by Neil Bauman, Ph.D.
© December, 2011
A man asked,
What can you tell me about Neuromonics for treating tinnitus? Is it for real? Does it really work?
Neuromonics Tinnitus Treatment is a relatively new treatment for tinnitus. Developed by audiologist, Paul Davis, Ph.D. of Australia to reduce the disturbing effects of tinnitus, Neuromonics opened for business in Australia in 2001. It came to the USA in late 2005. More and more tinnitus treatment centers are adding it to their arsenal of tinnitus treatments.
You see, no one tinnitus treatment protocol works for everyone. Some tinnitus treatment protocols work for some people and not for others depending on the kind and cause of their tinnitus. Neuromonics is the same—it works for some people but not for all.
The goal of Neuromonics is to reduce the physical, mental and emotional disturbance you perceive as a result of your tinnitus. To that end, Neuromonics uses a number of the same concepts used in Tinnitus Retraining Therapy (TRT) that was developed by doctors Pawel Jastreboff and Jonathan Hazell, including the importance of directive counseling and the use of white noise generators (although how these two programs use white noise is different).
Determining Whether Neuromonics Is the Right Tinnitus Treatment for You
Neuromonics seems to have a few advantages over standard TRT. One apparent benefit is that in the initial treatment stages, Neuromonics often gives a greater reduction in tinnitus symptoms more quickly than TRT because, unlike with TRT, it uses tinnitus masking at this point. Another apparent benefit of Neuromonics is that it uses music. Since most people find music more pleasant to listen to than straight white noise, people are more likely to successfully complete the Neuromonics program because of the music. A third benefit is that with Neuromonics you don’t need to wear a tinnitus masker all your waking hours like you would have to with TRT. Instead, you’d typically wear the Neuromonics sound generator between 2 and 4 hours a day.
Audiologist James (Jim) Shafer, Au.D., has used Neuromonics since early 2006, and has been using TRT even longer. I asked him how these two tinnitus treatments compare, and why a person would choose Neuromonics instead of TRT. He explained that when properly done, since both use directive counseling and sound generators, it largely boils down to a matter of personal preference, lifestyle and cost. (4)
Neuromonics is not for everyone. Here are some of the factors that might cause a person to choose Neuromonics versus TRT.
- Neuromonics is only a good choice for people that have normal hearing to moderate hearing losses. With greater losses, TRT with its sound generators combined with hearing aids provides a better “fit”.
- To get the most out of the Neuromonics program, a person should have 2 to 4 hours (preferably 4 hours) during each day when they are reasonably relaxed. This is because the Neuromonics music is designed to relax you and slow down your heart beat. This just doesn’t happen if you are caught up in the frenetic morning rush hour, if you are jogging on your treadmill, or if you are frazzled with a high stress job and never have a moment to yourself. If this is you, then TRT may be a better choice.
- Neuromonics is not for you if you don’t like listening to music in the first place. If you’d prefer just listening to white noise, then opt for TRT instead of Neuromonics.
- Another factor to consider is the size and placement of the sound generators. With TRT, you wear what looks like either in-the-ear or behind-the-ear hearing aids (and indeed they can be dual purpose devices—both sound generators and hearing aids at the same time if that is what you need). You wear them just like you would normal hearing aids. The Neuromonics sound generator is more like an MP3 player or iPod. You wear it on your belt or put it in your pocket and plug in the special ear buds. Because of the ear buds in your ears, you can’t wear hearing aids at the same time.
- Cost may be a factor. For example the total cost of TRT begins around $2,500.00 to $3,000.00, whereas the total cost of the Neuromonics treatment is more in the range of $4,500.00 to $5,500.00.
- Neuromonics is likely not for you if you have a fluctuating hearing loss as the Neuromonics sound generator needs to be programmed to fit your specific level of hearing.
- To be successful with the Neuromonics treatment, you need the ability to organize your day to fit in treatment periods. You do not need to find one 4-hour block of time. Neuromonics works just as well with several shorter blocks of time scattered throughout your waking hours.
- Neuromonics is probably not for you if you cannot eliminate factors that make your tinnitus worse, whether physical or emotional, for example, if you work in a loud environment without proper ear protection.
- Finally, you need to have realistic expectations. Don’t expect that your tinnitus will miraculously disappear. However, do expect that your tinnitus will become softer and less intrusive so it will not bother you much or at all.
The Neuromonics Tinnitus Treatment Program
Neuromonics tinnitus treatment typically consists of a 6 to 12 month program of support, monitoring, counseling and education combined with daily wearing of the Neuromonics proprietary sound generator/sound processor called the Oasis ™.
There are 5 stages in the Neuromonics tinnitus treatment program:
- Comprehensive assessment of your hearing and tinnitus
- Configuring the sound processor
- Phase I (preconditioning stage)
- Phase II (active treatment stage)
- Maintenance stage (1)
1. Comprehensive Assessment
During the assessment stage, your audiologist does a complete audiological evaluation of your hearing ability. You may have a high frequency hearing loss of which you’re not even aware—but you brain is—and the result can be tinnitus. (Around 70% of the people with hearing loss also have tinnitus accompanying their hearing losses.)
Your audiologist will then “test” your tinnitus to determine its frequency and perceived loudness. During this initial assessment, you will also fill out the Tinnitus Reaction Questionnaire (TRQ). Neuromonics uses the 26-item TRQ to subjectively measure how much tinnitus is affecting the quality of your life.
For each of the 26 questions on the TRQ you rate them between 0 and 4 with 0 being “not at all”, 1 “a little of the time” and up to 4, “almost all of the time”.
You answer each question as to how your tinnitus has affected you onlyover the past week. Since you’ll be taking this questionnaire at various points throughout the Neuromonics program, you can measure your progress—the more your score drops, the better your progress.
Incidentally, a lowered score does not necessarily reflect any change in the loudness of your tinnitus, but it does reflect a lessened impact of your tinnitus on the quality of your life.
Here are four of the statements on this questionnaire to give you a feel for the kinds of questions it asks.
- My tinnitus makes me feel tense.
- My tinnitus has led me to avoid quiet situations.
- My tinnitus has interfered with my ability to work.
- My tinnitus has interfered with my sleep.
Possible scores range from 0 to 104 with a score of 17 or greater being considered clinically significant. (5) When I took this questionnaire (just for fun), I was surprised to discover that my score was 0. I’m so thoroughly habituated to my tinnitus that I do not let it bother me although my ears are “ringing away” every waking moment, and get louder whenever I write about, or help people with their tinnitus, which seems to happen almost daily.
During the initial meeting, your audiologist will develop a comprehensive profile of your hearing loss and tinnitus. This information is needed in order to program the Neuromonics sound generator to meet your specific needs.
Your audiologist also will explain about tinnitus and how your autonomic nervous system and limbic (emotional) system play a very important role in how intrusive you perceive your tinnitus.
In addition to the information on tinnitus you receive in your initial session, you will receive another 8 to 10 hours of information and counseling, either face to face, via email or telephone, with the bulk of this coming in the first 6 months you are on the Neuromonics program. This helps keep you on track.
By the end of the initial session you will know whether the Neuromonics program is something you want to try or not.
2. Configuring the Sound Processor
If you decide to proceed with the Neuromonics program, your audiologist will send your tinnitus/hearing loss profile to the Neuromonics headquarters. There, a Neuromonics sound generator/sound processor (called the Oasis) will be specifically programmed to fit both your hearing loss and your tinnitus profile.
This sound generator/sound processor looks somewhat like an MP3 player that you listen to via special high-quality earphones. It contains several hours of highly modified Baroque and New Age music customized specifically to fit your profile. White noise is embedded in the music. Many people find white noise less “irritating” when it is embedded in music than listening to it alone like you do with the TRT program. The frequency range of these sounds lies between 100 Hz and 12,500 Hz.
It takes about two weeks from the time of your initial session until you will receive your customized Neuromonics sound processor.
3. Phase I (Preconditioning Stage)
During the first phase of the Neuromonics tinnitus treatment program, which lasts between 2 and 6 months, you listen to the Neuromonics sound generator for a minimum of two hours a day, but in order to get optimal benefits you are encouraged to listen for 4 hours a day. One study revealed that 75% of the people listening for 2 hours per day achieved at least a 40% reduction in their TRQ score, whereas 100% of the people that listened for more than 2 hours per day achieved this same result. (5) You can break up your listening sessions. You do not have to find a single four-hour block of time.
During the listening sessions, you want to be reasonably relaxed, not hard at physical work, or doing a task that requires your full mental concentration. You can typically listen while you go about your normal (unhurried) daily tasks. It is not something you have to stop and listen to—using up precious hours each day. For example, you could be eating your lunch or reading a book. You could also fit your listening times into relaxed travel times, or quiet work in order to meet your daily listening requirements.
The highly customized “easy listening” Baroque and New Age music needs to be familiar to fit into the background of your conscious mind, rather than requiring active listening on your part. This music promotes relaxation in addition to its main purpose of auditory retraining.
The audio program (music) includes an acoustic neural stimulus (a fancy way of saying it contains white noise). This white noise is intermittent and varies in intensity. It is set a bit louder than your tinnitus. By setting the volume a bit louder than you hear your tinnitus, it masks your tinnitus and can bring you almost immediate relief while you are listening to it. For example, one man went to a clinic to be evaluated for the Neuromonics program. He explained, “While there I had the Neuromonics headset on while talking and in a short time my tinnitus was almost inaudible and this was a stock unit, not set up for my particular sound and pitch.” Incidentally, you control the volume and set it to a comfortable level that brings you the most relief.
The purpose of listening to a pattern of processed music interspersed with white noise is designed to retrain the neural pathways in your auditory system to ignore tinnitus through a process called neuroplasticity. In short, it interrupts your preoccupation with tinnitus and relaxes you. Getting your mind off your tinnitus is critical to your success as your emotional response to your tinnitus is what typically makes your tinnitus to be so intrusive in the first place.
4. Phase II (Active Treatment Stage)
When you have gotten your tinnitus under control as indicated by a reducing TRQ score, you enter Phase II. During Phase II the white noise is eliminated from the music so your brain is intermittently exposed to your tinnitus and is trained to filter it out.
The way this happens is that without the white noise in the background, your tinnitus is now louder than the soft notes of the music you are listening to. Thus in the short intervals between the louder notes your tinnitus briefly “appears”. Since you are listening to the music, not your tinnitus, you learn to ignore your tinnitus in these tiny gaps in the music in a process called acoustical desensitization.
Note: if for some reason your tinnitus flares up, you can always go back to Phase I to bring it under control, then switch over to Phase II again. Some people need to do this, some don’t. Don’t let it discourage you if you have to do this. The goal is to get your tinnitus under control, not to see how quickly you can move through the program.
During Phase II, you set the music level low enough so it won’t disturb you. If you have normal hearing, you can still hear environmental sounds and conversations through this “background” music. If you have a significant hearing loss, this is not likely to happen.
As you progress through Phase II and you retrain your brain, you will find that your tinnitus becomes less and less intrusive, even when you are not wearing the Neuromonics sound generator.
5. Maintenance Stage
Once you are desensitized to the disturbing quality of you tinnitus such that your tinnitus no longer bothers you, you have entered the maintenance phase—typically 6 to 12 months into the Neuromonics program. At this point you can reduce your listening sessions to suit your needs. When they reach this stage, many people do not even need to use the sound generator any more. If you do need to use the sound generator, you will find that just brief listening sessions each day are all you typically need, unless you are having a “bad” tinnitus day.
A Word of Caution
Although the Neuromonics sound generator part of the program is basically the same wherever you go, it seems that a number of places providing Neuromonics are downplaying the importance of the directive counseling. They appear to be relying on the Neuromonics sound generator to carry the whole load. This is leaving out a critical part of the program.
The reason directive counseling is so important is that tinnitus is not just a “physical” thing in the auditory circuits that can be manipulated by sound generators or sound maskers, but the volume and intrusiveness of the tinnitus you experience is closely tied to your limbic (emotional) and autonomic nervous systems. Thus you need to learn how to control your mind and emotions in order to successfully habituate to your tinnitus. (In fact, for many people directive counseling may be all they need to bring their tinnitus under control—it’s that important.)
Therefore, if you are thinking about taking the Neuromonics program, and I can’t stress this enough, be sure your audiologist places a high value on the importance of the directive counseling part of the program. Otherwise, you may largely be wasting your money.
Another thing of which you need to be aware is that if you begin using the Neuromonics sound generator and your tinnitus gets worse, stop using it and talk to your audiologist. There may be some other factors that are contributing to your increasing tinnitus and need to be addressed. You don’t want to continue to do anything that makes your tinnitus worse.
What Kind of Results Should I Expect?
The goal of Neuromonics (and indeed, many other tinnitus treatments) is not necessarily to cure tinnitus, but rather, to reduce the amount of time you are aware of your tinnitus and reduce the degree to which it impacts your quality of life.
Therefore, the correct expectation of the Neuromonics tinnitus treatment program is not that your tinnitus disappears completely (although it does for some people), but that the volume and intrusiveness of your tinnitus drops such that you typically are no longer bothered by your tinnitus. As a result, you may go for hours without even noticing your tinnitus. This is success!
Does Neuromonics work? Consider the case of Tim. His tinnitus started and rapidly escalated until he could no longer tolerate the level of sound generated when his family got together. It disrupted his sleep. He could think of nothing else.
After taking the Neuromonics treatment he explained, “If I consciously listen for my tinnitus, it’s there, or in stressful situations it’s there. But during most of the day I’m not even aware of it, and I can sleep now without any medication. I would say there is a 60% improvement.” (2) Again, this is success!
About 90% of the people taking the Neuromonics treatment have at least a 40% reduction in their TRQ score. Success is defined as at least a 40% reduction in tinnitus disturbance as measured by the TRQ, an average improvement of 67% and a 2-month time frame for the benefits to be felt. (1)
In one study, 95% of the people at 6 months had a reduction in their tinnitus disturbance of at least 40%, while 79% reported that their tinnitus was no longer disturbing them (in other words it was not clinically significant, meaning their TRQ score was 16 or less). (5)
Neuromonics is worth investigating if you are having trouble dealing with your tinnitus. Just remember, it doesn’t work for everyone—but it does help a high percentage of the people who stick with this treatment. A lot depends on you.
The man who asked the question about Neuromonics at the beginning of this article, after I responded favorably to his query, ten days later, wrote: “I went for a hearing evaluation. They offered several alternatives to deal with my tinnitus. I am convinced that Neuromonics is the way to go for me. The program is $4500.00—costly—but if I get the relief, it is money well spent.”
Neuromonics has a good success rate (so do other tinnitus treatment programs such as TRT). However, it seems to have a higher acceptability rate, and that means that people stick with the program—which ultimately leads to success.
If you would like to learn more about tinnitus and the many things you can do to help bring it under control (apart from Neuromonics), see my book “When Your Ears Ring—Cope with Your Tinnitus—Here’s How.” Take charge of your tinnitus. You don’t have to let these phantom sounds control you.
- It’s All In Your Head. Renee Diiulio. In: Hearing Products Report, October, 2007.http://www.hearingreview.com/2008/03/its-all-in-your-head/.
- Music therapy shows promise for tinnitus sufferers.http://www.post-gazette.com/pg/07332/837125-114.stm.
- Neuromonics. http://www.neuromonics.com.
- Shafer, James, Au.D. A C Associates—Hearing, Tinnitus & Balance LLC. 200 Bailey Drive, Suite 201, Stewartstown, PA 17363http://www.acassociatesllc.org.
- Tinnitus: Addressing Neurological, Audiological, and Psychological Aspects with Customized Therapy. Teri Sinopoli, et. al. The Hearing Review. August. 2007.http://www.hearingreview.com/2007/08/tinnitus-addressing-neurological-audiological-and-psychological-aspects-with-customized-therapy/.