- Published on 28 January 2016
A.I. Audiologists, then, play an important role…
P.J.J. They can be very important, and should work as part of a team. In Spain, they should work hand in hand with ENT specialists, in order to combine their expertise, because they each master one specific aspect of the therapy. We have done training courses in India and in Holland, and very often, we have audiologists, ENT doctors and psychologists, because it is very important that all three talk the same language to address a case correctly. ENT doctors do not have enough time to provide adequate guidance, and this is true throughout the world.
A.I. Are there any common characteristics in the 80% of patients who do experience improvement with TRT?
P.J.J. What is interesting with TRT is that it does not try to solve tinnitus based on its root cause, but rather works on the connections between the auditory system and the other parts of the brain. That is precisely why it is it can be successful in any number of people, without them having any common characteristics or traits.
A.I. But there are still 20% of patients for whom it does not work…
P.J.J. 82% of patients experience clear improvement, but approximately 90% of patients report a certain improvement. Regarding the remaining 10%, I have learned to predict when TRT will or will not be successful. First, there is a group of patients who use tinnitus as a means of getting social attention, who need to feel victimized, and will never get better because they do not want to put an end to what makes them special. The second group are those who take large doses of benzodiazepines. These drugs reduce the plasticity of the brain and this makes it very difficult to change the connections. A third of my patients take benzodiazepines, because 70% of patients who suffer from tinnitus have sleep problems, and ENT doctors prescribe them as if they were sleeping pills. When patients are on doses of 1 to1.5 mg per day, I try to convince them to stop taking them altogether in the second phase of the TRT. But if they take 2 mg or more, I know it is very difficult for the TRT to work. Lastly, there is a group of patients who do not want to get better for financial reasons, so that they can receive healthcare benefits, after a car accident, for example.
A.I. Can the first results be felt after only six months?
P.J.J. In the 1990s, when we first started, the average time to start feeling results was a year; now it is a month. That being said, some people improve after only three days, whereas for others it can take three months. So as to prevent relapses, I recommend the therapy last nine months. In the 2,000 patients I have treated, I have seen only very few relapses, often triggered by a traffic accident or breast cancer, etc.