In-Ear Maskers and Reactive Tinnitus — Can They Help?

[Lilah]

Hi Dr. Nagler, thank you for answering my previous question. I have another question on in-ear maskers. I have read that in-ear maskers can help/cure hyperacusis. I suspect I have reactive tinnitus. My sound changes sometimes depending on external sounds (opening a plastic container, etc.) Do you think in-ear maskers can help with reactive tinnitus? Or, will my reactive tinnitus worsen due to the white noise in the in-ear maskers.

Some people think reactive tinnitus and hyperacusis are the same; what are your thoughts on this? Using this logic, I am thinking if maskers help hyperacusis, they should likewise help reactive tinnitus and perhaps calm my tinnitus.

Thank you,
Lilah

 

[Dr. Nagler]

Hi Dr. Nagler, thank you for answering my previous question.

You are most welcome.

I have another question on in-ear maskers. I have read that in-ear maskers can help/cure hyperacusis. I suspect I have reactive tinnitus. My sound changes sometimes depending on external sounds (opening a plastic container, etc.) Do you think in-ear maskers can help with reactive tinnitus? Or, will my reactive tinnitus worsen due to the white noise in the in-ear maskers.

Some people think reactive tinnitus and hyperacusis are the same; what are your thoughts on this? Using this logic, I am thinking if maskers help hyperacusis, they should likewise help reactive tinnitus and perhaps calm my tinnitus.

Thank you,
Lilah

So this area gets a little murky because of definitions. Let me start there.

Wearable devices that produce broadband sound are properly called "broadband sound generators." When these devices are used for the purpose of achieving immediate relief from tinnitus by totally covering the tinnitus (with a more pleasant sound than the tinnitus) or by partially covering the tinnitus, they may be called "maskers."

When broadband sound generators are used for any other purpose, it is best not to call them maskers.

With the above in mind, then, maskers do not help or cure hyperacusis. On the other hand, broadband sound generators can help (or sometimes cure) hyperacusis if they have large vents (so as not to occlude the ear canals) or if they are located behind the ear with thin tubes leading to the ear canals AND (in either case) if they are used according to a strict protocol with an eye towards gradual purposeful introduction of sound increasing in volume over time.

Hyperacusis and "reactive tinnitus" are two completely different things. I put the term "reactive tinnitus" in quotes because everybody's tinnitus reacts to something. (Mine reacts to the spices in Thai food!) When folks use the term "reactive tinnitus," they typically refer to tinnitus that gets louder when they are exposed to certain sounds or certain sound levels. I prefer to use the term "sound-sensitive tinnitus" for that condition because it is less ambiguous. Boardband sound generators can be used to facilitate the habituation of sound-sensitive tinnitus as part of a treatment protocol (for instance TRT), but using these devices strictly as maskers typically fails in sound-sensitive tinnitus because the volume emitted by the device for the purpose of masking tends to aggravate the tinnitus. Hyperacusis (see the paragraph above this one) is a condition wherein externally-generated sounds that are well-tolerated by others sound uncomfortably loud. A hyperacusic might or might not have sound-sensitive tinnitus and vice-versa.

I fear that in my effort to achieve clarity, I may have made the murky waters even more murky. But there you have it nonetheless.

All the best -

Stephen M. Nagler, M.D.