Tinnitus Retraining Therapy vs. Neuromonics or Masking The decision for choosing a treatment should be based on whether tinnitus is associated with hearing loss, hyperacusis, the frequency of the tinnitus, the duration of condition, and its effect on daily activities. In 1990 Professor Pawel J. Jastreboff of the University of Maryland School of Medicine first published papers describing his "neurophysiological model of tinnitus". Dr. Jonathan Hazell of the U.K. used Jastreboff's principles of tinnitus management, and applied it clinically to his patients. This is the basis of what we call Tinnitus Retraining Therapy (called Auditory Habituation at the time). Tinnitus Retraining Therapy depends on two factors: 1) The property of the central nervous system networks called "neuronal plasticity". Plasticity refers to the fact that our neural networks are not static and can be altered physiologically to a certain degree. 2) Certain pathways traditionally labeled as non-auditory (such as the limbic system and the autonomic nervous system) are considered essential components of tinnitus perception. Tinnitus Retraining Therapy (TRT) has a success rate greater than 80% in substantially improving tinnitus perception and annoyance: Sheldrake(1996); Bartnik, (1999); Heitzman (1999); Herraiz, (1999); Jastreboff (2001); Mc Kinney (1999). That is, patients often report that their tinnitus ceases to be an issue in their lives. This approach employs the temporary use of soft sound, often in the form of broad band "white noise" generators purposely set at a volume that does not mask the tinnitus. The contrast between the tinnitus signal and environmental sounds is thereby decreased, thus facilitating habituation to the tinnitus signal. Habituation means that the subconscious mind is passively retrained to filter out and not respond to the tinnitus signal the same way the subconscious mind naturally filters out the meaningless sound of a refrigerator or a computer fan. Neuromonics uses the neurophysiologic model as its basis, but holds that most patients who suffer from tinnitus have some degrees of hearing loss between 250-16000 Hz. Therefore, there is lack of stimulation perceived by the brain. This causes the central auditory nervous system to develop a compensatory action to offset this loss of stimulation. The Result is an artificial gain the central auditory nervous system that is perceived by the brain as sound. Accordingly, if we use a highly sophisticated algorithm to compensate this loss of sound to the brain, we can re-train the brain into reducing the artificial gain which will reduce patient's annoyance and in turn the volume of the tinnitus (known as minimum masking level). This calls for a very detail evaluation of auditory system, including high frequency audiometry, tinnitus pitch measurement, and tinnitus matching, loudness discomfort levels, and residual inhibition. If sleeping is affected due to tinnitus, Neuromonics can be a significant help since patients can wear the device to bed. Masking tinnitus involves partially or completely covering up the tinnitus sounds with other sounds from an external source. In fact, masking raises the threshold of the perception of tinnitus when an external source is presented. In clinical settings, masking is accomplished through the use of wearable noise generators (maskers) or "tinnitus instruments", which are wearable units that function both as a hearing aid and masker. Currently, the Widex Mind hearing aid is the only highly advanced tinnitus instrument that can combine noise, music, and amplification to accomplish masking. The Jazz-duo from General Hearing Instrument and Amplisound open system are also other choices, but do not produce music as a medium. Dr. Jack Vernon and his colleagues at the Oregon Hearing Research Center in Portland introduced the principles and concepts behind masking which helped improve the quality of life for literally millions of tinnitus suffers. Costs for masking instruments are based on each case.