Timothy C. Hain, MD. Tinnitus Page Page last modified: December 13, 2011
Controlled studies of maskers have shown small effects (Dobie, 1999). Nevertheless, masking is the most effective treatment of tinnitus. While not a cure-all, it is much more likely to work than any medication, or any device. Of course, surgery is generally not a treatment option for tinnitus. Manipulation of one's emotional reaction to tinnitus (medication or psychotherapy of various kinds), should be combined with masking.
Tinnitus masking is carried out by providing an external sound that reduces the annoyance of the tinnitus through either disguising it, suppressing it, or making it more pleasant. When masking suppresses tinnitus, it makes it controllable. This is extremely important for psychological well being !
Masking is most likely to occur if it the masking sound is similar in frequency to the tinnitus to be masked. Reduction of annoyance is important. Annoying and uncontrollable sounds can create a positive feedback look where there is even more annoyance and hypervigilance. If one's primitive brain can be fooled into thinking that tinnitus is "normal", or even pleasant, it is much easier for the person to ignore the sound.
The minimal masking level (MML) is the intensity of a sound required to mask tinnitus. The stimulus is raised in 5 db steps and patients are asked whether their tinnitus is still audible.
Residual inhibition (RI) means that the tinnitus remains inaudible after the masking sound is stopped (Feldman, 1971). It is good to have lots of residual inhibition. More than a minute of RI is unusual.
Most masking is implemented by trial and error. One tries out the fan, the TV, the clock-radio, the offerings of the ATA (american tinnitus association) on CD, and sees what works. Listening to the interstation static on the FM radio, tapes of ocean surf may be helpful. Pillow speakers sold by Radio Shack may be helpful in order to avoid disturbing others. This is a very cheap method.
Hearing aids can be bought with masking stimuli built in, or with blue-tooth that allows one to broadcast masking to one's hearing aid. This is an expensive way to do it.
CD's are available that contain masking sounds, for example, the "DTM-6B" system sold by Petroff Audio Research. This is a collection of 6 CD's found by Mike Petroff, an individual with tinnitus, to be helpful for him, and marketed for this purpose. They are endorsed by Jack Vernon, a tinnitus practitioner associated with the ATA. Our thought is that these CD's are probably good masking sounds, but we wonder if they are worth $139+$6 S/H. We suspect that there are much less expensive alternatives.
Tinnitus maskers are devices fitted and sold by audiologists. This is often expensive too.
A very expensive masker is the Neuromonics device. It is basically a customized sound file, loaded onto a proprietary MP3 player.
We are presently experimenting in our practice with customized masking. After matching the patient's tinnitus, we check for maskability using white noise. For those who are maskable -- i.e. tinnitus is reduced by white noise -- using a program called Matlab, we produce a sound file that is customized to the frequency of the tinnitus. This sound is mixed in with music provided by the patient. The idea is similar to the "Neuromonics" device, but the implentation is much simpler and less expensive.
The main way that this approach differs from conventional masking is that the sound is filtered, and customized to the tinnitus frequency. This makes the masking sound less disturbing as it does not contain useless frequencies (Paglialonga et al, 2011).
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