Tinnitus Retraining Therapy

Tinnitus Retraining Therapy

Tinnitus Retraining Therapy

Tinnitus is the sound perceived by the person without a sound source in the environment. It is highly frequent - 15% in the general population and 33% in the elderly.

Tinnitus worsens significantly the quality of life of 15% to 25% of the people affected, reducing concentration, sleep, emotional balance and social life. Jastreboff was the first to describe a neurophysiological model to explain tinnitus, which involves auditory and non-auditory pathways. In this model we have the participation of the limbic system and the autonomous nervous system as determinants of the disorder called tinnitus. The Tinnitus Retraining Therapy - TRT is based on habituation: the brain's capacity to ignore neutral, meaningless stimuli. According to the neurophysiological model, the links between the auditory and the limbic systems are responsible for the emotional reaction triggered by the tinnitus, affecting the autonomous nervous system, causing anxiety, depression and sleep disorders.

TRT is known today as one of the tinnitus treatment with the best results described in the literature. As we set up the multidisciplinary team specialized in tinnitus treatment at a large University hospital in the Otolaryngology Department, treating people with tinnitus, our goal was to apply TRT to all those patients who had not benefited from other treatments for tinnitus. Because of the high number of patients, the TRT individual treatment became impossible. Thus, the combination of Tinnitus Retraining Therapy (TRT) and the Behavioral Cognitive Therapy (BCT) in group therapies became a possibility to be tested.

Tinnitus emotional reactions are considered very important in establishing the discomfort caused by it. Anxiety and depression are frequently described and associated to a greater bother from this sound. The self-administered tinnitus treatment through the Internet, using behavioral-cognitive psychology techniques proved that the intervention by means of the BCT is efficient in the treatment of tinnitus.

Patients with psychiatric alterations are often times contraindicated for TRT because the instructions are more difficult to be understood and accepted and in these cases, tinnitus treatment is only started after controlling the base disease by the psychiatrist.

Although the combined treatment of tinnitus and associated emotional factors is a field of clinical research well documented in the international literature, we could notice that the group treatment for tinnitus with such methodology (TRT and BCT), has not been done in Brazil yet. Thus, we based the treatment proposal hereby discussed on the international literature, adapting the methodology used in these references to the reality of local needs.

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