Sound Enrichment and White Noise Generators

This post is intended for information only. It is based on using sound enrichment and white noise generators which I have used to help with tinnitus management. We are all different so please don't consider anything that I write to be professional medical advice. If you need help with your tinnitus and hyperacusis, please talk with your healthcare provider.

Thank you,
Michael Leigh​

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Some people believe there hasn't been much progress in the treatment for tinnitus. Whilst we are all entitled to an opinion, I disagree with this train of thought but will say, a lot more research needs to be done if a cure for tinnitus is to be eventually found and that is something I wholeheartedly welcome.

Tinnitus has been around for centuries and dates back to the Egyptians when the first account of it was written in medical records. They used a variety of remedies that included applying infused oil, frankincense and tree sap to the external part of the ear, also known as the bewitched ear, using a reed stalk to help suppress the ringing. The Mesopotamians, a collection of cultures and considered to be one of the main cradles of civilization, wrote about tinnitus and found benefit chanting a mantra or meditating to help ease the whispering sound in the ears as it was called. Physicians believed in those remedies for that was the best treatment available to people living with tinnitus at the time.

I believe medical treatment for tinnitus has come a long way over the years to help improve the quality of people's lives, especially for those in the early stages of the condition that may have immense difficulty adjusting to the strange new noise heard in their head and ears. Although no two people will experience tinnitus the same, it should be noted that tinnitus is a very common condition and fortunately, a lot of people eventually learn to habituate to it with or without being referred to an ENT clinic and possibly Audiology, for specialist help with an audiologist trained in tinnitus management.

Having said that, there is a more serious and sobering side to tinnitus that is not often talked about beyond the realms of the tinnitus forums. Whilst tinnitus is very common and a lot of people are able to carry on with their lives doing everything that they want to, it can also be very debilitating for some people and can affect the quality of their life tremendously. Carrying out simple everyday tasks or being able to work can be incredibly challenging and may require them to regularly take prescription medication to help cope with this condition.

One of the best ways to treat tinnitus in the early stages and beyond is to use sound enrichment. This is often encouraged by audiologists and hearing therapists that work with tinnitus patients. I believe it's particularly relevant to use with noise-induced tinnitus, whether hyperacusis is present or not.

I have lived with tinnitus for 26 years and still use sound enrichment. It can be provided by a simple tabletop sound machine that plays nature sounds to fill in the background ambiance in a room during the day and placed by the bedside at night. Many sound machines are fitted with an output audio socket that enables an under pillow speaker to be attached for privacy. The idea is to have the sound machine playing continuously in the background throughout the night without drawing attention to itself unlike a radio. For this reason playing low-level music at night might not be the best choice for sound enrichment as it can draw attention to itself. Again, we are all different so some people may find music to be more pleasurable.

The purpose for using sound enrichment at night is not to induce sleep but to help prevent the brain from increasing its background activity, which is quite possible if the brain hears silence. In doing so the tinnitus will also be increased which can make it louder and more intrusive during waking hours. Sound enrichment enables the brain to suppress its background activity which can also help to lower the tinnitus and treat hyperacusis by desensitizing the auditory system. It takes at least 6 to 8 weeks to get used to using a sound machine at night, so patience is required when using this form of therapy.

One of the best devices to provide sound enrichment and treat tinnitus and hyperacusis, are wearable white noise generators, formally called maskers. I think fate had a part to play in the inception of this wonderful piece of equipment and I don't think it happened just by chance. Although at first glance this does seem to be the case.

In 1973, Jack Vernon, PhD, led a research group in the studying of tinnitus. He was travelling with a friend Dr. Charles Unice who had severe tinnitus. As they were passing an outdoor fountain, Dr. Unice stopped abruptly and was reluctant to continue. As he stood listening to the soothing sounds of the fountain, he said to Dr. Vernon, “I cannot hear my tinnitus. This is the first time I’ve been unable to hear that unconscionably wretched sound since it began over two years ago. This is absolutely wonderful!” Dr. Vernon was taken aback by his friend's comments, and this inspired him to research the matter further until he developed a wearable masking device, as a way of providing relief for people with tinnitus.

White noise generators are no longer called maskers by healthcare professionals, although some people still refer to them as maskers. Tinnitus should not be masked as it can make it more difficult for the brain to habituate to the tinnitus if it can't hear it. As soon as the masking sound is removed or temporarily stopped, the brain immediately latches on to the tinnitus and often, it can appear to be louder and more intrusive. A much better way and preferred method that most audiologists and hearing therapists advise tinnitus patients, is to set the volume of the white noise below the level of the tinnitus and keep it there. Some also advise the white noise can be kept at the mixing point. This enables tinnitus and white noise to blend together. I don't particularly like this method as it can cause the tinnitus and hyperacusis to spike.

I have counselled and corresponded with many people over the years that have noise-induced tinnitus because it's something I am familiar with and know how it can affect a person's mental and emotional well-being. Some have asked for my advice on how to wear white noise generators, as they seem to have difficultly wearing them after following the advice of their audiologist/hearing therapist. They tend to find their tinnitus and hyperacusis spiking and find they can no longer continue wearing the devices which is something I completely understand.

My audiologist was born with tinnitus and I found her to be a very good tinnitus therapist. 24 years ago I had very severe tinnitus and hyperacusis with pain. I began TRT with counselling and was advised to introduce the white noise generators slowly to reduce irritation and possibly spiking the tinnitus and hyperacusis. I was told to set the volume below the level of the tinnitus and wear them for just 1 or 2 hours, then remove them for the same duration, and after the elapsed time put them on again and setting the volume below the tinnitus and wear them for another 1 or 2 hours. If I noticed any irritation, I was told the wearing time should be reduced. Some experimentation was needed to see what worked best for me.

This is something I advise people to do that contact me for advice on wearing of white noise generators. Some people may only be able to wear the white noise generators for 5 or 10 minutes, then take them off for 20 minutes and put them back on. That is fine. Just take things slowly and at your own pace.

I was advised to continue doing this on day one, two and throughout the week. Then to continue this process for the second week and so on, while gradually increasing the wearing time. The goal was to achieve a total wearing time of 6 to 10 hours which I did achieve. At night the white noise generators were not worn, instead a sound machine was placed by the bedside setting the volume slightly below the tinnitus and played throughout the night until morning.

Over time the white noise generators desensitized my auditory system and the hyperacusis was completely cured and it has remained this way. The tinnitus reduced to a very low level where I could only hear it in very quiet surroundings. Unfortunately I had a second noise trauma in 2008 that increased my tinnitus but the hyperacusis did not return. It took 4 years to habituate to the tinnitus for the second time.

This treatment can take up to up to 2 years and ideally, one should have regular counselling with a tinnitus therapist. Counselling helps to demystify the negative thinking that is often attached to tinnitus and hyperacusis. Contrary to some beliefs, hyperacusis can be completely cured or reduced to very low levels using white noise generators. Similar results can be obtained using self-help that I have covered in my thread: Hyperacusis, As I See It. It all depends how severe the tinnitus and hyperacusis are and the way they affect a person's mental and emotional well-being. Counselling with a tinnitus therapist may not always be needed when wearing white noise generators but it's something I advise them to have.

Some people believe playing white or pink noise through headphones or earbuds, is the same as when played through white noise generators and hearing aids but they are not.

White noise generators and hearing aids are not the same as headphones or earbuds. White noise generators and hearing aids don’t usually irritate the auditory system due to the volume being kept low and its frequency range remaining constant, which is unlike music that is constantly changing in pitch, rhythm and timber. In addition to this, the sound through white noise generators and hearing aids is delivered through a small plastic tube that goes over the back of the ear and enters the entrance to the ear canal. At the end of the tube there is a tiny aperture/hole where sound emits. Therefore these devices are not speakers.

Headphones and earbuds use a large speaker/diaphragm in comparison. When audio is played through them, they generate sound waves into the ear which can cause irritation, especially to someone that has noise-induced tinnitus with or without hyperacusis.

 

Hello @Michael Leigh,

TRT sound therapy has helped me so much in my journey with hyperacusis and tinnitus. And I am in a totally different place than two years ago.

Thank you for your advice on sound machines etc as they have truly helped in my recovery. And they are on constantly, especially in the evening like you suggested.

I shall write more about my improvements at a later date.

Eleanor89

 

@Michael Leigh, this is a bit of a separate topic from the TRT protocol and moreso involves music for sound enrichment.

You said you're an audiophile. I'm not so learned on it, but would you think that, when listening to music, it would be a good or bad idea to listen to vinyls on a record player vs. something like a CD speaker system? Can't tell if the 'Lo-Fi' sound would be less harsh, or not tolerable like a phone speaker. Then again people say vinyl sounds better so, I don't really know.

Also, I cannot tolerate pink or white noise really. Only low frequencies like brown. In your opinion is pink and white the only way to go?

 

Hi @Eleanor89.

Thank you for your kind comments. I remember how much you were suffering with hyperacusis 2 years ago and understandably reluctant to continue wearing the white noise generators. I am pleased that you followed my suggestions and have mentioned your improvements many times on the forum.

Two people have recently spoken to me that find their tinnitus and hyperacusis spike when using white noise generators. They are in a similar place to where you once were. I have advised them to introduce the white noise generators slowly and to use sound enrichment at night. In addition to this, to start to incorporate positivity into their life which is something I believe is crucial in the healing and habituation process with tinnitus and hyperacusis. This can be taking up a new interest or hobby anything that helps to direct one's thoughts away from focusing on tinnitus and hyperacusis. It doesn't happen overnight, but with patience time and resilience a person will eventually find themselves in a better place as you have.

Well done and take care,
Michael

 

Hi @Shizune,

You have asked a complex and interesting question. To arrive at what I think can help you will take some time, so please bear with me. I am an audiophile and extremely persnickety on the way music is reproduced through a high quality Hi-Fi system or something more modest like a portable Boombox for the home. Some of these units are capable of reproducing high quality audio and are often fitted with CD player, radio and can be Bluetooth to a phone to stream music. Some can stream music from a USB stick to play MP3 audio files downloaded from the Internet or directly from CD tracks recorded on computer.

Vinyl records can sound warmer and more musical than CD and MP3 audio files. However, this will mostly be realized by a discerning listener that has a high quality audio system. Vinyl records lack the ease and convenience of CD and MP3 audio files. Many audiophiles such as myself, compile a music library from tracks ripped from CDs on to their computer and save them as WAV files. These files are then streamed through a digital to analogue converter and played back through the Hi-Fi system at 192 kHz.

The quality is so close to CD it doesn't bear mentioning. One can have music playing all day from the computer hard drive in very high quality audio without interruption, this isn't possible with vinyl records, unless one goes to the arduous task of recording them to computer, which can be a long, drawn out process. If one has a reel-to-reel tape recorder which is rarely seen these days, then vinyl records can be recorded to this machine for long play. A cassette tape recorder is another option to record your records but is limited to 45 minutes each side of the cassette.

If your ears are very sensitive at the moment due to hyperacusis and you want to treat it, I suggest using noise reducing earplugs and have a sound machine playing nature sounds at low-level in the background for sound enrichment. Get used to this first before trying white or pink noise generators. I also suggest using a sound machine at night by the bedside and keep the volume low.

Try and get used to normal everyday sounds in the environment. Use noise reducing earplugs to help with this.

Hope this helps,
Michael

 

I have not undergone any formal TRT treatments, however I will mention that about 2 years ago I purchased hearing aids with white noise generators.

They changed everything for me.

Since wearing them, I am bothered by my tinnitus a lot less, but my hyperacusis has gone from a huge problem to seldom being a bother.

I would recommend white noise generators - and like Michael says, headphones are absolutely not the same, not even in the same ballpark.

 

Well said @cjbhab. I am pleased the combined hearing aids with white noise generators helped you.

All the best,
Michael

 

@cjbhab, do you mind disclosing which hearing aids you chose?

I tried TRT using the Serenade device and frankly it was disappointing, it only seemed to make the tinnitus worse.

My hyperacusis is much more pronounced these days, and just wearing musician's earplugs isn't going to make it better.

I am researching hearing aids with processing and noise sources. Any help appreciated.

Thanks,
Jack

 

HI @Jack S.,

Treating tinnitus and hyperacusis needs to be done carefully, otherwise there is a risk of making these conditions worse. The proper devices need to be used when playing sound directly into the ear. These are wearable white noise generators with or without hearing aids. It is best to be under the care of an audiologist, that specialises in tinnitus and hyperacusis treatment who will be able to advise you.

I am pleased that @cjbhab was able to help himself without being under the care of an audiologist. However, you may not be as fortunate because we are all different. Although counselling may not always be necessary when using wearable sound generators, to treat tinnitus and hyperacusis, it is advised.

Please remember the hearing aids and white noise should be introduced slowly, to reduce the risk or irritating the tinnitus and hyperacusis. I suggest starting with the hearing aids first. When you are comfortable with that, slowly introduce the white noise in the way I have described in my post.

Michael

 

I am using Signia Styletto X.

I do not have any significant measurable hearing loss on an audiogram - I am not using any amplification features. I am only using the noise generator feature.

It's been a life saver the last 2 years.

Unfortunately I am going through a rather bad spike right now that began around a week ago, which I hope subsides - I am thankful for the hearing aids during this spike as they make it a lot less bad.

 

Sorry to hear about your spike @cjbhab. I hope it subsides soon.

Spikes are usually (but not always) related to exposure to sound that, hasn't always got to be loud. It depends on certain factors. I don't know how long you have been using your hearing aids with integrated white noise generators. If they are responsible for the spike, then I suggest you start to introduce them slowly to your auditory system.

Begin with the hearing aids first without switching on the white noise. When you are comfortable with the hearing aids, slowly introduce the white noise and keep the volume low. Please follow my suggestions in my post on gradually increasing the white noise wearing time.

Best of luck,
Michael

 

Discernment may be a good idea. Whilst I don't dismiss those that have improved during white noise therapy, nor those worsened by it, it does not seem a panacea.

Unintended Consequences of White Noise Therapy for Tinnitus-Otolaryngology's Cobra Effect: A Review

 

Nothing is assured in tinnitus treatment. Treatments currently available for the condition are: sound therapy using white noise generators, counselling, medication and hearing aids. I agree they are not a panacea but they can help some people have a better quality of life. Whilst online information into tinnitus treatments can be helpful, those that are biased against them are not. I touched on this in my thread: Keeping Things Simple with Tinnitus.

Reading any negative information on tinnitus treatments like those mentioned above, can instil negativity into person, they could find themselves never making any progress in habituating to their tinnitus and getting on with life.

Michael

 

@Michael Leigh, firstly, thank you for the information above. I'll be purchasing a sound generator once I've chatted with you on here - and will definitely back off from earphones.

Can I ask - have you ever experienced the fluttering which accompanies sound sensitivity?

I'm due to see an audiologist who specialises in tinnitus next week, so will update you. I'll also see an ENT end of October.

Best wishes,
Tom

 

I have experienced many symptoms that affect sensitivity to sound, including fluttering.

 

Hi @Michael Leigh!

Did you ever experience burning or stabbing pains with your hyperacusis? Thinking I might be ready to slowly start sound therapy with Treble Health. I am planning to start only with the sound machine and no maskers. I know you had success with this, but I have seen mixed opinions for people with pain in the ears. I am interested in your opinion.

Thank you,
S

 

Yes I did. I have mentioned this many times on Tinnitus Talk. My hyperacusis was extremely severe and was cured in two years by wearing white noise generators, using a sound machine at night and having counselling with my audiologist who was born with tinnitus.

@Eleanor89 had very severe hyperacusis. She was having difficulty using sound generators the way her audiologist advised. She followed my advice to only use a sound machine at night and low-level sound enrichment from other sources such as music during the day. When she was comfortable with this, I advised her to slowly introduce the white noise generators. At first she could only wear them for 3 to 5 minutes and then had to take them off. Very slowly she increased the wearing time until she was able to wear them for 5 hours or more.

@Eleanor89 has made a lot of improvement in 2 years and no longer has severe hyperacusis. If you are in the UK, I advise that you seek help under the NHS for tinnitus and hyperacusis, as you will get the best help and long term aftercare which no private practice can match in the UK.

I wish you well,
Michael

 

I spoke with an audiologist today and found out I can get a pair of Widex Zen maskers covered completely through my insurance. I have no idea what to do. My ringing often worsens with external sounds and makes it difficult to mask. I don’t know if these things are going to help or hurt me. I don’t think this clinic deals with a lot of tinnitus patients.

Looking for some thoughts here. My goal is to habituate again. My previous habituation was excellent.

 

Wondering this myself.

 

Read my posts in this thread on the way to use white noise generators. They should be used while having counselling with an audiologist that specialises in tinnitus and hyperacusis management. You should also use a sound machine at night by the bedside, for low-level sound enrichment.

Information on habituation can be found by going to my started threads. Read The Habituation Process, How to Habituate to Tinnitus, Can I Habituate to Variable Tinnitus? Tinnitus and the Negative Mindset, Acquiring a Positive Mindset.

I advise that you print the posts and refer to them often. This way you will absorb and retrain the information much better than reading them on your phone or computer screen.

Best of luck,
Michael

 

And then there’s things like this. I feel like I can’t win either way.

 

I feel like that with this condition if you search for something you will find a study that says it did or didn't work or caused X. I agree that it seems like picking the lesser of two evils.

 

I believe it's possible for you to habituate again. However, corresponding with negative thinking people or reading negative posts about tinnitus and hyperacusis can halt or completely stop the habituation process if you're not careful. You have to try and guard yourself against this. It is the reason I have advised you to print and read the posts that I have mentioned on my started threads, they will help to reinforce positive thinking, as they are a form of counselling.

Engage in the things you like to do and gradually your focus on tinnitus and hyperacusis will begin to reduce and you'll start to feel better about life. It takes time.

Michael

 

Hi Michael.

Fellow Brightonian here.

I have different sound generators in different rooms. I have two Sound Oasis machines, although they have different sound cards. So at night I play Pink Noise in my bedroom but in the daytime I play a similar noise whilst on my computer. And in the evenings I play crickets on my Hi-Fi. I try to keep them all at the volume just below my tinnitus. Is that more important than having a consistent sound or should I be aiming for the same sound in all rooms at all times?

Do we have any research on this?

Thanks for any ideas,
Dan

 

That's essentially what I do. The volume being consistent shouldn't matter, it's going to vary anyway depending on how far away you are from the source of your sound. In my experience, tinnitus itself isn't "fixed", it varies throughout one's day, so wherever you wish to put your sound volume is going to be right for you at that particular moment in time.

Over the past 20-30 years (or however long I've had tinnitus), I can't remember any research that has come up w/ anything that's consistently made a difference in one's tinnitus other than TRT, which was around when I first got mine. If it had, we'd all be singing its praises. It appears that each of us has to figure out what works for us. My tinnitus isn't your tinnitus, and right now my tinnitus isn't what it will be later in the day.

A lot of this is managing what we currently have and trying not to make it worse. Stress, loud noise, our metabolism, drugs, all manner of things can make it worse. Even diet can be an influence, along w/ the ever changing state of our minds because there's a difference between the volume of our tinnitus and our perception of it. On the other end, discovering optimal sound masking, trying out some particular drug or individual therapies, meditation, being engaged in meaningful work or play, etc can make a positive change.

 

HI Dan and greetings to you.

I moved to Brighton in 2014 but originally I was born and bred in London. I like living in Brighton a lot. I see you have been a member of Tinnitus Talk since 2019 and yet this is your first post. Welcome aboard.

Staying in quiet rooms and surroundings is not usually a good idea for anyone that has tinnitus, particularly when they haven't habituated or find their tinnitus intrusive. Keeping sound enrichment slightly below the tinnitus is preferred and is often advised by hearing therapists and audiologists that work with tinnitus patients.

Although sound enrichment can be helpful, I believe it's important to know what caused the onset of tinnitus in order to be able to treat it successfully so a person habituates. Therefore, sound enrichment is just one type of treatment that can be used alongside: Medication, counselling, wearing white noise generators and relaxation therapy.

There is nothing wrong in the way you are using sound enrichment but I suspect, your tinnitus is overly intrusive to the point you have difficulty coping with it and hence, the need to have sound enrichment in every room in your home - I am just guessing for I could be completely wrong. One must be careful not to become overwhelmed with sound enrichment or find it an absolute necessary requirement to have it always playing in the background. My tinnitus is variable, meaning it can be completely silent, mild, moderate, severe and very severe.

There are times my tinnitus can be moderate to severe and I feel completely at ease. My brain hears the tinnitus but I am not in the least troubled by it, I only become aware of sound enrichment when I deliberately focus on it - this is my interpretation of habituation. I also believe habituation has its limitations which I have covered in posts on my started threads.

Research into tinnitus has its place but I also believe, it's not good to do too much reading about the condition, as it can cause a person to focus more on their tinnitus, something which I don't think is a good idea. Bringing positivity into one's life and focusing on the things they like to do helps take the mind off tinnitus and gradually, it will be pushed into the background instead of taking centre stage in a person's life.

As I have said, sound enrichment is good to use but it's important, to know what caused the onset of tinnitus particularly if a person is having difficulty habituating as other forms of treatment may be needed.

Hope this helps.

Take care,
Michael