Tinnitus is a common issue that can affect approximately 10-15% of the global population. Currently, it has been estimated that there is as many as 50 million Americans who are affected and although it affects mostly adults who are increasing in age especially those who are 50 years or older, children and adolescents are affected as well. While tinnitus is classically described as a ringing in the ears which is the commonest form, it can also sound like roaring, buzzing, humming, and more. Most patients who suffer from tinnitus have adapted to it and can function normally just like any other person but a small portion of those afflicted have severe symptoms that compromises their quality of life. Patients who suffer from tinnitus may also experience:

  • Dizziness
  • Anxiety
  • Irritability
  • Depression
  • Poor concentration
  • Inferior performance in school or work


There are many causes of tinnitus such as:

  • Exposure to loud noises (attending concerts or clubs, work hazard such as construction work)
  • Head and neck injuries
  • Allergies
  • Temporomandibular joint issues
  • Consumption of ototoxic medication
  • And more.


It is important to keep in mind that tinnitus itself is a symptom of an underlying disorder and not a disease. If you are experiencing tinnitus for the first time, it would be an innovative idea to make an appointment with your primary care provider to ensure that there is no serious underlying disorder that causes the tinnitus. Due to the various causes of tinnitus, naturally there would not be one way to cure or reduce tinnitus. To treat or reduce the symptoms of tinnitus, it is important to address the underlying issue that causes tinnitus. This also means that there are many potential ways that can be used in the treatment and management of tinnitus. One of it is known as the tinnitus retraining therapy (TRT).


Tinnitus Retraining Therapy (TRT)

This method of treatment has been around for approximately a decade. Although there have been some controversies and criticism regarding this method of treatment, the successful number of patient who have been helped through this method has increased at a steady rate not only in the United States, but also around the entire world. It is now a method that is successfully utilized in more than 20 countries.

So, you may ask what is TRT. TRT is the practical implementation of the neurophysiological model for tinnitus that has the following main principles:

  1. Limbic and autonomic nervous systems are dominant in the development of tinnitus while the auditory system has a secondary role in the manifestation of tinnitus.
  2. Elevated levels of plasticity I demonstrated by the brain and this gives it the capability of habituating to any neutral signal.
  3. One of the commonest symptoms to occur together with tinnitus I the hypersensitivity to sound or better known as hyperacusis.


There are 2 main components for TRT, which are:

  1. Counseling – this session is educational and is intensive, individualized and interactive. This session aims to educate the patient regarding tinnitus, so the patients are no longer afraid of it and understand more about the physiological mechanisms of the issue, what can relieve it, and what can aggravate it.
  2. Sound therapy – is also used in TRT sessions so help the patient relax and reduce their stress levels. Sound therapy utilizes the sounds that have a constant low level broad band sound to decrease the difference between tinnitus frequencies ad background neuronal activity. All patients who experience tinnitus are advised to avoid total silence and enrich their background sounds by playing nature sounds or music. Ear protectors should also not be used in normal everyday situations. In those who have hearing loss, hearing aids should be used to amplify the background sounds.


In broad band noise sound generators that can be bought online, this is a device that can be beneficial for all tinnitus patients as it facilitates tinnitus habituation and lowers the hyperacusis patients often experience which can lead to tinnitus.

To demonstrate the increasing use and acceptance of TRT, the 6th International Tinnitus Seminar in Cambridge, United Kingdom had a total of 132 publications where 25 of these addressed TRT. This is a great milestone that has been achieved as in the 5th International Tinnitus Seminar, there were no published papers on TRT. This shows that TRT was able to achieve a prominent level of recognition in a limited time.


Studies Conducting On Tinnitus Retraining Therapy

Although there is increasing popularity, there has yet been a double-blind study that is conducted to evaluate the outcome of TRT. TRT has been proven to be successful where success rates greater than 80% have usually been reported. For example, in:

  • Germany –  there was a success of approximately 80%
  • Poland – success rate of 80%
  • Spain – success rate of 84% and 88%
  • Unite States – 82% success rate
  • Bermuda – more than 80% success rate
  • Nagler – success rate more than 80%


Researchers have concluded that there is clear improvement using the TRT method for the treatment of tinnitus. Using functional brain imaging, it has confirmed that the neurophysiological system in the limbic system is indeed involved in tinnitus. Minimal masking during the duration of treatment have also supported that treatment induced modifications existed in the neuronal networks in auditory pathways that reflect the heightened ability to stop the tinnitus signal and therefore perception.

Patient concerns should always be addressed. Some of the concerns they face include:

  • Is tinnitus life threatening?
  • Is there a possibility I will lose my hearing?
  • Will the tinnitus worse?
  • No one understands what I am going thorough and everyone around me thinks I have mental issues!
  • I can no longer concentrate on my work or school.
  • I have problems sleeping.
  • I am afraid that my company will fire me once they find out I have this issue.
  • Are there any activities I cannot participate in?
  • I constantly feel anxious and depressed.


These are common concerns that tinnitus patients face every day. Therefore, a physician is required to exclude any medically or surgically treatable issues to ensure that there is no basis for health concerns related to tinnitus.


Conclusion About Tinnitus Retraining Therapy

TRT is a useful method that can be used in the treatment and management of tinnitus. It can be highly effective in both tinnitus and hyperacusis and easily incorporated into audiologic practice. Although easily conducted by a variety of health care personnel, the most qualified to perform a TRT is an audiologist as they know best regarding auditory physiology and hearing loss, counseling patients and can recommend sound generators and hearing aids if needed.