Based on a series of studies including brain function tests, we reinforced and improved treatment for tinnitus by developing a tinnitus retraining therapy (TRT) that incorporates the “tinnitus pain model”; our laboratory subsequently introduced this therapy in 2013. This model provides a clinical explanation that tinnitus manifests and worsens through nerve synchronization of the auditory path and the non-auditory path with the pain network. Therefore, the target of tinnitus therapy based on this model is the auditory path generating the tinnitus and the pain network that worsens the tinnitus. The therapy mainly uses “acoustic therapy” and “directive counseling”, which are the same as the original TRT. What characterizes this method is the central use of a hearing aid in the “acoustic therapy” targeting tinnitus patients with hearing loss. TRT incorporating the “tinnitus pain model” would be ideal for the establishment of an outpatient department dedicated to hearing loss and tinnitus. In actual practices, however, many hospitals avoid offering “directive counseling”, as it is often difficult to provide sufficient counseling in a general outpatient setting.
This report examined the tinnitus treatment practice of a municipal hospital with two otolaryngologists. The hospital administered TRT incorporating the “tinnitus pain model” to 62 cases (average age: 68.7 years, prevalence period: 16 months [median]). All the cases were treated with “directive counseling”, while 32 cases used hearing aids as a part of “acoustic therapy”. The tinnitus handicap inventory (THI) score showed a statistically significant reduction after treatment from 49.3±23.0 to 24.8±21.1. The improvement rate, based on an “improvement of 20 THI points or above” and “16 or lower final THI points” as the statistical criteria, was 62.9%. The proactive involvement of municipal hospitals in tinnitus treatment may reduce the frequency of doctor shopping by tinnitus patients and could help to break the “vicious circle” of tinnitus treatment practices.
