Tinnitus Recovery Timeline (And How To Improve With Tinnitus Retraining Therapy)

Tinnitus retraining therapy is one of the most common protocols used to treat tinnitus. It can improve the distress, anxiety and reaction to tinnitus. As a result of that, the volume shifts into a more manageable state. In Tinnitus Retraining Therapy (TRT), you follow a protocol that works for about 80% of patients by recommending the use of a combination of sound therapy and psychology. The cognitive aspect of tinnitus is important: managing reactions, expectations, worries, and fears.

Tinnitus Symptoms And Overview

Before diving into the tinnitus retraining therapy process, understanding tinnitus and what causes it in the first place is important. Tinnitus is defined as the perception of sound in the ears, even though there is no external source. Most people describe it as a buzzing, hissing, pulsing, clicking, or a ringing in the ears. This symptom is extremely common, and chronic tinnitus affects about 20% of the adult population. For some of those people, tinnitus symptoms can become a persistent problem that affects quality of life. 

A classic tinnitus-related experiment conducted by Heller and Bergman in 1953 demonstrated that when placed in a quiet soundproofed room, 97% of young individuals with normal hearing reported hearing noises in their ears. This study suggested that sub-auditory perceptions are always present, but are masked by a noisy environment or ambient sounds averaging around 35 decibels or more. This could explain why almost everyone experiences tinnitus at least once in their life.

What Causes Tinnitus?

In many cases, the tiny hair cells in the cochlea become damaged, so the auditory brain does not receive complete information. Without complete sound input, your brain compensates for the missing sound information, leading to tinnitus. The two most common causes of hearing loss and tinnitus are age-related hearing changes and loud noise exposure. 

Aging and noise exposure damage parts of the cochlea, and those damaged parts of the cochlea no longer transmit information to the brain. In the absence of stimulation, the brain develops phantom sound perception, which is thought to be the cause of tinnitus in a large number of individuals, with or without hearing loss.

Although age-related hearing loss and noise exposure are the most likely causes of tinnitus, there are other less common causes related to underlying medical conditions. Those conditions vary from benign – such as blockage from excessive earwax or sinus pressure from allergies – to more serious – like an acoustic neuroma or head injury. Most tinnitus occurs in both ears, but if you hear tinnitus in only one ear, it may be related to a more concerning condition. Always talk to your doctor and audiologist to rule out any underlying conditions.

If you’ve excluded or treated underlying conditions and are still experiencing tinnitus, TRT might be a good management technique to help reduce your tinnitus related symptoms.

Does The Ear Produce Tinnitus Sounds?

The hearing organ inside the inner ear, called the cochlea, contains the mechanism that processes sounds. Not only can the cochlea “hear” the sounds in our environment, it constantly produces low-level sounds either spontaneously or in response to other sounds.

These cochlea-produced sounds are called otoacoustic emissions, and they can be measured in people with normal hearing or mild moderate hearing loss. Otoacoustic emissions disappear in people with moderate or greater hearing loss, as is often the case among older adults. It’s unlikely that otoacoustic emissions cause permanent tinnitus symptoms, since people with severe profound hearing loss often experience tinnitus. Sudden sensorineural hearing loss is frequently accompanied by tinnitus as well.

What Is Tinnitus Retraining Therapy?

Tinnitus retraining therapy is one of the most common methods for treating tinnitus. Currently, there is no cure or medication to specifically treat tinnitus. Although it’s possible to experience a full spontaneous recovery from tinnitus, for many, it’s a chronic condition. Therefore, management is key.

As a management technique, tinnitus retraining therapy is effective in reducing the stress, anxiety, and strong emotional response that may accompany chronic tinnitus. You may notice this helps “turn down tinnitus” by making it seem quieter and easier to ignore.

TRT is made up of evaluation, education, directive counseling, and sound therapy and has an 80% success rate. Education and directive counseling portions are the psychological aspects of tinnitus retraining therapy and are very important: this will teach you how to manage and control your reactions, expectations, worries, and fears. Sound therapy portion helps to further reduce the perception of tinnitus.

Understanding The Tinnitus Retraining Therapy Model

After tinnitus onset, many patients develop negative reactions to it because they believe it is dangerous or a sign of a serious problem. Tinnitus is an unwelcome intrusion on their lives, and it can be upsetting to think one might not be able to enjoy a quiet life. Over time, those beliefs cause automatic reactions by the autonomic nervous system, similar to the fight-or-flight response. Negative response happens automatically every time tinnitus is noticed.

Tinnitus retraining therapy is based on a neurophysiological model created by Dr. Powel Jastreboff. This model says that tinnitus noise is not what causes the distress, but instead, it is our reaction to it. This reaction involves our autonomic and limbic systems – these are the parts of the brain that regulate our emotional reactions and reinforce behavior. By working with the neuroplasticity in these parts of the brain, you can take control of your reaction to tinnitus. 

What Is Directive Counseling Component In TRT?

TRT is rooted in the principle that the brain’s reaction to tinnitus can be retrained through education and counseling. Over the past couple of decades, there has been an abundance of research into neuroplasticity, which has to do with the brain’s ability to change in response to changing outside stimulus. This research shows that our brains continue to change even in adulthood, given the right stimulus. Tinnitus retraining therapy also has some elements that are similar to cognitive behavioral therapy (CBT).

The educational part of the therapy helps one to understand the mechanism of tinnitus as a phantom auditory experience. Directive counseling aims at removing negative associations from tinnitus, so one can learn to ignore it. An audiologist will help to neutralize tinnitus so that it can fade into background noise. 

What Is The Sound Therapy Component in TRT?

Sound enrichment – or sound therapy – is another important component of tinnitus retraining therapy. Sound therapy is often delivered in the form of hearing aids, ear-level sound generators (also called maskers), or sound machines. Ear-level sounds (through hearing aids or sound generators) are a convenient way to have constant access to sound therapy, since they are extremely discreet and do not require a physical sound machine to be carried around.

The actual sounds used in sound therapy can vary, but it’s best to use sounds that are calming or neutral. Choose a sound you don’t mind listening to, since it would be counterproductive to replace bothersome tinnitus with another annoying noise. Experiment with different sounds to find something that works for you. Some people like the sound of crickets, since it blends in with high-pitched tinnitus, making it less noticeable. 

There are also apps available, such as MyNoise and T-Minus, that typically have a large library of sounds that can be played individually or mixed together. App-generated sounds can be played on the phone, via earbuds or by streaming through hearing aids. However you decide to use sound therapy, it’s best to avoid complete silence, since this is when tinnitus is most noticeable.

What Does The Research Show Regarding TRT Treatment Timeline?

Research that evaluates tinnitus treatment does not measure tinnitus loudness because it is subjective, but instead, uses a tinnitus questionnaire to measure the psychological distress caused by the tinnitus. Interestingly, the research done to measure tinnitus loudness has not shown a significant correlation between the tinnitus loudness and the severity of tinnitus distress. 

One research study in the Textbook of Tinnitus showed that TRT had a significant improvement in tinnitus symptoms among a group of subjects using continuous sound therapy for their chronic tinnitus. In addition, participants had directional counseling by a well-trained audiologist. Within three months, they showed improvement with their tinnitus distress, their reaction, and how much they were bothered by tinnitus. A hallmark tinnitus study showed 80% improvement with tinnitus distress within 12 months. 

Another study looked at the long-term treatment effects of TRT at 18 months after beginning treatment. The treatment effects lasted as long as the researchers were in contact with the tinnitus patients. Researchers found that TRT produced significantly better results than standard care.

How Long Does Tinnitus Recovery Take With TRT?

It does take time. Everyone’s experience is different, but on average, you can expect to dedicate one to two years to your tinnitus retraining therapy journey. 

• 1-2 Months. You will have frequent visits with your audiologist to establish your treatment routine. Visits will become less frequent as the therapy progresses.
• 2-4 Months. Initial improvement may begin as soon as two to four months into TRT treatment. Some people say their tinnitus loudness decreased rapidly, and the benefits of TRT will compound over time. With continued treatment, you’ll continue to feel better and better. You may begin to notice frequent periods of not being aware of your tinnitus. 
• 6-18 Months. Many people experience a plateau in their chronic tinnitus at this point. The tinnitus loudness may not seem any quieter, but you may still be able to improve your symptoms. Continue your follow up visits with your audiologist to make sure your treatment is working well.
• Lasting relief. Many people find that dedicating time to tinnitus retraining therapy is well worth it. Unlike temporary or distraction-based treatment methods, TRT has the potential to help you find relief.

Initially, you may need more intensive sound therapy. But as you continue with tinnitus retraining therapy, you may become less dependent on background sounds to draw your attention away from chronic tinnitus. 

Reaching a plateau is not a bad thing. It means you have managed to get your tinnitus to as good of a state that your body and mind allow. Most people do not reach complete silence. Setting a goal of silence might be unrealistic and lead to disappointment. Occasional periods of silence are great, but you may not want your goal in tinnitus management to be all-or-nothing. If you can reduce the volume or reaction of tinnitus 50%, that would be a big win. 

The 4 Most Important Factors To Improve Tinnitus

To best understand your recovery, you may want to learn the different factors that affect tinnitus and hearing loss. Was it just hearing loss that caused tinnitus? Are there multiple factors that caused your tinnitus? How about stress, medication, or trauma?

1. Hearing Loss

As many as 90% of people with tinnitus also have hearing loss, but at the same time, not everyone who has tinnitus with hearing loss is bothered by it. It’s also important to note that hearing loss is unlikely the sole cause of very loud and obtrusive tinnitus – it is possible to have tinnitus without hearing loss.

2. Stress

Is stress affecting your tinnitus? Persistent stress and anxiety have been known to occur around the same time as bothersome tinnitus. This includes in your workplace or home.

3. Medication

Did you take a medication that may have tinnitus? Ototoxic medications can range from ibuprofen to cancer medications. Sometimes high doses of anti-anxiety medication are prescribed for the stress surrounding tinnitus, but it can make it much harder to overcome the ringing in your ears. Medication side effects can be complicated, so speak to your doctor about the way your medications interact. 

4. Trauma

Was there any emotional or physical trauma around the time your tinnitus became loud or bothersome? Examples of emotionally traumatic experiences at a hearing clinic include: ear surgery, ear infection, eardrum perforation, and earwax removal. Tinnitus can linger in the ear after these events, even though the medical condition that caused it improved.

Can You Regain Silence Once You Have Had Tinnitus?

The goal of tinnitus retraining therapy is not to achieve a complete tinnitus remission or a total silence. In fact, this may be an unrealistic goal since most people experience sounds in quiet environments. The main purpose is to alleviate tinnitus related distress, which in turn leads to less noticeable tinnitus. 

Our auditory system picks up a buzz, hum, or ringing that is usually outside our range of hearing when there are background noises. It’s normal to hear these sub-auditory sounds when it is quiet. When you’re managing the expectations of how much you can reduce your tinnitus, you may want to first start with your reaction to tinnitus. Then your tinnitus may improve slowly and by gradually. If you are still having challenges with anxiety and daily stressors, or having a hard time letting go of the trauma around the original incident of the onset of tinnitus, then it can be hard to reach that plateau. 

In time, TRT may be the key to tinnitus becoming nothing more than just another background noise that’s easy to ignore.