Sound Therapy Can Be Very Effective for Treating Tinnitus

Hyung Jin Jun, M.D., Eveling Rojas-Roncancio, M.D., and Richard S., Tyler, Ph.D., The University of Iowa

Introduction
Tinnitus is common, and can cause significant problems for many people. We have categorized the primary handicaps associated with tinnitus as 1) thoughts and emotions, 2) hearing, 3) sleep, and 4) concentration. But reactions to tinnitus vary, including some people being very upset and worrying about becoming deaf, or having a brain tumor. Tinnitus can create hearing difficulties and results in communication problems.

An exciting change in the last few years is that there are now many approaches to sound therapy and many more people are finding them very helpful.

Sound Therapy
First let us be clear that sound therapy should always include counseling. And of course an evaluation by an audiologist or otologist is an important first step if there are other health concerns. A hearing test and tinnitus measurements of severity can also be important.

Music can be helpful with tinnitus to facilitate relaxation, provide a distraction, and aid in falling sleep. Most music for tinnitus is moderate in tempo and soft instrumental music.

At this time, there is no cure for tinnitus. However, there are many ongoing studies using electrical stimulation and some pharmaceutical companies developing compounds that could be fruitful. We believe there will be new treatments for some tinnitus patients in the near future. It is important to distinguish treating tinnitus perception, and treating reactions to tinnitus. Even though there is no cure at this time, there are lots of approaches to helping with the reactions. There are many excellent self-help articles (Tyler et al., 2008) and books (Tyler, 2008; Henry and Wilson, 2002; McKenna et al., 2010); and the counseling approach we have advocated for years that we now call Tinnitus Activities Treatment (Tyler et al., 1989, Tyler et al., 2006).

The purpose of sound therapy is to make your tinnitus less noticeable. How does this work? We hear a sound then perceive it relative to other background sounds. A good analogy is a candle flame. In the dark it is more noticeable than in daylight. Your tinnitus can be more prominent in quiet, but with a low-level background sound your tinnitus can be less prominent and this can help you habituate. Sound therapy can be categorized by way of sound delivery and types of sound. You can choose between non-wearable sound generators and wearable sound generators. You also have a variety of different types of sound to choose from. Sound therapies also differ by the volume of the sound relative to the tinnitus.
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If you have not yet tried sound therapy as a treatment for your tinnitus, we encourage you to visit your audiologist and see if you can find a sound that helps put your tinnitus further into the background.

Sound Therapy Can Be Very Effective for Treating Tinnitus

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Sounds can completely or partially mask your tinnitus. Some partial maskers can be too loud in our experience (such as those at the mixing point between the noise and the tinnitus), but other partial masking at lower levels is usually acceptable. Some people experience reduction of their tinnitus even after the masking sound is off. This is called residual inhibition or post-masking relief.

Hearing Aids
Most tinnitus patients have some degree of hearing loss. Sometimes the hearing loss might only be in high frequencies, so the individual might not notice it, but they do notice their tinnitus. Simply using hearing aids can improve the tinnitus, as well as help facilitate easier communication. Hearing aids can also reduce stress and annoyance an individual may experience with their tinnitus or mild hearing loss.

Non-Wearable Sound Generators

Some find their own sound generators to bring relief. Fans, detuned radios, and soft background music are good options. It is often an advantage to be able to control the volume. There are some table-top sound generators like sound machines or even pillows and stuffed animals with speakers inside. You can choose from a variety of sounds with these kinds of devices. The devices often include sounds such as water falls, ocean waves, and wind blowing through trees. They should have a time and a volume control. Most tinnitus patients like the sound of nature since these sounds are monotonous and repetitive without interruption. Some use it in their workplace to help with concentration, others to help fall asleep.

References for Further Reading:

Henry, J.L. and Wilson P.H. (2002). Tinnitus: A Self-Management Guide for the Ringing in Your Ears. Boston: Allyn and Bacon. Kochkin, Sergei, Tyler RS. (2008) Tinnitus Treatment and the Effectiveness of Hearing Aids: Hearing Care Professional Perceptions. The Hearing Review, 15(13), 14-18. Kochkin, S.; Tyler, R. and Born, J. (2011). MarkeTrak VIII: Prevalence of Tinnitus and Efficacy of Treatments, The Hearing Review, 18(12), 10-26. McKenna L, Baguley DM, McFerran D. (2010). Living with Tinnitus and Hyperacusis. London: Sheldon Press. Tyler, R.S., Gehringer, A.K., Noble, W., Dunn, C.C., Witt, S.A., Bardia, A. (2006). Tinnitus Activities Treatment. Chapter 9. In R.S.Tyler (Ed.), Tinnitus Treatment: Clinical Protocols (116-132). New York: Thieme. Tyler, R.S., Stouffer, J.L., and Schum, R. (1989). Audiological rehabilitation of the tinnitus client. Journal of the Academy of Rehabilitative Audiology, 22, 3042. Tyler, R.S., Chang, S.A., Gehringer, A.K., Gogel, S.A. (2008). Tinnitus: How you can help yourself! Audiological Medicine, 6, 85-91. Tyler, R.S.(Ed). (2008). The Consumer Handbook on Tinnitus. Auricle Inc., Sedona.

Different Types of Sounds Available in Wearable Devices

Noise Some people find broadband noise helpful and it has been used for many years as a tinnitus remedy. By covering all audible frequencies and listening to a pattern of random static-like sound, like a shhhhhh can make tinnitus less noticeable. With devices today there are many ways to change the spectrum and quality of the noise. This can make it more effective and/or pleasant to listen to. Frequency and Amplitude Modulated Sound Newer approaches are now available that modulate the sound wave amplitude or frequency, giving it a slowly varying warbling or modulating pulse. Many find these sounds more acceptable. Music Music has been used as a relaxation technique for many years. We know that music can reduce heart rate, respiratory rate and lower anxiety. Music can be helpful with tinnitus to facilitate relaxation, provide a distraction, and aid in falling sleep. Most
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Wearable Sound Generators

Wearable sound generators are like hearing aids, only they produce sound. Usually, only you can hear the sound so you can use it whenever you need it. Some can also be combined with hearing aids. 14
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music for tinnitus is moderate in tempo and soft instrumental music. Loud music or fast tempo music have not been used because it is usually not good for relaxation. Vocal music is rarely used because it can be more arousing than relaxing. Music and Noise with Spectral Notches Removed Notched sounds refer to signals with a portion of the spectrum (the frequency content) filtered out. Some approaches filter at the frequency of the most prominent tinnitus pitch, but others filter out regions around the tinnitus pitch. We have decided that more research is needed with this approach before we try it in our clinic.

we encourage you to visit your audiologist and see if you can find a sound that helps put your tinnitus further into the background. For more information on Sound Therapy and why it works please visit ATA.org/for-patients/faqs. ATA has a sound mixer on their website where you can experiment with sounds and even export a free WAV file of the sounds you find most helpful: ATA. org/sound. ATA also sells tabletop sound machines and other soothing sound devices and CDs in their online store. Visit ATA.org/store to learn more and purchase these items. To locate a hearing health professional near you who understands sound therapy and tinnitus treatments, email tinnitus@ata.org or log-in to the Members section of ATA.org anytime for the most up-to-date listing.

Conclusions
Sound therapy has helped many people with tinnitus for decades. In the last five years these options have increased dramatically. This is wonderful because people not only have very different preferences, but respond to different sound stimuli. If you have not yet tried sound therapy as a treatment for your tinnitus,