The American pioneers of Tinnitus Retraining Therapy (TRT), neuroscientists Dr Pawel Jastreboff and Dr Margaret Jastreboff, have delivered face-to-face training in Melbourne for audiologists from around the world.
The 34 participants at the five-day in-person certification course included audiologists from around Australia as well as London, Canada, Singapore and New Zealand. The group will now meet online monthly.
The workshop, during international Tinnitus Awareness Week, 3 to 7 February 2025, was at the Novotel Glen Waverley. Ms Mini Gupta, a Melbourne audiologist specialising in tinnitus, hyperacusis, and misophonia at All Ears Hearing & Tinnitus Care Clinic, led the organisation of the intensive course.
She acknowledged the challenges of bringing the program to Melbourne but emphasised the team’s unwavering vision to provide Australians struggling with tinnitus access to the best possible treatment.
“Assessing, diagnosing, and treating complex auditory disorders like tinnitus requires specialised knowledge and skills,” Gupta said. “Although Dr Pawal Jastreboff and his team had officially designated their January 2025 online course as their last, our dedication to advancing clinical expertise and improving patient care in Australia persuaded them to conduct this in-person training.”
Dr Pawel Jastreboff is Professor Emeritus, Department of Otolaryngology, Emory University School of Medicine, Atlanta. His neurophysiological model of tinnitus, introduced in the late 1980s and formally published in 1990, laid the foundation for TRT. The therapy is based on the idea that tinnitus distress results from abnormal neural connections between the auditory and limbic (emotional) systems, leading to negative emotional and autonomic nervous system responses.
TRT combines directive counselling and sound therapy to facilitate habituation, helping individuals to gradually reduce their awareness and emotional reaction to tinnitus. It remains a widely used evidence-based approach for tinnitus management.
With his wife, Dr Margaret Jastreboff, he established the Jastreboff Hearing Disorders Foundation and Tinnitus and Hyperacusis Centre in the US.
Over 150 courses in 40 years
Dr Pawel Jastreboff told HPA: “There is effective help available for patients with tinnitus, hyperacusis, misophonia, and tensor tympani syndrome using a variety of approaches. Results of clinicians from all around the world and our results show that TRT, which has been used for nearly 40 years, is highly effective providing clinically significant help in over 80% of cases.
“Indeed, it is our intention to end organising TRT courses both online and in person. However, I learned in life to “Never say never again.” Since we started offering courses in 1996, we have provided 54 courses in the USA and we taught more than 100 abroad and interest does not seem to be decreasing. So – we shall see.”
Gupta, who previously completed the course, has spent years applying its techniques to help Australian patients. She highlighted the significance of the training in ensuring that individuals with tinnitus, hyperacusis, and misophonia receive the professional care they need and deserve.
“The participants of this course are now equipped with the essential skills and knowledge to assess, diagnose, and treat these complex auditory disorders effectively, making a real difference in the lives of those affected.
“We will be meeting monthly online to continue learning, sharing and supporting each other as professional buddies as we get ready to move forward to practise the ‘More than audiology’ approach (that the TRT teaches) for complex auditory disorders,” Gupta said.
“Professionals very often feel lonely when they work with unusual clinical conditions. This cohort of audiology professionals will work together to look after the population struggling with these chronic auditory disorders while they also support each other in all possible ways.”
Key messages
Gupta said the main messages from the Jastreboffs were to:
- Avoid negative counselling for tinnitus patients, such as saying nothing can be done.
- Avoid silence and instead use sound as a therapeutic agent.
- Advise patients to stop overprotecting their ears.
- Australia needs to work more in this realm and more clinicians need to be trained.
How TRT was developed
Dr Jastreboff said he developed the neurophysiological model of tinnitus and TRT around 1985 while creating an animal model of tinnitus. “Because it was totally different from all the other approaches and models, I was not presenting it,” he told HPA.
“Only when, during a visit in October 1988 to London, I learned from Dr Jonathan Hazell and Jacqui Sheldrake about results from patients which fully supported my model and TRT, I presented the model and TRT to them.
“They started using TRT, they got good results and moved from using masking treatment to TRT. I opened the first TRT centre at the University of Maryland in Baltimore in 1990.”
Dr Margaret Jastreboff was not involved in tinnitus until the late 1990s. “However, once she joined me and started to be involved in work with patients, she noticed the existence of a previously unidentified phenomenon which we named misophonia,” he said.
In 1996, after treating more than 500 patients, they started teaching TRT, offering three, and later five day courses. He said it was more complex than just a combination of low level, broad-band noise and counselling to achieve the habituation of tinnitus.
The Melbourne course outlined what tinnitus, hyperacusis and misophonia are, their symptoms, how to identify patients with misophonia, differential diagnosis of misophonia and hyperacusis, and their relationship with tinnitus.
Auditory neurophysiology (neural pathways), medical evaluation, medical conditions associated with tinnitus, medications, sound therapy, and psychological treatments were also discussed.
The mechanisms of tinnitus and decreased sound tolerance were reviewed along with past and current treatments. The neurophysiological model behind the practical aspects of implementing TRT was covered along with becoming familiar with the assessment and counselling methods, results and common misconceptions.
Treatment protocols for each disorder when they exist individually and when they coexist were outlined along with how counselling and sound therapy differ based on severity.
The Jastreboffs also discussed instrumentation in tinnitus management and how to program combination instruments such as hearing aids for the disorders, plus how to implement the principles and protocols in clinical practice.
One audiologist, Ms Sandra Pacheco, director of Central Audiology Taranaki, New Zealand, did the course for a third time.
Audiologist Ms Laura Drexler from Adelaide Tinnitus Clinic, said the depth of expertise from the Jastreboffs was incredible, and it was a privilege to learn from such experienced teachers.
“It was also inspiring to hear patient journeys, and how tinnitus therapy has improved their lives. They were all very brave to share their stories, emotions and all, to the room,” she said.
Read more in his paper, 25 Years of tinnitus retraining therapy.
More reading
Soundfair launches Find a Tinnitus Professional directory
Revolutionising tinnitus care: Scalable solutions for independent clinicians
Audiology Australia says awareness is the first step to tackling high rates of tinnitus
