Treating Reactive Tinnitus and Hyperacusis with In-Ear White Noise Generators (TRT)?

My reactive tinnitus and hyperacusis is a little bit more challenging at the moment. I have no pain involved but my tinnitus reacts to a lot of every day sounds. I'm trying to overcome it.

Last time around I had great success treating this with SSRI and Widex Zen sound generators. I think it is time for me to go looking for my old Widex Zens.

I am going to an audiologist but your advice on how to set the white noise generators would be most welcome

Here is the plan:

1. Adjust the white noise so it feels as comfortable as possible.
2. Start on a very low volume (just clearly audible, but not more than that) for 1 hour a day.
3. Next day for 2 hours a day, and so on...
4. Once I reach the full day, I will snap up the volume one step and do so every second week or as I feel comfortable.

Any other suggestions?

 

Hi @David S.

Please go to my started threads and read my posts on TRT. They explain how to use white noise generators correctly. They should be introduced to the auditory system slowly. My advice is to always keep the white noise slightly below the tinnitus and not increase the volume as you have mentioned in the second week of use.

Some audiologists tell tinnitus patients to first treat the hyperacusis, by slowly increasing the volume of the white noise, to help with desensitising the auditory system. Unfortunately, this often results in irritating the hyperacusis and spiking the tinnitus.

Michael

 

Increasing the volume like you have planned can improve your sound thresholds and reduce your reactivity.

However, having it so loud that it masks your tinnitus completely is not a good idea. I think it's widely accepted that tinnitus shouldn't be completely and persistently masked for the brain to better adjust.

 

@Michael Leigh, thanks for you kind advice. I saw in a previous thread that you recommended 1 hour of use and the same time of rest in continuous cycles. That might be the way for me to start. Also it would require a very high volume to mask my tinnitus. I guess i need to find the optimal setting between the following:

A: A good sound stimulation
B: Not mess too much with my reactive part of the hyperacusis. I know it will react but that is also what I am treating.
C: Hear normal external sounds like talking clearly through the white noise. I have minimal hearing loss (5-15 dB).

Actually I can live well with my tinnitus. I am not too bothered about it. It´s once it starts to react to external everyday sounds that it gets difficult. I can see the same pattern a lot here on Tinnitus Talk.

David

 

Hey David,

I'm just curious; has your tinnitus always been reactive? How as it progressed? Do you, like me, wear hearing protection all day? How does your reactivity manifest; does the increases recede immediately, or is it like spikes that last a bit after the exposure is over?

I'm also working with my severely reactive tinnitus and just now reintroducing sound again after a very long time of sound deprivation. I may be seeing signs of things going in the right direction, but I'm very careful to draw conclusions.

All the best,
Stacken

 

Hi @David S.

Noise induced tinnitus with or without hyperacusis and using white noise generators are my main areas of interest. I have used white noise generators for many years and used them exclusively when having TRT with good results.

In the near future, I will be writing a post about white noise generators and hopefully, it might be of help to someone.

My advice is not to mask your tinnitus when using the white noise generators. Keep the volume slightly below the tinnitus at all times. This was the way I was taught by my Hearing Therapist. Increasing the volume of the white noise generators or masking the tinnitus often makes the tinnitus and hyperacusis worse.

All the best
Michael

 

@Stacken77, I typically find that the reactiveness fades over time. Then I have setbacks. I need to figure out why this is. I suspect 2 major things:

1. Tension in neck and cheek. I am treating this right now with a specialist. Intense muscle massage.
2. Too much noise exposure.
3. Stress in general.

Right now I use soft earplugs pretty much all day. I take them out once I get home to enjoy dinner with my family and some TV.

Treatment protocol wold be something like this:

Once it is really ugly and reactive, just leave it alone and protect.
Once it improves, start to use white noise carefully.
I also take SSRI and some Oxazepam.

Noise generator all woken hours worked very well for me last time around.

David

 

@Michael Leigh, I would just like you opinion because I know your are one of the few that really knows everything about sound enrichment.

5 year ago I used white noise generators (Widex Zen) and SSRI with good success to treat my tinnitus. At the end of 18 months I had reasonable tinnitus (moderate) and pretty much no sensitivity to sounds. I could quite easy go by airplane without any protection etc.

Then over the last few years I had some setbacks. In the beginning of my setbacks I just start with the SSRI again. I thought the medication was more effective than the noise generators. Now I start to think it is the other way around.

Anyway, here is my question. Once you start to feel better with the use of the sound generators, and when you are about to let go of them on daily basis, how often do you think you should use them in order to keep the good effect? A couple of hours per day? A full day per week?

David

 

Hi @David S.

You have asked an interesting question. If I manage to write my post on white noise generators, I would like to include it. Thank you for the idea.

Once a person habituates to their tinnitus with white noise generators and the hyperacusis has been successfully treated, there is no need to continue with their use, unless a person wants to occasionally use them for sound enrichment. I have used them for many years for this purpose but for the last eight months, have used them daily for up to 10 hours. I will explain the reasons at a later date. I just want to say that my tinnitus has not increased.

You had good success 5 years ago using the Widex Zen sound generators. You habituated to the tinnitus and oversensitivity to sound was not much of a problem.

The increase in your tinnitus and in particular the hyperacusis, and having an oversensitivity to sound, I suspect is caused by one or two things. Either you have been subjecting your auditory system to loud sound without realizing it over time. It doesn't matter if you have been using earplugs, if external sound is loud enough it will pass through your head and transfer to your inner ear by bone conduction and cause irritation. At the time you may not be too aware of this because you habituated. However, if one continues subjecting themselves to loud sounds, there is a risk of the auditory system becoming so sensitive that one day it will make itself known and spike. Wearing earplugs is no guarantee that a person with noise induced tinnitus will be safe from external loud noise.

The other reason is using any type of headphones. This includes earbuds, AirPods, bone conduction headphones, noise cancelling headphones and headsets. If a person with noise induced tinnitus uses any of these devices, even at low volume, they risk making their tinnitus worse and making their auditory system more sensitive to sound which can manifest into hyperacusis.

After a person habituates to tinnitus, I recommend they try to avoid being in quite rooms and surroundings during the day for long periods. Therefore, use sound enrichment such as low level background music. Continue using sound enrichment at night until morning, using a sound machine to play nature sounds by the bedside. The sound should be set slightly below the tinnitus and not masking it.

Hope this helps.
Michael

 

Michel, you are a wise man. This is exactly what happened to me a few times. Last time around was a few weeks ago. We were traveling on large car-ferry. I was out on the car deck for a few minutes. They had super large fans and I was walking just 1m from them (I cloud really feel the power from the fans). I had hearing protection, but it must have been the bone conductive part. It is so hard to protect yourself from situations like this this without limiting yourself too much. I am not really ready yet to move to a cabin on the country side...

Now my auditory system is quite upset because of the incident. Should I wait a few months until it settles down before I start with the white noise generators?

How should I ever be able to protect myself from random traumas like this in the future without limiting myself too much? I have a long haul flight with my family coming up in 2 month. I guess I will use both in-ear soft earplugs and my 3M Peltors on top of that?

Thanks again Michael!

 

Hi @David S.

Thank you for your kind comments. I just want to say, a lot of the information I have given you, many people with noise induced tinnitus know this already or will come to know it with time. The reason being, one can only learn this by living with the condition and acquiring experience.

I have had tinnitus for 25 years. I have corresponded and counselled people with noise induced tinnitus at forums, by email and telephone. They have helped me to learn more about this type of tinnitus and will always be grateful to them.

I don't think it was one event that has caused your tinnitus and oversensitivity to sound to increase. If you have been using any type of headphones regularly, or listening to loud music, being exposed to overly loud sounds, then your symptoms would have been building up for some time without you realizing it. This is the danger when a person habituates to noise induced tinnitus. Please go to my started threads and read my post: Will My Tinnitus Get Worse?

You can experiment using the hearing protection that you have mentioned. However, I advise caution as it's not a good idea to become too dependent on them. Please read my post: Hyperacusis, As I See It. You will find it on my started threads.

Take care,
Michael

 

Hi David,

Did the white noise generators lower the reactivity of your reactive tinnitus?

 

Yes, I would say it did but now my tinnitus is far too reactive to start to treat it with WINGs again (white noise generators). As soon as it settles down again, I will start the treatment again.

 

@Stacken77 and others with reactive tinnitus.

Here is how I try to treat my reactive tinnitus. It would be interesting to compare with others. It is important to point out that in between my relapses I lived a very normal family life with my severe tinnitus. Of course there were limitations but nothing really big compared to what others have to deal with.

Meds:
15 mg Escitalopram (SSRI). Really helps to get my emotions under control.
5 mg Oxazepam in the evening. I know to be careful but it is a really small dose.
3.75 mg Zopiclone at 4 am when I typically wake up. It helps me to sleep another 3-4 hours.

I hope to face out the Oxazepam and the Zopiclone within a month or two. I have done it before without any hassle.
Sleep is really essential for me to heal. I need a good 9-10 hours per night.

Food & Supplements:
I try to use as little as possible sugar, gluten and salt. No processed food. A lot of fruits and veggies. Only french meat and fish. I will also try Magnesium, Ginkgo, Zinc, Vitamin D. I also have some Turmeric from last time around.
I still drink 3-4 cups of coffee and 2 small glasses of wine per day. You still need to enjoy something...

Physical therapy:
I go to a therapist weekly who works hard on my neck and cheek. I have bad posture and and stiff muscles.
I also started to use a mouth splint. 30-45 minute walks every day.

Sound enrichment:
I use 3M soft earplugs for half the days (know it is overprotecting right now). I cut them in to half. Normal speaking and tv without protection is ok, which is a progress. I would like to use WNGs but my tinnitus is still to reactive. I hope to start with the WNGs within 2-3 months once it settles down a little.

In general:
Try to live as normal as possible. Work 6-7 hours a day. I concentrate reasonably good despite these high pitched sounds.

 

How’s your quality of life now?

There are times where I forget it’s there if I keep distracting myself. Other times it pierces right through my thoughts. Not obsessing over the sound helps even if it’s pretending to not obsess.

 

@Wrfortiscue, when I got tinnitus almost 8 years ago my life was constantly 1-3 on a 10 degree scale. Now i would say I am at 3-5 (SSRI helps me not to get below 3). I would normally be at 5-8. I would say 5-8 is a good life. I would seldom get over 8 even before tinnitus.

I hear my tinnitus constantly but most of the times it is not hard for me to concentrate on other things. I can work pretty normally.

What I will do different this time around is to maintain the treatment of tinnitus even if i feel better. I will use white nose generator for a period of 3-12 months in order to improve my sound tolerance.

I also suspect the minimum amount of bonzo that I consume does more harm than good. I will try to stop those quite soon.

I suspect the following to be the reason for me getting worse the last few months:

- A few too loud noise exposures
- Tensed muscles in back and neck
- I cannot rule out the very small amount of Oxazepam and Zopiclone. I used Zopiclone for a long time. It is short acting so I think the concentrations in the blood remain for a couple of hours.

 

Hey David,

As you've had some bouts of reactive tinnitus previously, I'm curious; can you describe how your reactive tinnitus has manifested when at its worst?

My tinnitus basically spikes to any sound, no mater frequency, which are louder than my heartbeat and breathing.

All the best,
Stacken

 

@Stacken77, my tinnitus has like 3 stages, from the worst:

1. High pitched unstable sinus tone (intrusive)
2. High pitched morse code (intrusive)
3. High pitched tickling (not so intrusive)

The more sound I expose myself to, the higher up in the chain I go but there are times when it stays low for one or some days. It is reactive to most sounds but I got so used to it. Normally I cannot handle vacuums, frying pans, noisy fans etc.

I think this is from damage to synapses or hair cells in the cochlea. I also think that it can improve over time if the damn hair cells decides to function again or more likely die off. I suspect tense/inflamed muscles in cheek and neck could be involved in this.

Can you modulate your tinnitus? Try biting hard or open mouth wide while you push it back.

 

Hey @David S, just curious how your reactivity is doing? I’m in the same boat. Has it improved?

 

It typically always improves over time but then I go and spoil it all by doing something stupid. I recently just had my 4th or 5th trauma. Now I overprotect. My threshold for creating more damage is much less than for a normal person.

 

I’m sorry to hear this. I wonder if it’s a quality amongst us that have reactivity? I’m trying to stay positive but the ratio of folks with reactivity across Tinnitus Talk getting better doesn’t seem to be in our favor.

I’m glad you have periods of improvement though. To be able to mask would be amazing.

 

Hey @David S, I forgot to ask, is your tinnitus centralized/head tinnitus or in your ears?

 

Very much in my ears. I think reactive type typically is. Your brain can not create a noise like this. What about yours?

I feel like I have got zombie-cells in my cochlea. Not dead nor alive. Just firing to the brain without any reason. When my healthy cells start firing they also start to get overactive. When I drink alcohol or take a benzo, the zombie-cells slow down or my brain pays less attention to them. I do not know if this make any sense at all for you.

It is said that within 6 months your tinnitus should turn into a brain problem from a cochlear problem. That never happened to me. We just have to hope for any of the intratympanic treatments that are in development.

 

Hi @David S, that’s an interesting hypothesis my tinnitus started in my head and feels like it’s in the center/back of my brain. I know I’ve read that once it’s central it’s “harder to treat” but not sure I put much stock in that.

Yes that makes total sense to me as I think anything that depresses the CNS probably slows down that neuron hyperactivity that we hope is the cause of tinnitus in the DCN (following Susan Shore’s work).

I believe you said you have damage that’s reflected on an OAE? Any thoughts that bent/damaged hair cells that aren’t being picked up on the test/cochlear synaptopathy is causing the reactiveness? I think you mentioned this in another post and it made a lot of sense to me.

Agreed, maybe microwick injections could help in your case?

 

My OAE came back clean.

Interesting that I had never heard about the Microwick. For me tough, I decided that I will not try anything with at least a few medical studies with good results. It is too much stress involved.

Long term I kind of like the minimal invasive electric stimulation (most cochlea patients report great improvement of their tinnitus). There are research around this in both USA and Europe. It is kind of similar to the Susan Shore’s device but you treat the cochlea directly.

Working Towards an Interactive Tinnitus Implant

 

Michael, hope you are fine. Did you ever write that post about WNGs? If not, it would be most appreciated.

 

Hi David,

I am doing well and thanks for asking. I have written about white noise generators and the correct way to use them. For best results they should be introduced slowly and if possible, have regular counselling with an audiologist that is trained in tinnitus and hyperacusis management.

White Noise Generators

White noise generators should be introduced to the ears and auditory system slowly to reduce irritation and possibly spiking the tinnitus and hyperacusis. Therefore, the volume of the WNG should be set below the level of the tinnitus and wear them for just 1 or 2 hours then remove them for the same duration. After the elapsed time put them on again setting the volume below the tinnitus and wear them for another 1 or 2 hours. If you notice any irritation reduce the wearing time again.

Continue doing this on day one, two and throughout the week. Continue this process for week two and so on, then gradually increase the wearing time. The goal is to achieve a total wearing time of 6 to 10 hours and many people achieve this. At night white noise generators shouldn't be worn while asleep. Instead use a sound machine by the bedside setting the volume slightly below the tinnitus.

Over time the white noise generators will help to desensitize the auditory system so it becomes less sensitive to sound and thus hyperacusis will reduce. At the same time the tinnitus is treated as the brain will habituate to the white noise generators and will slowly push the tinnitus into the background so it becomes less noticeable. This treatment can take up to 18 months and ideally, one should have regular counselling with their audiologist. Counselling helps to remove demystifies the negative thinking that is often associated with 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.

There are a lot of people that believe tinnitus and hyperacusis cannot be helped with white noise generators and counselling, but this is not true. If a person engages with these people or reads negative posts about this treatment, it can hinder or completely stop any progress they are likely to make with it.

White noise generators and counselling cannot do all the work. A person also has to help themselves by reinforcing positive thinking, by participating in the things they like to do. It is something that takes time. My posts: Tinnitus and the Negative Mindset, Acquiring a Positive Mindset, How to Habituate to Tinnitus, The Habituation Process, Hyperacusis, as I See It, can all help one to achieve this. They are available on my Started Threads.

All the best,
Michael

 

@Michael Leigh, thanks like always for you kind advice. Later on I was thinking of using a Sonos One speaker during night. On Spotify there are 1 million natural sounds to choose from.

Any sounds that you could recommend? Any other good sources that you could recommend where you can stream/download colored noise and natural sounds from?

@Michael Leigh, just one more question if you would know. My Widex white noise generators is set so that I can barely hear it at the lowest volume. Then I can adjust it in 10 steps. How much would each step be in dB? What do you think? Going from the lowest to the highest?

 

It doesn't matter what type of sound you use @David S, as long as it's pleasing to you. The volume should be set at a level so it's not drawing attention to itself and you can easily ignore it. Your brain and auditory system are supplied with low level sound enrichment while you're asleep. If you sleep in a quiet room, it allows the brain to increase its background activity and also the tinnitus making it louder during waking hours.

My white noise generators use a variable volume control and doesn't increase in increments like yours, allowing me to set the volume as precisely as I like it. I do not pay much attention to dB and advise you to do the same. Please do not download a decibel app on your phone or buy a decibel meter. They often cause more harm than good, by instilling fear and negative thinking towards sound.

Try to keep the volume of the white noise below the tinnitus so it's not masking it or set at the mixing point. The mixing point is when the tinnitus and white noise are blended together so they are both heard. Not a good idea as this often causes irritation.

Once you are able to wear the WNGs for 6 to 10 hours per day, put them on in the morning, set the volume below the tinnitus and leave them alone. It can be tempting when out on the street to turn up the volume to hear the WNG. Don't do this as it makes it more difficult for the brain to habituate to the white noise if it is constantly adjusted throughout the day.

All the best,
Michael

 

@Michael Leigh, short report. I used the WNGs for about an hour yesterday. Today my tinnitus has spiked all day.

On the other hand, I know perfectly well this is the only treatment that possibly can take me out of the suffering I experience for now. I also know that this low noise can't possibly do any harm at all. The most logical reason to my spike is that my auditory system for now is super sensitive/alert.

It is hard to find the right balance and the courage to keep going despite the temporary worsening. I just want the WNGs to be a positive experience even though I understand that it might cause some bumpy roads ahead.

If my tinnitus settles down before tomorrow, I will be be using them again. Who am I to complain after just a day of trying?