Is Masking Tinnitus Harmful to Ears?

[Clare Johnson]

Hello Dr. Nagler.

Thank you for all your time dedicated to this forum, it means a lot to us.

I had a question. My tinnitus is fairly new, I'm going into my 7th week with it. For about a month or so I was masking it pretty frequently with headphones playing nature or rain sounds at low volumes. I always made sure it was either at the level or below the level of my tinnitus.

Do you think this could have done any further damage? I'm worried now that I may have made things worse for myself (even though in general, my tinnitus seems to be following a healing path).

Thank you.

 

[Dr. Nagler]

Hello @Clare Johnson. Thank you for your question.

Tinnitus masking has a long and interesting history. It was first described in the early 1820s by Jean-Marie Gaspard Itard, a French physician, and I am quite sure folks were successfully masking their tinnitus long before then. Itard used to suggest to his patients with high-pitched tinnitus that that sit near a hissing fire made from green sticks. Those with low-pitched tinnitus would sit near a roaring fire made from old wood. He had folks living near grist mills, etc. He even suggested riding on horse-drawn carts over cobblestone streets! Tinnitus masking was actually popularized by Dr. Jack Vernon (1922-2010) with the development of wearable maskers. I would say that Dr. Vernon is more responsible for helping tinnitus sufferers achieve meaningful relief than any other individual in the field.

Now to your question. Tinnitus masking cannot possibly cause auditory damage as long as the masking sound does not exceed 75-80dB or so. It would be incredibly rare to want to mask at that level anyway, since masking sounds exceeding 60dB will tend to interfere with communication. In short, you have not made things worse for yourself by playing nature or rain sounds at low volumes like you describe.

All the best -

Stephen M. Nagler, M.D.

 

[Dr. Nagler]

While on the subject of masking, let me try to clarify an issue that comes up every once in a while.

Dr. Pawel Jastreboff, who developed Tinnitus Retraining Therapy (TRT), believes strongly that tinnitus sufferers who seek to habituate should avoid masking their tinnitus. The idea there is that you cannot habituate a signal you cannot detect, and by definition you cannot detect your tinnitus when you are masking it. [Here we are talking about total masking, not partial masking.] The point I wish to make is that what Dr. Jastreboff is stating is an opinion, a theory if you will. While it makes sense that you cannot habituate a signal you cannot detect, there have been no studies demonstrating that this concept holds true for tinnitus in the real world. I suspect part of the reason is that even folks who mask a lot tend not to mask all the time; they are therefore exposed to their tinnitus when they are not masking as well as when they are only partially masking.

So in her masking is @Clare Johnson making things worse for herself by virtue of inhibiting her habituation? My answer is ... why worry about it? Clare obviously gets considerable relief from her masking, which is great! I mean, even if by masking she is inhibiting her habituation (which as I mentioned above is conjecture rather than proven fact), she isn't preventing it! At worse she is slowing things down a bit (which I personally consider to be a very good trade-off for getting some meaningful relief in the process!) And besides, by Clare's own admission her tinnitus seems to be "following a healing path." So why screw with success?

In my opinion the only reason you should strive to avoid total masking is if you are actually doing TRT under the close supervision of a knowledgeable and experienced TRT clinician. Otherwise, if masking affords you appreciable relief, I think it's just fine.

Stephen M. Nagler, M.D.