3. What happens in Tinnitus Retraining Therapy?
What is Tinnitus Retraining Therapy in detail?
Clinics vary, but will usually have the following elements:
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
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.
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.
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.
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
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.