Can White Noise Therapy Worsen Tinnitus?

 

by Neil Bauman, Ph.D.

© July, 2022

 

A man explained,

I have read a number of your really interesting articles. When I went to the Arches website to buy Arches Tinnitus formula, I noticed an article that talks about the damage caused by listening to white noise. I have read that it is essential to use sound enrichment to take advantage of brain plasticity to cure both hyperacusis and reactive tinnitus. After reading this article, I’d really like to know your opinion on this.

The research that Barry Keate (the head honcho at Arches) was quoting from was a paper entitled, “Unintended Consequences of White Noise Therapy for Tinnitus—Otolaryngology’s Cobra Effect” by Mouna Attarha, Ph.D., et. al. Here is my take on what listening to white noise means in a practical sense.

This recent research (2018) indicated that exposing your ears to constant broadband sounds such as the hissing, static-like sounds of white or pink noise that is often used in sound therapy for treating tinnitus, reactive tinnitus and loudness hyperacusis can have the opposite effect than what you want. It can make your tinnitus louder—at least initially—rather than softer. (3)

However there’s a catch. As they say, “The devil is in the details.” So don’t take this statement at face value without understanding the details of how and why this may happen.

According to studies on mice, if you are exposed to constant broadband noise for extended periods, your brain changes how it functions and rewires itself in a negative manner. (3)

This new research argues that broadband noise could actually be harmful to your central auditory system (5) because it causes maladaptive plasticity in the auditory pathways in your brain.

If this is true, it means that the potential adverse effects of using white-noise-masking strategies for treating tinnitus ultimately outweighs their therapeutic potential in reducing your tinnitus. Thus, Dr. Attarha recommends against sound therapies using unstructured (i.e. constant and unmodulated) broadband noise. (1)

Here’s what he found happens. Your brain is “plastic”—that is, it can change itself in either good (adaptive) or bad (maladaptive) ways. (1) These adaptive behaviors apply to your various senses, including your sense of sound.

It can do this because the two main neurotransmitters in your auditory system are the excitatory neurotransmitter, glutamate, and the inhibitory (or calming) neurotransmitter, gamma-amino-butyric acid (GABA). These two chemicals must be kept in balance in order for your auditory system to function properly. (8)

Note: Neurotransmitters are chemical messengers in your brain and other parts of your nervous system that allow nerve cells to signal to one another. (9)

Be aware that in most cases, tinnitus is ultimately tied to hearing loss. The three most common causes of tinnitus are hearing loss, exposing your ears to loud sounds (which results in hearing loss) and taking ototoxic drugs (which also can result in hearing loss). (3)

When you have a hearing loss, it knocks things out of balance. This is because when you have a hearing loss, less of the calming neurotransmitter (GABA) is released while excessive amounts of the excitatory neurotransmitter, glutamate, flood your auditory system. The excess glutamate overwhelms the effects of the inhibitory neurotransmitter (GABA). This leaves your auditory system in a hyper-excited state (8) and results in neurons firing together and thus wiring together.

The result? Over time, neural plasticity may further impair central auditory (brain) function by increasing, rather than decreasing, neural activity. This hyper-excitability rewires your auditory cortex in a maladaptive manner so that ultimately your tinnitus becomes a permanent sound, even if the initial input is no longer present. (8) You hear this hyper-excitability in your auditory cortex as tinnitus. Because of the consequent loss of inhibition, you perceive your tinnitus as even louder.

Furthermore, researchers have discovered that long-term exposure to non-traumatic noise (softer sounds that won’t damage your ears so that your hearing thresholds remain unchanged) is capable of inducing this maladaptive plastic reorganization of your central auditory system. (1)

Exposing your ears to what is essentially low-level, continuous, broadband (white or pink) noise can exacerbate your loudness hyperacusis—and thus, your reactive tinnitus if you have it—due to the stochastic resonance effect. (2)

Stochastic (stoe-KAS-tik) resonance is a phenomenon where listening to continuous, very faint, broadband noise can lead to mild auditory threshold shifts such that it actually increases your auditory gain, not reduces it. In plain English, this means that listening to faint, continuous sounds can make your loudness hyperacusis/reactive tinnitus temporarily worse. (2)

This seems to be the case in numbers of people who have the kind of reactive tinnitus called “winding up” where the longer you hear a constant background sound, the louder your tinnitus becomes. This winding up kind of reactive tinnitus doesn’t just limit itself to mild auditory threshold shifts (hearing loss), but can cause major threshold shifts as well. (3)

Therefore, if you choose continuous sound therapy, your clinician should advise you that you might experience a temporary increase in your loudness hyperacusis due to this stochastic resonance effect. (7) Note that with this kind of stochastic resonance, “temporarily worse” may last for a long time, not just for minutes or hours! That’s the bad news.

In contrast, the good news is that prolonged, but intermittent, exposure to low-level noise appears to suppress neuronal gain in your brain. Interestingly enough, the tonotopic (distributed by frequency) region that shows the greatest benefit, corresponds to the frequency band of the prolonged but intermittent noise. This means that for best results, your background sounds should focus on the frequencies of the sounds that bother you the most, which are typically higher-frequency sounds. (2)

These studies suggest that intermittent, prolonged exposure to low-intensity noise or pure tones will increase your tolerance to loud sounds. If this latest research proves to be true, then, when treating tinnitus, reactive tinnitus, and loudness hyperacusis, your hearing professional needs to consider temporal (timing) and spectral (frequency) features of the long-term noise in addition to noise intensity (volume). (10) In similar fashion to continuous sound therapy, the volume is fixed “to allow for listening throughout the allocated time slot. Gradually over weeks or months the volume is increased.” (6)

So far, researchers have observed these changes following exposure to continuous noise levels in the 60 to 70 dB SPL (sound pressure level) range. These sound levels are typically used in commercially-available noise generators. They are considered “safe” by the US Occupational Safety and Health Administration (OSHA). What’s more, researchers have seen these results developing following broadband noise exposures spanning as little as two months. Not only that, but these results may persist for several weeks or months after the end of the white-noise experiment. (1)

This research casts doubt on the therapeutic merits of sound therapies implementing unstructured masking noise. There are two fundamental reasons for this.

First, exposing your ears long-term to non-traumatic noise can produce the same anatomical, physiological, and behavioral symptoms of hearing loss associated with tinnitus.

This raises the disconcerting possibility that “broadband noise exposure may be sufficient to unmask, exacerbate, or prolong tinnitus symptoms, even without damaging the cochlea.” (1)

Second, non-traumatic noise exposure plays a role in problems “reflecting compromised temporal processing ability, which is critical for speech comprehension” and for detecting speech in noise. (1)

Thus, although sound therapies using broadband noise, while providing temporary relief by masking your tinnitus in the short term, may cause you problems in the long term. (1)

At this point, it is still too early to conclude that unstructured sounds such as white or pink noise are having these effects on people. (5) However, it is better to be “safe than sorry” since there are many other sounds that are readily available for treating tinnitus. These alternate sounds “do not carry known risks for exacerbating tinnitus symptoms in the long term, and are free from adverse effects known to be induced by long-term exposure to unstructured noise”. (1)

The simplest and easiest alternative to using unstructured broadband noise (white or pink noise) in sound therapy is to simply replace these sounds with structured (nonrandom, modulated) sounds, such as music or speech. When you do this, you should see a reduction in your tinnitus. (1)

Note that the arguments to support the results of this new research suffer from two fundamental flaws. First, the purpose of using broadband noise in controlling tinnitus is neither intended to treat your tinnitus, nor to engage neural plasticity in order to disrupt your tinnitus. Rather, the broadband noise in tinnitus management is to either “mask” or partially reduce the perception of your tinnitus or to aid in habituating to your tinnitus. In other words, broadband noise is used to treat your reaction to your tinnitus, not to create neural plasticity to disrupt the tinnitus signal itself. (1)

Second, this research data comes from mouse experiments where the mice are exposed exclusively to low-level broadband white noise for weeks on end without any other sounds present. (8) In contrast, people using broadband tinnitus-masking sounds also hear all the everyday sounds, including music and speech, that are part of the human experience. They are not locked away in soundproof rooms so they can only hear white noise. It is highly-likely that these many other sounds keep their brains from rewiring in a maladaptive way. (11)

Thus, the evidence that unstructured broadband noise exacerbates tinnitus in the majority of people who seek help for their tinnitus flies in the face of fairly substantial research on the effectiveness of masking and broadband sound therapy approaches in tinnitus therapy. (11)

Another point to consider in favor of using structured sounds rather than just unstructured, plain white noise is that in order to habituate to your tinnitus, you need to choose sounds that work for you. The therapy sounds used mustn’t annoy you in any way or you won’t be able to ignore them and thus habituate to them. For people like myself who find it annoying to listen to either white or pink noise, such therapy would not readily result in habituation. (3)

Fortunately, there are other sounds you can listen to in tinnitus reduction therapy. The idea with habituation sound therapy is that you are training your brain to ignore your tinnitus, so you need another, partially-masking, sound that it ignores. When it does this, at the same time it also learns to ignore your tinnitus. (3)

However, in order to ignore a sound, the sound has to be meaningless and unimportant to you. Thus, random noise works, whereas listening to real music or speech, which has meaning, typically won’t produce the desired effect. (3)

Therefore, if you don’t like white or pink noise, you can use structured sounds. One such sound is fractal music. This is because fractal music (which sounds a lot like wind chimes) is basically random. Thus, you can’t figure out what comes next and therefore, you don’t focus on it like you would if it was music that makes you want to sing the lyrics or tap your foot in unison with the beat or sway to the rhythm. Rather, you want sounds that you passively hear, not sounds that you actively listen to in order to habituate to your tinnitus. This makes fractal music a good choice. (4)

Perhaps an even better choice is listening to water sounds—waves lapping on the beach, babbling brook sounds, rainfall, waterfall sounds, etc. Not only are these structured broadband sounds, but they are also random sounds so you don’t actively listen to them. Furthermore, they have a big advantage over other sounds in that they are naturally-relaxing sounds to which you automatically habituate. (3)

Yet another emerging sound therapy is called NeuroWAV (also called “Tinnitus Mix”). NeuroWAV uses constantly-changing, truly random sounds like nothing you’ve ever heard before. (4) The NeuroWAV sounds are designed to encourage adaptive plasticity in the auditory pathways in your brain to bring your auditory circuits back into proper balance again and thus reduce/eliminate your tinnitus.

Finally, if you use a white noise generator day and night, there will be likely be long periods where you don’t hear much except your white noise (such as 6 or 8 hours every night. Therefore, using fractal music, water sounds or NeuroWAV sounds not only helps you habituate to your tinnitus, but it also takes away any opportunity for your brain to rewire itself in maladaptive ways. Until this recent research is proven or not, you get the best of both worlds by using the above sounds, rather than constant, unstructured broadband white or pink noise. I call this a win-win situation. (3)

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1  Attarha, Mouna, et. al. 2018. Unintended Consequences of White Noise Therapy for Tinnitus—Otolaryngology’s Cobra Effect. In: JAMA Otolaryngol. Head Neck Surg. 2018;144(10):938-943.

2  Bauman, Neil. 2020. Hypersensitive to Sound? Successfully Deal with Your Hyperacusis, Recruitment & Other Sound Sensitivities. 4^th Ed. Integrity First Publications. Lynden, WA 98264. ISBN: 9781935939238.

3  Bauman, Neil. 2022. Take Control of Your Tinnitus—Here’s How. 8^th Ed. Integrity First Publications. Lynden, WA 98264. ISBN: 9781935939276.

4  Case, David. 2021. NeuroWAV Tinnitus Therapy. Facebook. https://www.facebook.com/groups/195330444712586.

5  Dockrill, Peter. 2018. Listening to White Noise Might Affect Your Brain in a Weird Way, Study Suggests. ScienceAlert. https://www.sciencealert.com/white-noise-doing-something-bad-to-brain-study-suggests-tinnitus-hearing-loss-plasticity-neural.

6  Hyperacusis Focus—Sound Therapy & Counseling. 2018. Hyperacusis Focus. http://hyperacusisfocus.org/research/soundtherapy/.

7  Jastreboff, Pawel, & Jonathan Hazell. 2004. Tinnitus Retraining Therapy—Implementing the Neurophysiological Model. Cambridge University Press. ISBN: 978-0-521-08837-4.

8  Keate, Barry. 2018. White Noise Therapy Worsens Tinnitus. Arches Natural Products, Inc. https://www.tinnitusformula.com/library/white-noise-therapy-worsens-tinnitus/.

9  McKenna, Laurence, et. al. 2010. Living with Tinnitus and Hyperacusis. Sheldon Press. London SW1P 4ST. www.sheldonpress.co.uk.

10  Sheppard, Adam & Richard Salvi. 2019. Auditory Gain in Hyperacusis. In: The Hearing Journal. Vol. 72, No. 2. Feb, 2019.

11  Turn Off the White Noise Immediately…Well Maybe Not!. 2018. American Academy of Audiology. In the News. https://audiology.org/news/turn-white-noise-immediately%E2%80%A6well-maybe-not.