Tinnitus Sound Therapy: Everything You Need To Know

Visit us at www.neuromedcare.com or call 1-888-226-6330.   This podcast is an audio file of our YouTube video. 

Dr. Djalilian is the Director of Otology and Neurotology and Professor of Otolaryngology, Neurosurgery, and Biomedical Engineering at the University of California, Irvine.  His work is expanding the frontiers of medical science and tinnitus research. He has published over 300 peer-reviewed medical papers, authored multiple book chapters, and published several medical textbooks related to hearing and balance disorders.

In this podcast, Dr. Djalilian discusses everything you need to know about sound therapy for tinnitus. Sound therapy basics, generic vs. customized sound therapy, tinnitus masking, Tinnitus Retraining Therapy, bimodal stimulation therapy, tinnitus habituation, and more... 

We hope you enjoyed this podcast! You can find us at www.neuromedcare.com or call us at 1-888-226-6330.

Transcript

Tinnitus Sound Therapy, with Dr. Hamid Djalilian 

• Chief Medical Advisor for NeuroMed - Science-Based Tinnitus Care

Introduction to Tinnitus Sound Therapy:

The basic idea behind sound therapy is using background sound to reduce the perception of the ringing. Think of it like a candle in a dark room, it's going to appear like it emits a lot of light. But when the lights are on, the candle does not appear to be emitting as much light, even though it's technically emitting the same amount of light it was before. The same idea is true for sound therapy; by creating some background sound and what we call a sound enriched environment (so having something that creates some background sound, all the time), helps reduce the impact of the ringing because it doesn't make the ringing stand out as much in the silence.

Tinnitus in Quiet:

So does everyone experience tinnitus and acquire environment? The reality is actually it's a quite a high percentage in some studies, up to ninety four percent of people have experienced tinnitus when placed in a super quiet room. But in a natural environment that has some background noise, from outside, from air conditioning, etc., then that that sound is not as noticeable. The basic idea behind that has to do with contrast enhancement. So, basically, in the same way that we talked about the candle appearing more bright in a dark room, that's how tinnitus appears more prominent in a very quiet environment. The auditory system amplifies things in a quiet environment, there is less distraction. And finally, brain sensitivity and sometimes psychological factors lead to increased attention of the brain. Now there are other factors such as this migraine, but this atypical migraine, which can make tinnitus much louder when it is active.

Loud Tinnitus at Night:

Well, some people ask, why do I hear the tinnitus more at night? Again, that goes back to the fact that night is when it's most quiet, the brain has less things to focus on. And so then it tends to pick up this ringing sound. And so then it appears that it's louder at night when, in fact, in reality, the loudness has not changed. It's more that you have less stimulations. There is less background noise, and therefore, the tinnitus appears louder to you at night.

Tinnitus is a Brain Problem:

Tinnitus is not just an ear problem. It's really a brain problem that occurs as a result of an ear disorder, which is loss of hearing cells. So when you lose cells in the inner ear as a result of aging or noise or other factors, then you get an increase in the brain activity; that increased activity in the brain is what this ringing perception is that you hear. Basically, the rest of the brain looks at the hearing part and says, Hey, what's this electrical activity in the hearing part? That must mean there's sound there. So then you perceive it as a sound.

Sound Therapy Types:

There are different forms of sound therapies. People use what we call generic sound; generic sound could be things like white noise, which sounds like the sound of the rain. You could use things like pink noise or brown noise, which are shaped a different way, meaning that there's some pitches have more sound, some pitches have less sound. Some people use nature sounds like the sound of running water or things like that. And then finally, some people who like to use a mechanical thing like an air purifier or a fan. All of these basically create some kind of background sound to help drown out the ringing, so it makes it less prominent for the ringing. Now sound therapy is an essential part of treating tinnitus. Because when done using a customized protocol, we actually can reduce the perception of the ringing more long term by stimulating those cells in the brain that are being overactive and quieting them down. That's what customized sound therapy does, and when combined with a program that addresses all of the other triggers of tinnitus and uses cognitive behavioral therapy online or in person, then we found that actually has a bigger effect. When we've looked at the combination of customized sound therapy, with online cognitive behavioral therapy, we found that there was a forty percent reduction in the bothersome nature of the tinnitus. Sound therapy works even without cognitive behavioral therapy, but the effect is much higher when combined with cognitive behavior or therapy.

How To Use Sound Therapy:

How often should you be using sound therapy? We recommend generally doing one to two hours a day, but if you are not part of a formal program, we recommend using it whenever you feel, the tinnitus is most intrusive. So creating what we call a sound-enriched environment where you have background sound with either a fan or air purifier white noise, music, whatever it may be to help block your brain from paying attention to the ringing is helpful. Now if you are working and you're busy and you don't hear the tinnitus, then you don't need to have sound in the background. Quiet times, where you might be reading, or you might be trying to go to bed, then using a sound-enriched environment helps reduce the brain's attention to the ringing, and therefore reduce the impact of the ringing.

Hearing Aids and Tinnitus:

Can hearing aids help with tinnitus? If you have a hearing loss, then using hearing aids can definitely help. Because if you think about what hearing loss is, you basically have created a silent environment for yourself by reducing the sound that's getting into the brain. So by using hearing aids that creates a more acoustically enriched environment. And if your audiologist is experienced in the treatment of tinnitus can use some parameters to help you reduce the impact of the ringing even further. Sometimes you could have your sound therapy be playing on your hearing aids. So hearing aids work when there's sound around you, but when there's no sound around you, you can play some therapy either through the hearing aids or off your phone via Bluetooth into your hearing aid. Now or hearing aids covered by insurance if it is for tinnitus? Unfortunately, hearing aids are not generally covered by insurance. Some insurances have a partial benefit, and that may be something that you can look into with your insurance. What about over-the-counter hearing aids? Over-the-counter hearing aids, tend to have a set amplification schedule on it. So you set it at a certain level and it amplifies those sounds. You have very little control over the shape of this sound, meaning that if you have more high pitched hearing loss and less than the low pitches, then you're going to get what the hearing aid was programmed to do. You're not going to be able to make too many changes to the hearing aids.

What is tinnitus masking?

So tinnitus masking is a way of doing sound therapy where sound is individualized. The sound that you listen to is programmed specifically for you based on your hearing loss, the loudness of the tinnitus, and the pitch of the tinnitus; that is usually done by an audiologist who specializes in the treatment of tinnitus. It tends to be a little bit more expensive but it does work better generally speaking for patients.

What is partial versus total tinnitus masking?

Partial masking is when the sound therapy is made to a degree where it's not fully covering the sound of the tinnitus. Some schools of thought on this think that it's better to not have total masking and have it at a level where you can just still barely hear the tinnitus; that helps get the brain more adapted to the tinnitus and what we call "habituated". Now total tinnitus masking is when you cover up the ringing sound; the sound therapy is louder than your ringing, and that can make you not hear the tinnitus at all. Now there are some times that you need total masking, and there's times that it's probably better to use partial masking. Total masking is when you really don't wanna hear it at all, and you just want to cover it up. And partial masking is what we recommend doing most of the time.

What is residual inhibition?

Residual inhibition is basically using sound to treat tinnitus and then turning off the sound and seeing what period of time your tinnitus sound is quiet after the sound therapy has been stopped. Generally speaking, that might be very short, a few seconds; in some people, it could be a few minutes, potentially. Some people get a rebound in their tinnitus, meaning that after the sound therapy is turned off, the sound gets louder than it used to be. That is usually temporary. It's not permanent, don't worry. But it is usually less likely to occur if the last few minutes of your sound therapy, you gradually reduce the volume of the sound so that basically the tinnitus gradually comes back and the sound therapy gradually goes away. If you abruptly stop it, you're more likely to get a rebound.

What is notched therapy?

So the idea behind notched therapy came about maybe about ten to fifteen years ago, where some researchers thought that if we give patients sound, but don't give them sound around the pitch of the tinnitus. That has a positive effect on tinnitus. It was a very small study initially that was done, And, really, what we have found is that actually is not effective in most patients and in some patients can make the tinnitus worse. There is a phenomenon in the brain called an 'after effect' where when you stimulate certain areas but don't stimulate one area, and then you turn off the stimulation, that one area that didn't have stimulation actually has an increase in stimulation. And some people can actually make the tinnitus louder. We are actually not supporters of that theory, at all.

Best Sound Therapy for Tinnitus

 What has been found to be most effective for reducing tinnitus is to actually give you the same pitch of the ringing. However, when you think about it, that's not very useful because if you give the same pitch, you're just replacing the internal, kind of, high pitched E sound with an external, high pitched E sound. However, if we mix that sound with other sounds and broaden the sound pitches a little bit around that pitch, it just sounds like white noise. And that was the idea behind 'harmonic sound therapy' that we at University of California, Irvine developed and is now available and is used as part of the treatment regimen that you receive with NeuroMed. That sound therapy, which is customized to each individual, has been found to be much more effective in helping patients with tinnitus than using white noise. In fact, we did a study where we took patients, and in one group of them, had the customized sound therapy with the harmonic sound. We had another group that got just white noise. Each used it for about three months. We measured their tinnitus before and after, and then we switched them. And what found is that the patients with customized sound had a reduction in the annoyance of the ranking and how bothersome it was to them and the level of the ringing. Whereas the people who got generic sound therapy, which is like white noise, then they did not have improvement in those characteristics. So the conclusion was that customized sound therapy using our harmonic sound therapy protocol that we developed is very effective in reducing tinnitus, much more than what white noise is capable of doing.

What is Tinnitus Retraining Therapy?

Tinniness Retraining Therapy is basically using a combination of masking (white noise masking), and some cognitive behavioral therapy that is done through an audiologist. It's a one-to-two year program. Usually patients use what's called an 'ear-level masker', which it looks like a hearing aid, but just makes sound. And the patients have visits with the audiologist to try to understand better what's making your tinnitus worse and what can be done to help it. It is pretty effective based on the studies have been published, but it is a very long term commitment and tends to be somewhat expensive.

What is tinnitus habituation?

Tinnitus habituation is based the idea that the tinnitus is still there, but your brain has become habituated or sort of used to it in that the brain doesn't pay attention to it as much and is not causing stress or distress for the patient. So, meaning that someone says, "Hey, you still have that ringing in your ear?" and you, "When I think about it, I hear it, but it doesn't bother me". That's habituation. And that's the goal of a therapy to help patients with tinnitus.

What's the difference between Tinnitus Retraining Therapy and Cognitive Behavioral Therapy?

Cognitive behavioral therapy is usually done by a psychologist or done in an online platform, like the on form developed by our team at UCI, California. But what we use instead of the TRT using white noise, we use a protocol that we developed using harmonic masking that's much more effective than a white noise therapy. So, cognitive behavioral therapy, generally done by a psychologist or online; TRT, generally done by an audiologist in person.

 What is bimodal therapy for tinnitus?

Bimodal therapy is basically using two different ways of stimulating the brain. The primary one is using sound therapy and the secondary one is usually using some kind of electric stimulation, either through the tongue or the neck or wrist. And, it has been thought that bimodal therapy has a bigger effect than just sound therapy alone. Now from my experience with my own patients, I can tell you that we are yet to see patients have a significant benefit compared to sound therapy alone. And when we have done experiments and studies with our customized sound therapy, we found it to be just as effective as what the studies with the bimodal sound therapy devices are providing patients. So we haven't found them to be more effective than just sound therapy alone, and these devices tend to be much more expensive than sound therapy alone.

 Can sound therapy cure tinnitus?

While it doesn't cure tinnitus, it's an essential part of the treatment regimen. Where TRT or Tinnitus Retraining Therapy and sound therapy alone fail is they don't take into account the process in the brain that makes tinnitus louder. It's really only addressing one dimension of tinnitus and you really need to treat both the sound production and the loudness of the tinnitus. The loudness of the tinnitus is highly dependent on this phenomenon related to migraine. I've been doing research on tinnitus for twenty years, and we've finally figured out the process that makes tinnitus loud, it's what we call atypical migraine. So there are people who get migraine and they don't get headaches. They just get increased tinnitus loudness. They could get things like neck stiffness, ear fullness, head pressure, sinus pressure, facial pressure, vertigo; things like that that are not typically associated with migraine. These patients may not have headaches. They may have a history of headaches. They may have a history of ocular migraines, things like that. But they tend to not necessarily have the severe constant migraine headaches. Now these patients, when we treat this underlying migraine process, which is showing itself as loud tinnitus, they have a much better outcome in terms of how loud their tinnitus is. We can get the tinnitus from being very loud to being very quiet and not noticeable. Do we make tinnitus go away completely if somebody has acute tinnitus in the very early stages of tinnitus or have intermittent tinnitus, Yes, We can make it go away. But in chronic tinnitus, the goal of the treatment is to get your tinnitus down, and that we can do faster than any other treatment that's available currently.

Next Steps

If you want to see if the enrollment program is best for you, I would encourage you to schedule a pre-visit consultation by phone. It is free, and you can get more information about the program and see if it's a good fit for you. Visit www.neuromedcare.com or call 1-888-226-6330.