Tinnitus Retraining Therapy

Tinnitus Retraining Therapy

Tinnitus retraining therapy (TRT) was proposed by Jastreboff (1993). It involves the use of low level broad-band tone generators (placed in the ear like a hearing aid) and counseling to achieve "habituation." The aim of tinnitus retraining therapy is to redirect the brain's attention and focus away from the tinnitus.  In contrast to the typical use of "maskers," the noise therapy in tinnitus retraining therapy is set at a level such that the tinnitus can still be heard. The therapy is thought to enhance habituation by increasing the brain cell activity within the hearing part of the brain so the tinnitus is difficult to detect.
Bartnik and colleagues (2001) described a study of 108 patients with tinnitus.  The patients were divided into two groups: 68 patients with only tinnitus and 40 patients with tinnitus and hearing loss. Thirty-eight patients in the tinnitus only group were provided counseling and advised to avoid silence. The other 30 patients in the tinnitus group were given counseling and noise generators. In the second group of 40 patients, who had both tinnitus and hearing loss, 38 cases were given counseling and unilateral hearing aids.
A composite survey score was used to compare patients before and after treatment. In the group (counseling provided), significant improvement was reported by 80% of the patients. In the tinnitus only group who received counseling and noise generators, 73% of the reported improvement in tinnitus symptoms. In the second group with both tinnitus and hearing loss, 87% of the patients reported subjective improvement in tinnitus with the use of counseling and hearing aids to amplify environmental sounds. There were no statistically significant differences in treatment results between the two groups. The authors concluded the type of device used in tinnitus retraining therapy had no impact on treatment outcome and sound generators are not more effective than standard hearing aids. This study is limited by the lack of subject randomization and how 108 of their over 500 patients were recruited for the study.
Herraiz and colleagues (2005) reported their results of a prospective, non-randomized study of 158 patients assessing the effectiveness of tinnitus retraining therapy for tinnitus relief. Intensity and the Tinnitus Handicap Inventory scores were evaluated prior to tinnitus retraining therapy using both cognitive and white noise generators. Patients were evaluated at the end of 12 months of therapy. The authors reported that 82% of tinnitus retraining therapy treated patients improved with a Tinnitus Handicap Inventory score reduced from 48% to 32% and mean tinnitus loudness scores decreased from 6.6 to 5.3 (out of 10) when compared with an untreated group. This study, however, is limited how patients were divided among the two groups, the small number of patients included in the comparison groups, the use of patients on a "wait list" as a control group, and self-reported outcomes subject to bias.
Despite the suggested benefit of tinnitus retraining therapy reported in some of the peer-reviewed scientific literature, credible evidence is still lacking from randomized, controlled clinical trials comparing tinnitus retraining therapy with sugar pill therapies to sufficiently demonstrate the safety and effectiveness of this therapy for the treatment of tinnitus.

Advantages of Tinnitus Retraining Therapy for tinnitus treatment

Non-invasive
Effective in some patients

Disadvantages of Tinnitus Retraining Therapy for tinnitus relief

It requires wearing a device in the ear
The masking sound is not specific to the tinnitus (everyone gets the same sound)
It is very expensive ($3000) for whole duration of therapy
Very few audiologists are trained
It takes 12-18 months to reach improvement
Physicians at the University of California Irvine have developed a web-based customized sound therapy of tinnitus. For this breakthrough research-based tinnitus therapy click here.
References

  1. Bartnik G, Fabijanska A, Rogowski M. Effects of tinnitus retraining therapy (TRT) for patients with tinnitus and subjective hearing loss versus tinnitus only. Scand Audiol Suppl. 2001; (52):206-208.
  2. Herraiz C, Hernandez FJ, Plaza G, de los Santos G. Long-term clinical trial of tinnitus retraining therapy. Otolaryngol Head Neck Surg. 2005; 133:774-779.
  3. Jastreboff PJ, Hazell JW. A neurophysiological approach to tinnitus: clinical implications. Br J Audiol. 1993; 27(1):7-17.
  4. Jastreboff PJ, Jastreboff MM..Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance. Otolaryngol Clin North Am. 2003; 36(2):321-336.
  5. Jastreboff PJ, Jastreboff, MM. Tinnitus retraining therapy: a different view on tinnitus. ORL. 2006; 68(1):23-29.