Treatment with white or pink noise in tinnitus may delay habituation to reaction

Tinnitus, a condition characterized by the perception of sound in the absence of external stimuli, can have various psychological and emotional repercussions, making its management particularly challenging.

Two common approaches for alleviating tinnitus symptoms are sound therapy and Tinnitus Retraining Therapy (TRT) (Reddy et al., 2018; (Jastreboff & Jastreboff, 2001). The application of white and pink noise within these therapies serves an essential role, either in masking the tinnitus or facilitating habituation, which is the process of diminished perception of tinnitus over time.

Sound therapy, which includes the use of white and pink noise, aims to reduce the contrast between tinnitus sounds and background noise, making the tinnitus less noticeable. For instance, white noise is often used for this purpose as it provides a consistent masking sound, which can help distract from tinnitus, thereby reducing patients' overall perception of their condition (Reddy et al., 2018; Formby & Scherer, 2013).

However, the use of pink noise, which has a lower pitch and can be perceived as smoother than white noise, may enhance relaxation and improve emotional responses associated with tinnitus (Mondelli et al., 2020)Lai et al., 2021). The calming effects of pink noise can aid in reducing anxiety and promoting a more favorable environment for habituation (Mondelli et al., 2020).

The efficacy of TRT in promoting habituation is underscored by its foundational principles, which suggest that habituation involves both a decrease in the perception of tinnitus and the emotional response to it (Jastreboff & Jastreboff, 2001)Jastreboff & Jastreboff, 2006). Moreover, TRT aims to create long-lasting changes in the central auditory processing of tinnitus (Jastreboff & Jastreboff, 2001).

The incorporation of sound generators that allow for the patient’s preference in noise type may also facilitate this habituation process, as personalized soundscapes can improve treatment engagement and effectiveness (Barozzi et al., 2017).

Conversely, while employing sound therapy can mitigate the immediacy of tinnitus perception, reliance on consistent external noise might potentially delay the natural habituation process if patients become overly dependent on these sound sources (Mekki et al., 2024; Croft et al., 2013).

It is also essential to consider the potential drawbacks of using sound therapy for individuals with chronic tinnitus. Some studies suggest that patients who engage in passive avoidance of silence may struggle to achieve adequate habituation, indicating that continuous masking can create a psychological reliance that impedes natural coping mechanisms (Falkenberg & Wie, 2012; Meijers et al., 2020).

Thus, while white and pink noise can serve important roles in managing tinnitus, their application must be balanced carefully to avoid delaying habituation, especially for patients who might become reliant on the masking sounds during their treatment journey (Baguley et al., 2013; Wang et al., 2021).

In summary, the use of white and pink noise in tinnitus management underscores a nuanced approach to treatment wherein habituation, emotional response, and patient autonomy play critical roles. Continued research appears necessary to delineate the most effective protocols that leverage sound therapy without inadvertently delaying habituation in tinnitus patients.

References:

Baguley, D., McFerran, D., & Hall, D. (2013). Tinnitus. The Lancet, 382(9904), 1600-1607. https://doi.org/10.1016/s0140-6736(13)60142-7

Barozzi, S., Ambrosetti, U., Callaway, S., Behrens, T., Passoni, S., & Bo, L. (2017). Effects of tinnitus retraining therapy with different colours of sound. The International Tinnitus Journal, 21(2). https://doi.org/10.5935/0946-5448.20170026

Croft, C., Brown, R., Thorsteinsson, E., & Noble, W. (2013). Is tinnitus acceptance the same as tinnitus habituation?. The International Tinnitus Journal, 18(2). https://doi.org/10.5935/0946-5448.20130018

Falkenberg, E. and Wie, O. (2012). Anxiety and depression in tinnitus patients: 5-year follow-up assessment after completion of habituation therapy. International Journal of Otolaryngology, 2012, 1-7. https://doi.org/10.1155/2012/375460

Formby, C. and Scherer, R. (2013). Rationale for the tinnitus retraining therapy trial. Noise and Health, 15(63), 134. https://doi.org/10.4103/1463-1741.110299

Jastreboff, P. and Jastreboff, M. (2001). Tinnitus retraining therapy. Seminars in Hearing, 22(01), 051-064. https://doi.org/10.1055/s-2001-13020

Jastreboff, P. and Jastreboff, M. (2006). Tinnitus retraining therapy: a different view on tinnitus. Orl, 68(1), 23-30. https://doi.org/10.1159/000090487

Lai, H., Wang, G., Gao, M., Zhou, Y., Wu, S., & Wang, J. (2021). A new product development and effect analysis of tinnitus therapy based on pink noise tone.. https://doi.org/10.21203/rs.3.rs-146522/v1

Meijers, S., Lieftink, A., Stegeman, I., & Smit, A. (2020). Coping in chronic tinnitus patients. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.570989

Mekki, S., Sehlo, M., Youssef, U., Ibraheem, O., & Ghazaly, M. (2024). The effectiveness of cognitive behavioral therapy versus notched sound therapy in adults with chronic subjective tinnitus and normal hearing. International Archives of Otorhinolaryngology, 28(04), e634-e642. https://doi.org/10.1055/s-0044-1788000

Mondelli, M., Cabreira, A., Matos, I., Ferreira, M., & Rocha, A. (2020). Sound generator: analysis of the effectiveness of noise in the habituation of tinnitus. International Archives of Otorhinolaryngology, 25(02), e205-e212. https://doi.org/10.1055/s-0040-1713377

Reddy, K., Chaitanya, V., & Babu, G. (2018). Efficacy of tinnitus retraining therapy, a modish management of tinnitus: our experience. Indian Journal of Otolaryngology and Head & Neck Surgery, 71(1), 95-98. https://doi.org/10.1007/s12070-018-1392-6

Wang, J., Ding, J., Song, J., Hu, L., Cong, N., & Han, Z. (2021). A prospective study of the effect of tinnitus sound matching degree on the efficacy of customized sound therapy in patients with chronic tinnitus. Orl, 84(3), 229-237. https://doi.org/10.1159/000517631