2. Analysis of failures of TRT June 17, 2008 Dr. med. Christian Hellweg Gabriele Lux-Wellenhof Tinnitus-Hyperacusis Center Frankfurt am Main Germany

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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?

9. 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!

10. 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

11. Dr.Christian Hellweg f.c.hellweg @online.de Gabriele Lux- Wellenhof www. Ohrensausen.de

12. Question 1: What are the main reasons for todays increasing incidence of tinnitus in western countries ?

13. Question 2: What are the reasons for the increased incidence of low tone hearing loss? what are the underlying biochemical mechanisms?

14. Question 3: What is the first documented incidence of true hyperacusis ?