Analysis of Failures of Trt

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An analysis not only of patients treated successfully  with TRT  is  necessary and helpful, but also the cases  that remain resistant to the therapy can teach us  a lot about  the mechanisms of tinnitus development and  methods of its reduction by implementing TRT in the right way. Such an analysis should enable us to  remove the obstacle  before starting the TRT or at least  inform patients right from the beginning of therapy if they are in a less promising situation.

We examined  audiological  data and medical history of each single  patient  that  we could  not count as being  a successful case according to the criteria of Jastreboff  (Jastreboff et al. 1996).  We tried to find out what was impeding success or  preventing  the improvement of the suffering patient. It is important to note that in case of TRT a double blind study or similar  scientific method to prove efficiency of treatment is  not  applicable. The knowledge of our collection of factors preventing treatment success may be helpful for other therapists as well.

The findings may  be grouped into  seven different collectives.  42 patients had  a very low suffering rate from the very beginning of the treatment, so there was no real improvement in the  severity of tinnitus or in the disturbance of activities of life after TRT either.  However, these patients generally profited from the treatment anyway because they learned to understand why they had the symptom.  Another group of patients  had  law suits pending or  even had financial  gains  or other  privileges because of  their tinnitus.  The third group of therapy resistent patients  was   the  group of  category IV  patients.  The treatment  of  these patients  was very difficult in general, also in terms of psychological  compliance and  reduction of hyperacusis.  The next group of failures consisted of psychopathologic  and severely neurotic patients.  Especially single cases  with  hallucinations  and borderline syndrome  did not respond successfully  to TRT.  A relatively large contingent of patients  with  menier´s  desease or other forms of low tone hearing loss  ( LTHL)  were resistant to therapy as well.  The remaining  patients did not show  characteristic features  that could be  clearly attributed  to the failure of treatment.

The  findings reported here demonstrate that TRT is not always effective in reducing severity of tinnitus or tinnitus caused disturbance of life activities. The reasons of failures can be differentiated into several typical categories. The reasons found in our study that prevent success of treatment fully support the significance of the underlying neurophysiological model  of Jastreboff  for the  mechanisms of tinnitus reduction  when applying TRT.

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