4. Masking, relaxing, and distracting sounds, and tinnitus self-help

In addition to sounds that area specifically tailored to mask or distract from tinnitus, it is a good idea to listen to sounds that are relaxing and soothing. Tinnitus is also often accompanied by hyperacusis, in which external sounds seem excessively loud. This can be countered by sound enrichment of the daily environment. The enrichment can come from a commercially-available environmental sound generator (set for instance to make the sound of bird calls, water, or other soothing natural sounds), or downloaded from the internet. This means that we are never faced with absolute silence, so that the brain comes to associate sound with relaxation, and you do not become hypersensitive to sound. It is suggested that you play these sounds continually, both in the day, and at night when you are asleep.

If you are using your own stimuli, you need to experiment with which work best for you.
A simple and cheap solution is to listen to sound files through earbuds from an MP3 player (e.g. mobile phone). Here are some sound files for you to use, in two categories.

First are natural relaxing sounds. The sound files should be played in an endless loop, with the end and start faded into each other so that there is no break (each sound file lasts for 6-7 minutes). Choose the best file for you and adjust the loudness until the tinnitus becomes less intrusive. To download and save the sound file, click on the file name till it plays, and then in your browser go to File (or Tools) > Save page as... (in Edge rightclick in the playback window to save file). This will save the audio as an .mp3 file.

Birds 1    Birds 2    Night    Stream    Waterfall

The second group are high frequency distractors, suitable for people with high frequency hearing loss. In these cases the tinnitus commonly sounds like a high frequency hissing (though it can spread to a wider range of frequencies under stress). The sounds are provided for high-frequency losses starting at 16kHz (16,000 cycles/sec - the highest), and 12kHz, 10kHz, 8 kHz, 6 kHz4 kHz, down to 3 kHz - the lowest). Start at 16 kHz, and work down in frequency, c
hoosing the highest frequency distractor that you can only just hear through earbuds when you have the loudness on your player set nearly at its maximum*. Then it will be stimulating the nerves in your ear just on the edge of your region of hearing loss. Activity will spread from these nerves to the nerves that have lost their own input, so that they will not need to generate their own activity, so reducing the tinnitus. Again, play in an endless loop, cross-fading so there is no break. It is again suggested that you start by playing the sounds through earbuds for many hours/day, including when you are asleep. Listening with earbuds or earphones in both ears will mean that you hear in stereo, which will increase the brain stimulation.

*The sounds are like a high frequency twittering. If there are crackles, clicks or pops in the sound, this is probably because your sound system is being oversaturated. Turn the volume down on your player and try again.

If you wish, you can initially use these sounds as maskers. If you have a high-frequency hearing loss, and high-frequency tinnitus, the right masker will be able to mask out the sensation of tinnitus if you play it so that it is a bit louder than the tinnitus. It is suggested that you start by masking the tinnitus for about 2 weeks. By masking the tinnitus, you will reduce the stress associated with it.

     
E: If there is high frequency loss, stimulating the ear at nearby frequencies will allow some activity to spread (blue arrow) to the cells that have lost their own input, and which are generating tinnitus. They will not need to generate their own activity, and this will suppress the tinnitus, so that the tinnitus will have (eventually) disappeared when the masker/distractor is turned off.
F: Sample audiogram showing moderate to severe high frequency hearing loss (worse hearing is plotted downwards) wth black dotted lines. Blue: spectrum of the 8kHz masker/distractor sound from this page. Red area: resulting sound now reaching the brain: it is in a narrow frequency band with a frequency just below the main region of hearing loss.


After this phase, you need to start using the sounds as a distractor. Start reducing the loudness of the masker, so that you are just able to hear the tinnitus at the same time as the masker. Stay in this phase and when you become aware of the sounds, focus on listening to the masker, rather than the tinnitus
(the masker is now acting as a distractor). Maybe after a few weeks, as the tinnitus become quieter, you will be able to turn the volume of the masker/distractor down further, so it is still about as loud as the tinnitus, and again focus on the masker/distractor. In this way, you will gradually get used to the sound of the tinnitus in a non-threatening way, and the tinnitus will start to become quieter. Eventually, the tinnitus will cease to be a problem, and may disappear completely.

Tinnitus self-help is quite feasible in straightforward cases. These webpages contain the information you need to know to deal with tinnitus in these cases (e.g. if Tinnitus Retraining Therapy is not available in your area, or not available at a reasonable rate). However, it is always suggested that you start with a full audiometric examination by a qualified clinical audiologist. In addition, you may find it valuable to have experience with Cognitive Behaviour Therapy, in addition to a range of relaxation techniques.

It is quite possible that the tinnitus will reappear from time to time, maybe in times of stress. However it is not likely to be as bad as the first time. But now you have the techniques to deal with it, so you repeat the process, and the tinnitus is likely to quickly disappear again.

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