Tinnitus retraining therapy: implementing the neurophysiological model

292 Pages·2008·2.661 MB·English

by  Jastreboff, Pawel J.;Hazell, Jonathan W. P

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Tinnitus Retraining Therapy
Implementing the Neurophysiological Model
Tinnitusandoversensitivitytosoundarecommon,andhithertoincurable,distressing
conditionsthataffectabout17%ofthepopulation.PawelJastreboff’sidentificationofthe
mechanismsbywhichtinnitusanddecreasedsoundtoleranceoccurhasledtoanewand
effectivetreatmentcalledTinnitusretrainingtherapy(TRT).Audiologists,ENTspecialists,
psychologistsandcounsellorsaroundtheworldcurrentlypracticethistechnique,withsuccess
ratesofaround80%.
TRT,thetreatmentdevelopedbytheauthorsfromthemodel,hasalreadyprovedtobethe
mosteffectiveandmostwidelypracticedtinnitustreatmentworldwide.Thisbookpresentsa
definitivedescriptionandjustificationfortheJastreboffneurophysiologicalmodeloftinnitus,
outliningtheessentialsofTRT,reviewingtheresearchliteraturesupportingitsclaimsand
providinganexpertcritiqueofothercurrenttherapeuticpractices.
PawelJastreboffisProfessorandDirectoroftheTinnitusandHyperacusisCenterinthe
DepartmentofOtolaryngologyatEmorySchoolofMedicine,Atlanta,USA.Heistheauthorof
theneurophysiologicalmodeloftinnitusanddeveloperoftinnitusretrainingtherapy.
JonathanHazellisHonoraryConsultantSurgeonattheUniversityCollegeLondonHospitals
andDirectoroftheTinnitusandHyperacusisCentreinLondon.HewasthefirsttoapplyPawel
Jastreboff’sneurophysiologicalmodeloftinnitustoclinicalpractice.

Tinnitus Retraining
Therapy
Implementing the Neurophysiological Model
PawelJ.Jastreboff,Ph.D.,Sc.D.
ProfessorandDirector,EmoryUniversitySchoolofMedicine,Tinnitus&HyperacusisCenter,Atlanta,USA
and
JonathanW.P.Hazell,FRCS
DirectorTinnitusandHyperacusisCentre,andHonoraryConsultantSurgeon,UniversityCollegeLondonHospitals,
London,UK
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© Cambridge University Press 2004
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without the written permission of Cambridge University Press.
First published in print format 2004
isbn-13 978-0-511-22706-6 eBook (Adobe Reader)
isbn-10 0-511-22706-x
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To our wives Margaret and Rena, whose continuous
encouragement, criticism and contributions have made
this book a reality.

Contents
Preface page xi
1 Introduction 1
1.1. Definitionsoftinnitus 1
1.2. Categoriesofphantomauditoryperception 7
1.3. Otherphantomperceptions 8
1.4. Tinnitus-relatedneuronalactivity 9
1.5. Processingofsoundswithinthebrain 9
1.6. Tinnitusdurationandepidemiology 10
1.7. Commentsonsomatosounds 11
1.8. Componentsofdecreasedsoundtolerance 11
1.9. Involvementofhearinglossintinnitus 14
1.10. Summary 15
2 The neurophysiological model of tinnitus and decreased
sound tolerance 16
2.1. Developmentoftheneurophysiologicalmodel
oftinnitus 16
2.2. Mechanismsoftinnitussignalgeneration 23
2.3. Decreasedsoundtolerance 32
2.4. Relationshipoftinnitustohearingloss 32
2.5. Phantomperception 33
2.6. Naturalhabituation 33
2.7. Theprocessbywhichtinnitusbecomesaproblem 34
2.8. Thecomponentsoftheneurophysiologicalmodel 41
2.9. Themechanismoftinnitushabituationandthe
neurophysiologicalbasisfortinnitusretraining
therapy 52
vii
viii Contents
2.10. Aclinicalapproachtoinducehabituationoftinnitus 55
2.11. Summaryofthemodel 60
3 Tinnitus retraining therapy (TRT): clinical implementation
of the model 63
3.1. Outlineoftinnitusretrainingtherapy 63
3.2. Initialvisitandevaluation 65
3.3. Diagnosisandpatientcategories 80
3.4. Counseling(retraining)sessions:commonfeatures 85
3.5. Soundtherapy:commonfeatures 115
3.6. Specificmodificationsforindividualtreatmentcategories 121
3.7. Follow-upandclosureoftreatment 133
3.8. MinimalrequirementsnecessarytoperformTRT 142
4 Evaluation of treatment outcome and results 145
4.1. Introduction 145
4.2. Methodsofdatacollection 146
4.3. Criteriaforimprovementwithrespecttothe
neurophysiologicalmodel 147
4.4. Technicalaspectsofmeasurement 147
4.5. Specificcriteriaforscoringthesignificanceofindividual
improvement 148
4.6. Placeboeffectandspontaneousrecovery 150
4.7. Effectivenessoftinnitusretrainingtherapy 151
4.8. Whywebelieveourdataarevalid 168
4.9. Conclusions 169
5 Prevention 171
5.1. Avoidanceofsilence 171
5.2. Provisionofsoundenrichment 172
5.3. Avoidanceofexcessivenoise 173
5.4. Avoidanceofnegativecounseling 173
5.5. Emergencyhelpline 174
5.6. Identificationofsubjectswithapredisposition
totinnitus 174
5.7. Basicprinciplesofprevention 175