Tinnitus Retraining Therapy with a Doctor of Audiology

I’m here to explain the fundamentals of tinnitus retraining therapy (TRT), one of the most commonly used clinical tools to manage tinnitus.

Many patients succeed with tinnitus retraining therapy. And those who succeed learn one thing very well. The key here is to control our negative reactions towards the tinnitus. When we do that effectively, the volume of your tinnitus, and its quality, may improve over time.

We don’t really have direct control over the loudness of our tinnitus. But we do have some direct control over how our negative emotions can create stories or certain feelings towards our tinnitus.

In this article, I’m going to walk you through the fundamentals of tinnitus retraining therapy, as it was taught to me at one of the best hospitals in California. And I’m going to pretend like you’re my patient and walk you through some of the basic steps in the treatment protocol. If you prefer to watch a video to help you understand TRT, I made a video you can watch here:

Dr. Thompson’s video about the basics of tinnitus retraining therapy.

Tinnitus Retraining Therapy Fundamentals

The first part of tinnitus retraining therapy is to explain how we hear. Let’s go over the anatomy of the hearing system. It starts with the eardrum, then into the middle ear bones, and eventually to the cochlea, the hearing organ. Our hearing organ is shaped by pitch, meaning that the different turns of the hearing organ in the cochlea have different resonances for different pitches.

So the very center of your cochlea has a resonance towards bass or low frequency sound. Whereas the outer edge of your cochlea is most sensitive or resonates most with high frequency or treble sounds, it’s most common that sudden or prolonged loud noise exposure has an effect on tinnitus.

The loud noise exposure creates a damage to the high frequency or high pitch treble area of the cochlea. So when those cells are damaged, it has an effect going all the way up to the auditory brain. When you hear a high-pitched ringing in your ears, it’s actually because those high frequency resonant cells in your cochlea have been damaged.

Turns out that you don’t need significant loud noise exposure to get tinnitus. Tinnitus can also occur through the natural aging process associated with a hearing loss. So when those high frequency or high pitch cells of your cochlea are not sending signals through all the way to your auditory brain, then your auditory brain has this phenomenon where it creates this phantom sound.

The very sound that your ear cannot pass through, is heard in your brain. Your ear therefore acts like a filter. It filters out the soft high pitch treble noise. And that’s the exact sound of tinnitus that you hear from your auditory brain.

The Auditory Neuroscience You Need To Know

In order to fully understand tinnitus, we have to talk about some brain anatomy. There’s three parts to the brain that are relevant to tinnitus. We have the lower brainstem, the reptilian brain, we have the emotional brain which contains our limbic system, and we have the cortex. The only reason that tinnitus is bothersome, is because we have parts of our brain that can label it as bad or bothersome. And that sends a response through the rest of our body.

The meaning of every sound is a conditioned response. We learn that certain sounds have a relationship with certain things, or certain experiences. So the sound of rain typically is calming, relaxing, and settles us down. It’s peaceful.

Whereas the sound of a snake, the hissing of a snake, creates a high-alert response of danger and fear. We have a conditioned response to the sound of rain, and we have a conditioned response to the sound of a snake hissing, however, objectively they’re both just noise.

We live our lives based on the meaning of noise. So what is the true meaning of tinnitus?

Why Does Tinnitus Affect Some But Not Others?

The physiological explanation of tinnitus is that your ear is acting as a filter, not sending the sound all the way up through the brain, and the brain is making a phantom response because it’s not receiving that input. That’s the true meaning of tinnitus.

For a majority of people, this explanation is crucial in the process of tinnitus retraining therapy. Without fully understanding that aspect of the emotional brain, it’s hard to make significant gains for the remainder of the treatment sessions. A key to tinnitus retraining therapy is learning how to control your reaction.

There was a study of thousands of patients with persistent tinnitus who heard it most times throughout the day. And 85% of those people reported that their tinnitus wasn’t a problem in their lives. But around 15% of people reported it was a significant problem.

The research suggests that it’s not the loudness of the tinnitus that creates the bothersome response. But instead, it’s the emotional reaction by the individual that can create this bothersome experience of tinnitus.

Now many people with tinnitus find that very hard to believe. But that is what the research shows us. TRT is called tinnitus retraining therapy because you have to work and train yourself to think differently about your tinnitus.

How Effective Is Tinnitus Retraining Therapy?

There’s an active component to this, and there’s a passive component. The active component involves how we think about our emotions, and how we observe and process our feelings of tinnitus. The passive component is a natural habituation, where when certain things are set up correctly, and with your proper guidance, habituation can naturally take place over time.

Both the active and the passive components of tinnitus retraining therapy are important to make significant improvement. So for some of my patients, this is their first step into the door of understanding how their subconscious mind works. Their first step towards observing their feelings, their emotions, and their thoughts. It may surprise us how a lot of those thoughts can be negative.

Tinnitus retraining therapy has success rates of over 80%. It’s sometimes hard to measure the loudness of tinnitus. And as we discussed earlier, that’s not the best metric to determine who is doing well with their tinnitus and who is not.

The best way to measure the effectiveness of tinnitus retraining therapy is through questionnaires that have been scientifically validated. Here is a link to the Tinnitus Functional Index (TFI). I recommend to use this guide for scoring it.

Tinnitus retraining therapy is twofold. On one side of tinnitus retraining therapy is the psychological component. On the other side is having a sound rich environment.

So for the psychological component, there’s a few factors at play. Number one is learning about habituation and developing awareness of our own internal mind. Methods that have proven to be successful with the psychological aspect of tinnitus retraining therapy involve habituation, mindfulness, cognitive behavioral techniques, and some forms of meditation.

Psychology & Sound Therapy

Creating a sound rich environment is the other aspect of tinnitus retraining therapy. This can be as simple as using sound in your everyday life. For example, using a fan when you’re trying to fall asleep or using a white noise machine throughout your day. It’s common to feel like you can’t tolerate some situations because it’s so quiet and all you hear is the ringing in your ears. Fortunately, you can use sound intelligently in your day-to-day life to improve those specific situations that really frustrate you.

Some other options for having a sound rich environment involve wearing small hearing devices on your ears to play relaxing, calming sounds into your ears throughout the day. Those are called ear level noise generators. I’ll explain them more in detail on my YouTube channel.

Tinnitus Retraining Therapy & Hearing Aids

Another useful way to have a sound rich environment when you’re trying to manage tinnitus using the tinnitus retraining therapy model is to use modern hearing devices or hearing aids. This is relevant if you have a hearing loss. The devices amplify the soft sounds that you can’t hear. It’s amazing how many of my patients have reported an immediate positive effect on their tinnitus because they put on hearing aids.

If you have a hearing loss, wearing hearing aids can give that immediate relief sensation because they stimulate your auditory system. I would recommend going to get a hearing test from an audiologist. Hearing aids may help your hearing loss as well as your tinnitus.

Tinnitus retraining therapy is typically performed over a series of appointments. Oftentimes, the first appointment gives the patient a great starting block and a path to move forward with their tinnitus.

One aspect that you were not able to get today through this post was the individualized nature of the appointment. You have your specific lifestyle and tinnitus affects you in unique ways. In a personal session, I would ask you questions about your history and relate every point we covered back to you and your life.

Tinnitus Retraining Therapy Cost

The cost of tinnitus retraining therapy (TRT) depends on how many sessions your audiologist recommends and whether or not you need hearing aids to aid your treatment. One TRT session may cost between $150-$300. A pair of hearing aids can cost $3,000-$6,000. Tinnitus retraining therapy that includes hearing aids is likely to cost thousands of dollars.

Next Steps In Your Journey

Right now think about the top three situations where you notice your tinnitus causing problems in your life. Write down those three problems in the comments below so that your community here at Pure Tinnitus can support you in this.

It’s been a pleasure to help you better understand tinnitus retraining therapy. I do offer one on one tinnitus retraining therapy and counseling. That’s how you can get in contact with me.

Remember, take your tinnitus journey one step at a time.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson is an audiologist in California and founder of Pure Tinnitus. Dr. Thompson has a comprehensive knowledge of tinnitus management. He completed his residency at University of California at San Francisco (UCSF) and is a past board member of the California Academy of Audiology. Via telehealth, Dr. Thompson provides services to patients with hearing loss and tinnitus.

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