Tinnitus and sound masking: what the evidence actually supports
Masking is one of the most commonly recommended tinnitus self-help measures. The main Cochrane review found no trial data showing it beats placebo — and the therapy with the strongest evidence is rarely mentioned.
General information, not medical advice. Keep the volume low to protect your hearing, and talk to a doctor or audiologist about tinnitus or any hearing concern.
If your ears ring, the internet has a suggestion ready: play something. White noise, rain, a fan, a dedicated tinnitus app. It is the most common self-help advice there is, and audiology clinics do offer sound-based options as part of care. So it comes as a surprise that when Cochrane reviewers went looking for proof that sound therapy works, they could not find it.
That does not mean you should stop. It means the honest picture is more nuanced than either the apps or the sceptics let on — and there is one section of this article that matters more than all the rest, which is the one about when to see a doctor instead.
Sound masking is widely used, has no reported harms at comfortable volumes, and many people find it helpful — but the best available evidence has not shown it outperforms placebo or simple education. The therapy with the strongest evidence for tinnitus distress is cognitive behavioural therapy, not sound. And some patterns of tinnitus — sudden, one-sided, or pulsing in time with your heartbeat — are reasons to see a doctor promptly rather than reach for an app.
What tinnitus actually is
Tinnitus is the perception of sound with no external source — ringing, hissing, buzzing, whooshing. It is a symptom rather than a disease, and it is common. Reviews put it at roughly 10% to 15% of adults, with some estimates as high as 21%, depending on how the question is asked.12 For most people it is a background nuisance. For about one in five of those affected, it negatively affects quality of life — for example sleep and concentration.12
The crucial thing to understand is that two people with similar tinnitus can experience it very differently. That is part of why the treatment with the best evidence is a talking therapy.
Why sound masking is the obvious idea
The logic is intuitive and basically sound. Many people find tinnitus most noticeable in quiet surroundings, where there is little else to hear. Add gentle background sound and you reduce the contrast — the ringing no longer stands alone against a silent field. This is the same masking principle behind the colors of noise, and it is why a silent bedroom at night can be so hard for a person with tinnitus.
In tinnitus retraining therapy, clinicians set sound at the mixing point: the level where it just begins to blend with the tinnitus without masking it. (One trial comparing this with complete masking found similar results.) Complete masking — drowning it out entirely — requires more volume, and volume is the one thing to be careful with when hearing is already involved.
What the evidence actually shows
Here is where honesty is required. A Cochrane review of sound therapy for tinnitus, covering hearing aids, ear-level sound generators and combination devices, identified eight trials with 590 participants. Its conclusion was blunt: there is no evidence to support the superiority of sound therapy over a waiting list, placebo, or education and information with no device at all.1
Nor could the reviewers say one device beat another. Hearing aids, sound generators and combination devices produced little or no difference between them, and the certainty of the evidence, assessed with GRADE, was rated low.13 Low certainty means the true effect could turn out to be quite different from what these trials suggest.
Sound therapy has not been shown to outperform placebo or plain education for tinnitus, and no device type has been shown to beat another. This is not proof that it fails — the trials are few and small and made little or no use of blinding, but it is a long way from the confidence with which it is marketed.
Notice what that conclusion does not say. It does not say sound therapy is useless, and it does not say people who find it helpful are imagining things. The trials made little or no use of blinding, and because tinnitus is subjective, a placebo response is likely, which makes genuine relief hard to attribute. The reviewers themselves called for future trials with rigorous randomisation and blinding for exactly this reason.1
Clinical guidelines reflect that uncertainty rather than ignoring it. They stop short of strongly recommending sound therapy and explicitly allow patient preference to guide the choice (the US otolaryngology guideline, updated in October 2026, still lists sound enrichment only as an option) — while recommending a hearing aid evaluation for anyone with hearing difficulties and persistent, bothersome tinnitus, since treating the hearing loss itself has a clearer rationale.14
The thing with better evidence
If sound is the famous answer, this is the effective one. A separate Cochrane review of cognitive behavioural therapy for tinnitus pooled 28 studies and 2,733 participants and found low-to-moderate-certainty evidence that CBT reduces the negative impact tinnitus has on quality of life, with few or no adverse effects.2
The evidence is not uniformly glowing. Compared with standard audiological care, CBT may slightly reduce depression but showed little or no difference in anxiety or general quality of life, all at low certainty.2 Still, it is a substantially larger and more consistent body of evidence than sound therapy has, and it targets the thing that makes tinnitus unbearable: not the sound, but your relationship to it.
This is worth saying plainly, because the internet has it backwards. The most-promoted intervention is the one with the weaker evidence, and the one that actually helps people cope is rarely mentioned in a list of “best tinnitus sounds.”
The myth: the right frequency or masking track can cure, reverse or “retrain away” tinnitus.
The evidence: no sound has been shown to eliminate tinnitus. Masking changes how much you notice it while it plays. Anything sold as a cure — particularly a specific “tinnitus frequency” — is making a claim the research does not support.
When to see a doctor instead
This is the most important section on the page, and the one an app will never show you. Most tinnitus is benign. Some is not, and certain patterns warrant prompt medical assessment rather than a masking playlist:
- Sudden onset, especially alongside sudden hearing loss — this can be a medical urgency where early treatment matters.
- Tinnitus in one ear only, or clearly worse in one ear.
- Pulsatile tinnitus — a whooshing or thumping in time with your heartbeat.
- Tinnitus with dizziness, vertigo, facial weakness or other neurological symptoms.
- Tinnitus alongside noticeable hearing loss, which may warrant a hearing assessment and possibly hearing aids.
- Tinnitus that is causing significant distress, hopelessness or sleep collapse. That deserves real support, and effective help exists.
This article is general information, not medical advice, and nothing here diagnoses or treats anything. Sound masking is a comfort measure. If tinnitus is new, one-sided, pulsing with your heartbeat, or affecting your wellbeing, please see a doctor or audiologist — and never use background sound as a reason to delay getting assessed.
How to use sound sensibly
If a doctor or audiologist has assessed you and you want some relief in the meantime, these are the usual practical suggestions; follow your clinician’s advice where it differs.
Aim to blend, not to bury. Set the level just where your tinnitus softens into the background. Chasing complete silence means pushing the volume up, which is the opposite of what ears with tinnitus need.
Keep it quiet. If you have to raise your voice over it, it is too loud. Prolonged exposure to loud sound can damage hearing, and hearing loss is a common companion of tinnitus — so keep masking quiet.
Find the level where your tinnitus blends rather than disappears. That point is much quieter than most people expect, and it is the setting clinicians describe as the mixing point.
Prioritise the night. Many people find gentle sound at night comforting, and it costs nothing to try.
Choose softer, lower textures. Some people prefer rain, waves or the warmer end of the noise spectrum to bright hiss. Preference is legitimate here. Since no type of sound device has been shown to beat another, and sound textures have not been compared, the one you find least irritating is a perfectly rational choice. Our Sound Studio lets you compare textures directly, and nature sounds covers the evidence on natural audio.
Do not chase “tinnitus frequencies.” Products claiming a specific healing tone for tinnitus have no more support than Solfeggio claims: there is no evidence that a particular pitch resolves tinnitus.
The most useful thing the evidence offers is permission to stop searching for the right sound. There isn’t one. What helps most is changing how much room the sound is given — and that is a different project entirely.
Frequently asked questions
No. No sound has been shown to cure or eliminate tinnitus. Masking can make it less noticeable while it plays, which many people find a real relief, but the underlying tinnitus remains. A Cochrane review found no evidence that sound therapy outperforms placebo or education alone.
There is no evidence-based best. The Cochrane review found insufficient evidence that any device type beats another, and it did not compare sound textures, so the sensible choice is whichever texture you find least irritating at a low volume. Some people prefer rain or waves to bright broadband hiss.
Many people find gentle sound at night helpful, because silence makes tinnitus more prominent. Keep the volume low and comfortable. If tinnitus is severely disrupting your sleep, speak to a doctor or audiologist, as effective support exists.
On current evidence, cognitive behavioural therapy has the strongest support: a Cochrane review of 28 studies and 2,733 participants found it reduces the negative impact of tinnitus on quality of life, with few or no adverse effects. A hearing aid evaluation is recommended for people with hearing difficulties and persistent, bothersome tinnitus.
Seek prompt medical assessment if tinnitus is sudden, in one ear only, pulsing in time with your heartbeat, or accompanied by hearing loss, dizziness or neurological symptoms. Also seek help if it is causing significant distress or destroying your sleep.
Sources
- Sereda, M., Xia, J., El Refaie, A., Hall, D. A. & Hoare, D. J. (2018). Sound therapy (using amplification devices and/or sound generators) for tinnitus. Cochrane Database of Systematic Reviews, 12, CD013094. (Eight trials, 590 participants; no evidence of superiority over waiting list, placebo or education with no device; low-certainty evidence; no device type superior to another.) cochranelibrary.com
- Fuller, T., Cima, R., Langguth, B., Mazurek, B., Vlaeyen, J. W. S. & Hoare, D. J. (2020). Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews, 1, CD012614. (28 studies, 2,733 participants; low-to-moderate-certainty evidence that CBT reduces the negative impact of tinnitus on quality of life, with few or no adverse effects.) cochranelibrary.com
- Cochrane plain-language summary — sound therapy using amplification devices or sound generators for tinnitus (GRADE assessment and clinical interpretation). cochrane.org
- Adams, M. E., Cramer, J. D., Tunkel, D. E., et al. (2026). Clinical practice guideline: tinnitus update. Otolaryngology–Head and Neck Surgery, 175(S1). (American Academy of Otolaryngology–Head and Neck Surgery Foundation, October 2026: sound enrichment is an option; CBT and a hearing aid evaluation for people with hearing difficulties are recommendations.) doi.org