# White Noise Exemplifies the Constrained Disorder Principle-Based Concept of Overcoming Malfunctions
## 1 Introduction
### Using White Noise to Treat Timnitus  
Subjective tinnitus, defined as the perception of a sound without an external source, affects approximately 25% of the US population, with about 8% experiencing a chronic and debilitating condition [115; 116]. It is associated with a nearly threefold increase in rates of depression and anxiety [117; 118]. While factors such as noise exposure, sensorineural hearing loss, traumatic brain injury, concussion, drug exposure, and others are thought to contribute to tinnitus, most cases lack an identifiable cause [119]. Tinnitus arises primarily from the nervous system's activity rather than mechanical or vibrational activity in the cochlea or external stimuli [120]. For individuals with mild hearing loss or the elderly, WN still affects their hearing. Since individuals with hearing loss often suffer from tinnitus, cognitive dysfunction, and depression, WN may provide a means of therapy for these patients [121; 122; 123]. Tinnitus is considered a brain disorder initiated by cochlear trauma, followed by neuronal hyperactivity in the cochlear nucleus and higher regions of the central auditory system, including the inferior colliculus, thalamus, and auditory cortex [124]. Neurons in these areas show increased activity in individuals with tinnitus, firing synchronously to compensate for cochlear hair cell damage [124]. There is no standardized treatment for tinnitus. Available options, including hearing aids, sound masking, drug therapies, acupuncture, and neuromodulation, have shown limited effectiveness. Cognitive-behavioral therapy has improved quality of life but does not significantly reduce tinnitus loudness [125; 126; 127]. Sound masking, employing broadband sound to alleviate tinnitus, was first described in the late 1970s [128]. WN provides sound masking, reduces the perceived intensity of tinnitus, and assists patients in habituating to the sounds associated with tinnitus [129; 130]. This approach relieves stress with soothing sounds, diverts attention from tinnitus by increasing background noise, and alleviates the emotional burden of tinnitus [131]. Some individuals even report tinnitus suppression or temporary disappearance following masking therapy. However, evidence supporting its ability to suppress tinnitus remains limited [132; 133]. A Cochrane review by [PERSON] et al. found no significant benefits of sound therapy alone. Still, the authors claimed that the \"absence of conclusive evidence should not be interpreted as evidence of ineffectiveness\" [132]. Early sound therapy approaches, known as \"complete masking\", used devices resembling hearing aids to generate white noise at increased levels that completely obscured the tinnitus. Later, a different approach emerged, using the minimal appreciable level of white noise to promote habituation to the disordered auditory perception [132]. Another technique, \"sound enrichment\", adjusts noise generators to produce sound at a level where the tinnitus and external noise blend. This method forms the basis of Tinnitus Retraining Therapy (TRT), which combines sound therapy with behavioral counseling [134]. Clinical trials comparing TRT with complete masking have shown that both methods significantly reduce tinnitus-related distress, with TRT yielding slightly more significant benefits [135; 136]. Neuromonics Tinnitus Treatment (NTT) represents another method, combining noise with music to alleviate tinnitus. This six-month intervention requires patients to listen for at least two hours daily. During the initial two months, wideband noise is added to the music to mask tinnitus audibility during the quiet portions of the music. In the subsequent four months, the noise is removed, and patients gradually reduce the music volume to minimize the interaction between tinnitus and the music [137]. Patients often find that they respond better to external sounds that match the frequency of their tinnitus.