Masking Question

Dr Nagler,

I realized that as bad as my tinnitus experience has been, I'm sure I would have had a harder time, and even more negative thoughts to challenge if not for masking. My tinnitus is variable, sometimes I can barely hear it, but then yesterday afternoon I could hear it while driving 70 down the interstate with the radio playing at a decent volume. I have an iphone app that plays a cricket sound that I'm able to play in my office and at home. I literally stick the phone in my pocket and carry it with me everywhere I go just so I'm not assaulted by the sound while walking down a hall or into a quiet room. I sleep with the same sound playing as well. My question is-- at some point this masking during the day has to stop, do you have any suggestions regarding how I should try to ween myself off masking and when I would know its even the time to try?

Thanks,
Matt

 

Hi Matt –

You ask a very straightforward question with a rather complex answer.

Tinnitus masking is an excellent approach for the achievement of immediate relief. I think it may have been the French auditory physician, Jean Marc Gaspar Itard, who first described tinnitus masking in the early 1800s. He took his patients who had high-pitched tinnitus and asked them to sit near a hissing fire made with green wood. He asked his patients with low-pitched tinnitus to sit near a roaring fire made with old wood. He had patients living near grist mills. Others would spend time in a horse-drawn carriage going over cobblestoned streets. The man was indeed quite inventive!

Dr. Jack Vernon introduced the era of modern tinnitus masking in the 1970s. A tinnitus sufferer, Dr. Charles Unice, was visiting Dr. Vernon in Portland from his home in Southern California. They were having lunch outdoors near Lovejoy Fountain in Portland, and after lunch Dr. Unice would not leave his place, transfixed by the sound of the flowing waters of the fountain. He told Dr. Vernon that was the first time this he could remember since the onset of his tinnitus that he was unable to hear it. Dr. Vernon took that ball and ran with it! He soon introduced the concept of wearable tinnitus maskers that look like hearing aids but that instead of amplifying external sound produced a quiet "shhhh" sound of their own. He subsequently created the "tinnitus instrument," a combination hearing aid and masker.

And even up to today, there is actually nothing wrong with wearing such devices if they provide you with the relief you seek, nor is there anything wrong with simply providing enough background sound in the environment to take the edge off one's tinnitus. Masking – complete masking or partial masking – is just fine!

The problem arises if one's goal is not the immediate achievement of relief, but rather the facilitation of habituation of one's tinnitus. The idea is that you cannot habituate a signal that you cannot detect; and if you completely mask your tinnitus, by definition you cannot detect it!

First of all the above issue may be more of a concern in theory than in practice, because even if you try to totally mask your tinnitus throughout much of the day, typically there are times during the day when your tinnitus is for one reason or another not totally masked.

Nevertheless, I personally feel that if you are satisfied with the immediate relief that can be obtained with partial masking, you can in many ways kill two birds with one stone. Looking at things that way, the question of how and when how you should wean from masking becomes moot.

I just want to add (while hopefully not adding to the confusion) that masking and partial masking are terms that are not applicable if one is using broadband sound in TRT. Wearable broadband sound devices are used in TRT not to mask and not to partially mask. Rather they are used to decrease contrast and to induce associative learning. That's more information than you needed, Matt, but I wanted to insert it here for completion.

Best regards –

Dr. Stephen Nagler