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Tinnitus is a condition that makes a person hear various noises in one or both ears without an external source.
Stress tinnitus can be triggered by a number of situations.  Anything that makes a person feel pressured or sense a loss of control will cause stress. All things that cause stress may trigger tinnitus or make the condition’s symptoms greater. Sound therapy for the treatment of tinnitus can take many forms; however, all forms of sound therapy are intended to alter the tinnitus perception and reactions for clinical benefit. Managing tinnitus has evolved from a highly specialized skill that few treated to something that hearing care professionals (HCPs) must be prepared to address. Clearly the pervasiveness of tinnitus necessitates a primer for HCPs looking to add tinnitus services to their practices, or for those wanting a refresher. Although there are many forms of tinnitus, the most common form an HCP will encounter is subjective tinnitus. There is strong evidence to suggest that acoustic therapy can help mitigate the effects of subjective tinnitus.2 Acoustic therapy can occur in many forms, such as fitting the patient with appropriate amplification, modifying advanced signal processing features for the purpose of tinnitus treatment, or following a formal tinnitus protocol.
Sound therapy for tinnitus is defined as any use of sound intended to alter the tinnitus perception and reactions for clinical benefit. 2) Partial masking: The addition of an alternative stimulus to reduce the focus of the patient’s subjective tinnitus on both a conscious (psychological level) and unconscious level (central auditory perception). Both employ the use of broadband noise sound generators, hearing instruments, or combination devices. The HCP may also give the patient a volume control to adjust the therapy signal independent from the hearing aid microphones. To set the therapy signal according to the TRT protocol, the HCP needs to look for the mixing point: the point where the noise mixes with the tinnitus—without masking it!
Setting the noiser according to the Tinnitus Activities Treatment (TAT).3-5 TAT is a treatment for the reaction to tinnitus that also uses counseling, sound therapy, and other activities based on Cognitive Behavioral Therapy (CBT). To set the therapy signal according to the TAT protocol, the HCP should also use the ascendant technique and stop when the sound is audible and comfortable for the patient.
If the amplification of the natural environment isn’t sufficiently reducing the patient’s reaction to tinnitus, a designated hearing instrument program in a mixed mode (microphone+noise) can be activated. Acoustic therapy doesn’t always require a noiser signal in the device or following an established tinnitus treatment protocol. When habituation is the treatment goal, a standard recommendation is to avoid silence.6 However, not all patients are candidates for noise therapy. Habituation to tinnitus can take between 12 to 18 months even with appropriate sound therapy. This is why counseling should be an essential part of tinnitus treatment, and is featured prominently in most successful therapy programs such as TRT and TAT. Mental health professionals often specialize in CBT, which is commonly used in treating a patient’s psychological response to tinnitus. Ocean Waves Therapy Signals was introduced in March 2015 as an expanded feature for all Siemens binax products (Figure 2). Recent research in tinnitus therapy signals suggests that, although the long-term effects of modulated sounds have yet to be determined, they can be considered for use on a case-by-case basis. As discussed in this article, sound therapy for the treatment of tinnitus can take many forms; however, all forms of sound therapy are intended to alter the tinnitus perception and reactions for clinical benefit. Gisele Munhoes dos Santos, PhD, MD, is an audiologist and Product and Marketing Manager of Sivantos Solucoes Auditivas Ltda, Sao Paulo, Brazil.
A great article and overview for those of us who have not fully ventured into Tinnitus treatments.

Therefore, when the auditory nerves send a tinnitus signal through the head, the limbic system reacts in a negative manner. Often, periods of prolonged stress will lead to depression or deep anxiety.  Relationship problems, money issues, illness, death of a loved one, or job challenges may lead to stress tinnitus. To add to the problems, many individuals will feel extra stress from the noises in the head.  It is common to have feelings of worry and anxiety about tinnitus. The steadily increasing number of people with tinnitus—now approximately 1 out of every 10 Americans—has helped drive the need for HCPs to add tinnitus treatment to their armamentarium of services provided.
This paper provides a general guide on how the tinnitus therapy options available in modern hearing aids can be utilized for acoustic therapy.
Besides hearing instrument use for tinnitus relief, numerous methods of sound therapy have been used since tinnitus masking was introduced in the 1970s.
Sound therapy is thought to provide relief from tinnitus and reduce the emotional consequences of tinnitus.3-5 Additionally, sound therapy may promote habituation to tinnitus by reducing the contrast between the tinnitus and environmental sound.
Ideally, hearing aids with tinnitus therapy signals should be designed to fit the needs of virtually any established protocol (Figure 1). The following are suggested protocols for programming the therapy signal according to the more established tinnitus programs, as well as fitting suggestions for those not following a specific tinnitus protocol.
The HCP chooses one of the therapy sounds and then adjusts in an ascendant technique by utilizing the Master Gain handle (Figure 1). The majority of tinnitus patients seen by HCPs require a combination treatment for both hearing loss and tinnitus. Typical set up will include one program with amplification alone and another program with the mixed mode.
When treating tinnitus without hearing loss, a noise-only mode without microphone input is appropriate.
As mentioned above, amplification alone is a common treatment for tinnitus patients,2,8 and is often the starting recommendation by the HCP. Acoustic therapy with the hearing instrument alone typically involves making environmental sounds more audible for the patient.
In order to use environmental sounds as a natural masking noise for your patient with hearing loss and tinnitus, you many choose to reduce or eliminate some of the noise reduction features. HCPs can choose alternative trigger points for the directional microphone modes and varying levels of directionality. Modern streaming devices like the Siemens easyTek™ connect to virtually any audio device, wirelessly turning a pair of hearing instruments into a personal headset. Because of this, many patients return to their HCP feeling discouraged, frustrated, and desperate. The patient must understand what tinnitus is in order to overcome or avoid the negative associations that inhibit habituation. An HCP may consider a multi-disciplinary approach to tinnitus treatment where the HCP fits and adjusts the hearing instrument for effective sound therapy and provides only the initial tinnitus counseling. These new modulated therapy signals complement the five static therapy noises which can be chosen from a preset or be customized in up to 20 bands by the HCP. Since the patient’s reaction to the configuration of a particular hearing instrument or sound generating device is subjective, there is no right or wrong combination of features to use when it comes to tinnitus treatment. Hearing aids as an adjunct to counseling: Tinnitus patients who choose amplification do better than those that don’t. MarkeTrak VIII: The prevalence of tinnitus in the United States and the self-reported efficacy of various treatments.
Feeling inadequate we HCPs may be the reason many tinnitus sufferers do not have this treatment suggested.

It also looks at therapy signal alternatives, including the new Ocean Waves Therapy Signals in the Siemens binax devices. Other drivers include more awareness of the condition than ever, which is tied to a consumer thirst for more information. This can be done by first decreasing the Master Gain until the therapy signal is no longer audible to the patient, and then increasing the noise level until the patient says the sound is mixed to tinnitus.
While the goal here is not to achieve total masking or mixing point, it is acceptable to use total masking if the patient prefers it. However, as hearing instruments have become more sophisticated, less circuit noise has meant much “quieter” hearing aids. Consider a multi-channel approach of less noise reduction applied in the lower frequencies where “room noise” is typically present.
A tinnitus wearer may prefer the hearing instrument stay in an omnidirectional mode to amplify more ambient noise when the tinnitus is more intense. Once sound therapy has begun, the mental health professional can provide additional counseling and CBT to further support the emotional well-being of the patient.
It is recommended that the HCP try different combinations of features at various settings to find what’s right for each patient. This begins a cycle of stress in the body that can have an extremely negative affect on mental health. Stress triggers tinnitus, tinnitus causes worries, and more stress follows about the condition. In fact, according to the Better Hearing Institute, one-third of all hearing loss related online searches are related to tinnitus. The amount of noise shaping desired is the primary consideration for these patients, which is often based on the hearing instrument technology level.
Additionally, modern hearing instruments automatically reduce background noise with noise reduction algorithms and directional microphones. In some cases, it may be advantageous to give the patient a second dedicated program where noise reduction is completely eliminated. A quick search in Google Play or the Apple App Store for “Tinnitus,” “Relax,” or “Audio” yield several apps that may help complement your tinnitus therapy program.
The four modulated signals differ primarily in terms of the intensity and frequency of the modulation, or breaking ocean waves. Getting in touch with the inner spirit is a great way to boost the mood and relax the mind.
To prevent the problem, it is important to protect the ears from disruptive noises and to avoid stress. Here, more economic hearing aid models are appropriate, as they often do not feature the sophisticated amplification algorithms necessary for people with hearing loss. Although these advances improve sound quality and comfort for traditional hearing aid wearers, they may be counterproductive for tinnitus patients. As an alternative to the more artificial and static therapy noises, these new signals were designed to provide a positive, soothing, and stress-relieving listening experience ideal for tinnitus patients who prefer a more natural therapy signal. Although stress is not a direct cause of tinnitus, it is a trigger that sets off a cycle that makes symptoms worse.

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