What are tinnitus maskers and how are they used in the treatment of tinnitus?

Updated: Feb 27, 2020
  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Tinnitus masking has been central to tinnitus therapy for over 50 years. From a psychoacoustic viewpoint, masking is an important tool in the clinical armamentarium because it relieves the percept of tinnitus, even if only transiently, when the masking noise is present. From a neurophysiology point of view, masking appears to act by relieving hyperactivity in the auditory cortex (and associated pathways) that accompanies peripheral deafferentation.

A literature review by Makar et al indicated that tinnitus is best treated with a combined approach incorporating masking, counseling, and attention diversion. [22]

Perhaps the most elegant treatment of the topic of masking is from the neuro-computational literature, where the phenomenon of ‘homeostatic plasticity’ is used to describe how the loss of peripheral afferents can cause central hyperactivity. Importantly, this literature explains the paradoxical finding that stimulation of the region of damage (ie, the lesion-edge frequencies) is the most efficient way to decrease this central hyperactivity.

Masking. In this graphic, masking sounds are appli Masking. In this graphic, masking sounds are applied at C6, the tinnitus frequency. The result is that the sensation of tinnitus is reduced. In the auditory cortex, this corresponds to decreased spontaneous firing rates.

These devices resemble hearing aids and fit either behind or in the ear. Tinnitus maskers create and deliver constant low-level white noise to the ear(s) of the patient. This device is recommended for patients with normal or near-normal hearing who are disturbed by the tinnitus. Patients should be advised to wear the device during their waking hours (successful wearers tend to wear the device even while sleeping). Of patients referred for a masker, two thirds investigate the possibility, one third rent the device, and one sixth actually wear the device for a time and find it helpful.

Many people are bothered most by tinnitus at bedtime. In these cases, a bedside clock or radio may serve as a useful masker. Such instruments fill the ambient silence with low-level noise that masks tinnitus. An obvious problem with maskers is that sound is masked from inside and outside the ear. Tinnitus maskers, therefore, may interfere with hearing and communication. However, patients have reported better hearing when their tinnitus was helped with the masker. Occasionally, a residual inhibition of tinnitus occurs, so patients can wear maskers at bedtime and still benefit from the effect when not wearing the device during the day.

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