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Dr. Nagler

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Martin asked:

Dr. Nagler, when you were a TRT patient 20 years ago, did you also use some kind of sound (partly) masking your T? You said that your T was unmaskable. So what kind of sound did you use? I am asking because I tried hearing aids, white noise generators and combi devices.

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Martin, Tinnitus Retraining Therapy (TRT) is a very specific protocol. It starts with an evaluation during which a person's "TRT category" is identified by his or her TRT clinician. There are five distinct TRT categories, which are inconveniently numbered 0 through 4. The numbering does not reflect severity; rather it is based on the presence or absence of hyperacusis, hearing loss, and a number of other auditory factors. Sound therapy and TRT counseling (which used to be called "directive counseling") are the two essential elements in TRT. The particular form of sound therapy as well as the TRT counseling strategies are dictated by the TRT category. Thus, for instance, a Category 0 patient would receive completely different sound therapy and counseling recommendations from a Category 3 patient. My parameters fell into Category 1, and I was instructed by my TRT clinician in the use of broadband sound delivered through wearable devices in accordance with that category. I set them each morning as I was told, each device independent of the other. The end result of the instructions was that (1) the sound did not suppress my tinnitus in any way, (2) the sound was not annoying, (3) the sound did not interfere with communication, (4) the sound did not elicit the stochastic resonance phenomenon, and (5) within the aforementioned constraints the sound maximally facilitated habituation.

Dr. Stephen Nagler

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