For Physicians

Specifics Concerning Our Therapeutic Approach to Tinnitus and Decreased Sound Tolerance

The specific tinnitus treatment program we select for each patient depends on which problems are active and their severity. There are eight syndrome patterns or categories and five levels of clinical treatment complexity. Patients may best benefit by a specific single or combination treatment approach, which we specify in the Individual Treatment Plan.

Identifying the Problem

We begin first by identifying the clinically significant components associated with the tinnitus and/or decreased sound tolerance problem. We separate reactions to tinnitus and sound from simpler awareness of these sounds. Only 20% have significant clinical reactions causing tinnitus to be a "major problem". After the rehabilitation assessment, we triage tinnitus problems into three management categories, which we work with individually:

  1. Limbic system driven reactions: We discover how patients are reacting to tinnitus in terms of emotions and mood. When limbic activation occurs with fear, anxiety, distress or hypervigilence, the "problem" is not isolated to the auditory areas alone, and therefore is more diverse within the neural networks of the brain. These limbic and behavioral patterns may be related to primary pre-existing psycho-physiological problems or are secondary.
  2. Cognitive problems: Distortions of facts or aversive or incorrect thinking patterns can trigger limbic reactions, hypervigilence, and catastrophic or further distorted thinking. This may create a cascade effect conditioned for further rumination, distress and attention to tinnitus. We treat to break and minimize centrally active anti-therapeutic influences and patterns, giving patients more control.
  3. Auditory problems: We measure how the auditory system operates peripherally, centrally and perceptually for hearing, tinnitus, and sound sensitivity and in response to therapeutic sound stimulation. We test and measure responsiveness to multiple treatment devices' acoustic signals and describe each treatment to your patient as they experience it.

Determining Treatment

Secondly, we then determine the types of treatments that should be specifically used, based on both medical evidence and patient preference. We plan an approach to address each of the three above areas in a clinically helpful way in a 2-4 step Individual Treatment Plan. Ideally, patients choose what we recommend, however, when they will not, we offer assistance in implementing treatment they are willing to follow. This is the basis of the new Veterans Administration triage protocol called Progressive Audiologic Tinnitus Management, which emphasizes fitting treatment to the needs, disposition and capacities of each patient. It is important to know that someone who is trained in a single modality of treatment cannot offer a multiple strategy approach or options. We offer seven forms of Sound Therapy, plus refer and coordinate care to manage relevant comorbid conditions.

Finally, the treatment we choose to employ allows us two means of attack:

  • We provide specific intensive tinnitus TRT educational and directive tinnitus counseling to teach patients how to manage their condition. This takes one to five clinical hours, depending on the need. We refer to CBT therapists or psychiatrists for anxiety, depression, insomnia, panic attack, and trauma when professional management is indicated. Many patients with significant problems are satisfied and need no further treatment after 60-90 minutes of thorough tinnitus management counseling. Of course, some patients will not choose to pursue treatment for any number of reasons. However, at this point they will know that treatments are possible, the nature of them, and are aware of who to contact should they want further help.
  • We provide Sound Therapies that expose the patient to controlled dosages of clinical sound for specific lengths of time daily during treatment to induce habituation or desensitization, masking, or partial masking effects to aversive tinnitus or external sounds, and may restore hearing ability in cases of hearing loss.

Sound Therapies for Milder Problems

These Sound Therapies primarily reduce the intensity of awareness or perception of tinnitus temporarily and to varying degrees while wearing a treatment device. Methods include Masking, Partial Masking or Amplification- Hearing Aid Therapy, and Sound Cure. Often their effect is immediate and sufficient to meet the needs of the patient. Sometimes patients start with this simpler approach before moving to more habituation-based therapies.

Sound Therapies for Greater Problems

Other Sound Therapies for greater magnitude problems aim to induce habituation of the reaction to tinnitus. This is achieved by exposing the auditory system and participating activated neural networks and centers in the brain to clinical doses of sound, usually including specifically calibrated white noise or amplitude modulation signals used in particular ways. These include Tinnitus Retraining Therapy, Neuromonics, Hyperacusis Retraining, and sometimes Sound Cure. Over time, these protocols gradually desensitize the auditory, attention-perception, limbic and central cognitive systems and processes to tinnitus and sound sensitivity. These methods usually work when the simpler methods fail, if followed correctly.

The treatment process reduces central gain cortically and centrally by reclassifying tinnitus or offending sound to less or no longer important status, and by altering perception of the existing tinnitus or external sound as it has been perceived in the past. The result is a detuning of the midbrain and lower brainstem response and central auditory re-calibration, where tinnitus and sound becomes less loud or dominant, and the auditory experience becomes more normal. In addition, acoustic stimulation activates the cochlea in the inner ear and its connections up the auditory pathway into the cortex. Effective habituation may eventually bring the patient to the point where there is little or no need for Sound Therapy devices anymore, as the attention and reaction process has changed.