7 Pro Tips Of Tinnitus Retraining Therapy (TRT)

This article will explain seven pro tips that I learned after attending the five-day Tinnitus Retraining Therapy course, originally pioneered by Dr. Pawel Jastreboff and his wife, Dr. Margaret Jastreboff, who are both well known researchers in the audiology field.

Tip #7:

Tinnitus Retraining Therapy works to help someone with tinnitus by focusing equally on teaching, counseling, and constant sound therapy. Teaching involves a proper understanding of the relationship between the ear, the cochlea, the hearing organ, the auditory nerve, and the subconscious auditory processing of the brain, and how all of these components can create bothersome tinnitus. Tinnitus is not solely an auditory phenomenon, and is impacted by other areas not directly tied to the auditory pathway. This is essential in order to connect the dots about how tinnitus relates to your history, and oftentimes make a big difference in the tinnitus habituation process.

Counseling involves an ongoing relationship between an audiologist trained in TRT and the patient, with the goal of figuring out a way to live with tinnitus and managing any concurrent anxiety and stress. Six months is typically enough time to initiate the counseling process, as it will create a compounding effect over time.

Sound therapy simply involves avoiding silence and creating a sound-rich environment. It’s recommended to use sound therapy during all waking hours of the day, if possible. Usually, this can be achieved by having a high quality speaker play different kinds of steady-state sounds, whether that be white noise, brown noise, crickets, or anything similar in quality. It helps to use sound therapy in any quiet spaces that would otherwise create loud obtrusive tinnitus, and it can even help at night when falling asleep or waking up. Constant sound therapy is typically recommended for a period of nine to 18 months in a treatment protocol for tinnitus. For hyperacusis, it is possible to treat sound sensitivity within a matter of months, but for tinnitus it traditionally takes longer, and is often individualized based on one’s personal history with tinnitus.

Tip #6:

Tinnitus is not in your mind. Tinnitus itself is not a psychological condition or a psychiatric disorder, and there is nothing wrong with your mind for having loud tinnitus. What’s important to realize is that tinnitus is affected by the deep emotional networks of the brain that control and regulate emotions, fear, safety, anxiety, and stress. These psychological aspects can make tinnitus worse and can often lead to a sustained activation of tinnitus in the brain. However, realizing that there’s no diagnosable psychiatric disorder because you have chronic bothersome tinnitus can help calm some of the catastrophic thinking that comes with tinnitus. 

Tip #5:

Tinnitus distress does not correlate at a population level with tinnitus loudness. This means that if you have a loud tinnitus, it does not mean that you’re very bothered by tinnitus. There are many people who have a severe amount of hearing loss and who report loud tinnitus. But if you ask them about it, they generally say that they tune it out and barely notice it. Loudness of tinnitus is thus not the only factor at play. This can be eye-opening to some, as it shows that tinnitus is not solely an auditory phenomenon and that there are other influences between the brain and the body. 

Neuroplasticity, or the brain’s ability to change, can explain how one can go from a point in time where there was no tinnitus to one where there was suddenly loud obtrusive tinnitus But neuroplasticity, along with certain treatment protocols, can also be used to explain positive changes towards a calmer state where one is not so bothered by tinnitus.

Tip #4:

Tinnitus Retraining Therapy induces habituation. This means that with the right resources, direction, support, education, counseling, and sound therapy, your brain and body can naturally heal itself over time. People get better from tinnitus without surgery or pills. Over time, the brain and body can recalibrate and decrease the loudness of tinnitus.

Tip #3:

The loudness of tinnitus for the average patient is only five decibels above the threshold of hearing that they have at that pitch. Some people report tinnitus as being very loud. But researchers have measured the loudness differential of tinnitus, and the average sensation level is around five decibels, which is not loud at all. If you play a five-decibel difference of sound between one loudness level and the next, it’s not too dramatically different. And when applied to very soft levels, a five-decibel difference means that you don’t need much noise to influence or interact with the tinnitus. This is useful when educating someone who believes their tinnitus to be louder than it actually is. Sound therapy can thus be applied as a background sensation, just like tinnitus. It’s only when there’s no other sounds around that tinnitus can be perceived as quite loud. Otherwise, sound therapy can help immensely, and it won’t interfere with speech or the ability to hear other people.

Tip #2:

Sound therapy may actually work better with simpler sounds that can easily blend into the background. Patients have found that sound therapy may work best with a consistent, neutral background sound that does not offer many adjustments for one to tinker with throughout your day. Moreover, sound therapy is best achieved with devices that sit on the ears (known as ear-level sound generators) or other combination instruments for tinnitus. Most sound therapy protocols use a steady state white noise or something similar. While some patients might respond better to sound therapy that offers variability, most patients respond best to steady state sound therapy. 

Tip #1:

Almost 100% of tinnitus patients with an audiogram (hearing test) within the normal range have some degree of cochlear damage or dysfunction in their outer hair cells. Part of the cochlea (the hearing organ) has little cells which have what’s called stereocilia, also known as the outer hair cells. Most people who have tinnitus and score in the normal range for a hearing test also have a dysfunctional cochlea. This may have occurred due to mere loud noise exposure, the natural aging process, or some form of infection or virus. Not understanding this reality can create a lot of confusion and can potentially lead to a long path of getting irrelevant medical tests and straying from the fundamentals of Tinnitus Retraining Therapy, which has an average success rate of 80%.