Tinnitus masking:unresolved problems.

With care to provide properly chosen masking sounds, masking can help in 60-80% of clinically significant tinnitus cases. There is no universal masker; instead, an individual evaluation of each patient's tinnitus must be performed in order to match the masking sounds to the patient's audiogram and the spectral characteristics of the tinnitus. Successful long-term masking can usually be achieved in patients for whom (1) hearing impairment is not excessive. (2) the tinnitus frequency, FT, can be reliably located, and (3) the tinnitus can be completely masked by a band of noise at or near FT at a low sensation level. Such patients often experience residual inhibition (temporary suppression of tinnitus upon cessation of masking) which may accumulate with sustained use of masking, in some cases becoming permanent. Long-term masking is difficult or impossible for patients whose hearing is so impaired they cannot hear the masker, or those for whom the masking sounds must be presented at unacceptably loud levels to obtain adequate coverage of the tinnitus. There is a great need for additional work to determine what factors influence the effectiveness of masking, in order to improve our ability to provide appropriate masking stimuli even for the difficult cases.