far participated Of these participants about 50 are now beginning or have begun to implement TRT throughout the U S Thus far over 90 additional clinicians have expressed interest in attending future training courses We will try to fulfill this obligation this year Recently it has became a significant problem to patients and to us that some people claim to offer TRT without possessing sufficient knowledge of the method TRT seems to be easy but in reality it is complex and it requires specific understanding knowledge and instruction We see patients who believe they were offered TRT but were disappointment with the treatment outcome While talking with them it became readily apparent that either they received improper counselling or improper instruction on how to use sound generators in their particular subtype of tinnitus Others were simply given devices without any counseling at all TRT is still a new and developing procedure and not enough information describing it in detail has been yet presented in the literature Moreover complexity of TRT make it unlikely to learn it by reading papers the situation is similar to attempt to learn surgery for removal of acoustic tumor by studying literature Therefore it is impossible to acquire sufficient knowledge to treat tinnitus patients just by reading

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  • Theoretical Basis of the Approach and Main Practical Guidelines
    it This negative reinforcement of tinnitus perception actually enhances the initial responses of the autonomic nervous system evoked by fear As tinnitus is commonly continuously present and evokes a strong emotional response this results in the tuning of the neuronal networks detecting the tinnitus signal itself Consequently this increases the time an individual is aware of the tinnitus and further enhances the aversive emotional responses and the reaction of the autonomic nervous system thus increasing annoyance Notably the involvement of the limbic and autonomic nervous systems is responsible for the annoyance evoked by tinnitus the loudness and pitch of tinnitus are irrelevant to a large degree and normally do not play a significant role For a significant proportion of patients the compensatory action of the auditory system results in the emergence of hyperacusis Research on animals has revealed that after permanent or temporary hearing loss the increased sensitivity of about 25 of the neurons in the subcortical auditory centers These data are in agreement with human data which showed that if a person is put in a chamber with a very low sound level the sensitivity of hearing increases all sounds starts to sound loud and 94 of the people develop temporary tinnitus These data indicate that tinnitus can result from enhanced sensitivity of the auditory system which in turn may lower the maximum sound level that person finds comfortable For these patients tinnitus and hyperacusis are two manifestations of the same internal problem In practice the contribution of the hyperacusis component to tinnitus ranges from none at all to the situation where hyperacusis is the only or dominant problem From the patient s point of view the crucial question is what can be done to remove tinnitus evoked annoyance To our knowledge there is no drug procedure or surgery that can eliminate the source of tinnitus without profound side effects As evident from the model even in cases with significant inner ear contribution attempts to solve the problem by destroying the cochlea or the auditory nerve would not be consistently helpful while making the patient deaf To make the situation worse it has been shown that cutting the auditory nerve which is still promoted by some as a treatment for tinnitus actually causes tinnitus in close to 60 of the people who did not experience tinnitus before the operation Another problem arises from the observation that quite frequently more than one type of tinnitus coexists and therefore we would need to attenuate all various sources of tinnitus The Tinnitus Retraining Therapy which was developed by Dr Jastreboff in mid 80s and published in 1990 Jastreboff P J Phantom auditory perception tinnitus mechanisms of generation and perception Neurosci Res 8 221 254 1990 offers a potential solution to this problem If we cannot erase the source s of tinnitus we should turn our attention to what is happening between the source of tinnitus most frequently at the periphery and the level where tinnitus is perceived the cerebral cortex The idea

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  • Tinnitus Retaining Therapy Association
    who are properly trained and who provide a service to their patients according to the requirements of TRT 1 participation in one of the TRT courses Jastreboff s in the USA or Hazell s in London 2 to have used TRT for at least 6 months 3 to accept that TRT requires at least the following components to be fulfilled The concept of the neurophysiological model Jastreboff P J Phantom auditory perception tinnitus mechanisms of generation and perception Neurosci Res 8 221 254 1990 and Jastreboff P J Tinnitus In Current Therapys in Otolaryngology Head and Neck Surgery ed George Gates Mosby Year Book Inc St Louis MO 1998 must be the basis for the diagnosis and treatment of each patient Categorization of patients according to the model A specific treatment protocol adjusted to each patient individually One to one directive counseling tailored to each individual case Use of sound therapy according to the model not necessarily involving the use of noise generators or hearing aid A series of follow up visits involving further individual one to one counseling over a period up to two years The ability by the professional to answer patients questions on the basis of the

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  • Further Reading
    hearing aids for tinnitus patients Proceedings of the 5th International Tinnitus Seminar Portland Oregon 1995 eds G Reich and J Vernon American Tinnitus Association Portland Oregon pp 312 314 1996 Back to Top Other Clinical Works Jastreboff P J Ikner C L Hassen A An approach to objective evaluation of tinnitus in humans In Tinnitus 91 Proceedings IV International Tinnitus Seminar Bordeaux France 1991 ed Jean Marie Aran Kugler Publications Amsterdam pp 331 340 1992 An application of a mathematical method used for discrimination between tinnitus and non tinnitus subjects in a blind study Hazell J W P Jastreboff P J Meerton L E Conway M J Electrical tinnitus suppression frequency dependence of effects Audiology 32 68 77 1993 The results of work with extracochlear electrical stimulation rather promising however due to a high success rate with habituation techniques this approach has been limited to totally deaf patients who are getting a cochlear implant Back to Top An Animal Model of Tinnitus Jastreboff P J Brennan J F Sasaki C T Phantom auditory sensation in rats An animal model for tinnitus Behavioral Neuroscience 102 811 822 1988 The main paper describing the principle and the results of our behavioral paradigm for inducing and detecting tinnitus in rats Jastreboff P J Brennan J F Sasaki C T An animal model for tinnitus Laryngoscope 98 280 286 1988 The outline of the model presenting both behavior and electrophysiology Chen G D Jastreboff P J Salicylate induced abnormal activity in the inferior colliculus of rats Hearing Research 82 158 178 1995 To my knowledge this is the first paper to present abnormal neuronal activity which may be related to tinnitus in a large number of neurons and recorded under conditions when animals were shown to perceive tinnitus Notably the results point out specific categories of mechanisms involved in tinnitus and suggest types of drugs which may be effective Series of papers on the animal model presented at the IV International Seminar in Bordeaux the titles are self explanatory Jastreboff P J Brennan J F Animal model of tinnitus Recent developments In Tinnitus 91 Proceedings IV International Tinnitus Seminar Bordeaux France 1991 ed Jean Marie Aran Kugler Publications Amsterdam pp 283 292 1992 Jastreboff P J Brennan J F The psychoacoustical characteristics of tinnitus in rats Tinnitus 91 Proceedings IV International Seminar Bordeaux France 1991 ed Jean Marie Aran Kugler Publications Amsterdam pp 305 309 1992 Jastreboff P J Nguyen Q Brennan J F Sasaki C T Calcium and calcium channel involvement in tinnitus In Tinnitus 91 Proceedings IV International Tinnitus Seminar Bordeaux France 1991 ed Jean Marie Aran Kugler Publications Amsterdam pp 109 114 1992 Jastreboff P J Appropriateness of salicylate based models of tinnitus In Tinnitus 91 Proceedings IV International Tinnitus Seminar Bordeaux France 1991 ed Jean Marie Aran Kugler Publications Amsterdam pp 309 313 1992 Jastreboff P J Sasaki C T An animal model of tinnitus A decade of development American Journal of Otology 15 19 27 1994 A summary of

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