Unintended Consequences of White Noise Therapy for Tinnitus—Otolaryngology's Cobra Effect

[linearb]

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2697852

DANGER WILL ROBINSON, FLAME BAIT AHEAD

Importance Critical to the success of many medical therapeutics is a consideration of the brain's miraculous ability to dynamically rewire itself anatomically and neurochemically on the basis of incoming information. We argue that white noise exposure, a commonly recommended therapy for patients with tinnitus, engages these plastic processes in a way that induces maladaptive changes in the brain that degrade neurological health and compromise cognition.

Observations The pathophysiologic mechanisms commonly associated with hearing loss and tinnitus reflect cortical dedifferentiation and widespread loss of inhibitory tone throughout the central auditory pathway. Importantly, these same changes are also induced by exposure to unstructured noise, even at nontraumatic levels in the adult nervous system. Not by coincidence, the same changes appear in age-related decline of central auditory function, suggesting that both tinnitus and white noise accelerate the aging of the brain.

Conclusions and Relevance Noise exposure therapies offer a seductive short-term solution for relief but, in the long term, undermine the functional and structural integrity of the central auditory system and the brain more generally. Sound therapies using unstructured, random ("white") noise should be avoided as a treatment for tinnitus. Alternative therapeutics that drive positive, adaptive plastic changes are discussed.

This strikes me as a pretty big deal, not to mention extremely controversial.

I have not yet read the full text, but at a high level, if this is remotely accurate -- then it makes both using TRT-style broadband ear-level generators, as well as "sleep with a fan / run a fan all the time" seem like exactly the opposite of what you want to be doing.

This meshes with my personal observation that fans and white noise in general piss my ears off, rather than soothing them.

@threefirefour I am curious to get your thoughts here.

 

[JohnAdams]

Well I'm not a big "fan" of TRT but I need my fan to sleep and my water sounds to work.

 

[linearb]

Well I'm not a big "fan" of TRT but I need my fan to sleep.

I slept with a fan for most of my life; once the tinnitus got to the point that I could hear it over the fan, I stopped.

Now, ~8 years later, I can comfortably sleep with earplugs in. It took a lot of work to get to that point, but it's made my life much better, because it means I am now capable of sleeping comfortably in environments with a bunch of annoying background noises. You're relatively new to this annoying condition, do not assume that you're going to be stuck blasting fans forever.

That's neither here nor there, though -- I need to get my hands on the full text, because on the face of it this is literally the most controversial thing I've read about tinnitus research in the last 5 years at least.

 

[Johan_L]

That's neither here nor there, though -- I need to get my hands on the full text, because on the face of it this is literally the most controversial thing I've read about tinnitus research in the last 5 years at least.

Enjoy:
https://www.brainhq.com/sites/default/files/pdfs/media-kits/whitenoise/journal.pdf

 

[Contrast]

I'm on a schedule slacking and I don't have time to read this, can someone summarize in a short sentence what's going on?

 

[kelpiemsp]

Nice shout out to signal timing there!

 

[kelpiemsp]

I am trying to figure out if the belief is tinnitus is a predictor of dementia or if dementia is a predictor of tinnitus.

 

[threefirefour]

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2697852

DANGER WILL ROBINSON, FLAME BAIT AHEAD

This strikes me as a pretty big deal, not to mention extremely controversial.

I have not yet read the full text, but at a high level, if this is remotely accurate -- then it makes both using TRT-style broadband ear-level generators, as well as "sleep with a fan / run a fan all the time" seem like exactly the opposite of what you want to be doing.

This meshes with my personal observation that fans and white noise in general piss my ears off, rather than soothing them.

@threefirefour I am curious to get your thoughts here.

It looks interesting. I will read the full paper to check it out. Thanks.

 

[kelpiemsp]

Proceed with caution. Author is an employee of BrainHQ, one of the beneficial types quoted in the paper... FWIW... and is using the term neuroscientist when in reality they are a cognitive psychologist by training.

 

[frohike]

I'm on a schedule slacking and I don't have time to read this, can someone summarize in a short sentence what's going on?

The paper says that you will reinforce tinnitus if you play white noise, even when it is initially distracting.

The theory is that white noise reinforce cells that generate the perception of noise, and vice versa, you are better off listening to music and speech, specially if they have been "notched" to exclude frequencies neighboring tinnitus.

 

[85dB T]

The paper says that you will reinforce tinnitus if you play white noise, even when it is initially distracting.

The theory is that white noise reinforce cells that generate the perception of noise, and viceversa, you are better off listening to music and speech, specially if they have been "notched" to exclude frequencies neighboring tinnitus.

Frohike, thanks for the review.

"White Noise" reminded me of the snowy mountains. Sound is muffled by blankets of snow. So you can actually hear gentle thumping of large snowflakes stacking upon one another.

Now it's the worst environment because of tinnitus. Like a stealthy wolf constantly stalking you.

 

[GregCA]

The theory is that white noise reinforce cells that generate the perception of noise, and viceversa, you are better off listening to music and speech, specially if they have been "notched" to exclude frequencies neighboring tinnitus.

There is a sound therapy called Windowed White Noise, which is essentially white noise that is notched around a given frequency (with a specific "width") - which has the best volume reduction of all the sound therapies I've seen (compared to ACRN or general notched music).

 

[kelpiemsp]

It seems the link with dementia is more that there is a specific type of dementia related to auditory processing that seems to cause tinnitus. Now hearing loss on the other hand is absolutely linked to dementia, but that is "mostly" because of people no longer being social. The mere mental power of maintaining friendships and socializing seems to ward off dementia in those with hearing loss.

 

[Manny]

It seems the link with dementia is more that there is a specific type of dementia related to auditory processing that seems to cause tinnitus. Now hearing loss on the other hand is absolutely linked to dementia, but that is "mostly" because of people no longer being social. The mere mental power of maintaining friendships and socializing seems to ward off dementia in those with hearing loss.

Phew. Lol.

 

[Spiral]

I have had a fan on while I slept for most of my life. When I was 12 I had a bad case of tinnitus after listening to a fan that was particularly loud. After it took about a week or so for the noise to go away, I wore ear plugs to sleep along with a fan.

We often think of fans & white noise as a savior to distract us from the tinnitus. However, even at perceived safe levels, over time it can still do damage. If you do use a fan, be sure not to sleep to close or have it too loud or you could still be hurting your ears.

After I got my tinnitus, I did not have a loud fan or white noise blasting in my ear(s). I did not mask at all for the first or second month even though it was very difficult. It has gone down a little bit since, however, it is safe to say at this point that it is chronic.

I don't believe that listening to a fan or white noise will make it chronic or "stick" if you will, but I will say if the noise level is too loud, you will definitely make it worse.

 

[85dB T]

but I will say if the noise level is too loud, you will definitely make it worse.

I feel the same way about my hearing aids. To hear clearly the volume needs to be near full. This hurts my ears. This isn't much different than wearing ear buds listening to an mp3 playing loud music!

I can't sleep with near silence. If white noises make it worse that's just going to have to be an unwanted side effect of my "treatment".

Peace

 

[DebInAustralia]

@linearb

I know this is an older thread.

Does this include notched white noise?

 

[DebInAustralia]

I slept with a fan for most of my life; once the tinnitus got to the point that I could hear it over the fan, I stopped.

Now, ~8 years later, I can comfortably sleep with earplugs in. It took a lot of work to get to that point, but it's made my life much better, because it means I am now capable of sleeping comfortably in environments with a bunch of annoying background noises. You're relatively new to this annoying condition, do not assume that you're going to be stuck blasting fans forever.

That's neither here nor there, though -- I need to get my hands on the full text, because on the face of it this is literally the most controversial thing I've read about tinnitus research in the last 5 years at least.

@linearb

Old thread I know...

But did you ever follow up on this study?

I wanted to know if this would include notched white noise...

 

[linearb]

@DebInAustralia what @kelpiemsp said above made me basically discount this paper entirely. Weird singleton paper that presents a theory based on no human data, and researcher involved has clear conflict of interest. Meh.

 

[DebInAustralia]

@DebInAustralia what @kelpiemsp said above made me basically discount this paper entirely. Weird singleton paper that presents a theory based on no human data, and researcher involved has clear conflict of interest. Meh.

Thanks.

It did alarm me.

Really struggling with tinnitus.

And wondered if notched white noise would be a problem.

 

[linearb]

Thanks.

It did alarm me.

Really struggling with tinnitus.

And wondered if notched white noise would be a problem.

There's a long thread on it here, I haven't kept up but my blurry memory of it is that as with most audio therapies some people reported temporary spikes, but that's about it.

I did a long stint with ACRN and it definitely was doing something because some weird stuff was happening with my audio; I remember that sometimes when I'd be falling asleep hours later my brain would start playing ACRN tones as though I could really "hear" them. Very strange.

I didn't stick with notched noise long enough to have any opinion.

 

[DebInAustralia]

There's a long thread on it here, I haven't kept up but my blurry memory of it is that as with most audio therapies some people reported temporary spikes, but that's about it.

I did a long stint with ACRN and it definitely was doing something because some weird stuff was happening with my audio; I remember that sometimes when I'd be falling asleep hours later my brain would start playing ACRN tones as though I could really "hear" them. Very strange.

I didn't stick with notched noise long enough to have any opinion.

Thanks.

I'm not terribly compliant with sound therapies because I don't enjoy listening to it.

I'll try it again though as I think it does do something.