What is Tinnitus Retraining Therapy?
Tinnitus Retraining Therapy is a scientifically backed, long-term treatment designed to help the brain stop reacting negatively to tinnitus. Unlike other approaches that try to mask or eliminate the ringing, TRT works by changing how your brain processes the sound. Developed by Dr. Pawel Jastreboff in the early 1990s, it’s based on the idea that tinnitus isn’t a problem with your ears-it’s a problem with how your brain interprets it.
Most people with tinnitus hear a constant noise-ringing, buzzing, hissing-that others can’t. At first, it’s terrifying. Your brain treats it like a threat, triggering stress, anxiety, and sleepless nights. TRT doesn’t make the sound disappear. Instead, it helps your brain stop noticing it as something dangerous. Over time, you learn to ignore it, just like you ignore the hum of your fridge or the ticking of a clock.
How TRT Works: The Two Pillars
TRT isn’t one thing. It’s two parts working together: counseling and sound therapy. Neither works well alone. Together, they retrain your brain’s wiring.
Counseling is where the real change begins. In weekly or monthly sessions with a certified audiologist, you learn exactly how tinnitus forms in the brain. You’ll hear about the cochlea, the auditory nerve, and how the limbic system-your brain’s emotional center-gets stuck in a loop with the tinnitus signal. The goal? To remove fear. When you understand that tinnitus isn’t damage, isn’t a sign of something worse, and isn’t going to get louder, your brain stops panicking. Studies show this counseling makes up 60-70% of TRT’s success.
Sound therapy is the other half. You wear small devices-like hearing aids or sound generators-that play low-level, soothing noise 6-8 hours a day. This isn’t loud music or white noise blasts. It’s subtle, just enough to reduce the contrast between your tinnitus and the silence around it. Think of it like turning on a faint background hum so your brain doesn’t have to focus on the ringing. The sound is calibrated to be slightly quieter than your tinnitus. This helps your auditory system stop overreacting.
Who Is TRT For?
TRT isn’t one-size-fits-all. Patients are grouped into four categories based on hearing ability and tinnitus type:
- Group 1: Normal hearing, tinnitus only → Uses sound generators only.
- Group 2: Hearing loss, no tinnitus in quiet → Uses hearing aids only.
- Group 3: Hearing loss + tinnitus → Uses both hearing aids and sound generators.
- Group 4: Tinnitus + sensitivity to everyday sounds (hyperacusis) → Uses modified protocols to reduce discomfort.
If you’ve had tinnitus for more than a year and it’s affecting your mood, sleep, or concentration, TRT is worth considering. It’s not for people looking for a quick fix. It’s for those ready to change how they live with the sound.
What Happens During Treatment?
TRT is a marathon, not a sprint. Treatment lasts 12 to 24 months. The first three months involve monthly 60-90 minute sessions. After that, check-ins happen every few months. You’re expected to wear your sound devices daily, keep a log of your progress, and attend every appointment.
Early on, you might feel the sound therapy is annoying. Some people quit because it feels tedious. But here’s the truth: the first six months are the hardest. That’s when your brain is learning to reinterpret the signals. By month 12, many patients report being aware of their tinnitus only 5-15% of the day-down from 80-100% before treatment. They still hear it, but it doesn’t bother them anymore.
One patient from Bristol, who asked to remain anonymous, shared: “I used to check my phone every 10 minutes to see if the ringing had stopped. After 18 months of TRT, I realized I hadn’t thought about it all morning. That’s when I knew it worked.”
Is TRT Effective? The Evidence
TRT is one of only two tinnitus treatments with the highest level of clinical evidence (Level A) according to the American Academy of Otolaryngology. Multiple studies show 75-85% of patients achieve significant improvement when TRT is delivered correctly.
A 2019 review in JAMA Otolaryngology found TRT improved Tinnitus Functional Index scores by an average of 13.2 points more than standard care. That’s not a small change-it’s the difference between being unable to sleep and sleeping through the night.
But here’s the catch: success depends on who delivers it. Certified TRT providers-those who’ve completed the 40-hour Jastreboff training program-achieve success rates of 85%. Non-certified providers using simplified versions see rates drop to 55%. That’s why finding a qualified audiologist matters.
There are only about 500 certified TRT practitioners in the U.S. as of 2023. In the UK, the number is even smaller. Many audiologists know about TRT, but few are trained to deliver the full protocol.
Cost, Time, and Challenges
TRT isn’t cheap. In the U.S., the full course costs $2,500-$4,000. Sound generators range from $500 to $1,200 each. In the UK, NHS coverage is rare-you’ll likely pay privately.
Time is the biggest barrier. You need to commit to daily sound therapy for at least a year. Studies show 30-40% of people drop out before finishing. Common reasons? “Too much work,” “sound devices felt uncomfortable,” or “I didn’t see results fast enough.”
Reddit communities like r/tinnitus show mixed reviews. Of 347 users who tried TRT, 62% reported moderate to major improvement after 12+ months. But 28% said it barely helped. The difference? Those who stuck with the full protocol and saw a certified provider had far better outcomes.
TRT vs. Other Treatments
TRT isn’t the only option. Cognitive Behavioral Therapy (CBT) is the other evidence-based treatment. Here’s how they compare:
| Aspect | TRT | CBT |
|---|---|---|
| Primary Goal | Change brain’s automatic response to tinnitus | Change thoughts and behaviors around tinnitus |
| Time Commitment | 12-24 months | 8-12 weekly sessions |
| Equipment Needed | Sound generators or hearing aids | None |
| Provider Training | Specialized certification required | Standard psychotherapy training |
| Success Rate | 75-85% with certified providers | 60-70% |
| Best For | People who want to reduce automatic brain reactions | People with high anxiety or negative thought patterns |
Some people combine both. CBT helps you manage the stress, while TRT rewires your brain’s response. If you’re overwhelmed by the thought of wearing sound devices daily, CBT might be easier to start with.
What’s New in TRT?
TRT is evolving. In 2021, the Jastreboff Foundation launched a telehealth certification program to make it more accessible. Now, you can do counseling sessions remotely.
Researchers are also testing TRT combined with transcranial magnetic stimulation (TMS). A 2023 trial showed 92% of participants improved after 6 months when TRT was paired with TMS-compared to 78% with TRT alone. This could be a game-changer for people who don’t respond to TRT by itself.
More hearing clinics are now using TRT principles-even if they don’t call it that. You might hear terms like “habituation training” or “sound enrichment.” That’s good. But if you want the full, proven protocol, you need a certified provider.
Getting Started
If you’re serious about TRT:
- Find a certified TRT provider. Check the Jastreboff Foundation’s registry or ask your audiologist if they’re trained.
- Get a full hearing test. TRT is tailored to your hearing profile.
- Ask about the full protocol-not just “sound therapy.”
- Be ready to commit for at least a year.
- Track your progress. Note when you notice the tinnitus less, sleep better, or feel calmer.
Don’t expect miracles in 3 months. But if you stick with it, your brain will learn to let go of the noise. Not because it’s gone-but because you no longer need to fight it.
Can TRT cure tinnitus?
No, TRT doesn’t cure tinnitus. It doesn’t make the sound disappear. Instead, it helps your brain stop reacting to it. Most people still hear their tinnitus, but they no longer feel stressed, anxious, or disturbed by it. That’s habituation-your brain learns to filter it out, like background noise.
How long does TRT take to work?
Most people start noticing changes between 6 and 12 months. Full habituation-where tinnitus barely registers-usually takes 12 to 24 months. Patience is key. The brain doesn’t rewire overnight.
Do I need to wear sound devices all day?
Yes. Sound therapy requires 6-8 hours of daily use during waking hours. It’s not meant to be loud or distracting-it’s a gentle background sound. Skipping days slows progress. Consistency is what makes TRT work.
Is TRT covered by insurance?
In the U.S. and UK, TRT is rarely covered by insurance. Most patients pay out-of-pocket. Some private health plans may cover part of the cost if you have hearing loss and need hearing aids. Always check with your provider before starting.
Can I do TRT at home without a therapist?
Not effectively. While you can buy sound generators online, the counseling component is essential. Without understanding the neurophysiological model, you won’t retrain your brain’s emotional response. Self-guided TRT has a much lower success rate. Certified providers are rare, but they’re necessary for real results.
What if TRT doesn’t work for me?
TRT works for 75-85% of people when done correctly. If you don’t see improvement after 12 months, ask your provider to review your protocol. Maybe the sound levels are off, or the counseling wasn’t thorough. You can also try CBT, mindfulness, or a combination. Don’t give up-there are other options.
Final Thoughts
Tinnitus doesn’t have to control your life. TRT isn’t magic, but it’s one of the few treatments backed by real science. It works because it doesn’t fight the sound-it changes your relationship with it. If you’re tired of being scared of your own ears, TRT offers a path forward. It takes time. It takes effort. But for many, it’s the only thing that finally brings peace.
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