The model is based on basic, well-established neurophysiological and psychological principles. Mainly:

1. The processing of information occurs on different levels for each sensory system, each level contributing to the final stage when a signal reaches the cortex.
2. The auditory system is closely connected with the part of the brain that controls emotions and the automatic response of the body to danger.
3. Connections within the nervous system are continuously modified, resulting in the enhancement of significant signals, and a decrease of neuronal response to irrelevant signals.
4. Sounds that are new, or associated with a negative experience, are treated as significant; evoke an emotional response that triggers the body to prepare for “fight or flight.” The repetition of these sounds results in the enhancement of their perception to be suppressed by other signals. The repetition of signals not associated with positive or negative reinforcement results in the disappearance of a response to their presence, i.e. habituation.
5. The detection of sound occurs on a pattern-matching principle, allowing for nearly complete perception of a signal even when it is highly distorted.

The main point of the theory of tinnitus based on these neurophysiological principles is the postulate that non-auditory systems, particularly the limbic system (involved in emotion), and the autonomic nervous system, which controls all body functions and triggers the “fight or flight” reaction, are an essential part in each case of troublesome tinnitus. The auditory pathways play a secondary role. According to this model the annoyance of tinnitus is determined exclusively by the limbic and autonomic nervous system.

From the patient’s point of view, the crucial question is what can be done to remove the tinnitus-evoked annoyance. To our knowledge, there is no drug, procedure, or surgery that can eliminate the source of tinnitus permanently if it’s associated with the inner ear.

TRT, which was developed by Dr. Jastreboff in the mid ’80s and published in 1990 (Jastreboff, P.J. Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci.Res. 8:221-254, 1990), offers a potential solution to this problem. If we cannot erase the source(s) of tinnitus, we should turn our attention to what is happening between the source of tinnitus (most frequently at the periphery) and the level where tinnitus is perceived- the cerebral cortex. The idea is to block tinnitus-related neuronal activity from reaching the level of the cortex where it is perceived, and from activating the limbic and autonomic nervous systems- to habituate tinnitus perception and tinnitus-induced reactions.

TRT trains the brain to classify tinnitus-related neuronal activity as representing a neutral, non-significant signal, then the brain will habituate automatically. To achieve this, it is necessary, however, to fulfill two basic conditions: 1) removal of the negative association attached to the tinnitus perception, and 2) preservation of tinnitus detection (but not necessarily perception) during treatment.

Low level, broadband sound is used to facilitate tinnitus habituation. The sound used in TRT is a broadband noise generated by devices, worn behind the ear. The TRT program consists of an extensive audiological evaluation, several counseling sessions, the use of external sound, and frequently the use of sound devices. It does not involve any surgery or drugs. The process of retraining takes 12-18 months. However, once tinnitus habituation is achieved, there is no need for continuing the treatment. TRT has shown success rates of 80%.

To book a consultation, please contact our clinic at (236) 420-0294.