T-gone is one of the largest tinnitus therapy companies in the world and similarly to Arches Formula, it’s flagship products are multivitamins including zinc, magnesium, ginkgo biloba, vitamin A, B12, C, E and melatonin. However, this is priced at $34 for a 30 day supply. As previously mentioned there is some evidence that these compounds are beneficial for tinnitus reduction, but there are many cheaper multivitamin packages available.

T-gone additionally advertise they their products boost the immune system which has a direct effect on reducing tinnitus severity. However, to the best of the author’s knowledge there is no conclusive scientific evidence to validate this claim.

The company Arches Formula specialise in providing vitamin and mineral supplement pills. They sell 3 different 90-day-supply packs:

1.     Relief Formula: Contains zinc, ginkgo biloba extract and deodorized garlic.

2.     Stress Formula:  contains niacin, riboflavin, folic acid, as well as a number of other compounds advertised as a potent treatment to ‘alleviate the anxiety and frustration due to the effects of stress caused by tinnitus’.

3.     Tinnitus B12 formula: contains high levels of folic acid and Vitamin B12.

The reasoning behind the Relief formula supplements are scientifically sound but they are expensive. Each bottle is priced at $34.95 for 90 pills. In addition, there is no conclusive evidence that ginkgo biloba is an effective therapeutic for tinnitus, and taking it unnecessarily is to be discouraged as it carries side effects (see gingko biloba section).

The Tinnitus B12 formula contains only folic acid and Vitamin B12 but is priced at a staggering $34.95. In addition, each pill contains 1mg of Vitamin B12, which is 10 times the Recommended Daily Allowance (RDA) which does not equate to ten times the therapeutic benefit. 

Arches Formula also promote a stress relief supplement package, which may cause some surprise. Although diet can play an important part in stress management, true stress reduction can only be achieved by support, counseling, and education.

There are many multi-vitamin retailers often providing the same dosage of vitamins and minerals for much lower prices.

Tinnitus masking is perhaps the most common form of tinnitus therapy. A masker produces a sound which is matched to the tinnitus signal, resulting in the suppression of the ringing, buzzing sound.  A tinnitus masker can provide instant relief by substituting the tinnitus sound with one that is less intrusive, helping patients get to sleep or relax when they would otherwise be distracted. 

It is believed that tinnitus masking can lead to long-term changes in the brain, reducing tinnitus intensity and awareness. This process has been termed habituation and is covered in more detail in the Tinnitus Retraining Therapy section.

Development of Tinnitus Maskers

Commercial tinnitus masker devices have been available since the mid-1970s and their development is largely attributed to the work of Dr Jack Vernon, who is one of the founders the American Tinnitus Association and a leading figure in tinnitus research.  Being a physician who suffered with tinnitus, he found that when standing in one location near a water fountain, his tinnitus disappeared. He synthesised the sound of falling water and found it to be an effective masker of tinnitus. Before this breakthrough, researchers had neglected the idea that an external sound could mask an internal sound such as tinnitus.

Since Dr Jack Vernon’s early forays into tinnitus masking technology, today tinnitus maskers range from CDs, MP3s and bedside noise generators to wearable devices, hearing aids, and custom-made electronic devices.

Wearable maskers 

Around 1974, the first white noise generator was added to hearing aids so that tinnitus masking could occur at the same time as external sound amplification for those that were hard of hearing. These are often known as combination devices or wearable sound generators (WSG).

These WSGs are commonly used by tinnitus sufferers who require masking at all times. A study conducted in 2006 found that patients who used WSGs for 18 months showed significant improvement in self-rated tinnitus loudness when compared to patients who did not use hearing aids or WSGs in the same period [[i]].  However, another study reports that only 30% of tinnitus patients found wearable maskers helpful for tinnitus [[ii]]. Not everyone will benefit from this type of masking, but the 35 to 40% who do benefit, appear to show significant improvement [[iii]]. 

It is believed that WSGs are ineffective for most tinnitus sufferers, as they cannot reproduce high frequencies essential for masking tinnitus. Most tinnitus sufferers report their tinnitus tone to be above 6kHz, but the small speakers in the device are physically incapable of producing these frequencies. There is an obvious need for improving the high-frequency output of wearable hearing aid devices to improve effectiveness for tinnitus masking [[iv]].

Other wearable maskers include the devices used in Neuromonics, TRT and Tinnitus Phase-Out. These are explored in separate sections. 

Tinnitus CDs and noise generators

These are often the most cost-effective and immediate way to get the benefits of tinnitus masking without the need for WSG fitting.  They often use one or more sounds described below.

White Noise

White noise is historically the most common sound used for tinnitus masking purposes. White noise is analogous to white light in that it contains all the frequencies of sound in equal proportions.  White noise is a great masker and many people find it a relaxing sound to listen to. It is commonly used by people to block out distracting noise and improve concentration. However, some people do find the presence of the highest frequencies harsh on the ear.

There are other shades of noise which are not as harsh that are becoming increasingly popular amongst tinnitus sufferers.

Pink Noise

Pink noise is considered a more natural masking sound to listen to for extended periods. It is similar to white noise, but the highest frequencies have been filtered out, rendering it effective for masking while being comfortable on the ear.

Brown Noise

A sound with a much lower frequency content than pink and white noise, most effective for masking lower tinnitus sounds such as rumbles and roars rather than pure tone ringing. Brown noise is similar to the distant sound of the sea.

Noise Generators

There are numerous desktop/bedside noise generators on the market. The better ones have a range of noise and nature sounds and can normally be timed to turn off.  But these devices have one main problem in that their often poorly-produced speaker cannot reproduce the highest frequencies. If you cannot match the frequency of high-pitched tinnitus tones due to ineffective high frequency output, efficient masking will not occur. High frequencies have been demonstrated to be necessary for successful tinnitus masking [[v]].

Your personal “hi-fi” will probably have better speakers than a bedside noise generator, and so a tinnitus masker CD may be a more efficient masking solution.  Otherwise, ensure the bedside noise generator can be connected to other playback equipment.

Masking tapes are uncommon today and are inadvisable as the high frequency output of most cassette players is usually about 16kHz, while CD which have sampling rates of 44.1kHZ can reach 20kHz.

Nature Sounds

Most people find the sounds of nature enjoyable and relaxing. The sound of water is particularly popular and well-tolerated. White, pink and brown noise can be thought of as simpler synthetic-sound versions of water as they are similar in frequency characteristics. If you periodically increase and decrease the volume of pure noise, it can sound almost identical to the waves of the sea. 

There are a wide variety of nature sound CDs and some of these will lack the high-frequency content essential for masking high pitched tinnitus. In addition, be aware that some nature sounds contain distracting sounds such as bird calls, which although they can add to the overall ambience, can be more distracting than relaxing, especially when trying to sleep. 

Music, Radios and TVs

All music and speech evokes a subconscious reaction at a time when the nervous system should be in the absence of acoustic stimulation. Therefore, it is advisable that they are not used for tinnitus masking. Some tinnitus sufferers are told that using a radio tuned just-off station is an appropriate masker. However, Professor Martin Lenhardt of the Otolaryngology Department of Virginia Commonwealth University says that:

 ‘while the mistuned radio advice has often been offered to tinnitus sufferers, its general utility and long-term acceptance is low’. [[vi]]

Tinnitus Phasing is novel compared to all of the other audio treatments for tinnitus currently available, utilising the same concept behind noise-cancelling headphones (described later). This concept holds that every sound has an opposing sound which can completely neutralise it. This is known as phasing.

Essentially, if you know the exact amplitude and pitch of someone’s tinnitus, you can create a special phased wave which cancels out the tinnitus sound. Sound cancellation and phasing has been utilised in many devices from special ‘quiet’ headphones for helicopter pilots to effects-pedals for guitarists.

The company Tinnitus Phase-Out has created a device which delivers phase-shifted sounds specific to a sufferer’s tinnitus tone, resulting in tinnitus sound cancellation.  There have been a number of encouraging scientific reports conducted into the Tinnitus Phase-Out device. The creator of the company, Dr Daniel Choy MD designed the first experiment.

Clinical Trials

He found that of 35 patients given a sham tinnitus tone with no phasing three times weekly for 10 minutes at a time, only 24% showed improvement in tinnitus when. However, when those same patients were given phase out treatment for the same length of time, 82% reported an improvement in tinnitus. These improvements are equated as a 6db reduction in tinnitus which approximately equates to a halving in tinnitus volume [[i]]. Similar results have been described in several independent reports:

A study by the Lake Erie College of Osteopathic Medicine demonstrated that 57% of patients had improvement in tinnitus reduction using the phase out device. They also stated that ‘46% of patients reported periods of complete residual inhibition (CRI) averaging two days’. Residual Inhibition is a term for the complete suppression of tinnitus sensation [[ii]].

The Department of Otorhinolaryngology, University of Antwerp, found that after only three sessions of using tinnitus phase out, 21 of 35 patients had a significant improvement in tinnitus loudness and quality of life [[iii]].

Below you will find a link to a free copy of the study.

http://tinnituscare.net/pdf/Antwerp_Study.pdf  

Prior to the use of the device, patients require a psychoacoustic profile to determine the frequency and amplitude of tinnitus and afterwards they require a check-up twice a year to ensure the treatment is working.  A major drawback of this treatment is that it is only for sufferers of predominantly pure tone tinnitus who experience the tinnitus noise as a single pitch. It is unclear what percentage of tinnitus sufferers perceive pure tone tinnitus, although a study in 2003 showed that 75% of tinnitus sufferers can match their tinnitus to a specific frequency or tone [[iv]].

Below is a link to a Youtube video of the device being promoted on British television: http://www.youtube.com/watch?v=LrIO3K6bgDs

The UK company www.tinnituscare.net charges approximately $1550 USD, which includes a $420 three-session consultation and $1130 for the device. You can rent the device instead of purchasing but I am unaware of the concession this offer provides.

In conclusion, the independent evidence that Tinnitus Phase-Out works is quite strong. Its founder Dr Choy is a well-respected scientist and has the support of other high-profile tinnitus experts, including Dr Jack Vernon. However, larger studies are needed to identify the long term therapeutic benefits of Tinnitus Phase-Out when compared to other therapies or placebo alone. It’s also not the cheapest of therapies but is considerably cheaper than Neuromonics and other custom-sound therapy devices. In most respects Tinnitus Phase-Out appears to be an encouraging new form of sound therapy for sufferers of pure tone tinnitus.

Cochlear nerve section is often the last resort for patients with intractable tinnitus who have failed to respond to all other treatments. The cochlear nerve forms one part of the vestibulocochlear (also known as the auditory nerve), and carries sensory information from the ear. 

Cochlear nerve section is sometimes a complication of VS tumor removal.  There are reports that cochlear nerve severance does not result in a reduction in tinnitus symptoms, and actually causes tinnitus in patients who did not previously have the condition [67]. 

However, an earlier study reported that cochlear nerve section resulted in complete relief of tinnitus in 101 out of 150 patients with preoperative tinnitus, although seven patients reported no improvement.

This is, however, an extreme measure to take and must always be considered as a last resort when all other therapies have been exhausted. It requires careful examination to ensure that the tinnitus emanates from the cochlear nerve as opposed to higher auditory centers in the brain, as it may have no beneficial effect while rendering the patient deaf in the process.

The mention of earplugs commonly conjures images of cheap disposable earplugs that are typically bright orange or yellow in color. These tend to make everything sound dull because they attenuate high frequencies at greater levels than lower frequency sounds.  However, there are many alternatives available which can be customised for a specific loud noise activity.  

For example, musicians who need earplugs for rehearsals and concerts, should invest in a pair of earplugs with built-in filters that attenuate external sound evenly across the sound spectrum. These reduce noise levels while preserving sound quality.

Motorcyclists are best suited to elacin-biopact custom moulded earplugs. These earplugs cut sound particularly in the 2-4 KHZ region which is the same as loud wind sounds experienced when riding. This ensures that the loudest frequencies are cut, without overly attenuating other frequencies and so endangering the rider and his awareness of other road users.

If earplugs are used frequently, it may be best to invest in a pair of high quality moulded earplugs. These earplugs are specifically fitted to the shape of the user’s ear canal reducing the chance of loud sounds escaping through air gaps.

It is advisable that you aim for at least 15dB or 25dB reduction. If you are particularly worried about your hearing, 35dB and above may be appropriate, but sound quality is normally reduced with these high attenuating ear plugs.

Cochlear implants are a surgically implanted form of hearing aid which stimulate sensory neuron activity in the surrounding auditory nerves by electrical stimulation.

They are almost exclusively used by patients who are predominantly deaf or severely hard of hearing. A large proportion of these patients with hearing loss also have tinnitus. 

Interestingly, there have been unexpected findings that many tinnitus sufferers who are fitted with cochlear implants report a total or partial suppression of tinnitus [[i]][[ii]].

Clinical Trials

One study conducted into the effects of multi-channel cochlear implantation surgery reported surprising results. Of 22 patients presenting with tinnitus before surgery, seven reported total suppression, and eight reported partial relief. The study also shows that success rates were increased if the tinnitus was experienced in both ears. Interestingly, patients with an implant only in one ear reported that the tinnitus in the opposite ear was reduced after surgery [[iii]].

There are a number of published studies which support the findings described above. However, the exact mechanisms of tinnitus suppression are as yet undetermined.  Some believe that the electrical field produced by the cochlear implant, as well as being able to restore sensation of sound can also regulate abnormal neural activities in the cochlea, which is known to be involved in tinnitus generation.

Cochlear Impanation is only applicable for a small subset of patients with tinnitus but it is hoped that further research into the mechanisms of tinnitus suppression may open up treatment options for more tinnitus sufferers.