Tinnitus Retraining Therapy (TRT) in Louisiana

1. What TRT actually is

Tinnitus Retraining Therapy, or TRT, is a structured 12 to 24 month program that helps the brain reclassify tinnitus as a neutral background sound rather than a threat. It was developed in the 1990s by Dr. Pawel Jastreboff, a neuroscientist, and Dr. Jonathan Hazell, a British otologist. It is built on a specific model of how tinnitus becomes a problem, called the neurophysiological model.

The idea is simple. Most people generate faint neural signals in the auditory system that could be perceived as tinnitus, but the brain filters them out. When those signals get labeled as important, dangerous, or threatening, the brain amplifies them and pulls attention toward them. Emotional distress reinforces the loop. TRT breaks the loop from two sides at once: education (to remove the threat) and sound therapy (to reduce the contrast between tinnitus and background sound so the brain stops treating it as a signal worth tracking).

TRT is not masking. It does not try to cover the tinnitus with a louder sound. It uses low-level sound that keeps the tinnitus perceptible while the brain habituates.

2. Who is a good candidate

TRT works best for patients who share four features:

• Chronic tinnitus lasting at least six months
• Tinnitus that is interfering with sleep, concentration, work, or mood
• No untreated medical cause, meaning ENT clearance if needed
• Willingness to commit to daily sound therapy and monthly counseling for 12 to 24 months

TRT is less appropriate when the tinnitus is very new (under six months, since much of new-onset tinnitus resolves on its own), when the tinnitus is pulsatile and has not been medically evaluated, or when depression, anxiety, or PTSD is untreated and severe. In those cases, we co-manage with a mental health provider before starting TRT counseling.

At the initial visit, Dr. Allred classifies each patient into one of five Jastreboff categories, from Category 0 (minimal impact) to Category 4 (severe hyperacusis with or without tinnitus). The category determines how intensive counseling and sound therapy need to be, and it sets expectations for the timeline.

3. The two components: counseling and sound therapy

TRT has exactly two components, both required. Removing either one drops success rates significantly.

Component one: directive counseling

Counseling is not talk therapy. It is not cognitive behavioral therapy. It is a structured, information-based series of sessions in which the audiologist teaches the neurophysiological model of tinnitus and works with the patient to remove the negative meaning attached to the sound.

Most patients need eight to twelve counseling sessions during the first year, then quarterly booster sessions. Sessions run 30 to 45 minutes. The content is standardized but personalized to the individual patient's beliefs, questions, and progress.

Component two: sound therapy

Sound therapy is continuous, low-level broadband sound delivered for at least eight hours per day. The exact device depends on whether hearing loss is present.

• Normal hearing: open-fit sound generators. These look like small hearing aids but only produce broadband sound at a level just below the tinnitus.
• Mild to moderate hearing loss: combination devices. These are hearing aids with a built-in tinnitus sound generator. The patient gets hearing correction and TRT sound therapy in one device.
• Environmental sound: sound machines at bedside, low-level music or nature sound during the day, and fans or bathroom exhaust as ambient enrichment. Every patient uses some environmental sound, even those with dedicated sound generators.

The sound-therapy setting matters. The generator must be set at the "mixing point" — the volume just below where tinnitus and sound begin to fade together. Setting it too loud (masking) or too soft (no effect) breaks the protocol. This is why TRT must be delivered by a clinician trained in the Jastreboff protocol and not simply by dispensing sound-generating hearing aids without counseling.

4. What to expect at each visit

Initial evaluation (90 minutes)

Full diagnostic audiologic evaluation, tinnitus pitch and loudness matching, Loudness Discomfort Level testing, Tinnitus Handicap Inventory questionnaire, Tinnitus Functional Index questionnaire, patient interview using the Jastreboff category structure, and a written care plan with cost estimate.

First counseling session and device fitting (75 minutes)

Delivery of the first two counseling modules (auditory system anatomy, and the neurophysiological model). Fitting and programming of open-fit sound generators or combination devices at the mixing point. Home practice instructions.

Monthly follow-up (30 to 45 minutes)

One counseling module per visit for the first six months. Sound generator or hearing aid adjustment, verification of daily use hours, THI and TFI re-score at months 3 and 6.

Reassessment visits at 6, 12, and 24 months

Repeat Tinnitus Handicap Inventory and Tinnitus Functional Index. Compare against baseline. Adjust plan. Formal outcome discussion. If the THI has moved from severe or moderate handicap down to mild or negligible for two consecutive visits, the patient graduates from active TRT.

5. Timeline and realistic expectations

TRT is slow. Patients who expect a quick fix are usually disappointed and drop out. The realistic milestones look like this:

• Weeks 1 to 4: initial adjustment to sound generator wear time. Tinnitus itself is unchanged. Patient begins to understand the neurophysiological model.
• Months 2 to 6: most patients report that the tinnitus feels "less loud" or "less sharp," even though pitch and loudness measurements are unchanged. This is early habituation of reaction.
• Months 6 to 12: the majority of responders see a measurable drop on the Tinnitus Handicap Inventory. Attention shifts away from tinnitus more of the time. Sleep improves.
• Months 12 to 24: full habituation. Tinnitus is still perceptible in quiet environments but no longer captures attention or triggers distress. The patient may still hear it if listening for it, but it does not interfere with daily life.

Some patients habituate faster. A few need the full 24 months. Adherence is the single strongest predictor of success — patients who wear sound generators eight or more hours per day and complete all counseling sessions have the best documented outcomes.

6. TRT vs Lenire vs sound-therapy hearing aids

These are the three main structured tinnitus treatments ACI offers. Each fits a different patient profile.

Many patients do more than one of these in sequence. A common combined plan is Lenire first (12 weeks of active neuromodulation for a quick reduction in tinnitus intensity), then TRT (12 to 24 months to build durable habituation). Dr. Allred builds each combined plan at the evaluation.

7. Cost and insurance

TRT at ACI has two cost components:

• Counseling and program fee: $2,800 for the full program (initial evaluation, all counseling sessions, reassessments at 6, 12, and 24 months). This portion is usually not covered by commercial insurance or Medicare, because counseling is coded as an educational service, not a medical procedure. Cherry financing is available with 0% interest options.
• Sound-therapy devices: $500 to $1,500 for open-fit sound generators, or the price of combination hearing aids (typically $3,000 to $8,000 depending on technology tier). If you have hearing loss and hearing aid benefits through your insurance or an HRA, that benefit usually applies to combination devices.

We verify benefits before you start. You will receive a written cost estimate at the initial evaluation, before any device is dispensed and before the counseling program is invoiced.

Ready to schedule?

8. Common questions

Twelve of the most common questions patients ask about TRT are answered in the FAQ schema on this page and reproduced below.

How long does TRT take to work?

Most patients notice a meaningful reduction in tinnitus distress between month 6 and month 12. Full habituation, where the tinnitus is still perceived but no longer bothersome, typically occurs between month 12 and month 24. TRT is a slow, structured program, not a fast fix.

How is TRT different from Lenire?

Lenire is a 12-week FDA-cleared device protocol. TRT is a 12 to 24 month habituation program built on counseling plus continuous sound therapy. Lenire drives neural plasticity fast, TRT builds long-term habituation. Some patients do both, Lenire first for quick relief, TRT for durable habituation.

Does insurance cover TRT?

TRT counseling is typically not covered. The sound-therapy device portion may be partially covered under hearing aid or DME benefits. We verify benefits at your evaluation.

Who should not try TRT?

Patients with pulsatile tinnitus needing medical workup, patients unwilling to commit to daily sound therapy for 12+ months, patients with untreated severe depression or anxiety, and patients with very new tinnitus (under six months) that may resolve on its own.

Do I need hearing aids to do TRT?

Not always. Normal hearing uses open-fit sound generators. If you also have hearing loss, combination devices (hearing aids with built-in sound generators) tend to have the best outcomes.

Can I do TRT and Lenire together?

Yes. A common sequence is Lenire first for the 12-week active protocol, then TRT for long-term habituation. Both are evidence-based and non-conflicting.

Related resources

• Tinnitus care at ACI Hearing Center — overview of all tinnitus treatment options.
• Lenire in Louisiana: a patient guide — companion piece on the FDA-cleared device.
• Lenire certified provider page
• Pulsatile tinnitus — different subtype, different workup.
• Dr. Kimberly Allred, Au.D. — tinnitus specialist bio.

This guide is for education only and does not replace individualized clinical evaluation. If you have tinnitus, schedule an evaluation with a licensed audiologist. Written and medically reviewed by Dr. Kimberly Allred, Au.D., ACI Hearing Center, Lafayette, LA. Last reviewed 2026-07-20.