Sound masking for tinnitus: what it is and what it is not

Q: Is this a treatment?

No. Slo is a sound player, not a medical device. The controlled evidence does not show that sound therapy beats a placebo, and a persistent or one-sided ringing belongs with a doctor.

Atmospheric night scene illustrating Sound masking for tinnitus: what it is and what it is not

Sound masking means playing a steady background sound, such as rain or a fan, at a low level while a room is quiet. People with tinnitus use it so the ringing has something else to sit against. Masking describes what a listener does. It does not describe a result, and this page will not pretend otherwise.

See a doctor first

Start with a doctor, not an app. The US National Institute on Deafness and Other Communication Disorders advises seeing a primary care doctor first, who can check for earwax or an infection blocking the ear canal. Ringing in one ear only, ringing that pulses along with your heartbeat or any sudden change in your hearing needs a proper assessment. Ask for a hearing test with an audiologist or an ENT doctor. Slo does not diagnose or treat anything.

What the evidence stops short of

The most recent Cochrane review of sound therapy for tinnitus pooled 8 trials covering 590 people. Its authors concluded that there is “no evidence to support the superiority of sound therapy for tinnitus over waiting list control, placebo or education/information with no device”, and they graded the evidence low quality. The trials tested hearing aids and dedicated sound generators rather than phone apps, so the review neither backs an app nor rules one out. Nothing in it lets anyone promise you a result.

Clinical guidance goes only a little further. The 2014 tinnitus guideline of the American Academy of Otolaryngology-Head and Neck Surgery Foundation says clinicians may offer sound therapy when tinnitus has lasted six months or longer and bothers the patient. “May offer” is an option, not a recommendation. The same guideline gives cognitive behavioural therapy a stronger one, so if the ringing is wearing you down, ask an audiologist about CBT before you spend money on sound.

What people actually do with it

The NIDCD describes tabletop and smartphone sound generators as an aid for relaxation or sleep, playing sounds such as waves, waterfalls, rain or a summer night. It notes that plenty of people simply switch on a radio or a household fan. That description matches what Slo is: a player with a volume slider, a timer and a mixer for layering. It is not a medical device and it has no tinnitus frequency matching.

Two habits are worth keeping whatever you play. Use the quietest level that still gives the room something audible, because a loud masking sound only swaps one thing you cannot ignore for another. Keep alarms, doorbells and speech audible.

Questions people ask

What does a masking sound actually do?

It gives your ears something audible other than the ringing. That is a statement about a quiet room, not a claim about your hearing.

Which sound should I start with?

Rain and brown noise are the usual first choices because they hold fairly steady and contain no speech. Try brown noise and white noise on the same evening and keep whichever you stop noticing sooner.

How loud should it be?

Quiet enough that you could hold a conversation over it. Turn it down if your ears feel tired.

Is this a treatment?

No. Slo does not diagnose or treat tinnitus, and the controlled evidence does not show that sound therapy beats a placebo. Take a persistent or one-sided ringing to a doctor.

Sources

Cochrane review of sound therapy for tinnitus, Sereda and colleagues 2018: CD013094
Tinnitus page at the US National Institute on Deafness and Other Communication Disorders
Clinical practice guideline on tinnitus, Tunkel and colleagues 2014: PubMed record

Explore more sounds in Slo

Stack two or three sounds, keep the blend, and let the timer stop it. Slo, on iOS, Android and Mac.

Filip Kowalski is the developer of Slo and writes about sound, sleep, and focus.