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Form of habituation therapy for tinnitus

Tinnitus retraining therapy (TRT) is a form of habituation therapy designed to help people who experience tinnitus—a ringing, buzzing, hissing, or other sound heard when no external sound source is present. Two key components of TRT directly follow from the neurophysiological model of tinnitus: Directive counseling aims to help the sufferer reclassify tinnitus to a category of neutral signals, and sound therapy weakens tinnitus related neuronal activity. The goal of TRT is to allow a person to manage their reaction to their tinnitus: habituating themselves to it, and restoring unaffected perception. Neither Tinnitus Retraining Therapy or any other therapy reduces or eliminates tinnitus. An alternative to TRT is tinnitus masking: the use of noise, music, or other environmental sounds to obscure or mask the tinnitus. Hearing aids can partially mask the condition. A review of tinnitus retraining therapy trials indicates that it may be more effective than tinnitus masking.

Not everyone who experiences tinnitus is significantly bothered by it. However, some experience annoyance, anxiety, panic, loss of sleep, or difficulty concentrating. Not everyone is a good candidate for TRT. Those most likely to have a favorable outcome from TRT are those with lower loudness of tinnitus, higher pitch of tinnitus, shorter duration of tinnitus since onset, , lower hearing thresholds (i. e. better hearing), high Tinnitus Handicap Inventory (THI) score, and positive attitude toward therapy.

Although no studies have , TRT has been used to treat hyperacusis, misophonia, and phonophobia.

The first component of TRT, directive counseling, may change the way tinnitus is perceived. The patient is taught basic knowledge about the auditory system and its function, and how tinnitus and the annoyance associated with tinnitus is generated. The repetition of these points in follow up visits helps the patient come to perceive the tinnitus signal as a non danger.

The second component of TRT uses a sound generator to partially mask the tinnitus. This is done with a device similar to a hearing aid that emits a low level broadband noise so that the ear can hear both the noise and tinnitus. This is intended to acclimate the brain to reducing its emphasis on the tinnitus versus the external sound. One study found that a full tinnitus masker was just as effective as partial masking, nullifying a key component of habituation therapy. Other review studies have found no value to the sound therapy component of TRT.

Confounding factors make it difficult to measure the efficacy of TRT: tinnitus reporting is entirely subjective, varies over time, and repeated evaluations are not consistent. Researchers note there is a large placebo component to tinnitus management. In many commercial TRT practices, there is a large proportion of dropouts; reported "success" ratios may not take these subjects into account. There are few available studies, but most show that tinnitus naturally declines over a period of years in a large proportion of subjects surveyed, without any treatment. The annoyance of tinnitus also tends to decline over time. In some people, tinnitus spontaneously disappears. A summary in The Lancet concluded that in the only good study, TRT was more effective than masking; in another study in which TRT was used as a control, TRT showed a small benefit. A study that compared cognitive behavior therapy (CBT) in combination with the counselling part of TRT versus standard care (ENT, audiologist, maskers, hearing aid) found that the specialized care had a positive effect on quality of life as well as on specific tinnitus metrics.

Sound therapy for tinnitus may be more effective if the sound is patterned (i. e. varying in frequency or amplitude) rather than static. For people with severe or disabling tinnitus, techniques that are minimally surgical, involving magnetic or electrical stimulation of areas of the brain that are involved in auditory processing, may suppress tinnitus. Notched music therapy, in which ordinary music is altered by a one octave notch filter centered at the tinnitus frequency, may reduce tinnitus.

Cognitive behavioral therapy (CBT), the counselling part of TRT, as a generalized type of psychological and behavioral counselling, has also been used by itself in the management of tinnitus.

If tinnitus is associated with hearing loss, a tuned hearing aid that amplifies sound in the frequency range of the hearing loss (usually the high frequencies) may effectively mask tinnitus by raising the level of environmental sound, in addition to the benefit of restoring hearing.

White noise generators or environmental music may provide a background noise level that is of sufficient amplitude that it wholly or partially "masks" the tinnitus. Composite hearing aids that combine amplification and white noise generation are also available.

Numerous non TRT methods have been suggested for the treatment or management of tinnitus. pharmacological – No drug has been approved by the U. S. Food and Drug Administration (FDA) for treating tinnitus. However, various pharmacological treatments, including antidepressants, anxiolytics, vasodilators and vasoactive substances, and intravenous lidocaine have been prescribed for tinnitus
lifestyle and support – Loud noise, alcohol, caffeine, nicotine, quiet environments, and psychological conditions like stress and depression may exacerbate tinnitus. Reducing or controlling these may help manage the condition. alternative medicine – Vitamin, antioxidant, and herbal preparations (notably Ginkgo biloba extract, also called EGb761) are advertised as treatments or cures for tinnitus. None are approved by the FDA, and controlled clinical trials on their efficacy are lacking.