What is Tinnitus Retraining Therapy (TRT)?
What is Tinnitus Retraining Therapy?
Tinnitus Retraining Therapy, or TRT, is a structured approach to tinnitus management that combines specialised tinnitus counselling with carefully considered sound therapy.
The aim is not simply to cover tinnitus with another sound. Instead, TRT works towards reducing the importance and reaction attached to tinnitus so that it can gradually become less intrusive in everyday life.
TRT developed from the neurophysiological model of tinnitus described by Professor Pawel Jastreboff and Dr Margaret Jastreboff.
Many people can hear tinnitus without being particularly troubled by it. For somebody else, a similar sound may become intrusive, frightening, frustrating or extremely difficult to move into the background.
TRT developed from the understanding that tinnitus distress is not determined simply by how loud the tinnitus seems. Attention, emotion, previous experiences, beliefs about tinnitus and the body's automatic responses can all influence how significant tinnitus becomes.
If the brain repeatedly interprets tinnitus as important, threatening or something that needs to be monitored, there is good reason for it to keep bringing that sound into conscious attention.
TRT aims to gradually change this relationship.
TRT is based around habituation.
Habituation is a normal function of the brain. We are constantly exposed to sensory information that is repetitive and unimportant. Once the brain determines that information does not require a response, it can progressively reduce how much attention it receives.
With TRT, the goal is for tinnitus to become a neutral signal that no longer produces the same automatic emotional, attentional or physiological response.
TRT has two main components
Traditional Tinnitus Retraining Therapy combines structured tinnitus counselling with sound therapy. The two components are intended to work together.
Tinnitus counselling
TRT counselling helps explain how tinnitus is generated and processed and why some tinnitus sounds trigger a much stronger response than others.
The counselling component explores the auditory system, attention, emotion and the body's automatic responses to tinnitus.
The purpose is not simply to tell somebody that tinnitus is harmless or that they need to ignore it. It is to help change the significance that the brain has attached to the sound.
Sound therapy
Sound is used to reduce the contrast between tinnitus and the surrounding acoustic environment.
Depending on the individual, this may involve environmental sound or hearing devices programmed to provide gentle tinnitus sound therapy.
Importantly, traditional TRT does not rely on completely covering tinnitus with another sound.
What happens during TRT counselling?
A core part of TRT is helping you understand what is happening in the auditory system and why tinnitus can become so difficult to disengage from.
When tinnitus has become associated with fear, frustration, uncertainty or constant monitoring, those reactions can help maintain its importance.
Understanding tinnitus does not mean dismissing what you are experiencing. Instead, good counselling aims to make the tinnitus signal more understandable, less threatening and progressively less deserving of attention.
TRT counselling is not simply: “There is nothing wrong, so learn to live with it.”
It is a structured therapeutic component of treatment.
TRT sound therapy is not the same as masking tinnitus
This is one of the most commonly misunderstood parts of Tinnitus Retraining Therapy.
Covering tinnitus with another sound
Masking involves using external sound at a level that makes tinnitus difficult or impossible to hear.
Some people find temporary masking useful for relief, but complete masking is not the central objective of traditional TRT.
Reducing contrast while tinnitus remains audible
In TRT, therapeutic sound is generally used at a comfortable level that reduces the contrast between tinnitus and the surrounding acoustic environment.
The tinnitus usually remains audible rather than being completely covered. This supports the process of habituation rather than relying on continuous masking for relief.
What can you expect if TRT forms part of your treatment?
Appropriate TRT is more involved than simply being provided with a device. Treatment should begin by understanding your tinnitus, your hearing and how tinnitus is affecting you.
Comprehensive assessment
Your tinnitus history, hearing, sound tolerance, functional difficulties and relevant medical or audiological factors are considered before a management plan is developed.
Understanding your tinnitus
Counselling helps make sense of how the auditory system, attention, emotion and nervous-system responses may be interacting in your particular tinnitus experience.
An individualised sound strategy
Sound therapy is selected according to your hearing, tinnitus and sound-tolerance profile. For some people, environmental sound may be sufficient. Others may benefit from hearing devices programmed to provide tinnitus sound therapy.
Follow-up and adjustment
Treatment is reviewed over time. Counselling priorities, sound settings and other strategies may change as your response to tinnitus changes.
Gradual habituation
The aim is for tinnitus to progressively provoke less reaction and occupy less attention. This is usually a gradual change rather than something that occurs after a single appointment.
Sound therapy does not look the same for everyone
The appropriate sound strategy depends on your tinnitus, hearing, sound tolerance and everyday listening environments.
Environmental sound
Everyday sound enrichment may be sufficient for some people. This can include naturally occurring sound within the home, workplace and outdoor environment.
Hearing devices for sound therapy
Hearing devices can be programmed to provide gentle therapeutic sound for tinnitus, including when amplification is not the primary reason the devices are being used.
Hearing devices for hearing loss
If hearing loss or hearing difficulty is present, amplification can improve access to everyday environmental sound and speech, which may also reduce the contrast between tinnitus and the surrounding acoustic environment.
You do not automatically need hearing devices simply because you have tinnitus.
Device recommendations should be based on your assessment, hearing, tinnitus and treatment goals.
The goal is not to spend your life trying to ignore tinnitus
With habituation, tinnitus can still be present without requiring the same reaction or attention.
People sometimes imagine that successful tinnitus treatment means forcing themselves not to think about tinnitus. That is not the aim.
As tinnitus becomes less significant, periods of reduced awareness can begin to occur naturally. Even when tinnitus is noticed, it may no longer trigger the same frustration, fear or interruption.
This difference between hearing tinnitus and being distressed by tinnitus is an important part of understanding habituation.
Traditional TRT programs have historically been described as taking approximately 12 to 24 months, although this does not mean everybody requires the same number of appointments or the same treatment duration.
In contemporary tinnitus care, follow-up frequency and treatment length can vary considerably according to the person's needs, progress, hearing, sound sensitivity and other management strategies being used.
Many people notice changes before the end of a formal treatment program. These changes may include reduced emotional reaction, improved sleep or concentration, less checking of tinnitus, or longer periods where tinnitus simply does not occupy attention.
Tinnitus and sound sensitivity commonly occur together, but the sound-therapy approach may need to be different when everyday sounds are uncomfortable or overwhelming.
Simply increasing sound exposure without considering sound tolerance is not an appropriate one-size-fits-all strategy.
When clinically significant hyperacusis or sound sensitivity is present, this may need to be addressed as a priority within the treatment plan, often using carefully controlled and gradual sound exposure.
Sound therapy should remain appropriately comfortable. Treatment does not require forcing yourself to tolerate painfully loud sound.
Is TRT the right treatment for everyone?
No.
Tinnitus is not experienced in exactly the same way by every person, and no single treatment should automatically be prescribed to everyone who reports tinnitus.
TRT principles remain useful within modern tinnitus care, but assessment may identify other areas that also need attention — for example hearing difficulty, hyperacusis, sleep disturbance, anxiety around tinnitus, jaw or neck factors, or the need for medical investigation.
Treatment should therefore be selected according to the individual rather than forcing somebody into a standard tinnitus package.
Depending on the individual, tinnitus management may include:
- Tinnitus education and counselling
- TRT-based sound therapy
- Hearing rehabilitation
- Cognitive Behavioural Therapy strategies
- Acceptance and Commitment Therapy strategies
- Sleep management
- Hyperacusis or sound-sensitivity management
- Medical or allied-health referral where indicated
A balanced view of Tinnitus Retraining Therapy
TRT has been used internationally for several decades, and the neurophysiological model that underpins it has influenced the development of modern tinnitus management.
Research has shown that people undergoing TRT can experience meaningful reductions in tinnitus-related distress.
It is also important, however, not to overstate the evidence. Randomised trials and systematic reviews have not consistently shown that the complete traditional TRT protocol is superior to other high-quality tinnitus interventions.
Tinnitus education and counselling can themselves have therapeutic value. Cognitive behavioural approaches also have strong evidence for reducing tinnitus-related distress.
This is one reason contemporary tinnitus management is increasingly individualised: the most appropriate treatment may involve TRT principles alone or in combination with other evidence-based approaches.
Tinnitus Retraining Therapy FAQs
Does TRT cure tinnitus?
TRT is not generally described as a cure for the underlying tinnitus signal. Its main aim is to reduce tinnitus-related reaction and intrusion through habituation.
Does TRT make tinnitus quieter?
Some people report that tinnitus seems quieter as treatment progresses. Others continue to hear a similar sound but find that it no longer carries the same importance or distress. Improvement therefore should not be measured by tinnitus loudness alone.
Is TRT just listening to white noise?
No. Structured tinnitus counselling is a central component of TRT. Sound therapy is used alongside counselling and is selected according to the individual's hearing, tinnitus and sound tolerance.
Should sound completely cover my tinnitus?
Usually not in traditional TRT. Therapeutic sound is generally set so that tinnitus remains audible rather than being continuously and completely masked.
Can TRT be used if I have hearing loss?
Yes. When hearing loss or hearing difficulty is present, hearing rehabilitation may form part of the tinnitus management plan. Improving access to everyday sound can also reduce the contrast between tinnitus and the surrounding acoustic environment.
Can TRT be used for hyperacusis?
Principles arising from the TRT model have also been used in management of decreased sound tolerance. When significant hyperacusis or sound sensitivity is present, sound exposure needs to be appropriately controlled and gradually progressed.
How long does TRT take?
Traditional TRT has historically been described as a 12–24 month process. Contemporary treatment may be shorter or longer depending on the individual's needs, progress, hearing and sound-tolerance profile.
Is TRT the only evidence-based treatment for tinnitus?
No. TRT is one approach to tinnitus management. Tinnitus counselling, cognitive behavioural approaches, hearing rehabilitation and other interventions may also be appropriate depending on the individual.
References
- Jastreboff PJ. Tinnitus Retraining Therapy. Progress in Brain Research. 2007;166:415–423. PubMed
- Jastreboff PJ, Jastreboff MM. Tinnitus Retraining Therapy: a different view on tinnitus. ORL Journal for Oto-Rhino-Laryngology and Its Related Specialties. 2006;68(1):23–29. PubMed
- Scherer RW, Formby C, et al. Effect of Tinnitus Retraining Therapy vs Standard of Care on Tinnitus-Related Quality of Life: A Randomized Clinical Trial. JAMA Otolaryngology–Head & Neck Surgery. 2019. View study
- Cochrane. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Evidence
- Systematic review of randomised controlled trials evaluating Tinnitus Retraining Therapy. PubMed
This information is provided for general education and does not replace individual medical or audiological advice. New, unilateral, pulsatile or otherwise medically concerning tinnitus may require appropriate medical investigation.
No two tinnitus experiences are exactly the same.
A comprehensive tinnitus assessment can help identify the hearing, sound-tolerance and other factors contributing to your tinnitus experience, and guide an individual management plan rather than a one-size-fits-all approach.
Learn about tinnitus assessment