Comparison of Progressive Tinnitus Management, Tinnitus-Hyperacusis Retraining Therapy, Neuromonics and Levo Tinnitus System

There are 2 ways to approach therapy for people distressed by tinnitus-hyperacusis. One is progressive. Start with audiologist evaluation, basic educational counselling on coping tools, and then customize treatment based on the individual’s needs. As little or as much as necessary. Progressive Tinnitus Management [PTM] was developed over 10 years ago by a team of doctors, ENTs, audiologists and psychologists in the US Department of Veterans Affairs. No special training is required for providers, usually audiologists. Tinnitus-Hyperacusis Retraining Therapy [TRT-HRT], Neuromonics and Levo are other formal therapy approaches for hyper ears. Providers, usually audiologists, must have special training to offer each of these approaches. They must be authorized sales distributors for Neuromonics or Levo.

PTM may include self-help tools, Hearing Aids, HAs + sound generators, in-depth counselling one-on-one or group sessions, or possibly progressing to individual formal therapy like Tinnitus-Hyperacusis Retraining Therapy or counselling therapy with a psychologist. The goal is to guide people to cope better by managing their hyper ears without spending more effort, time or money than necessary.

TRT-HRT was developed decades ago by neurologist Dr Pawel Jastreboff and audiologist Dr. Jonathan Hazell. The goal is to habituate to T and desensitize to H so that the person is not bothered or distressed any more. Therapy includes directive counselling and day/night sound therapy e.g. coloured noise or fractal music. Some people find even one evaluation/counselling session is enough to steer them on the path to coping better. Others need ongoing appointments, with significant improvement usually happening with the first 3 months, and ongoing follow-up appointments scheduled as needed. The timeframe for TRT-HRT is much shorter now than when it was first introduced over 25 years ago.

If you've tried Tinnitus Retraining Therapy for T, would you recommend it to other people with T?

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If you've tried Tinnitus (Hyperacusis) Retraining Therapy for H, would you recommend it to other people with H?

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Neuromonics, introduced around 2001 by Neuromonics, Inc., uses specially processed music and relaxation tracks for sound therapy. People use the music at key distress times, usually for at least 2 hours per day to start. It takes about 6 months to complete therapy.

If you've tried Neuronomics Tinnitus Treatment for T, would you recommend it to other people with T?

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If you've tried Neuromonics Tinnitus Treatment for H, would you recommend it to other people with H?

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Levo, introduced around 2010 by Otoharmonics, Inc., uses a T pitch match during sleep for sound therapy. Treatment takes about 3 months. It’s not an option for H.

If you've tried the Levo Tinnitus System, would you recommend it to other people with T?

  • No (63%, 57 Votes)
  • Yes (37%, 34 Votes)

Total Voters: 91

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Which is best? There’s no real way to know…because they don’t use the same outcome measures. PTM and TRT-HRT use the Tinnitus Handicap Inventory which is commonly used internationally. Neuromonics uses the Tinnitus Reaction Questionnaire and Levo uses the Tinnitus Functional Index so they can’t be compared to see which is most effective. This also means none of these therapies can be compared to see which is most effective for specific types of T-H e.g. noise trauma, head injury, ototoxicity, Meniere’s, conductive, pulsatile, etc. Wouldn’t it be nice if scientists and clinicians knew which people are the best candidates for which approach? Scientists internationally have been begging for a universal outcome measure; but companies developing T therapy devices don’t seem to be listening.

So where does that leave the person with hyper ears? If you’re referred to a clinic that is an authorized sales distributor for Neuromonics or Levo, then you’re looking at a $5000 price tag. If you’re referred to a clinic offering TRT-HRT, then price depends. If you just need the initial eval and counselling, it’s around $300. Devices include hearing aids, which the person might need or already use anyway if they also have hearing loss, as well as tabletop sound machines if needed (~$100-200). Follow-up appointments are shorter, maybe only $50 to $100 per appt for counselling sessions that can be done by phone, email or skype depending on the provider.

Any audiologist should be more than capable of working with people using a progressive approach. Even if an audiologist hasn’t used PTM before, most should be happy to work with interested people using the step-by-step workbook and provider materials. Fees would be at the audiologist’s counselling rate e.g. $250 per hour or pro-rated for shorter appts. Plural Publishing sells the materials including PTM Clinician Handbook, PTM Counselling Guide and client How to Manage Your Tinnitus workbook with CDs and DVDs as a 3 book package or separately. The 3 book provider set is about $300 and the client workbook/CD/DVD set is about $80. People can use the step by step workbook either with an audiologist’s guidance or independently on their own. PTM encourages people to use sound therapy devices or aids they already own e.g. smartphone loaded with coloured noise or personal music library docked to speaker, air purifier, etc.

If you've tried Progressive Tinnitus Management, would you recommend it to other people with T?

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If you have hyper ears distress and formal therapy is recommended, do you need to start at the top end with a $5000 formal approach? Or would you prefer a more progressive approach, possibly even self-help, after audiologist evaluation and basic counselling guidance on how to cope better? Only progressing to intensive formal therapy and devices if needed. It all depends on your individual needs. Keeping in mind that throwing money at hyper ears never made it go away.

Released February 2019

For the latest comparison of current tinnitus-hyperacusis coping tools, check out Jan’s latest book. Click the cover at left to learn more.

Plural Publishing PTM How to Manage Your Tinnitus Workbook

Tinnitus Retraining Therapy


Jan L. Mayes MSc writes horror fiction and non-fiction, and is an international Eric Hoffer Award winning author, blogger and audiologist specializing in noise, tinnitus-hyperacusis, hearing health education and plotting murders. Her writing has been featured at Tinnitus Today, Communique, and The Horror News Daily.