TINNITUS RETRAINING THERAPY (TRT)

My TRT started in July, 1998 at the Southeastern Comprehensive Tinnitus Clinic in Atlanta. I will describe my first visit and then summarize the results of the TRT process on a quarterly basis.
  • First Visit
    •

    After arriving in Atlanta, it was very easy to take MARTA (for only $1.50!) from the airport to a stop which was within an easy walk to Dr. Nagler's office.

    The first visit involved two sessions on consecutive days. The office was very nicely decorated and everyone was exceptionally pleasant. I was pleased that there was very little ventilation system noise in the waiting room. However, there was a device in the waiting room which was making bubbling "water noises." I guess most people with tinnitus like water noise; but, I don't. Any kind of water noise I avoid. Can't stand those shopping malls which have water fountains in them. Anyway the first day included a discussion of the neurophysiology of the inner ear and the brain and how TRT was related based on the Jastreboff treatment protocol. The first day also included several sophisticated audiological tests as well as an extensive physical and neurological exam. The second day started out with an explanation of the prior day's test findings which was followed by an expanded discussion of TRT and how TRT was applicable in my situation based on the test abnormalities. Then I was fitted with a pair of Viennatone (Silent Star I model) behind-the-ear sound (BTE) generators. The sound generators are very small and weigh hardly anything. They are comfortable to wear and no one has asked me what they are for.

    About a week after my visit, I received a lengthy letter from Dr. Nagler summarizing the findings of my visit and a recapitulation of the instructions I received in Atlanta.

  • Summer - 1998
    •  This is going to be a good summer! Within a few weeks the hyperacusis was markedly reduced. My noise tolerance has correspondingly increased. When in Atlanta I was admonished that I was over-protecting my ears with noise protection devices and should not use protection devices unless the noise was of such a volume as to require one to raise their voice to be able to communicate. This is a reasonably good rule to follow for me; but, there is a small corridor of decibel level just below the point which requires a raised voice that still "feels" uncomfortable and increases the intensity of the tinnitus. Perhaps this phenomenon will disappear with continued use of the sound generators. There is hardly a day now when I have that old feeling of raging tinnitus at the end of the day. Those rare bad days occur only when I am somewhere without noise protectors and get exposed to too much noise. Guess that says something right there - I don't bother to carry around any noise protection devices anymore! Even the grandchildren are now tolerable! Isn't that wonderful. Still don't like the shower and other water noises. Still can't tolerate the hair blow dryer or vacuum cleaner without getting out of the house or wearing ear muffs. I can now drive on any kind of road surface without aggravating the tinnitus.

    All of this seems almost too good to be true - but I'll take it! If this is a trend, this will be a great summer.

  • Fall - 1998
    •  Summer sure did go by in a hurry. Must have been enjoying it unusually well. By the end of summer, the hyperacusis was about 85% resolved. As of now (mid-November), I would say the hyperacusis is at least 95% resolved. I no longer carry ear muffs or ear plugs with me anywhere. I have about 200 packets of disposable ear plugs which I give to people who have power mowers or leaf blowers. The only ear protection I carry now are my hands. If I encounter some sound which I perceive as offensive, I just cup my hands over my ears. Can't stick my fingers in my ears because of the sound generators.

    The typical sounds which I still don't tolerate well are vacuum cleaners, hair dryers, Harley-Davidson motorcycles, diesel trucks and buses, sirens, and water sound sources. I sure don't understand the problem with water sounds. Almost everyone else likes the soothing sound of water fountains, showers, and similar water sounds. But, I don't. When I go into a shopping mall landscaped with water fountains or water falls, I just leave. Any one have an explanation for this?

    There is another strange sound source I don't tolerate well - in fact, it is about the very worst sound I encounter. My driveway is surfaced with crushed rock. Occasionally it needs to be dressed up and I rake the rock around to get rid of humps and bumps. If I don't wear ear muffs will doing this, I get that roaring, raging tinnitus after only about four strokes of the rake! Actually this is about the only sound source which really drives my tinnitus wild for a sustained period of time. The other "unwanted sounds" just make the volume of the tinnitus louder for a brief, transient moment after which the tinnitus quickly returns to my base line level.

    Okay, that's the state of my hyperacusis. What about the tinnitus? That is hard to quantify. About all I can say at this point is that it is definitely not as much of a disturbing aspect in my life as it was when I started TRT. The change in the "disturbance factor" is subtle. I have fleeting moments when I suddenly realize I'm not conscious of the tinnitus. And when I have that experience and stop to examine what the state of the tinnitus is, I suddenly become aware that it is still there. Perhaps one of these days I'll just stop taking note of what the tinnitus is doing.

    Now that the hyperacusis has improved so dramatically, I am considering a hearing aid to correct the hearing deficit which resulted from this whole disaster. I've had a visit with my audiologist and she is investigating the best choice of devices. More on the outcome of this in the next update.

    That's about it for the fall quarter. So here comes winter. That means Christmas and parties and such. I'll be letting you know how that goes. Christmas 1998 will definitely be better that Christmas 1997!!

  • Winter - 1998
    •

    Christmas was great! The usual holiday sounds were all tolerable. What a contrast to the holiday season a year ago!

    There are only three sounds I don't handle well. These three sounds only increase the perceived intensity of my tinnitus on a very transient basis - perhaps three to five minutes - and then the intensity is back to its acceptable baseline level. No more or that raging, roaring, prolonged tinnitus!

    #1 - Hair Dryers - This is still a totally unacceptable sound source. We have a house rule that hair dryers will not be used if I'm in the house! #2 - Vacuum Cleaners - An occasional short term use to clean up a little mess is OK. Any prolonged use requires use of ear muffs. #3 - Water Sounds - I know this is a strange one. Most people like water sounds but not me. Water fountains in shopping malls and water falls in hotel lobbies are still just awful and I avoid them completely if possible. On occasion they can't be avoided so I just cover my ears with my hands and leave as quickly as possible.

    What about the tinnitus? Just a few days ago I returned to Dr. Nagler's clinic in Atlanta. Part of the return visit involved the completion of a questionnaire. One question was "What portion of your day are you aware of your tinnitus?" One of the multiple choice answers was "20% or less." The only other answer I could have chosen was "0%." That wouldn't have been a truthful answer. If you consider that I am asleep 8 hours a day, that leaves 16 hours during which I have a chance to be aware of the tinnitus. At a rate of 10%, that would be 1.6 hours or 96 minutes. My total daily awareness is about 20 minutes or about 2% of the time I am awake. I suspect Dr. Nagler considers this a success for the TRT protocol. It certainly fits my criteria for a success!

    Recently I have started wearing a hearing aid - an in the ear (ITE) device. It is wonderful. I can hear almost normally and the hearing aid also functions as a sound generator. I continue to wear the sound generator in the other ear and will likely do so for a few more months.

    Well, in my opinion this is pretty much the end of my ear disaster saga. The conclusion: TRT was an unqualified success. Since I really don't want to dwell on this topic any longer, I will consider this website finished, make no further revisions, and bid you all farewell. I thank Dr. Nagler for giving me back my sanity and providing me the opportunity to feel that life can once again be a happy, rewarding experience.

    Peace, TinnGuy

    Revised January, 1999