Notch Therapy in Reverse? Dramatically Reduces My Tinnitus for a Few Seconds

My history:

Musician for 30+ years. I had unilateral tinnitus in my left ear for a long time now but it has been very mild and has not affected my quality of life.

My tinnitus is a single tone, approx 10.5 kHz.

About 10 years ago I spent a day using a wet tile saw without hearing protection and it caused a massive spike in the tinnitus in my left ear. Fortunately, it went away after about a month but the baseline tinnitus remained.

Fast forward to about a month and a half ago. A handheld air horn (the kind used for boating that is loud enough to carry a mile away) went off about 3 ft from my head. It was only a millisecond but it caused the tinnitus to intensify in volume by about 3 times. It is now loud enough that I hear it above everything. The TV, the radio, etc...

It keeps me awake at night and I haven't managed to sleep soundly in the 6 weeks since it kicked up.

It is somatic and I can make it even louder by tilting my head back and to the left and also by manually pressing some areas behind my left ear. This leads me to believe that there is a physical component beyond just hearing loss.

I went to an audiologist who found mild hearing loss in my left ear at a couple of different frequencies - 3 kHz, 6 kHz, 8 kHz. This is not a surprise as I already knew this.

Since then I've tried all kinds of things and am currently using an android app called Relief to be able to sleep. It lets you create all kinds of masking noises and I've found that the ones that work best are a combination of crickets and rain. I need to wear some sleeping headphones which are basically a headband with two tiny speakers placed in flaps that go over your ears. Tried an external Bluetooth speaker but the noise from that keeps my GF awake so the headphones are my only option.

Notch Therapy Question:

I've also looked at different types of therapy and came across notch therapy. I've only tried it a couple of times so I can't say whether it will work or not long term.

However, I've discovered something interesting. While doing some tone matching trying to find the frequency of my tinnitus tone, I found that when I play a high pitched tone close to my tinnitus frequency, pretty much anywhere between 9 kHz and 12 kHz, for even just a few seconds, when I turn it off the tinnitus level is dramatically reduced for a few seconds. In some instances it was completely imperceptible.

This seems to be the opposite of notch therapy since I'm playing only the tinnitus tone and nothing else rather than white noise with the tinnitus frequency removed.

My questions -- Is this a thing and has anyone else found that this works for them? A cursory search didn't turn up anything on this. I just found info on notch therapy.

Not being familiar with this, I'm not sure if I should keep doing it and trying to play the tone for longer periods or if this might make the tinnitus worse.

 

Hi @GuitarMan.

You have had noise induced tinnitus for many years and it's fortunate that it remained stable even though you have continued to play guitar. I will assume you played this instrument in a band? Since the tinnitus has now increased as a result of being exposed to a handheld air horn, you need to be very careful that it doesn't get worse.

It is possible for the tinnitus to reduce but the methods you are using, I believe won't work and you risk the tinnitus increasing and in the process you could also develop variable tinnitus. Variable tinnitus is usually a more severe form of noise induced tinnitus and can be difficult to habituate to.

It is entirely your choice what you decide to do. However, based on my experience living with noise induced tinnitus for many years, counselling and corresponding with people that have the condition, I suggest that you stop listening to all types of audio through headphones, earbuds, headsets, AirPods, including the headband that you are using at night to listen to the Android app, as you risk making your tinnitus worse. This is just my opinion and is not absolute.

My advice is not to use the Notch Therapy either as I think it could make your tinnitus worse. Instead, see an audiologist that specialises in tinnitus and hyperacusis management for treatment. This usually involves the wearing of white noise generators and having regular counselling.

If you are unable to see an audiologist you could try self help and give it plenty of time, because this isn't usually a quick fix. You need stop being exposed to loud noise/sounds. Unfortunately this means stop playing music in a band. Not listening to audio through any type of headphones even at low volume. Start using low level sound enrichment during the day and especially at night using sound machine by the beside. More information about this is given in the posts mentioned below that are available on my started threads.

Tinnitus, A Personal View, The Habituation Process, How to Habituate to Tinnitus, Tinnitus and the Negative Mindset, Acquiring a Positive Mindset, Will My Tinnitus Get Worse? Hyperacusis, As I See It, What Is TRT and When Should It Be Started?

Please print the above articles and those in the links below and refer to them often. This way you will absorb and retain the information better rather than reading on your phone or computer screen.

All the best,
Michael

New to Tinnitus, What to Do? | Tinnitus Talk Support Forum
Can I Habituate to Variable Tinnitus? | Tinnitus Talk Support Forum

 

Thanks for the reply. There's a lot of information out there and much of it is very confusing. I'm not sure what variable tinnitus is and I haven't been able to find anything on it. From what I've personally been able to piece together, and from what the audiologist and ENT I recently saw tell me, I have what may be a combination of subjective and somatic tinnitus.

Subjective because it has a hearing loss component and somatic because it does respond to physically pressing nerves/muscles/blood vessels behind my left ear.

The ENT and audiologist both recommended using masking sounds. They were both familiar with notch therapy and neither recommended against it. Your post is a little concerning since I'd hate to make it worse but they didn't say anything about masking sounds making it worse. Although I have read about some people who said that notch therapy made their tinnitus worse, but it went back to normal after they stopped the notch therapy.

Regarding playing in bands, I do use custom audiologist-made musician's earplugs.

The sleeping headphones I've been using at night are very low volume and I use them at the lowest volume setting possible that is still audible to me. It's about the only way I can sleep currently other than resorting to sleeping pills of various kinds which themselves are probably ototoxic and can make the tinnitus worse.

I have an appointment scheduled for September with a neuro-ENT who specializes in tinnitus. September seems like a lifetime away but hopefully it will get here soon enough.

It's very frustrating knowing that in my case there is at least a partial physical component (as evidence by my ability to make it worse by pressing behind my ear) but most audiologists and ENTs are essentially conditioned to ignore that and reply with the "form letter" reply of "there is no cure."

Have you heard of any sound therapy like what I mentioned? Namely, playing an actual tone at the frequency of the tinnitus?

 

It's not anything special you experimented with. You experienced what is called "residual inhibition" - a lot of folks can suppress their tinnitus for a few seconds after doing something like you did. It's not a sign of anything and doesn't mean you have a better prognosis than those who don't experience residual inhibition.

 

Thanks. I didn't imagine it would be anything new or unheard of given how many people suffer from tinnitus and the countless number of things people have done in attempts to fix it. I was just wondering what exactly was happening and why it seemed to give me some temporary relief when it was the opposite of the notch therapy that is widely mentioned.

Knowing the name of it, residual inhibition, has been very helpful! Looks like there has been a bit of research on it. Just based on the small amount I've read so far it generally doesn't seem to make things any worse For most people it either has little effect or it reduces the severity of the noise for up to a couple of minutes at a time.

Even if it doesn't cure it, it can be a brief but welcome respite from the constant tea-kettle in my ear. I can also see how it might be useful in initially getting to sleep at night or falling back asleep if you wake up in the middle of the night.

I can also see a downside. Namely that if you're in the process of habituating to the noise and you take "breaks" during which you don't perceive the noise, when the sound does return your perception might be that the sound is now louder.

 

I advise you not to use masking sounds to cover up your tinnitus. By this I mean using a sound to match your tinnitus or cover it up so it can't be heard, as you risk making the tinnitus louder. More is explained in my articles.

Tinnitus is a complex condition that comes in many forms and intensities and no two people experience it the same. Due it's complexity I mostly advise and help people affected with noise induced tinnitus because I have lived with it for many years. Hyperacusis often accompanies noise induced tinnitus but not always. I once had very severe hyperacusis that has been completely cured with treatment, my experience has enabled me to advise people on how to cope with it mentally and emotionally and give advice on treatments.

Whilst ENT doctors are familiar with tinnitus because they consult with patients that have it, they do not treat tinnitus because this is not their area of expertise. They are physicians and treat underlying medical conditions within the auditory system that cause tinnitus and there are many. When no underlying medical condition can be found to be causing the tinnitus as in noise induced, the patient should be referred to Audiology to see an audiologist, that specialises in tinnitus and hyperacusis management and treatment.

Please print and take your time to read the articles that I have mentioned in my previous post. Most of your concerns I believe you will find answers to them there.

Many people experience fluctuations in their tinnitus and call this variable. The type of variable tinnitus I refer to in my post: Can I Habituate to Variable Tinnitus? is an entirely different kettle of fish.

Whilst variable tinnitus isn't officially recognised as a medical condition and you won't probably find information online about it, I assure you that it's quite real and mostly affects people that have noise induced tinnitus that have habituated for quite some time usually over a year. At some point they have suffered a second noise trauma or a series of them causing the tinnitus to spike. However, the tinnitus doesn't doesn't usually reduce as before but instead increases and changes into a completely different anomaly unlike anything the affected person has previously experienced. Please read the post for more information.

Not all audiologists that work with tinnitus patients are tinnitus specialists. Some may just be taking a hearing test, prescribing hearing aids or giving a Pep-talk on how to manage tinnitus. Although this information is helpful, it is also available online. In my opinion this does not make a tinnitus specialist.

To be a tinnitus specialist, I believe the audiologist or therapist has to be living with tinnitus. Preferably for 5 years or more and have experience of it being severe. This way they are able to understand how it affects a person's daily life and their mental and emotional well-being. This is especially important when giving tinnitus counselling as part of CBT and TRT. It is something that cannot be learnt from a book.

Many audiologists and hearing therapist that practice TRT and CBT with tinnitus patients, were either born with tinnitus or acquired it at some time in their life.

I wish you well,
Michael

 

I've been reading through the posts you mentioned and have a question. More of a clarification really.

You advise not masking the tinnitus but you also advise using sound therapy like nature sounds. Wouldn't part of the function of nature sounds be to mask the tinnitus? For example, the past few nights I've been using an Android app called Relief to play nature sounds which do mask the tinnitus just enough that I can manage to fall asleep.

I've been using cricket sounds which are at frequencies high enough that although the tinnitus isn't completely masked, it does blend in to the cricket sounds and becomes much less intrusive. This is the only way I've been able to sleep.

I sometimes also add rain or a stream which are similar to white noise. Do you advise against using any sounds that are similar to white/pink/brown noise or are nature sounds like rain, waterfalls, streams, ocean waves, etc, OK?

You also mention finding an audiologist who specializes in tinnitus. How would one go about this in the US? I haven't found any audiologists who list tinnitus as a specialty. The closest I've found is a Neuro-ENT who I have scheduled an appointment with in September. Other than that, the audiologist I did see didn't know much about tinnitus and the regular ENT she sent me to, although he said he has suffered from tinnitus himself for decades, had nothing new to offer that I wasn't already aware of. He just offered the typical things to try like white noise and notch therapy which are things you advise against.

 

Tinnitus should never be masked, for the simple reason the brain will never be able to habituate to it.

The term masking is old fashioned and out of date. Most audiologists and hearing therapists advise to use sound enrichment. This is achieved by playing nature sounds or something similar that doesn't draw attention to itself. The sound should always be set slightly below the tinnitus. In other words you should always be able to hear your tinnitus above the sound enrichment. This way, the brain learns to habituate to the tinnitus over time and no longer see's the tinnitus as a threat.

I have explained this in: New to Tinnitus, What to Do? Tinnitus, A Personal View and The Habituation Process.

To get the best from sound enrichment at night, the sounds should be played continuously throughout the night until morning. It is not a good idea to wear a headband with speakers or any type of headphones to play sound enrichment. Instead, a sound machine should be placed by the bedside. You can also connect a pillow speaker to the sound machine via the external 3.5 audio output jack. Many sound machines have this jack particularly those sold by Sound Oasis. Model S-650 is popular.

Using the Android app is fine but keep in mind that I have advised not to play this through a headband or any type of headphones, as you risk making your tinnitus worse, no matter how low you set the volume. The choice is yours.

Some people use a sound to blend with their tinnitus which is known as the "mixing point". If this works for you then fine but keep in mind it can irritate the tinnitus for some people and make it more intrusive.

Use any sounds that you find comfortable to listen to because there are no hard and fast rules. However, most people find it's best to use sounds that don't draw attention to itself - this is the reason music isn't advised to use for sound enrichment at night, as it draws attention to itself. When sound enrichment is used correctly, it should be easily ignored and only noticeable when you focus on it.

I realize finding an audiologist that specialises in tinnitus and hyperacusis management can be difficult for some people. I live in the UK. If ENT find no underlying medical problem within the auditory system that's causing the tinnitus, as in noise induced, the patient is usually referred to Audiology for treatment. I have explained this in my post: What Is TRT and When Should It Be Started.

As I have previously mentioned, ENT doctors are physicians and not tinnitus specialists. Most (not all) know very little about tinnitus because it's not their area of expertise. You may not need to see an audiologist that specialises in tinnitus treatment, as it could improve with time using some of the self help methods that I have mentioned in my articles. See how you get on.

Michael