Discomfort and Annoyance with TRT Pink Noise Generators

Dr. Nagler,

Is there any harm in discontinuing TRT after 8 months? The sound generators are very annoying; have been the entire time. I have both tinnitus and hyperacusis. The generators are emitting pink noise. What other methods can I use to treat hyperacusis? Sound machine or phone apps???? Is pink noise best for hyperacusis?

Thank you in advance. God Bless. Peace.

 

Hello @Christopher805. Welcome to the Doctors' Corner, and thank you for your very good questions.

I will try to answer them without bias pro-TRT or con-TRT. There are a number of good things about TRT and a number of bad things as well. I will set all that aside and just go to your questions.

If you are referring to TRT devices (i.e., wearable broadband sound generators), there is no harm whatsoever in discontinuing their use.

If your sound generators are annoying, then (1) they have not been fitted properly, (2) you have not been properly instructed in their use, or (3) TRT is not for you. Moreover, you ought to be able to tell within three or four weeks - and if TRT is not for you, then you ought to be able to return your devices before the trial period is up and get your money back.

The philosophy behind wearing the devices is simple.

First, just as a candle looks less bright in a room with the lights on softly than it does in a room that is completely dark, so too adding in some low-level constant background sound via wearable devices can make the tinnitus seem "less bright" and consequently easier to habituate over time.

Second, there is the concept of associative conditioning. To a person with severe tinnitus, the tinnitus sound is typically unpleasant, intrusive, threatening, aggressive, and of great interest (to say the least). If TRT devices are set properly, the sound that they emit should be neutral (i.e., not unpleasant), non-intrusive, non-threatening, benign, and uninteresting. Moreover, even though the sound from the devices should approximate the tinnitus sound, it should not overpower the tinnitus. Finally, because the sound from the devices is so ... boring, if you will ... within a few minutes of wearing the devices you should be largely unaware of them. The theory is that the long-term consequences of wearing devices set in such a manner while approximating the tinnitus is that eventually the brain should begin to view the tinnitus as neutral, non-intrusive, non-threatening, benign, and boring. Which makes it easier to habituate. That's the theory, anyway.

Now, again, I am not arguing the pros and cons of TRT, but what I am very definitely saying is that if an individual is going to do TRT, then he or she should be instructed properly and not have to struggle with the wearable broadband sound generators. Intrusive tinnitus is enough of a struggle as is. Why compound the problem??!!

The key to treating hyperacusis lies in desensitization, by which I mean gradual progressive purposeful exposure to constant broadband sound that you and only you control (so as not to make yourself miserable!) This process should be benign and easy. It should absolutely not be some sort of chore, but you do have to gently push the envelope. There are any number of protocols that have been proposed. Wearable broadband sound generators provide a convenient way of delivering that sound because they travel with you, they are unobtrusive, and they do not block the ear canals. But they are just one option. Interestingly, for a number of folks who have both tinnitus and hyperacusis (like yourself), the tinnitus tends to be less and less of a problem once the hyperacusis has been effectively addressed - because absent any appreciable sound sensitivity, such individuals are more accepting of the natural masking effect of the sounds typically encountered in everyday life, thereby allowing the brain to “turn down the gain” and perhaps take the edge off the tinnitus.

No. The reason some clinicians recommend pink noise for hyperacusis desensitization as opposed to any other type of broadband sound can be traced back to Dr. Jack Vernon (1922-2010) and his group in Portland, Oregon. Dr. Vernon observed that some hyperacusics find the spectral characteristics of pink noise to be more pleasant to the ear - so those individuals might be more apt to follow through with the protocol. But if you are committed to the protocol (which, again, should be relatively benign and not some sort of teeth-gritting torture), then pink noise is no more effective than any other form of broadband sound.

Hope this helps.

Stephen M. Nagler, M.D.

 

Please note: I just now reworded the sentence beginning with the word “Interestingly” in the second-to-last paragraph above. My original wording was unclear and might have been misleading. Apologies.

Stephen M. Nagler, M.D.