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Michael F

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 #1 
Dr. Nagler, 

First and foremost, thank you for all you do for the tinnitus patient community. You are a grounding voice of reason in what appears to be a very turbulent area of patient care and knowledge. After spending the last 7 weeks doing research, and exploring forums and other areas of the internet, I have come to the conclusion that there are some seriously crazy people lurking about!

Anyway, I have new onset tinnitus (7 weeks) due to acoustic trauma (gun fire). I have done the usual flowchart of tx (PCP, Audiologist, ENT, and upcoming Audiologist who allegedly does tinnitus management). I am fairly certain that TRT will be discussed in my upcoming appointment, and am hopeful I will get to try dual-purpose hearing aids. I have moderate hearing loss in the 4-7 KHz frequency in my right ear. 

It is my understanding that TRT involves two components: Counseling (Educational with CBT?) and sound therapy. 

Neuromonics, CR Neuromodulation, Levo, Notch Music/White noise, Brain Training, etc. seem to all be prevalent offerings from the audiology community. It is very confusing though because the premise of several of these therapies contradicts another. Do you remove the bandwidth of the tinnitus frequency in the sound therapy, or attenuate it? 

Which has the most clinical support and evidence for effectiveness? 

Thank you for your time. 

Michael 
Dr. Nagler

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 #2 
Quote:
Originally Posted by Michael F
First and foremost, thank you for all you do for the tinnitus patient community. You are a grounding voice of reason in what appears to be a very turbulent area of patient care and knowledge.

Thank you for the kind words. I appreciate it.

Quote:
After spending the last 7 weeks doing research, and exploring forums and other areas of the internet, I have come to the conclusion that there are some seriously crazy people lurking about!

There are, indeed, some crazy people lurking about. And some folks would argue that I am one of them! :-)

Quote:
Anyway, I have new onset tinnitus (7 weeks) due to acoustic trauma (gun fire). I have done the usual flowchart of tx (PCP, Audiologist, ENT, and upcoming Audiologist who allegedly does tinnitus management). I am fairly certain that TRT will be discussed in my upcoming appointment, and am hopeful I will get to try dual-purpose hearing aids. I have moderate hearing loss in the 4-7 KHz frequency in my right ear. 

It is my understanding that TRT involves two components: Counseling (Educational with CBT?) and sound therapy.

TRT does have a sound therapy component and a counseling component - but the counseling component has little in common with CBT. In fact I see TRT and CBT as largely incomparable with one another. They are both good approaches, by the way. But the downside is that they are both highly clinician-dependent. 


Quote:
Neuromonics, CR Neuromodulation, Levo, Notch Music/White noise, Brain Training, etc. seem to all be prevalent offerings from the audiology community. It is very confusing though because the premise of several of these therapies contradicts another. Do you remove the bandwidth of the tinnitus frequency in the sound therapy, or attenuate it?

Ahhh. The shadows and mirrors of tinnitus! 


Quote:
Which has the most clinical support and evidence for effectiveness?

None of the stuff you have listed directly above has any decent reliable and independently verifiable studies supporting efficacy. Like I said - shadows and mirrors.

Quote:
Thank you for your time.
 
Not sure it's the answer you were hoping for, but you are very welcome nonetheless.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Michael F

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Posts: 2
 #3 
Dr. Nagler, 

Thanks for your reply. Yes, I am finding that everything with tinnitus management is clinician dependent.

Quote:
None of the stuff you have listed directly above has any decent reliable and independently verifiable studies supporting efficacy. Like I said - shadows and mirrors.


So, that being the case, when I am offered sound therapy, as a part of TRT, through a combination device, do I just go with white noise? What is the standard of care for sound therapy linked to TRT?

Some pretty expensive therapies on the market with no supporting data. How can that be? The FDA has no reign over these therapies I'm assuming?

Thank you
Dr. Nagler

Owner
Registered:
Posts: 1,599
 #4 
Quote:
So, that being the case, when I am offered sound therapy, as a part of TRT, through a combination device, do I just go with white noise? What is the standard of care for sound therapy linked to TRT?

What you do is locate a knowledgeable and experience TRT clinician and follow his or her suggestions in that regard. How do you find a knowledgeable and experienced TRT clinician? Well, that can require a good bit of due diligence on your part since there is no standardization or certification in TRT. I have placed a series on bulleted questions towards the end of my article on TRT to help in that regard. CLICK HERE

Quote:
Some pretty expensive therapies on the market with no supporting data. How can that be?

But there are supporting data. The issue is not its presence; the issue is its quality! That's why in my response above I referred specifically to the absence of reliable and independently verifiable studies. There are loads of worthless studies with substandard methodology that demonstrate whatever the manufacturer desires! Tricky business.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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