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.

Methods: 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.

Results: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.

Conclusion

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.