Effect of Binaural Beat and Tailor-Made Notched Music Training on Reducing the Loudness and Annoyance of Chronic Tinnitus: A Controlled Trial Study
Abstract
Background and aim: Tinnitus is a persistent perception of sound without an external source and is often accompanied by emotional distress. Tailor-Made Notched Music Therapy (TMNMT) and Binaural Beat Stimulation (BBS) are non-invasive auditory approaches proposed to alleviate tinnitus symptoms. This study compared the effects of TMNMT alone and TMNMT combined with BBS in adults with chronic subjective tinnitus.
Methods: In this randomized controlled trial, 24 adults with chronic tinnitus were allocated to either the TMNMT group or the TMNMT + BBS group. Individualized music files were created by removing the tinnitus frequency band; in the combined group, an 8-Hz alpha-range binaural beat was embedded at -20 dB. Participants listened to the audio stimuli twice daily for four weeks. Outcomes included the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Visual Analog Scales for tinnitus Loudness (VAS-L) and Annoyance (VAS-A).
Results: Both groups showed significant improvement across all outcome measures (p < 0.01). Greater mean reductions were observed in the TMNMT + BBS group for THI (Δ = 17.33 ± 13.11 vs. 9.00 ± 8.16) and BDI (Δ = 4.08 ± 1.79 vs. 1.83 ± 1.26), though between-group differences were not statistically significant. Effect sizes (Cohen’s d = 0.76-1.46) favored the combined intervention.
Conclusion: TMNMT and TMNMT + BBS effectively reduced tinnitus-related distress and depressive symptoms. The addition of binaural beats produced stronger clinical gains; however, these differences were not statistically significant and therefore should be interpreted cautiously. Larger trials with extended follow-up are recommended.
Trial Registration Number: IRCT20250215064735N1
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24. Chaieb L, Wilpert EC, Reber TP, Fell J. Auditory beat stimulation and its effects on cognition and mood States. Front Psychiatry. 2015;6:70. [DOI:10.3389/fpsyt.2015.00070]
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26. Gao X, Cao H, Ming D, Qi H, Wang X, Wang X, et al. Analysis of EEG activity in response to binaural beats with different frequencies. Int J Psychophysiol. 2014;94(3):399-406. [DOI:10.1016/j.ijpsycho.2014.10.010]
27. Trevis KJ, McLachlan NM, Wilson SJ. Cognitive Mechanisms in Chronic Tinnitus: Psychological Markers of a Failure to Switch Attention. Front Psychol. 2016;7:1262. [DOI:10.3389/fpsyg.2016.01262]
28. Zeman F, Koller M, Langguth B, Landgrebe M; Tinnitus Research Initiative database study group. Which tinnitus-related aspects are relevant for quality of life and depression: results from a large international multicentre sample. Health Qual Life Outcomes. 2014;12:7. [DOI:10.1186/1477-7525-12-7]
29. Padmanabhan R, Hildreth AJ, Laws D. A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery. Anaesthesia. 2005;60(9):874-7. [DOI:10.1111/j.1365-2044.2005.04287.x]
30. Molnár A, Mavrogeni P, Tamás L, Maihoub S. Correlation Between Tinnitus Handicap and Depression and Anxiety Scores. Ear Nose Throat J. 2025;104(8):NP565-NP571. [DOI:10.1177/01455613221139211]
2. Weisz N, Moratti S, Meinzer M, Dohrmann K, Elbert T. Tinnitus perception and distress is related to abnormal spontaneous brain activity as measured by magnetoencephalography. PLoS Med. 2005;2(6):e153. [DOI:10.1371/journal.pmed.0020153]
3. Okamoto H, Stracke H, Stoll W, Pantev C. Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity. Proc Natl Acad Sci U S A. 2010;107(3):1207-10. [DOI:10.1073/pnas.0911268107]
4. Teismann H, Okamoto H, Pantev C. Short and intense tailor-made notched music training against tinnitus: the tinnitus frequency matters. PLoS One. 2011;6(9):e24685. [DOI:10.1371/journal.pone.0024685]
5. Vernon D, Peryer G, Louch J, Shaw M. Tracking EEG changes in response to alpha and beta binaural beats. Int J Psychophysiol. 2014;93(1):134-9. [DOI:10.1016/j.ijpsycho.2012.10.008]
6. Dos Anjos T, Di Rienzo F, Benoit CE, Daligault S, Guillot A. Brain wave modulation and EEG power changes during auditory beats stimulation. Neuroscience. 2024;554:156-66. [DOI:10.1016/j.neuroscience.2024.07.014]
7. Prakash P, Konadath S. Outcome measures of brainwave entrainment using delta wave stimulation in individuals with tinnitus having normal hearing sensitivity. Eur Arch Otorhinolaryngol. 2024;281(7):3821-8. [DOI:10.1007/s00405-024-08641-w]
8. Sadeghijam M, Moossav A, Akbari M, Haghani H, Yousef A, Mohsen S. Correction: An increase in the auditory steady-state response amplitudes after a period of listening to binaural beat stimuli in tinnitus patients: a pilot study. Egypt J Otolaryngol. 2023;39:53. [DOI:10.1186/s43163-023-00415-1]
9. Neff P, Zielonka L, Meyer M, Langguth B, Schecklmann M, Schlee W. Comparison of Amplitude Modulated Sounds and Pure Tones at the Tinnitus Frequency: Residual Tinnitus Suppression and Stimulus Evaluation. Trends Hear. 2019;23:2331216519833841. [DOI:10.1177/2331216519833841]
10. Pandey HR, Keshri A, Sinha N, Kumar U. Auditory network plasticity in tinnitus across the adult lifespan: Insights from fMRI and structural connectivity. Hear Res. 2025;466:109406. [DOI:10.1016/j.heares.2025.109406]
11. Jiang C, Ding Z, Zan T, Liao W, Li H, Yang X, et al. Pathophysiological Insights and Multimodal Interventions in Chronic Tinnitus, Anxiety, and Sleep Disorders. Nat Sci Sleep. 2025;17:2257-73. [DOI:10.2147/NSS.S548093]
12. Hackenberg B, Döge J, O'Brien K, Bohnert A, Lackner KJ, Beutel ME, et al. Tinnitus and Its Relation to Depression, Anxiety, and Stress-A Population-Based Cohort Study. J Clin Med. 2023;12(3):1169. [DOI:10.3390/jcm12031169]
13. Lee ZY, Shin SH, Byun SW, Oh SH, Lee HY. Treatment effects of combined transcranial direct current stimulation and counseling for the treatment of chronic tinnitus. Am J Otolaryngol. 2025;46(5):104699. [DOI:10.1016/j.amjoto.2025.104699]
14. Zhu Y, Zhu JY, Qi YY, Li XR, Tian Y, Guan RR, et al. Neural Oscillations and Tinnitus: A Review of Pathogenesis and Therapy. Sens Neurosci. 2025;1(1):e70001. [DOI:10.1002/sen2.70001]
15. Bakhtarikia S, Tavanai E, Rouhbakhsh N, Sayadi AJ, Sabet VK. Investigating the effectiveness of music therapy combined with binaural beats on chronic tinnitus: A randomized controlled trial. Am J Otolaryngol. 2024;45(4):104308. [DOI:10.1016/j.amjoto.2024.104308]
16. Moossavi A, Mehrkian S, Najafi S, Bakhshi E. The effectiveness of the combined transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) on psychoacoustic, psychometric, and cognitive indices of tinnitus patients. Am J Otolaryngol. 2022;43(1):103274.
17. Mahmoudian S, Shahmiri E, Rouzbahani M, Jafari Z, Keyhani M, Rahimi F, et al. Persian language version of the "Tinnitus Handicap Inventory": translation, standardization, validity and reliability. Int Tinnitus J. 2011;16(2):93-103.
18. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21(4):185-92. [DOI:10.1002/da.20070]
19. Pantev C, Okamoto H, Teismann H. Music-induced cortical plasticity and lateral inhibition in the human auditory cortex as foundations for tonal tinnitus treatment. Front Syst Neurosci. 2012;6:50. [DOI:10.3389/fnsys.2012.00050]
20. Munro BA, Searchfield GD. The short-term effects of recorded ocean sound with and without alpha frequency binaural beats on tinnitus perception. Complement Ther Med. 2019 Jun;44:291-295. [DOI:10.1016/j.ctim.2019.05.005]
21. Moosapour Bardsiri M, Cheraghipour P, Irani M, Mousavi SM, Ghazi Mirsaeed SS. Investigating the Effect of Binaural Beat Stimulation on the Annoyance of Tinnitus in Military Personnel. Aud Vestib Res. 2023;32(1):19-25. [DOI:10.18502/avr.v32i1.11314]
22. De Ridder D, Vanneste S, Song JJ, Adhia D. Tinnitus and the Triple Network Model: A Perspective. Clin Exp Otorhinolaryngol. 2022;15(3):205-12. [DOI:10.21053/ceo.2022.00815]
23. Ibarra-Zarate DI, Naal-Ruiz NE, Alonso-Valerdi LM. Binaural sound therapy for tinnitus treatment: A psychometric and neurophysiological evaluation. Am J Otolaryngol. 2022;43(1):103248. [DOI:10.1016/j.amjoto.2021.103248]
24. Chaieb L, Wilpert EC, Reber TP, Fell J. Auditory beat stimulation and its effects on cognition and mood States. Front Psychiatry. 2015;6:70. [DOI:10.3389/fpsyt.2015.00070]
25. Solcà M, Mottaz A, Guggisberg AG. Binaural beats increase interhemispheric alpha-band coherence between auditory cortices. Hear Res. 2016;332:233-7. [DOI:10.1016/j.heares.2015.09.011]
26. Gao X, Cao H, Ming D, Qi H, Wang X, Wang X, et al. Analysis of EEG activity in response to binaural beats with different frequencies. Int J Psychophysiol. 2014;94(3):399-406. [DOI:10.1016/j.ijpsycho.2014.10.010]
27. Trevis KJ, McLachlan NM, Wilson SJ. Cognitive Mechanisms in Chronic Tinnitus: Psychological Markers of a Failure to Switch Attention. Front Psychol. 2016;7:1262. [DOI:10.3389/fpsyg.2016.01262]
28. Zeman F, Koller M, Langguth B, Landgrebe M; Tinnitus Research Initiative database study group. Which tinnitus-related aspects are relevant for quality of life and depression: results from a large international multicentre sample. Health Qual Life Outcomes. 2014;12:7. [DOI:10.1186/1477-7525-12-7]
29. Padmanabhan R, Hildreth AJ, Laws D. A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery. Anaesthesia. 2005;60(9):874-7. [DOI:10.1111/j.1365-2044.2005.04287.x]
30. Molnár A, Mavrogeni P, Tamás L, Maihoub S. Correlation Between Tinnitus Handicap and Depression and Anxiety Scores. Ear Nose Throat J. 2025;104(8):NP565-NP571. [DOI:10.1177/01455613221139211]
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How to Cite
1.
Samaei S, Lotfi Y, Yazdani N, Vahedi M, Shabani M. Effect of Binaural Beat and Tailor-Made Notched Music Training on Reducing the Loudness and Annoyance of Chronic Tinnitus: A Controlled Trial Study. Aud Vestib Res. 2026;.
