PLEASE READ THE FOLLOWING CAREFULLY.  FOR MANY YEARS INSURERS HAVE BEEN DENYING COVERAGE OF TRT BECAUSE THEY SAY IT IS EXPERIMENTAL AND NOT WELL DOCUMENTED. THIS PAGE SHOULD BE PRINTED OUT AND SENT TO YOUR PHYSICIANS AND INSURERS TO DEMONSTRATE THAT THERE ARE SEVERAL UNBIASED STUDIES SUPPORTING THE CLAIMS OF DR. JASTREBOFF AND OTHER TRT CLINICS LIKE OTHTC.  WE ARE CONVINCED THAT TRT IS THE BEST THERAPY FOR THE MANAGEMENT OF TINNITUS AND HYPERACUSIS IN THE WORLD AT THIS TIME.

In a prospective non-randomized clinical trial of the efficacy of TRT for tinnitus relief (compared to a waiting list group and partially treated group (i.e., patients who refused prosthesis adaptation) by Herraiz, Hernandez, Plaza, and de los Santos ( Unidad de Acufenos, Instituto ORL Antoli-Candela, Madrid, Spain. cherraizp@seorl.net ), the visual analogue scale (VAS) for intensity and Tinnitus Handicap Inventory (THI) were evaluated at a 12-month period. 82% of the TRT patients improved their tinnitus according to their self-evaluation. Their THI score was reduced from 48% to 32% after one year and their VAS score decreased from 6.6 to 5.3 during the same period. These patients showed a higher improvement on their tinnitus, THI and VAS scores when compared with the waiting list patients and patients who refused prosthesis adaptation when recommended.

In a clinical control study of 225 tinnitus patients to investigate the clinical effects of TRT on tinnitus by Wang, Jiang, Yang, and Han, (Department of Otolaryngology and Head Neck Surgery, Institute of Otolaryngology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China), patients were divided into two groups. In the first group, 117 patients were treated with TRT and drugs. In the control group, 108 patients were treated with tinnitus masking and drugs. Both groups received drugs, such as vasodilator, neurotrophic drugs, and sedative consisting of a similar dose and duration. Evaluations were made two months, six months and 12 months after starting therapy to determine if tinnitus was attenuated or disappeared, and if the patients' emotion, sleep and work were disturbed by tinnitus. In the TRT group, the relief rate was 17.09% after 2 months, 82.05% after 6 months, and 88.03% after 12 months. In the control group, the relief rate was 2.78% after 2 months, 26.85% after 6 months, and 41.6% after 12 months.

In a study of 95 patients suffering from chronic tinnitus to evaluate the effectiveness of TRT when combined with CBT by Delb, D'Amelio, Boisten, and Plinkert (Klinik und Poliklinik fur Hals-Nasen-Ohren-Heilkunde, Universitatskliniken des Saarlandes, Homburg, Germany. hnowdel@med.-rz.uni-sb.de), 16 of the 95 patients served as a waiting list control group. The patients were divided into three treatment groups. Group 1 was fitted with wideband noise generators; group 2 was fitted with hearing aids; group 3 was not supplied with any device. All patients participated in Cognitive Behavioral Therapy for three months. 64,5% of patients improved significantly after the initial group therapy. In contrast, the waiting list control group patients showed no significant improvement. This initial treatment effect was maintained over the period of control. The study was unable to show significant advantages of noise generators as compared to cognitive behavioral group therapy alone, and therefore concluded that TRT combined with CBT is an effective treatment for patients with chronic tinnitus.

A non-randomized prospective analysis of 32 patients undergoing TRT was undertaken by Berry, Gold, Frederick, Gray and Staecker (Tinnitus and Hyperacusis Center, Division of Otolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore 21201-1619, USA) to determine whether the Tinnitus Handicap Inventory (THI), may improve the ability to quantify impact and assess therapy for tinnitus patients. The analysis concluded there is significant improvement in self-perceived disability following TRT as measured by the THI. The results confirmed the use of the THI as a patient-based outcomes measure to quantify treatment status in patients with primary tinnitus. Assessment tools included comprehensive audiology, a subjective self-assessment survey of tinnitus characteristics, and the THI. Tinnitus Handicap Inventory scores (assessed at baseline and 6 months following TRT). Baseline analysis revealed significant correlation between the subjective presence of hyperacusis and higher total, emotional, and catastrophic THI scores. Tinnitus Handicap Inventory scores correlated with subjective perception of overall tinnitus effect (P<.001). Mean pure-tone threshold average was 17.4 dB, and mean speech discrimination was 97.0%. There were no consistent correlations between baseline audiologic parameters and THI scores. After six months of TRT, the total, emotional, functional, and catastrophic THI scores significantly improved (P<.001). Loudness discomfort levels also significantly improved (P< or =.02).

In a clinical trial by Bartnik, Fabijanska, and Rogowski (Tinnitus and Hyperacusis Management Clinic, The Institute of Physiology and Pathology of Hearing, Warsaw, Poland.bartnik@ifps.org.pl) patients with tinnitus and/or hyperacusis undergoing TRT for 18-24 months were divided into five treatment categories. Different types of counseling and sound therapy were used in each category. The selection of patients into a specific category depended on factors such as hyperacusis, subjective hearing loss, and long-lasting effect of noise on tinnitus. 108 cases were evaluated after one year of treatment. The results of therapy of 40 patients with tinnitus and subjective hearing loss were compared with the results of therapy of patients with tinnitus only. A questionnaire, answered before and during the treatment, was used to assess the results. The trial showed significant improvement in about 70% of patients with tinnitus only and in about 90% of patients with tinnitus and subjective hearing loss after one year of therapy.

In a report by Suchova L. on 55 tinnitus outpatients who used TRT thru the Department of Tinnitus Treatment in Bratislava, Slovakia ( bll@fmed.uniba.sk ), after six months more than 50% of patients reported improvement or disappearance of tinnitus.

In a report by Zagolski O. on the benefits of TRT for 30 elderly patients, aged 65-90, suffering from chronic tinnitus with sensoineural hearing loss, 24 of 30 patients indicated they had considerable improvement in tolerance of the tinnitus.

Otolaryngol Clin North Am. 2003 Apr;36(2):321-36.

Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance.Jastreboff PJ, Jastreboff MM.
Tinnitus and Hyperacusis Center, Department of Otolaryngology, Emory University School of Medicine, 1365A Clifton Road, NE, Atlanta, GA 30322, USA. pjastre@emory.edu
Our experience has revealed the following: (1) TRT is applicable for all types of tinnitus, as well as for decreased sound tolerance, with significant improvement of tinnitus occurring in over 80% of the cases, and at least equal success rate for decreased sound tolerance. (2) TRT can provide cure for decreased sound tolerance. (3) TRT does not require frequent clinic visits and has no side effects; however, (4) Special training of health providers involved in this treatment is required for this treatment to be effective.

Zhonghua Yi Xue Za Zhi. 2002 Nov 10;82(21):1464-7.

[Tinnitus retraining therapy: a clinical control study of 117 patients]

Wang H, Jiang S, Yang W, Han D.

Department of Otolaryngology and Head Neck Surgery, Institute of Otolaryngology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.

OBJECTIVE: To investigate the clinical effects of tinnitus retraining therapy (TRT) on tinnitus. METHODS: 225 tinnitus patients were divided into two groups. 117 patients in the TRT group were treated with TRT and drugs, and 108 patients in the control group were treated with only tinnitus masking and drugs. The TRT is consisted of four strategies: (1) tinnitus masking with low level and broad band noise; (2) deep relaxation of the whole body; (3) diversion of the attention to other things; and (4) psychological counseling and therapy. Drugs, such as vasodilator, neurotrophic drug, and sedative of the similar dose and duration of pharmacotherapy were administered to the 2 groups. Effect evaluation was conducted thrice 2, 6, and 12 months after the beginning of therapy to see if the tinnitus was attenuated or disappeared and if the patients' emotion, sleep, and work were disturbed by tinnitus. RESULTS: The relief rate was 17.09%, 82.05%, and 88.03% in the TRT group 2, 6, and 12 months after respectively; and 2.78%, 26.85%, and 41.6% in the control group 2, 6, and 12 months after respectively (chi(2) = 12.54, 69.30, and 63.64, all P < 0.01). CONCLUSION: TRT is effective in treatment of tinnitus.

J Am Acad Audiol. 2002 Nov-Dec;13(10):545-58.

Assessment and treatment of tinnitus patients using a "masking approach."
Schechter MA, Henry JA.VA Audiology Clinic, VA Medical Center, Portland, Oregon 97207, USA.

Audiology clinics are increasingly being asked to provide tinnitus treatment services to patients who are severely distressed by tinnitus. It is unclear what levels of tinnitus care are available at different audiology clinics across the nation. Some clinics have staff who are experienced with the tinnitus masking technique or with tinnitus retraining therapy (TRT), whereas other clinics may limit their care to the provision of hearing aids. This article is an attempt to provide some basic information for those clinicians who would like to provide at least a minimum level of care for their tinnitus patients using the tinnitus masking approach. The most important requirement is a commitment by the clinician to assemble some basic resources and to structure the clinical schedule so that adequate time is available for historical review, evaluation, trial and selection of devices, and tinnitus counseling. A minimum set of measurements is recommended for inclusion in the tinnitus evaluation process. This informal review summarizes a variety of clinical observations culled from years of direct patient care experience. A tinnitus questionnaire is provided to help clinicians review potentially relevant issues.

J Am Acad Audiol. 2002 Nov-Dec;13(10):523-44.

Assessment of patients for treatment with tinnitus retraining therapy.
Henry JA, Jastreboff MM, Jastreboff PJ, Schechter MA, Fausti SA.
Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon 97207, USA.

Clinical management for patients complaining of severe tinnitus has improved dramatically in the last 25 years. During that period of time, various methods of treatment have been introduced and are being used with varying degrees of success. One method that has received considerable attention is tinnitus retraining therapy (TRT). This method is being practiced by hundreds of clinicians worldwide, and retrospective clinical data indicate that TRT has been effective for the majority of patients. This article provides a guide for clinicians to evaluate their patients for treatment with TRT. Included in this guide is the expanded version of the TRT initial interview and specific instructions for the clinician administering the interview.

Arch Otolaryngol Head Neck Surg. 2002;128(10):1153-

Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy. Berry JA, Gold SL, Frederick EA, Gray WC, Staecker H.
Tinnitus and Hyperacusis Center, Division of Otolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore 21201-1619, USA.

OBJECTIVE: To determine whether the Tinnitus Handicap Inventory (THI), a validated patient-based outcomes measure, may improve our ability to quantify impact and assess therapy for patients with tinnitus. DESIGN: Nonrandomized, prospective analysis of 32 patients undergoing tinnitus retraining therapy (TRT). Assessment tools included comprehensive audiology, a subjective self-assessment survey of tinnitus characteristics, and the THI. Tinnitus Handicap Inventory scores were assessed at baseline and 6 months following TRT. RESULTS: Baseline analysis revealed significant correlation between the subjective presence of hyperacusis and higher total, emotional, and catastrophic THI scores. Tinnitus Handicap Inventory scores correlated with subjective perception of overall tinnitus effect (P<.001). Mean pure-tone threshold average was 17.4 dB, and mean speech discrimination was 97.0%. There were no consistent correlations between baseline audiologic parameters and THI scores. Following 6 months of TRT, the total, emotional, functional, and catastrophic THI scores significantly improved (P<.001). Loudness discomfort levels also significantly improved (P< or =.02). CONCLUSIONS: There is significant improvement in self-perceived disability following TRT as measured by the THI. The results confirm the utility of the THI as a patient-based outcomes measure for quantifying treatment status in patients with primary tinnitus.

Scand Audiol Suppl. 2001;(52):206-8.

Effects of tinnitus retraining therapy (TRT) for patients with tinnitus and subjective hearing loss versus tinnitus only. Bartnik G, Fabijanska A, Rogowski M.
Tinnitus and Hyperacusis Management Clinic

The patients with tinnitus and/or hyperacusis undergoing an 18-24 month period of TRT are divided into five categories of treatment. Different types of counselling and sound therapy are used in each category. Selection of patients into a specific category depends on such factors as: hyperacusis, subjective hearing loss and long-lasting effect of noise on tinnitus. The 108 cases were evaluated After 1 year of treatment. The results of therapy of 40 patients with tinnitus and subjective hearing loss (category II) were compared with the results of therapy of patients with tinnitus only (categories 0 and I). A special questionnaire, answered before and during the treatment, was used to assess the results. Our data indicate significant improvement in about 70% of patients with tinnitus only and in about 90% of patients with tinnitus and subjective hearing loss after one year of therapy.