Tinnitus Retraining Therapy
The Most Effective Protocols
Tinnitus Retraining Therapy (TRT) is the most widely used form of habituation Sound Therapy around the world, and the most universally effective for most conditions and degrees of hearing loss. It was developed by neuroscientist Pawel Jastreboff, Ph.D., who published the first treatment protocols in 1990. TRT is a special form of habituation desensitization Sound Therapy, not to be confused with Masking. TRT treatment uses specific types of Sound Generators, set in particular ways and used for specific lengths of time in conjunction with Informational and Directive Tinnitus Counseling. Counseling is necessary to explain how one can put an end to negative reaction to tinnitus, alter perception of tinnitus, and diminish and potentially end perception of significant tinnitus as problematic and unmanageable. The most effective protocols, as demonstrated in clinical results, follow the Jastreboff Method. Dr. Jastreboff has identified 5 clinical syndrome patterns, and 2 sub-patterns, each of which uses different protocols for treatment, which he has described.
We find TRT offers tremendous relief to the greatest number of patients so long as they are willing to take the time and make the effort to learn and implement our recommendations. There are professionals who use their own abbreviated forms of what they term TRT. However, these alternate methods are not approved by Dr. Jastreboff as a form of TRT and do not, in our opinion, demonstrate clinically validated benefits to the degree as do the Jastreboff Methods.
Approximately 80 percent of those who stick with TRT through the 14-24 month treatment period, following the correct protocol, successfully habituate to tinnitus to a significant degree.
Randall Bartlett, our Tinnitus Audiologist, has completed training and certification by Dr. Jastreboff in Tinnitus Retraining Therapy, and has been treating patients using the Jastreboff Method since 1992. Mr. Bartlett has observed through many second opinion assessments and consultation of patients not progressing after being treated for TRT elsewhere, that these patients are commonly not using their devices properly, are using the incorrect sound signals and are not following Dr. Jastreboff's TRT protocols. Most often, patients are not aware of this. We have found the key to success is to follow the correct protocols and use of sound therapy devices, and have them set properly for hyperacusis or tinnitus. Often, devices appropriate for hearing are not suitable for tinnitus or hyperacusis management.
The habituation approach of TRT intends to alter the perception of tinnitus by reprogramming the auditory system and the attention processes of the brain. The first goal is to habituate to the reaction to tinnitus, return tinnitus to a level of less or no significance similar to in the past when the awareness of tinnitus was not perceived to be problematic. Tinnitus is then trained to reduce by habituation to more of a background sensation, rather than one of great significance in the foreground of perception and attention. The effect of altering the sound landscape of a sound environment with tinnitus progressively harder to find, is similar to reducing the appearance of a lighted candle in a dark room by turning up the room lights. Even though the candle's flame may still glow, it is much harder to see in a background of light rather than dark.
Through tinnitus counseling, patients are also taught how to refocus thinking and attention further and more frequently away from the tinnitus experience, which further accelerates the habituation process. Once habituation to the reactions to tinnitus is achieved, the "problem" is minimized and the process of habituation to the awareness and sensation of tinnitus altogether becomes more possible.
TRT retrains the brain to effectively recalibrate and redirect the auditory system, forming new therapeutically controlled, appropriate and acceptable neurological patterns and auditory memories of tinnitus upon which it can operate. As the retraining process continues, with repeated therapeutic sound exposure and attention control, neurons repeatedly firing together begin wiring together into increasingly stronger and more stable neurological patterns, which then becomes the new normal neurological and perceptual track. The auditory system reverts increasingly less to operating through the old neurological network patterns associated with tinnitus the way it used to be.
Effectively managed TRT looks at and uses many avenues to positively influence and strengthen the process of habituation to the reaction to and awareness of tinnitus, including specialized Informational and Directive Tinnitus Counseling and sometimes interdisciplinary care by cognitive behavioral psychotherapists, sleep medicine specialists, and other interdisciplinary healthcare providers.
TRT is performed at many leading tinnitus treatment centers, including the Veterans Administration medical system.