Tinnitus sound therapy, or sound masking, is the practice of using various types of background noise to cover some of the volume of your tinnitus and reduce its perceived intensity.
When used correctly, sound masking can not only help you to raise quality of life and better cope with your tinnitus in the short term, but it can also help you to habituate and find lasting relief as well.
In fact, with certain tinnitus habituation strategies such as Tinnitus Retraining Therapy, sound therapy is used as the primary method of facilitating habituation.
But even when you aren’t using sound therapy strictly to habituate (here at Rewiring Tinnitus, I teach a meditation-based approach to habituation), it’s still a powerful coping tool. And if you learn to use it effectively, it can make a meaningful difference in your quality of life, especially early on.
To get the best possible results with sound masking, you just need to follow a few simple rules and best practices.
What type of sounds should be used for sound therapy?
Technically speaking, any background noise that either covers some of the volume of your tinnitus or distracts you from the sound in some way can be considered masking.
Music, broadband sounds like white noise, podcasts, radio, audiobooks, and nature sounds can all be effective, depending on the situation.
But let’s put radio, podcasts, audiobooks, and other content-based audio distractions aside, and focus on continuous background noise options that will cover the volume of your tinnitus in a consistent and non-intrusive way: nature sounds and broadband sounds.
For the vast majority of sufferers, nature sounds and broadband sounds are the best options for tinnitus sound therapy as they generally will not distract you from your daily tasks or hinder productivity.
How to find the best tinnitus masking sounds:
First things first, you are not going to find the best masking sounds by purchasing a nature sound therapy machine or white noise machine. They can be helpful, but there are MUCH better options.
In my opinion, your smartphone is the best device for sound therapy, as there are countless sound therapy apps (as well as apps that allow individual creators to share their unique sound therapy sounds such as Spotify and YouTube) with a much higher quality selection to choose from.
Plus, if your masking sounds are on your phone, you’ll always have them with you should the need arise.
There are many excellent apps available for both Android and iOS. If you search for “Nature Sounds” or “Sound Therapy” in the app store on your phone or tablet, you will find thousands of results.
I always recommend downloading at least several different apps to try out. To get you started, here are a few of my favorites.
My two favorite sound therapy apps:
Naturespace (iOS link) (Android link – may not work with the latest version of Android): Naturespace is my all time favorite sound therapy app. It comes with 6 free sounds that are decent, but there are more than 150 other soundscapes can be previewed and purchased a la carte or in packages. (It’s a $30 one-time payment to unlock everything). Naturespace offers the most immersive and realistic nature soundscapes I’ve ever found, especially when you listen with high quality headphones. For iOS users, there is an option to mix the nature sounds with other apps, so you can have your nature sounds playing over an audiobook, podcast, or any other type of sound, and there is an equalizer setting that increases the audio quality on inexpensive earbud headphones.
myNoise (iOS link) (Android link) (Web App): Of all the sound therapy apps I’ve tried, myNoise offers the most customizable nature sounds. For each soundscape, you get a series of sliders that allow you to change the volume of individual elements within the soundscape.
My two favorite Youtube channels for tinnitus sound therapy (All Free):
The Silent Watcher: The Silent Watcher is hands down my favorite YouTube channel for extremely high-quality nature sound videos. The channel is run by nature photographer and videographer Petar Paunchev and features dozens of incredible soundscapes and videos to choose from, all meticulously recorded in beautiful natural locations all over the world.
Dalesnale – Noise Ambient: Dale has put together the best free broadband sounds and electronic sounds that I have found to date. He goes way beyond white, or any other color of broadband sound, and offers a wide variety of different frequencies and types of broadband sounds.
Finding the right sounds for your tinnitus:
In my opinion, there is no “best” sound therapy option for tinnitus, broadly speaking. The type of sound that works best for each individual person is going to depend on what their tinnitus sounds like and whether they are experiencing sound sensitivity or sound reactivity as well. The most effective masking sounds are always going to be the ones you like the most and are actually willing to use day to day.
You want to browse and listen to as many different sounds as you can, across many different apps, with the goal of finding at least 3-5 different sounds that are both comfortable to listen to for extended periods of time and blend nicely with the sound of your tinnitus.
It sounds simple, but for some tinnitus sufferers, it can be challenging and time consuming to find the sounds that work best. But this is the best strategy in my experience.
Even if you struggle with severe hyperacusis and are very sensitive to sounds, or if you feel that masking doesn’t work for you for any other reason, it’s very likely that you just haven’t found the right sounds yet. But that doesn’t mean they don’t exist. You just need to keep trying new sounds (or even combinations of sounds), until you find options that actually provide relief.
Once you find 3-5 sounds that work well for you, keep them on rotation. If one of them ever isn’t working well, for any reason, switch to one of the others.
Masking volume levels are very important:
When using sound masking, you need to make sure that you set the volume to a level where you can still hear your tinnitus. You never want to drown out the sound of your tinnitus entirely because it can cause a temporary increase in volume when you turn off the background noise. This is known as a rebound spike.
You also want to make sure to always use safe volume levels. Never listen to any sound at a volume level that can cause hearing damage, especially when listening for a long period of time. When in doubt, a good rule of thumb for headphones is keep your phone set at 60% volume or less.
As long as you can still hear your tinnitus a little bit through the masking sounds, and you are using safe volume levels, you can use sound therapy all day and night without any negative consequences.
Many people are worried that if they use sound masking all the time, it will become a crutch that they cannot live without. In my experience, this is simply not the case. Masking used properly will help you to habituate more quickly, and so the more you use it early on, the quicker you will get to the point where you don’t need it at all.
Ways to listen to masking:
Once you find a handful of sounds that work well for your tinnitus, there are a variety of ways to listen to the sounds as you go about your day. Each option has pros and cons.
First, it’s important to understand that sound quality matters in a way that is not obvious at all, even for broadband sounds like white noise.
A small portable white noise machine that plays a looping recording of white noise through an inexpensive speaker is not going to be anywhere near as therapeutic as algorithmically generated white noise played out of a high-fidelity sound system. This is especially true for nature sounds.
So while your smartphone speaker may be helpful in a pinch, you can get much better results by playing your masking through an external listening device like a Bluetooth speaker, headphones, or hearing aids.
A portable Bluetooth speaker of even mediocre quality paired with the right sound masking app is superior to just about every sound therapy machine on the market.
You can easily carry it from room to room and the sound quality is going to be excellent. You can also take it with you when you travel. The only downside to using a speaker is that everyone around you will hear it as well, so it’s not always ideal for every situation.
In my work as a tinnitus coach, I always recommend that my clients purchase a Bluetooth speaker to have as an option for masking. You can find a decent one for as little as $20-30, and a phenomenal one for around $100-150.
Headphones can work well for masking too, and you have a variety of options to choose from. Generally speaking, headphones are safe to use as long as you are listening at safe volume levels. In my experience, most tinnitus sufferers have no issues using headphones.
Though some patients do find that headphones aggravate their tinnitus for one reason or another. If you fall into this category, it’s best to avoid them for the time being.
Over-the-ear headphones are generally safer than earbuds, but earbud headphones can work well too. Noise cancelling headphones are always a great option as well because it allows you to hear your masking sounds clearly at lower volume levels, even in noisy environments.
Some headphones, such as the Apple AirPod Pro headphones, offer a transparency mode where you can hear your masking and the sound of your environment at the same time.
Alternative headphones: Bone conduction, open Ear, invisible Earbuds
Another interesting and effective headphone option worth mentioning here are bone conduction headphones, which don’t go into or over your ears at all. Instead, small vibrational transducer pads sit on your cheek bones next to your ears and transmit the sound as vibration straight to the inner ear.
The benefit here is that nothing is covering your ears so you can maintain complete situational awareness. You can be in a meeting at work listening to nature sounds, or at the dinner table with your family, and still hear what everyone is saying perfectly clearly.
There are many inexpensive options available on Amazon if you want to experiment with bone conduction headphones, but Shokz is currently the gold standard company when it comes to high quality bone conduction headphones. (Check out my previous review of Shokz bone conduction headphones.)
Open Ear headphones can be a great option for masking as well. Open ear headphones play sounds directionally into the ear but without blocking external sounds, and generally offer better sound quality than bone conduction, while still allowing for full situational awareness of environmental sounds.
One final headphone type worth mentioning are invisible earbuds, which are essentially just very tiny wireless Bluetooth earbud headphones that can be worn very discreetly. The sound quality tends to suffer the smaller you get with earbuds, but I’ve seen these earbuds work well for tinnitus sound therapy.
Hearing aids with tinnitus masking features:
Hearing aids are an excellent option for tinnitus sound therapy, especially if you have hearing loss, but even if you don’t. Much like bone conduction, with hearing aids, you can hear your masking sounds, and everything else at the same time, allowing for discreet all-day masking.
Some hearing aids offer preloaded tinnitus masking sounds, but most modern hearing aids are Bluetooth enabled and can function essentially like wireless headphones to play your masking sounds. In my opinion, Bluetooth enabled hearing aids are always the best option because you can connect them to any sound therapy app on your phone.
If you are interested in trying hearing aid tinnitus maskers, I recommend making an appointment with your local audiologist, or scheduling a telehealth appointment with Treble Health (for patients in the US).
I recently partnered with Treble Health to provide telehealth audiology services and hearing aid/tinnitus masker fittings for the Rewiring Tinnitus community! The audiologists at Treble Health can fit you for hearing aids, program them for you remotely, and set up your tinnitus maskers, all via telehealth from the comfort of your home.
Click here to schedule a hearing aid consultation with Treble Health. (Only available for patients in the US)
I truly believe that sound therapy should be an important part of every tinnitus sufferer’s toolkit. Even if you have severe hearing loss, you may be able to benefit from sound masking via hearing aids.
The lowest effort coping tool is always the easiest to implement when tinnitus is negatively affecting your quality of life. And sound therapy can easily be combined with other coping tools and strategies, which can synergistically increase the benefit.
Once you find the most effective sounds and listening devices for your unique tinnitus sound and situation, and you listen at a safe volume level where you can still hear your tinnitus, there is really is no real downside to using masking as much as possible whenever the need arises. I hope you find these suggestions and strategies helpful!