3. What happens in Tinnitus Retraining Therapy?

What is Tinnitus Retraining Therapy in detail?

Clinics vary, but will usually have the following elements:

1. The first stage should be an audiometric examination by a qualified clinical audiologist. This will diagnose any underlying disease and quantify any hearing loss. If possible, the hearing loss may be corrected (for instance, the hearing loss may arise from wax in the ears or a middle ear infection, or if arising in the inner ear – the cochlea - a hearing aid may be prescribed). In rare cases, there may be a dysfunction that needs attending to surgically (e.g. a thinning of bone between blood vessels and the auditory nerves).

2. The tinnitus is measured in level and type (where possible), by asking the patient to match it in loudness and sound quality with an external sound provided by the audiologist.

3. Psychological counselling is provided to explain the therapy, reduce anxiety and reassure the patients that in a high proportion of cases there is successful control of the tinnitus.

4. The next stage may be to mask the tinnitus so that it is no longer heard, or not heard as loudly as before. A masker is chosen of the correct pitch and loudness, to hide the tinnitus. This enables the patient to regain some control over the tinnitus and reduce the stress and anxiety associated with it.

5. The stage after is to provide a distracting stimulus, which sounds rather like the tinnitus (but is clearly different) and which is under the control of the patient. The distracting stimulus is presented quiet enough so that it can be heard at the same time as the tinnitus. This distracts attention away from the tinnitus (helping to break the vicious cycle referred to earlier). Because the tinnitus can still be heard but does not attract attention, the distractor reduces it to a sound of no significance (also helping to break the vicious cycle). Eventually, the result (over many weeks or longer) is that the tinnitus is no longer heard.

The distracting stimulus should not only sound a bit like the tinnitus (though should be clearly distinguishable), but should fluctuate in time. It should be pleasant and relaxing to listen to, one of those sounds that fades into the background if not attended to. It may be the same as the tinnitus masker, but quieter. In that case, the protocol is to listen to the masker for a few (or more) hours per day for 2-3 weeks, and then gradually reduce its intensity, until the tinnitus is only just heard again. Over time, as the tinnitus becomes quieter and quieter, the distracting stimulus is made quieter and quieter as well, so that the tinnitus and distractor can both be heard at the same time. Eventually, the distractor will be turned so quiet that it is found that it is no longer needed.

Broadband noise may well not be a good masker or distractor, because it may add loudness to the tinnitus while contributing little to masking or distraction (i.e. will make the tinnitus sound worse, not better).

Next page: Masking, distracting, and relaxing sounds.