Piskosz (2012) reports that there are multiple approaches to managing tinnitus and most management programs involve sound therapy. The primary goal of sound therapy is to divert the patient’s attention away from their tinnitus through the introduction of alternative sounds, thus minimizing the difference between the tinnitus and environmental sounds.
Traditional sound therapies have included white noise, pink noise, table-top noise sources (electric fans, static from an AM /FM radio, etc.) and proprietary noises. Pikosz reports that smart phones can download many traditional sound therapies as well as tinnitus apps including nature-sounds for playback through the smart phone’s speaker or headset. Unfortunately, these same downloadable apps do not (generally) account for hearing loss, which many tinnitus patients have. However, wireless streaming hearing products offer the opportunity to download virtually any sound source (traditional masking sounds, music, speech, environmental or natural sounds, etc.).
Piskosz notes rain noise is often the preferred background noise (see Searchfield and colleagues) as compared to white noise, and of note, music may sometimes be too interesting (cognitively) to serve as an excellent masker, because it draws attention to itself. Further, he notes sound therapy preferences change, and having multiple options is ideal to better meet the needs of the patient across time and in multiple acoustic environments.
Tinnitus retraining therapy (TRT) is based on a neurophysiologic model and is designed to help patients habituate (re-train the brain) to their tinnitus. TRT states tinnitus patients react to the relative strength of their tinnitus as compared to the background noise, rather than the absolute strength. TRT works to reduce the contrast between the perceived tinnitus and the background neuronal activity. TRT states the sound source should not be annoying to the end-user, the perceptual characteristics of the tinnitus should be maintained, sound sources should not interfere with other important sound perceptions (such as speech) and sound sources should not fully mask the tinnitus.
Progressive tinnitus management (PTM, see Henry and colleagues, 2012) is a patient-centered approach to tinnitus management and like TRT, uses counseling and sound sources within a five-step hierarchical plan. The five steps include triage, audiologic evaluation, group education, tinnitus evaluation and individualized management. Three classifications of sounds are used in PTM—soothing sounds, background sounds, and interesting sounds.
For More Information, References, and Recommendations
Baigi A, Oden A, Almlid-Larsen V, Barrenas ML, Holgers, KM.(2011): Tinnitus in the General Population With a Focus on Noise and Stress—A Public Health Study. Ear & Hearing 32(6):787–789.
Beck DL. (2011) Hearing Aid Amplification and Tinnitus:2011. Hearing Journal 64(6):12-14.
Henry JA, Zaugg TL, Myers PJ, Kendall CJ. (2012) Progressive Tinnitus Management, NCRAR, U.S. Dept. of Veterans Affairs. Reviewed/Updated Date: March 30
Jacobson G. (2012) Tinnitus Relief- At What Cost? Journal of the American Academy of Audiology 23(2):80.
Kochkin S, Tyler R, Born J. (2011): MarkeTrak VIII: The Prevalence of Tinnitus in the United States and the Self-Reported Efficacy of Various Treatments. Hearing Review18(12):10–26.
Newman CW, Sandridge SA. (2012) A Comparison of Benefit and Economic Value Between Two Sound Therapy Tinnitus Management Options. Journal of the American Academy of Audiology 23:126–138.
Piskosz M. (2012) The Role of Wireless Streaming in Tinnitus Management. Hearing Review March:12–15.
Sanchez TG, Akemi MA. (2008) Modulating Tinnitus with Visual, Muscular and Tactile Stimulation. Seminars in Hearing, Tinnitus Part Two 29(4).
Stouffer LJ, Tyler RS. (1990) Characterization of Tinnitus by Tinnitus Patients. Journal of Speech and Hearing Disorders 55:439-453.
Tyler RS, (2012) Patient Preferences and Willingness to Pay for Tinnitus Treatment. Journal of the American Academy of Audiology 23:115–125.
Tyler RS, Haskell GB, Gogel SA, Gehringer AK.(2008) Establishing a Tinnitus Clinic in Your Practice. American Journal of Audiology 17(1):25–37.