Neuromonics Tinnitus Treatment: Is It for Real?
© May 2009 by Neil Bauman, Ph.D.
What can you tell me about
Neuromonics for treating tinnitus? Is it for real? Does it really work?—D. L.
Answer: Neuromonics Tinnitus Treatment is a relatively new
treatment for tinnitus. Developed by audiologist, Paul Davis, Ph.D. of Australia
to reduce the disturbing effects of tinnitus, Neuromonics opened for business in
Australia in 2001. It came to the USA in late 2005. More and more tinnitus
treatment centers are adding it to their arsenal of tinnitus treatments.
You see, no one tinnitus treatment protocol works for everyone. Some tinnitus
treatment protocols work for some people and not for others depending on the
kind and cause of their tinnitus. Neuromonics is the same—it works for some
people but not for all.
The goal of Neuromonics is to reduce the physical, mental and emotional
disturbance you perceive as a result of your tinnitus. To that end, Neuromonics
uses a number of the same concepts used in Tinnitus Retraining Therapy (TRT)
that was developed by doctors Pawel Jastreboff and Jonathan Hazell, including
the importance of directive counseling and the use of white noise generators
(although how these two programs use white noise is different).
Determining Whether Neuromonics Is the Right Tinnitus Treatment for You
Neuromonics seems to have a few advantages over standard TRT. One apparent
benefit is that in the initial treatment stages, Neuromonics often gives a
greater reduction in tinnitus symptoms more quickly than TRT because, unlike
with TRT, it uses tinnitus masking at this point. Another apparent benefit of
Neuromonics is that it uses music. Since most people find music more pleasant to
listen to than straight white noise, people are more likely to successfully
complete the Neuromonics program because of the music. A third benefit is that
with Neuromonics you don’t need to wear a tinnitus masker all your waking hours
like you would have to with TRT. Instead, you’d typically wear the Neuromonics
sound generator between 2 and 4 hours a day.
Audiologist James (Jim) Shafer, Au.D., has used Neuromonics since early 2006,
and has been using TRT even longer. I asked him how these two tinnitus
treatments compare, and why a person would choose Neuromonics instead of TRT. He
explained that when properly done, since both use directive counseling and sound
generators, it largely boils down to a matter of personal preference, lifestyle
and cost. (4)
Neuromonics is not for everyone. Here are some of the factors that might
cause a person to choose Neuromonics versus TRT.
- Neuromonics is only a good choice for people that have normal hearing to
moderate hearing losses. With greater losses, TRT with its sound generators
combined with hearing aids provides a better “fit”.
- To get the most out of the Neuromonics program, a person should have 2 to 4
hours (preferably 4 hours) during each day when they are reasonably relaxed.
This is because the Neuromonics music is designed to relax you and slow down
your heart beat. This just doesn’t happen if you are caught up in the frenetic
morning rush hour, if you are jogging on your treadmill, or if you are frazzled
with a high stress job and never have a moment to yourself. If this is you, then TRT may be a better choice.
- Neuromonics is not for you if you don’t like listening to music in the
first place. If you’d prefer just listening to white noise, then opt for TRT
instead of Neuromonics.
- Another factor to consider is the size and placement of the sound
generators. With TRT, you wear what looks like either in-the-ear or
behind-the-ear hearing aids (and indeed they can be dual purpose devices—both
sound generators and hearing aids at the same time if that is what you need).
You wear them just like you would normal hearing aids. The Neuromonics sound
generator is more like an MP3 player or iPod. You wear it on your belt or put it
in your pocket and plug in the special ear buds. Because of the ear buds in your
ears, you can’t wear hearing aids at the same time.
- Cost may be a factor. For example the total cost of TRT begins around
$2,500.00 to $3,000.00, whereas the total cost of the Neuromonics treatment
is more in the range of $4,500.00 to $5,500.00.
- Neuromonics is likely not for you if you have a fluctuating hearing loss as
the Neuromonics sound generator needs to be programmed to fit your specific
level of hearing.
- To be successful with the Neuromonics treatment, you need the ability to
organize your day to fit in treatment periods. You do not need to find one
4-hour block of time. Neuromonics works just as well with several shorter
blocks of time scattered throughout your waking hours.
- Neuromonics is probably not for you if you cannot eliminate factors that
make your tinnitus worse, whether physical or emotional, for example, if you
work in a loud environment without proper ear protection.
- Finally, you need to have realistic expectations. Don’t expect that your
tinnitus will miraculously disappear. However, do expect that your tinnitus
will become softer and less intrusive so it will not bother you much or at
The Neuromonics Tinnitus Treatment Program
Neuromonics tinnitus treatment typically consists of a 6 to 12 month program
of support, monitoring, counseling and education combined with daily wearing of
the Neuromonics proprietary sound generator/sound processor called the Oasis ™.
There are 5 stages in the Neuromonics tinnitus treatment program:
- Comprehensive assessment of your hearing and tinnitus
- Configuring the sound processor
- Phase I (preconditioning stage)
- Phase II (active treatment stage)
- Maintenance stage (1)
1. Comprehensive Assessment
During the assessment stage, your audiologist does a complete audiological
evaluation of your hearing ability. You may have a high frequency hearing loss
of which you’re not even aware—but you brain is—and the result can be tinnitus.
(Around 70% of the people with hearing loss also have tinnitus accompanying
their hearing losses.)
Your audiologist will then “test” your tinnitus to determine its frequency
and perceived loudness. During this initial assessment, you will also fill out
the Tinnitus Reaction Questionnaire (TRQ). Neuromonics uses the 26-item TRQ to
subjectively measure how much tinnitus is affecting the quality of your life.
For each of the 26 questions on the TRQ you rate them between 0 and 4 with 0
being “not at all”, 1 “a little of the time” and up to 4, “almost all of the
You answer each question as to how your tinnitus has affected you only
over the past week. Since you’ll be taking this questionnaire at various
points throughout the Neuromonics program, you can measure your progress—the
more your score drops, the better your progress.
Incidentally, a lowered score does not necessarily reflect any change in the
loudness of your tinnitus, but it does reflect a lessened impact of your
tinnitus on the quality of your life.
Here are four of the statements on this questionnaire to give you a feel for
the kinds of questions it asks.
- My tinnitus makes me feel tense.
- My tinnitus has led me to avoid quiet situations.
- My tinnitus has interfered with my ability to work.
- My tinnitus has interfered with my sleep.
Possible scores range from 0 to 104 with a score of 17 or greater being
considered clinically significant. (5) When I took this questionnaire (just for
fun), I was surprised to discover that my score was 0. I’m so thoroughly
habituated to my tinnitus that I do not let it bother me although my ears are
“ringing away” every waking moment, and get louder whenever I write about, or
help people with their tinnitus, which seems to happen almost daily.
During the initial meeting, your audiologist will develop a comprehensive
profile of your hearing loss and tinnitus. This information is needed in order
to program the Neuromonics sound generator to meet your specific needs.
Your audiologist also will explain about tinnitus and how your autonomic
nervous system and limbic (emotional) system play a very important role in how
intrusive you perceive your tinnitus.
In addition to the information on tinnitus you receive in your initial
session, you will receive another 8 to 10 hours of information and counseling,
either face to face, via email or telephone, with the bulk of this coming in the
first 6 months you are on the Neuromonics program. This helps keep you on track.
By the end of the initial session you will know whether the Neuromonics
program is something you want to try or not.
2. Configuring the Sound Processor
If you decide to proceed with the Neuromonics program, your audiologist will
send your tinnitus/hearing loss profile to the Neuromonics headquarters. There,
a Neuromonics sound generator/sound processor (called the Oasis) will be
specifically programmed to fit both your hearing loss and your tinnitus profile.
This sound generator/sound processor looks somewhat like an MP3 player that
you listen to via special high-quality earphones. It contains several hours of
highly modified Baroque and New Age music customized specifically to fit your
profile. White noise is embedded in the music. Many people find white noise less
“irritating” when it is embedded in music than listening to it alone like you do
with the TRT program. The frequency range of these sounds lies between 100 Hz
and 12,500 Hz.
It takes about two weeks from the time of your initial session until you will
receive your customized Neuromonics sound processor.
3. Phase I (Preconditioning Stage)
During the first phase of the Neuromonics tinnitus treatment program, which
lasts between 2 and 6 months, you listen to the Neuromonics sound generator for
a minimum of two hours a day, but in order to get optimal benefits you are
encouraged to listen for 4 hours a day. One study revealed that 75% of the
people listening for 2 hours per day achieved at least a 40% reduction in their
TRQ score, whereas 100% of the people that listened for more than 2 hours per
day achieved this same result. (5) You can break up your listening sessions. You
do not have to find a single four-hour block of time.
During the listening sessions, you want to be reasonably relaxed, not hard at
physical work, or doing a task that requires your full mental concentration. You
can typically listen while you go about your normal (unhurried) daily tasks. It
is not something you have to stop and listen to—using up precious hours each
day. For example, you could be eating your lunch or reading a book. You could
also fit your listening times into relaxed travel times, or quiet work in order
to meet your daily listening requirements.
The highly customized “easy listening” Baroque and New Age music needs to be
familiar to fit into the background of your conscious mind, rather than
requiring active listening on your part. This music promotes relaxation in
addition to its main purpose of auditory retraining.
The audio program (music) includes an acoustic neural stimulus (a fancy way
of saying it contains white noise). This white noise is intermittent and varies
in intensity. It is set a bit louder than your tinnitus. By setting the volume a
bit louder than you hear your tinnitus, it masks your tinnitus and can bring you
almost immediate relief while you are listening to it. For example, one man went
to a clinic to be evaluated for the Neuromonics program. He explained, “While
there I had the Neuromonics headset on while talking and in a short time my
tinnitus was almost inaudible and this was a stock unit, not set up for my
particular sound and pitch.” Incidentally, you control the volume and set it to
a comfortable level that brings you the most relief.
The purpose of listening to a pattern of processed music interspersed with
white noise is designed to retrain the neural pathways in your auditory system
to ignore tinnitus through a process called neuroplasticity. In short, it
interrupts your preoccupation with tinnitus and relaxes you. Getting your mind
off your tinnitus is critical to your success as your emotional response to your
tinnitus is what typically makes your tinnitus to be so intrusive in the first
4. Phase II (Active Treatment Stage)
When you have gotten your tinnitus under control as indicated by a reducing
TRQ score, you enter Phase II. During Phase II the white noise is eliminated
from the music so your brain is intermittently exposed to your tinnitus and is
trained to filter it out.
The way this happens is that without the white noise in the background, your
tinnitus is now louder than the soft notes of the music you are listening to.
Thus in the short intervals between the louder notes your tinnitus briefly
“appears”. Since you are listening to the music, not your tinnitus, you learn to
ignore your tinnitus in these tiny gaps in the music in a process called
Note: if for some reason your tinnitus flares up, you can always go back to
Phase I to bring it under control, then switch over to Phase II again. Some
people need to do this, some don’t. Don’t let it discourage you if you have to
do this. The goal is to get your tinnitus under control, not to see how quickly
you can move through the program.
During Phase II, you set the music level low enough so it won’t disturb you.
If you have normal hearing, you can still hear environmental sounds and
conversations through this “background” music. If you have a significant hearing
loss, this is not likely to happen.
As you progress through Phase II and you retrain your brain, you will find
that your tinnitus becomes less and less intrusive, even when you are not
wearing the Neuromonics sound generator.
5. Maintenance Stage
Once you are desensitized to the disturbing quality of you tinnitus such that
your tinnitus no longer bothers you, you have entered the maintenance
phase—typically 6 to 12 months into the Neuromonics program. At this point you
can reduce your listening sessions to suit your needs. When they reach this
stage, many people do not even need to use the sound generator any more. If you
do need to use the sound generator, you will find that just brief listening
sessions each day are all you typically need, unless you are having a “bad”
A Word of Caution
Although the Neuromonics sound generator part of the program is basically the
same wherever you go, it seems that a number of places providing Neuromonics are
downplaying the importance of the directive counseling. They appear to be relying on the
Neuromonics sound generator to carry the whole load. This is leaving out a
critical part of the program.
The reason directive counseling is so important is that tinnitus is not just
a “physical” thing in the auditory circuits that can be manipulated by sound
generators or sound maskers, but the volume and intrusiveness of the tinnitus
you experience is closely tied to your limbic (emotional) and autonomic nervous
systems. Thus you need to learn how to control your mind and emotions in order
to successfully habituate to your tinnitus. (In fact, for many people directive
counseling may be all they need to bring their tinnitus under control—it’s that
Therefore, if you are thinking about taking the Neuromonics program, and I
can’t stress this enough, be sure your audiologist places a high value on the
importance of the directive counseling part of the program. Otherwise, you may
largely be wasting your money.
Another thing of which you need to be aware is that if you begin using the
Neuromonics sound generator and your tinnitus gets worse, stop using it and talk
to your audiologist. There may be some other factors that are contributing to
your increasing tinnitus and need to be addressed. You don’t want to continue to
do anything that makes your tinnitus worse.
What Kind of Results Should I Expect?
The goal of Neuromonics (and indeed, many other tinnitus treatments) is not
necessarily to cure tinnitus, but rather, to reduce the amount of time you are
aware of your tinnitus and reduce the degree to which it impacts your quality of
Therefore, the correct expectation of the Neuromonics tinnitus treatment
program is not that your tinnitus disappears completely (although it does for
some people), but that the volume and intrusiveness of your tinnitus drops such
that you typically are no longer bothered by your tinnitus. As a result, you may
go for hours without even noticing your tinnitus. This is success!
Does Neuromonics work? Consider the case of Tim. His tinnitus started and
rapidly escalated until he could no longer tolerate the level of sound generated
when his family got together. It disrupted his sleep. He could think of nothing
After taking the Neuromonics treatment he explained, “If I consciously listen
for my tinnitus, it’s there, or in stressful situations it’s there. But during
most of the day I’m not even aware of it, and I can sleep now without any
medication. I would say there is a 60% improvement.” (2) Again, this is success!
About 90% of the people taking the Neuromonics treatment have at least a 40%
reduction in their TRQ score. Success is defined as at least a 40% reduction in
tinnitus disturbance as measured by the TRQ, an average improvement of 67% and a
2-month time frame for the benefits to be felt. (1)
In one study, 95% of the people at 6 months had a reduction in their tinnitus
disturbance of at least 40%, while 79% reported that their tinnitus was no
longer disturbing them (in other words it was not clinically significant,
meaning their TRQ score was 16 or less). (5)
Neuromonics is worth investigating if you are having trouble dealing with
your tinnitus. Just remember, it doesn't work for everyone—but it does help a
high percentage of the people who stick with this treatment. A lot depends on
The man who asked the question about Neuromonics at the beginning of this
article, after I responded favorably to his query, ten days later, wrote: “I
went for a hearing evaluation. They offered several alternatives to deal with my
tinnitus. I am convinced that Neuromonics is the way to go for me. The program
is $4500.00—costly—but if I get the relief, it is money well spent.”
Neuromonics has a good success rate (so do other tinnitus treatment programs
such as TRT). However, it seems to have a higher acceptability rate, and that
means that people stick with the program—which ultimately leads to success.
find a Neuromonics tinnitus treatment clinic near you, put in your zip code
If you would like to learn more about tinnitus and the many things you can do to help bring
it under control (apart from Neuromonics), see my book "When Your Ears
Ring—Cope with Your Tinnitus—Here's How." Take charge of your
tinnitus. You don't have to let these phantom sounds control you.
- It’s All In Your Head. Renee Diiulio. In: Hearing Products Report,
- Music therapy shows promise for tinnitus sufferers.
- Neuromonics. http://www.neuromonics.com.
- Shafer, James, Au.D. A C Associates—Hearing, Tinnitus & Balance LLC. 200
Bailey Drive, Suite 201, Stewartstown, PA 17363
- Tinnitus: Addressing Neurological, Audiological, and Psychological Aspects
with Customized Therapy. Teri Sinopoli, et. al. The Hearing Review. August.