A change in nerve activity within the auditory system, often related to damage in the inner ear, results in the perception of tinnitus.  In some cases, the perception of tinnitus is associated with a negative emotion, such as fear or anger.  As a result, attention is focused on the tinnitus, which reinforces the initial response.  With increased attention, the tinnitus becomes even more annoying.  In most cases, the continued presence of tinnitus without any positive or negative association results in the person no longer noticing the sound, a process known as habituation.  Although the tinnitus may still be heard, there is little or no annoyance or discomfort.

To our knowledge there is no drug, procedure, or surgery that can eliminate the source of tinnitus without profound side effects.  The Tinnitus Retraining Therapy (TRT), which was developed by Dr. Pawel Jastreboff in mid 1980s offers a potential solution to this problem.  Since the source(s) of tinnitus cannot be removed, TRT works to block tinnitus-related nerve activity from reaching the level of the brain where it is perceived, and from activating the systems that create the negative emotions, that is, to habituate tinnitus perception and tinnitus-induced reactions.  

TRT uses a combination of low level, broadband noise and counseling to achieve the habituation of tinnitus.  The sound used in Tinnitus Retraining Therapy can be of various origins, but for both theoretical and practical reasons broadband noise generated by devices that are worn behind the ear is used.  Patients are advised to avoid silence and immerse themselves in a low level, emotionally neutral sound environment.  The process of retraining takes 12 to 18 months.  However, once tinnitus habituation is achieved, there is no need for continuing the treatment.  With habituation, the patient is no longer aware of their tinnitus, except when they focus their attention on it, and even then tinnitus is not annoying or bothersome.