Tinnitus Retraining Therapy Flashcards
What is the neurophysiological model?
A number of systems in the brain, other than the auditory system, are involved in the phenomenon of tinnitus
Limbic system and autonomic nervous system
Both systems are crucial for well-being, learning, and brain retraining, but problems can arise when they overreact to neutral stimuli like tinnitus
Why do they think that the limbic system is involved in tinnitus?
The limbic system triggers strong emotional responses to stimuli and activates the “fight or flight” response in intense situations like immediate threats
Why do they think that the autonomic system is involved in tinnitus?
The autonomic nervous system regulates automatic body functions such as heart rate and breathing, preparing the body for quick action without conscious control
When tinnitus becomes associated with negative emotions, does it trigger strong reactions in the limbic and autonomic nervous system?
Yes
Once arousal of the limbic and autonomic nervous systems is sufficiently high, the stimulus linked to this activation will dominate all other brain functions
What differs from patients who merely experience tinnitus and those who suffer?
Depends on the presence of the connections between the auditory system, the limbic system, and the autonomic nervous system
How does the vicious cycle of tinnitus occur?
Once tinnitus acquires a negative connotation and starts to induce activation of the autonomic nervous system, it initiates a cascade of events
This leads to progressively stronger activation of the limbic and autonomic nervous systems through a conditioned reflex arc
Once we associate a stimulus with something negative, we are unable to remove this association easily because it is a part of a conditioned reflex
Are conditioned reflexes an aspect of tinnitus perception?
Yes
If perception of a signal is associated with high levels of emotional distress, conditioned reflexes are created, causing the tinnitus-related neuronal activity (conditioned stimulus) to evoke high levels of activation of the limbic and autonomic nervous systems (conditioned reaction)
A constant state of alertness causes tinnitus patients to become exhausted and complain of lack of sleep
They are be unable to focus attention on anything else but tinnitus and experience overall loss of life quality
Can all conditioned reflexes be reversed?
Yes
Natural habituation of various stimuli is continuously taking place
More than three-quarters of people who experience tinnitus naturally habituate to it
*Foundation of TRT - teaching the brain how to do this
What is habituation?
Repetitive appearance of a particular sound, the subcortical pathways will block it, and the individual will be unaware that the sound is present
Prevents the signal from reaching higher cortical areas involved in awareness
Not a cure for tinnitus, it can still be perceived when attention is focused on it, but there is no reaction and awareness is reduced
What are the two types of habituation?
Habituation of reaction
Habituation of perception
When does tinnitus become bothersome?
When there is a failure of filtering mechanisms at a subcortical level and that the symptoms becomes distressing because of the involvement of the emotional and reaction systems
Model implies that these filtering mechanisms could potentially be modified or retrained to filter again
What is tinnitus retraining therapy?
A treatment based on the neurophysiological model of tinnitus described by Dr. Pawel J Jastreboff
TRT is a habituation-based treatment that utilizes counseling to decrease the strength of tinnitus-evoked reactions and sound to decrease the strength of the tinnitus signal
Patients are taught the principles of brain function, the mechanisms of tinnitus and of tinnitus-induced annoyance, and the basis for achieving tinnitus habituation
What are the goals for TRT?
Induce and facilitate the patient’s habituation to their tinnitus.
Eliminate reactions induced by tinnitus
Prevent spread of tinnitus signal to other brain systems
Has TRT had successful outcomes?
Yes
Patient still perceives tinnitus but not bothered by it anymore (Habituation)
Enhanced quality of life through decreased tinnitus distress
What are the two main components of TRT?
Retraining counseling (habituation of the reaction to tinnitus)
Sound therapy (habituation to the perception of tinnitus)
What is the basic protocol for TRT?
Introductory contact
Initial visit: taking history of tinnitus, audiologic and medical assessment, assessing the category for treatment, and TRT counseling.
Instrument fitting (if needed)
Follow-up visits: evaluation of the patient’s status and further counseling
Closing the treatment
Is a thorough audiological and medical evaluation required prior to treatment?
Yes
Including condition, need for treatment, motivation to comply with treatment requirements
What is the TRT initial interview?
A structures set of questions that are designed specifically to determine proper placement of patients into TRT treatment categories, assess tinnitus impact and severity, identify sensitivity to sounds, and assess subjective hearing difficulties that could impact treatment
This can last up to 1 hour and psychoacoustic testing can require up to 2 hours
Can you send the TRT interview form to a patient prior to the appointment for them to fill out?
No
Not a questionnaire, so do not email it to the patient to fill it out beforehand or have them do it in the office
What should happen after the TRT initial interview?
Once the assessment is completed, the clinician and patient should review the results and collaborate to determine the most appropriate course of action
Patient must fully understand all aspects of the treatment prior to making the commitment (treatment objectives, schedule of treatment sessions, requirements for using ear-level devices, costs associated with treatment, any other pertinent details of the planned treatment)
