Most people coming to the OHSU Tinnitus Clinic have tinnitus in a severe form. Severe tinnitus is that which greatly disturbs the patient, interrupting or preventing normal sleep, interfering with reading, concentration, work activity, recreational pursuits, etc. Some people have tinnitus that is mild and does not interfere with routine activities. These people may have concerns about whether the tinnitus will get worse or damage their hearing. For these people, it is only necessary to caution them against exposure to loud sounds. Repeated exposures to loud sounds can exacerbate tinnitus and cause hearing loss.

The Tinnitus Clinic has now seen over 7,000 patients with severe tinnitus. Acoustic Therapy is one of the most successful categories of treatments offered at our Clinic. It is the addition or enhancement of external sounds that can reduce the perception of tinnitus. Acoustic Therapy is available in the following forms:

• Cassette tapes - broad band (2kHz-12kHz) or pink noise
• CDs - broad band, pink noise, or natural masking sounds
• Bedside units - patient sets the frequency and volume of background sound; can be used with or without headphones; has a timer which can be set before bedtime
• Sound pillows - small speakers embedded in a comfortable pillow can be plugged into CD, cassette player, or sound machine
• Wearable devices

Wearable Acoustic Therapy devices are available in three different configurations:

• A standard hearing aid amplifies environmental sounds which often reduces the perceived loudness of tinnitus.
• An ear level sound generator can be used for those patients who have tinnitus without significant hearing loss.
• A tinnitus instrument is a combination of a hearing aid and a sound generator. The two components are packaged in a single case but with independent volume controls.

Some patients ask, "Why would I want to replace one sound with another?" This question has several answers:

1. Tinnitus is often a high-pitched, shrill tone that can be extremely annoying. Sound generators produce sounds like rain or the ocean, which are more pleasant to listen to and can muffle the sound of high-pitched tinnitus.
2. Because masking-type sounds are like background noise, they can be ignored more easily than tinnitus sounds.
3. Because masking-type sounds are generated by an external source (unlike tinnitus, which is generated within the patient's brain), patients can more easily adapt to them and ignore them.
4. Sound generators give patients a way of exerting control over their tinnitus, rather than the tinnitus always having control over the patient. Patients can decide when, where, and at what volume to use their sound generators.

The goal of Acoustic Therapy is not necessarily to completely cover or mask the tinnitus sound. In fact, complete masking is not possible for some patients. Wearing sound generators usually gives patients immediate relief from tinnitus. Sound generators can help patients to concentrate, sleep, feel less anxious, and improve the quality of their lives. There is also some evidence to suggest that wearing sound generators for 6 or more hours per day over an extended period of time (6 months to 2 years) will facilitate retraining of the auditory areas of the patient's brain and result in a permanent reduction of tinnitus loudness and severity. This is a major component of Tinnitus Retraining Therapy or "TRT."