7 Pro Tips of Tinnitus Retraining Therapy (TRT)
I studied with Dr. Jastreboff, the founder of Tinnitus Retraining Therapy. This video is designed to help you better understand Tinnitus Retraining Therapy (TRT). I cover seven pro tips to help with the management and treatment of tinnitus. Enjoy these pro tips!
Hey everyone, it’s Ben Thompson here, founder of thebestsolution4u.com. I wanted to make this specific video to help you understand Tinnitus Retraining Therapy better. I recently completed a five-day online course for Tinnitus Retraining Therapy, including tinnitus treatment, hyperacusis treatment, and misophonia treatment. And I studied with Dr. Powell Jastreboff. A handful of years ago, I would only have dreamed about being able to work directly with the founder of Tinnitus Retraining Therapy.
And when I saw the opportunity to study with Dr.Jastreboff, not only the neuroscientist and creator of TRT, Powell Jastreboff, but also his wife, Margaret Jastreboff, they’re both PhD researchers in our field. They’ve contributed an immense amount to help understand how we can improve tinnitus. And when I had the opportunity to work with them, I knew I had to say yes. This video is to explain seven pro tips that I learned from the Tinnitus Retraining Therapy course, that I wanted to share with you to make these next few weeks or months living with tinnitus easier.
Even if I can help you a little bit, a baby step of improvement, that will be worth my time making this video. So let’s start with number seven. Number seven is that Dr. Powell Jastreboff’s main advice, the overall umbrella of how Tinnitus Retraining Therapy works to help someone with tinnitus focuses on teaching, counseling, and constant sound therapy. The teaching aspect involves a proper understanding of the relationship between the ear, the cochlea, the hearing organ, the auditory nerve, the subconscious auditory processing of the brain, and how that system can create bothersome tinnitus. It is not only an auditory phenomenon.
Tinnitus is impacted by other areas that are not directly on the auditory pathway. That’s key to understand, and to get into the specifics and connect the dots about how it relates to your history, oftentimes is enough to make a big difference in the tinnitus treatment, the tinnitus habituation process, how we actually get better and reduce the perception of the ringing sound. Counseling is that ongoing process between you, an individual, a patient, trying to overcome loud, bothersome tinnitus that’s affecting your concentration at work or trying to fall asleep at night or affecting overall your anxiety and stress levels.
Counseling means the ongoing relationship between myself, an audiologist trained in TRT, and you, who are trying to figure out how to live with this condition every hour of every day and trying to go to sleep in the night. That’s an ongoing relationship. And six months is typically a good timeframe to use the protocols in place, get the progress where we want it to be, keep the momentum going, and that six months period of working with therapists trained in TRT is usually enough to make sure the counseling is ongoing, and it has a compounding effect over time.
Tip number 7:
When I mentioned the sound therapy part of this tip, tip number seven, this is an important basic recommendation for any tinnitus patient who’s going through the first stages of tinnitus. Avoid silence. Create a sound rich environment. Use sound therapy constantly during all waking hours of the day, if possible. Usually a high quality speaker playing different kinds of steady state sounds whether that be white noise, brown noise, crickets, anything similar to those kinds of sounds. Having that in a quiet space that would typically create loud obtrusive tinnitus, that is your friend.
Using sound as a therapy is your friend. Helping at night when you’re trying to fall asleep, or if you wake up in the middle of the night or you wake up in the mornings, you don’t want that situation to be quiet either. Sound can be a therapy for you in those situations as well. Using constant sound therapy for a period of nine to 18 months is typically recommended in a treatment protocol for tinnitus. For hyperacusis, it is possible to treat the sound sensitivity aspect within a matter of months. For tinnitus, it takes longer. It can take a matter of months or it can extend up to about a year. It’s individualized based on your history and how long you’ve had tinnitus, what are the causes, your stress, anxiety levels, et cetera.
Tip number 6:
The next pro tip, pro tip number six, is that tinnitus is not in your mind. Tinnitus itself is not a psychological condition or a psychiatric disorder. You do not have a diagnosable psychiatric disorder for having loud tinnitus. There is nothing wrong with you for having loud tinnitus. It does not mean you’re crazy because your tinnitus is loud and it’s sustained loud over a period of months or even years. There is nothing wrong with the psychological parts of your brain.
What’s important to realize here is that tinnitus is affected by the psychological centers of the brain. the emotional networks of the brain that control and regulate emotions, fear, the fight or flight response, safety, and anxiety and stress. Those psychological aspects can make tinnitus worse. And often those centers of the brain can lead to a sustained activation of tinnitus in your brain. But there’s nothing psychologically wrong with you necessarily.
There’s no psychiatric diagnosable disorder because you have chronic bothersome tinnitus. And this can help calm some of the catastrophic thinking that can sometimes come when you feel like the sound in your head is stuck in your head, there must be something wrong with your brain. Not so, there’s not so much wrong with your brain. As much as your brain over time needs to be recalibrated and calmed down, calming and easing the sustained activation of the limbic system, the emotional center of the brain, and the central nervous system of the physical body.
Tip number 5
Now pro tip number five. And let me tell you that this one was hard for me to believe when someone told me. But when I looked at the research, I couldn’t argue with the scientific data that showed that tinnitus distress, tinnitus bother, does not correlate at a population level with tinnitus loudness. So what this means is that if you have a loud tinnitus, it does not mean that you’re very bothered by tinnitus. Now, if you’re watching this video, you probably are bothered by tinnitus.
But it doesn’t mean that your tinnitus is so loud. There are many people who have a severe amount of hearing loss, and who it report loud tinnitus. But if you ask them, “Does it affect your sleep concentration or stress?” They say, “No, I basically tune it out, most of the time I barely notice it.” So that shows it’s not loudness of tinnitus that is the only factor at play. And this makes you scratch your head a bit because you think, “Well, it must be related to loudness.
It’s the ear, it’s the auditory system. Dr. Ben, how can you tell me that my loud tinnitus is not guaranteed to have this enhanced sustained reaction between my brain and my body?” And I’m here to be the middleman between the scientific research, the researchers, who have studied this at a population level for 30 plus years, and you who’s looking for the right kind of scientific information that loudness of tinnitus does not correlate with how much it bothers someone.
So this can be eyeopening because we realize it’s not only an auditory phenomenon and there’s other influences between your brain and your body that we can understand. And if we understand the system, then we know where the healthy inputs are. And we know what part of this system we can positively influence. The term neuroplasticity or brain changes, it means that you went from point A to point B in your state, whether that’s your mind, your body, your nervous system, whatever it may be.
You went from point A to point B. So a negative change would be you were healthy, point A, and then point B, things are not healthy, not feeling quite right. So most people, that means everything was fine in my life and then, somehow a period of time passed or suddenly, and then point B, loud obtrusive tinnitus. And that creates a cascade of negative effects on your life and quality of life.
So that’s a negative trend. Now we can take neuroplasticity and flip it into a positive trend as well. We’re starting at point A now, which is at a negative state, bothersome tinnitus, loud, obtrusive, negatively affecting you. And we’re going to enact certain methods, certain protocols. So over a period of time your brain and body can change and improve itself. So that point B, the new point B, is a healthy, calm state where you’re not bothered by your tinnitus, and you rarely think about it. Listen to the success stories of tinnitus, whether it’s here on my channel or other places on the internet, or talk to someone in person at a support group and ask them what is it like to be habituated to tinnitus?
And that may help you get a sense of the right kind of expectations or the goal of how much better we can get your life. And doing that, I’m hoping that you’ll be able to better understand what is the end goal or the end result that we’re after in this process. How much better can you get and recover with your tinnitus?
Tip number 4:
Pro tip number four is that Tinnitus Retraining Therapy induces habituation. That means it’s using your brain’s natural abilities between your brain and your body, to heal itself over time. This means that with the right of resources, direction, support, education, counseling, and sound therapy, that your brain and body can naturally take care of the problem. People get better from tinnitus without a surgery, without a pharmaceutical pill to cure the problem. And it gets better to the point where they realize, “Hey, my life is good now. I don’t need to try to silence tinnitus because I don’t mind if I hear it every now and then.”
That means your brain and your body over time can recalibrate the system and calm down the loudness of tinnitus. I have seen it personally, and I wanted to make sure I make it clear that it’s possible out there. I work with some patients who are religious, who connect with this on a religious and spiritual level on the sense that their body, the body they were born with, the spirit they have within them and their body and their brain can naturally get better over time.
Tip number 3
Now, pro tip number three that I learned with Dr. Powell Jastreboff in the Tinnitus Retraining Therapy course, is that the loudness of tinnitus on average for a patient, it’s only five decibels above the threshold of hearing that they have at that pitch. Some people report tinnitus as being very loud. And that makes researchers measure actually how loud is the tinnitus.
And when we try to measure the loudness of tinnitus, we measure what pitch, what frequency is your tinnitus, and what is the softest sound you can hear at that pitch, at that frequency. And then we measure the loudness of your tinnitus by matching the loudness at that pitch. And that creates this differential. And that’s considered the sensation level of tinnitus.
Now for most people, that sensation level is on average around five decibels. And that’s not loud at all. If you play a five decibel difference of sound between one decibel sound level, one loudness level and the next, you wouldn’t think it’s too dramatically different. And when we get to the very soft levels, five decibel sensation level means that you wouldn’t need much noise to influence or interact with the tinnitus. And this is useful to educate someone that your tinnitus may be perceived as being loud. But when we use sound around you, when we consistently use sound therapy, that sound therapy doesn’t need to be so loud.
That sound therapy will be a background sensation, just like your tinnitus. That sound therapy will be a background sound, and it won’t interfere with your speech. It won’t make it harder to hear people. And overall, tinnitus does not negatively affect your ability to hear people. That’s because the sound of the tinnitus is at a very small sensation level, that for most people, any kind of conversational sound or important sound is going to be much louder than the sensation level of their tinnitus. So it might seem very loud and it might be perceived as being very loud.
But for most people, when it’s tested in an audiology booth, the sound level, it’s not extremely loud. In fact, it’s relatively quiet. But if there’s no other sounds around you then the tinnitus can be perceived as quite loud. You guys still with me? Thank you again for being here and watching this video, as well as being here in this community. We have two more pro tips left.
Tip number 2:
Pro tip number two is that sound therapy may actually be better when it is simple, has few adjustments, and it can become a background sound. Not something that changes, not ocean waves going (swooshing sounds) not all kinds of (beeping sounds) not there crazy dramatic changing sounds that bring your attention to the sound. But sound therapy may be best when it’s a consistent neutral background sound that does not have many adjustments for you to tinker with throughout your day.
And is probably best when that is coming through devices that are sitting on your ears. Those are called ear level sound generators, or combination instruments for tinnitus. I learned that in the course, and I believe it’s true. We don’t want to be spending too much time focusing on changing the sound, adjusting the sound around us, making sure there’s sound therapy everywhere we go. It might be best to just have simple steady state sound therapy played through our ears that we don’t have to tinker with or adjust too much. Now, this is more of my opinion that this is better, because it has not necessarily been studied so extensively about what is the best proven sound therapy type.
Most of the protocols use a steady state white noise or something similar. And that’s what I recommend when I’m working with patients in telehealth for attendance retraining therapy protocol. However, if this is true that a simple sound therapy is best for most people, then this would mean something like the wide XN therapy which has ding, ding, ding, ding, ding, ding, ding.
It’s more variable with different kinds of tones, those Zen tones, and a lot of the neuromodulation audio sounds that are on YouTube which aren’t medically or scientifically validated but they do have different kinds of beeps and boops, and apps like T-minus, for example. That would mean that those types of sound therapy aren’t simple. ‘Cause those kinds of sound therapy do have variability to them. And that might be right for you, I’m not here to say that’s wrong for every person. But overall, at a population level, I believe that steady state sound therapy is the fundamental here. Those other kinds of sound therapies that have different qualities to the sound, that can be considered as well.
Tip number 1:
Now last but not least, pro tip number one from my Tinnitus Retraining Therapy course with Dr. Jastreboff is, drum roll, please, that almost 100% of tinnitus patients who get a pure tone audiogram hearing tests within the normal range, almost 100% of those patients have some degree of cochlear damage or dysfunction in the outer hair cells.
Part of the cochlea, the hearing organ, has little cells which have what’s called stereocilia. And those little cells are called the outer hair cells. I mentioned this on some of my other videos. I won’t go into the depth of the details. But most people who have tinnitus that get a hearing test and the hearing test shows your hearing is in the normal range, a vast majority, nearly 100% of those cases, when we perform a more specific objective test we can point to part of the anatomy and explain your hearing is overall fine. You’re hearing well.
But part of your cochlea, part of your hearing organ, has a dysfunction. And this may have happened from some loud noise exposure. It doesn’t take much to create this dysfunction. It may have happened from the natural aging process. Those are the two most common situations or potentially some form of infection or virus.
That sounds very simple, but imagine you’re told that from your doctor and how you would understand better how the system works and what part of your ear, your brain, your body, is malfunctioning. Now it’s a quite different experience from most people who go to their audiologist, to their doctor, and they say, “Well, the hearing test showed your hearing is fine.
So the tinnitus is not an ear thing.” That creates a lot of confusion and it can potentially lead to a long path of getting highly specific medical tests related to things that are completely irrelevant. And essentially, bring you down the wrong path of misinformation or tryna solve tinnitus without focusing on the fundamentals of the Tinnitus Retraining Therapy, which are proper education about the ears and normal hearing and the outer hair cells of the cochlea, how that system all relates to itself and your history, ongoing counseling, and then consistent use of sound therapy for tinnitus and or hyperacusis.
I found a research paper that I wanted to include just to validate this point, scientifically. And it’s talking about the test called OAE. otoacoustic emissions, or DP, distortion product otoacoustic emissions. And the article is titled, “Evaluation of Cochlear Function in Patients with Normal Hearing and Tinnitus.” It was a study that looked at the OAE objective test of patients who have normal hearings and tinnitus. And I’m reading here. “These findings show that tinnitus in normal hearing patients is often associated with varying degrees of cochlear dysfunction.”
All right, that was a long video. But those are the seven pro tips that I learned from personally studying with Dr. Powell Jastreboff and his wife, Dr. Margaret Jastreboff. They’re both neuroscientists, PhD researchers, very well known in the audiology field. And those are the pro tips that I’m sharing to help you wherever you are at with your experience, with your journey with tinnitus, the very beginning, in the middle, or you’ve had it for many years.
These seven pro tips can still be applied. Thank you for watching. If you want to work with me or find out more about pure tinnitus, head over to puretinnitus.com. Leave a comment on this video. Or you can directly email my team at [email protected] Thank you again. Make sure to subscribe to this channel, and I will see you on another video. May you be well, thank you.
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