With so many tinnitus therapies currently on the market, it can be really overwhelming to figure out what’s what and more importantly, what works. This accounts for the shocking lack of consistent messaging that’s presented to not just tinnitus sufferers themselves, but to hearing healthcare professionals as well. This is also why so many hearing clinics tend to shy away from providing comprehensive tinnitus services and tend to focus only on the hearing component. Unfortunately, this accounts for only one piece of a very perplexing puzzle that is tinnitus.
Traditionally, tinnitus treatment tools tend to focus either on acoustic therapies that attempt to completely or partially drown out tinnitus or Cognitive Behavioural Therapy (CBT) that is designed to change negative thought patterns about tinnitus. While these therapies can be effective to some degree in their own rights, they only treat individual components of what makes tinnitus so bothersome, rather than addressing the unique individual as a whole.
More recently, there has been research developing new approaches that combine the best of both worlds. It is well accepted that the distress related to tinnitus has a strong association with hearing loss, negative emotions, fear, and stress. That’s why it is so important to address ALL of these issues, to whatever degree they may be affecting your quality of life. Bear in mind, that despite the wide range of available therapies, none are intended to CURE or suppress tinnitus; rather, the overall objective is to ensure that tinnitus does not negatively impact your quality of life.
This is where my Tinnitus Toolbox comes in: I’m passionate about helping people with auditory disorders and have devoted over a decade learning and applying principles of various treatment disciplines, so I’m in the unique position of having specialized training in multiple tinnitus therapies in order to develop a more dynamic approach that I can apply to my own clients. I’ve integrated key elements I’ve learned over the years into a comprehensive tinnitus management program that considers the tinnitus sufferer as a whole, rather than individual and isolated systems. Now, let’s take a closer look.
Inside the Tinnitus Toolbox
Progressive Tinnitus Management (PTM)
Developed by Dr. James Henry of the National Center for Rehabilitative Auditory Research, PTM is a complete program of assessment and intervention based on studies completed with veteran tinnitus patients. PTM is structured on the premise that tinnitus is managed most efficiently using a hierarchy of clinical services that address different levels of need. Using tinnitus-management education and support, patients are managed only to the degree necessary to meet their needs. PTM includes five levels of management that provide a logical, sequential means of working collaboratively with tinnitus sufferers. In addition, patients are taught how sound is used with other sound-based methods of tinnitus management (e.g., Tinnitus Retraining Therapy).
The basic philosophy of PTM is that educating the patient is the most important concern. That’s why Tinnitus and Hearing Health Calgary adopts PTM as the basic framework to involve other forms of therapy, including:
Tinnitus Retraining Therapy
Developed in 1990 by Dr. Pawell Jastreboff, TRT is considered by many to be the gold standard in tinnitus management with clinical success rates of 80-88% (e.g, Bartnik, Fabijanska & Rogowski, 1999; Heitzmann et al, 1999; Herraiz et al, 1999). TRT is achieved by directive counseling and exposure to low-level broad band noise. Directive counselling is designed to change the way tinnitus is perceived; patients are taught basic knowledge about the auditory system and its function, the mechanism of tinnitus generation and the annoyance associated with tinnitus. The repetition of these points in follow-up visits helps the patient to perceive the signal as a non-danger. Meanwhile, the second component of TRT involved delivered therapeutic sound to provide relief and facilitate habituation (a reduction in the perception of tinnitus).
Sound therapy is one of the more commonly used forms of tinnitus management in hearing healthcare, but is often not accompanied by any structured counseling regiment. Although sound therapy does not specifically require counseling, it is more effective when it is employed. A vital component of TRT, sound therapy decreases the sound contrast between tinnitus and silent environment leading to a reduced detection of tinnitus. Sound therapy can be delivered through ear-level devices, personal listening systems, and tabletop devices using a variety of sounds, such as noise, music, and environmental sounds.
A type of sound therapy, amplification in the form of hearing aids, is used in cases where there is hearing loss. The goal is to stimulate the ears and brain which minimizes your brain’s attempt to overcompensate for a lack of sound. Specific amplification characteristics must be followed to ensure that hearing aids are providing adequate stimulation to the auditory system without aggravating the tinnitus.
Read more about how we use sound therapy in our Sound Enrichment Program here.
Widex Zen Therapy (WZT)
Developed by Widex in cooperation with Dr. Robert Sweetow, Professor of Audiology at the University of California, WZT incorporates counseling to educate the tinnitus sufferer and alter negative perceptions, amplification, relaxation strategies, and fractal tones, a proven acoustic stimulus that is delivered in a discreet and convenient manner, designed to both relax and provide acoustic stimulation. A proprietary program designed for tinnitus sufferers with and without hearing loss, Widex Zen Therapy is one of the few integrated strategies to address multiple components of tinnitus distress. Reported success rates in reducing tinnitus annoyance range from 88-93% (e.g., Herzfeld & Kuk, 2011; Kuk, Peters, & Lau, 2010; Sweetow and Sabes, 2010).
Tinnitus Activities Treatment (TAT)
Developed by Dr. Richard Tyler of The University of Iowa’s Tinnitus and Hyperacusis Clinic, TAT includes counseling of the whole person in four areas: 1) thoughts and emotions, 2) hearing and communication, 3) sleep, and 4) concentration. In accordance to Tinnitus and Hearing Health Calgary’s philosophy, TAT considers individual differences and needs. Patient engagement is encouraged via thorough and structured counseling and interactive activities to facilitate progress.
Although advocated as integral part of PTM and TAT, educational workshops are exceedingly rare as a tool for tinnitus management in hearing healthcare, as most clinics tend to focus only on the auditory component. However, Tinnitus and Hearing Health Calgary believes it is VITAL to teach tinnitus sufferers how to use sound and coping techniques to manage their reactions to tinnitus. More specifically, patients learn how to develop and implement individualized plans for using therapeutic sound and apply principles of cognitive-behavioral interventions to increase realistic, logical and rational thinking in order to manage their tinnitus.
The Take Home Message
The important thing to remember is that each person suffering from tinnitus is unique; so even though our Tinnitus Toolbox is designed to address multiple facets of tinnitus, not everyone will require all components. Tinnitus and Hearing Health Calgary works closely with you to determine which tools are appropriate through a thorough intake process with personalized interviews, subjective measures to determine your reaction and distress to your tinnitus, as well as a comprehensive audiologic evaluation to establish the specific characteristics of your symptoms.
Most importantly, however, the most powerful tool in our arsenal, is to empower the tinnitus sufferer by helping you gain the ability to know how to address any situation in which your tinnitus is bothersome or intrusive.
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