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Analysis of failures of TRTJune 17 , 2008
Dr. med. Christian HellwegGabriele Lux-Wellenhof
Tinnitus-Hyperacusis CenterFrankfurt am Main
Germany
613 patients were evaluated 2 years after treatment withTRT:
491 successful cases (at least 30% improvement in at least 3 main documented parameters of tinnitus )
122 cases resistant to this kind of improvement
Analysis of failures of TRT is useful because:
1)It allowes improvement of treatment strategies of
TRT
2)It allowes some prognosis of treatment outcome
3)It leads to a better understanding of tinnitus mechanisms and neurophysiological model
4)It is a valuable feedback for the treatment provider to be aware of his performance
Groups of non-responders:
• 42 patients with low suffering level from
the beginning• 17 patients with pending law suits • 4 patients category IV • 6 patients with psychotic symptoms• 19 patients with menieres desease• 12 patients having mechanical and technical problems
with the devices etc.• 22 patients with miscellaneous reasons, or unknown
What follows from our analysis?
1) Tinnitus is not equal to tinnitus,
it makes a difference:
• if there are psychotic elements involved
• if the tinnitus is triggered again and again by inner ear structures (i.e.morbus meniere)
• if the tinnitus is permanently enhanced by external sounds (category IV patients)
What follows from our analysis?
2) TRT may also have prophylactic effects and benefits:
- councelling may prevent worsening of tinnitus
- the right sound environment may prevent tinnitus
- it may also be called a success if the patient after councelling is not afraid anymore that he may eventually get tinnitus
What follows from our analysis?
3) Patients attitude is important for treatment outcome:
- what gain does he have from tinnitus? - what is his state of treatment expectation? - is his thinking based on scientific,
religious, homeopathic, esoteric or other background?
- what was his history of treatment experience before TRT?
What follows from our analysis?
4) We should offer only easy, aggreable and pleasant tools, devices and exercises:
- if anything scratches, hurts or pricks:
no success!
- if TRT exerts another form of stress, if patient feels that he has to perform:
no success!
- if patient doesn´t like sounds of sound therapy: no success!
What tells this analysis to the TRT provider:
• He should be competent as a human beeing as well as a tinnitus specialist
• He should avoid to show dominance or superiority.He should meet with the patient on an equel eye to eye level
• He should try to participate….• apply active attentive listening…..• and create an atmosphere in which the patient feels that
he is the most important member of the TRT team…• and all members of the team are together trying to
reach the common goal : getting rid of the problem • He should check all technical aspects throughout the
treatment
Question 1:
What are the main reasons for todays increasing incidence of tinnitus in western
countries ?
Question 2:
• What are the reasons for the increased incidence of low tone hearing loss?
• what are the underlying biochemical mechanisms?
Question 3:
• What is the first documented incidence of true hyperacusis ?
