Therapy and Treatment Options

Hearing Aids / Masking Devices

Hearing Aids

Hearing aids can be classified as a type of sound therapy because they augment external noise as a way of increasing auditory stimuli and diverting attention from the perception of tinnitus. People often mistake that loud tinnitus, rather than hearing loss, interferes with their hearing. It is therefore critical to have one’s hearing evaluated since as many as 90 percent of people who experience chronic tinnitus also have hearing loss.

To learn more about distinguishing between hearing loss, tinnitus, and hyperacusis, and the recommended protocols for evaluation, click here.

Why Hearing Aids?

Tinnitus is overwhelmingly connected to some level of hearing loss. Augmenting the reception and perception of external noise can often provide relief from the internal sound of tinnitus.

Most patients develop tinnitus as a symptom of hearing loss, caused either by age, long-term hearing damage, or acute trauma to the auditory system. According to the general scientific consensus, hearing loss results in less external sound stimuli reaching the brain. In response, the brain undergoes neuroplastic changes in how it processes different sound frequencies. Tinnitus is the product of these maladaptive neuroplastic changes.

Patients with hearing loss and tinnitus may find relief from the use of hearing aids and other sound amplification devices. Hearing aids are small electronic devices worn in or behind the ear. Using a microphone, amplifier, and speaker, hearing aids supplement the volume of outside noise and increase the amount of sound stimuli received and processed by the body’s auditory system.

In a 2007 survey of hearing health professionals, respondents self-reported that roughly 60% of their tinnitus patients experienced at least some relief when wearing hearing aids; roughly 22% patients found significant relief.

Hearing aids can be effective for several reasons:

Masking and Attentional Effects

Hearing aids can augment the volume of external noise to the point that it covers (masks) the sound of tinnitus. This makes it more difficult to consciously perceive tinnitus and helps the brain focus on outside, ambient noises. The masking impact of hearing aids is particularly strong for patients who have hearing loss in the same frequency range as their tinnitus.

Auditory Stimulation

Increasing the volume of external noise also increases the amount of auditory stimulation received by the brain. There may be benefits to stimulating the brain’s auditory pathways with soft background sounds that might not otherwise be heard.

Improved Communication

Hearing aids help by augmenting the external volume so that it’s easier to hear conversations and surrounding sounds. As a result, patients may feel less personal frustration and social isolation.

To better understand how hearing aids can help with tinnitus, consider the two images below as simple visual representations of tinnitus and hearing loss. Imagine that the cricket represents a person’s tinnitus, and the background image represents background sounds.

A

grasshopper

B

waterfall

In Picture A, the person has a hearing loss. The background sound is indistinct, and the cricket (tinnitus) is very clear. In Picture B, the person has been fitted with a hearing aid, and the background is clear and rich in detail. Although the cricket (tinnitus) is still present, it blends into the background. The listener’s attention is diverted to other aspects of environmental sound. The success of hearing aids in managing tinnitus depends on how well background sounds can be made to blend with tinnitus.

Modern digital hearing aids, with open-fit designs and patient-customized hearing loss profiles, may be particularly useful for managing tinnitus. Moreover, many newer hearing aids include supplemental sound masking functionality (white noise or other artificial ambient sound played directly into the ear) that further covers the perception of tinnitus.

Like most tinnitus treatments, hearing aids may work best when paired with a structured tinnitus education program and some form of patient counseling.

Cochlear Implants

Cochlear implants, surgically implanted devices that restore the sensation of sound to deaf patients or those with severe hearing loss, are another form of sound amplification that may be useful in alleviating tinnitus symptoms. These work on the same principle as hearing aids — they increase outside sound stimulation, helping to distract the brain from the sounds of tinnitus. Cochlear implants are generally available only to patients who have severe hearing loss that prevents understanding spoken communication, limited benefit from hearing aids, as determined by an audiologist, and no medical conditions/factors that would increase the risks associated with cochlear implants..

Considerations

Price: Hearing aids can be expensive and are often not covered by insurance plans. Tinnitus patients with negligible hearing loss may find it difficult to find insurance coverage for hearing aids.

Lifestyle and Comfort: Research suggests hearing aids are most effective when they are used consistently during waking hours. This requires the patient to wear the devices on a full-time basis.

Sound Sensitivity: Patients with hyperacusis or other forms of sound sensitivity may encounter some discomfort when using sound amplifying devices.

Age: While hearing aids may benefit most patients, some studies suggest that they are most effective for younger patients and those with a shorter history of tinnitus.

References

Del Bo, L. and Ambrosetti, U. (2007) “Hearing Aids for the Treatment of Tinnitus.” Progress in Brain Research, 166: 341-345.

Folmer, R.L., Theodoroff, S.M., Martin, W.H., Shi, Y. (2014) “Experimental, Controversial and Futuristic Treatments for Chronic Tinnitus.” Journal of the American Academy of Audiology, 25:106-125.

Hoare, D.J., Edmondon-Jones, M., Sereda, M., Akeroyd, M.A.and Hall, D. (2013) “Amplification with Hearing Aids for Patients with Tinnitus and Co-Existing Hearing Loss.” Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD010151. DOI: 10.1002/14651858.CD010151.pub2.

Hoare, D.J., Searchfield, G.D., Refaie, A.E. and Henry, J. (2014) “Sound Therapy for Tinnitus Management: Practicable Options.” Journal of the American Academy of Audiology. 25: 62-75.

Kochkin, S and Tyler, R. (2008) “Tinnitus Treatment and the Effectiveness of Hearing Aids: Hearing Care Professional Perceptions.” Hearing Review, Available at: http://www.hearingreview.com/2008/12/tinnitus-treatment-and-the-effectiveness-of-hearing-aids-hearing-care-professional-perceptions/  (Accessed March 25, 2015.)

Searchfield, G. (2005) “Modern Hearing Aids - A Help for Tinnitus.” Tinnitus Today, 30,2: 14-16.

Shekhawat, G.S., Searchfield, G.D., and Stinear, C.M. (2013) “Role of Hearing Aids in Tinnitus Intervention: A Scoping Review.” Journal of the American Academy of Audiology. 24(8):747-62.

Trotter, M.I and Donaldson, I. (2008) “Hearing Aids and Tinnitus Therapy: A 25-Year Experience.” The Journal of Larnygology and Otology, 122: 1052-1056.

Sound Therapies

Tinnitus is a non-auditory, internal sound. But patients can use external sound to counteract their perception and reaction to tinnitus. Sound masking can cover the sound of tinnitus, while more advanced therapies may provide more robust relief.

“Sound therapy” is a broad term that may be used in many ways, depending on the specific product, clinical setting, or individual clinician. In general, sound therapy refers to the use of external sound to alter a patient’s perception of, or reaction to, tinnitus. Like other tinnitus treatments, sound therapies do not cure the condition, but they may significantly lower the perceived burden and intensity of tinnitus.

Sound-based therapies function on four general mechanisms of action. (Mechanisms of action are the putative processes, or reasons why, a given intervention is effective.) Different products may emphasize a specific aspect, or include a combination of approaches:

  • Masking: exposing the patient to an external sound at a loud enough volume that it partially or completely covers the sound of their tinnitus
  • Distraction: using external sound to divert a patient’s attention from the sound of tinnitus
  • Habituation: helping the patient’s brain reclassify tinnitus as an unimportant sound that can and should be consciously ignored
  • Neuromodulation: the use of specialized sound to minimize the neural hyperactivity that is thought to be the underlying cause of tinnitus

There are many devices that offer different levels of sound therapy. Below is a list of general types of sound therapy products, and a discussion of their specific mechanisms of action and reported efficacy.

Sound Masking Devices

These are devices or applications that provide generic background noise — often white noise, pink noise, nature sounds or other ambient, subtle sounds. The sound generated by sound machines can partially or fully mask a patient’s perception of tinnitus, providing relaxation and temporary respite from the condition.

The “traditional” sound masker is a single-function table-top or bedside device with several pre-set sound options. However, almost any sound-producing device can be used for masking purposes, including personal media players, computers, radios, and televisions. Even electric fans or table fountains can provide masking sounds. In general, the most effective masking sounds are those that elicit positive emotional responses in the patient.

Sound masking devices are typically only effective during or immediately after active use; they have very limited long-term effectiveness in reducing the overall perception of tinnitus.

Modified-Sound / Notched-Music Devices

While commercial-grade sound machines deliver a generic sound selection, a variety of medical-grade devices provide more customized sounds designed around the patient and his/her tinnitus. These devices play special notched-music or algorithmically-modified sounds in which specific frequencies and tones are emphasized — often at a level not consciously perceivable by the listener. The reported function of these modified sounds varies according to the specific product.

Unlike standard white noise machines, notched-music devices are generally worn intermittently (only during defined therapy sessions or times of predictable acute need, such as before bed or immediately upon waking), and provide lingering benefit after the device is turned off.

Also, unlike standard white noise machines, notched-music and modified sound devices may, over time, alleviate the perceived burden of tinnitus — even after they are turned off. By facilitating habituation, these products may help the patient naturally “tune out” the perception of tinnitus.

The reported clinical efficacy of modified-sound and notched-music devices varies by product, but in general these devices appear to provide some level of relief to many patients. Optimal results typically require at least some patient counseling and education in addition to the use of sound devices.

Combination Devices

Many hearing aids now come with integrated sound generation technology that delivers white noise or customized sounds to the patient on an ongoing basis. These devices combine the benefits of a hearing aid with those of other sound therapies and are particularly well suited for tinnitus patients with measurable hearing loss. Also, because of the portable nature of these devices, they can provide semi-continuous use and more consistent benefit throughout the day.

The efficacy of these combination devices varies, depending on the device, the integrated sound feature, and the particular patient. And, although research data is not definitive, the professional consensus seems to be that hearing aids with integrated sound generators benefit a significant number of patients.

Sound and Sleep Apps

With countless apps and little direction, it can be hard to figure out which sound and sleep apps might help with tinnitus and/or getting a good night’s sleep. By clicking in the image below, you’ll find a list of sound and sleep apps, many of which are free, that were compiled by an audiologist based on patient feedback. The apps are available through Apple’s App Store and under Google Play’s App section.

SoundTherapy_Apps_Page

Considerations

  • Price: Hearing aids and medical-grade sound therapy devices can be expensive and are often not covered by insurance plans.
  • Tinnitus Symptoms: Patients should consider their lifestyles and the times when they most require relief from their tinnitus. If tinnitus is mostly an issue immediately before or during sleep, a bedside white noise machine may be sufficient; if tinnitus is an ongoing, 24/7 concern, a more portable option may be preferable.
  • Sound Sensitivity: Patients with hyperacusis or another form of sound sensitivity may encounter some discomfort when using sound amplifying devices.
  • Education and Support: Nearly all sound therapy systems work best when they are coupled with a program of supplemental patient education and counseling.

References

Hoare, D.J., Searchfield, G.D., Refaie, A.E. and Henry, J. (2014) “Sound Therapy for Tinnitus Management: Practicable Options.” Journal of the American Academy of Audiology. 25: 62-75.

Hobson, J., Chisholm, E., El Refaie, A. (2012) “Sound Therapy (Masking) in the Management of Tinnitus in Adults.” Cochrane Database of Systematic Reviews, Issue 11. Art. No.: CD006371. DOI: 10.1002/14651858.CD006371.pub3.