What is Tinnitus Retraining Therapy (TRT) for the treatment of tinnitus?

From the Guidelines

Tinnitus Retraining Therapy (TRT) is a highly effective treatment approach for managing tinnitus, and it is recommended that patients with persistent, bothersome tinnitus undergo TRT to improve their quality of life. TRT typically requires a commitment of 12-24 months and works by retraining your brain's auditory processing system to classify tinnitus as a neutral signal rather than a threatening one 1. The therapy consists of two main components: directive counseling and sound therapy. During counseling sessions, you'll learn about how the auditory system works, why tinnitus occurs, and how your emotional reactions can intensify your perception of tinnitus. The sound therapy portion involves using low-level background noise or sound generators (often worn behind the ear like hearing aids) to reduce the contrast between your tinnitus and the surrounding environment. This makes the tinnitus less noticeable over time. Many patients report significant improvement within 3-6 months, though full habituation may take longer 1.

Key Components of TRT

• Directive counseling to educate patients about tinnitus and its management
• Sound therapy to reduce the contrast between tinnitus and the surrounding environment
• Commitment of 12-24 months for optimal results
• Delivery by trained audiologists or otolaryngologists who specialize in tinnitus management

TRT is most effective when delivered by trained audiologists or otolaryngologists who specialize in tinnitus management 1. The therapy works by leveraging the brain's natural ability to habituate to unimportant sounds, similar to how you eventually stop noticing background noises like a refrigerator humming. While TRT doesn't eliminate tinnitus completely, it can substantially reduce its impact on your daily life and emotional well-being. Clinicians should recommend TRT to patients with persistent, bothersome tinnitus, as it has been shown to be an effective treatment approach 1.

Benefits of TRT

• Reduces the impact of tinnitus on daily life and emotional well-being
• Improves quality of life for patients with persistent, bothersome tinnitus
• Can be used in conjunction with other treatment approaches, such as cognitive-behavioral therapy (CBT) 1
• Has been shown to be effective in reducing tinnitus symptoms in patients with hearing loss and persistent, bothersome tinnitus 1

From the Research

What is Tinnitus Retraining Therapy (TRT)

• Tinnitus Retraining Therapy (TRT) is a method for treating tinnitus and decreased sound tolerance, based on the neurophysiological model of tinnitus 2
• TRT aims at inducing changes in the mechanisms responsible for transferring signal from the auditory system to the limbic and autonomic nervous systems, and through this, remove signal-induced reactions without attempting to directly attenuate the tinnitus source or tinnitus-evoked reactions 2

Components of TRT

• TRT consists of two main components:
  • Counseling based on the neurophysiological model of tinnitus, which aims to reclassify tinnitus into the category of neutral stimuli 2
  • Sound therapy (with or without instrumentation), which aims to decrease the strength of the tinnitus signal 2

Effectiveness of TRT

• Studies have shown that TRT can be an effective method of treatment for tinnitus, with significant improvements in tinnitus severity and quality of life 2, 3, 4, 5, 6
• A randomized controlled trial found that TRT was more effective than tinnitus masking in reducing tinnitus severity 6
• Another study found that TRT resulted in significant improvements in tinnitus severity and quality of life, with 77.55% of participants showing clinically meaningful reductions in the effect of tinnitus 4

Treatment Response Dynamics

• A study found that the change in response to TRT took less time to achieve than that for either partial TRT or standard of care, with significant differences in treatment response dynamics between TRT and standard of care 3
• The study also found that sound generator use in TRT increases treatment efficiency without affecting treatment efficacy 3

Patient Outcomes

• Studies have shown that TRT can result in significant improvements in patient outcomes, including reductions in tinnitus severity, improved quality of life, and increased ability to cope with tinnitus 2, 3, 4, 5, 6
• A study found that 76.7% of participants had compensatory tinnitus and 23.3% had decompensated tinnitus after treatment, with significant changes in the composition ratio of compensated and decompensated tinnitus before and after treatment 5