Which noise preset is best for my tinnitus patient?

By Michael Piskosz

In recent years there has been substantial growth in hearing aid-tinnitus combination instruments options for patients suffering from tinnitus.  This has led many clinicians asking the question, ‘What sounds are best for my patient(s)?’  The quick answer is that there is no one best sound for all tinnitus patients.  Sounds that help facilitate tinnitus relief vary from person to person, because not everyone likes listening to the same sounds for the same reasons.  The sounds we prefer vary not only from person to person, but also depending on the activity we are engaged in, or even the time of day.  An example of this would be the type of music you prefer to wake up to early in the morning before work, compared to the type of music you might prefer to hear if you were at a dance club on a Friday night.

Since the sounds for tinnitus management vary from person to person, it is important to use instruments that offer the flexibility to deliver sounds unique to the patient’s preferences.  In our latest fitting software release, Aventa 3.6, we have introduced 4 new ‘Noise Presets’ – High Tone Noise, White Noise, Speech Noise and Pink Noise (Aventa screendump).  Keeping in mind what we talked about earlier regarding individual preference to sound, there is no one preset that will work for everyone.  Rather, these preset options are meant to be used as starting points when introducing sound therapy.

By introducing sound therapy, our main intention is to divert one’s attention away from the tinnitus. By introducing sound into one’s environment, we are able to minimize the contrast between the tinnitus and the background environment. For example, in a quiet room tinnitus is easily detected since there is a large discrepancy between the loudness of the tinnitus and quietness of the environment. By enriching the environment with sound, we increase the loudness of the background environment, therefore making the tinnitus less prominent and noticeable (Figure 1). Sound therapy can have immediate effects, helping to reduce tinnitus audibility (e.g. masking/partial masking) which can also potentially result in taming the underlying tinnitus.

Sound stimulation may also reverse or modify the abnormal cortical reorganization thought to be responsible for tinnitus (Searchfield et. al, 2010).  In essence, we are trying to train the brain to defocus from the tinnitus through neural plasticity.  So, it is important to select sounds that are therapeutic and preferred by the patient, which can vary between speech and environmental sounds, music, as well as differently weighted noise.

Which preset is best for your patient?

Let’s take a look at each of the ‘Noise Presets’ offered in Aventa 3.6 a little more closely.  First, High Tone Noise is noise that emphasizes the high frequencies more than either the mid or low frequency regions.  For some tinnitus patients with a very high-pitched tinnitus, this could be a useful starting point.  Unfortunately, for many tinnitus patients, sound tolerance abnormalities also accompany the tinnitus.  Often, sound tolerance abnormalities are exacerbated by high-pitched sounds, therefore the High Tone Noise may not be best for this individual.  This is why we also offer a Pink Noise option.  Pink Noise has a slight energy roll-off per octave in the high frequencies.  Often times, patients with sound tolerance abnormalities prefer this, as the noise is perceived as less ‘harsh’ and more ‘soothing.’  In addition, we offer our standard White Noise option, which has a flat spectrum of equal energy within bands.  This is the most commonly used noise stimulus for tinnitus management, and is often the default starting point for many patients.  Lastly, we also offer a Speech Noise option, which has most of the spectral energy in the mid frequencies.  This could be a good starting point if none of the other options are preferred by the patient.

Considering that approximately 85% of tinnitus sufferers also have some treatable hearing loss, the ‘noise presets’ will not be loud enough for most users at their default settings.  Aventa 3.6 allows you to further customize the presets by adjusting the frequency filters and/or tinnitus sound generator (TSG) volume level. When a change is made to the default ‘noise preset’ setting, the word ‘Custom’ will appear, indicating that you have customized the TSG fitting from the original default setting (Aventa screendump).

Working with tinnitus patients can be challenging at times, but having the flexibility to offer them multiple sound options will allow for a collaborative decision on choosing the best sounds for that individual.

To learn about more treatment options for tinnitus visit the American Tinnitus Association (ATA) at:

http://www.ata.org/for-patients/treatment

Searchfield GD, Cameron H, Irving S, Kobayashi K. “Sound therapies and instrumentation for tinnitus

management.” New Zealand Medical Journal 19 March 2010. Vol 123 No 1311; ISSN 1175 8716

Page 112-125. URL: http://www.nzma.org.nz/journal/123-1311/4040/