What Is Tinnitus Retraining Therapy?
Tinnitus Retraining Therapy, or TRT, isn’t about making the ringing in your ears disappear. It’s about teaching your brain to stop noticing it. Developed by Dr. Pawel Jastreboff in the early 1990s, TRT is built on a simple but powerful idea: your brain has already learned to treat tinnitus as a threat. TRT reverses that learning.
Unlike hearing aids or masking devices that try to cover up the noise, TRT works at the neurological level. It targets the connection between your auditory system and the parts of your brain that control emotion and stress-the amygdala and the anterior cingulate cortex. When these areas are overactive, tinnitus feels unbearable. TRT helps calm them down.
How TRT Works: Two Key Pieces
TRT isn’t one thing. It’s two tightly linked parts: counseling and sound therapy. Neither works well without the other.
The counseling part is where most of the change happens. You sit down with a trained audiologist who explains exactly how tinnitus forms in your brain. They show you diagrams of the cochlea, how sound travels through your ear, and how the brain can misinterpret harmless neural noise as a problem. You learn that tinnitus isn’t damage-it’s a glitch in the system. This isn’t just information. It’s a mental reset. When you stop fearing the sound, your brain stops reacting to it.
These sessions happen monthly at first, then every few months over 12 to 24 months. Each one lasts about an hour. There’s no pressure. No quick fixes. Just clear, science-backed explanations that slowly reframe your experience.
Sound Therapy: The Quiet Background
The second piece is sound therapy. This isn’t about blasting music or white noise to drown out the ringing. It’s the opposite.
You wear small devices-like hearing aids or low-level sound generators-that emit a soft, steady sound. Think of it like the hum of a refrigerator or distant rainfall. The volume is set just below your tinnitus level. Why? To reduce the contrast between your tinnitus and the silence around it. When your brain has something neutral to focus on, it stops fixating on the ringing.
You wear these devices for 6 to 8 hours a day, every day. That’s not optional. The goal is constant, gentle exposure so your brain gets used to the sound pattern. Over time, your brain stops tagging it as important. That’s habituation.
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, bothersome tinnitus → uses sound generators only
- Group 2: Hearing loss, no tinnitus in quiet → uses hearing aids only
- Group 3: Hearing loss with tinnitus → uses both hearing aids and sound generators
- Group 4: Tinnitus plus sensitivity to everyday sounds (hyperacusis) → specialized protocols
If you have hearing loss, your hearing aids can often double as sound generators. That cuts cost and complexity. If your ears are overly sensitive to noise, TRT can help with that too-without using earplugs or silence, which make things worse.
What Does Success Look Like?
Success in TRT isn’t silence. It’s freedom.
People who complete TRT don’t suddenly stop hearing the tinnitus. Instead, they notice it only 5% to 15% of the time during waking hours-down from 80% to 100% before treatment. They don’t get startled when it pops up. They don’t lie awake worrying about it. They go about their day without checking if it’s louder today.
Studies show 80% of patients who stick with the full protocol see a major drop in distress, measured by tools like the Tinnitus Handicap Inventory. A 2019 review found TRT improved scores 13 points more than standard care. That’s not a small change. That’s life-altering.
Why Some People Don’t Benefit
TRT isn’t magic. It’s work. And not everyone sticks with it.
Thirty to forty percent of people quit before the 12-month mark. Why? The daily sound therapy feels tedious. Monthly appointments take time. The counseling can feel slow. Some people expect results in weeks, not months.
There’s also a big difference between certified TRT providers and those who just use “TRT-like” methods. A 2020 study found certified practitioners achieved 85% success rates. Non-certified providers? Only 55%. That’s a huge gap. If you’re considering TRT, ask if your provider is officially trained by the Jastreboff Foundation. Certification requires 40 hours of training plus supervised clinical work.
Cost, Time, and Accessibility
TRT isn’t cheap. In the U.S., the full program typically costs between $2,500 and $4,000. Sound generators run $500 to $1,200 each. Insurance rarely covers it, and Medicare doesn’t either.
But here’s the real cost: time. You need to commit to daily sound use and regular visits for up to two years. That’s hard if you work full-time, live far from a specialist, or have trouble with consistency.
That’s why things are changing. In 2021, the Jastreboff Foundation launched a telehealth certification program. Now, some providers offer virtual counseling and remote monitoring. It’s not perfect, but it’s making TRT more accessible than ever.
TRT vs. Other Treatments
TRT isn’t the only option. Cognitive Behavioral Therapy (CBT) is the other evidence-backed approach. Both are recommended by the American Academy of Otolaryngology.
CBT focuses on changing thoughts and behaviors around tinnitus. It’s great if anxiety or depression is driving your distress. TRT works deeper-on the brain’s automatic response to sound.
Many people use both. CBT helps with panic attacks. TRT helps with the brain’s wiring. They’re not rivals. They’re teammates.
Other methods-like acupuncture, supplements, or apps that play “tinnitus-relief” sounds-have little to no scientific backing. Don’t waste your money on them.
What’s New in TRT?
Research is moving fast. A 2023 clinical trial is testing TRT combined with transcranial magnetic stimulation (TMS). Early results show 92% of patients improved in just six months-faster than TRT alone.
Also, more hearing clinics are starting to blend TRT principles into standard care. You don’t need a full TRT program to benefit. Even basic counseling and gentle sound enrichment can help.
As of 2023, there are only about 500 certified TRT providers in the U.S. But that number is growing. The key is finding someone who knows the protocol inside and out.
Is TRT Right for You?
Ask yourself these questions:
- Do you feel anxious or overwhelmed by your tinnitus?
- Do you avoid quiet places because of the ringing?
- Have you tried masking or noise-canceling apps and still feel stuck?
- Are you willing to commit to daily sound use and monthly visits for a year or more?
If you answered yes to the first three and maybe to the last one, TRT could be your best path forward.
It’s not the fastest solution. But it’s the most durable. Once your brain learns tinnitus isn’t a threat, the relief lasts. You don’t need to keep using the devices forever. You don’t need to keep going to therapy. The change sticks.
Where to Start
Find a certified TRT provider. The Jastreboff Foundation maintains a registry on their website. Look for audiologists who mention “TRT certification” and the neurophysiological model in their bios.
Don’t settle for someone who says, “We do sound therapy.” Ask: “Do you use the full Jastreboff protocol?” If they don’t know what you mean, keep looking.
Start with a hearing test. If you have hearing loss, get hearing aids first. They can often do double duty as sound generators.
Be patient. The first three months are the hardest. But by month six, most people start noticing a shift. Not because the ringing changed. Because they did.