Tinnitus can be a complex condition and if hyperacusis is present it can be more. Many newbies have difficulty coping with tinnitus and understandably, getting rid of this constant intruder becomes paramount on their mind. In an attempt to do this, they will usually try every means possible to distract themselves from the tinnitus which will include masking it completely with another sound so that it can’t be heard.
However, tinnitus is quite resilient, any attempts to mask it completely are usually unsuccessful. As soon as the masking sound is removed or stopped temporarily, the brain will immediately focus back on it and often, it appears to be louder and more intrusive. This can cause stress especially for someone new to tinnitus. For anyone that doesn’t know, the more stressed we are the tinnitus becomes more intrusive, and the louder the tinnitus is the more stressed we are. It can become a vicious circle.
Anyone that is seasoned to tinnitus and has habituated, knows that trying to mask it completely so that it can’t be heard is not achievable. A much better way and preferred method that Hearing Therapists advise tinnitus patients, is to use sound enrichment. One can use music or nature sounds from a sound machine and set the volume slightly below the tinnitus. By doing this, the brain over time will learn to no longer see the tinnitus as a threat and gradually push the noise further into the background giving it less importance and helps the habituation process.
In-ear or BTE (behind the ear) white noise generators can also be used and often these devices are used as part of TRT and do a similar thing. By setting the volume slightly below the tinnitus, over time the brain habituates to the white noise and gradually pushes the tinnitus further into the background.
Michael
PS: If someone uses tinnitus maskers better known as white noise generators. They are best put on in the morning. The volume is set to just below the tinnitus and then left alone. The volume shouldn't be adjusted throughout the day. Some people tend to do this if they are out and about and the sound of road traffic prevents them from hearing the white noise. Please try not to do this. Constantly adjusting the white noise can make it more difficult for the brain to habituate to it and this can slow the habituation process.
Thanks Michael, was wondering if i have my masking sound too high? And maybe thats why it doesn't seem to be working. I can adjust it myself so its tempting to do this when you can't hear the sound because of louder background noises. Ie when Im at work. I also have pink noise as opposed to white noise. White noise i find is too close to the sound of my tinnitus and it just irritates me even more but pink noise is fine. I also have ocean waves as i find this more soothing if i have to keep it in at night but i do have the volume turned down to below my level of tinnitus. But i do wonder if the more reliant you become on the maskers, the less chance there is that your brain will filter out the noise on its own but only time will tell if thats the case.
I don't know how long you have had tinnitus? TRT was developed by Professor Pawel Jasterboff and it follows a strict protocol. I have had TRT twice in 20 years and found it helpful on both occasions. I also have the TRT book, written by Pawel Jasterboff and Jonathon Hazell. This book is the reference that all Hearing Therapists and Audiologists refer to for practicing TRT treatment to tinnitus patients. It explains everything about tinnitus, hyperacusis and the auditory system and the brain.
In the TRT book Jasterboff says two white noise generators should be worn to keep the auditory system in balance. He says the while noise should be set to just below the tinnitus. He also recommends at night they shouldn't be worn in bed although some people do this. He suggests a sound machine should be used by the bedside and the volume set to just below the tinnitus. It should be played throughout the night until morning.
TRT (Tinnitus retraining therapy) is a two part treatment. It involves counselling with a Hearing Therapist or Audiologist trained in TRT. Jastaboff says counselling is very important and I agree with him. The second part of the treatment is using white noise generators in the manner that I've discribed above and using a sound machine at night.
Jasterboff says that if a person is wearing one white noise generator this is not TRT. He then says: if two white noise generators are worn and no tinnitus counselling is given this is not TRT. He finishes by saying: If a person just wears two white noise generators or one and receives no tinnitus counselling, via a hearing therapist or audiologist, the results or outcome of the treatment might not be satisfactory.
The benefits of tinnitus counselling through a Hearing Therapist or Audiologist is as follows:
Tinnitus can become a problem when the patient starts to believe nothing can be done about the condition. If one isn’t careful anxiety and depression can start to take hold. Through regular counselling sessions with a Hearing Therapist the patient learns not to look at their tinnitus as non life threatening and not to be constantly afraid of it and to be monitoring every little change in its perception.
At first the therapist discusses with the patient how the tinnitus makes them feel and how it has impacted on their life. Often people say they have lost interest in the things they once liked doing, which is perfectly understandable. The main goal here is to gradually help them look at life differently and with a more positive outlook. Over time the negative thinking that is often associated with tinnitus and hyperacusis is gradually dispelled and demystified.
The Hearing Therapist does this in a controlled and precise manner so that the patient feels relaxed and not pressured. Therefore, it must be stressed and understood, this treatment takes time. To complete a course of TRT takes approximately twelve to twenty four months and in some cases longer. The duration of each counselling session is left to the discretion of the Hearing Therapist. Typically, these can last up to one hour or more. The amount of appointments required will be different for each patient, but it is quality rather than the quantity of the counselling that really matters.
Some people still manage to make good improvement and habituate to their tinnitus by wearing one white noise generator or two and without having tinnitus counselling.
Hi Micheal, Ive had tinnitus in my right ear for 15 months and this started 3 months after i truamatically lost my mother. It took me 5 months to be referred to ent and audiology, i had mri which was normal and last april was given a hearing aide with built in masker for my right ear and i have mild hearing loss in that ear too. I started using the HA but soon after this i started noticeing T in my left ear. Not sure if it was always there or not. Although it doesn't seem as loud as it is in my right ear. When i first noticed my T I was in the early stages of grief so emotionally i was all over the place and maybe this is why i reacted so badly when tinnistus started. I did have bereavement counselling which helped me alot. Ive also had CBT but struggled with this as it was only 1/2 hour sessions over 6 weeks and it didnt seem to help.i use sound enricment at night but have it on a timer (90 mins) and i normally fall asleep before thats up. Since using the hearing aid, i have noticed that my T is more noticable and have more spikes but when i didnt use it, my T was quieter more frequently but using the masker does give me relief when T is noisy. So you can see why Im becoming a bit confused as to whether i should continue using the masker or not. I don't know if my nhs trust supports TRT and thats something i can ask about on my next visit in march. I appreciate your words of wisdom though. Lesley
I am sorry for the loss of your mother. I know how that can feel. I still miss mine and she has gone 10 years now. My father passed 2 years later. I was very close to them and looked after them for quite a while.
TRT is a good treatment but it's expensive and only available at some NHS hospitals.
If a person has hearing loss and tinnitus, it is recommend to use a hearing aid to help supply the brain with sounds from the outside environment so that it turns down its internal gain. If a hearing aid isn't used, the brain tries to compensate for the frequencies (sounds) that it can't hear by turning up its internal gain (volume control). This will also increase the tinnitus making it louder and more intrusive.
It can be a bit of a balancing act to see what works for an individual when using a masker or white noise generator with built-in hearing aid. When using the masker, try to keep the masking sound lower than the tinnitus. I think it is best to discuss with your hearing therapist or audiologist in March.
The sound machine should be set to play throughout the night until morning. The sound machine works on your brain and auditory system when you are in deep sleep. The brain and auditory system never switch off. This is why when some people are in a coma for instance, doctors say to relatives speak to their loved one as they brain can still hear.
If someone has intrusive tinnitus and sleeps in a silent room, their is a risk of the tinnitus becoming louder. If the brain hears silence, it has the ability to turn up it's internal gain (volume control) at the same time increasing the level of the tinnitus. This can make it louder and more intrusive during waking hours. Some people with tinnitus choose to sleep in a quiet room and this is fine if it works for them. However, I always advise people with tinnitus to use a sound machine and set it to play all night until morning, keeping the volume slightly lower than the tinnitus. It mustn't draw attention to itself like a radio - in other words, it should be able to be easily ignored.
Professor Jasterboff recommends sound enrichment, should be used throughout the night until morning.
Hi Michael, thank you for this post, I have wondered about this. I have been listening to more music during the day thanks to the echo dot and am finding Im concentrating more on that then my own sounds. Its helping
Thank you. Tinnitus and how to manage and cope with it is about finding what method works for you. I'm pleased to hear that you've found a coping strategy that's giving you steady improvement, and I hope this continues.
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