Tinnitus Retraining Therapy

Michael PiskoszBy Michael Piskosz

Tinnitus Retraining Therapy (TRT) focuses on breaking the vicious cycle of Tinnitus annoyance.  This approach is based on the neurophysiological model of Tinnitus and educates the individual in how to ultimately habituate to the Tinnitus. Habituation is the process of retraining the brain from conditioned responses.  In TRT the habituation process turn the Tinnitus from a negative signal back into a neutral signal, diminishing any negative emotions towards the Tinnitus.

Tinnitus Vicious Cycle Chart








Sound therapy therefore plays an important role in TRT by decreasing the contrast between the loudness of the Tinnitus and the background noise.  There are strict rules as to what sounds should be used to increase the background environment.

  • The external sound being used should not provoke any negative reactions, irritate or annoy the user
  • It is important to maintain the perceptual characteristics of the Tinnitus
  • Sounds should not draw attention, interfere with other important signals of interest, such as speech, or affect daily activities
  • Sounds should not fully mask the Tinnitus (the Tinnitus signal should be audible), as this will prohibit habituation from occurring (you can’t habituate to something you can’t hear)
  • Sounds should have stable continuous amplitudes (easier to habituate to than fluctuating sounds)
  • Users should have the ability to control the volume of the sound to optimize habituation
  • Broadband noise is a good choice (stimulates a wide range of neurons)

Michael Piskosz discusses Tinnitus Retraining Therapy in detail in his article “The Role of Wireless Streaming in Tinnitus Management“.


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