2. Tinnitus Retraining Therapy: How does it work?

Sound is normally a valuable warning and alerting stimulus – for instance sound can be heard round corners, and in the dark. Therefore sound is naturally wired to generate alarm, producing the fight-or-flight response. However, the alarm in itself tells us that the sound is important, and this directs our attention to it and makes us hear the sound even more strongly. So the alarm generated by the sound becomes even greater. The result is that a vicious cycle can set in: tinnitus -> alarm 
-> tinnitus. The tinnitus is heard more strongly -> yet more alarm -> yet more tinnitus, until it can come to dominate someone’s life. This is particularly the case with something like tinnitus, where the sound is not only unwelcome, but the listener may feel helpless and unable to control it.

Tinnitus Retraining Therapy aims to reverse this process, (1) firstly by allowing the patient to achieve some control over the tinnitus, so reducing the sense of helplessness, and (2) then by reducing its significance, so it becomes like one of the background sounds that are present but not normally noticed. Indeed, a common outcome of therapy is that while the tinnitus is still present, it is no longer noticed, unless the patient’s attention is drawn to it (by reading about tinnitus, for instance).

A: Normally external sound at the ear will stimulate nerve cells in the brain (red). B: But if there is some hearing loss, some brain cells will not get a stimulus (white). So over time, they will learn to make their own activity (because nerve cells like to be active: red). C: This means that even when there is no external sound, these nerve cells will continue to be active, making sounds in the head (tinnitus: red). D: If this generates alarm, it tells the brain that the activity is important, and the activity will spread to other nerve cells, so the tinnitus can become louder.

What does Tinnitus Retraining Therapy involve?


Clinics will have their own favourite protocols, but there are two elements. (1) The first is reassuring psychological therapy, to reassure the patient that the tinnitus can improve over time, can be controlled, and does not signify the existence of serious underlying disease (except for the hearing loss). The patient is shown techniques to reduce the stress produced by tinnitus. (2) Patients are then given control over the tinnitus, initially by the use of appropriately-chosen maskers to hide the tinnitus, and then by the use of distracting sounds, so that the patient learns that even though he or she can hear the tinnitus, it has no significance for them.

Next page: What happens in Tinnitus Retraining Therapy?