Good to Go
Devices that can be worn on the ear deliver sound therapy for tinnitus relief virtually anytime and anywhere.
A tinnitus management plan is designed to help give you control over and relief from chronic tinnitus. Most comprehensive tinnitus management plans will incorporate some kind of sound therapy.
Sound therapy is the use of sound to provide relief, change your perception of the tinnitus over time, and facilitate habituation. Habituation is a reduction in your perception of the tinnitus even in the presence of the tinnitus, and it is often the goal of sound therapy programs. The exception may be when using an external sound to mask the tinnitus, during which the goal may be immediate relief rather than habituation.
Sound therapy can be delivered through ear-level devices, personal listening systems, and tabletop devices. Here we will focus on ear-level devices due to their portability, allowing the wearer the ability to use sound consistently throughout the day.
Appropriate sounds will be different for every person. A systematic approach to finding the right sounds, with the help of a professional, is usually the best method. For example, we had one patient who sampled our catalog of roughly 30 sounds, but he did not find any to be tolerable and to reduce his perception of tinnitus. When he went home and walked past his sprinkler, he realized that he couldn’t hear the tinnitus in the presence of the sprinkler. He recorded his sprinkler, downloaded the sound onto his smartphone, and listens to it through his Bluetooth-capable hearing aids.
Ear-Level Sound Generators
Ear-level sound therapy devices are worn on the ear, like a hearing aid, and deliver a variety of predetermined or programmable therapeutic sounds. They are appropriate for individuals with minimal hearing loss.
The sounds most commonly available are broadband sounds that many tinnitus patients find to be very tolerable—rainfall or flowing water, for example. Some devices offer preset broadband sounds, and some offer broadband sounds that can be modified.
Any of these devices can deliver a controlled, consistent sound to your ears. This should provide not only some relief but also a feeling of control over your tinnitus, which will aid habituation. The volume should be set to a very comfortable level that does not interfere with your ability to concentrate or communicate.
Hearing aids are normally intended to improve speech comprehension in a wide range of listening environments. But they can also be programmed in ways that provide therapeutic intervention for tinnitus.
The frequency of tinnitus is quite commonly within the range of frequencies included in an individual’s hearing loss. For some people with tinnitus, the use of hearing aids to amplify sound in the range of their hearing loss can also help reduce their perception of their tinnitus.
Enhanced hearing ability can have a therapeutic effect on the tinnitus by providing relief and facilitating habituation. Amplified am
bient sounds may be adequate to compete with the tinnitus and provide relief.
Though amplification alone may be minimally helpful for tinnitus relief in a quiet room, some patients report relief even in quiet conditions. This is probably due to the presence of the low-volume circuit noise generated by the devices. Most hearing aids will have some level of internal noise produced by the hearing aid itself. This can actually be of benefit to the tinnitus patient. As hearing aid circuits get quieter with improvements in technology, it is sometimes helpful to actually adjust the hearing aid settings to make them “noisier” to help quiet the tinnitus.
It is important to understand that fitting hearing aids for hearing loss as well as tinnitus often requires programming and adjustments that are quite different than those needed for compensating for hearing loss alone. But continued, consistent use of well-fit hearing aids can help solve both issues and encourage habituation.
A combination unit is an ear-level device combining the amplification of a hearing aid with the ability to provide a background sound like a sound generator. Although these devices were once hard to come by, they are currently in production by several well-known manufacturers.
The devices allow you to choose among an assortment of background noises, including a preset broadband noise, an adjustable broadband noise, and random chime-like tones. Individuals have a wide variety of subjective preferences and tolerability of these sounds, so you should ask to try the devices before purchasing one.
Look for a device that allows you to adjust the hearing aid volume and the generated sound volume separately. Then you can adjust the volume of the background sound without increasing the overall volume of the amplifier, which is helpful if your tinnitus often varies in loudness.
With the addition of wireless Bluetooth capability to most hearing aids, it is now possible to stream additional sounds through hearing aids and combination units for tinnitus management. As a result, any Bluetooth-capable device can be made into a customized combination unit.
You can now use sounds from your MP3 player or smartphone to manage your tinnitus. This offers tremendous flexibility. If you do not prefer broadband sounds or chimes, you can benefit from the combination of amplification and background sound.
A good sound therapy plan takes into account your individual needs, including hearing ability, tinnitus status, physical dexterity, and financial considerations. The most important factor for a person using sound therapy devices to relieve tinnitus is to provide background sound in a consistent, systematic way to encourage habituation.
Jennifer E. Martin, Au.D., holds a faculty position at Oregon Health & Sciences University (OHSU). She is a senior tinnitus specialist and research audiologist at the OHSU Tinnitus Clinic, both in Portland.
William H. Martin, Ph.D., is the director of the OHSU Tinnitus Clinic. He is a professor of Otolaryngology–Head and Neck Surgery and a professor of Public Health and Preventive Medicine at OHSU.