Tinnitus FREQUENTLY ASKED QUESTIONS

Q: What is tinnitus?
A: Tinnitus is an auditory symptom described as a head or ear noise. It in itself is not a disease, but is one possible symptom or effect caused by nearly all types of hearing loss. It is a heightened activation of neuronal activity within the brains auditory and sometimes non-auditory systems. We distinguish between what causes tinnitus to emerge and what perpetuates it within the central processing of the brain. It is reported that 90% of patients with significant tinnitus demonstrate hearing loss. Also, in the very quiet conditions of a sound proof room, 94% of individuals with normal hearing also experience tinnitus.

Q: Does tinnitus cause hearing to get worse?
A: There is no clinical evidence of measurable changes in hearing thresholds or discrimination in the presence of tinnitus. However, tinnitus may be very distracting to the listener, and interfere with the attention process. Hearing is a sensory process, where sound causes a neurological signal to be generated in response and transmitted to the brain for processing. The ears neurologically respond the same regardless of tinnitus. Research shows hearing itself is almost always stable even when tinnitus changes. Listening, on the other hand, is the brains use of input from the ears and is an extremely active neurological, perceptual and cognitive process. The auditory system has many neurological links to other brain functions, such as the autonomic nervous system and limbic system (emotions). Anything that disrupts the listening process may seem, to the listener, to be a change in hearing. Other functions linked within the brain can be activated, however, due to ones subconscious reaction to tinnitus.

Q: What is Hyperacusis?
A: Hyperacusis is an abnormally strong physical reaction by the auditory pathways to sounds of specific physical characteristics, in terms of frequency and intensity. It is a disorder of the controlling mechanisms of the inner hair cells, the outer hair cells and the central auditory pathways in the brain. Hyperacusis may occur with or without tinnitus and with or without hearing loss as measured by a conventional audiogram. In TRT, when hyperacusis and tinnitus both occur, hyperacusis must be treated first before tinnitus is treated.

Q: What is Tinnitus Retraining Therapy (TRT)?
A: Tinnitus Retraining Therapy or TRT is also known as habituation-oriented therapy, desensitization therapy, the Jastreboff Method, or treatment based on the Neurophysiological Model. Its goal is to retrain the brain to turn down the neuronal activity of tinnitus and/or hyperacusis within the brain and its activation of non-auditory brain functions. TRT involves specialized audiological evaluations, the deliberate use of external sound on a full-time basis in a Sound Therapy program, frequently the use of table top and ear level sound devices called Sound Generators in cases of tinnitus, and counseling sessions. Treatment for hyperacusis generally involves a 6 month program, while treatment for tinnitus requires an 18-24 months program. When both conditions occur, Hyperacusis must be treated during the first 6 months first before the 18-24 month tinnitus program can begin.

Q: What does habituation mean?
A: Habituation is a condition where the individual responds less and less to a stimuli, such as tinnitus, to the point where it does not have any special negative meaning, and therefore it is much more difficult to detect. When one is totally habituated to tinnitus, cortical neurons in the brain no longer respond to it, and it is not heard.

Q: What is meant by residual inhibition?
A: Residual inhibition is a condition where cortical neuronal response to tinnitus or hyperacusis is not occurring.

Q: Does Tinnitus Retraining Therapy (TRT) cure tinnitus?
A: TRT does not cure tinnitus, but it may significantly relieve the negative impact and suffering that occurs, significantly reduce the awareness of tinnitus, and in some cases reduce the perception of tinnitus altogether, some or most of the time. TRT may eliminate symptoms of Hyperacusis altogether.


Q: Is TRT the only treatment for tinnitus?
A: No, but it has the highest significant rate of significant improvement of all approaches, up to 80%, when the Jastreboff Method protocols are exactly followed. The success rate is significantly lower when this method is modified or not followed, or other methods are used instead.

Q: My tinnitus changes daily. How relevant is that to TRT treatment?
A: It isnt. We measure the trend of tinnitus symptoms by periods of one month at a time, not daily or even weekly. Daily changes are normal.

Q: Are there any negative side effects from treatment?
A: No, TRT is safe. We also do not use any drugs or surgery.

Q: If I have already had hearing tests, do I need them repeated at your center?
A: Yes, we must make very specific measurements which are not routinely made in other clinics, and which must be done in a specific way. Our testing may be more extensive in some areas and is particular to TRT using the Jastreboff Method.

Q: What kind of tests is performed?
A: Testing includes a more extensive Audiogram and specific tests which allow us to evaluate the degree of tinnitus and hyperacusic behavior. This may also include a particular type of diagnostic Otoacoustic Emission test, which evaluates outer hair cell conditions within the inner ear.

Q: Will testing hurt my ears?
A: The tests begin with low levels of sound that only gradually get louder; therefore none of the tests will be painful.

Q: How is external sound used in TRT treatment?
A: In Sound Therapy, the auditory system is deliberately exposed to specific types of low level sound on a full-time basis during treatment, to induce habituation to tinnitus or hyperacusis. These sounds reduce the perceived contrast between tinnitus and silence to the brain, which fosters a decreased reaction or induced subconscious habituation to the presence of tinnitus and the therapeutic sound.

Q: What are Sound Generators used for?
A: Sound Generators provide a controlled constant low level of sound stimulation at times when you are not near a table top sound generator. TRT Sound Generators are not hearing aids however. As such, they do not amplify external sound like a hearing aid, but rather generate a specific type of controlled barely audible sound. We do not use them to mask tinnitus.

Q: What do the Sound Generators look like?
A: Sound Generators look like either small in-the-ear or over-the-ear hearing aids. Table top models look like a radio or CD player.

Q: How can I use TRT Sound Generators if I wear hearing aids?
A: We may be able to use hearing aids as part of your Sound Therapy treatment, depending on the type of aids you have.

Q: What is the difference between Masking Devices and TRT Sound Generators?
A: Maskers aim at blotting out the perception of tinnitus while devices are worn. When they are removed, tinnitus returns, as residual inhibition rarely occurs. Maskers are often much louder than TRT Sound Generators. TRT Sound Generators create an additional specific controlled low level sound to distract attention away from tinnitus. This helps you feel more comfortable and notice tinnitus less, as the brain subconsciously retrains itself to respond to tinnitus differently and less intensely. This is called residual inhibition. The goal is that even if you do hear tinnitus, your reaction will be much milder with much less discomfort. Reduced awareness of tinnitus is also possible, some or most of the time.

Q: What is included in the counseling sessions?
A: Counseling includes extensive discussions about the mechanisms of tinnitus, hyperacusis and hearing, how to manage external sound and sound generators, treatment progress and answering your questions and addressing your concerns. Completing the counseling sessions has been shown to have a very significant effect upon the TRT success rate.

Q: Will medications interfere with TRT?
A: Some may reduce the ability of the brain to retrain itself to habituate to tinnitus. In general however, if you are taking medications for any condition other than tinnitus, you will be able to continue on your medication.

Q: How long is TRT treatment?
A: TRT treatment averages 18-24 months, with some improvement often experienced after 6 months. The estimated average treatment time with TRT specialist over this 24 month period is 16 hours, which includes office visits, telephone consultations, testing and case management behind the scenes.

Q: What is the treatment guarantee?
A: There is none; however TRT centers using the Jastreboff Method report significant improvement in 80% of tinnitus cases and even higher success rates for hyperacusis...

Q: When do I return for tinnitus follow-up care?
A: Short 30 minute follow-up sessions for tinnitus are necessary following the initial evaluation and treatment at one month, two months, 3 months, five months, 9 months and 15 months. At every 6 months point longer consultation and re-testing sessions lasting up to 1 -2 hours are necessary. Some of the short follow-up sessions may be conducted by telephone if necessary, although an appointment to do so is required. We do not encourage telephone consultations however.

Q: When do I return for hyperacusis follow-up care?
A: Follow-up sessions at one month, 2 months, 12 weeks and 6 months are required, with some retesting at the first two sessions included. At the conclusion of hyperacusis treatment, treatment for tinnitus may begin if required.

Q: What will happen if I dont follow the protocol and treatment program completely?
A: There is a much greater chance of losing any improvement you may be achieving.