Pink Noise Therapy

[Mark Beehre]

Hey Doc,

I'm really glad to hear you're doing better!

I was hoping you could spare a moment for some advice. Driving to and from work is still causing my tinnitus to wind up even with wearing the ear plugs prescribed by Dr Searchfield. He said it can take a couple of months for the hearing pathways in the brain to reorganize. Being that as it may, I am still experiencing the winding, even with plugs in place.

I made the mistake of driving to work twice without plugs at the start of this week because I felt great. The second day my tinnitus/pain was so intense I didn't sleep. I spent the third day at home and so didn't drive and by the forth day almost felt back to normal, although my ears felt very tired and sore. Today, the fifth day I feel as though my sound tolerance has collapsed further. My tinnitus is perceived as louder and merely typing on my keyboard is causing me discomfort.

I've read about pink noise therapy as a way of rebuilding my tolerance to sound. I am speculating that I am category 3, because the winding up component of tinnitus has settled after a nights sleep, so within 24 hours. According to the advice on the hyperaccusis network, I should listen for 2 hours a day. There is no indication on the site of how loud the noise should be or if open speakers are sufficient. Can you please advise here?

Furthermore, when I am having these louder days, should I still be listening to pink noise? Again what volume level?

Are there any other recommendations you can think of? It's been almost 6 months now since this all started and I don't feel any improvement other than in my emotional reaction.

Could my ear plugs be collapsing my tolerance further. Sounds are more sensitive when I take them out after the trip. At first for 15-20 minutes, now it seems be taking longer to bounce back.

Doc, I seem to have a set back each week. I'll feel good for 2-3 days and then bad for 2-3 days. During those set backs my ears are more sensitive, the tinnitus is louder and I am in physical discomfort. Are these setbacks a hindrance to my recovery? In other words should I take steps to reduce the setbacks from occurring by taking such drastic action as resigning and slowly rebuilding my tolerance via pink noise in the quiet comfort of my home?

Thank you for your advice.

Cheers,
Mark

 

[Dr. Nagler]

I've read about pink noise therapy as a way of rebuilding my tolerance to sound. I am speculating that I am category 3, because the winding up component of tinnitus has settled after a nights sleep, so within 24 hours. According to the advice on the hyperaccusis network, I should listen for 2 hours a day. There is no indication on the site of how loud the noise should be or if open speakers are sufficient. Can you please advise here?

Hi Mark. Thank you for your very good question. I am so sorry to hear that you continue to be having a difficult time of it.

I will try to shed some light as best I can, but I can only speak in generalities since, of course, I have not evaluated you. Moreover, as I recall Dr. Searchfield has not evaluated you either - he is just going by what you told him over the telephone. That puts him at a disadvantage ... and it puts me at an even greater disadvantage, since you and I haven't even done that much.

What I am saying is that were Dr. Searchfield to do a full evaluation, he might come up with a different set of recommendations than he gave you. And were I to do a full evaluation, I might possibly agree with what he has said. So this is really a case of the blind leading the blind.

First of all, you speculate that you are Category 3. That means that hyperacusis is your primary problem - with tinnitus, if it exists at all, being a relatively minor concern when compared with hyperacusis. Sound sensitive tinnitus is not Category 3, no matter how sensitive your tinnitus might be to sound. Sound sensitive tinnitus is most commonly Category 1, although in some cases it might be Category 4. Each category is treated differently - so right off the bat my hands are tied behind my back.

All that said, and leaving the very crucial counseling component aside, let's talk a bit about pink noise. There is absolutely no therapeutic advantage to pink noise over white noise in treating Category 1, 3, or 4 patients. The only advantage is that some patients simply prefer pink noise over white noise - but since they really don't have to actively listen to it, that difference really does fall away in most cases. Based on what you are saying, for the sound therapy component of your treatment I would probably (emphasis on probably) fit you with a pair of broadband sound generators (white noise or pink, whichever you preferred) and start you off wearing them all day long in the "Off" position for a couple of weeks. I would then probably ask you to turn them on to the lowest audible volume for a few hours each day, turning them off (but still wearing them) the rest of the day. After a week or so more, I would probably ask you to keep them at the lowest audible volume all day long. And after another week or two, I would ask you to "turn them up a notch," but nowhere near loud enough to cause you any discomfort. And eventually we would have them at a level where we could begin using them to effectively treat your tinnitus in accordance with your category. Instead of earplugs, I would probably have you wear earmuffs that can fit over your sound generators. And even then, I would have you wear them only when absolutely necessary.

Now that's a gross oversimplification, and indeed it might be totally wrong for you if I knew more about your case - but it's what I would at least be thinking about.

Lastly, specifically regarding the Hyperacusis Network's pink noise therapy routine that you asked about, I would prefer not to comment.

All the best -

stephen nagler

 

[Mark Beehre]

First of all, you speculate that you are Category 3. That means that hyperacusis is your primary problem - with tinnitus, if it exists at all, being a relatively minor concern when compared with hyperacusis. Sound sensitive tinnitus is not Category 3, no matter how sensitive your tinnitus might be to sound. Sound sensitive tinnitus is most commonly Category 1, although in some cases it might be Category 4. Each category is treated differently - so right off the bat my hands are tied behind my back.

I understand. My tinnitus on a quiet day doesn't bother me too much, it is bearable and I know that eventually I will habituate so that's fine. It's just that I can't get passed the ear pain and the associated feeling on those days where my ears feel more abused and my surroundings seem louder. I mean if I am feeling soreness/tightness while typing on a keyboard or flushing a toilet does that not indicate a sound tolerance problem i.e. hyperaccusis?

All that said, and leaving the very crucial counseling component aside, let's talk a bit about pink noise. There is absolutely no therapeutic advantage to pink noise over white noise in treating Category 1, 3, or 4 patients. The only advantage is that some patients simply prefer pink noise over white noise - but since they really don't have to actively listen to it, that difference really does fall away in most cases. Based on what you are saying, for the sound therapy component of your treatment I would probably (emphasis on probably) fit you with a pair of broadband sound generators (white noise or pink, whichever you preferred) and start you off wearing them all day long in the "Off" position for a couple of weeks. I would then probably ask you to turn them on to the lowest audible volume for a few hours each day, turning them off (but still wearing them) the rest of the day. After a week or so more, I would probably ask you to keep them at the lowest audible volume all day long. And after another week or two, I would ask you to "turn them up a notch," but nowhere near loud enough to cause you any discomfort. And eventually we would have them at a level where we could begin using them to effectively treat your tinnitus in accordance with your category. Instead of earplugs, I would probably have you wear earmuffs that can fit over your sound generators. And even then, I would have you wear them only when absolutely necessary.

Thank you, this is very useful knowledge, but what do you mean by off and on with the sound generators. Do you mean I put the sound generators over my ears but not activate them, so in other words they are just purely cosmetic for the first few weeks? Is this a physiological thing?

Lastly, specifically regarding the Hyperacusis Network's pink noise therapy routine that you asked about, I would prefer not to comment.

Thank you for the advice you did give me. Doc, I really do appreciate it! I'm hoping to talk to Dr Searchfield again soon. I may just have to go to Auckland.

Just a separate question entirely...if I were to get Noise Cancelling Headphones, would that eliminate the sound of a jet turbine engine if I were to fly to Auckland?

 

[Dr. Nagler]

I mean if I am feeling soreness/tightness while typing on a keyboard or flushing a toilet does that not indicate a sound tolerance problem i.e. hyperaccusis?

It might be hyperacusis. Or it might be something else, like possibly some form of misophonia. Or possibly a combination of things. Difficult to say without evaluating you. I'd especially want to check your LDL curve and compare it with your audiogram curve. Bottom line: I do not have enough information at this point of time to answer your question responsibly.

Do you mean I put the sound generators over my ears but not activate them, so in other words they are just purely cosmetic for the first few weeks? Is this a physiological thing?

The idea is for you to fairly quickly become unaware of the sound as well as the feel of the devices. In some people who are very sensitive or who have heightened awareness, it helps to start out by wearing the devices without any sound being produced, just to accommodate to the feel. But I continue to stress that I do not know exactly what you have - so I do not know if my recommendations are appropriate. That's why I use the word "probably" so much in my response to your original question.

Just a separate question entirely...if I were to get Noise Cancelling Headphones, would that eliminate the sound of a jet turbine engine if I were to fly to Auckland?

They would make it considerably softer, but they would not eliminate it.

One reminder, if I may. The Doctors' Corner is really not designed for back-and-forth discussion. If you want to have a back-and-forth discussion, the person to do that with would be your own clinician, who knows you best. So do try to arrange that trip to Auckland for a proper evaluation. You owe it to yourself. Anyway, I will try to merge this second pink noise thread with your original thread. I hope it works.

stephen nagler