Lifetime Hearing Clinic

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1430 W Baddour Parkway, Suite D, Lebanon, TN, 37087
615-443-4070
Monday - Thursday 7:30-5:00 | Friday: 7:30-3:00

Tinnitus Treatment Options

Tinnitus Retraining Therapy (TRT) was developed by Dr. Pawel Jastreboff and Dr. Jonathan Hazell in London in 1988 and was published and implemented in the U.S. in 1990. Dr. Jastreboff is a neurophysiologist who has conducted research at universities such as Yale, U. of Maryland and Emory.

Dr. Jastreboff observed that 17% of the general world population experiences tinnitus but only 20% of those experiencing it are disturbed by it. This led him to a theory that the auditory system, while obviously involved in the phenomenon of tinnitus, is not the root of the problem for clinically-significant tinnitus. The main issue appeared to be the brain’s ability to increase or decrease the amount of attention that is paid to sounds, regardless of whether the sounds are internal or external. The decision to attend to a sound or disregard it happens on a subconscious level in the brain, in a physical location that also monitors essential body functions such as heart rate, sleep cycles, emotional feelings of well being or distress, hormone productions and all other important unconscious regulatory functions.

Simply put, when the brain first hears a sound, it makes a decision if that sound is important or not. The loudness of the sound makes no difference, only the emotional link attached to the sound. If the new sound is deemed unimportant (i.e. air conditioner, road noise, grandfather clock striking/ticking, refrigerator) the brain no longer attends to it or “tunes it out” (habituation). If the sound is deemed important (i.e. a baby crying, our name, a floor creaking in the middle of the night), an emotional link is attached to the sound. Once this link is made, the brain is conditioned to attach the same emotion every time it hears the sound. This has little ill effect if the new sound is deemed pleasant; however, if the new sound is deemed negative, annoying or a sign of danger, a nasty loop begins. The brain attends to the sound more and more as a subconscious protection mechanism and attaches those initial negative feelings such as fear and annoyance every time it senses the sound. Once a negative association is linked to a sound, habituation cannot occur because your sub-conscious is protecting you from danger (flight or fight response).

TRT uses 2 main principles to break this loop of negative association:

1.The use of sound therapy to assist in recovery.

Sound therapy floods the brain and auditory system with sound to facilitate the process of tinnitus habituation. In more significant cases, sound therapy is accomplished through the use of wearable ear-level sound generators or, if hearing loss is present, hearing aids/combination units.

The subconscious part of the auditory nervous system is constantly organizing, blocking and filtering sounds so that a person can concentrate on important information needed for survival and well being. Flooding the system with low level random sound keeps this filtering system busy and causes the tinnitus to be less noticeable within the auditory nervous system in the midst of this heightened activity. Over time, the brain will “rewire” or “retrain” itself by removing the negative emotion/association to the tinnitus and classifying it as unimportant (habituation).

2.The provision of professional, highly trained directive counseling by an experienced and trained TRT clinician

These 2 elements are essential to the recovery of a person who wishes to benefit from a TRT program. The goal of TRT is to allow tinnitus to fade to the background, making it easy to ignore. Successful habituation to tinnitus would result in a patient commenting “I haven’t noticed my tinnitus all day”. If tinnitus goes unnoticed, then tinnitus is not a problem.

TRT Success

To achieve maximum success with TRT, compliance with the program is essential. TRT is not a “quick fix” tinnitus program. The process of “rewiring” or “retraining” the brain is gradual and takes patience. TRT is not a “cure” but a treatment that does not promise 100% success. TRT requires several factors to optimize success:

Consistent and persistent use of sound devices.

The sound devices (sound generators, hearing aids, combination units) should be worn during all waking hours.

Setting the sound devices to appropriate level or “mixing point”

Devices are not designed to replace one sound for another. Sound devices are set to a loudness level where tinnitus is still noticeable but not quite as loud. You cannot habituate to a sound that you can’t hear; therefore, hearing the tinnitus is an important step in “rewiring” the brain to deem it unimportant. After making the initial adjustments to sound generators when beginning use in the morning, patients must also adopt a “set and forget” philosophy, never readjusting devices throughout the day. Once in the ears, leave them alone.

AVOID SILENCE

There is a thought in our society that “silence is golden”. This could not be further from the truth, especially for someone struggling with tinnitus. Sound is vital to our mental health. The brain craves auditory stimulation because it is wired for it. When sound is absent, the brain actually “cranks up the volume” of the system to look for stimulation from low level sounds. If external environmental sounds are unavailable, the brain will find the internal sound of the tinnitus, and hone in on it for stimulation. In addition to wearing the sound generators, hearing aids or combination units, TRT patients must also attempt to enrich their sound environment 24 hours a day, seven days a week. Since a large portion of the day is spent sleeping, patients should have some sort of bedside device that produces constant, low-level sound that does not interfere with sleep (i.e. CDs, alarm clocks/noise generators, tabletop fountains, “pillow speakers”, fans). Again, these devices are not meant to replace the sound of the tinnitus, just to reduce the contrast between the tinnitus and the background silence of the bedroom.

Attending regular follow-up appointments

The importance of follow-up appointments cannot be stressed enough. Patients often forget critical aspects of the therapy that were given to them during the initial counseling. Follow-up appointments ensure all directions are being followed precisely to ensure success of the treatment.

Become invested in helping yourself

A positive internal dialogue can be invaluable in “retraining” the brain. Mentally and verbally saying to yourself “Every day in every way I am getting better and better” will encourage the subconscious to let go of the negative associations linked to your tinnitus and encourage habituation. Knowing the importance of auditory stimulation for good mental health, continue enriching your surrounding environment with sound long after the program has ended. If you are wearing sound generators as a part of the therapy process, wear them longer than you think you will need them to ensure the retraining is firmly established.

Candidates for TRT

  • Patients struggling with tinnitus and/or hyperacusis/misophonia
  • Able to communicate verbally with some degree of hearing present in at least 1 ear.
  • Motivated and able to attend follow-up appointments
  • It is strongly recommended that all patients receive medical clearance prior to admittance.

Initial Evaluation Protocol

  • 3-4 Hour office visit
  • Otoscopic evaluation, full audiological test battery evaluation including specific Tinnitus/Hyperacusis Measurements, Distortion Product Otoacoustic Emissions
  • Extensive case history and review of medical documents
  • Results discussed with patient. Intensive directive counseling session
  • Diagnosis and placement into one of five diagnostic categories
  • Treatment recommendations discussed and planned with patient and family.
  • Referral to otologist if warranted; Referral to personal physician if warranted; Referral for special testing if warranted
  • Copy of results given to patient for their personal file and report of all results sent to referring/primary care physician.
  • Patient scheduled for follow up appointment within 1-2 days to fit sound generator/hearing aid/combination unit if warranted based on diagnosis.

Follow-up Treatment Protocol

  • Intensive directive counseling sessions
  • Fitting of devices, hearing aids, as needed
  • Telephone follow-up in 2-3 days
  • 24 month follow-up, frequent telephone contact
  • 6, 12, and 24 month re-evaluations if possible
  • Continued education for patient regarding research, treatment, articles, etc.

TRT Frequently Asked Questions

What is the cost of the therapy?

Complete cost of the 24 month program can range from $3990 to $6990 depending on the type of sound therapy devices the patient is fitted with.

Cost of Initial Evaluation and Assessment: $240-$550

This cost may be partially or fully covered through insurance and we will file insurance as a courtesy for our patients. We are happy to provide CPT codes and pricing for your information if needed. Be sure to check to see if you require a referral or have met your deductible for this calendar year. Please bring your insurance card to your first appointment. Most insurance companies do not cover the cost of the devices. Medical savings accounts are most often the most appropriate way to set up coverage for the program. Regardless of the insurance status, patient’s are ultimately responsible for the balance on their accounts for professional services and purchases rendered.

Sound Therapy Devices

TRT Instruments are discrete behind-the-ear units with a thin flexible tubing that inserts into the ear canal. This device is extremely comfortable and easy to use. $3990 per set

Soft Sound Sensitivity Units are open behind-the-ear units as described above or open in-the-canal custom made units. $3990 per set

Hyperacusis Instruments are custom designed in the ear units. $3990 per set

Hearing aids may be recommended for sound therapy instead of the other devices mentioned above. Prices range from $3990 per set to $6990 per set and are selected based on the patient’s lifestyle (very quiet lifestyle versus active lifestyle) and budget.

Are there payment options?

Yes! We accept Care Credit and offer a 1 year interest free program. We also accept Visa and MasterCard.

What kind of results should I expect?

Significant improvement in quality of life, decreased frustration levels and reduced anger. Most patients also note increased ability to concentrate on work and social activities without the distraction of tinnitus. Hyperacusis sufferers find improved tolerance for environmental sounds. Dr. Jastreboff’s in-house study of 303 significantly involved tinnitus patients found that 81.4% showed significant improvement of at least 20 points on the Tinnitus Handicap Inventory (THI). There was rapid improvement seen in these patients after 1 month followed by gradual subsequent improvement without indication of reaching plateau.

  • Positive and Negative Aspects of TRT
  • Positive Aspects of TRT:
  • No side effects
  • Cannot create any harm
  • Both tinnitus and decreased sound tolerance (hyperacusis and misophonia) are treated
  • Effectiveness over 80%
  • Used only for a limited time
  • Highly effective for hyperacusis and misophonia
  • Removes tinnitus annoyance and decreases its perception
  • Does not require frequent visits
  • Does not interfere with hearing
  • In 20% of cases provides temporary total block of tinnitus perception
  • Based on scientific model
  • Negative Aspects of TRT:
  • Takes about 9-24 months to complete
  • Personnel involved in the treatment have to be comprehensively trained to administer TRT

What Is Neuromonics?

Neuromonics was developed in the early 1990s and is a FDA-approved tinnitus treatment administered and monitored by our trained audiologist. A compact, light-weight medical device is used to deliver a spectrally-modified neural stimulus embedded within precisely-designed music. The treatment is customized to each patient’s unique hearing and tinnitus profile and specifically targets the neurological, auditory, attention and emotional aspects of tinnitus. The treatment, which typically lasts for 6 months, includes daily treatments for two or more hours per day. The treatment typically takes place at times when tinnitus is most disturbing and can be administered while doing regular daily activities such as reading, cooking or working. Listening time does not need to be all at once and can be broken up into several sessions throughout the day. The sound is very soothing and induces relaxation to aid in overall health and stress reduction as well. The treatment involves several steps for optimal results.

Step 1 – Initial Evaluation (Cost - $240-$550)

  • 2-Hour office visit
  • Otoscopic evaluation, full audiological test battery evaluation including specific Tinnitus/Hyperacusis Measurements, Distortion Product Otoacoustic Emissions
  • Extensive case history and review of medical documents
  • Results discussed with patient. Intensive directive counseling session
  • Diagnosis and placement into one of five diagnostic categories
  • Treatment recommendations discussed and planned with patient and family. .
  • Referral to otologist if warranted; Referral to personal physician if warranted; Referral for special testing if warranted
  • Copy of results given to patient for their personal file and report of all results sent to referring/primary care physician.
  • Patient scheduled for follow up appointment within 1-2 weeks to fit device.

Step 2 – Processor Configuration

Processor is about the size of a cellular phone and comes with high fidelity earphones. It delivers a pleasant acoustic sound, embedded in music, at a comfortable listening level. This sound stimulates a wide range of auditory pathways, as well as the emotional (limbic) and autonomic nervous system of the brain. The result is decreased tinnitus disturbance over time.

Step 3 – Pre-Conditioning Stage

The main goal of the Pre-Conditioning Stage is to provide relief from tinnitus symptoms. This occurs by delivering a high level of interaction with your tinnitus. This stage typically lasts for 2 months and requires a minimum of two hour treatment sessions per day. Patients begin to feel they are controlling their tinnitus instead of the tinnitus controlling them.

Step 4 – Active Treatment Stage

The main goal of the Active Treatment Stage is to begin to gain relief from your tinnitus outside of treatment times. The acoustic signal is altered to deliver an intermittent or lower level of interaction with your tinnitus perception. This allows desensitization to occur, which is proven to decrease tinnitus’ negative impact on quality of life. This stage typically lasts 4 months and also requires two hour treatment sessions per day initially. Over time, as the tinnitus perception is reduced outside of treatment times, the daily treatment dose gradually decreases.

Step 5 – Maintenance Stage

The main goal of the Maintenance Stage is for the patient to handle and manage their tinnitus independently. Many patients’ discontinue the use of the processor or use it infrequently.

Candidates for Neuromonics

  • Patients struggling with tinnitus and/or hyperacusis/misophonia
  • Able to communicate verbally with some degree of hearing present in at least 1 ear. Cases of severe to profound hearing loss may not qualify for Neuromonics
  • Patients with fluctuating tinnitus as often seen in noise-induced hearing losses, Meniere’s Disease or medication induced tinnitus
  • It is strongly recommended that all patients receive medical clearance prior to admittance.

Cost of Neuromonics

The cost of treatment is approximately $4500 including the counseling visits, follow up telephone consults and the processor. The initial tinnitus evaluation is not included.

For more information, check out the website at www.neuromonics.com.

Lifetime Hearing Clinic, Inc. is a medical based hearing clinic working within the medical community. Audiologist and Wilson County native Dr. Heather Hancock Dooley works with your physicians to develop an individualized plan to meet your hearing, tinnitus and communication needs. Dr. Dooley has been extensively trained in Tinnitus Retraining Therapy by creator and neurophysiologist Dr. Pawel Jastreboff. Specializing in adult diagnostic hearing evaluations, hearing aids and tinnitus management, we are located directly across the street from UMC hospital on the “by-pass” in Lebanon. Lifetime Hearing Clinic is locally owned and operated and offers easily accessible parking with local convenience. We have been voted “Best Hearing Clinic in Wilson County” by readers of the Lebanon Democrat for the past 10 years.

We offer a relaxed, no pressure environment in which to learn about your hearing, tinnitus and sound sensitivity. State of the art diagnostic equipment is used to ensure an accurate hearing and tinnitus assessment and results and recommendations are patiently and thoroughly explained to you and your family. Lifetime Hearing Clinic is a provider for most major insurances.