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Oversized items scheduled for expedited delivery (Premium or Express) may incur additional shipping and services charges because of their unusual size. The use of masking for tinnitus has been a primary method of treatment of patients with severe tinnitus since 1976. In 1976, a tinnitus clinic was inaugurated at Oregon Health Sciences University which has been in existence to the present time. During the course of history of the tinnitus clinic, most patients who are candidates for the masking program are referred by physicians and have already undergone a medical evaluation. The audiometric workup for the tinnitus patient does not differ greatly from the typical audiologic assessment performed for diagnostic purposes or for hearing aid evaluation. In addition to providing diagnostic information with regards to the type of hearing loss that the patient exhibits, the audiogram also aids in the selection of the appropriate masking device for a particular individual. The audiogram also may restrict the use of masking devices for patients who have severe hearing loss.
In attempting to quantify the patient's tinnitus, an evaluation of pitch, loudness, masking effectiveness, residual inhibition, and an actual trial with masking devices helps determine whether the patient can benefit from a tinnitus masking program.
The final measurement in the clinical evaluation of the tinnitus patient is to determine if the tinnitus can be inhibited by exposure to the masking sound. Once the clinician has completed the tinnitus evaluation, a decision is made as to whether the patient needs a masker, a hearing aid, or a tinnitus instrument.
Maskers are generally suggested for those patients who have normal, or near normal, hearing and do not need amplification.
Hearing aids are recommended for those patients who have a hearing loss and meet certain criteria: (a) the tinnitus does not have any effect on their sleep habits, and (b) they have extended residual inhibition. Over the past several years, of those patients who have merited a trial of masking, 60% have had recommendation for a tinnitus instrument. The final step in the tinnitus masking program is the dispensing of the instruments when indicated. Since 1976 and the inception of the tinnitus masking program, there have been several studies evaluating the efficacy of this approach for patients. From January 1, 1992 through December 31, 1995, 618 new patients were seen at our tinnitus clinic.
All of the information regarding this series of patients was entered into the Tinnitus Data Registry at Oregon Hearing Research Center. Of the 180 patients who were provided with instrument recommendations, exactly 100 patients purchased these devices.
Table IV demonstrates the duration and time of day the patients tend to wear their instruments. The phenomenon of residual inhibition hopefully was thought to indicate those patients who would have most success with masking devices.
One last and important observation with regard to patients who were involved in the tinnitus program is that many of them view their masking devices as a source of comfort, knowing that if they need relief they can find it within the masking device. In conclusion, it appears that reasonable success can be achieved with these new masking devices if care is taken in fitting them.
Presented at the American Neurotology Society Meeting, Scientific Program, Tinnitus Panel, September 28, 1996, Washington, DC. Tinnitus isomasking contours were determined for unmasked tinnitus and for tinnitus partially masked by high-pass noise.
Tinnitus is frequently described as tonal or as a narrowband stimulus (Reed, 1960; Kodama & Kitahara, 1990).
If the pitch of tinnitus is perceptibly changeable, then tinnitus might not even be a narrowband stimulus. If tinnitus were generally a fluctuant, broadband stimulus as the above data suggest, then, even if tinnitus were generated in the cochlea, it could not be masked by a single pure tone. To understand what other perceptual judgment might have been made, consider a prominent model of the masking a single external pure tone. An empirical demonstration enabling the separation of isomasking and isoloudness judgments might be possible if tinnitus were a narrowband stimulus.
Before the onset of the tasks which constitute the focus of this manuscript, the subjects were checked for spontaneous otoacoustic emissions, SOAEs (as in Penner, et al. A computer (IBM 486) controlled a commercially available Tucker Davis Technologies (TDT) System II module (consisting of one digital signal processing board, two channels of digital-to-analog conversion, one antialiasing filter, two programmable attenuators and one headset buffer).
Each subject sat inside a double-walled Industrial Acoustics chamber (IAC model 1201A) which contained both a video display terminal (VDT) and a keyboard. Each experimental session lasted 2 hours , with intermittent rest periods spaced about 20 minutes apart. In the FCDS procedure, the subject chose one of two clearly demarcated (1 sec) temporal intervals. Task 2 was an adjustment task in which the subject adjusted a (1 sec) pure tone at the audiometric frequencies to mask the tinnitus. Task 3 was an adjustment task in which the subject adjusted the level of a pure tone to mask the lowest pitch component (as determined in Task 1) of the partially masked tinnitus. To eliminate the tinnitus in one ear, a broadband white Gaussian noise was adjusted by the subject so that it masked the tinnitus in that ear.
Each subject adjusted the level of the high-pass noise so that only the lowest pitch component of the tinnitus remained audible.
For all subjects, five tonal maskers were presented at 1% frequency intervals centered at the tinnitus frequency presented in Table 1.
Task 4 is analogous to Task 3 except that the signal was an external tone rather than the tinnitus and therefor two psychophysical methods (method of adjustment and twointerval forced-choice) could be employed. For all subjects, five maskers were presented at 1% frequency intervals centered at the tinnitus frequency presented in Table 1. In each case, the tinnitus isomasking contour was obtained using the tinnitus as the signal.
Masking in psychoacoustic experiments means that the perception of an acoustic signal is "swamped" (Moore, 1989) by that of the masker. In an attempt to better delineate the tinnitus, tinnitus isomasking contours were determined when all but a portion of the tinnitus was masked. If tinnitus cannot be masked by swamping, then why might tinnitus "maskers" (Vernon, 1977) nonetheless be used successfully by some patients? This research was supported by a grant from the National Institutes of Health (NIDCD 321RO1 DC00068). This item will be shipped through the Global Shipping Program and includes international tracking. Will usually ship within 1 business day of receiving cleared payment - opens in a new window or tab.
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However, we also recognize the need for people with Tinnitus (ringing ears) to find some relief. Widely recommended by audiologists, the device’s 10 white-noise frequencies (6,000-16,000 kHz) let you choose the sound that best cancels out your tinnitus.
For complete shipping & service charges please call Customer Service at 1-800-321-1484. Over 5,000 patients have been treated in the Tinnitus Clinic at Oregon Health Sciences University since that time. Initially, the patients have (1) a medical examination to rule out any medical problem that may cause or exacerbate their symptoms, (2) a routine audiometric evaluation to determine the type and degree of hearing impairment, and (3) a tinnitus evaluation.
Many patients have seen numerous physicians and continue to seek relief for their tinnitus. The procedure includes pure tone testing, speech testing, tympanometry, and an uncomfortable loudness level measurement. Three different types of devices are used to offer relief for tinnitus patients: (1) tinnitus maskers, (2) tinnitus instruments, and (3) hearing aids. Most measurements of the loudness of tinnitus are based upon the patient's threshold for a particular sound and how much above the threshold one has to make the sound so that it equals the loudness of the patient's tinnitus. Although considerable effort has been made to design maskers whose output does not exceed the level at which sound is potentially dangerous to the ear, the clinician must always be aware that patients with severe to profound hearing loss could lose some of their residual hearing if the masking level is too loud. These measurements can be made with a special tinnitus synthesizer (as in our case), or an audiometer.
After determining pitch and loudness, masking is attempted with wide bands of noise in the same ear as the tinnitus.
Upon removal of the masking noise, patients who exhibit tinnitus inhibition will report complete elimination or reduction of the tinnitus.
This is based on the observation that results obtained with the synthesizer or audiometer do not adequately predict the patient's ability to be masked with ear level instruments. Over the course of the years with the tinnitus clinic, there has been a progressive diminution in those patients who receive maskers alone.
They have also been used for patients who have a sensitivity problem and cannot tolerate loud noise. As is true with hearing aids, tinnitus maskers and tinnitus instruments are dispensed on a trial basis.
A total of 180 patients were given recommendations to be fitted with tinnitus maskers or tinnitus instruments and 83 were provided with masking tapes when they were seen at the clinic.

As would be expected, hearing aids are worn much of the day to improve understanding of conversational speech. Many times patients will report that just having the instrument available when they require it is a relief to them. Thirty-eight percent of patients seen in our clinic did not receive recommendation for any device. In our most recent follow-up, 55% of those patients who were specifically advised to purchase a hearing aid, masker or tinnitus instrument did so. Thirty-six percent noted significant residual inhibition after using a device which was beneficial.
Eighty-two percent of patients who received tinnitus instruments had significant relief of symptoms.
Although the results obtained with the masking devices are not as positive as we had hoped in that only 30% of patients seen in our clinic benefitted from some type of masking instrumentation. The noise was selected so that it masked all but the low frequency components of the tinnitus. Indeed, the broadband nature of tinnitus was demonstrated by permitting subjects to mimic the sensation of tinnitus with a complex sound pattern consisting of the sum of sine waves (Penner, 1993; 1995).
However, tinnitus is often reported to be masked by an intense pure tone of any frequency (Feldmann, 1971).
In this excitation model, masking is thought to be a "swamping" of neural activity elicited by the signal on the neural channels which respond to it (Moore & Glassberg, 1982). If the neural activity due to narrowband tinnitus encompassed a few channels, masking of tinnitus might be easy to distinguish from variation in the tinnitus itself. Subject 1 had sensorineural hearing loss and had been a subject in this laboratory for 16 years, whereas Subjects 2 and 3 had nearly normal audiometric thresholds and were not experienced subjects. 1993), and thresholds were measured at the audiometric frequencies (0.5, 1, 2, 4, 6, 8 kHz) using a two-interval forced-choice (2IFC) adaptive procedure (Levitt, 1971). All stimuli were played at a 40-kHz sampling rate and filtered using a 20-kHz low-pass filter. The stimuli were played in synchrony with a visual display on the computer screen and the subject responded by pressing a key on the keyboard. Briefly though, the procedure used two randomly interleaved forced-choice dependent sequences of trials with different decision rules. For example, the subject might have been instructed to pick the interval with the lower pitch tone, in which case the subject should pick the first interval if the standard seemed lower in pitch than the external tone, or the second if the converse were true. For the first adjustment, the level of the pure tone was set at 90 dB SPL (so that tinnitus was masked).
To restrict the subject to the lowest pitch component in the contralateral ear, white Gaussian noise was high-pass filtered with a cutoff frequency twice the frequency matching the lowest pitch tinnitus component as measured in Task 1.
A simultaneous external tone was then added to the high-pass noise and the subject adjusted the level of that tone until it masked the lowest component of the tinnitus. The level of a pure tone required to mask the signal (whose level and the frequency were those that matched the tinnitus in Task 1) was determined in both a forced-choice and an adjustment task. Audiogram (circles) and tinnitus isomasking contour (triangles) at the audiometric frequencies using the adjustment procedure. For all the subjects, the tinnitus isomasking contours are nearly flat despite the evident tuning for the frequency of the tone said to match the tinnitus in Task 1. Isomasking contours for tinnitus and for pure tones in the presence of broadband contralateral and high-pass ipsilateral noise. Signals and maskers compete with each other in well-recognized ways, as first documented by Wegel and Lane (1924). As seen in Figure 2, tinnitus isomasking contours again fail to exhibit frequency specific masking even when the tinnitus itself is a relatively narrow band stimulus, as it was for Subjects 1 and 2. Burns EM: A comparison of variability among measurements of subjective tinnitus and objective stimuli.
Feldmann, H: Homolateral and contralateral masking of tinnitus by noise-bands and by pure tones. Kodama A, Kitahara M: Clinical and Audiological characteristics of tonal and noise tinnitus. Moore BJ, Glassberg R: Interpreting the role of suppression in psychoacoustical tuning curves. Penner MJ, Bilger RC: Psychophysical observations and the origin of tinnitus, in Mechanisms of Tinnitus (Eds. Wegel RL, Lane CE:The auditory masking of one pure tone by another and the probable relation to the dynamics of the inner ear.
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Import charges previously quoted are subject to change if you increase you maximum bid amount. In the free download above subtle virtual dreaming techniques are used to enhance the feeling of walking toward a large waterfall on a rainy day.
The digital sounds play continuously, without the jarring silences that separate MP3s, to aid concentration at work or promote restful sleep at night. The paper discusses the results of management of new patients followed for one year from January 1, 1992 through December 31, 1995.
This level, which is based upon the patient's own threshold, is referred to as the sensation level. The effectiveness of this noise to mask the tinnitus is determined by first establishing the threshold of the masking stimulus and then increasing the noise until the tinnitus is just masked.
This intriguing phenomenon has been coined "residual inhibition" and is generally measured by presenting the masking signal to the patient for one minute and then, following removal of the noise, observing the duration of tinnitus inhibition. Therefore, the synthesizer is not necessarily a good measure of the masking ability of an ear level instrument. There are a small number of patients who can control their tinnitus through the extension of residual inhibition. Generally, the return rate of tinnitus maskers and tinnitus instruments is greater than that for hearing aids. During the period from 1992 to the present, we have been recommending a new tunable tinnitus masker, or tinnitus instrument, manufactured by the Starkey Corporation. As is noted, over 38% of the patients had no recommendation for either tinnitus instruments, maskers, hearing aids, or masking tapes. Of the 618 patients seen during this four-year period of time, 373 returned their questionnaires.
These masking tapes have proven to be very successful in offering relief to tinnitus patients who find their tinnitus bothersome only part of the time - especially at night.
This table clearly indicates that the tinnitus instrument has been the unit of choice for most of our patients.
The same is true of the tinnitus instrument, which includes both amplification and masking. Considerably more residual inhibition is observed under ear phones than with wearable masking devices because the noise level generated under ear phones (10 dB above tinnitus threshold) is greater than that used for the ear level units.
Table VII demonstrates the number of patients in our group who felt the maskers were helpful when the tinnitus was troublesome.
These patients either had tinnitus of insufficient degree to require masking, could not be masked, or had medical problems which were felt to be contraindicative to the use of a masking device.
Although few felt the instruments effectively inhibited tinnitus all the time (6%), only 12% felt the instruments were totally ineffective (the majority of these used only the hearing aid).
When combining the successful instrument users with those who benefited from masking tapes, the overall success of the program has been good.
As a control, the masking pattern of an external tone in the tinnitus region and in the presence of the high-pass noise was compared with that of the partially masked tinnitus. The inconsistent matches to tinnitus are not indicative of an inability to perceive pitch because subjects whose matches to tinnitus are labile may nonetheless make reliable matches to external tones in the tinnitus region (Burns, 1984; Penner, 1983).
For all the subjects so tested, the sensation of tinnitus was mimicked more accurately with a complex sound pattern than with a single sine wave and the complex spanned an average of 2.94 kHz (Penner, 1995).
The neural activity pattern (Moore & Glassberg, 1982; Zwicker, 1958) evoked by a broadband fluctuant stimulus, such as tinnitus, would produce activity encompassing many neural channels, some sporadically. In these circumstances, the tinnitus "masker" might produce the same overall excitation as the tinnitus in the specific channels corresponding to the tinnitus. In one double staircase, the sequence began with comparison stimuli which were above the tinnitus pitch or loudness and one with the comparison stimuli which were below it. The first interval was marked with a flash of light, and the subject instructed to listen to the standard (an external tone or the tinnitus) during that flash. The rules for adjusting the stimuli in response to the subject's subjective choices are those of Levitt (1971). As in Task 3, a broadband white Gaussian noise in one ear and a high-pass filtered noise in the contralateral ear were presented. The scant variability of the matches to the lowest pitch component of the tinnitus raises the question of whether the tinnitus might be psychophysically equivalent to a low-frequency tone in certain psychophysical tasks.
The reason for this discrepancy is that the tone matching the tinnitus loudness in the FCDS task was quite near threshold and so it was easier for the subjects to perform the task at slightly higher signal levels. The interaction of the masker and the signal is thought to reflect the mechanics of the cochlea.
Because even narrowband tinnitus isomasking contours are not frequency-specific, it is likely that the masking of tinnitus involves perceptual or neural mechanisms of inhibition above the site of the origin of the tinnitus, as Feldmann (1971) has argued.
First, it may be that the maskers obscure the fluctuation in the tinnitus, as Penner (1986) as argued.
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This is why we have offered free tinnitus masking MP3 downloads since the beginning of our site. Of the 373 patients who could be accurately followed and evaluated for this period of time, 180 patients were recommended for tinnitus maskers or tinnitus instruments, and 83 were provided with masking tapes.

Nonetheless, a thorough evaluation, preferably by an otolaryngologist, is an essential first step in evaluating and treating these patients. Although not all agree that this is a useful means for accurately determining the loudness of tinnitus, it has served us well in evaluating the severity of the patient's complaint. This level is termed the "minimum masking level" and again is the difference between the threshold level for the noise and the amount of noise needed to mask the tinnitus. The trial period with wearable instruments adds about a half hour to the evaluation process but has resulted in a more effective method of determining if a masking program should be initiated. Maskers or tinnitus instruments can be in the ear or behind the ear and, more recently, can be individually tuned. These patients, upon removal of the masking stimulus, experience reduced tinnitus and thus may benefit from intermittent use of a masking device. There is very little difference in cost between the tinnitus instrument and the hearing aid and so consequently when there is a possibility the patient may at some time use both the hearing aid and a masker, the tinnitus instrument is recommended.
Therefore, it is doubly important that the initial decision regarding the appropriate instrument be made carefully and thoughtfully.
These devices have allowed clinicians and patients to make changes in the frequency response of the masking signal.
Many patients indicate that their tinnitus is annoying only when they are in quiet environment or when the tinnitus is especially loud.
Not only is the tinnitus instrument more effective in masking the tinnitus, but the masking noise presented is more acceptable as a substitute for the tinnitus than it is for the tinnitus masker. Some patients use only the hearing aid portion of their instrument during the day, but at night when they are in a quieter environment they will use the masking portion. Table VI reveals the number of patients who observe this phenomenon with the various instruments.
Frequency-specific masking was obtained for the external tone but not for the partially masked tinnitus. With the neural activity due to tinnitus changing noticeably over many channels, masking of tinnitus might be hard to distinguish from variation in the tinnitus itself. In all tasks, the final step size for the stimulus level was 2 dB and, for the adjustment tasks, 10 adjustments were made. The second (1 sec) interval was also marked with a flash of light and an external comparison tone was presented.
The data presented are based on 10 reversals per staircase, with at least the preceding 4 reversals discarded. Because low-frequency noise could potentially mask highfrequency tinnitus components, only high-pass noise which did not affect the audibility of the low-frequency tinnitus components was employed.
The standard error of the mean is shown whenever its width exceeded the width of the data point used in the graph. The triangles represent the data for the tinnitus isomasking contour and the squares (adjustment) and circles (forced-choice) represent the data for the isomasking contour of an external tone. It may also be that the maskers provide another perceptual focus for the subject so that concentration on the tinnitus is minimized, as Jastreboff and Hazell (1993) have argued. A longer, higher quality and more extensive version can be found here.Free Virtual ShowerHere is a free 30 minute shower sound.
The results of this study, along with the overall success of the tinnitus program utilizing masking, are discussed. Tinnitus, like hearing loss, is a symptom and any possible medical or surgical treatment for the problem must be excluded prior to any recommendation.
The reference sound might be a pure tone signal for those patients who complain of a ringing sound, a high-frequency band of noise for those who report a hissing-like sound, a low-frequency noise band for patients who hear a roaring sound, or a combination of several sounds.
They produce a tunable band of noise which allows for the highfrequency cutoff to be varied.
In this group of patients, there were either medical contraindications for use of these devices, other medical ailments which could account for the complaint, insufficient symptoms to merit masking, inability to be effectively masked, or inability to pay for a device. These patients do not need expensive wearable maskers but can use these tapes in conjunction with a cassette tape recorder when they are experiencing difficulty. Many of our patients who could not benefit from masking were successfully managed by other treatment modalities. In these circumstances, the tinnitus "masker" might merely produce the same overall excitation as the tinnitus, but not necessarily in specific channels. In other words, it might be possible to better delineate the masking task for the subject if the tinnitus were narrowband or partially masked. By agreement with the University of Maryland's Institutional Review Board, the maximum level of a pure tone was limited to 90 dB SPL. The step size for the stimulus frequency was initially 32 Hz, changing to 2 Hz after 4 reversals. Instead, they are flat when the tinnitus is not restricted to a specific narrow frequency region. In any event, the impact of the data presented in Figure 2 is that even narrowband tinnitus is unlikely to be masked in the cochlea so palliatives for tinnitus are likely to be those that affect retrocochlear events. Some people find it an effective sleep-aid as it eases their tinnitus while others just like the soothing sound.
Since many patients report having several sounds in their ears or localize their tinnitus in the head rather than the ear, our ability to match the pitch of the tinnitus is generally less accurate than for measuring loudness. The new tinnitus maskers (Model TM) are available either in the ear or in the canal with custom configuration and are recommended for patients with normal or near normal hearing. Hearing aids do reduce the level of tinnitus for some patients but do not offer sufficient relief for patients with severe symptoms. It is also interesting to note that some patients report an increase in their tinnitus when the instrument is removed. Thus, tinnitus maskers need not include the frequency region presumed to contain the tinnitus. The attenuated stimuli served as the input to the headset buffer, and were then delivered to an insert phone (Etymotic ER-2). The step size for the stimulus level was initially 8 dB changing to 2 dB after 4 reversals. However, it is unlikely that broadband external stimuli can be masked in the cochlea, raising the possibility that some other psychophysical judgment is inadvertently made at least for broadband tinnitus (Penner & Bilger, 1994). We added plenty of White Noise along with a few audio effects to simulate the environment and aid in sleep onset. A review of the most common medical problems which induce tinnitus has been presented in previous publications. To measure loudness, the best pitch match for the patient (previously determined) is used as the reference signal. The masker is also combined with two hearing aid variations (tinnitus instruments) for those patients who have both hearing loss and a tinnitus problem. Patients who had medical recommendations generally were treated pharmacologically with medications, such as Xanax, Klonopin, Ativan, or Nortriptyline. These patients can generally mask their tinnitus quite effectively when the noise is present, but when they remove the device the noise may appear quite loud for a short period of time before returning to its original level. Because overall excitation is likely to be related to loudness (Zwicker, 1963), the masking contours could represent isoloudness contours with the tinnitus serving as the standard, as Penner and Bilger (1994) have argued. Measured harmonic distortion levels of the computergenerated pure tones were at least 90 below the primary level. This one was squeezed down to 28 megabyte.Oscillating Virtual FanOur virtual fan subtly pans left and right and produces that calming sound that we all know.
If this product ever disappoints you, for any reason, you may return your Hammacher Schlemmer purchase for exchange, credit, or refund.Should you have any questions, we are available 24 hours a day, seven days a week. One model is a masker and linear hearing aid combination (Model TML) and the other is a masker and compression hearing aid combination (Model TMC). The link between "isoloudness contours" and tinnitus "isomasking contours" was further implicated by the close fit of the linear-correction power law describing isoloudness judgments to the tinnitus "isomasking" contours (Penner & Bilger, 1994). The stimuli were all 1 sec in duration with a 10 msec cosine-shaped rise-decay time and the time between intervals in all tasks was 500 msec. But add 500 people talking in the same time and the irritating noise gets lost in a much more pleasant murmur. However, most patients do not wear the masking apparatus more than three to four hours each day. If you or a friend are suffering from ringing ears, or have noise induced insomnia, I hope these recordings help you get some sleep.
Then the sound is increased until the patient indicates that it is equally loud to their tinnitus.
Do you have an idea for natural or nature sounds that can be used for effective noise mask? The difference between the threshold and the loudness level is considered the tinnitus loudness. Clearly, for those who purchase the instrument, the tinnitus masker is an instrument deemed more effective in masking than were hearing aids. Unfortunately, the method that is used for making this measurement is controversial and does not always represent, or correlate to, the magnitude of the patient's complaint. It's obvious that many patients cannot be completely masked or prefer to use the masking noise at a lower level that does not totally mask their tinnitus. I have heard from a number of patrons how relaxing and soothing they thought the sound of a standard household dryer was.
However, if patients can significantly mute their tinnitus to reasonable intensity level, they generally cope with their problem quite well. This white noise is loop-able, slowly fades in and out at the beginning and end, and is 20 minutes long.

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