Tinnitus Retraining Therapy and Other Sound-Based Treatments

When tinnitus does not go away, the goal of treatment usually shifts from silencing the sound to helping your brain stop paying attention to it. Several sound-based therapies are built around this idea, which is often called habituation or desensitization.

Why the brain amplifies tinnitus

Your brain constantly filters sound, deciding what is important and what can be ignored. You stop noticing the hum of a refrigerator because your brain has labeled it harmless. With tinnitus, the brain can do the opposite: it treats the sound as a threat, which triggers stress and makes you notice it more, which causes more stress. Sound-based therapies try to break that loop.

Tinnitus Retraining Therapy (TRT)

TRT was developed in the late 1980s by Dr. Pawel Jastreboff. It has two parts:

• Counseling. A trained clinician explains how hearing and tinnitus work, so the sound feels less threatening and more like a harmless signal.
• Sound therapy. You wear small sound generators, or use other sound sources, that play a gentle, broadband sound at a low level, set so you can still hear your tinnitus. The point is not to cover it up but to make it less distinct, so your brain gradually learns to treat it as background.

TRT usually takes 12 to 24 months. Studies have shown improvement for many people, though the research quality is mixed and it is not clear how much of the benefit comes from the counseling versus the sound.

Neuromonics

Neuromonics uses a small device with headphones that plays specially processed music, tailored to a person's hearing. It is typically used for a couple of hours a day over about six months. In the early phase the music partly covers the tinnitus to give relief. Later, the level is adjusted so the tinnitus is heard more often, to encourage desensitization. Some people report good results, but the evidence base is smaller than for other approaches.

Newer options

In 2023 the FDA cleared a device called Lenire, which combines sound through headphones with gentle electrical stimulation of the tongue. Early studies are promising, but it is new and not widely available.

What has the strongest evidence?

Cognitive behavioral therapy (CBT) has the most research support for reducing how much tinnitus bothers people. It is often combined with sound therapy. You can work with a therapist, use an online CBT program, or follow a structured self-help guide.

Getting started

An audiologist can tell you whether TRT or another sound therapy is a good fit. In the meantime, simple sound enrichment, such as a fan, soft music, or a nature sound app, is a safe, low-cost way to start.