As it is argued in the listed papers, the reactions of the autonomic nervous system are responsible for tinnitus annoyance and decreasing these reactions is a primary goal of the therapy. The second condition is less obvious, but equally important. For retraining the neuronal networks involved in processing the tinnitus signal, it is fundamental that tinnitus-related activity can be detected. In these patients tinnitus and its annoyance did not change in all these years. Low level, broad band sound is used to facilitate tinnitus habituation.
Silence actually enhances tinnitus and hyperacusis.
All our patients are advised to avoid silence and immerse themselves in a low level, emotionally neutral sound environment. The sound used in Tinnitus Retraining Therapy can be of various origins, but for both theoretical and practical reasons we are using broad band noise generated by devices which are worn behind the ear. The process of retraining takes 12 to 18 months. However, once tinnitus habituation is achieved there is no need for continuing the treatment. Another important property of Tinnitus Retraining Therapy is that it cannot create any harm.