The perception of sound without an external source, often described as a ringing, buzzing, hissing, or clicking, is known as tinnitus. This internal sound affects millions of people, ranging from a minor annoyance to a debilitating condition that interferes with sleep and concentration. While there is currently no universal cure, management strategies focus on reducing the perception and distress caused by the sound. White noise, a broadband sound containing all audible frequencies at equal intensity, is a widely accessible and non-invasive method for managing symptoms. By introducing a steady, neutral auditory signal, white noise helps individuals minimize their awareness of the persistent internal noise.
The Mechanism of Auditory Masking
The immediate benefit of using external sound like white noise is auditory masking. This process involves introducing a competing sound to reduce the perceived loudness or prominence of the internal tinnitus sound. The white noise provides a constant, non-threatening signal that the brain can focus on instead of the ringing or buzzing.
The goal is not full masking—completely eliminating the tinnitus sound—which is discouraged because it prevents the auditory system from learning to ignore the internal signal. Instead, the preferred technique is partial masking, sometimes called the “mixing point.” Here, the external sound is just loud enough to blend with the tinnitus.
This blending allows the tinnitus to remain audible but less noticeable, facilitating the longer-term goal of habituation. Habituation is a neurological process where the brain learns to filter out a constant, meaningless stimulus. By consistently presenting the tinnitus alongside a neutral background sound, the brain reclassifies the internal noise as unimportant.
The auditory system eventually moves the tinnitus from conscious perception to a subconscious level, similar to how a person ignores the sound of a refrigerator hum. Successful habituation means the person is minimally aware of their tinnitus, and it has little negative impact on their daily life.
Types of Sound Used in Tinnitus Management
While white noise is the most recognized form of sound therapy, several other types of sound, often distinguished by their spectral color, are utilized. White noise contains uniform energy across the entire frequency spectrum, which some people find too harsh or high-pitched for comfortable, long-term listening.
Pink noise is a variation with more energy concentrated in the lower frequencies and reduced intensity in the higher ranges. This distribution makes the sound less sharp and is often described as being more balanced, similar to a waterfall or steady rainfall. Because of its gentler profile, pink noise is sometimes preferred over white noise for continuous exposure.
Brown noise, also known as red noise, reduces the higher frequencies even further than pink noise, resulting in a deeper, rumbling quality that may resemble a strong wind or a rushing river.
Structured Therapies
Beyond colored noise, structured therapeutic approaches like Tinnitus Retraining Therapy (TRT) combine sound generators with directive counseling. TRT typically uses a low-level broadband noise to promote habituation to the tinnitus signal.
Another specialized approach is notched or tailor-made sound therapy, which uses sounds or music with the specific frequency of the individual’s tinnitus surgically removed. The theory is to decrease the neural hyperactivity thought to be the underlying cause of the phantom sound. These structured therapies are often delivered through custom devices or programs under the guidance of an audiologist.
Guidelines for Using Sound Therapy
Effective use of sound for tinnitus management depends heavily on consistency and maintaining the correct volume level. The volume of the external sound should be set slightly softer than the perceived loudness of the tinnitus, or just loud enough to create the “mixing point.” The goal is to blend the sounds, not completely drown out the internal ringing, as full masking impedes the habituation process.
Sound therapy should be used for a minimum of several hours each day, with a common recommendation being at least four hours daily, including for sleep assistance. Consistency is paramount, as the brain requires continuous low-level auditory stimulation to reorganize its response. While some individuals notice initial relief within a few weeks, full habituation often takes many months, sometimes up to a year, to achieve maximum benefit.
The sound can be delivered through various methods:
- Tabletop sound machines
- Smartphone applications
- Dedicated wearable devices
- Specialized sound generators worn like hearing aids
For individuals with hearing loss, using a hearing aid can also serve as sound enrichment by amplifying environmental sounds, which naturally helps lessen the contrast of the internal noise.