Hearing Aids / Masking Devices | American Tinnitus Association (2023)

Headphones

Hearing aids can be classified as a type of sound therapy, as they increase external noise as a way to increase auditory stimuli and divert attention from the perception of tinnitus. People often mistake loud tinnitus, rather than hearing loss, as interference with their hearing. Therefore, it is fundamental that the hearing be tested, because the maximum of90 percent of peoplewho suffer from chronic tinnitus also have hearing loss.

For more information on how to distinguish between hearing loss, tinnitus and hyperacusis and recommended protocols for evaluation,Click here.

Why headphones?

Tinnitus is strongly related to some level of hearing loss. Increasing reception and awareness of external noise can often alleviate the internal sound of tinnitus.

Most patients develop tinnitus as a symptom of hearing loss, caused by age, prolonged hearing damage, or acute trauma to the auditory system. According to general scientific consensus, hearing loss causes less external sound stimuli to reach the brain. In response, the brain undergoes neuroplastic changes in the way it processes different sound frequencies. Tinnitus is the product of these maladaptive neuroplastic changes.

Patients with hearing loss and tinnitus may find relief using hearing aids and other sound amplification devices. Hearing aids are small electronic devices that are placed in or behind the ear. With a microphone, amplifier and speaker, hearing aids supplement the volume of external noise and increase the amount of sound stimuli received and processed by the body's auditory system.

on a2007 survey of hearing care professionals, respondents reported that approximately 60% of their tinnitus patients experienced at least some relief when wearing hearing aids; approximately 22% of patients found significant relief.

Hearing aids can be effective for several reasons:

Masking effects and attention

Hearing aids can increase the volume of external noise to the point of covering up (masking) the tinnitus sound. This makes it harder to consciously notice tinnitus and helps the brain focus on external environmental noises. The masking effect of hearing aids is particularly strong for patients with hearing loss in the same frequency range as tinnitus.

auditory stimulation

Increasing the volume of external noise also increases the amount of auditory stimulation the brain receives. There may be benefits to stimulating the brain's auditory pathways with soft, inaudible background sounds.

improved communication

Hearing aids help by increasing the external volume to make it easier to hear conversations and sounds around you. As a result, patients may experience less personal frustration and social isolation.

To better understand how hearing aids can help with tinnitus, consider the two images below as simple visual representations of tinnitus and hearing loss. Imagine that the cricket represents the hum of a person and the background image represents the background sounds.

ONE

B

NoImage A, the person has hearing loss. The background noise is indistinct and the cricket (buzzing) is very clear. At theImage B, the person has been fitted with a hearing aid, and the background is sharp and rich in detail. Although the cricket (hum) is still present, it blends into the background. The listener's attention is diverted to other aspects of the ambient sound. The success of hearing aids in controlling tinnitus depends on how well the background sounds can be combined with the tinnitus.

Modern digital hearing aids with open designs and individual hearing loss profiles can be particularly helpful in treating tinnitus. Additionally, many newer hearing aids include additional sound masking functionality (white noise or other artificial ambient sound played directly into the ear) that further covers the perception of tinnitus.

Like most tinnitus treatments, hearing aids may work best when combined with a structured tinnitus education program and some form of patient counseling.

cochlear implants

Cochlear implants, surgically implanted devices that restore the sensation of sound in patients who are deaf or have severe hearing loss, are another form of sound amplification that can be helpful in relieving tinnitus symptoms. They work on the same principle as hearing aids: they increase external sound stimulation, which helps to distract the brain from tinnitus sounds. Cochlear implants are generally only available to patients with severe hearing loss that prevents them from understanding spoken communication, limited benefit from hearing aids as determined by an audiologist, and no medical conditions/factors that could increase the risks associated with implants.

Considerations

Price:Hearing aids can be expensive and are often not covered by insurance. Patients with tinnitus and insignificant hearing loss may have difficulty finding insurance coverage for hearing aids.

Lifestyle and comfort:Research suggests that hearing aids are most effective when worn consistently during waking hours. This requires the patient to wear the devices full time.

Sound sensitivity:Patients with hyperacusis or other forms of sound sensitivity may experience some discomfort when using hearing aids.

Years:While hearing aids can benefit most patients, some studies suggest they are more effective for younger patients and those with a shorter history of tinnitus.

References

Del Bo, L. and Ambrosetti, U. (2007) “Hearing aids for the treatment of tinnitus”.Advances in Brain Research, 166: 341-345.

Folmer RL, Theodoroff SM, Martin WH, Shi Y. (2014) "Experimental, Controversial, and Futuristic Treatments for Chronic Tinnitus."Journal of the American Academy of Audiology, 25:106-125.

Hoare DJ, Edmondon-Jones M, Sereda M, Akeroyd MA. & Hall, D. (2013) "Amplification of Hearing Aids for Patients with Tinnitus and Coexisting Hearing Loss".Cochrane Database of Systematic Reviews, Number 1. Art. No.: CD010151. DOI: 10.1002/14651858.CD010151.pub2.

Hoare DJ, Searchfield GD, Refaie AE. and Henry, J. (2014) "Sound Therapy for the Treatment of Tinnitus: Viable Options".Journal of the American Academy of Audiology. 25: 62-75.

Kochkin, S & Tyler, R. (2008) "Tinnitus Treatment and Hearing Aid Effectiveness: Perceptions of Hearing Care Professionals." Hearing screening, available at:http://www.hearingreview.com/2008/12/tinnitus-treatment-and-the-efectiveness-of-hearing-aids-hearing-care-professional-perceptions/(Accessed March 25, 2015).

Searchfield, G. (2005) "Modern Hearing Aids: An Aid to Tinnitus."buzz today, 30,2: 14-16.

Shekhawat, G.S., Searchfield, G.D. and Stinear, C.M. (2013) "Role of hearing aids in tinnitus intervention: a scoping review".Jornal da Academia Americana de Audiologia. 24(8):747-62.

Trotter, M.I & Donaldson, I. (2008) "Hearing aids and tinnitus therapy: a 25-year experience".Journal of Laryngology and Otology, 122: 1052-1056.

sound therapies

Tinnitus is a non-auditory internal sound. But patients can use an external sound to neutralize their perception and reaction to tinnitus. Sound masking can cover up the tinnitus sound, while more advanced therapies can provide more robust relief.

“Sound therapy” is a broad term that can be used in a variety of ways depending on the specific product, clinical environment or individual practitioner. In general, sound therapy refers to the use of external sound to change the patient's perception or reaction to tinnitus. Like other tinnitus treatments, sound therapies do not cure the condition, but they can significantly reduce the perceived burden and intensity of tinnitus.

Sound-based therapies work on four general mechanisms of action. (Mechanisms of action are the putative processes or reasons why a particular intervention is effective.) Different products may emphasize a specific aspect or include a combination of approaches:

• Masking:exposing the patient to external sound at a volume high enough to partially or completely cover the sound of their tinnitus
• Distraction:using an external sound to divert the patient's attention away from the tinnitus sound
• Habituation:help the patient's brain to reclassify tinnitus as an unimportant sound that can and should be consciously ignored
• Neuromodulation:the use of specialized sound to minimize the neural hyperactivity believed to be the underlying cause of tinnitus

There are many devices that offer different levels of sound therapy. Below is a list of general types of sound therapy products and a discussion of their specific mechanisms of action and reported effectiveness.

Sound masking devices

These are devices or applications that provide generic background noise, usually white noise, pink noise, nature sounds, or other subtle ambient sounds. The sound generated by sound machines can partially or completely mask the patient's perception of tinnitus, providing relaxation and temporary relief from the condition.

The "traditional" sound masker is a single function table or bedside device with several preset sound options. However, almost any sound-producing device can be used for masking purposes, including personal media players, computers, radios and televisions. Even electric fans or tabletop sources can provide masking sounds. In general, the most effective masking sounds are those that elicit positive emotional responses from the patient.

Sound masking devices are usually only effective during or immediately after active use; they have very limited long-term effectiveness in reducing the overall perception of tinnitus.

Modified sound devices/notched music

While commercial grade sound machines provide a generic sound selection, a variety of medical grade devices provide more personalized sounds designed for the patient and their tinnitus. These devices play music with special notches or algorithmically modified sounds in which specific frequencies and tones are emphasized, often to a level not consciously perceived by the listener. The reported function of these modified sounds varies by specific product.

Unlike standard white noise machines, notched music devices are typically used intermittently (only during defined therapy sessions or times of predictable acute need, such as before bedtime or immediately upon awakening) and provide persistent benefits. after the device is turned off.

Also, unlike standard white noise machines, notched music and modified sound devices can, over time, alleviate the perceived burden of tinnitus, even after turning them off. By facilitating habituation, these products can help the patient to naturally "turn off" the perception of tinnitus.

The reported clinical effectiveness of notched music and modified sound devices varies by product, but overall these devices appear to provide some level of relief for many patients. Optimal results usually require at least some patient counseling and education, in addition to the use of sound devices.

Combined Devices

Many hearing aids now come with built-in sound generation technology that continuously delivers white noise or personalized sounds to the patient. These devices combine the benefits of a hearing aid with those of other sound therapies and are particularly suitable for patients with tinnitus and measurable hearing loss. Additionally, due to the portable nature of these devices, they can provide semi-continuous use and more consistent benefits throughout the day.

The effectiveness of these combined devices varies by device, built-in sound feature, and individual patient. And while the survey data are not definitive, the professional consensus seems to be that hearing aids with built-in sound generators benefit a significant number of patients.

Sound and sleep apps

With countless apps and little guidance, it can be difficult to figure out which sound and sleep apps can help with tinnitus and/or get a good night's sleep. By clicking on the image below, you will find a list of sound and sleep apps, many of which are free, compiled by an audiologist based on patient feedback. Apps are available from the Apple app store and the apps section of Google Play.

Considerations

• Price:Hearing aids and medical-grade sound therapy devices can be expensive and are often not covered by insurance.
• Tinnitus Symptoms:Patients should consider their lifestyles and when they most need tinnitus relief. If tinnitus is primarily a problem immediately before or during sleep, a bedside white noise machine may suffice; if tinnitus is a constant concern 24/7, a more portable option may be preferable.
• Sound sensitivity:Patients with hyperacusis or other forms of sound sensitivity may experience some discomfort when using hearing aids.
• Education and support:Almost all sound therapy systems work best when combined with a complementary patient education and counseling program.

References

Hoare DJ, Searchfield GD, Refaie AE. and Henry, J. (2014) "Sound Therapy for the Treatment of Tinnitus: Viable Options".Journal of the American Academy of Audiology. 25: 62-75.

Hobson, J., Chisholm, E., El Refaie, A. (2012) “Sound therapy (masking) in the treatment of tinnitus in adults”.Cochrane Database of Systematic Reviews, Number 11. Art. No.: CD006371. DOI: 10.1002/14651858.CD006371.pub3.