Tinnitus retraining therapy (TRT) is based on the neurophysiological model of tinnitus proposed by Jastreboff. According to this model, the persistence and distress of tinnitus is primarily attributable to:

• A Persistent cochlear hair cell damage generating spontaneous signals that cannot be suppressed
• B Eustachian tube dysfunction causing pressure changes that generate tinnitus
• C Abnormal central auditory gain and limbic/autonomic system conditioned responses to a perceived tinnitus signal, independent of its cochlear origin ✓
• D Vascular pulsations transmitted to the cochlea in the absence of noise exposure

Explanation

Jastreboff's neurophysiological model proposes that tinnitus signals arise from central auditory system hyperactivity (possibly initiated by cochlear damage but maintained centrally), and that its clinical impact and distress are mediated by conditioned activation of the limbic system (emotional responses) and autonomic nervous system (arousal). TRT uses sound therapy (broadband or partial masking noise) to promote habituation — breaking the conditioned reflex — combined with directive counselling. This model explains why tinnitus severity correlates poorly with its loudness (which is typically only 5–10 dB above threshold) and better with psychological factors.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.