Tinnitus retraining therapy (TRT) explained: how it works and what the evidence says

Tinnitus retraining therapy (TRT) combines structured counselling with low-level sound, usually from small devices worn in the ear, to help you get used to tinnitus until it bothers you less. Many people improve during TRT, but in the largest trial so far people improved just as much with standard care. It is a long programme of a year or more, and cognitive behavioural therapy has stronger evidence.

Last reviewed: 28 October 2026

By the Tinnitus Haven editorial team. Sources are listed at the end of the page.

• Treatment
• Sound therapy

What is tinnitus retraining therapy?

TRT is based on a neurophysiological model of tinnitus described by Pawel Jastreboff^{[1, 2]}. In this model, tinnitus becomes a problem when the sound is linked with the brain systems for emotion and stress. TRT aims to weaken that link, so that you first react less to the tinnitus and later notice it less^[2].

It has two parts^{[2, 3]}:

• Directive counselling: structured explanations of how hearing and tinnitus work, meant to help you see tinnitus as a neutral sound rather than a threat.
• Sound therapy: continuous, low-level sound, usually from a small device worn in the ear, to help you get used to the tinnitus.

The Cochrane review describes TRT as one of the most widely used tinnitus treatments, and notes that many studies use modified versions rather than the strict protocol^[1]. In Germany, specialists adapted TRT in 2000 to include elements of cognitive behavioural therapy, delivered by a team of an ENT doctor, a psychotherapist and a hearing aid professional^[4].

Does TRT work?

• A 2010 Cochrane review found only one trial, with 123 people, that followed the strict TRT protocol. It suggested TRT was much more effective than tinnitus masking, but it was a single trial of low quality^[1].
• The largest trial so far, the US Tinnitus Retraining Therapy Trial (2019), randomised 151 people with moderate to severe tinnitus to full TRT, TRT counselling with placebo sound devices, or standard care. After 18 months all three groups had improved by a similar amount, and about half of the participants had a clinically meaningful improvement. TRT did no better than standard care^[5].
• In a 2017 trial in people with tinnitus and hearing loss, both TRT with combination hearing aids and standard care with hearing aids led to lasting improvement over 18 months, with a somewhat larger effect after TRT^[6].
• A 2025 systematic review of 15 randomised trials with 2,069 people found that TRT did not work better than the approaches it was compared with, such as tinnitus masking, educational counselling or usual care^[7].

The sound devices seem to add little: counselling with placebo devices did just as well as full TRT^[5], and the German guideline concludes that noise devices bring no additional benefit^[4].

What do guidelines say?

• Germany (S3 guideline, 2021): TRT can be considered as a long-term approach of at least 12 months for chronic tinnitus, based on weak evidence; noise generators are not needed^[4].
• United Kingdom: NICE made no recommendation on sound therapy or on combining it with other support, and asked for more research^[8]. The NHS says TRT may be available on the NHS for severe or persistent tinnitus, that it is unclear whether it works for everyone, and that it is widely available privately^[9].
• United States (AAO-HNSF, 2014): sound therapy is an option clinicians may offer for persistent, bothersome tinnitus, while cognitive behavioural therapy is recommended^[10].

How is TRT different from CBT?

Both aim to make tinnitus less distressing, and both include education about tinnitus. TRT combines directive counselling with sound. Cognitive behavioural therapy is a psychological therapy that works on the thoughts and behaviours that keep distress going, and in tinnitus care it is usually delivered by psychologists^{[11, 8]}.

The evidence differs too. A Cochrane review of 28 trials found that CBT probably reduces the impact of tinnitus more than audiology-based care^[11]. Only one small trial, with 42 people, compared CBT directly with TRT. It suggested that CBT may reduce the impact of tinnitus more, but one small study is not enough to be sure^[11]. Guidelines in the UK, the US and Germany all recommend CBT^{[8, 10, 4]}. See our guide to CBT for tinnitus.

What does TRT involve in time and cost?

• Time. TRT is a long programme. The German guideline only supports it over at least 12 months^[4], and the main trials followed people for 18 months^{[5, 6]}.
• Appointments. The German guideline describes three to five steps, from a detailed tinnitus history to sound therapy with a device and counselling^[4].
• Devices. Classic TRT uses sound generators worn in the ear^[3], or combination hearing aids if you also have hearing loss^[6]. The evidence suggests the devices themselves add little^{[5, 4]}.
• Cost. In the UK, TRT may be available on the NHS for severe or persistent tinnitus and is widely offered privately^[9]. Before you commit to a private programme, ask what the total price includes, such as sessions, devices and follow-up, and whether you really need to buy sound generators.

Is TRT right for me?

If you are considering TRT, it is worth asking the clinic whether they follow the full protocol or a modified version, how long the programme lasts, what is included and how your progress will be measured. If you have hearing loss, hearing aids come first^{[8, 4]}; see hearing aids and tinnitus. If your main difficulty is distress, anxiety or poor sleep, ask about cognitive behavioural therapy, which has the strongest evidence^[11].

Related guides

• CBT for tinnitus
• Sound treatment and notched sound
• Hearing aids and tinnitus
• Tinnitus treatment options
• All tinnitus guides
• FAQ and support: questions about the Tinnitus Haven app

Tinnitus Haven brings sound therapy, a hearing check and CBT-based lessons together in one calm iPhone app, coming soon to the App Store. Learn more about Tinnitus Haven.

Sources

1. Phillips JS, McFerran D. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Database of Systematic Reviews, 2010.
2. Jastreboff PJ. 25 years of tinnitus retraining therapy. HNO, 2015.
3. National Institute on Deafness and Other Communication Disorders (NIDCD), NIH. Tinnitus. 2023.
4. Mazurek B, Hesse G, Sattel H, et al. S3 Guideline: Chronic Tinnitus. German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC). HNO, 2022. English version of the German AWMF guideline 017/064 (2021).
5. Tinnitus Retraining Therapy Trial Research Group; Scherer RW, Formby C. Effect of tinnitus retraining therapy vs standard of care on tinnitus-related quality of life: a randomized clinical trial. JAMA Otolaryngology, Head and Neck Surgery, 2019.
6. Bauer CA, Berry JL, Brozoski TJ. The effect of tinnitus retraining therapy on chronic tinnitus: a controlled trial. Laryngoscope Investigative Otolaryngology, 2017.
7. Alashram AR. Effects of tinnitus retraining therapy on patients with tinnitus: a systematic review of randomized controlled trials. European Archives of Oto-Rhino-Laryngology, 2025.
8. National Institute for Health and Care Excellence (NICE). Tinnitus: assessment and management (NG155), Recommendations. NICE guideline, 2020.
9. NHS. Tinnitus. NHS website, 2024.
10. Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngology, Head and Neck Surgery, 2014 (AAO-HNSF).
11. Fuller T, Cima R, Langguth B, et al. Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews, 2020.