Tinnitus Retraining Therapy for Beginners (What to Expect)

You may be experiencing a sound that others don’t hear, maybe a ringing, buzzing, hissing, or a sharp high-pitched whistle that never goes away. This constant sound could leave you feeling frightened, lonely and exhausted.

That’s tinnitus. Tinnitus occurs from the inside of your head – your hearing system and brain — not from anything in the outside world. When your brain recognizes it as a danger signal, your stress system activates and stays activated. This makes falling asleep difficult; it causes you to lose your concentration; and quiet times become unpeaceful.

Tinnitus Retraining Therapy (TRT) is a long term, evidence based method of helping your brain respond to the tinnitus as little as possible. TRT is not a magic solution or a solution to instantly eliminate tinnitus. TRT teaches your brain to react to tinnitus as a normal background noise; therefore, you will pay less attention to it and worry less about it.

In this article, you will find answers to some basic questions about what TRT is and how it works; what TRT appointments feel like; how long tinnitus retraining therapy lasts; and how to do tinnitus retraining therapy at home using simple techniques you can apply to your everyday activities.

What Is Tinnitus Retraining Therapy (TRT) and How Does It Work?

TRT is a treatment plan combining sound and counseling to decrease the amount of emotional response to tinnitus. Think about a refrigerator humming in the kitchen or car horns outside your window. Initially you hear them, then you realize they are not important and they fade into the background. Tinnitus Retraining Therapy (TRT) utilizes the same mechanism of the brain.

With the correct sound and proper education, your brain begins to realize, “this ringing is annoying,” but “it is not a threat.” Over time you begin to react less; your body remains more calm; and the sound appears less powerful, even though the sound is still present.

The Goal of TRT: Less Stress, Less Focus on the Ringing

The major concept of TRT is called habituation. Habituation is defined as your brain paying less attention to something that is not relevant.

When you achieve habituation, you may still hear tinnitus, but:

* You do not immediately go into panic mode.

* You fall asleep more easily.

* You can read, work or talk without the sound dominating your mind.

As a result, life becomes less burdensome, regardless of whether the sound is completely eliminated.

Key Parts of TRT: Counseling and Sound Therapy

TRT typically includes both counseling/education and sound therapy.

Counseling and Education:

* You learn what tinnitus is and what it is not.

* You discover why your brain responds to it with such intensity and how that can change.

* You receive tools to manage fear, stress and racing thoughts.

Sound Therapy:

* You utilize soft, consistent sounds that blend with your tinnitus.

* The sound is not loud, it simply keeps your brain from focusing on the ringing.

* Over time your brain begins to relax with regard to the sound rather than fight against it.

What to Expect From Your First Tinnitus Retraining Therapy Appointment

During your first TRT visit, you will essentially meet the provider and share information about you and your tinnitus. Providers, which can be audiologists or tinnitus specialists, will listen to you and assess your hearing, and develop a plan of action that fits your lifestyle.

There is no expectation that you arrive with everything figured out. Simply arrive and speak honestly.

Your Tinnitus Story: Questions Your Provider Will Ask

You will discuss:

* When did your tinnitus start and what does it sound like?

* How does your tinnitus affect your sleep, mood, focus and social interactions?

* Have you had any recent exposure to loud noises? Ear infections? Significant stress? Other health-related issues?

Writing down a few details prior to your appointment can assist. Consider writing down when the tinnitus is the loudest; what seems to trigger it; and what scares you the most. This can give you a sense of control prior to visiting.

Hearing Tests and Sound Checks: What Happens in the Exam Room

Most individuals will undergo:

* Standard hearing testing with beeping sounds in each ear.

* In some cases, a tinnitus pitch and loudness match to determine how loud your tinnitus sounds and which sounds might complement it for therapy.

Both tests are painless and commonly performed. These tests assist providers in determining your hearing, the perceived loudness of the tinnitus, and which sounds would provide good blending for therapy.

Building Your TRT Plan: Devices, Sounds, and Follow Up Visits

After your exam, you and your provider will discuss your plan of action. Your plan may involve:

* Sound equipment, including sound generators, hearing aids with sound features, mobile apps or simple sound machines.

* Periodic counseling appointments at first and decreasing frequency as your response to the tinnitus improves.

Typically, you will visit your provider monthly or bi-monthly at the beginning of the therapy process. As your responses improve, visits will generally become less frequent.

How Long Does Tinnitus Retraining Therapy Take and What Results Can You Expect?

Many TRT plans last between 12-24 months. While 12-24 months may seem lengthy, you may also observe smaller improvements during the initial months, possibly within several months.

Improvement is typically gradual and subject to fluctuations. Successful TRT means you are less distressed and less fearful of the sound, although not necessarily silent.

TRT Timeline: From the First Month to a Year and Beyond

Here is an example of how your progression might unfold:

* Weeks 1-2: You begin to learn about tinnitus and start your sound therapy. You are becoming accustomed to your new routine.

* Months 3-6: You may begin to notice you react less frequently to tinnitus, even if the tinnitus continues.

* Months 12+ : Tinnitus often ceases to dominate your daily life and may appear similar to a distant fan that you can ignore.

Each person progresses at their own rate. And that is fine.

What Progress Looks Like: Signs TRT Is Working for You

You may notice subtle changes:

* You fall asleep faster, even if the tinnitus is present.

* You remain awake for longer stretches without paying attention to the tinnitus.

* An increase in tinnitus produces annoyance, but not terror.

* You are able to focus at work, watch a movie or engage in a conversation without constantly checking in with the tinnitus.

Keeping a simple journal can be helpful. Each day, write brief descriptions of your sleep quality, stress levels, and the degree to which you were aware of the tinnitus. On challenging days, referring back to your journal will remind you of the progress you’ve made.

Common Challenges During TRT and How to Stay Motivated

Brain training is the nature of TRT. Brain training can be frustratingly slow. You may:

* Feel as though little to no progress is occurring initially.

* Become frustrated with additional sounds coming from devices.

* Feel as though quitting is a viable option when tinnitus increases.

Communicate openly with your counselor. The volume of the device can be adjusted. Counseling can shift to address areas that you find the most difficult to overcome. Remind yourself that, “this is a long-term process, not a quick fix. My brain is learning, even though I am not currently perceiving it.”

How to Do Tinnitus Retraining Therapy Day to Day (Including At Home)

While TRT is primarily an office-based procedure, it is also how you choose to live with sound and stress every day that is important. Therefore, tinnitus retraining therapy at home is significant.

Daily Sound Therapy Habits You Can Use at Home

You can use:

* White noise machines.

* Fans or air purifiers.

* Mobile apps featuring nature sounds or soft background music.

Play the sound softly enough that it blends with your tinnitus, but is not overpowering. The safe volume should be comparable to a conversation, not louder.

Using Counseling Tools in Real Life: Thoughts, Feelings, and Reactions

Your words to yourself matter. You can begin practicing the following thought shifts:

* From “this sound will drive me crazy”

to “this sound is safe, my brain is learning to tune it out.”

* From “I’m unable to handle this”

to “I was able to handle it yesterday, I can handle it today.”

Combine these thoughts with deep breathing exercises, brief breaks or gentle movements when the tinnitus is particularly loud. You are teaching your brain that “we can relax, even while the ringing is present.”

Sleep, Stress, and Lifestyle Habits That Support TRT

Your daily routines support your brain retraining. Helpful actions include:

* Maintaining a regular sleep schedule whenever possible.

* Utilizing soft background sounds at bedtime so silence does not amplify the tinnitus.

* Avoiding extremely loud noises, but not wearing earplugs throughout the entire day.

* Reducing consumption of caffeine and/or nicotine if you notice that they stimulate spikes in the tinnitus.

Small changes practiced regularly can produce positive outcomes.

Is Tinnitus Retraining Therapy Right for You?

TRT is not the only tinnitus treatment available, however it provides relief to numerous people who are tired of being plagued by tinnitus and are frightened of the tinnitus. It is likely to be most effective for you if you are willing to invest time in developing skills and strategies to manage the tinnitus, rather than seeking rapid solutions.

You can determine if TRT is a suitable choice for your circumstances after speaking with a hearing care professional or tinnitus specialist.

Who Can Benefit Most From TRT (And Who Should Ask for Extra Checks)

TRT is likely to benefit individuals when:

* The tinnitus occurred as a result of excessive noise or hearing loss.

* The tinnitus coincides with increased stress, anxiety, or depression.

* Individuals are highly disturbed by the tinnitus, even if standard hearing tests indicate only slight hearing loss.

If you have experienced sudden onset tinnitus, tinnitus confined to only one ear, dizziness, ear pain, or any other concerning symptoms, consult with a medical doctor or ear specialist immediately. Cases requiring a comprehensive evaluation must occur prior to initiating any form of therapy.

Questions to Ask Your Provider Before You Start TRT

Ask your provider questions in advance of your initial consultation. Some examples include:

* How many years of experience do you have utilizing TRT?

* What is included in your TRT program?

* What type of interval between appointments will be required? For how long?

* What are the costs associated with the TRT program? Will my insurance coverage assist with payment?

* What types of success have your clients typically achieved in terms of their tinnitus?

You are entitled to a provider who listens, communicates clearly and makes you feel comfortable and secure.

Key Takeaways

*Tinnitus Retraining Therapy (TRT) teaches your brain to ignore the tinnitus (noise).

It doesn’t eliminate the sound coming from your ears. Rather, it trains your brain to perceive the tinnitus as simply background noise, such as a refrigerator humming. After some time, your reactions to the tinnitus diminish, and so does your stress associated with it.

*TRT is made of two major elements; sound therapy and counseling.

Sound therapy provides your brain with a consistent, gentle sound to focus on, allowing the tinnitus to stand out less. Counseling educates you on what tinnitus is, how/why tinnitus occurs, and how your nervous system responds to tinnitus. Together, these provide the education needed to disrupt the vicious cycle of noise, fear, and stress.

*The ultimate goal of TRT is habituation-not finding a magic cure.

Habituation is your brain becoming accustomed to the tinnitus. Although you will likely continue to hear the tinnitus, it will no longer represent an emergency. The relief this brings, along with regaining control over the tinnitus, is significant.

*Tinnitus Retraining Therapy is a long-term commitment, and it is normal for it to take 12-24 months-or more.

This is a long term therapy process-not a short term fix. Progress is often slow and unpredictable, with good days and bad. Continuing through the program-even when it seems dull or worthless-is typically where real change begins to occur.

*Most often, sound therapy is based upon steady, neutral sounds designed to “soothe” the tinnitus.

People most commonly use sound generating devices placed behind the ear, hearing aids with sound feature capabilities, and other devices (fans, etc.) or apps that generate sound. Typically, the sound is relatively low volume and gentle, rather than loud enough to completely mask everything. The purpose of the sound is to combine the tinnitus with a more acceptable, less harsh sound environment.

*Counseling in TRT is not to tell you that tinnitus is “all in your head,” it is to assist you in altering your brain’s warning response.

You learn how the auditory system connects to the stress system and why tinnitus can seem so ominous. The counselor assists you in reframing frightening thoughts (such as “I’ll go crazy”) into less frightening, more rational thoughts. This can reduce your anxiety and give you the perception that you have regained control over tinnitus.

*TRT is most successful with a trained audiologist or tinnitus specialist.

They can assess your hearing, create a plan for the proper sound device(s), and guide you through counseling. You will receive a plan that is tailored to your hearing needs, your lifestyle needs, and your ability to manage stress. Attempting to “do-it-yourself” and perform both the sound and counseling aspects of TRT can be frustrating and disorienting.

*Tinnitus Retraining Therapy does not produce identical results for everyone-that is a factual aspect of the research.

Research has shown that many people experience a reduction in how much tinnitus bothers them after completing TRT. However, not everyone experiences the same level of relief. Some people experience a large reduction, while others experience a moderate reduction. A few individuals experience virtually no change. What affects the level of success of TRT is your initial stress level, how well you sleep, how much hearing loss you have experienced, and whether or not you have adequate support systems in place.

*TRT is generally safe and medication-free.

There are no medications in the central component of the TRT model. Only sound and counseling. This can be reassuring for those who are extremely sensitive to medications or are currently taking multiple prescription drugs. If you require additional treatments such as anti-anxiety medications or sleep aids, they should be coordinated with your doctor along with TRT.

*Consistent daily exposure to the steady, gentle sound is a crucial element in the TRT model.

TRT frequently requires that you maintain sound in your ears for many hours each day-even when you feel “fine.” The consistent sound allows your brain the opportunity to become educated that tinnitus is not a danger. If you constantly start and stop TRT, your progress will either come to a halt or slow dramatically.

*Your stress levels, sleep, and overall mental health influence the effectiveness of TRT.

When your anxiety is elevated or you have difficulty sleeping, the tinnitus can appear louder and more distressful. Many of the people who undergo TRT also utilize relaxation techniques, mild physical activity, and/or cognitive therapies for anxiety and/or depression. Supporting your entire nervous system is often beneficial in enhancing your TRT gains.

*Although Tinnitus Retraining Therapy is not the only therapeutic approach available for tinnitus, it does provide a structured approach and hope.

Some people attempt sound masking, cognitive behavioral therapy (CBT), mindfulness, or combinations of tools. TRT provides a structured, step-by-step model explaining the physiological changes occurring within your body and what you can do to improve your situation. Having a structured approach can alleviate feelings of isolation and confusion with respect to managing the tinnitus.

*Your attitude towards the therapy is more important than achieving perfection.

It is not necessary for you to adhere to every rule of TRT perfectly to realize some degree of benefit. Participating in the program, sharing your anxieties, and maintaining curiosity regarding small improvements in your reaction to tinnitus will aid you in your journey. It is less about doing TRT correctly, and more about gradually educating your brain that you are safe.

*Many individuals who participate in TRT and remain committed to the program report an improved quality of life, despite continued presence of the tinnitus.

As the tinnitus becomes less intimidating, individuals report they can engage in activities they previously avoided due to tinnitus (reading, enjoying hobbies, falling asleep without panic). Interpersonal relationships are often enhanced once the constant battle with tinnitus subsides. While the tinnitus may continue to exist, it is no longer controlling your thoughts, emotions, and actions.

*The key point: TRT provides you with tools to live effectively, regardless of the tinnitus continuing to exist.

It provides educational information, sound support, and emotional guidance to enable you to develop a calmer, less threatening relationship with the tinnitus. You don’t have to “tough it out” or pretend it is not bothering you. Through continued support and patience, you can develop a new relationship with the tinnitus in your ears.

Conclusion

Tinnitus Retraining Therapy is not about eliminating tinnitus entirely. It is about instructing your brain to care less about the sound, thus providing a greater sense of freedom and ability to participate in activities, despite the presence of tinnitus.

The therapeutic process involves a combination of time, sound and accurate educational materials, not solely relying on will power. Many individuals who previously believed themselves to be bound by tinnitus are now sleeping better, thinking more clearly and experiencing reduced anxiety due to their continued participation in the therapeutic process.

Your next step may be small. Write down your questions; monitor your tinnitus for a week; or arrange for a consultation with a tinnitus professional. You are not bound. With patience and the appropriate assistance, you may develop the ability to live comfortably, even with the presence of tinnitus.