by Neil Bauman, Ph.D.
A lady explained:
My audiologist says I have severe recruitment and hyperacusis—sound really hurts my ears.
I’ve worn ear plugs most of my life, not so much to guard my hearing against sounds that would do more damage (though it’s common sense to wear ear plugs during those events that would damage your ears—concerts, air shows, shooting firearms, etc.), but because sound hurts my ears. I’ve “blown the top of my head off” often! The audiologist I had with my last hearing aid trials told me that I needed to expose myself to the sounds that hurt, even though they hurt, to get used to the hearing aids.
Unfortunately, I just couldn’t tolerate wearing hearing aids. My brain would be fried at the end of the day. I always had a headache, was always wincing at sound and my tinnitus would become unbearable. People even commented that I looked distressed. Is there anything you can do for recruitment and/or hyperacusis?
You betcha. It’s not easy, but you can slowly—and I emphasize very slowly—retrain your brain to reduce its sensitivity to sound.
When you have recruitment as I have, or hyperacusis, all or certain sounds seem to “blow the top of your head off”, give you headaches, make you wince or jump and/or make your tinnitus worse as you well know. That’s the bad news. Now for the good news. Such sounds do not physically damage your ears. It just seems like they do.
If a sound is not so loud that people with normal hearing wince, jump, etc. then it almost certainly won’t physically damage your ears either. You won’t lose further hearing from a sound that recruits and sounds dangerously loud because in reality, it isn’t anywhere’s near as loud as you perceive it to be.
My article, “Recruitment from Hearing Loss Explained“, explains why you now perceive normal sounds as much too loud.
When you wear ear plugs when you don’t absolutely need to wear them, especially if you have recruitment or hyperacusis, you are doing yourself a disservice. Here’s why. Your brain wants to hear sounds and when you wear earplugs to block the sounds, your brain turns your internal volume up more to try to hear through the ear plugs. Ultimately, this just makes your hyperacusis worse and worse.
Thus, your audiologist is basically right—you may be overprotecting your ears. The solution is to only wear ear protectors when you really need them. One way to do this is to use your hands—clap them over your ears whenever sounds get too loud for you, but take them away as soon as the sound level drops. You can do this at a railway crossing for example. A train is going by—cover your ears—when the train is past, uncover them again.
You should also carry several strengths of ear protectors, but only use the minimum strength you need at any particular time.
Over time (and this can take a couple of years or more) you will slowly build up your tolerance for louder sounds again. This is what you need to do.
Begin to learn to tolerate sounds a bit louder than you are now—not loud sounds, just a tiny bit louder—and when you can tolerate those sounds, a little bit louder sounds, and so on.
Incidentally, recruitment only affects people with a sensorineural hearing loss. Hyperacusis can affect anyone whether they have a hearing loss or not.
If you have recruitment and wear hearing aids, you need your audiologist to set the maximum output on your aids by frequency. In order to do that, first she has to test you for recruitment by frequency (which audiologists almost never do—they typically use an overall average—and this just doesn’t work well at all) in order to see exactly where your recruitment kicks in. Then she needs to set the compression on your hearing aids a few decibels below that level. If she does this properly, you should be able to stand almost any volume of sound as your aids will keep them all below the level at which they would recruit.
Unfortunately, when you do this, it causes a certain amount of distortion. As a result, you may not understand speech as well as you would otherwise. This is the tradeoff—understand speech better but yank your aids out because certain sounds recruit, or have the compression set so sounds won’t recruit, but not understand speech as well as you should.
I walk a fine line here. I have the compression set on my aids such that they work for me in most normal listening situations but if certain frequencies of noise are present, I have to take my aids off as they still recruit. I then either rely 100% on speechreading or I speechread and use various assistive listening devices.
At the same time, just setting the compression as much as I have costs me 12% in lost discrimination. Thus, when I wear my aids I still have to speechread to try to fill in the “mushy” words I miss. Nothing is perfect, but I’ve found this trade-off typically works for me.