scholarly journals The Tinnitus Retraining Therapy Counseling Protocol as Implemented in the Tinnitus Retraining Therapy Trial

2020 ◽  
pp. 1-15
Author(s):  
Susan L. Gold ◽  
Craig Formby ◽  
Roberta W. Scherer
Keyword(s):  
Standard Of Care ◽  
Historical Background ◽  
Clinical Implementation ◽  
Tinnitus Retraining Therapy ◽  
Hearing Sensitivity ◽  
Care Protocol ◽  
Retraining Therapy ◽  
Therapy Trial ◽  
The Impact ◽  
To Receive

Purpose This clinical focus article is a companion to the work of Erdman et al. (2019), in which we described the rationale, development, and implementation of the standard-of-care protocol used in the Tinnitus Retraining Therapy Trial (TRTT), a multicenter, placebo-controlled, randomized, definitive efficacy trial of tinnitus retraining therapy (TRT). We now describe the historical background, development, and standardized implementation and delivery of the TRT counseling protocol (tinnitus counseling [TC]) used in the TRTT. TC is conjectured to be the key component in the TRT protocol for initiating the habituation process that reduces the response to the tinnitus signal and, ultimately, reduces its impact. In the TRTT, participants assigned to receive TC achieved > 30% reduction in the impact of tinnitus. Method and Results The design and implementation of standardized treatments in multisite randomized controlled trials presents many challenges for investigators. Here, subsequent to presenting the background, rationale, and the TRT protocol model, we describe the development, refinement, and training/certification for standardized delivery of TC in the TRTT. The primary challenges encountered while distilling and streamlining TC for standardized delivery across multiple clinicians and their replacements at six participating military treatment centers in the TRTT are considered, and the resulting counseling protocol is detailed. Conclusions The standardized and streamlined TC used in the TRTT was successful for treating debilitating tinnitus among persons with functionally adequate unaided hearing sensitivity. The structured TC protocol described here appears to be the main determinant of the significant and sizable TRT treatment effects measured in the TRTT, thus bolstering the merits of this standardized counseling approach as one model for the clinical implementation of TRT for the treatment of primary tinnitus.

A consideration of the effect of ear canal resonance and hearing loss upon white noise generators for tinnitus retraining therapy

1997 ◽  
Vol 111 (9) ◽  
pp. 810-813 ◽  
Author(s):  
David M. Baguley ◽  
Graham J. Beynon ◽  
Frances Thornton
Keyword(s):  
Hearing Loss ◽  
White Noise ◽  
Noise Generator ◽  
Major Advance ◽  
Ear Canal ◽  
Tinnitus Retraining Therapy ◽  
Hearing Sensitivity ◽  
Actual Spectrum ◽  
Retraining Therapy ◽  
White Noise Generator

AbstractTinnitus retraining therapy has been heralded as a major advance in the alleviation of tinnitus perception. A cornerstone of this technique is to use white noise produced by a white noise generator (WNG) over a period of several months in order to assist the patient to habituate to their tinnitus. There are three factors which influence the frequency spectrum of the perceived noise such that the perception of white noise from a WNG is unlikely. These factors are the actual spectrum of the emitted noise, the ear canal resonance of the patient and the hearing sensitivity of the patient.Advocates of tinnitus retraining therapy state that white noise is the optimal stimulation to assist habituation of tinnitus. This paper demonstrates that this optimal situation is unlikely to be achieved and that this may account for the long periods needed for patients to achieve benefit from the technique. The development of devices that allow for the above factors to be countered is suggested.

Evaluation and Management of Misophonia Using a Hybrid Telecare Approach: A Case Report

2021 ◽  
Vol 42 (02) ◽  
pp. 123-135
Author(s):  
Lori Zitelli
Keyword(s):  
Case Report ◽  
Adult Female ◽  
Hybrid Approach ◽  
Negative Reaction ◽  
Tinnitus Retraining Therapy ◽  
Environmental Sounds ◽  
Retraining Therapy ◽  
Future Care ◽  
Detailed Assessment ◽  
The Impact

AbstractDecreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.

scholarly journals Rationale for the tinnitus retraining therapy trial

2013 ◽  
Vol 15 (63) ◽  
pp. 134 ◽  
Author(s):  
Craig Formby ◽  
Roberta Scherer
Keyword(s):  
Tinnitus Retraining Therapy ◽  
Retraining Therapy ◽  
Therapy Trial

scholarly journals Lessons learned conducting a multi-center trial with a military population: The Tinnitus Retraining Therapy Trial

2018 ◽  
Vol 15 (5) ◽  
pp. 429-435 ◽  
Author(s):  
Roberta W Scherer ◽  
Leonora D Sensinger ◽  
Benigno Sierra-Irizarry ◽  
Craig Formby
Keyword(s):  
Military Population ◽  
Tinnitus Retraining Therapy ◽  
Military Hospitals ◽  
Institutional Review ◽  
Study Staff ◽  
Military Security ◽  
Retraining Therapy ◽  
Therapy Trial ◽  
Study Participants ◽  
The Military

Background The Tinnitus Retraining Therapy Trial (TRTT), a randomized, placebo-controlled, multi-center trial, evaluated the efficacy of tinnitus retraining therapy and its individual components, tinnitus-specific educational counseling and sound therapy versus the standard of care, in military practice to improve study participants’ quality of life. The trial was conducted at six US military hospitals to take advantage of the greater prevalence of tinnitus in the military population. Methods During the trial, various challenges arose that were uniquely related to the military setting. To convey these challenges to investigators planning future multi-center trials in military hospitals, we itemized various challenges that arose during the trial, interviewed clinic directors and coordinators to elicit their viewpoints, and then collated and organized their responses, together with those challenges presented while conducting the Tinnitus Retraining Therapy Trial. Results We encountered challenges in site selection, the approval process, administrative issues, study personnel training and retention, participant recruitment methods and issues, adherence to protocol, reimbursement issues, and military security. Site selection involved visiting 20 military hospitals to identify six sites that enrolled and followed study participants. We found that commitment for the trial must be obtained from the full military chain of command, but with ongoing changes in staff or military priorities, initial commitments were insufficient to sustain support throughout the entire trial. More time is required to obtain necessary administrative approvals by various military authorities and institutional review boards than is typically experienced in civilian settings. Recruitment strategies must be flexible due to changing military regulations regarding display of materials. Protracted periods of inactivity were due to sequestration and delays in institutional review board approval of required study personnel or protocol amendments. While mostly adherent to the protocol, study staff had difficulties in integrating study visits into the military clinical schedule. Unexpected study expenses revolved around hiring civilian study staff and obtaining associated security clearance while maintaining a consistent flow of funds to each site. The added expense negated cost savings realized by conducting the National Institutes of Health–funded trial at federal institutions, whose personnel could not be reimbursed for their efforts. Military security concerns impacted the use of web-based data systems and led to increased time and effort required for site visits. Conclusion Overall, US military hospitals provide a unique setting to conduct multi-center trials. Challenges arise mainly due to ever-changing authority personnel and military priorities. Pre-planning and flexibility are keys in overcoming these challenges. Multi-center trials conducted in the military will likely take longer to initiate and complete than those in the civilian sector due to multiple levels of command and administrative approvals.

Evaluation and Management of Severe Tinnitus: An Evidence-Based Case Report

2021 ◽  
Vol 6 (1) ◽  
pp. 130-142
Author(s):  
Lori Zitelli
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Negative Impact ◽  
Well Being ◽  
Tinnitus Retraining Therapy ◽  
Sound Therapy ◽  
Retraining Therapy ◽  
The Impact ◽  
Severe Tinnitus

Purpose Tinnitus is reported by millions of Americans and is significantly problematic for many people. Commonly, individuals suffering from tinnitus report disturbances in the areas of sleep, hearing, emotional well-being, and so forth. This case report presents the evaluation and treatment of an adult female with severe tinnitus and multiple relevant comorbidities. This case includes the onset, evaluation, and management of significantly bothersome tinnitus in a 60-year-old woman. Tinnitus was first reported after she was treated with an Epley maneuver intended to resolve benign paroxysmal positional vertigo. An evaluation of tinnitus (including a comprehensive audiometric evaluation, an assessment of the impact of tinnitus on her life, and psychoacoustic measures of tinnitus perception) was completed. The tinnitus was reported to have a severely negative impact on her overall health, mental state, and quality of life. Method This patient opted to manage her tinnitus with a combination of pharmaceuticals, sound therapy, and education (the latter two in the form of tinnitus retraining therapy). Results The course of her active treatment spanned approximately 18 months, and, at the completion of her treatment, she demonstrated significant improvements in all areas of her life that had been impacted by tinnitus. She has become an active advocate for tinnitus management and has made herself available as a resource for other individuals who are struggling to cope with intrusive tinnitus. Conclusion Tinnitus retraining therapy is a treatment option that may significantly improve the quality of life of individuals suffering from severely bothersome tinnitus.

scholarly journals Treatment fidelity in the Tinnitus Retraining Therapy Trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Roberta W. Scherer ◽  
◽  
Sue Ann Erdman ◽  
Susan Gold ◽  
Craig Formby
Keyword(s):  
Treatment Fidelity ◽  
Tinnitus Retraining Therapy ◽  
Retraining Therapy ◽  
Therapy Trial
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