Using hearing aids to manage tinnitus - What is Tinnitus Notch Therapy?

Koorosh Nejad
6 days ago
8 min read

Updated: 5 days ago

Living with tinnitus (call it T) is like having a background soundtrack that you didn’t ask for — a ringing, buzzing, hissing, sometimes whistling, in both ears every day.

As an audiologist who also has binaural tinnitus, I've walked this path from both sides: as a clinician helping others, and as a patient trying to manage my own symptoms. One of the tools that has helped both myself and many of my clients is the use of hearing aids — not as a cure, but as a powerful aid in reducing tinnitus distress and improving quality of life.

Using Hearing Aids to Manage Tinnitus - HearingNow

My Story: Coming to terms with my tinnitus

I first noticed tinnitus several years ago: a faint ringing, often after being exposed to loud music in a club or event. It wasn't bothersome at all, and often I couldn't hear it, just when I was in a very, very quiet room.

Years later, I experienced severe vertigo for 3-4 days. I noticed that over a week, my tinnitus became louder and more persistent in both ears. The hearing tests showed that I have a mild to moderate cookie-bite sensorineural hearing loss.

Like many, I have moments where the tinnitus feels overwhelming: in quiet moments, at night, during fatigue or stress. I tried several techniques to alleviate my tinnitus, including sound therapy, meditation, yoga, painting, gardening, masking and notch therapy (on my hearing aids). I still take advantage of most of these techniques. I learned that absolute silence makes my tinnitus perceived louder. I keep listening to podcasts, music soundtracks, or nature sounds as a way of sound therapy (see this article on the best Apps for innitus sound management).

What the research tells us

1. Hearing Aids Reduce Tinnitus Severity - A recent study found that hearing aids with tinnitus sound support significantly reduced Tinnitus Functional Index (TFI) scores over 12 weeks, showing large effect sizes (Beukes et al., 2023).

2. Neural Changes with Hearing Aid Use - Positron emission tomography (PET) imaging has shown that after six months of hearing aid use, tinnitus patients had measurable neural changes in emotion- and memory-related regions, along with reduced tinnitus distress (Shin et al., 2021).

3. Amplification vs. Sound Generators - A Cochrane review highlights consistent benefit from amplification alone, with further improvement when combined with masking sounds (Hoare et al., 2014).

4. Emotional Benefits - Patients report improvements in anxiety, concentration, and sleep when using hearing aids (Tinnitus Journal, 2020).

5. Factors Influencing Benefit

Greater high-frequency loss improves benefit (McNeill et al., 2012)
Bilateral fittings are generally more effective than unilateral ones (Tinnitus Journal, 2020)
Consistency and patience are crucial (Beukes et al., 2023)

6. Neuroscience Explanations - Neuroimaging supports the idea that amplification helps normalise aberrant neural hyperactivity. Predictive coding models suggest hearing aids reduce “phantom” signals by restoring auditory input (Sedley, 2022).

Practical tips for managing tinnitus with hearing aids

Here is a list that I keep in mind when fitting a hearing aid for a patient with tinnitus.

Aspect	Practical Advice
Assessment	Obtain a full audiogram, including extended high frequencies. Identify tinnitus pitch/loudness.
Bilateral fitting	Improves balance, spatial, and reduces the perception of tinnitus.
Open vs closed fit	Assess the effect of open versus closed fitting on your tinnitus.
Gain settings	Adequate gain in your T frequency is essential; REM can help too.
Sound support	Use masking programs selectively (e.g. white, pink, babble, HF, Brown,...).
Consistency	Wear daily to maximise neural and psychological adaptation.
Notch therapy	Set up the Notch Therapy if your hearing aids allow
Counseling	Combine aids with stress management, CBT, and mindfulness.

What causes tinnitus?

Tinnitus is not a disease; it is a side effect of another problem. Your tinnitus may be caused by a reaction to a specific medication or a change in the dose of your medication. It can start because of severe stress (e.g. grievance, loss of a family member, divorce, etc). It can also start as a side-effect of other health issues, e.g. diabetes, or a body response to antidepressants, a strong painkiller or a strong antibiotic. For tinnitus not associated with a hearing loss, you might need to consult with your GP on the type and the dose of your medication and the potential side effects of the medication you are on.

When is the best time to start managing my tinnitus?

The tinnitus usually starts at a low volume, then if the cause of it is not resolved, its perception becomes louder over time. In the case of a tonal tinnitus associated with hearing loss, I observed that rarely my patients with a mild hearing loss have tinnitus, but almost half of them report a mild tinnitus when their hearing loss is recorded as mild to moderate. The higher the hearing loss, the higher the tinnitus. The sooner you address your tinnitus, the easier it is to manage.

How do hearing aids help alleviate tinnitus?

When auditory input is reduced due to hearing loss, the brain amplifies “internal noise,” creating tinnitus. Hearing aids restore input, reducing the brain’s gain and perceptual mismatch. Neuroimaging shows changes in auditory and limbic regions after consistent use (Shin et al., 2021).

What is Notch Therapy, and how can it help manage patients' tinnitus?

Tinnitus Notch therapy is a technique introduced by Signia, the manufacturer of Signia and Rexton hearing aids. The technique considers the frequency and the loudness of your tinnitus when tuning the hearing aid for the profile of your hearing loss. According to Signia's in-house research, the Notch Therapy technique has about a 60% success rate in alleviating the perception of tinnitus. See this white-paper on Signia Notch Therapy.

Please see the following resources if you are interested to learn more about Signia tinnitus Notch Therapy:

Notch therapy explained on the Signia website
Notch therapy explained on the HearingNow website
Notch Therapy: A New Approach to Tinnitus Treatment
Signia Notch Therapy: A Novel Approach Clinically Proven to Reduce the Perception of Tonal Tinnitus
Notched Sound Alleviates Tinnitus by Reorganization the Emotional Center

What models of hearing aids can do tinnitus Notch therapy?

Only Signia and Rexton hearing aids are capable of doing Signia Notch Therapy.

How fast does Signia Notch Therapy cure tinnitus?

Signia's research paper suggests that most of the successful cases noticed some degree of reduction in the sound of their tinnitus in about 6 to 12 months.

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I have a pair of Signia hearing aids. Can the Notch therapy be set up on them remotely?

Unfortunately, the Notch Therapy needs the presence of the patient in the clinic for the initial consultation session.

Do I need a regular visit to the audiology clinic to adjust the settings for tinnitus Notch Therapy?

When the notch therapy is set up in your hearing aids, there is no need for follow-ups. However, I do revalidate the setting I did for the notch therapy in the hearing aids of the patient when s/he visits for an annual hearing test in the clinic.

My tinnitus sounds like a buzzing sound. Does tinnitus Notch Therapy work for me?

According to Signia, the tinnitus Notch Therapy has a better chance of success in a case of tonal tinnitus. A tonal tinnitus is often perceived in the form of a high-pitched hissing sound, and it is often associated with a hearing loss. My advice is that if your tinnitus is not tonal, try other techniques to alleviate your tinnitus.

Is tinnitus notch therapy worth switching my hearing aids to Signia or Rexton?

It is hard to answer this question. If you have had your hearing aids for many years and you are in the market to buy new hearing aids, then it becomes a choice to go for Signia or Rexton hearing aids, especially if your tinnitus is tonal and it is loud or annoying. Please remember that according to Signia, the chance of success for the notch therapy to alleviate your tinnitus is around 60%. I would suggest consulting with your audiologist to assess your options.

How do I manage my tinnitus?

I use a mix of tinnitus management techniques that work for me. Here is my fix:

Through my Bluetooth hearing aids, I listen to music and podcasts while commuting to work, travelling, etc. Remember, you need to avoid silence as much as you can. The objective is to focus your mind on something entertaining and educational.
I do yoga and practice mindfulness a few times a week. You may want to try a regular spa, dance classes, etc. Best to attend group yoga or other group activities. Again, the objective is to reconnect to a source of joy and contentment.
At night, I listen to Resound Relief on a home speaker when reading a book, writing an article (I am listening to it right now), ... until I go to bed. If you live with a partner and this is disturbing for them, you can use your hearing aids to stream it through. My favourite sound therapy is the sound of a fire pit in the desert, with cricket noise, which I usually keep on a lower volume overnight. This combination takes my mind to those memories of my childhood when camping with my father. You may want to try some sound which takes you to pleasant memories you had. The objective here is to direct your mind to those parts of your life experience (memories) that you experienced a great time with.
I paint as a means to meditate. Engage with the creative side of your brain. It works for me; I lose track of time; I don't hear my tinnitus when I am painting. It does not cure my tinnitus, but it allows me to recharge my cognitive batteries. You need to find your hobby. Something that you feel so passionate and connected to that helps disconnect from your tinnitus. You may try learning a musical instrument, pottery, gardening, or any other hobby that involves some degree of fun and creativity.
I notice that my tinnitus is quieter at the start of the day and gets louder towards the end, especially when I have a stressful day. Try to slow down the pace of life. Avoid stress. I also cut back on alcohol. Noticed that red wine makes it flare up. Listen to your body, it talks to you.

Please manage your expectations

Hearing aids don’t “cure” tinnitus but can reduce distress.
Improvement often takes 6-12 months.
Quiet environments may still require masking or sound management.
The best approach is to combine several tinnitus management techniques together, i.e hearing aids (and notch therapy if a tonal T), sound therapy, mindfulness, avoiding stress, and optimum rest.

Conclusion

There is no quick fix for your tinnitus, but there is a way to tame it down to a manageable level. It needs determination and some work. You need to plan a holistic approach for managing your tinnitus through a combination of several tinnitus management methods discussed in this article.

Questions?

Please reach out if you have tinnitus and need a consultation. Please book a hearing test to start the investigation, or book a free online consultation if you still have questions.