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Tinnitus maskers are a range of devices based on simple white noise machines used to add natural or artificial sound into a tinnitus sufferer's environment in order to mask or cover up the ringing. [1] The noise is supplied by a sound generator, which may reside in or above the ear or be placed on a table or elsewhere in the environment. The noise is usually white noise or music, but in some cases, it may be patterned sound or specially tailored sound based on the characteristics of the person's tinnitus.
The perceived loudness of tinnitus, called sensation level (SL), is how much louder the tinnitus is above the ambient noise of the environment. By raising the ambient level of noise (playing white noise into the ear), the apparent loudness of tinnitus is reduced. The noise level is close to and usually somewhat louder than the perceived loudness of the tinnitus. The generated noise is designed to be a calming, less intrusive sound than the ringing or hissing of tinnitus. Depending on the loudness of the noise, tinnitus may be fully or partially masked. Tinnitus masking cannot reduce or eliminate tinnitus, only reduce awareness of it.
The efficacy of a tinnitus masker may depend on the wearer's capacity to experience residual inhibition, the temporary suppression of tinnitus in response to particular sound patterns.
The mechanism of sound masking can be explained by analogy with light. In a dark room where someone is turning a lamp on and off, the light will be obviously noticeable. However, if the overhead lights are turned on, turning on the lamp will no longer be as distracting because it has been "masked". While sound masking is an effective solution for a majority of those with tinnitus, it does not work for everyone.
The concept that an external sound could suppress perception of an internal one was first realised clinically in the mid-1970s by Dr. Jack Vernon, when he reported that white noise was effective in alleviating tinnitus. [2]
Tinnitus suppression is different than but related to tinnitus masking. It is an acoustic or neurological effect that results in temporary suppression of tinnitus by listening to an appropriately tailored sound for a short period. After the sound is withdrawn, tinnitus may be fully (complete silence) or partially suppressed. Most (70–90%) of persons can experience the effect. There is usually a period of complete silence followed by a gradual return of tinnitus to its original level. The effect lasts for 5 minutes or less in 90% of persons but in rare cases, an hour or more. The period of complete silence is usually seconds to about a minute. If the trigger sound is repeated at intervals, tinnitus can be suppressed as long as the repetition lasts.
The residual inhibition (RI) effect, first noted in 1903, is the capacity of a sound of the right frequency and intensity to briefly attenuate or suppress tinnitus. To distinguish the tailored sound used for inhibition from the broadband undifferentiated sound employed in tinnitus maskers, it is usually referred to as the 'trigger' or 'quieting' sound. The trigger sound is closely matched to the pitch and spectrum of the tinnitus, and as loud or somewhat louder than the perceived loudness of the tinnitus. The trigger sound is applied to the ear or ears with tinnitus and typically lasts a minute or two. Not everyone can experience RI; for those who do not, tinnitus masking is likely to be ineffective.[ citation needed ]
Two qualities of a tinnitus masker need to be taken into account: how effective the masking is, and how intrusive or distracting the generated sound itself is.
The masking sound may have various temporal, spectral and amplitudinal characteristics. In some cases, the sound is tuned to the pitch, loudness and other qualities of the tinnitus. However, frequencies widely divergent from the tinnitus frequency may also mask the tinnitus, if they are of sufficient loudness. The minimum energy (or loudness) mask is usually one closely matched to the central frequency and bandwidth of the tinnitus. But it has also been discovered that a tinnitus mask close to the frequency of the tinnitus can be ineffective, while a masker with a different frequency or bandwidth effectively masks the tinnitus. This indicates different origins of tinnitus.
Tinnitus maskers may use music or natural sounds, wide band white or pink noise, narrow band white noise, a notched soundfield, frequency or amplitude modulated sound, intermittent pulsed sound, or other patterned sound. Temporally patterned sound may be more effective than white noise or background music in masking tinnitus. [3]
Studies have found that bandpass maskers are less annoying than pure tone maskers, that the annoyance rating of bandpass maskers is proportional to bandwidth, that intermittent maskers were more annoying than continuous ones, and that control over the center frequency and bandwidth was important in minimizing the annoyance of maskers.
In addition to the spectrum of masking sound, the amplitude determines the degree of masking achieved. In some cases, the required masking amplitude is so high as to cause discomfort to the user of the sound generator, and the tinnitus is therefore considered unmaskable.
The frequency and other characteristics of tinnitus can vary over time, and the shifts can be temporary or permanent. They may also be cyclical. Therefore, the optimal tinnitus mask may need to be adjusted periodically, within days, hours, or even minutes. So a fixed recording (i.e. CD, DVD or audio file) of a tinnitus mask is not a very efficacious application.
There are also safety issues associated with use of tinnitus maskers: the "safe" level of continuous sound depends on the duration of the sound. For maskers worn continuously, or most of the day, a safe level is no more than 70 dB, in accordance with EPA maximum safe exposure level for 24-hour environmental sound. Maskers louder than 45 dB or so (the ambient background level of an average home living area) may start to interfere with understanding conversation (about 60 dB).
Masking of high frequency tinnitus (>6,000 Hz) is difficult because of the resonance characteristics of the human ear as well as high frequency limitations of in-ear devices. The ear has a resonance frequency (highest frequency response) at 3,000 Hz and rolls off at a very steep 26 dB/octave on the high frequency side. Unfortunately, most tinnitus is associated with hearing loss, and most hearing loss and tinnitus is high frequency. Most maskers are limited to about 6,000 Hz of effective output. Higher frequency output results in increasing distortion, and may cause rejection of the device.
The minimum masking level (MML) is the minimum amplitude of narrowband noise centered on the tinnitus pitch (or frequency range) necessary to completely mask the tinnitus.
Tinnitus maskers are commonly used by tinnitus sufferers when trying to sleep or relax, as it is within these quiet environments that the tinnitus is at its most noticeable. They commonly take the form of CD or MP3 recordings, or bedside noise generators. When used in conjunction with a sound pillow (which contains small embedded speakers) they can mask a person's tinnitus sounds without disturbing his/her partner.
These masker devices use soothing natural sounds such as ocean surf, rainfall or synthetic sounds such as white noise, pink noise, or brown noise to help the auditory system become less sensitive to tinnitus and promote relaxation by reducing the contrast between tinnitus sounds and background sound.
More advanced software based tinnitus maskers can use a combination of natural and synthetic sounds or a filtered noise generator tailored to mask the specific frequencies at which the tinnitus signal is experienced.
Some sufferers require masking at all times. These people may employ wearable hearing aids which amplify ambient sound, generate low level wide band sounds such as white noise, or combination devices that mix both functions into one device.
A standard hearing aid may be used for tinnitus masking; the tuning and amplification characteristics are different than when one is used in compensation for hearing loss. A study by Jalilvand in 2015, showed that hearing aids instead of tinnitus maskers used to amplify sounds helped with the perception of tinnitus for veterans with blast-induced tinnitus. [4]
Sound generators (masking devices) have received Class II approval from the FDA. However, they are considered to be "experimental, investigational, or unproven" therapies.
Bose Sleepbuds II comes with an app that streams white noise (and soundscapes, and ambient music).
There is one report of a bone conduction vibration masker that transmits a 60 Hz fundamental with adjustable harmonics up to 1000 Hz. A commercial device based on the phenomenon (Aurex3) was approved by the FDA.
A new development in tinnitus management is the use of high audio (10–20 kHz) or ultrasonic (20–100 kHz) via bone conduction.
A 2012 Cochrane Review stated the available studies do not show strong evidence of the efficacy of sound therapy including tinnitus maskers in tinnitus management.
Audiologic Tinnitus Management (ATM) is a clinical protocol for management of tinnitus involving counselling and sound therapy including tinnitus maskers.
Neural Plasticity and Cortical Remapping – tinnitus is associated with cortical reorganization after hearing loss.[ clarification needed ][ citation needed ]
A weighting filter is used to emphasize or suppress some aspects of a phenomenon compared to others, for measurement or other purposes.
Tinnitus is a variety of sound that is heard when no corresponding external sound is present. Nearly everyone experiences faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearing, or is associated with other problems. The word tinnitus comes from the Latin tinnire, "to ring". In some people, it interferes with concentration, and can be associated with anxiety and depression.
Headphones are a pair of small loudspeaker drivers worn on or around the head over a user's ears. They are electroacoustic transducers, which convert an electrical signal to a corresponding sound. Headphones let a single user listen to an audio source privately, in contrast to a loudspeaker, which emits sound into the open air for anyone nearby to hear. Headphones are also known as earphones or, colloquially, cans. Circumaural and supra-aural headphones use a band over the top of the head to hold the speakers in place. Another type, known as earbuds or earpieces consist of individual units that plug into the user's ear canal. A third type are bone conduction headphones, which typically wrap around the back of the head and rest in front of the ear canal, leaving the ear canal open. In the context of telecommunication, a headset is a combination of headphone and microphone.
Audio system measurements are a means of quantifying system performance. These measurements are made for several purposes. Designers take measurements so that they can specify the performance of a piece of equipment. Maintenance engineers make them to ensure equipment is still working to specification, or to ensure that the cumulative defects of an audio path are within limits considered acceptable. Audio system measurements often accommodate psychoacoustic principles to measure the system in a way that relates to human hearing.
A hearing test provides an evaluation of the sensitivity of a person's sense of hearing and is most often performed by an audiologist using an audiometer. An audiometer is used to determine a person's hearing sensitivity at different frequencies. There are other hearing tests as well, e.g., Weber test and Rinne test.
Earmuffs are clothing accessories or personal protective equipment designed to cover a person's ears for hearing protection or warmth. They consist of a thermoplastic or metal head-band that fits over the top or back of the head, and a cushion or cup at each end to cover the ears.
Sensorineural hearing loss (SNHL) is a type of hearing loss in which the root cause lies in the inner ear or sensory organ or the vestibulocochlear nerve. SNHL accounts for about 90% of reported hearing loss. SNHL is usually permanent and can be mild, moderate, severe, profound, or total. Various other descriptors can be used depending on the shape of the audiogram, such as high frequency, low frequency, U-shaped, notched, peaked, or flat.
In audio engineering, electronics, physics, and many other fields, the color of noise or noise spectrum refers to the power spectrum of a noise signal. Different colors of noise have significantly different properties. For example, as audio signals they will sound differently to human ears, and as images they will have a visibly different texture. Therefore, each application typically requires noise of a specific color. This sense of 'color' for noise signals is similar to the concept of timbre in music.
Audiometry is a branch of audiology and the science of measuring hearing acuity for variations in sound intensity and pitch and for tonal purity, involving thresholds and differing frequencies. Typically, audiometric tests determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or distinguish speech from background noise. Acoustic reflex and otoacoustic emissions may also be measured. Results of audiometric tests are used to diagnose hearing loss or diseases of the ear, and often make use of an audiogram.
Hyperacusis is the increased sensitivity to sound and a low tolerance for environmental noise. Definitions of hyperacusis can vary significantly; it can refer to normal noises being perceived as: loud, annoying, painful, fear-inducing, or a combination of those, and is often categorized into four subtypes: loudness, pain, annoyance, and fear.
Tinnitus retraining therapy (TRT) is a form of habituation therapy designed to help people who experience tinnitus—a ringing, buzzing, hissing, or other sound heard when no external sound source is present. Two key components of TRT directly follow from the neurophysiological model of tinnitus: Directive counseling aims to help the sufferer reclassify tinnitus to a category of neutral signals, and sound therapy weakens tinnitus-related neuronal activity.
In audiology and psychoacoustics the concept of critical bands, introduced by Harvey Fletcher in 1933 and refined in 1940, describes the frequency bandwidth of the "auditory filter" created by the cochlea, the sense organ of hearing within the inner ear. Roughly, the critical band is the band of audio frequencies within which a second tone will interfere with the perception of the first tone by auditory masking.
A white noise machine is a device that produces a noise that calms the listener, which in many cases sounds like a rushing waterfall or wind blowing through trees, and other serene or nature-like sounds. Often such devices do not produce actual white noise, which has a harsh sound, but pink noise, whose power rolls off at higher frequencies, or other colors of noise.
Noise health effects are the physical and psychological health consequences of regular exposure to consistent elevated sound levels. Noise from traffic, in particular, is considered by the World Health Organization to be one of the worst environmental stressors for humans, second only to air pollution. Elevated workplace or environmental noise can cause hearing impairment, tinnitus, hypertension, ischemic heart disease, annoyance, and sleep disturbance. Changes in the immune system and birth defects have been also attributed to noise exposure.
Ultrasonic hearing is a recognised auditory effect which allows humans to perceive sounds of a much higher frequency than would ordinarily be audible using the inner ear, usually by stimulation of the base of the cochlea through bone conduction. Normal human hearing is recognised as having an upper bound of 15–28 kHz, depending on the person.
Noise-induced hearing loss (NIHL) is a hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies or impaired perception of sound including sensitivity to sound or ringing in the ears. When exposure to hazards such as noise occur at work and is associated with hearing loss, it is referred to as occupational hearing loss.
In audio signal processing, auditory masking occurs when the perception of one sound is affected by the presence of another sound.
In physics, sound is a vibration that propagates as an acoustic wave, through a transmission medium such as a gas, liquid or solid. In human physiology and psychology, sound is the reception of such waves and their perception by the brain. Only acoustic waves that have frequencies lying between about 20 Hz and 20 kHz, the audio frequency range, elicit an auditory percept in humans. In air at atmospheric pressure, these represent sound waves with wavelengths of 17 meters (56 ft) to 1.7 centimeters (0.67 in). Sound waves above 20 kHz are known as ultrasound and are not audible to humans. Sound waves below 20 Hz are known as infrasound. Different animal species have varying hearing ranges.
Psychoacoustics is the branch of psychophysics involving the scientific study of sound perception and audiology—how human auditory system perceives various sounds. More specifically, it is the branch of science studying the psychological responses associated with sound. Psychoacoustics is an interdisciplinary field of many areas, including psychology, acoustics, electronic engineering, physics, biology, physiology, and computer science.
Acoustic trauma is the sustainment of an injury to the eardrum as a result of a very loud noise. Its scope usually covers loud noises with a short duration, such as an explosion, gunshot or a burst of loud shouting. Quieter sounds that are concentrated in a narrow frequency may also cause damage to specific frequency receptors. The range of severity can vary from pain to hearing loss.