Tinnitus Retraining Therapy (TRT)
A long-term program that pairs counseling about how tinnitus works with low-level sound, delivered by a trained audiologist or tinnitus specialist.
How does TRT work?
Tinnitus retraining therapy, usually called TRT, was developed by Pawel Jastreboff and has two parts. The first is directive counseling, where your clinician explains how tinnitus works, with the aim of changing how your brain classifies the sound. The second is sound therapy, using low-level sound through the day from small sound generators, hearing aids, or the sound around you.
The goal is habituation, meaning your brain gradually stops flagging the tinnitus as something that needs attention. TRT is aimed at your reaction to the sound.
The sound is set quietly enough that you can still hear your tinnitus alongside it. That is deliberate, because the idea behind TRT is that habituation happens to a sound your brain can still detect. People who have tried masking, where sound covers some or all of the tinnitus, are sometimes surprised by this.
Who is TRT for?
TRT is aimed at people whose tinnitus bothers them from day to day. It tends to suit people who want a structured program with a clinician alongside them, and who can commit to a long course. Understanding what is happening is a large part of the approach, since counseling is one of its two halves.
If sleep or distress is the most pressing problem right now, ask your clinician what can help in the meantime, since TRT is designed as a long course.
What does the evidence say?
Every treatment page on Tinnitus Support lays out the evidence the same way, so you can compare options on an even footing.
The studies
TRT has been used in clinics since the 1990s. A Cochrane review published in 2010 found only one trial that met its standards, with 123 participants. That trial suggested TRT helped more than masking, and the review judged its quality too low for firm conclusions.
The largest trial since then was run at six US military hospitals and published in 2019. It followed 151 people for 18 months and compared three groups. One had full TRT, one had TRT counseling with placebo sound generators, and one had standard care, which included its own counseling and encouraged using background sound.
What was found
In the 2019 trial, tinnitus distress fell in all three groups, and there was no meaningful difference between them. About half of participants showed a clinically meaningful reduction in how much tinnitus affected them. Participants had normal hearing or mild hearing loss, so the results say the most about people in a similar situation.
Guidelines address TRT's two parts separately. The 2014 guideline from the American Academy of Otolaryngology (the US professional body for ear, nose, and throat doctors) recommends educating patients about ways to manage tinnitus, and lists sound therapy as an option, which is a lighter grade. The same guideline recommends cognitive behavioral therapy (CBT), which carries stronger guideline support than TRT. The 2024 guideline from the US Department of Veterans Affairs and Department of Defense suggests sound enrichment with ongoing tinnitus education from an audiologist, naming TRT as one example. In the UK, the National Institute for Health and Care Excellence (NICE), which sets national health guidance, was unable to make a recommendation on sound therapy.
How TRT is provided
TRT is a treatment program delivered by trained clinicians, so there is no product for the US Food and Drug Administration (FDA) to clear. Any hearing aids or sound generators your clinician fits are medical devices in their own right.
Worth knowing
TRT has a long history in clinical practice, and its published trial evidence is limited. Both are worth knowing before you start a program that runs for a year or more.
Ask your clinician what progress should look like at six months, so you both have a point to check against.
Sources. Cochrane review CD007330, Tinnitus retraining therapy for tinnitus, 2010. Tinnitus Retraining Therapy Trial Research Group, JAMA Otolaryngology Head and Neck Surgery, 2019. AAO-HNSF Clinical Practice Guideline, Tinnitus, 2014. VA/DoD Clinical Practice Guideline for Tinnitus, 2024. NICE guideline NG155, Tinnitus assessment and management, 2020. Aazh and colleagues, simplified tinnitus retraining therapy, BMC Ear, Nose and Throat Disorders, 2008.
Last reviewed September 2026
Tinnitus Retraining Therapy FAQs
How long does TRT take?
A full course usually runs 12 to 24 months, which is longer than the other options on this site. In the original protocol, that time includes around seven clinic sessions, with sound therapy through the day in between. Your clinician can tell you how they structure the program and how often they expect to see you.
Will TRT make the sound go away?
TRT is designed to change how your brain responds to tinnitus, so it stops flagging the sound as something that needs attention. The tinnitus stays audible during treatment. In the largest trial, about half of participants showed a meaningful reduction in how much tinnitus affected them, and your clinician can talk through what to expect.
Is TRT the same as masking?
Masking uses sound to cover some or all of the tinnitus while it is playing. TRT sets the sound below that level, so you can still hear your tinnitus alongside it. The aim there is gradual habituation over months, and the sound feels quite different to live with, so it helps to know which one you are being offered.
Do I need hearing aids or sound generators for TRT?
TRT uses low-level sound, which can come from small ear-level sound generators, hearing aids, or enriched background sound at home. If you have hearing loss, hearing aids are often part of the plan. Your clinician recommends a setup based on your hearing test and your tinnitus, and can explain what each device is for.
How does TRT compare with cognitive behavioral therapy?
Both work on your reaction to tinnitus. Clinical guidelines give stronger support to CBT, and the largest TRT trial found similar results for TRT and standard counseling-based care. Your clinician can talk through which approach, or which mix of approaches, fits your situation and what you hope to change.
What should I ask before starting TRT?
Ask how many sessions the program includes, which sound devices it uses, and how long it is expected to run. It helps to ask what progress should look like at six months, so you both have a point to check against. A clear plan at the start makes it easier to review how things are going.
Ready to talk it through?
Clinics listed on Tinnitus Support that offer TRT can assess your tinnitus and hearing, and explain how they run the program.
This page is for general information about tinnitus treatments. It does not replace advice from an audiologist or doctor who has assessed your hearing. Treatment suitability and results vary from person to person.
Published September 2026 ยท Last reviewed September 2026