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October 2018

Unintended Consequences of White Noise Therapy for Tinnitus—Otolaryngology's Cobra Effect: A Review

Author Affiliations
  • 1Posit Science Corporation, San Francisco, California
  • 2Coleman Memorial Laboratory, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
JAMA Otolaryngol Head Neck Surg. 2018;144(10):938-943. doi:10.1001/jamaoto.2018.1856

Importance  Critical to the success of many medical therapeutics is a consideration of the brain’s miraculous ability to dynamically rewire itself anatomically and neurochemically on the basis of incoming information. We argue that white noise exposure, a commonly recommended therapy for patients with tinnitus, engages these plastic processes in a way that induces maladaptive changes in the brain that degrade neurological health and compromise cognition.

Observations  The pathophysiologic mechanisms commonly associated with hearing loss and tinnitus reflect cortical dedifferentiation and widespread loss of inhibitory tone throughout the central auditory pathway. Importantly, these same changes are also induced by exposure to unstructured noise, even at nontraumatic levels in the adult nervous system. Not by coincidence, the same changes appear in age-related decline of central auditory function, suggesting that both tinnitus and white noise accelerate the aging of the brain.

Conclusions and Relevance  Noise exposure therapies offer a seductive short-term solution for relief but, in the long term, undermine the functional and structural integrity of the central auditory system and the brain more generally. Sound therapies using unstructured, random (“white”) noise should be avoided as a treatment for tinnitus. Alternative therapeutics that drive positive, adaptive plastic changes are discussed.

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