Straightforward Information About Tinnitus
Tinnitus Retraining Therapy (TRT) is a structured management program developed in the early 1990s by Dr. Pawel Jastreboff. It combines two components — directive counseling and sound therapy — to promote habituation of the tinnitus signal.
TRT is based on the neurophysiological model of tinnitus, which holds that the tinnitus signal originates in the auditory system but that the problem — the suffering — arises from the brain's emotional and autonomic response to that signal. The goal of TRT is not to eliminate the signal but to retrain the brain so that it stops classifying the signal as important or threatening. See How Your Brain Creates the Sound for related science.
When this retraining is successful, the tinnitus signal is filtered out of conscious awareness much of the time — the same way you stop noticing the hum of a refrigerator or the feel of clothing against your skin.
The counseling component of TRT is educational. It teaches you how the auditory system works, how tinnitus arises, and why the emotional and stress reactions to tinnitus are what make it a problem. Understanding this can reduce fear and anxiety, which in turn reduces the brain's tendency to amplify the tinnitus signal. This is called "demystification."
The sound therapy component typically involves wearing ear-level sound generators (similar in appearance to hearing aids) that produce a soft, broadband noise. The sound is set at a level below the tinnitus — you should still be able to hear the tinnitus above the sound generator. This is different from masking, which aims to cover the tinnitus entirely.
The rationale is that by providing low-level background sound, the contrast between the tinnitus and silence is reduced. Over time, this helps the brain reclassify the tinnitus as an unimportant background signal. For people with hearing loss, hearing aids may be used instead of or in addition to sound generators.
TRT is a long-term approach. The typical treatment course lasts 12 to 24 months. Many patients begin to notice improvements within the first few months, but full habituation takes time. Commitment to consistent use of the sound generators and engagement with the counseling component are important for success.
TRT has been used since the 1990s and has a substantial clinical following. Several studies have shown positive outcomes, though the evidence base is not as robust as that for CBT in terms of randomized controlled trials. Some researchers have noted that it can be difficult to separate the effects of TRT's counseling and sound therapy components, and that the counseling shares features with CBT.
TRT requires a trained provider, typically an audiologist. Not all audiologists offer TRT, so you may need to ask specifically. The sound generators and the extended treatment timeline mean TRT can be a significant financial commitment. Check with your insurance provider about coverage.