Tinnitus retraining therapy

Tinnitus retraining therapy (TRT) is a structured clinical programme for tinnitus, the perception of sound (often a ringing, buzzing, or hissing) with no external source. It was developed by Pawel Jastreboff and Jonathan Hazell and rests on a neurophysiological model of tinnitus, which holds that the distress comes less from the sound itself than from how the brain's emotional and reflex systems react to it. TRT has two components used together: directive counselling (structured education that reframes how a person interprets their tinnitus) and sound enrichment using low-level broadband sound. It is delivered by trained audiologists and clinicians, usually over an extended period of roughly 12 to 24 months. See Wikipedia: Tinnitus retraining therapy.

The stated goal of TRT is habituation (the nervous system gradually learning to stop reacting to a constant, non-threatening signal), so the tinnitus is filtered out of conscious awareness and causes less distress, rather than the sound being removed. TRT is a recognised management approach, but the controlled-trial evidence is limited and mixed. A Cochrane systematic review of TRT for tinnitus found only one randomised controlled trial that met its inclusion criteria, judged that single study to be low quality, and concluded that the quality was not good enough to draw firm conclusions, so more research is needed; see Phillips JS, McFerran D. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Database of Systematic Reviews, 2010 (CD007330). The UK National Health Service likewise lists TRT as an option for severe or persistent tinnitus while noting that it is unclear whether it works for everyone; see NHS: Tinnitus.

As described in audiology, TRT works through two components used together over many months. The first is low-level broadband sound therapy: a steady, gentle sound played at a volume below the tinnitus, so the contrast between the tinnitus and the background is reduced and the tinnitus stands out less. The second is directive counselling: structured sessions in which a clinician explains how the hearing and alarm systems work and helps the person reclassify the tinnitus as a neutral, non-threatening signal. The aim is habituation, the brain gradually learning to filter the tinnitus signal out of conscious awareness so it provokes less reaction and less distress; the goal is to change the response to the sound, not to remove the sound. This programme is delivered by trained clinicians, typically over a period of roughly 12 to 24 months.

The honest evidence verdict is that TRT is a recognised management approach but the high-quality comparative evidence is limited and mixed. A Cochrane review identified only a single low-quality randomised controlled trial and concluded that firm conclusions could not be drawn and that more research is needed (see Phillips JS, McFerran D. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Database of Systematic Reviews, 2010 (CD007330)). The NHS lists TRT among options for severe or persistent tinnitus while stating that it is unclear whether it works for everyone (see NHS: Tinnitus). TRT aims at habituation and at reducing distress; it is not a cure and it does not eliminate the tinnitus sound, and individual results vary.

Tinnitus is a recognised medical condition, and a sudden, one-sided, or distressing change in what you hear should be assessed by a professional. If you are considering tinnitus retraining therapy, consult a qualified audiologist or your doctor, who can assess your situation, discuss the current evidence, and tell you whether the programme is available to you. Sonora is a general wellbeing and sound app; it is not a medical device, it does not diagnose or treat tinnitus, and it does not provide tinnitus retraining therapy. For context, see the notched sound therapy glossary term, the sound and tinnitus guide, and the sound healing pillar.