Tinnitus Treatment

The Tinnitus and Hyperacusis Center located at All Ears Audiology in Ithaca was one of the first in the country.

It was established in 1996, based on Tinnitus Retraining Therapy as developed by Pawel Jastreboff. Pawel Jastreboff is a neuropsychologist. While at Yale University Dr. Jastreboff  initiated a clinical approach called Tinnitus Retraining Therapy or TRT. Carol Bass was one of the first eighteen audiologists to open a tinnitus and hyperacusis center after her course work with Dr. Jastreboff.

Success rate is over 80%. Although the TRT protocol can be completed up to eighteen months most patients have finished within six months and about eighteen percent after two sessions. The rate of completion is individual for each patient.  We see mild to severe tinnitus and hyperacusis patients who complete with the same success. There certainly is hope for the tinnitus and loudness sensitivity patients. Misophonia is also treated at our center.  Although noise generators can be recommended, our first goal is to have the patient free from tinnitus and hyperacusis and they may not be needed. We can often use other environmental sounds as well.  In some cases, tinnitus noise generators and hearing aids may be used along with the TRT therapy. The counseling is imperative for remediation of tinnitus, hyperacusis and misophonia. Until recently, there was a sense of hopelessness for the tinnitus and hyperacusis patient.  With the advent of TRT,  our patients can be helped not to hear the tinnitus sounds.

What is tinnitus?

Tinnitus can be heard in one or both ears. It is perceived as high pitch ringing, crickets ,hissing, bells, hum,white noise, roaring, pulsing  etc. or a combination of sounds. About 17% of the general population are affected by the sounds. The tinnitus range of bothersome can range from mild to profound. It can affect sleep states and all aspects of one’s life.  Relationships and lifestyles may suffer. We see many patients that are devastated by the tinnitus sound. It affects them and their loved ones significantly and adversely.

TRT or Tinnitus Retraining Therapy

TRT is the method that we employ to assist patients to habituate to the perceived tinnitus signal. Our success rate I well over 80%. Success means that the patient no longer hears the sound or is not bothered by it. This usually happens at the same time.

What does auditory habituation mean?

Our brain can habituate or ignore sounds that are felt to be unimportant. For instance, the sound of one’s refrigerator can be loud, but is not heard. People living near a train station will not hear the train after awhile. Likewise one living near an airport will give little notice to the planes flying overhead while they are having their dinner or sleeping. In a similar way it is possible to retrain or rewire the brain to no longer hear the tinnitus. The protocol is eighteen months. Most of our patients complete or at least have significant relief after six months.  Nearly 20% are finished within two sessions. Every individual is different.  and we honor that difference.

Sound generators

Most patients complete the process without needing sound devices, this includes our most severe patients.

However, we have sound generators and hearing aids available. They are used not to mask the sound, but to assist the patient wearing them in the habituation process. There are white noise generators and there are alternate sound devices with fractal sound technology. The fractal sound ones can be for normal hearing patients or included in hearing aids instruments. The sounds are pleasant, similar to wind chimes.

When needed, both ears need to be stimulated.  Otherwise tinnitus may be noticed in the ear that previously did not notice the tinnitus. You need counseling on how to adjust your devices or not adjust them. Continual adjusting the devices can hamper your progress. The reason for the devices is to reduce the contrast between your sound and the environment. We want the tinnitus to be less detectable within your auditory system.

Hearing aids

Patients with hearing loss may best be served by amplification tuned specifically for tinnitus.  Any hearing aid devices will be helpful. If we can tune your devices to hear soft sounds even in quiet settings, it may reduce the overcompensation of the central nervous system. It will provide the rich environment that the patient needs so that one is not listening to tinnitus even in quiet.

Counseling and Sound Therapy

TRT employs counseling and sound therapy. Counseling is imperative in the TRT or auditory habituation process to help the brain not hear the tinnitus. The first session lasts about an hour. The auditory mechanism is explained as regard to the perception of tinnitus. You will understand the mechanism of tinnitus and how you are holding on to the sound and ways to facilitate habituation. The main information is provided in the first session. Follow-up sessions are typically scheduled three weeks later,

Six weeks, twelve weeks and every six months until completion.  The follow-up sessions help you to stay on track until you are done. We walk these steps with you with confidence.

Sound therapy can be environmental sounds, or devices. The idea is to provide a rich sound environment during the therapy process.

Neuroplasticity noise sensitivity

The brain is plastic. It can change or be rewired. It is constantly changing and rewiring itself. You can learn how to not hear your tinnitus or ringing in the ears. Fears, emotions and concerns need to be addressed to demystify the tinnitus perception.

The limbic system of the cortex is responsible for emotions. There is a connection between the auditory

system and the limbic system. Sounds can evoke certain emotions, like a baby crying for instance, or a siren, or a fire alarm.  Sounds that have no associated emotion can easily be habituated.

What can trigger the tinnitus sound?

There are multiple causes of tinnitus.  Noise exposure, hearing loss, medications, allergies, sinusitis, neck and jaw injuries may trigger tinnitus. These are common causes. Evidence shows that tinnitus can be related to non-auditory factors as well. There is a strong relationship between stress and emotions.

When a negative association is initially paired to tinnitus it is easy to continue to hear the tinnitus.

Can other therapies help?

After the counseling sessions, relaxation, meditation, stress reduction, guided imagery and cognitive behavioral therapies will assist the patients in their process. They can be integrated beautifully once the understanding of the first session is completed. Cognitive Behavioral therapy simply identifies the unwanted behaviors and thoughts and replaces them with alternative thoughts that are valid.

Many patients have insomnia when they are first evaluated.  Sleep deprivation is probably the number one complaint for the tinnitus patient.  Not everyone has a sleep disturbance, but, it does affect one’s emotional state. Relaxation can only be helpful. Stress can affect tinnitus.

Fractal tones and other acoustic stimuli will help to relax the patient as well as help provide the rich ambient sounds need for habituation. When thoughts change, emotions change and you are well on your way.

An integrative approach is important.

The initial interview with the TRT audiologist is critical to success. Each session is individualized to the patient. An experienced TRT clinician is needed to navigate this path with you.  A thorough evaluation and questionnaire will provide the necessary information so that habituation can easily occur.

Supporting spouse

A family member or friend can provide the emotional support and understanding in this treatment. They are most welcome to come in the session with you.

You may call our office to schedule an appointment at 607-257-3903. The assistance you need commence with speaking on the phone to our experienced staff.

Thank you kindly for your attention…Carol Bass, Audiologist

Peace is Possible

Our guiding principle is committment  to excellence with kindness to every patient we serve.