What is a tinnitus masker?
Tinnitus is a common problem that millions of Americans face everyday. In fact, it is the third largest reported disability in the United States. It is also the most widely reported disability in the United States Military/VA population too. Tinnitus is the perception of hearing a noise without the presence of an auditory stimulus. A few examples can be ringing, buzzing, hissing, or whooshing. The severity of tinnitus ranges depending on the person: some people can go throughout their day and never notice their tinnitus, while others are greatly bothered by it. Although we do not know exactly where tinnitus is generated, the most current theory is that it is associated with the limbic system within our brain. The limbic system is responsible for your “fight-or-flight response” and our emotions. When their tinnitus is present, their brain and body activate this response and create a negative reflex, telling the listener that their tinnitus is dangerous, bothersome, and damaging to their life. Although currently there is no cure for tinnitus, it can be managed in several ways. The most successful and researched method is by using a tinnitus masking device. This article will discuss what a tinnitus masking device is and how it will be used. Therefore, this can explain and support the wide variety of responses to tinnitus that people experience. It can also explain why many people with tinnitus and underlying mental health diagnosis can more often be more significantly bothered and on edge because of their tinnitus. Over 2 million Americans report that their tinnitus is to the point that it is debilitating. If you or a loved one are experiencing tinnitus, especially debilitating tinnitus, please reach out to a loved one, your primary care physician, or even the American Tinnitus Association Tinnitus hotline, 800-784-2433.
Would a masking device be appropriate for you?
A tinnitus masking device is a device that introduces sound, typically white noise or some other calming sound, into the listener’s ear to help distract the brain from the tinnitus. Most often, tinnitus masking devices come in the form of hearing aids meaning they are ear-level-devices and can be worn throughout the entire day. The sound used should not be annoying or bothersome, but instead give you something with a neutral emotional response. It also should not be at a volume that is distracting, in fact, it should be barely audible. The goal is to make it like elevator music! Whenever we walk into an elevator, we notice the music right away. Usually, it has a soft melody and acts as a calming effect, and after you go up a few floors it is no longer noticeable. The elevator is not playing your favorite pop song that makes you want to sing and dance. The goal is just to play music in the background. The tinnitus masker works exactly like this. When you first put the masking devices on, you will notice the sound. After a half hour of wearing the devices, you will no longer pay attention to the sound, and you become less aware of your own tinnitus. You can then go about your day with the devices on and get through tasks that before you may have struggled with due to your tinnitus. The four main goals of tinnitus masking devices are to wear them consistently as needed, to have the sound be loud enough to be audible but not loud enough to interfere with daily activities, to use a sound that is not bothersome or annoying, and to be able to still hear your own tinnitus when thinking about it. When following these goals, tinnitus masking devices can be very successful in reducing that negative reflex created by the limbic system!
Tinnitus life hacks
Determining if a tinnitus masking device is right for you should be a discussion made with an audiologist. More specifically, you should find an audiologist who specializes in tinnitus as they understand the theories behind tinnitus, have continuing education on this topic, and use evidence-based treatment methods. Masking is not tinnitus management, so it is important to your long term treatment of your tinnitus that you have the correct provider from the beginning. The audiologist will likely complete a comprehensive hearing and tinnitus evaluation before providing treatment. This will include obtaining air and bone conduction hearing thresholds, speech recognition testing, and pitch and loudness matching of your tinnitus. What this testing provides is information about your entire hearing system from the outer ear all the way into our brains. The audiologist may decide to start with hearing aids if hearing loss is present, because sometimes by treating the hearing loss, we also treat the tinnitus. This is because one theory behind tinnitus is sound deprivation, meaning our brain is not getting full access to sound. Sound deprivation is equal to hearing loss, so when we have hearing loss our brain thinks it is missing out. It then creates its own sound, tinnitus, to make up for this deprivation. By fitting you with well fit hearing aids for your hearing loss, the brain has full access to sound again which can sometimes completely resolve the tinnitus. If not, then you are a great candidate for a tinnitus masking device. There are many types of hearing aids that include sound generators, but they vary by the type of sound used. Some use white noise, while others use fluctuating/rolling noise to best mimic water. Others use music that has no identifiable pattern, allowing your brain to always focus on this sound instead of tuning it out. It is important to discuss your likes and needs for the sound stimulus with your audiologist, as this can help determine which tinnitus masking device should be used. It is important to remember though that all of them can provide the same relief! Aside from the hearing and tinnitus evaluation, your audiologist also may provide Tinnitus Retraining Therapy (TRT). This is a specific type of tinnitus therapy created by Dr. Jastreboff that focuses on teaching you about the auditory system and where tinnitus is generated, and then teaching you various methods to cut your emotional response to tinnitus. Much of TRT is counseling and these appointments can be very long but beneficial. It also includes using tinnitus masking devices!
As stated earlier, it is important to appropriately and consistently use the tinnitus masking device to help reduce the negative reflex in the limbic system. Typically, this means wearing the devices all day long from the time the sun comes up until it sets at night. Sometimes, though, people with tinnitus are not bothered during the day. They are having difficulties falling or staying asleep at night. For these individuals, the tinnitus masker can be worn while you are sleeping. It is not harmful for our ears and can help improve the quality of sleep, which also has positive effects on our mood and overall health. Determining the right sound for people who want to wear their devices while sleeping is important though. These individuals may want to use fractal noises, meaning there are no specific patterns to the sound, which can include nature sounds or specific music, like Widex Zen Tones. The reason why fractal noise may be most successful is because over time our brain likes to listen, identify patterns, and then tune out repetitious noise. If you use white noise, your brain may tune out the noise in the middle of the night causing you to wake up and hear your own tinnitus again. If we use the natural sounds or Zen Tones, the goal is that your brain will not be able to identify a pattern and you will hopefully be able to sleep entirely through the night and not be bothered by your intrusive tinnitus. Again, it is important to discuss your goals for the tinnitus masking devices and when you would most use them with your audiologist so they can help make the best decision on device and noise type for you.
Hearing Aids for Tinnitus
If tinnitus masking devices on your ear do not seem like a good treatment method for you, there are other tools you can try to help make your tinnitus less bothersome. You can have a high-fidelity custom earplug, also known as Musician’s earplugs, made. These custom earplugs will be made according to your ear anatomy and protect your ears from further noise exposure. By limiting our noise exposure, we are helping prevent the tinnitus from becoming worse (louder or a more annoying pitch). These earplugs still allow non-damaging sounds to pass meaning you can still hear others while wearing them! You could also create what we call a “Tinnitus Go Bag” to carry around with you. Inside you should include things that help reduce your tinnitus and raise your overall mood. This could include medications for mental health conditions, natural supplements, headphones to protect from loud sounds or to listen to music, stress balls, drinks or snacks that you really enjoy, or fidgets. All of these materials can be used when you start to become overwhelmed by your tinnitus and help calm the limbic system and your body’s response. It is also important to have a list of emergency contacts in the bag as well in case you need outside support if the tinnitus becomes too much. Other tools can include sound machines that you can place around your home or work environment to enrich it with sound, or multi-sensory distraction devices. The goal of these devices is to excite our other senses (touch, taste, smell) to inhibit the negative response of our auditory system and reduce our tinnitus. Currently, Widex Zen tones have FDA approval for their tinnitus management but there are no other devices within the United States. There are some exciting devices in the FDA approval process which we should see some movement on by Quarter 1, 2023. If this is something that interests you and you are very bothered by your tinnitus, please contact us and we are happy to discuss this with you further.
Overall tinnitus masking devices can be very beneficial for individuals with bothersome tinnitus when used appropriately. Masking is not tinnitus management. Masking to solely “mask out” or hide the tinnitus is only going to provide short term relief, which will not satisfy your long term management goals. It’s like hiding a fresh cut with a bandaid, the band aid didn’t heal the cut or make it disappear, it just covered it up so we can’t see it. When the band aid is removed, the cut is still present in short bursts. We are quick to injury, but healing takes time. Tinnitus management is no different. When working with a tinnitus trained audiologist be sure to inquire as to their tinnitus management methods. Short term and long term tinnitus goals are important to discuss realistic expectations before beginning tinnitus management. It is important to discuss your tinnitus with your audiologist and get a full hearing evaluation. Hearing loss should be treated, as well, and can often help resolve the tinnitus. Tinnitus masking devices are great as they allow constant, on-ear, sound stimulus to the listener, but they may not be the correct treatment for you. There are many other off-ear options including sound machine, Tinnitus Go Bags, and multi-sensory distraction devices. The most important thing is to find what device works best for you and provides the most relief from your tinnitus. Remember, our main goal is to stop the negative reflex created within the limbic system and reduce our fight or flight response associated with the tinnitus.