Tinnitus Retraining Therapy - An Overview

Introduction:

The presence of continuous ringing or other sound in the ear that is not caused by an external source is called tinnitus. Tinnitus can be suggestive of an ear canal blockage or hearing loss or can occur due to certain medications. About 10 to 15 percent of adults may experience tinnitus. Tinnitus retraining therapy involves a blend of sound therapy and counseling to train the brain and disregard the sound in the ear. A few studies have found tinnitus retraining therapy to be efficacious in many people, but there are limited proofs to regard it as more beneficial than other treatments.

What Are the Components of Tinnitus Retraining Therapy?

Tinnitus is usually caused by exposure to noise, genetic factors, and unavoidable deterioration of hearing due to aging. The two components of tinnitus retraining therapy are as follows:

• Directive counseling.

• Sound therapy.

Directive counseling involves education about the ringing sound or tinnitus and the interactions with other body systems. Sound therapy enables the brain to get acquainted with tinnitus alongside reducing the contrast between tinnitus and the surrounding silent environment. This encompasses environmental sound enrichment, hearing aids, ear-level sound generators, or a combination.

How Is Tinnitus Caused?

The mechanism of tinnitus can be explained based on the neurophysiological model in the following ways:

• Tinnitus happens due to the abnormal processing of a signal that is produced in the auditory system.

• This abnormal processing happens before the signal is recognized centrally.

• This can result in feedback wherein the annoyance caused by the tinnitus makes the individual concentrate increasingly on the noise, amplifying the problem and forming a vicious cycle.

• According to this model, tinnitus can happen due to the continuous firing of cochlear fibers to the brain due to hyperactivity of cochlear hair cells or permanent damage to these cells. The brain can misinterpret this phantom sound-like signal, making it believe that a sound is heard.

How Does Tinnitus Sound?

The sounds that can be heard in tinnitus can vary from a mild whistling, or humming sounds to complex sounds like music. One can listen to single or multiple sounds. It can be experienced in one or both ears or within the head, or outside the body. Usually, the condition is subjective, meaning only the affected person can perceive the sound. The sound may appear realistic to the affected person since no parallel external sounds can be regarded as phantoms. Objective tinnitus is a type of tinnitus that can be appreciated by an examiner either while using a stethoscope or microphone in the ear canal or which can be heard without the help of any aids. This is, however, rare and can be due to the sound produced by blood flow in the ear or the surrounding region or as a result of abnormal activity of tiny muscles within the middle ear.

What Is the Mechanism of Tinnitus Retraining Therapy?

Tinnitus that happens as a side effect of certain medications or due to ear impaction can be resolved by discontinuing the drug or cleaning the ears. Many cases of tinnitus that manifest as a result of hearing loss cannot be treated. However, certain treatments can help cope with tinnitus. The mechanism of tinnitus retraining therapy revolves around two components, namely:

• Counseling: Before commencing with tinnitus retraining therapy, one might be interviewed and examined by the physician to assess the individual's hearing status and symptoms. The treatment plan will vary if an underlying medical condition or a medication is the reason for tinnitus. The counseling session is handled by an audiologist (healthcare expert who detects, assesses, and manages disorders of hearing, balance, and other neural systems.

Counseling targets to change one's perception of tinnitus and helps them get acquainted with the habitation process. Each session can last for about one to two hours. The counselor will assess the progress during this stage and teach about the functioning of the auditory system and change one's negative notion about tinnitus. The counselor will guide the individual on initiating the habituation process and changing one's negative emotional response and hypersensitivity to sound.

• Sound Therapy: In this, sounds are used to mask the tinnitus by wearing a device behind the ear that plays white noise or other masking noise at an intensity slightly lower than the existing tinnitus. The aim of sound therapy is to enable the brain to get familiarized with tinnitus by minimizing the contrast between the tinnitus and the sound in the external environment.

When Should One Approach a Physician for Tinnitus Retraining Therapy?

Though tinnitus is a common condition, it can influence the quality of life in a few individuals. If tinnitus is bothersome, one can approach a physician if they experience the following symptoms:

• Presence of tinnitus in only one ear.

• The onset of tinnitus is sudden.

• The sound of tinnitus is like a heartbeat.

• The sound is too annoying that one finds it difficult to concentrate.

• Presence of dizziness, hearing loss, or vertigo (a feeling of spinning or motion that is usually described as dizziness).

Is Tinnitus Retraining Therapy Safe and Effective?

• Tinnitus retraining therapy has been regarded to be safe without any known side effects. Before starting the treatment, one can discuss their queries with their physician or audiologist. It takes 12 to 18 months for individuals to experience habituation through tinnitus retraining therapy. One can notice initial improvements after three months. From the results of 100 studies on the efficacy of this therapy, it was observed that remarkable improvements were noted in about 80 percent of individuals who underwent the treatment.

• The efficacy of tinnitus retraining therapy has been improved through various modifications incorporated with time. Tinnitus has also been found to gradually decline with time in many individuals without the need for any therapy. A few people learn to get used (habituate) to tinnitus on their own or come up with strategies to obscure the tinnitus sounds like using a fan while sleeping or using a sound machine.

• The efficacy of tinnitus retraining therapy has remarkably increased, especially in the past 25 years, primarily due to changes introduced in its implementation. The significant improvement has been to reduce the average time until seeing marked improvement from one year to one month, with a statistically notable improvement seen at and after three months.

Are There Other Treatment Options Available for Tinnitus?

Other treatment options include:

1. Lifestyle Changes: Lifestyle changes can be made by adopting the following measures:

• Reducing the intake of alcohol.

• Avoiding stress.

• Refraining from smoking.

• Maintaining the blood pressure in the healthy range.

• Refraining from any known triggers.

• Avoiding loud noises or playing loud music while using earbuds.

2. Use of Hearing Aids: Tinnitus most often occurs as a result of hearing loss. A hearing aid can amplify external sounds and can obscure tinnitus. Also, many hearing aids have been incorporated with tinnitus masking programs.

3. Sound Masking Devices: Sound masking devices can play sounds that veil the tinnitus or play white noise. These devices can be operated from a device placed directly in the ear, from a phone, or through an external sound machine.

4. Cognitive Behavioral Therapy: This therapy identifies negative thought patterns and behaviors and aims to modify them.

5. Medications: No specific drug has been proven beneficial in treating tinnitus in all people. Few physicians prescribe antidepressants to eliminate tinnitus, but studies have shown they are useless. They can perhaps aid people suffering from sleep disorders and major depression. Anticonvulsants (a drug that is prescribed to prevent or treat convulsions or seizures) are also not very efficacious but have been shown to offer relief in a few people.

Conclusion

Tinnitus retraining therapy is a therapy to help one overcome the symptoms of tinnitus. The treatment aims to attain the habituation of tinnitus. Habituation means that the individual gets acquainted with the tinnitus and can no longer perceive it unless the individual purposefully focuses on it. Even if an individual perceives it, it no longer bothers or disturbs the individual. This therapy encompasses both the individual's perception and response to tinnitus. Tinnitus retraining therapy requires 9 to 18 months of dedicated commitment by the individual to experience remarkable results.