Since 1996 tinnitus patients consulting the Tinnitus & Hyperacusis Center Frankfurt have been treated using the tinnitus retraining therapy (TRT) developed by Jastreboff and Hazell (Jastreboff et al. , 1985). For this study only patients with at least half a year of medically guided active treatment were taken into account and evaluation was done after at least five years from the beginning of the treatment.
Since 1996 tinnitus patients consulting the Tinnitus & Hyperacusis Center Frankfurt have been treated using the tinnitus retraining therapy (TRT) developed by Jastreboff and Hazell (Jastreboff et al. , 1985). For this study only patients with at least half a year of medically guided active treatment were taken into account and evaluation was done after at least five years from the beginning of the treatment. Special attention was directed to the subjective estimation of the patients quality of life and overall well-being. In addition a few cases of relapse of tinnitus were evaluated and documented. It may be of interest that in almost all cases evaluated here the patients after five years still were applying selected elements of TRT in their everyday life. In conclusion, in more than 85% of the patients evaluated in this study treatment using TRT was successful after fife years. The success consisted in the fact, that the person previously being ridden and dominated by tinnitus had been transformed into a person being able to actively control this phantom perception and resume the full potential of human activity in life.
Tinnitus is a major problem in a growing number patients around the world. It is estimated that in Germany alone up to eight million people suffer from this functional disturbance, some of which being severely affected to a degree that they cannot lead a normal life in their family or during work. Since Jastreboff presented his paper on clinical implication of his neurophysiological model on tinnitus during the tinnitus seminar in Portland (Jastreboff, 1995), TRT was widely discussed as a new effective therapy for tinnitus and was introduced in Germany as well (Lux-Wellenhof, 1999). Following the ideas of Jastreboff and Hazell (1993), we started to implement TRT in the treatment of tinnitus patients in Frankfurt in our Tinnitus – Hyperacusis Center in 1996. We were very skeptical in the beginning. Other methods of tinnitus treatment before had been shown to be ineffective in our hands although these methods had been affirmed to be highly effective and very promising. Some of these seemingly ineffective methods of treatment even had been supported and recommended by well renowned university hospitals and extremely good results had been published in the literature. In the case of TRT, however, we felt that the scientific basis of the neurophysiological model was very appealing and convincing. In our opinion the concept of TRT as a whole sheds new light onto the mysteries of human phantom perception. It is as if isolated hitherto well known peaces of a puzzle were put together in a new and unique way to form a picture. To put clinical findings and results from scientific experiments into this new context helped to understand the nature of tinnitus and led to the development of the totally new therapeutic concept of TRT.
The treatment of all patients evaluated below consisted in the TRT described by Jastreboff (1995). Following strictly the original treatment protocol we applied the counseling and in addition the sound therapy as well to each single patient. Initial counseling was done and parameters of tinnitus were collected and documented in the original questionnaire developed by Jastreboff. Follow-up sessions were scheduled consecutively every month in average. Patients were initially categorized and tinnitus instruments were fitted accordingly if necessary. Evaluation of results was done not earlier than five years after the initial counseling. Only patients having received full counseling and having done at least half a year of directed active treatment were taken into account. Data were taken either from the questionnaires or were retrieved individually later on by telephone interview or mailed to us in form of a written report.
Data of 84 patients were evaluated and are Presented here. More than 50% of the patients had been suffering from the tinnitus for more than 4 years. Included in this study are also patients with a shorter history of tinnitus prior to treatment, no significant differences in treatment outcome between these patients could be noted. The main disturbances caused by tinnitus before therapy concerned concentration and sleep (Fig. 1).
Especially the initiating phase of sleep was a problem for many patients. We therefore provide in our tinnitus-hyperacusis center a special sleep – counseling for these patients. This was recommended by Jastreboff (Jastreboff, personal communication) during the TRT courses he gave in Frankfurt. Sleep-counseling may be viewed as being a special part of the TRT -counseling. It is especially directed to improve the sleep pattern of patients by deconditioning and habituation with similar mechanisms as are used elsewhere within the context of TRT. This will be described in detail elsewhere. The severity of tinnitus and hyperacusis prior to treatment was estimated by the patient on a subjective scale. According to Jastreboff we used a scale between 0 (symptom practically absent) to 10 (symptom as severe as possibly imaginable). Cumulated data prior to treatment are shown in Figure 2.
One can see that the majority of subjective estimates from these patients was given between 5 and 10 and tends to accumulate around 7-8. After five years of treatment, however, the situation has changed completely (Fig. 3). The number of patients complaining about sleep disturbance was reduced significantly to about one third of the previous number, practically all other activities of everyday life were improved by the treatment as well. It may be noted here that social activities which are perhaps the most important parameter of quality of life showed the largest improvement by TRT in our patients after five years (Fig. 3).
Whereas few patients (9%) showed a full remission and practical absence of tinnitus the majority of patients showed improvement and reduction of tinnitus but not a cure as such even after five years of treatment.. The fact, however, that more than 85% of our patients reported at least a moderate improvement of tinnitus by TRT justifies further efforts in the practical implementation of this effective method among providers of tinnitus therapy.
The findings reported here demonstrate that TRT was highly effective in reducing severity of tinnitus and hyperacusis in more than 85 % of patients seen in the tinnitus-hyperacusis center in Frankfurt. However, the results after five years were not much better than those after two years of treatment (Lux -Wellenhof, 1999). This indicates that the effectiveness of TRT slows down with time and reaches a saturation of improving power after about two to three years. A further improvement of tinnitus or hyperacusis after this time may not be generally expected to occur. This does not mean, however, that efforts of treatment should be suspended after two years. TRT In order to further stabilize the achieved success five years after beginning of patients still were using single elements of the TRT. Many of them continued sound therapy even without noise instruments was by enriching the sound environment and by avoiding silence.
About 25% of the patients were using the noise instruments after this time only in situations where tinnitus was increased by stress or other external factors. Even carrying the devices in the pocket or taking them along on a trip etc. helped some patients to keep control in the situation and feel safe.
1. Jastreboff, PJ, 1995. Clinical implication of the neurophysiological model of tinnitus. Proc. Fifth International Tinnitus Seminar. American Tinnitus Association, Portland, OR.
2. Jastreboff PJ, Gray WC, Gold SL, 1996.
Neurophysiological approach to tinnitus patients. Am. J. Otol. 17:236-240.
3. Lux-Wellenhof G, 1999. Treatment outcome of TRT patients of the Frankfurt Tinnitus & Hyperacusis Center. Proc. Sixth International Tinnitus Seminar, The Tinnitus and Hyperacusis Centre, London