by Neil Bauman, Ph.D.
A lady asked,
Some people can’t wear hearing aids because of severe recruitment. Recruitment seems to be such a weird word for this problem. The word means “to enlist.” The dictionary doesn’t describe anything to do with hearing loss and hearing aids. So what really is recruitment and how did it get this strange name?
Good questions. No wonder you are confused! Even many of the hearing health care professionals don’t understand this condition that goes by the strange name of recruitment. There is a lot of misunderstanding about recruitment. Actually, recruitment really is a good word to describe this phenomenon—once we understand what goes on in our inner ears.
What is Recruitment?
Very simply, recruitment is when we perceive sounds as getting too loud too fast.
Before we look at how recruitment got its name, there are two things we need to know about recruitment.
First, recruitment is always a by-product of a sensorineural hearing loss. If you do not have a sensorineural hearing loss, you cannot have recruitment.
Second, there are two other phenomena that often get confused with recruitment. These are hyperacusis (super-sensitivity to normal sounds) and phonophobia (fear of normal sounds resulting in super-sensitivity to them). Both hyperacusis and phonophobia can occur whether you have normal hearing or are hard of hearing. In fact, if you have a sensorineural hearing loss, you could suffer from all three conditions at once!
How Recruitment Got Its Name
Now let’s look at how recruitment “works” and how it got its name. Perhaps the easiest way to understand recruitment is to make an analogy between the keys on a piano and the hair cells in a cochlea.
The piano keyboard contains a number of white keys while our inner ears contain thousands of “hair cells.” Think of each hair cell as being analogous to a white key on the piano.
The piano keyboard is divided into several octaves. Each octave contains 8 white keys. Similarly, the hair cells in our inner ears are thought to be divided into a number of “critical bands” with each critical band having a given number of hair cells. Each critical band is thus analogous to an octave on the piano.
Just as every key on the piano belongs to one octave or another, so also, each hair cell belongs to a critical band.
When you play a chord on the piano—you press two or more keys together but they send one sound signal to your brain. Similarly—but yet different—when any hair cell in a given critical band is stimulated, that entire critical band sends a signal to our brains which we “hear” as one unit of sound at the frequency that critical band is sensitive to. This is the situation when a person has normal hearing.
However, when we have a sensorineural hearing loss, some of the hair cells die or cease to function. When this happens, each “critical band” no longer has a full complement of hair cells. This would be analogous to a piano with some of the white keys yanked out. The result would be that some octaves wouldn’t have 8 keys any more.
Our brains don’t like this condition at all. They require each critical band to have a full complement of hair cells. Therefore, just as our government, when it runs short of military personnel, puts on a recruitment drive, so too, our brains do the same thing. However, since all the hair cells are already in service, there are no spares to recruit.
What our brains do is rather ingenious. They simply recruit some hair cells from adjacent critical bands. (Here is that word recruit or recruitment.) These hair cells now have to do double duty or worse. They are still members of their original critical band and now are also members of one or more additional critical bands.
If only relatively few hair cells die, then adjacent hair cells may just do double duty. However, if many/most hair cells have died, then in order to have a full complement of hair cells in each critical band, any given hair cell may be recruited into several different critical bands.
The Result of Recruitment
The result of this recruitment causes us two basic problems.
First, the sounds reaching our brains appear to be much louder that normal. This is because the recruited hair cells still function in their original critical bands and also in the adjacent one(s) they have been recruited into.
Remember that when any hair cell in a critical band is stimulated, the whole critical band sends a signal to our brains. So the original critical band sends one unit of sound to our brains, and at the same time, since the same hair cell is now recruited to an adjacent critical band, it stimulates that critical band also. Thus, another unit of sound is sent to our brains. Hence, we perceive the sound as twice as loud as normal.
If our hearing loss is severe, a given hair cell may be recruited into several critical bands at the same time. Thus our ears could be sending, for example, eight units of sound to our brains and we now perceive that sound as eight times louder than normal. You can readily see how sounds can get painfully loud very fast! This is when we complain of our recruitment.
In fact, if you have severe recruitment, when a sound becomes loud enough for you to hear, it is already too loud for you to stand.
The second result of recruitment is “fuzzy” hearing. Since each critical band sends one signal at the frequency of that critical band, when hair cells get recruited into adjacent bands, they stimulate each critical band they are a member of to send their signals also. Consequently, instead of hearing just one frequency for a given syllable of sound, for example, perhaps our brains now receive eight signals at the same time—each one at a different frequency.
The result is that we now often cannot distinguish similar sounding words from each other. They all sound about the same to us. We are not sure if the person said the word “run” or was it “dumb,” or “thumb,” or “done,” or “sun,” or? In other words, we have problems with discrimination as well as with volume. If our recruitment is bad, our discrimination scores likely will go way down.
When this happens, basically all we hear is either silence or loud noise with little intelligibility in it. Speech, when it is loud enough for us to even hear it, becomes just so much meaningless noise.
This is why many people with severe recruitment cannot successfully wear hearing aids. Their hearing aids make all sounds too loud—so that they hurt. Also, hearing aids cannot correct the results of our poor discrimination. We still “hear” meaningless gibberish.
However, people with lesser recruitment problems will find much help from properly adjusted hearing aids. Most modern hearing aids have some sort of “compression” circuits in them. When the compression is adjusted properly for our ears, these hearing aids can do a remarkable job of compensating for our recruitment problems.
thank you for the article on recruitment. my 8 yr old came home from school with a note from the teacher saying he refuses to wear his hearing aids at school. he wears them at home for therapy, when he bowls with the special olympics, but wont wear them in the car, bus or at school. but this is new behavior at school. he would always wear them for most of the day, this year though, even though he is in the same classroom as last year, he keeps taking them out. i am thinking of going in to observe to see if there is a child that may make noises that he cant tolerate. he is in a self contained class with new students hes never been with before. thank you again!!!
Hi Lisette:
What does he say when you ask him why he takes them out? If he complains of sounds too loud and hurting, ask him specifically which sounds are doing that. You need to get very specific.
Going to school and observing is a good idea, but you may totally miss the sounds that are bothering him because to you they sound normal. They maybe are not even loud or irksome to you. That is why you need to find out ahead of time exactly what sounds are bothering him. Do the same to discover exactly what sounds are bothering him in the car and bus. They may be different sounds.
Once you know exactly what kinds of sounds are bothering him, then have his hearing aids adjusted to greatly reduce those sounds. They will tend to all have a certain frequency in common that needs to be turned down.
Just be aware that turning down the volume on that frequency can worsen his discrimination (word recognition scores). This means he won’t understand as much speech as he would have otherwise, but at least sounds won’t bother/hurt him–so it is a trade off. For example, my last pair of hearing aids cost me 12% worse discrimination in order to partially eliminate the sounds that bothered me the most. Most audiologists wouldn’t want to “detune” hearing aids like that so you hear worse–but you need to realize that the alternative is he is going to take his aids off and hear almost nothing. When looked at from that perspective, you can see it is worthwhile.
Cordially,
Neil
Great ! explanation .
Nice one well
Explained
What a beautiful explanation!so tnx for good pathophysiology of recruitment
Thank you for this! I wish someone I knew cared enough to try to understand why I usually can hear nothing and then all of a sudden something sounds REALLY LOUD. They just think I’m nuts or a liar or living in the twilight zone. And yes, it hurts.
Boy can I identify with your problem. Many of my friends keep sending me information on hearing aids. They don’t believe me when I say hearing aids won’t help!
Thank you so much for this! I’m a medical student in India studying for my final ENT exam, and was having a lot of trouble understanding this concept. The way you explained it is absolutely beautiful. Thank you so much!
Thank you for the article. I am a medical student in India. Was going through a case and this helped me to understand it far better.
once diagnosed, does recruitment ever get better or modify?
i am 75,have moderate tinnitus in one ear and becoming more isolated due to inability to hear clearly in large gatherings or noisy
backgrounds.
what might have caused the recruitment?
Hi Caroline:
Recruitment is the result of a sensorineural hearing loss–so as long as you have the hearing loss, you’ll have the recruitment. In your case, it appears you have a high-frequency hearing loss. (A high-frequency sensorineural hearing loss is VERY common in seniors. It is due to aging.) This makes in very hard to hear in noisy groups and gatherings.
You need to learn some good hearing loss coping strategies to use in such situations. They won’t be perfect, but they will help.
Cordially,
Neil
I’ve been hard of hearing since birth with profound sensorineural hearing loss in my left ear and severe in my right ear.
I also suffer from high and low frequency hearing loss and tinnitus 24/7.
This article explains so much about why certIn sounds hurt more than others. I only wish family, friends and strangers would understand.
Thank you so much for this article! I have severe recruitment causes me pain with certain tones. I can finally explain why in way that makes sense.
Thank you so much. I’m a medical student in India. You have beautifully explained a concept that I never understood.
My son who is 11 has recently been suffering from sensitive hearing and we just came home from the doctor and discovered he has hearing loss, Which lead me to this information. Thank you so much for this useful information.
I am age 58 and a high functioning autistic woman. I have a lot of problems with certain sounds that could variously be related to the recruitment as you described above, phonophobia or misophonia (because certain sounds that bother me have a deep-seated emotional connection), and in a whole separate category: sensory processing disorder that often accompanies autism. I am beginning to suffer presbycusis and the kinds of hearing difficulties are very similar to those described by other commenters. In particular, I cannot hear the initial consonants of many words. So if someone says”fair” I might hear just “air”… What do you think about this situation? Thanks
Hi Martha:
You gave the reason yourself–presbycusis. Typically this is where you begin to have a high frequency hearing loss. The result is that you no longer hear the highest frequency consonants such as f, s, sh, ch, th. That’s why you don’t hear the f in fair.
The solution is to get hearing aids that are set to give you back your high frequency hearing so you can hear these sounds well again.
Cordially,
Neil
My mother suffered sensorineural hearing loss as I grew up. From memory it started around the time she was 30-35 and since then, she’s 49 now, has lost much of her hearing in one ear and almost all in the other.
I’ve recently started producing symptoms such as the ones she initially got like recruitment.
Is this something that can be passed on genetically, am I potentially going to go deaf too?
Hi Liam:
If your mother had a genetic hearing loss, then yes, she could pass it on to you. That is exactly what happened in my case. My mom had a genetic hearing loss and passed it on to me. In turn, I passed it on to my younger daughter.
Having said that, you could get hearing loss from exposing your ears to loud sounds, from taking ototoxic drugs, etc., etc.
It possible that you have both a genetic hearing loss and hearing loss from other causes at the same time.
Cordially,
Neil
Hi, I’m unsure of what to do. My partner (Aged 55) has just been diagnosed with moderate hearing loss in both ears. He also has Tinnitus and a problem with loud noises such as a scream siren etc During the hearing test he has had two days recovering from the whooshing distraction sound that has caused pain and distress. I don’t know where to go or what to do next! He says that the noises are much too loud and there is no need for such screams etc How could this be helped? Thank you
Hi Karen:
Moderate hearing loss can result in recruitment. Recruitment, as you know, is where normal sounds get too loud too fast. Thus screaming or sirens can sound MUCH louder to him than to you.
He may also have hyperacusis where he perceives all or certain sounds as being much louder than they really are. I wouldn’t be surprised that he has hyperacusis from what you describe.
I don’t know where you live in the UK, but Jacqueline Sheldrake at the Tinnitus and Hyperacusis Center (in London) would be the person to see if you can’t find a qualified person closer to you.
Cordially,
Neil
I am 23 and have had these symptoms for about 3-4 years now and it’s just getting worse. I can’t understand anything if their is any background noise but my hearing tests where perfect when checked 3 years ago. Now any high pitch noise such as my kids arguing or a woman on speaker phone talking hurts my ears very bad. Especially if the tone of voice goes from mildly high to a laugh in high pitch. Sirens, car honks, etc hurt my ears. We found out my daughter who is 1 has 2 gene microduplicatiins that alot of people that have also have the sensorineural hearing loss and we are waiting for my genetic result to come back to see if I have it also or not… do my symptoms sound like I could have recruitment and sensorineural hearing loss of does it sound like something different?
Hi Shelena:
If you last had your hearing checked 3 years ago, and you now have these symptoms, the first thing I’d do is have my hearing tested again to see if there are any problems.
If you don’t have hearing loss, then you CAN’T have recruitment. It only occurs with a sensorineural hearing loss. So that’s why you need to get your hearing tested.
Instead, what you can have is hyperacusis. The results are much the same as recruitment–normal sounds are now much too loud and can hurt. Often hyperacusis is a result of exposing your ears to loud sounds.
Cordially,
Neil
I’m fairly sure that I suffer from recruitment, (self diagnosed after reading the internet). On many occasions the background noise has suddenly surged to a deafening level, leaving me unable to hear anyone talking to me. Doctors in a big London hospital were mystified by it. If this is really recruitment, how on earth do I get treatment for it? I have other weird problems as well, and lots of doctors think that if they’ve never heard of it, the patient must be making it up.
Hi Judith:
You can only have recruitment if you also have a sensorineural hearing loss. You don’t say whether you have a hearing loss or not. If you have normal hearing, then you can’t have recruitment, but you likely do have hyperacusis.
Since you are in London, I’d see Jacqueline Sheldrake at the Tinnitus and Hyperacusis Center at http://tinnitus.org/
Cordially,
Neil
Can this also result from a purely conductive hearing loss? My son has a profound conductive hearing loss on his right side and seems to exhibit these same symptoms, especially when wearing his hearing aid.
Hi Laura:
Recruitment, as I understand it, can only arise from a sensorineural hearing loss, not from a conductive loss. However, a somewhat similar condition, called hyperacusis, can occur with any kind of hearing loss, or with no hearing loss at all.
So, either your son has some sensorineural hearing loss that was not diagnosed, or he has hyperacusis for some reason.
When hearing aids are not set properly–set without specifically checking for the uncomfortable level (UCL) for EACH test frequency, some frequencies of sound get set too loud and hurt. So I’d go back to his audiologist and have them specifically check for his UL at EACH frequency, then set his hearing aids for each band such that NO sound is able to be louder than the UL (and indeed should be set a little lower) for each frequency. If it is done right that should largely eliminate this problem.
Cordially,
Neil
I have moderate loss and have been using hearing aids for about 7 years. Never heard of the term “recruitment ” before. Pretty sure I suffer from it at a few high frequencies I thought might simply be a HA artifact.(back up beeper on electric wheel chair, Westminster chime clock, etc) – my question- will wearing HA’s slow down the progression of recruitment?
Hi Steve:
Supposedly, wearing hearing aids can slow down the progression of hearing loss. Since recruitment is closely associated with hearing loss, if you slow down the progression of your hearing loss, then your recruitment will follow in step since recruitment only changes as your hearing gets worse.
Cordially,
Neil
Hi there,
I am an Audiologist in Cape Town, South Africa. Thank you for that lovely explanation of recruitment! It will definitely help me explain it better to my patients. I saw a man this week with bilateral profound hearing loss since a very young age. Several Audiologists have tried testing him and all refuse to fit hearing aids. I made a point of increasing the dB in the smallest increments possible trying to find a threshold, as he had warned me he had severe recruitment. I got to 105dB at 1000Hz on the first ear and he still had heard nothing. When I increased to 110dB he literally jumped from the chair and pulled all the equipment off his head/ears and was in terrible pain. I have only ever once seen this severe reaction. Is there anything one can do for these patients???
Hi Nadine:
Glad my article on recruitment helped.
This man has a collapsed dynamic range of less than 5 dB–probably only 1 or 2 dB if even that. Thus as soon as sound becomes loud enough to hear, it is already too loud to stand. Thus normal amplification–hearing aids or assistive listening devices–are out. Besides I’m not aware of any hearing aid that could compress all sound into a 1 or 2 dB range. That would be quite a feat–and make the resulting sound mostly unintelligible.
The only solution I see is for him to see if he is qualified to get a cochlear implant. Many people with CIs find that their CIs expand their collapsed dynamic ranges considerably. But I’ve never heard of the results of anyone with this severe a collapsed dynamic range who got a CI. Maybe he’d need to be the guinea pig.
Cordially,
Neil
I had profound “sudden hearing loss” and then gradually increasing tinnitus in my right ear 20 years ago at 40.
The hearing in the other ear has regularly been tested and is excellent.
Nevertheless, this Spring the left ear has suddenly developed a very soft, brief, periodic hum – as if the buzzer on a kitchen timer had gone off, two rooms away.
It’s a “floating, phantom”
sound, like tinnitus, but is completely unlike the latter’s high pitched wail.
Is there a word or condition to describe this?
Hi Bernard:
Yes, tinnitus. You see, there are many other tinnitus sounds besides a high-pitched wail. One of the many tinnitus sounds is a humming sound.
You may hear your tinnitus as a ringing, roaring, beating, clicking, banging, buzzing, hissing, humming, blowing, fluttering, clanging, drumming, sizzling, whooshing, rumbling, pulsating, whistling or dreadful shrieking noise. To some people, tinnitus sounds like owls hooting, crickets chirping, radio static, rushing water, breaking glass, bells ringing or chain saws running.
On top of that you can hear more than one tinnitus sound at the same time, or different sounds it each ear. It’s not unusual to hear 2 or 3 or more different tinnitus sounds at the same time.
For example, my tinnitus is normally a high-pitched hissy-whine sound in both ears. Sometimes I’ll hear or a low-pitched hum or a loud roaring sound in both ears. However, sometimes I also hear what sounds like a flock of birds twittering–but only ever in my right ear.
Cordially,
Neil
Hi
Thanks so much for explaining recruitment which describes my experience. I have severe hearing loss in my left ear and mild\moderate loss in my right ear. I wear hearing aids in both ears.
Mostly I can cope but when the organ and choir suddenly start up in church it all distorts and can be almost painful. Also when travelling in an aeroplane I am left with strange tinnitus which sounds like two bars of a tune over and over. This lasts a week or so and then fades.
I have started removing the hearing aid from my left ear in these situations. Is this the sensible thing to do or the coward’s way out?
Thanks
Janice
Hi Janice:
I’m with you on this. When hearing aids cause more problems than they solve, it’s time to yank them out for the duration. I do the same all the time. I don’t consider this the cowards way out at all–but a sensible approach.
For church, you could turn down the volume so the sounds don’t recruit–or quickly change memories to another program that won’t recruit when the music plays. I have separate programs for music.
When you are flying, the “strange tinnitus” you experience isn’t tinnitus at all. Rather I put it under the umbrella of Musical Ear Syndrome–but a special subset of it called Audio Pareidolia. This is where your brain takes the constant background roar of the jets and tries to make a pattern out of it. The result is often some sort of music such as you experience.
If you are interested, you can read all about it in my article at http://hearinglosshelp.com/blog/apophenia-audio-pareidolia-and-musical-ear-syndrome/
Cordially,
Neil
Dear Neil,
My 5 year old daughter is having Bilateral sloping moderate SNHL. She is showing recruitment signs when exposed to loud noise. Many say that sloping hearing loss will be progressive. Please could you explain if sloping hearing loss is always progressive in nature and will recruitment add to this? We are now in the process of getting her hearing aids for both ears.
Hi Vino:
Sloping losses typically progress, but that depends on the cause of your daughter’s hearing loss. Have you seen any progression so far?
Since your daughter is so young, it may not progress. It could stay the same for the next 50 years–again depending on the exact cause of her hearing loss.
Recruitment is a result of the hearing loss, not a cause of hearing loss. Thus, as hearing loss gets worse, so typically, does recruitment.
Cordially,
Neil
Hi Neil,
Thanks for your reply.
We had her first audiogram 6 months back and since then the loss is 50db in both ears (+/- ~3db). The reason told to us is cochlear hair cell damage. She had reflexes and failed in her OAEs.
Hi Vino:
If her hearing gets worse–around 70 dB, she won’t have reflexes either. That’s just the way it is.
Cordially,
Neil
Hi Neil. I’m 52 years old. I was recently told that I have mild hearing loss, with high frequency sounds. I also hear hissing coming from my ears. The hissing started recently, and at the same time I have trouble tolerating loud noises. I also have ear pain that is coming from my neck pain and my jaw pain. It’s frustrating for me, because I don’t know if the hissing and intolerance to noise is coming from the hearing loss, are the pain that I’m experiencing. I started having these symptoms when the pain started. Could you please tell me what you think?
Hi Denise:
I think that your hissing (tinnitus) and ear pain and sound intolerance are the result of your jaw and neck being out of proper alignment. If you have upper cervical chiropractic treatments and maybe massage or physiotherapy on your neck and jaw and face, you can get things relaxed and into proper alignment. Then your ear problems should largely go away. This kind of tinnitus is called somatosensory tinnitus. It is probably not related to your hearing loss–but still could be. It could be caused partially your hearing loss and partially your neck out of whack.
Cordially,
Neil
My brother has recruitment and has recently developed involuntary movement in his hands and legs.. his fingers look like he is playing a piano and his feet like he is dancing. I can feel vibrations when I touch his hands.
Hi Catherine:
I rather doubt that he has recruitment in that case. More likely he has some weird case of hyperacusis, possibly associated with pinched nerves in his upper neck. That’s my guess based on what little you’ve said.
Cordially,
Neil
I am 67 years old and have had Meniere’s disease for over 34 years. I work in a VERY loud environment with incredibly horrible spotlights all around. The pain and unbalance make it almost too hard to function. It totally exhausts me! At night and my days off, I need COMPLETE silence to recoup! And, of course, weather fronts throw me into vertigo. I have to work! Is there ANY help????
Hi Marge:
Since you have Ménière’s disease, I recommend you go to an upper cervical spine chiropractor and get it taken care. That should eliminate the vertigo and balance problems.
I wrote a comprehensive article on Meniere’s disease and how to get rid of it. I highly recommend you read this article and then act on it. The people that have taken this treatment as outlined in this article and have gone to an upper cervical spine chiropractor and then have gotten back to me have all had good success with this treatment. It should work for you too. The link to my article is at http://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/.
I’m assuming the pain you experience is from the loud sounds recruiting, is that right? If so, then wearing earplugs or ear protectors to reduce the sound to a tolerable level would be a good solution. that your protection needs to be strong enough that it will bring the sounds down to just below where they cause recruitment.
Cordially,
Neil
I’m having trouble when my husband turns the volume up on the TV so he can hear, I CAN’T STAND it.
Hi Elaine:
This problem is fairly easy to solve. Your husband needs to use various assistive listening devices so that he can keep the volume on the TV down and yet here it wonderfully well. For example, he could use a home loop system, he could use a remote speaker system, he could use something like TV ears, or an FM system.
All of these solutions would allow you to set the volume on the TV to what is comfortable for you and yet not affect the volume your husband listens to the TV at via an assistive device.
two devices I particularly recommend or the Contacta HLD3 home loop system. You can see it at http://hearinglosshelp.com/shop/contacta-hld3-hearing-loop-system/ and Serene Innovation’s TV Sound Box remote speaker system. You can see it at http://hearinglosshelp.com/shop/tv-soundbox/.
Cordially,
Neil
Does recruitment have any treatment?? I’m suffering from this.
Hi Rani:
You don’t mention having hearing loss. Recruitment is exclusively a byproduct of a sensorineural hearing loss. As far as I know, there is no really effective treatment for recruitment. If you wear hearing aids, you need your hearing aids sat such that no sounds recruit. This is hard to do, but it’s the best they do at this time.
Cordially,
Neil
I was in a car accident last September where the noise of the impact caused recruitment in both ears. I feel like it’s getting worse. Is that possible? I live in the greater Portland, Maine area. Do you know a doctor who you could refer me to? I can’t find anyone who knows anything about it.
Hi Terry:
A point of correction. Sudden loud noise does not cause recruitment. It causes hyperacusis. Recruitment is a byproduct of a sensorineural hearing loss. If the sudden loud noise resulted in hearing loss, then you could have recruitment. But at the same time you probably also would have hyperacusis.
Theoretically, your hyperacusis should have been getting better, given the number of months that have past since it happened. However, two things could prevent it from getting better. First, if you have continued to expose your ears to loud sounds over the intervening weeks and months, that could prevent your week hyperacusis from improving because you keep causing further ear trauma every time your ears are exposed to loud sounds.
Second, if you worry about it or obsess over it, you can make it worse.
If you need help dealing with your hyperacusis, typically the person to go to would be an audiologist that runs a tinnitus and hyperacusis center. I don’t know anyone in Maine then run such a center. However, ask one of your local audiologists to find the closest one to you.
Cordially,
Neil
Hmmm…I’m a violinist/teacher. Nobody told me to stop. Yikes!
Hi Terry:
You don’t have to stop playing the violin or teaching music. All you need to do is protect your ears from louder sounds. You can easily do that by wearing a pair of musicians ear protectors. These ear protectors do not distort what you hear, just reduce the volume.
Cordially,
Neil
Hi Dr. Baumann,
When you warn against exposing your ears to “loud” sounds in this context, what is considered loud, and what would be considered a dangerous amount of time (based on the dB level)? For example, 80dB is considered relatively safe under normal circumstances for several hours. Would this level be considered unsafe under these circumstances, even for a matter of, say, 20 minutes (such as walking next to a noisy street)? And if unsafe, could such an activity have caused even further damage?
Thanks.
Hi Kyle:
Here’s the way it works. You have to consider both the volume of the sound and how long your ears are exposed to it. For every 3 dB increase in sound intensity, you have to drop your exposure time in half.
Let’s assume 80 dB is safe for eight hours exposure (the keep changing the base as they find that they have been to high in the past–for example they used 90 dB and then 85 dB and the EPA is now using 70 dB). Therefore, if you increase the sound by 3 db on the average–to 83 dB, the safe exposure time drops to four hours. And if you increase that to 86 dB, the safe time drops to two hours, and so forth. Thus, if you were walking along the street where the average noise level was 95 dB, your safe exposure time would be 15 minutes.
Remember, this is for the average ear. Your ears may be more or less sensitive and therefore the sound level/exposure time may vary from these theoretical average figures. If you exceed these figures, you could assume that you are damaging your ears to some degree, whether it is obvious or not.
Cordially,
Neil
Dr Neil
Had a hearing test as I felt that I had super sensitive ears .I wear ear plugs to various places and at night, as noises or birds can wake me,used to jokingly say I could hear a mosquito 100 ks away will wake me up !!!!!Have to have the volume down on radio or TV.
I was quite shocked when I was told I was suffering from recruitment and if I worked in a noisy environment.
I have been a Podiatrist for 46yrs and still enjoy making my own orthotics for my patients,something I’m sure is no longer being made in surgeries as there are many Labs that have been set up to cater for prescription orthotics.
Having said that no protection was worn and now guess all these years of grinding 3-4mls of plastics ,graphite etc seem to have “come home to roost”.
I’m quite shattered about the situation as I thought I had the opposite to hearing loss.!!!!!
Whilst I was told to wear protection from now on and the other tests were ok,she said hearing was ok.My long winded story was to ask you is,will my hearing get worse as “time goes by” I just turned 67 which I know am not a “spring chicken” but thought I had several yrs to go before “old mother time” caught upwith me ??? I live in Australia thought you answers to everyone’s questions extremely helpful .
Thanking you
Daphne Georgoussis
Hi Daphne:
It is quite a shock to find that what you think is super-hearing is just the opposite–a damaged auditory system. I’m not so sure that you have recruitment since your hearing doesn’t seem very bad.
I think it is more likely that you have hyperacusis. You can have hyperacusis whether you are a hearing loss or not. Furthermore, hyperacusis is often caused by exposure to loud sounds.
You want to be careful about wearing ear protectors so you just make the hyperacusis worse and worse if you wear them when you are not in truly noisy situations where others should wear ear protectors too.
The trick is not to overprotect your ears, but protect them enough so that louder sounds don’t hurt you.
Now to answer your question. Typically, your hearing will get worse as you age. That goes under the name of prebsycusis–hearing loss due to aging. But, in addition, typically, hearing loss due to noise exposure accelerates hearing loss as you age. Hyperacusis itself has no bearing on how fast you may lose hearing in the future.
Cordially,
Neil
Thank you this perfectly describes what I have been trying to explain to my family and doctors along with hearing problems I’ve had vestibular issues so my hearing and it’s effects on my school life was kinda swept aside hopefully now I have the words to better describe it I can get help because it has taken a toll on my daily performance
I had been working as a restock filler in a supermarket. The sounds from the canned – vegetables where very unfomcortable to my ears. It made them more sensitive to loud sounds. I worked there for a while and I notice that my hearing is very slowly degreading. I also noticed that since a few weeks that the sensitivity in my hearing is becoming worse everytime I notice that I loss little bits of it for a while when I hear a short ringing after a normal sound. My ears have no wax in them so it is not a conductive loss. A few years ago my hearing used to be more sensitive due to autism but it went a bit more away after I started to go to school in a noisy city. A month ago I had a hearing test done and the results were fine for my age. They resulte was a bit lower than a few years before. But my symptoms seem to be very much related to recruitment. I get even bits of hearing loss from normal sounds but I guess it resulted from the damage that my ears went slowly from my work at the supermarket. I’m only 19 years old but I’m pretty much afraid that I am developing recruitment. What can I do?
I forgot to mention that I’m starting to become more sensitive to the sound of when people talk also.
Just mainly low frequencies seems to be louder than before. I do not know if autism and recruitment go a bit hand in hand when someone who is autistic and sensitive to noise loss a bit of hearing.
Hi Susan:
I don’t think that you have recruitment. Rather, you have a somewhat similar condition called hyperacusis which is a supersensitivity to sound. Often hyperacusis is caused by exposing your ears to loud sounds. Also, often tinnitus and hyperacusis go together in such cases.
Another cause of hyperacusis is taking certain drugs. Are you, or have you been taking any medications?
I do not know much about autism, but it is well-known that some/many autistic people are super sensitive to certain sounds. In other words, they have hyperacusis. I think this is your situation.
Thus, you find the clinking of the cans when you put them on the shelves very irritating and somewhat painful, as well as certain other sounds.
Treating hyperacusis such as you have requires professional help. Probably the best would be to find an audiologist that is experienced in helping people with tinnitus and hyperacusis–using the Tinnitus Retraining Therapy (TRT) protocol–and who will work alongside a rehabilitation psychologist who is well versed in ear conditions like tinnitus and hyperacusis.
Cordially,
Neil
I have recruitment due to some hearing loss in high frequency sounds. Can this be affected by the sound of your own voice? My ears hurt when I say words with sibilant sounds like ‘s’. I understand these sounds are coming in through the bones of my skull more than my auditory canal. Would they affect my recruitment?
Hi Frank:
I think you have it backwards. Sibilants are higher-frequency, lower-powered sounds. Thus they don’t travel though your skull well–not like the higher-powered, lower-frequency sounds such as a “z” sound which you can feel vibrating your skull as you make the sound.
I’ve never heard of someone having problems with recruitment due to their own voice. I have pretty severe recruitment and I know I’ve never had any problems with my own voice as long as I’m not wearing hearing aids. With hearing aids on, all sorts of sounds can recruit depending on volume and frequency.
When you say your own voice sounds can hurt, are you wearing hearing aids or using other amplification at that time or not?
Are your Eustachian tubes working properly? If they are stuck open, then you will hear your voice louder than normal. You also hear your breath sounds much louder than normal. Could that be your problem?
Cordially,
Neil
Thank you for this information. I have some hearing loss and I have recruitment. I got it from listening to loud music at home. The question is, can all of this become worse over time if I am still feeling discomfort whilst listening on moderate levels. I am an aspiring music producer and I need to sit home and work on music. No live gigs and insane sound levels. Only time i am not feeling pain is if i don’t listen to music at all and don’t get out. Can it get worse if I am feeling pain? Thank you.
Hi Mike:
You may have some recruitment as a result of your hearing loss, but I think your sensitivity to sound is really hyperacusis, not recruitment. Hyperacusis often results from exposing your ears to excessively loud sounds.
If you are feeling discomfort while listening to music at moderate levels my question is, “Just how loud is moderate to you”? You want to keep the volume down below 75 or 80 dB. A good level to listen to music is the same level that you hear people speaking—around 55 or 60 dB or so. You do not have to listen to music at high levels. If you do you could expect your hyperacusis to be ongoing.
If you turn the music down to 55 or 60 dB, does that still cause you discomfort? if so, turn it down even more. There must be some level where music does not cause you discomfort. Do people talking to you cause discomfort?
You need to protect your ears from loud sounds in the future, and give them time to heal now.
Cordially,
Neil
With hearing loss and recruitment I gave up my profession as a Piano Tuner, Organist/Pianist and music teacher and switched to piano rebuilding and refinishing enabling me to work alone quietly except when I finish a player piano. My son took over all tuning and I gave my phone to his wife. Is it normal to ultimately become totally deaf? During the past month I’ve lost almost all ability to understand speech. My daughter works with me in our shop and I can hardly understand her or my wife in our apartment, or anyone else unless they are very close and not too loud. Tinnitus has also worsened. I already had five sounds in my head, but one night I thought the outside fire alarm which I normally cannot hear was on, but realized it was internal and has remained the same. I can usually understand on the phone with my Phonak Bluetooth attached to my IPhone 6 even though distortion is poor at all levels. I test myself a few days ago showing I cannot hear a piano note under60 decibels. By 70 it sounds too loud and distorted as soon as I hear it. The audiologist two years ago found my range was 70 – 75. That’s understanding speech below 70 and 75 volume intolerable and distortion the whole time. If I hear a person playing a piano it sounds like they are randomly pounding on all keys at the same time, and I tried a church service where singing sounds like they are yelling various notes with no harmonic relationship. I looked at the book and knew they song, but could not blend in at all with singing. I know I lost the lower range and can still hear the upper. I can still hear the pitch differences on the highest 2 piano octaves. I used to tune and play pianos at 90- 95 decibels all day. I’m willing to accept the fact I’m going deaf, but would like to know for sure so I can tell people there is no cure. I’ve been helped much by what you have written, but this needs to be shortened …
Hi Clayton:
Having a collapsed dynamic range such as you have makes life difficult indeed! You’re almost to the point that when a sound becomes loud enough to hear, it is already too loud to stand. I had a deaf friend that was like that.
My own dynamic range is also very collapsed to around 20 to 30 dB depending on frequency. Thus I am having a tough time finding the Goldilocks zone where I can hear speech comfortably. Too often, the soft syllables “drop out” and the louder syllables recruit and “go through the roof”.
What is causing your hearing loss? You didn’t mention that fact. Was it the loud sound levels you experienced over the years? Or was it from taking some drugs that stole your hearing? Or what?
The good news is that VERY seldom does your hearing drop to nothing. You may not hear much, but you will still hear some sounds.
You are right that there is no cure for sensorineural hearing loss. However if you can get hearing aids that have excellent compression so that they will work with your hearing loss, that would be one solution. It will not be perfect but at least you will hear, and most sounds will not recruit and go through the roof if the compression is set for your hearing. However, I think that you’re collapsed dynamic range is so narrow that no hearing aids can compress that much.
The other solution is to investigate getting cochlear implants. There is an excellent chance that with cochlear implants your dynamic range will expand again and you will be able to understand speech. Unfortunately, cochlear implants don’t usually give people good music appreciation since they were designed for speech intelligibility, not music appreciation. However, some people do very well in their appreciation of music.
And of course, learn to speechread. Practice speechreading so that you can see what people say when you can’t hear them or can’t understand them. Quite often what you hear is difficult to speechread and what is easy to speechread is difficult to hear, so your brain puts both together and often you have a good understanding of what a person is saying. I’ve been speechreading since birth and I would never want to be without it.
Cordially,
Neil
Originally from over use of sinus, pain relievers, and then after a hernia operation with more pain relievers and anesthesia became much worse and now it seems to be from noise as well. Hearing aids seemed to make tinnitus worse. I’m now content to accept the fact I cannot hear well and have stopped looking for a cure. I do have one question no one seems to answers. My first reason for having hearing examined 7 years ago was that one morning when I struck a tuning for in preparation for tuning a piano it sounded like two notes instead of one which I knew was impossible for a tuning fork. It sounded like the fundamental note A-440 plus one octave lower. When striking a single string harmonics always are higher…not lower. I now realize that must have been distortion. It’s been that way ever since. I don’t see how any external aid could correct something origination internally from my own head. Recently I listened to a tuning fork and heard the distortion louder than the note. I’m also wondering if hearing aids amplify harmonics. If I strike the lowest “C” on a piano I hear “A#” one step below middle C which is the 7th harmonic. I know everyone could hear that if they listened, but with hearing aids that as well as other notes are louder. I’m not expecting a cure for this, but have noted it’s a subject not discussed. I’ve attempted to inform my son about the various types of hearing loss because he has had several customers call to have their piano tuned and has recognized their signs of hearing loss. Of course some believe him and some do not. The ones who have had their hearing checked found he was right.
Hi Clayton:
The drugs you have taken over the years can not only give you hearing loss and tinnitus and other ear problems, they can also mess up your hearing so you hear things the way you do now.
What you have is diplacusis where you hear a sound twice–either different in time or different in pitch. I’ve written about this subject at http://hearinglosshelp.com/blog/diplacusisthe-strange-world-of-people-with-double-hearing/ You may find it fascinating as well as frustrating.
You may also be interested in my article on when you hear music at the wrong pitch at http://hearinglosshelp.com/blog/when-you-hear-music-in-the-wrong-key/ and the links in this article and the comments under it.
You are correct in that a hearing aid cannot change what you brain “hears” or how it perceives sound. You can expect a hearing aid to make sounds louder, and fancy ones can filter out a lot of low-frequency background noise, and compress sounds so the range from the softest to the loudest is reduced to better fit your reduced dynamic range. That’s about it.
Cordially,
Neil
Thanks for your informative information. I’m thinking of writing a short summary of the various hearing problems which would enable my son to help customers who call to have their piano tuned. He may be the first person to observe signs of hearing loss. I used to presume it was my tuning or the piano itself, but as I look back there were many occasions indicating the customer and I had no idea they had a hearing problem. This leads to the question how do you inform a person they have hearing loss, but do not want to admit it. He’s dealing with a few now including very advanced musicians as well as two piano tuners who should quit.
Hi Clayton:
It’s difficult to get through to a person who denies they have a hearing loss, especially us men. The first thing you don’t do, especially with men, is say that you can’t hear. You see, they know that’s a lie, because they do still hear a lot of sounds, especially if those sounds are low frequency sounds.
This is because hearing loss typically starts in the high frequencies and works down the frequency spectrum. At the same time, the high frequency sounds are typically quite soft sounds in the first place, so you don’t have to lose much hearing in the high frequencies to not be able to hear that well.
Unfortunately, it is these high frequency sounds they give speech most of its intelligibility. Thus when you have a high-frequency loss, you can still hear quite well because you hear the low frequencies, but you can’t understand what a person is saying because you can’t hear the high frequency sounds that make the speech understandable.
In contrast, the low-frequency sounds are typically louder sounds and because you don’t lose much hearing there, it gives you the impression that you are hearing well. That is why they deny they have a loss.
Thus you have to change your tactics.
One way is to ask the person whether they’ve noticed that they’re having more difficulty understanding speech when it’s noisy around them. If they say “yes”, then you know they have a high-frequency loss and you can explain what I just said above. that way you are not telling them they can hear, but they can’t hear everything anymore. That softens the blow, and hopefully they can see what you’re saying.
At that point, your son, if he is working on a piano, could play some of the lowest keys and have them note how loud they are. Then play some of the highest keys and ask them how loud they hear them in comparison to the low-frequency keys. If they have a severe high-frequency loss, they might not hear anything and that will shock them.
If they say they hear it only half as loud, or a quarter as loud, that again demonstrates that they have a fair amount of high-frequency hearing loss.
It is at this point that you can then suggest they might want to have their hearing checked and just see whether what you have said is true. Some will follow through, and others will just plain deny it, even though it’s as plain as the nose on their face that they can’t hear well. At that point you’ve done all that you can do.
Cordially,
Neil
I have moderate hearing loss in both ears. I know I have some form of recruitment, hyperacussis, phonophobia along with severe tinnitus. (MES and multiple T sounds). I’m extremely sensitive to high pitch sound like price scanners, alarms etc. I fear any loud sound too. I’ve worked full time in a mill for the past 30 years in which some areas are 90 decimals. The area I’m in now is around 70 decimals, but the paging system is 83 Decimals, way out of my comfort zone,,,, so I wear hearing protection most of my 40 hours per week. I also wear earplugs in all stores, in heavy traffic,,, basically all the time. I only wear my hearing aids when I’m at home or a few hours elsewhere, and never at full volume. Human voices sound very gibberish to me. I’m constantly on guard for any loud sound to happen, fearing that my tinnitus will go out of control. (Which it does all the time anyway) How do I get over the fear and not see sound as my enemy? I also need 3 crowns done soon or I will lose those teeth. Thanks, Julie
Hi Julie:
Living with hyperacusis and phonophobia is not easy to say the least. The good news is that you do not have to put up with it. You can do things to get your life back to close to normal if not completely normal again. However, it will take time and a lot of work and effort on your part.
A good place to start is to visit a good tinnitus and hyperacusis center that also treats phonophobia. The Hyperacusis Retraining Therapy (HRT) should really help you.
Cordially,
Neil
Could a future cure for hearing loss cure recuitment in the future?
hi Susan:
Since recruitment is a function of a sensorineural hearing loss, if they find a cure for hearing loss, theoretically that would also fix the recruitment.
Cordially,
Neil
Dear Dr. Bauman,
Thank you for being so responsive to all of these questions! I do have sensorineural hearing loss. My left ear “went” ten years ago, but I had excellent hearing in my right ear and got a BAHA which worked well. However, hearing in my right ear has begun to drop. The loss was kept at bay for a year with high doses of steroids and then methotrexate, with the occasional intratympanic injection. All of those options have taken their toll, and my hearing seems to have settled in the moderate hearing loss range—with a dose of mild to moderate recruitment. I teach at the university level, and have been able to get by with my hearing aids (both ears, no more BAHA) but in meetings or out to dinner, the sound gets to be overwhelming. Might any of the retraining techniques for hyperacusis work for my recruitment, or am I just stuck with this situation?
Hi Carol:
Theoretically, the techniques for treating hyperacusis can also work for recruitment, but I’ve never found anything that fixes my recruitment. It’s always there.
If you can set the compression on your hearing aids enough, theoretically, you could keep all sounds below your recruitment level for each frequency. Then nothing should get so loud it hurts, but you may not understand much speech either as the more compression you have, the poorer your speech discrimination becomes.
I use a two-pronged approach. Use compression (hearing aids) when it is not too noisy and the aids help me hear and don’t make my recruitment too severe.
When it is noisy, off come my hearing aids and I use assistive listening devices and microphones that capture speech without all the noise. This means you have to be close to the speaker for this to work. For example, in noisy convention halls or in the hotel hallways between sessions it gets pretty noisy. If I want to talk to someone in such places I use my PockeTalker and super directional microphone–hold it about waist high and aimed at the speaker’s mouth. I hear very well with it and never get headaches from recruitment either.
You can see the PockeTalker I use at http://hearinglosshelp.com/shop/pocketalker-2-0/ and the super-directional microphone’s link is there 4 links from the bottom of the page.
The deal is to be flexible and find what works for you in any given situation. Hearing aids alone are not the answer no matter how much audiologists tell you otherwise.
Cordially,
Neil
Thanks so much. I hadn’t thought about using a PockeTalker in crowded and noisy situations. I tried in early on in my hearing loss and didn’t know how to use it; I found it really overwhelming. I’ll go back and try it again. I’m also in line to demo a Roger Pen, which will help me in the classroom. Thanks again.
Actually, on second glance, I didn’t have the PockeTalker 2. I had a similar (and less effective) device. That looks really promising, especially with the various microphones and devices. Thanks so much!
Hi Carol:
The PockeTalker Pro and the PockeTalker Ultra–the two previous models all work just as well as the PockeTalker 2 if you use my two favorite microphones–the super-directional handheld one and the lapel one. I used them with both the previous models and loved them.
The secret is using those microphones rather than the microphone that came with the PockeTalkers.
Cordially,
Neil
Hi, thanks for this website.
I have normal hearing. However when trying to sleep and only when trying to sleep (naps or bedtime) I experience a few moments of recruitment where a small noise is amplified 2-3 times, such as my breathing or any random clicking noise. It is quite bothersome, but does not always occur. It started about 6 months ago.
I have also experienced Exploding Head Syndrome. This abated when I enacted a healthier sleep routine.
Thank you
Hi Steve:
It is quite common when you are just falling asleep to perceive sounds louder than they really are–exactly like you describe–a clicking sound will seem a lot louder. I think this is perfectly normal. It happens to me from time to time. It seems there is a “Goldilocks” zone just before you actually fall asleep where certain sounds seem so loud the startle you awake.
Cordially,
Neil
Hi Neil,
It’s been great to read your advice and wondered if you could help with a problem I have started experiencing. About 2 months ago I started hearing a high pitched whistling sound in my right ear. The whistling gets modulated by any external sound. For example, my own voice causes the whistling to get louder and softer. The louder the external sound,the louder the whistle. I have hearing loss and I have suffered from tinnitus for several years, but this problem is much worse. If I am in noisy environment my right ear is very uncomfortable. It seems like a cross between tinnitus and recruitment. I also find that if I clench my jaw on the right side, the whistling gets much louder. So I wondered if it was bruxism. Any help or ideas would be really appreciated as right now I am in misery and avoiding social situations.
Hi Anthony:
What you are experiencing is called reactive tinnitus. Your tinnitus “reacts” or gets louder when you are around louder sounds. What this means is that you have both tinnitus and hyperacusis. It is the hyperacusis that makes your tinnitus seem louder. You would do well to read my article on “Reactive Tinnitus” at http://hearinglosshelp.com/blog/reactive-tinnitus/ . This article explains what reactive tinnitus is, and what you can do to bring it under control.
Cordially,
Neil
Thank you for the article on recruitment.
All started with a loud hiss at 12700 Mhz 4 months ago overnight.
After two months of tinnitus now I have a fuzz effect on hight frequency, some sounds seem to pass through a metal tube, and some sounds like, hair dryer, flowing water, trigger my tinnitus generating a sort of larsen effect.
The audiometric tests are good, only a small loss of 6000.
My doctor says that I don’t have recruitment, because a strong hearing loss is required.
So my questions are these:
1) the audiometric test i did has a max test value of 8000 and not 12000 hz, how does the doctor say that I have no hearing loss on 12.000?
2) I’m a musician, and this metallic distortion is driving me crazy, it gets worse on very low notes and very high notes, is there any chance of improvement in the future?
Is there anything I can do to get out of this hell?
Thank you in advance for your kindness
Hi Raffaele:
That’s 12,700 Hz, not MHz. I’m sure you know that and it was just a typo.
1. You are right that your doctor doesn’t have a clue what your hearing is at 12,000 Hz because he never tested you at that frequency.
He’s also wrong is his statement about recruitment. I can show you mathematically that ANY degree of sensorineural hearing loss causes recruitment. However, it may not be noticeable until you get a more significant loss, so that is what he was basically saying.
You may not be experiencing recruitment, but more likely hyperacusis. Hyperacusis can result from exposing your ears to louder sounds–and most musicians do that regularly. Sound trauma can manifest itself in a number of weird ways
Musicians are much more sensitive to changes in their hearing and how they perceive sounds than most people.
I’d suggest that you keep the volume down to 75 dB or so. If it is louder, then wear ear protectors. Over time, your ears may revert to working normally again if they are not exposed to loud sounds. This can take a number of months, so don’t be impatient.
Note, there is a fine line you tread between over-protecting your ears and not protecting them enough. So only wear ear protectors when you need to, not when the sound levels fall below 80 dB or so. Have you tried wearing musicians ear protectors when it gets louder? They let you hear the full spectrum of sound normally, whereas typical ear protectors filter out more of the low frequency sounds but leave the highs, giving you distorted hearing. That’s fine for a factory worker, but not a musician.
Cordially,
Neil
Neil, I thank you very much for the answer you gave me. You gave me some hope, maybe one day this bad problem will go away. I forgot to ask you if the TRT with pink noise can help me. (the white noise makes the situation worse). Thanks
Hi Raffaele:
Are you taking a proper TRT program? I thought they only used white noise. Neuromonics uses more agreeable sounds. But if you want to use pink noise instead of white noise, I don’t see any reason not to. After all, its supposed to be neutral to hear, not aggravate you–or it won’t do the job it’s supposed to do.
Cordially,
Neil
I was recently diagnosed with recruitment, at age 47. I have mild-to-moderate hearing loss in the high frequencies, difficulty hearing people clearly in crowded rooms, and pain in my ears at loud noises, especially at high pitches. I have seen two audiologists. It is helpful to have a diagnosis – it helps me understand why I now seem to go so frequently from telling my kids “I can’t hear you” on the one hand to “that’s too loud and it hurts!!!” on the other. But the audiologist who diagnosed me told me I am not a candidate for a hearing aid (presumably because the hearing loss is not acute?). I don’t know what to do. I am now sometimes using earplugs at home when the dog is barking, the kids are being loud, or the neighbor is using power tools in their yard. That has been helpful but it also further reduces my ability to hear normal conversation. I feel like there has to be *something* that could help me. I left the audiologist thinking, “All right, I’ve definitely got a problem, and I’ve been told there’s nothing I can do about it.” It’s frustrating. The pain also makes me irritable and cranky, which is no fun for my family. Any suggestions? Thank you.
Hi Bill:
How long have you noticed you had recruitment problems? Anything you can think of that led up to it–taking any drugs or medications, exposing your ears to loud sounds, etc?
How do you know that you only have recruitment and not also hyperacusis? Or you could have both at the same time.
I certainly understand how you feel as I’ve had recruitment basically my whole life and it is getting worse as I age–but then my hearing is dropping as I get older too.
I’m surprised your recruitment is so bad, given that recruitment is solely a product of a sensorineural hearing loss, and your audiologists say your hearing loss isn’t bad enough to even get a hearing aid.
I find that sounds only recruit WHEN I am wearing my hearing aids. Without them, I don’t notice any recruitment.
Any chance you can get a copy of your audiogram and email it to me? I’d like to see for myself what your audiological results look like.
Wearing ear protectors when around sound that recruit is one coping strategy–but you have to be very careful that you don’t overprotect your ears or you will make things even worse. This is because your brain wants to hear, and when you wear ear protectors, you cut down on the sounds your brain expects. It responds by turning up its internal volume in order to try to hear better and when you take the ear protectors off–now everything is too loud. So Just wear ear protectors when you absolutely have to, and as soon as you no longer need them, take them off before your brain starts monkeying with its volume control.
If you give me more about your hearing history and how this all started, I may be able to help you more.
Cordially,
Neil
I am a 21 year old female. For about a year I have had sensitivity to noise, tinnitus, and have difficulty making out what people say if they aren’t facing me or speaking loud enough. I finally was able to get my hearing checked but all my doctor said was that my ears seem fine though my hearing isn’t what it should be for my age and to come back in a year to check again. Since then, (about 8 months ago) the sensitivity has gotten worse, I keep having to ask people to repeat things, and sleep is almost impossible with tinnitus. I am seeing a new doctor tomorrow, recommded by my Primary Doctor, but I’m not sure what to expect. Should I be concerned that I have hearing loss, or could it just be hyperacusis?
Hi Rachel:
What happened a year ago that caused your sensitivity to noise and problems hearing people? Did you attend a loud concert, listen to earbuds set to loud, or what? It was almost certainly some kind of loud noise trauma.
Obviously you have a hearing loss because your “hearing isn’t what it should be for your age”. It isn’t a severe loss, but I’ll bet you also have some hidden hearing loss your doctor didn’t test for. All that makes it very difficult to hear and understand people when there is sufficient background noise present.
This loud noise also caused you to have tinnitus.
You should always be concerned when you get a hearing loss when you are so young. This hearing loss is almost certainly permanent and will only get worse if you don’t take care of your hearing in the future.
The tinnitus and hyperacusis are related to each other and are the result of the noise trauma that caused you your hearing loss.
Cordially,
Neil
Hi Neil,
Thank you for explaining what recruitment is as well as other types of hearing loss/issues. And kudos for taking the time to respond to comments. Please allow me to share the issues I am experiencing with my hearing. I was diagnosed at an early age with moderately severe hearing loss. For some unknown reason, I was only fitted with one hearing aid until I was an adult and was finally fitted with two hearing aids. Changed my life for the better! About 18 months ago, tinnitus became a constant presence in my life, and I had my ears checked by a specialist which revealed nothing new. Recently I decided to replace my 5yr old hearing aids as the newer ones had blue tooth capabilities as well as programs I could run for somewhat effective tinnitus relief. As it turns out, the new hearing aids cause me pain and discomfort, and despite repeated adjustments, the hearing aid dispenser has been unable to adjust my aids to improve my comfort level.
My experience from the outset of wearing these new Oticon Opn aids is that sharp sounds (and even my own voice when I speak certain words) cause discomfort. The dispenser would adjust the ranges in her office, and all would sound fine until I went out and about my day and again, certain sounds would cause discomfort. And at times it would vary. For example, I tried driving with a window open in the car, and most cars would pass me and sound normal, but others would cause discomfort. And then there would be times when I could not hear people speaking clearly, and I would
Hi John:
Years ago they thought you only needed one hearing aid–so that’s all you got. I only ever had one hearing aid until I was an adult and could afford to by two–just like you.
I have always had problems with wearing hearing aids when there are other sounds around as some are, as you say, too sharp and hurt, or too loud and hurt, etc. This is because we have recruitment.
Theoretically, if compression on hearing aids is set correctly, no sounds would recruit. However, in order to do that, you’d take a hit on the necessary amplification you need to hear “normally”. Hearing aid dispensers always seem to want to set the amplification correctly according to your audiogram, and to heck with whether you can stand the amplified sounds or not.
You need to compromise–reduce some amplification where it recruits, but at the same time lose some of the effectiveness of your hearing aids to help you hear/understand speech. That’s the trade-off.
What they need to do is set the compression for EACH frequency band at a level so that frequency of sounds won’t recruit. When they do this for each band, then sounds shouldn’t hurt anymore, but you likely won’t hear/understand speech as well as otherwise.
The way I do it is to make a reasonable compromise so my hearing aids benefit me in reasonably quiet environments, and take my hearing aids off in places where sounds still recruit. I don’t hear then, but sounds don’t hurt either.
You could have one program set for quiet situations and one for noisy places and have the compression set differently for each. That can work reasonably well too. I have two such programs, but I still have problems.
This is because the more severe your hearing loss, the narrower your dynamic range so the more compression you need and this can exceed the ability of your hearing aids to compress sounds that much.
Cordially,
Neil
Hi Neil,
You were very generous in an earlier response to my situation, and I am hoping I can ask for more of your insight.
To recap, about 6 weeks ago I had a loud noise incident that messed up my hearing to a degree that is noticeable to me, even though my audiogram is objectively normal (5db sloping down to 20 db at 4khz, then back up. Classic noise notch, though only a slight one). As my hearing is in the normal range, the ENT has not offered much help, and I was left with hoping that time would heal some of the injury.
I felt that things were improving for a while, or perhaps I was just adjusting to the shift. But then a week ago I had a sort of relapse – very strong tinnitus, a return of aural fullness, and a sensitivity to certain loud sharp noises (for example, my mom’s dog barking seems to piece right through me).
My first guess is that living in a loud city, and being in noisy environments like grocery stores and subway stops, has prevented my ears from sufficiently “resting”. I am afraid now of further damage, as some research has found that nerve connections continue to degenerate for weeks after trauma.
It is also said that recruitment differs from hyperacusis in that it only makes certain sounds too loud (corresponding with one’s hearing loss frequencies), while hyperacusis makes all sounds too loud.
My questions:
Is that true? And if so, will I suffer recruitment forever? I am still a relatively young man.
Does the return of aural fullness mean additional damage? Is there anything I can do for this symptom, perhaps a potassium-sparing diuretic?
Does this shift in symptoms, from improving a bit to getting worse again mean that I should intervene with a steroid, or perhaps even HBOT?
I understand the permanence of sensorineural loss, but if there are still nerves in there trying to survive, I want to help them. I am taking high-absorption Mg, Taurine, NAC, curcumin, CoQ10, DHA, and a few other vitamins, just in the off-chance they have even a small effect. I also considered getting attenuated ear plugs for noisy environments, although I’ve seen you say that one has to be careful not to overprotect the ears.
Sorry for so many questions. I know that many other people deal with worse losses than mine, but I still want to do whatever I can to have the healthiest hearing possible and mitigate any damage. Thank you for your time and for all that you do on this informative website.
Hi Dean:
It is true that nerve connections (synapses) can be broken with sudden loud noise and some of them reconnect. Those that do no reconnect, then die and so does the hair cell it is attached to. Thus for a period of time you hearing can get worse from that one incident. This is called hidden hearing loss. You can see my article on the subject at
http://hearinglosshelp.com/blog/hidden-hearing-loss/
Recruitment and hyperacusis are not the same. With hyperacusis you have a reduced tolerance to sound. This means that when they are loud enough, you hear them as much too loud. This is especially noticeable in the higher frequencies. Recruitment can happen whether you have a hearing loss or not.
With hyperacusis you don’t have a reduced tolerance to sound. And it only occurs in people with sensorineural hearing losses. With recruitment, sound growth occurs abnormally fast. Thus, if you ask me something and I don’t quite hear it, so I ask you to speak up a bit. You do, and I tell you not to yell at me. You just raised your voice a bit, but to me it seems like you are yelling because for every bit of increase in sound, I perceive it as much louder than it really is.
So, if you have a sensorineural hearing loss, you will have recruitment to some degree and it will last as long as you have a hearing loss.
Hyperacusis, with proper treatment and hard work on your part can be fixed, but it takes time–up to 2 years or more depending on a bunch of factors.
A return of aural fullness is usually a result of further exposing your ears to a sudden loud sound. You could have acoustic shock syndrome, or tonic tensor tympani syndrome–both of which can have aural fullness as a symptom. A diuretic isn’t the answer as there is no extra fluid in your inner ear. The problem is more related to your middle ear.
Personally, I wouldn’t do the steroids or hyperbaric oxygen. I’d just keep working on my hyperacusis program. It’s a setback, but not a permanent one. You just start again, but are a couple of steps down from where you were before the loud noise set you back.
Those supplements are all good for your ears. You want to take them in therapeutic doses however. For example, to help your ears, your NAC intake should be closer to 1,500 to 2,000 mg. An ineffective dose isn’t going to help. But you don’t want to keep taking it–just take it at that dose for a week or two right after you notice a change in your ears.
I’d take some zinc too–no more than 30 mg. I take zinc picolinate as it is the most bioavailable form of zinc. Magnesium threonate in the most bioavailable form of magnesium in case you are interested. I take both of these every day for ear (and body) health. I also take Ubiquinol, the best form of CoQ10.
You don’t want to overprotect your ears–but at the same time, if you under-protect your ears you’ll get setbacks–so you walk a fine line. Thus, wear ear protection when there is a high probability of loud noise and don’t wear them when the probability for loud noise is low. The rest of the time, don’t wear ear protectors unless you notice that the sound level is making your hyperacusis worse.
So that should answer all your questions.
Cordially,
Neil
Wow this explanation was just amazing. Thanks!
However I had one doubt though. In recruitment phenomenon, why is it that adjacent hair cells are recruited only after a certain dB (which eventually leadts to sudden increase in loudness or rather more specifically suddenly decreased threshold to loudness)? Since hair cells in a specific bunch or row are not functional or dead, shouldn’t the adjacent ones be recruited as soon as the damage is recognized?
Hi Zarna:
With recruitment, remember there is hearing loss. So as the sound gets louder and louder, you don’t hear it until it reaches a certain level–then wham–recruitment shows up. It doesn’t show up at a lower volume because at that point you can’t hear that sound.
Cordially,
Neil
I appreciate the clear explanation of these matters, but I do have one question.
I have been diagnosed with sensorineural hearing loss and the recruitment that comes with it.
My audiogram dips from 5-10 dB at 1500 Hz or less down to 20-25 dB from 2000 – 4000 Hz, then back up to 5 dB for higher frequencies.
Common things like shutting my car door too close to my ear or my work’s PA system can be painful. So my question is, are these formally normal, benign sounds actually capable of doing additional permanent damage to my hearing now? Has my safe dB level dropped lower than the standard 70-80 dB?
Hi Michael:
Good questions. The short answer is “no”–they will not hurt your ears. You see, with recruitment and with hyperacusis there is a difference between the REAL level of sounds that your ears hear and the volume at which your brain PERCEIVES that sound.
Damage only occurs based on the real sound levels, NOT on perceived sound levels–although those sounds may seem so loud that they hurt.
So let’s say a sound is really only 70 dB (which won’t damage your ears), but you PERCEIVE it as really loud (say equivalent to 100 dB), thus you wince and jump when it occurs and you may even get headaches from it, but it is still not hurting the structures in your ears. It only “hurts” in your brain.
Cordially,
Neil
Hi, can i know how and why hyper recruitment is seen in patients with Menier’s disease? Thank you
Hi Lana:
It’s not the Ménière’s disease that causes recruitment, but any hearing loss you get due to the Ménière’s disease. Typically the worse the hearing loss, the worse the recruitment.
However, you may not have recruitment so much as have loudness hyperacusis. with hyperacusis, you don’t even need any hearing loss, whereas recruitment is a function of a sensorineural hearing loss.
If you explain your symptoms in more detail I should be able to help you determine whether you have recruitment or hyperacusis.
Cordially,
Neil
Greetings Neil, I would like to sincerely thank you for taking the time to offer some clarity into this phenomenon with the human hearing system. I will try and simplify my story as much as I can. My daughter was born with connexin 26 deafness. She was diagnosed at age 5yrs and now 18yrs, it started of as a mild to moderate loss and has progressed to moderately severe in both ears. So far hearing aids have supported her hearing.
The last 5 yrs she has become a drummer in her own band not fully protecting her ears until recently with musicians ear monitors. Fully protecting them with ear plugs would not allow her to tune into the bands instruments. Unfortunately there was one performance for one hour that the sound guy could not set up her ear monitors properly that she did not protect her ears but took out her hearing aids, my husband and I were not aware of this sadly. The next day she noticed a change with her hearing it became sensitive to loud sounds and also developed tinnitus the following days, this has been going on and off for a year and no doctor we have dealt with has any extensive knowledge about this topic.
Would this be hyperacusis or recruitment? or both? I am getting an mri this week because her doctor has found it unusual that tinnitus is only present in one ear, she was fine before that performance…
How long does the process of recruitment take? I ask because I had a bad cold, my right ear plugged up, and after it unplugged, it had a deficit of 25 dB at 6khz and 45dB at 8 khz compared to the (normal) left ear, but after 2-3 weeks, my right ear had fully recovered at 6khz, and at 8khz, the deficit had decreased to 35dB. Can recruitment work in that short time span? Thank you.
Hi Anthony:
I’m not sure what you are driving at. Recruitment is not a process–basically it is instantaneous–you have a sensorineural hearing loss–you have recruitment to some degree or other, whether you realize it or not.
In your case, it seems you got a cold virus that attacked your inner ear and gave you some permanent sensorineural hearing loss, in addition to the temporary conductive loss you had while your ears were clogged up. Fortunately, you recovered most of your sensorineural loss, but you have a permanent high-frequency loss in that ear.
Cordially,
Neil
Thank you. You answered my question: recruitment is instantaneous, not a lengthy process like I was assuming.
Greetings Neil, I would like to sincerely thank you for taking the time to offer some clarity into this phenomenon with the human hearing system. I will try and simplify my story as much as I can. My daughter was born with connexin 26 deafness. She was diagnosed at age 5yrs and now 18yrs, it started of as a mild to moderate loss and has progressed to moderately severe in both ears. So far hearing aids have supported her hearing.
The last 5 yrs she has become a drummer in her own band. She was not fully protecting her ears until recently with musicians ear monitors because fully protecting them with ear plugs would not allow her to hear the bands instruments. Unfortunately there was one performance for one hour that the sound guy could not set up her ear monitors properly that she did not protect her ears but took out her hearing aids, my husband and I were not aware of this sadly. The next day she noticed a change with her hearing it became sensitive to loud sounds and also developed tinnitus the following days, this has been going on and off for a year and no doctor we have dealt with has any extensive knowledge about this topic.
Would this be hyperacusis or recruitment? or both? A doctor has found it unusual that tinnitus is only present in one ear and therefore would like her to do an mri, she was fine before that performance…could one unguarded performance cause this? Sincerely Faii
Hi Faii:
It sounds like your daughter now has hyperacusis due to the noise trauma she experienced. It is not unheard of to have tinnitus in one ear and not the other from noise exposure. Typically, unless the noise comes “head on” and hits both ears identically, one ear can absorb more sound than the other, and thus have tinnitus and not the other.
Personally, I doubt the MRI will find anything. But it is not without risk as they are loud, and loud sounds will just make things worse. She will need to wear both ear plugs and ear muffs over them (and not have any music blasting into them like some places do). So you want to take this into consideration.
And to answer you final question, “Yes, just one unguarded performance can cause this.” That is why it is always so important to protect your ears at all times when around loud noise. Remember, her ears are already damaged–so each additional noise exposure causes more and more noticeable damage because she has fewer and fewer hair cells left to damage.
I’d recommend she abstain from any performances for a couple of months and let her ears heal. Loud sounds will just set her back each time they occur. The trick with hyperacusis is to protect your ears from loud sounds, but not overprotect your ears from normal sounds. She needs to wear ear protectors whenever she is around sounds that are loud and take them off as soon as the noise passes.
Cordially,
Neil
Thank you so much Neil, I am very grateful for your thorough reply, I will definitely bring this forward to my daughter.
Hello dr Neil
So I have had the whole heartbeat in my ear noise for about a year plus some. I had a np look at it. She said there was to much wax to see anything. So I tried the mineral oil drops etc. nothing is taking it away. Please help.
Hi Jess:
If you have excessive wax in your ears, then see your doctor or ENT and get them to take it out. Then see whether you still hear your heartbeat in your ears.
Cordially,
Neil
Hi Neil, Thank you for your article, I found it really interesting and insightful.
Approx. 14 months ago, my husband was diagnosed with tinnitus and put on low dose anti-depressants to see if they helped. After 6 weeks and no improvement the gp changed the diagnosis to Hyperacusis. His main symptom was and still is pain and ringing after an unexpected high pitched noise – our 5 year old daughter shrieking in excitement is the cause about 90% of the time. When she makes this noise during generally loud rough-housing with my husband it doesn’t seem to cause problems. Pre diagnosis, he had a hearing test which diagnosed mild hearing loss at particular high frequency levels, but no other hearing issues. I am wondering if you think recruitment could actually be part of the problem? He also suffers with severe pain in one particular tooth when he is either stressed or suffering “post – shrieking” symptoms. My thoughts are that there could be a connection there?
Regards,
Deirdre
Hi Deirdre:
I would say your husband really is suffering the effects of Acoustic Shock Syndrome–the loud unexpected shrieks from your daughter close to his ear. This can produce the pain he feels, coupled with tinnitus, hyperacusis and maybe Tonic Tensor Tympani Syndrome. These conditions can all be intertwined.
It takes time for the pain to go away and things return to normal. But if, in the meantime, he has more episodes of loud, sudden sounds, that just sets him back.
I’d suggest that before he does the roughhouse stuff, he puts foam earplugs in his ears to cut out as much of the shrieks as he can. And this is important, he needs to take the ear protectors out as soon as the roughhousing and shrieking is over.
Facial pain and ear pain can all be inter-related, but so far, I’ve not heard of tooth pain being part of the mix.
Cordially,
Neil
I am very sensitive to amplified bass music, but if the music does not use an amplifier (direct from a piano, tuba, bass, or tympani) it does not hurt or bother my ears. Could this be a result of recruitment? I’ve not had a hearing test, but I know I often listen to things at home with a little higher volume, except when there is a heavy bass in it.
Hi Kirsten:
Good question. It could be due to recruitment, but I rather think it comes from some degree of hyperacusis–what I am calling amplification hyperacusis. This is because amplified music typically is manipulated so it is not the same as natural music directly from instruments. If they put too much energy into certain frequencies and thus make them too loud, it causes your hyperacusis to kick in.
I find this with wearing hearing aids. Sounds that never bother me no matter how loud (within reason) can bother me enormously when I hear them via my hearing aids. I think the same principle holds true with you and amplified music (and maybe certain other sounds).
Cordially,
Neil
How can you tell the difference between recruitment and menieres syndrome? Will having a cochlear implant help overcome recruitment issues? I have a severe bilateral sensorineural hearing impairment which was diagnosed at age 4. I’m now 39 and have struggled with vertigo and dizzyness in my right ear as a result of changing over hearing aids 10 years ago. I still haven’t managed to get to the bottom of this as everyone seems clueless. 3 months ago my left ear started with extremely loud tinnitus and feels blocked. At the momnet I have no idea whether they are separate issues or linked.
Interestingly your article on menieres mentions neck pain at the base of the brainstem. I have suffered neck ache for a significant while now as well.
Hi Nicky:
Recruitment is when you have a sensorineural hearing loss and sounds rapidly get too loud. Meniere’s has four symptoms– periodic episodes of fluctuating hearing loss, vertigo, tinnitus and feeling of fullness in your ear.
A CI can help with recruitment, but it can take time.
It sure wouldn’t hurt to be checked out by an upper cervical chiropractor. That may be the cause of your dizziness/vertigo.
I don’t see the connection between the hearing aid 10 years ago and the dizziness/vertigo. Do you think it is connected, or was it coincidental? And why?
What happened 3 months ago that might have caused your tinnitus to spike?
Cordially,
Neil
Hi Neil,
Thanks for your response.
I’ve never had any issues with Vertigo and dizzyness in my ears until i changed over the hearing aid. Even when I switched from analogue to digital I just had a period of adjustment but no dizzyness. The only other events are that I started flying long haul more frequently from 2007 onwards.
My right ear has repeatedly given me sound induced vertigo and dizzyness that I simply haven’t got to the bottom of. I managed to get my aid in but on a very low volume for a few months then
About 6 months ago I suffered from a virus which made me quite ill and gave me vertigo attacks and tinnitus made worse by using the hearing aid in the right aid. Again I gave up on it and struggled with one aid until about 3 months ago when suddenly the sound in my left ear went muffled and distorted and I started with roaring tinnitus which was loud enough to drown out all sound that I heard. My ear also felt full…like it needed to pop and I started suffering with covid like symptoms so presumed it was covid and would resolve. 2 months on it hasn’t and I have been given a variety of antibiotics from the doctors and am currently using steroid nasal spray. I have also been given an urgent ent referral but in light of covid I have no idea when I will be seen. I am unsure at the momnet whether my left ear is a temporary eustachian tube dysfunction issue which will resolve in time or whether it is linked to the right ear issues which are much more long term.
I was prescribed betahistine 48mg/day but havent seen any improvement…..there are mixed reviews as to whether they are effective. My last GP suggested they aren’t.
Hi Nicky:
When you have sound-induced vertigo/dizziness, that is called Tullio’s Phenomenon and is typically caused by a “third” window into your inner ear besides your oval and round windows. Often it is a hole (dehiscence) in your superior semi-circular canal causing this. This condition is called Superior Canal Dehiscence Syndrome.
Have you ever been checked out for this (or related “third windows”)?
Three months ago when your left ear had problems, you had an active virus in your body at that time–correct? If a virus gets into your inner ear, it can cause also sorts of problems including hearing loss, tinnitus, vertigo and other balance problems, ear pain, etc.
Have you ever been to a hearing and balance clinic where they can check for vestibular function? Something else to consider.
Betahistine can work, but it has to be prescribed for the right problem. It may not be the right thing for you at this time.
Cordially,
Neil
I’ve just been diagnosed with this. I had radical mastoidectomy and was rebuilt with bioglass. And recently certain noises have suddenly become unbearable. In the car with window open is an horrendous noise i get a static sound with certain letters like “ss” words even when I talk they’re just awful for my ears. I stopped wearing my.hearing aid being in a busy place has been difficult. I’ve noticed particular sounds make it 10x worse like kettle boiling, noise of wind through a open window of car, crisp packets rustling etc. Today a sound therapist told me she noticed something on my last 2 hearing tests and from what I’ve been complaining about. I have to wait to get updated hearing aids and she said she can help me
I have been diagnosed with recruitment, and the implant process is daunting. 8 weeks to activation, and 8 more before speech recognition. Then 12 to 18 months to differentiate words satisfactorily .
Is this normal?
Bill
Hi Bill:
I don’t understand. Everyone with a sensorineural hearing loss, which includes 90% of hard of hearing people, all have recruitment to some degree or other. So that diagnosis doesn’t really mean anything.
And having recruitment has nothing to do with getting a cochlear implant. You get an implant because you can’t hear. When your hearing improves, your recruitment reduces.
I don’t know where you get these statistics. Most people only wait 2 to 4 weeks for activation. The activation period is getting shorter and shorter. Some are activated after just 1 week.
Speech recognition varies. Many people hear and understand speech the day they are turned on. Many other people take longer, much longer in some cases. Most of it has to do with your auditory memory and how long its been since you basically couldn’t hear much. If you lost your hearing last month and then get a CI this month, you’ll probably understand speech from the get go–or certainly in less than a week. If you lost your hearing 50 years ago, then expect it to take a lot longer and not be as successful.
You should have functional hearing long before 12 to 18 months. But your hearing will keep on improving for at least 5 years or longer. The more you practice, the faster you improve. Again, it depends on your auditory memory and how long you were without hearing.
Cordially,
Neil
Thank you! You are very encouraging. I suspect The Dr. who made those comments is an intern with little experience in Dx or treatment. One comment was, “…if it is recruitment…”. I take it from you that recruitment is lot more common than I was inclined to believe.
Bill
Hi Bill:
Recruitment is very common–but it may not be very noticeable if you have a mild to moderate hearing loss. But with severe/profound losses, it is typically very noticeable. To put it succinctly, all recruitment is that you perceive sounds getting too loud too fast. So unless you complain about it, doctors think you don’t have it. And also, doctors frequently mix up recruitment with loudness hyperacusis and sometimes use these terms interchangeably which is totally wrong. Furthermore, you can have both at the same time.
Cordially,
Neil
Neil, thank you for your continued interest. Yes, I have been covering my ears any time a fire or police siren is in the same block for 30 years. I am 82.
I use a “speech-to-text app” that skates close to privacy issues, so the following has been edited, no names, gender, or location. This is what the Dr. said:
“That’s the tricky part. Your amount of sound sensitivity. Let me rephrase that. The level of loudness where you are sensitive to sounds is almost exactly the level that you raised your hand for the softness level of speech.
So you’ve raised your hand for the soft beeps. Then I tried to present the words, a little louder than that. Just, just barely louder. Okay. And, and that was not tolerable. So, you have, what is probably called recruitment. It’s a fancy way of saying the inability to tolerate loud sounds that are close to your
okay no you understand that, so
your range is very small, from softest sound to tolerating sound is very, very small. Hearing aids are meant to make things louder. And if you’re not able to tolerate it being louder.”
Based on what I have learned from you, and others, I suspect the Dr. is painting a worst case scenario. I am much more comfortable now with an implant on the horizon.
Thanks again for your interest.
Bill
Hi Bill:
According to what the Dr. told you, you have a very small dynamic range–that is, from the softest sound you can hear to the loudest sound you can stand. If you dynamic range is less than 10 dB, then hearing aids can’t help you because they can’t squeeze all sounds into a 10 dB dynamic range. For that you’d need at least 15 dB of dynamic range and even that is very small.
A cochlear implant may help you to greatly expand your dynamic range again–but it can take time.
Cordially,
Neil
My 8 year old was prevented from complying with her MRI scan on Monday. This was due to the initial sound of the sequence that was going to look at her hearing apparatus. I knew certain sounds “hurt” her ears with or without hearing aids but this finally explains the mechanism behind it in very simple terms. Thank you kindly for sharing your knowledge in an approachable manner.
Thank u for the explanation doctor
But i have a question which kind of hair cells recruit the adjacent ones ? The outer or the inner hair cells
And why ?
I mean can u explain further details about the fact that this phenomenon is usually caused by outer hair cells damage .
Hi Farah:
Good questions. I’d never thought about it, but thinking about it, I’d say it is the inner row of hair cells, not the outer 3 rows. I say this because the outer hair cells don’t send signals to the brain. Rather, it is the other way round–the brain tells the outer hair cells which sounds to amplify and which to suppress. In other words, they do some sound processing before the sound signal is sent to the brain.
Since it is only the inner hair cells that send sounds to the brain, and they send these signals in critical bands, it has to be the inner hair cells that cause recruitment. That’s how I see it.
Cordially,
Neil
Thank you for this marvellous explanation. I have very recently realised that I may have hearing loss but couldn’t see how that was possible because I am super sensitive to ‘loud’ noises. Something as small as a metal chair leg knocking against a metal table leg seems so loud that I jump out of my skin! My work colleague who made the noise with her chair looked at me as if I was mad or exaggerating. My son dropped a knife one inch onto the surface and the sound was painful. This article has confirmed to me that I probably have hearing loss. What I don’t understand its why I can hear birds sing but struggle to follow conversations because everyone seems to have a speech impediment?
Hi Debbie:
Based on what you have described, I don’t think you have recruitment. Rather, you have a different condition called loudness hyperacusis. In order to have recruitment you need a significant sensorineural hearing loss–and according to you, you don’t have one. However, you symptoms are explained from having sustained acoustic trauma (acoustic shock disorder) by having exposed your ears to (typically sudden) loud sounds in the past, such as going to loud concerts, etc.
Being super-sensitive to sounds when you hear sudden sharp sounds like you describe is a hallmark of loudness hyperacusis. These sounds are often painful because they seem so loud–but in actual fact, these sounds are not loud at all.
You also have “hidden” hearing loss because it doesn’t show up on a standard audiogram. When you have this kind of loss, you can hear the birds sing, but can’t follow conversations when there is noise or other talking at the same time.
When you expose your ear to loud sounds it doesn’t necessarily damage your ability to hear softer sounds such as the birds singing, but wrecks your ability to pick out and understand one person’s voice when there are competing sounds around.
In order to get your ears back under control in regards to loudness hyperacusis, you need to avoid louder sounds or protect your ears when around louder sounds. Over time, you can slowly expose your ears to louder and louder sounds to rebuild your dynamic range again. This process can take months or years, but you can succeed if you persevere.
I explain this all in much greater detail in my book, “Hypersensitive to Sound?” that you can get at https://hearinglosshelp.com/shop/hypersensitive-to-sound/ .
Cordially,
Neil
Thank you for your lengthy reply – I appreciate it very much. I’ve never been a concert goer and have taken care to wear ear defenders as a Police officer when necessary and when I used to ride a motorbike. However, in the last two years I’ve noticed that I can no longer hear my Garmin watch beep when running, I don’t hear the doorbell or my phone ring if I leave it in another room or I’m out and a big complaint of my son is that when I call out to him i don’t hear him respond until he shouts. I’ve always insisted that he doesn’t answer me but he insists that he does! I also cant follow conversation on the TV without subtitles or listen to the radio without headphones – what’s causing this?
Something else that is strange is this: if I see what is about to make a loud noise, it doesn’t sound too loud to me, it’s only too loud when it’s unexpected. What could cause this? Thank you so much for being so interested in all of our comments and questions
Hi Debbie:
You obviously have developed quite a hearing loss, especially in the higher frequencies. Have you had your hearing checked lately? It sounds like you need hearing aids.
You may be losing hearing from all the racket (sirens, etc.) when you are on the job. This could also be the cause of your hyperacusis.
When you see that a loud sound is about to occur, you subconsciously flinch and by doing so, your tympani tensor muscle pulls your hammer bone away from your eardrum so the loud sound isn’t transmitted to your middle and inner ears like it otherwise would be transmitted. This protects your inner ear from hearing loss.
When you do not anticipate a loud sound coming, obviously you do not flinch (until the sound occurs) and thus initially the loud sound reaches your inner ear and causes some hearing damage.
Cordially,
Neil
Hello Neil:
Fascinated by your article and the comments in the thread as I’ve been struggling to understand and, if possible, improve my hearing function in the past 6 months or more.
I am a professional musician playing clarinet and piano and I also conduct and teach. I have known for some years that I was probably experiencing some hearing loss and this was confirmed by an audiologist around 6 moths ago. He told me that my right ear had lost far more than my left and sent me for an MRI in case there might be a tumour present. I assume you may know about this issue. Happily, all was fine so I was just supplied with hearing aids. All the while my main issues, as a musician, were about perceived distortion of sounds and sounds seeming to be too loud. Strangely this varies day to day and even during the day. It is at its worst on days when I’m tired and I have entered a vicious circle or worrying about it and then not sleeping! The pandemic has definitely made things worse.
Each morning I check the state of play and play something on the piano. For a while I may hear fine but after a while or perhaps later in the day certain frequencies will be very difficult to tolerate. I have a particular issue with C sharp 2 octaves above middle C (1108 Hz)! Also, thick, loud musical textures almost hurt.
I had wondered if it might be Eustachian Tube Disfunction as performing the various blowing exercises including the use of Ottovent can temporarily improve matters. The audiologist said there were no visual clues to such a problem and I have not had any infections. I do have a sense of ‘fullness’ in both ears all the time however.
From what i describe would you have a suggestion for my best course of action? My docotr was not much help and didn’t think an ENT specialist would shed much light on it either. Hence my query here!
Many thanks in anticipation.
Best wishes,
Walter
Hi Walter:
Musicians run the risk of hearing loss and other sound problems–recruitment, hyperacusis, distortion, etc if they don’t wear ear protection when it is really needed. This is also true of conductors. Your ears can only adsorb so much “punishment” before they begin to “break down”. Thus it is always better to protect your ears so this never happens.
The reason for the MRI was to see if you had an acoustic neuroma on your right auditory nerve. It’s seldom the case, but they like to check anyway.
You have some degree of recruitment if you have a sensorineural hearing loss. Recruitment makes sounds seem to get too loud too fast.
At the same time, you probably also have loudness hyperacusis. Loudness hyperacusis is not related to hearing loss, but is caused by exposing your ears to loud sounds (the common case) such that you perceive louder sound and higher frequency sounds as being much too loud.
Since your sound sensitivity varies from day to day and is tied to your emotional state, no doubt you have loudness hyperacusis as your main problem.
Also, since you can start out the day with normal hearing and as the you play or listen to music for some time (hours) you begin to experience loudness recruitment, you have the “winding up” kind of loudness recruitment.
Higher frequency sounds are typically harder to tolerate because your dynamic range is typically compressed (collapsed more) in the higher frequencies.
Your Eustachian tubes can become involved, particularly if you have experienced acoustic shock.
This is a complex subject and there isn’t space here to fully describe what is going on and what you should do. Thus, you’d do well to get and read my recent book on the subject–Hypersensitive to Sound? I’d suggest getting the eBook version as the printed version costs far more to mail to the UK than the cost of the book itself.
You can get this eBook version (identical to the printed version) at
https://hearinglosshelp.com/shop/hypersensitive-to-sound/
Once you have read it, you will have a much better understanding of what you have and how best to treat it. If you still have questions, then, by all means, contact me again.
Cordially,
Neil
I’m 80 year old, have severe/profound sensorineural hearing loss, have worn hearing aids successfully for about 45 years, and haven’t had a serious problem with recruitment until I was recently assessed for new aids. Then I discovered what recruitment really sounds like! Do some aids cope better with recruitment than others?
In an earlier reply you suggested that a cochlear implant might serve better. Why is that? What are the pros and cons for someone of my age? I also suffer from imbalance caused by neuronitis which onset two years ago.
Hi Hilary:
If recruitment hasn’t been a problem for you all these years with wearing hearing aids and the new ones do, you probably don’t have a problem with recruitment at all. Rather, what you have now is called amplification hyperacusis (or hearing aid hyperacusis) and is due to your new hearing aids not being properly fitted to your hearing needs.
I’d go back and have your hearing aids properly fitted specifically to your hearing needs, and not by using the manufacturers algorithm which is set to the theoretical “average” person rather that to your specific needs. The result is that you hear some/many sounds as much too loud and this could largely be corrected by setting the compression by frequency and confirming things with real ear measurements (which not many audiologists do).
A cochlear implant may be better if your hearing loss is profound since hearing aids can only correct to about half your loss. So if you have a 90 dB loss, hearing aids could get you up to a 45 dB loss, but never up to 0 dB which is the theoretical normal. Cochlear implants can do better than that.
If you were happy with your previous hearing aids and unless you hearing has changed dramatically since you got them, your new hearing aids should be able to be reprogrammed much better than they obviously are.
That would be my first step. Then, if that won’t work, I’d consider a CI instead.
Cordially,
Neil
Thank you. Your replies have been very reassuring,
I had a sudden total unilateral sensorineural hearing loss five months ago. I have recovered about 30% of ability to perceive sounds. However the sounds are distorted — sort of like hearing a kazoo in my ear — so my ability to understand speech us much more limited. All sounds cone in at an abnormally high pitch and sounds such as loud speech or a siren or dog barking are painful . My otologist thinks this is due to recruitment. He thinks a hearing aid in the bad ear will reduce the distortion; I’m not sure. I am meeting with an sudiologist in five days to try hearing aid devices. Is there anything I should suggest to him.?
This basically drives me crazy and interferes with my hearing in my good ear because the kazoo noise from the bad ear is overlaid on top of the hearing in the good ear. Thanks in advance.
Hi John:
You have recruitment if you have a sensorineural hearing loss–which I’m sure is the cause of your hearing loss.
Like you, I am doubtful that hearing aids will reduce the distortion. Here’s why I say this. Think of an analogy of trying to see through a dirty window. Furthermore, this window is dirty on both sides. One side is accessible to you and the other side not.
You can clean and polish your side of the dirty window until it is spotless, but you still can’t clearly see through it because there is still a lot of dirt on the other side and you don’t have access to the other side. Thus, you may see a bit better, but not a lot better.
This is analogous to your hearing. You have access to one side–the outside–basically your outer and middle ear, but you do not have access to the inside–your cochlea, auditory nerves and the auditory parts of your brain.
So you can take the wax out of your ear canals, make sure your middle ear/Eustachian tubes are not clogged up, and wear the best-fitted hearing aids you can find, but you don’t have access to your cochlea with its dead/damaged hair cells and dead/damaged synapses. Thus, wearing hearing aids can only possibly help a bit but still have the distortion from the inside where you can reach.
Having said that, you can try hearing aids and see whether they make an appreciable improvement in your hearing distortion. However, even so, you may find they are of limited use because of your severe recruitment making amplifying any sounds problematic.
Furthermore, amplifying the kazoo sounds from your bad ear can just make it even harder for your brain to extract the information from your good ear. If this is the case, then wearing a hearing aid is counterproductive.
So, try a good hearing aid, but don’t feel you need to keep it if it doesn’t significantly help you and not just make sounds louder (and your recruitment worse, etc.).
Cordially,
Neil
I am 25, diagnosed three years ago with sensorineural hearing loss. Since the loss started, certain sounds at even speaking level will cause sharp pain and eventually I’m left with earaches all day. My family doesn’t understand why I ask them to turn the TV down when I’m supposedly losing my hearing. This explains a lot to me and hopefully to them as I won’t feel like I’m somehow faking my symptoms. Thank you
Hi Rachel:
Recruitment is no laughing matter, especially if you have a severe case of it. To others it seems incredible that ordinary sounds now give you ear pain and “blow the top of your head off”, but that is the way it is for some people. Other people have mild cases of recruitment that don’t bother them.
Cordially,
Neil
My husband tried wearing hearing aids about 12 years ago. After a couple weeks he turned them back to the Dr because they were more annoying than helpful. His chief complaint was certain instruments hurting his ears. Bass guitar and snare drum. He then saw a Dr at the UMS in Jackson, MS. and was diagnosed with recruitment. The Dr gave my husband no hope of getting help for his hearing because he said he could never wear hearing aids with recruitment. Sadly he has coped with this diagnosis all these years but recently his hearing has gotten worse making the recruitment worse when exposed mainly to the snare drum. He has even tried ear plugs and even though it reduces the sound somewhat he still gets a headache and has to leave the building.
I felt a glimmer of hope when I found your forum quite by accident last night while searching for some kind of help and hope for his condition.
You had a John Clark on Dec 9, 2018 discuss his issues. One of the things you told him was “Theoretically, if compression on hearing aids is set correctly, no sounds would recruit.” “What they need to do is set the compression for EACH frequency band at a level so that frequency of sounds won’t recruit.” Our question is, will the hearing aids help to not get the usual headache that ear plugs do not help? My husband has felt so isolated and that he was alone with his issues. Thank you for your website. Wish I would have found it years ago.
Hi SL:
It is quite common for hearing aids to make some sounds painfully loud. This happens when they are not set properly.
If sounds get too loud too fast this is recruitment. You should notice this whether you are wearing hearing aids or not. However, if you only notice that certain sounds are too loud when you are wearing hearing aids, this isn’t recruitment, but rather amplification hyperacusis.
His doctor is basically correct that if you have bad recruitment, hearing aids won’t help because there is only limited help for recruitment because it is due to dead hair cells and you can’t fix that.
In contrast, amplification hyperacusis is due, not to dead hair cells, but to the volume not being regulated correctly for your ears. This CAN be fixed if your hearing aids are set properly for how your brain perceives sound.
The problem is that audiologists want to set the sound to fit their hearing target (which theoretically is the proper volume you need), but that fails to take into consideration how your brain perceives sound. When there is a conflict, typically audiologists stick with their target saying that is the correct volume.
As a result, you can get headaches, ear pain and worsening of this condition.
If the compression on hearing aids is set band by band such that you do not perceive any frequencies as too loud, you shouldn’t have the above problems. Unfortunately, audiologists often insist that your hearing aids fit the target rather than what you perceive is a comfortable level, which is less than the optimal level you theoretically should have.
As a result, you don’t wear your hearing aids and thus get no benefit from them. If they would set the aids to your perceived comfort level, even though it is less than optimal, you will get some benefit from your hearing aids because you will wear them, especially in quieter situations.
Now to answer your specific questions. If your husband has true recruitment, and thus has to wear ear protectors when around certain sounds and still gets headaches, then probably hearing aids won’t be of use in such situations, but could be useful in other quieter situations.
However, you have to consider the level of the sounds. If they are truly loud sounds, say more than 90 dB, where everyone should be wearing ear protectors, you shouldn’t be wearing hearing aids, but stronger ear protectors.
In contrast, if the sounds that are hurting his ears are 70 dB or less and he still needs to wear ear protectors, I suspect he has loudness hyperacusis rather than just recruitment–or more likely, has both conditions. There IS help for loudness recruitment but few hearing professionals know much about it and how to treat it properly.
I wear my hearing aids in quieter situations, but typically not in louder situations because I get exactly what your husband experiences–headaches and ear discomfort. Thus I choose whether to wear nothing, wear hearing aids, or use other assistive listening devices depending on the situation.
If you want help, send me an email with his audiogram attached and explain in greater detail his hearing history, etc. My email address is at the bottom of every page on Center’s website.
Cordially,
Neil
i am medical student from india who is trying to understand recruitment . i read your theory and according to me it is miss explanation to unable to hear at low db . single is send by normal hair cell ( one time from own and one from recruitment band ) then this not work at low db
Hi Parth:
You can theoretically mathematically graph recruitment, but the problem is that not everyone perceives recruitment the same. It really bothers some people and not others.
At low sound levels, recruitment is so little that I doubt anyone notices it, but as the hearing loss increases, recruitment becomes more and more perceptible. So I basically agree with you that soft sounds basically have imperceptible levels of recruitment.
Cordially,
Neil
Wow I just now found your article. THANK YOU! This is so helpful. At age 40 I was diagnosed with Ménière’s after an episode of “sudden deaf”. I have a very high pitch tinnitus, and had severe vertigo, which is now mostly under controle. I am 66 now and two weeks ago I came home from visiting my family in The Netherland (I immigrated to Canada 2006). I had not seen them for 3 years due to COVID-19. Early into my 3 week visit, I noticed I was getting very irritable. There was noise everywhere, and a lot of it agitated me. I have a boisterous family and always loved being with them, only this time not so much. I tried to get some breaks from all the steady noise and all the talking, but never really managed. Due to the jet lag I did not sleep well either and it became a bit of a “perfect storm”. Since the onset of Ménière’s, after my hearing came back only not for a 100%, I have noticed a severe decrease in hearing. I also noticed sounds can drive me crazy, but this also depends on how I feel, how much energy I have. I struggled and still do with understanding speech. I can hear people talk, just have no clue what they are saying. I mostly guess and have become a good guesser. I was told hearing aids could be beneficial and help with understanding speech, but in the same breath it could also make sounds and coping with the volume of those sounds harder for me due to my sensorineural hearing loss. I did not understand that at the time, reading your article, now I do. THANK YOU. Since 4 years I am wearing hearing aids. My GP told me to get a hearing test, which as I already knew showed a severe hearing loss. I wear my hearing aids every day, and for the full day. It helps with understanding speech, but I still guess a lot, luckily I am good at it. What I do noticed is my decline in overall energy, I am more often tired, the irritability I feel when sounds become agitating noise, the sudden jolts when the dog barks, all kinds of noises can bug me, and then there is the sadness when my husband doesn’t understands that my hearing aids do not solve the problem completely. I hear him, I just don’t always understand what he is saying. Frustrating for us both. Once home from our trip to visit my family I was so extremely exhausted, and it worried me. I wanted complete silence, I graved silence and I could sleep for weeks. Instead I looked for information to find solutions. I found a lot on the internet that now makes sense to me, but your article on recruitment is kind of a “life saver”. It explains something about my hearing loss and also about my hearing aids I wasn’t really aware of. It also confirms I am still my social self, not really depressed, I just have a hearing problem. With the proper changes in place I can do better. So THANK YOU Neil for your insight and this explanation. I understand so much more now, and it will help me make my loved ones understand as well.
Hi Helma:
I’m glad you found this article so helpful. It’s nearly impossible for people that do not experience recruitment to understand what it like and how difficult it is to endure louder, particularly higher-frequency, sounds.
If you have Meniere’s disease, you can get rid of it quite readily if you know how–and unfortunately doctors don’t seem to know how. You can learn how to effective get rid of your Meniere’s in my comprehensive article on Meniere’s at https://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/
If your hearing aids are adjusted properly, they will severely limit the results of recruitment. I’m just trying out new Oticon MORE hearing aids and so far, I am quite impressed. Once I get them tweaked, I think I’ll be very happy with them.
Cordially,
Neil
My 3 year old daughter was born with a profound Hearing loss in her right ear and normal hearing in her left. She started showing a mild loss in her left ear around 6 months. By 2 years old, she needed a hearing aid. She currently has a reverse slope loss and hears around 60 decibels in the lower frequencies rising to around 20 decibels in the highest frequency. Our last audiology appointment was the first time I had heard them say her hearing looks like it may be stabilizing. However, recently she has started complaining about sounds being “too loud” that seem like they’d be lower frequency sounds that aren’t loud at all (like the dishwasher running.) She will hold her ears, look distressed, and yell “too loud!” Could this be what it is?
Hi Shanna:
Often people with reverse slope losses have hereditary losses–like runs in my family. One of the interesting things is that hearing drops fast in the first 4 years of life, then around age 5 it stabilizes and stays that way for the rest of your life (until you get older like I am where you lose the high frequencies with normal aging. So this is what may be happening to your daughter.
When she says sounds are too loud, you need to take action and listen to her because they she is perceiving normal sounds as extremely loud-so loud they hurt.
Were her hearing aids adjusted in the days just before she began complaining about the loud sounds?
Also, if she takes her hearing aid off, do the sounds bother her? I assume not.
If this is the case, she is suffering from her hearing aid not being adjusted correctly. I call this amplification hyperacusis. I’ve been in the same boat as she is for all my life. In fact, I seldom wore my hearing aids (for the past 69 years) because I perceived certain sounds as so loud they hurt, yet without my hearing aids, those sounds were just faint sounds that wouldn’t bother anyone.
The good news is that if her hearing aid is adjusted correctly, it won’t be a problem. The real problem is that audiologists test hearing and come up with a “target”. They set the hearing aids to that target and theoretically then she will hear the best she can. However, this ignores the fact that her brain perceives sounds differently and basically much too loud.
Now here’s the good news. I am currently trying out new hearing aids–and wonder of wonders, these aids can be set so NO sounds “blow the top of my head off”. But I have to work with the audiologist to get them set just right because only a little too much amplification at a certain frequency can cause a given sound to be horribly loud.
I was just at the audiologist yesterday getting the second tweaking and I’m pleased with the results. I can’t believe that after 69 years of wearing hearing aids, sounds can now be comfortable. I’m almost certain this is what is happening to your daughter.
Her audiologist has to forget about reaching the target and set the aids so NO sounds become so loud they hurt. Her audiologist may resist and insist that the target is what she needs to meet and that she needs to learn to accept that noise level. It may be theoretically true, but in practice that is NOT how it works out. If all you heard was someone yelling directly into your ear–how long would you put up with it? That is essentially what your daughter is experiencing. That’s how she is perceiving certain sounds.
It can be fixed now. It sure works with my new Oticon MORE hearing aids.
NEVER make her wear her hearing aid when she says “Too loud”. Either stop the offending sound immediately, or take her aid off until the sound stops, or move her to a place without offending sounds.
The difference between her and me is that I understand what is happening and can teach the audiologists what they need to do. Your daughter can’t. She just knows when she perceives a sound as being much too loud and complains. That’s how you know her hearing aid is not properly adjusted for her specific hearing loss.
Cordially,
Neil
Thank you so much for the reply. It definitely runs in my family. My dad and aunt were both born with a profound hearing loss in thier right ear, but unlike my daughter, did not develope hearing loss in thier left ear until adults due to age. My daughter has never liked wearing her hearing aid. We have been working on “increased wear time” per the audiologist recommendations. However, she usually pulls it out herself after anywhere from 20 minutes to an hour. Our audiologist says there is much more limitation on children’s hearing aid technology versus adult hearing aids. She wears a Phonak. I am definitely mentioning all this to her audiologist at her next appointment. Thanks again.
Hi Shanna:
There are several reasons why a person doesn’t like wearing hearing aids.
1. The hearing aids are uncomfortable to wear. For example, the earmolds and tubes can “burn” after a while so are extremely uncomfortable. Thus you take them off after a while. This has been a problem all my life and one reason I find it hard to wear hearing aids all day. This is a physical thing and nothing to do with sound. If this is the case, then try different mold materials or try domes. With my current hearing aids, things are better–I can almost at times forget I’m wearing them, but right now they are bugging me and I’ll probably take them off and rest my ears.
2. When you begin wearing hearing aids, you now hear too much sound. It can take your brain 90 days or so to adapt to new hearing aids. You can slowly get used to all these new sounds. If it is too loud at first, forget about the target and set the volume to a comfortable level (below target). Then, over time slowly raise the level to target as your brain adapts. If you can’t reach target, go as close to it as possible.
3. You have amplification hyperacusis. Your hearing aids need to be set so NO sounds go through the roof of your dynamic range no matter what volume it is. I think this is the hardest one to fix because audiologists are so set on reaching the theoretical target, and don’t understand you can’t get used to the pain of sounds that you perceive as too loud–even though they are not really loud sounds. This is not something you adapt to. You have to have the aids set right.
If you don’t meet all three of these conditions, no one wants to wear their hearing aids for very long if at all.
For me, number 3 is the most important, followed by number 2 then number 1.
Cordially,
Neil
After researching for many weeks, finally an article which might explain my symptoms, and even if recruitment is not my issue, I thank you for explaining it so well in terms of what can cause distortion.
I developed unilateral (left ear) tinnitus in Sept 2022, probably 11KHz, and a few months later the distortion started, plus slight sensitivity to louder sounds, e.g. a knife on a chopping board. The distortion was the left ear (responding to a piano note at approx 850Hz). At the time I had fullness of the left ear and trying to ‘pop’ it had no effect. In Feb 2023 started to get headache on left side, around temple but often spread wider than that. Still fullness of ear and now distortion in right ear at frequency six tones lower than the right. Had hearing test and left ear worse than right, -20dB down at 4KHz compared to the lower frequencies, but rose to -10dB at 6KHz and -55dB at 8KHz. Right ear was 0dB (4KHz), -30dB (6KHz) and -45dB (8KHz). Also, some speech distorting a little at times.
I had an MRI scan and clear, but an ENT consultant diagnosed ‘hyperacusis/recruitment due to distorted hearing’ going on to say ‘distortion hyperacusis with certain sounds and tinnitus’.
Roll on to Jan/Feb 2024 and both the distortion and tinnitus is getting worse, with say four or five occasions when suddenly (say overnight) the tinnitus became a lot louder and distortion far more prevalent in the left ear, e.g. most notes on a piano now, though some more than others, but also far more in the right ear. On each occasion it has got worse it has been associated with a left sided headaches and fullness to the ear (sometimes with popping to the left ear), yet everytime the ears have been examined, they have been normal and I have been told there is no eustachian tube issue. I have been diagnosed with some slight TMJ dysfunction. However, a year after the original hearing test, nothing has changed and in fact, maybe slightly improved. In fact, I can still hear perfectly okay so long as not above the threshold at which distortion occurs.
The most recent diagnosis is hyperacusis and tinnitus, rather than recruitment, but I am not sure. If I listen very carefully to the distortion, trying to ignore the note I am playing, it seems like it is a number of high frequency tones that are close to one another sounding at the same time. It seems to be the same distortion (e..g. pitch) for the different notes, but hard to be sure. Also, there is a threshold. Playing music, say below 70dBA, does not distort, but now more everyday sounds are distorting, e.g. radio, speech. Also, I do seem more sensitive (as in, creating discomfort) to more sounds now, but not pain as such and more of a shock response that clears in a second or two. As you could imagine, as a pianist, the distortion is causing significant worry and an ENT consultant said I could be in a vicious circle making things worse.
I also met a musician who said what I am describing is exactly what he had but his hyperacusis went (using sound therapy), which was great to hear, but I would love to get your opinion. Is this more likely to be hyperacusis or recruitment? I would rather the former as there is scope to recover, unlike, I understand, with recruitment. What do you think and is there any scope for things to reverse and improve.
Many thanks,
Phil.
Hi Phil:
Before I get into answering your situation, just a word of correction. On your audiogram, hearing loss BELOW the 0 dB line is a positive number and ABOVE it is a negative number. I know it is not intuitive, but that’s the way it is. So you show it backwards. Just show you hearing loss as 30 dB or whatever it is. Only people with exceptional hearing go above the 0 dB line (or if you have severe hyperacusis it can go up there too).
Now I have a number of questions for you to try to understand your situation better. That is the first step towards an accurate diagnosis and suggested treatment.
What happened back in Sept 2022 that caused your tinnitus to start? Any ideas? Did you expose your ears to loud sounds? Are you on any medications now? Did you begin taking a medication or change the dose on an existing medication back then? Are your neck/shoulders/jaw “tight”? Do you have any dizziness or balance problems?
There are a number of things that can cause distortion which you describe as a change in pitch.
Do I understand correctly that you don’t have distortion in the low frequencies–only in the higher frequencies where you have more significant hearing loss?
I don’t think your main issue is recruitment because I’ve never heard of recruitment causing pitch changes, it just makes the sounds get abnormally louder faster where you have significant hearing loss.
If you are taking certain drugs, that can cause pitch distortion. So can having different hearing losses in each ear.
Read my two articles and questions/answers (links below) for more on these subjects.
https://hearinglosshelp.com/blog/when-you-hear-music-in-the-wrong-key/
https://hearinglosshelp.com/blog/diplacusis-the-strange-world-of-people-with-double-hearing/
Get back to me with the answers to all my questions and your thoughts relating to these two articles. Do you see something that rings a bell with what you are experiencing?
Cordially,
Neil
Hello Neil,
Many thanks for getting back to me.
My apologies over the audiogram. It was force of habit to state those figures as negative from the graphs owing to my engineering profession! I can forward you the audiograms if you like (just let me know how).
I must clarify what I said as it was certainly not clear. I am not hearing things at different pitches between the ears, rather what I was attempting to say was that the note/frequency that created distortion in the right ear was several notes lower than the frequency that caused distortion in the left ear. However, that was in the early days. Most notes, even lower notes, now lead to a level of distortion in both ears, but some notes far more than others. However, the notes in the range say 250Hz to 1KHz lead to the more noticeable distortion. Also, the level of distortion is greater now than it was. I can mitigate this by wearing ear defenders over a woolly hat, the latter being to let some higher frequencies through, but trying to limit this for the reasons of making the hearing yet more sensitive.
To answer your other questions, there was no event that triggered any of the symptoms, either initially on the other occasions when symptoms suddenly worsened. So no loud noises, no loud concerts attended etc. I was not and still am not on any medications (other than B12 tablets, Vitamin D3+K2, Zinc and Glucosamine Sulphate 2KCL – the B12 because I have a natural deficiency). I have no balance nor dizziness problems and I would not describe my jaws/neck/shoulders as being noticeably tight.
The really worrying aspect over the last two months have been those several occasions when for no apparent reason the tinnitus got louder and the distortion far worse. Plus voices sounding louder with distortion. Yet, my hearing has not deteriorated looking at either test results or from what I hear, i.e. not having to turn up the volume on the radio.
I have come across the word dysacusis, but when I mentioned it to an ENT consultant, he said it was rather non specific, presumably meaning it did not really describe a particular condition.
Many thanks again,
Phil.
Hi Phil:
I’m a bit confused by your use of the word “distortion”. If I have it correct, you are not hearing pitch distortion. I can’t tell for sure if you are meaning volume distortion which would be loudness hyperacusis. Or are you meaning some other kind of distortion?
Are you meaning that this distortion (increased loudness???) is worse at some frequencies than at others, and that each ear has its own range of pitches that distort?
Your ENT is correct in that dysacusis is a general term and basically means your hearing is messed up one way or another, although some doctors redefine it to mean a specific kind of “distortion”. So I don’t use this term as it is too nebulous when trying to find out exactly what a person has.
Cordially,
Neil
Hello Neil,
My apologies for the lack of clarity.
In general terms, the distortion is probably what you have called volume distortion. Hence, think of a small loudspeaker, which as the volume is turned up cannot cope and hence distorts the sound and the louder it gets, the worse it gets. It is sort of similar to that. If someone is talking in a quiet voice, or if music is played at a lowish volume, then the sound is clearer, but as it gets louder, the distortion becomes far more obvious and unpleasant. The distortion from playing an acoustic piano is very unpleasant.
Some piano notes are more distorted than others, even though played at the same volume. In addition, a note that distorts badly in one ear may not distort as badly in the other ear, and vice versa. I am not even convinced that a note that sounds the worst on say a Monday, is the worst sounding note on the Tuesday, but my mind could be playing tricks on me.
Some bass notes (e.g. 31Hz) also sound distorted, but then piano notes are rich in harmonics, though I would say that the worse range is probably for notes in the 250Hz to 1KHz range.
And it seemingly continues to worsen as the days go by, along with the amplitude of the tinnitus, which still seems to be just in the left ear. Yet, my hearing ability (sensitivity) is not changing, as proven by hearing tests over the space of a year and in general by my ability to hear quiet sounds.
Many thanks,
Phil.
Hi Phil:
When I think of distortion, I think of sounds as coming from a blown speaker–largely incomprehensible, rather than too loud or changing pitch. That is why I wanted to understand what you were meaning by distortion.
So what you are experiencing is the blown speaker kind of distortion with the degree of distortion governed by the volume–getting worse as the volume increases. Have I got it right now?
Your tinnitus may be increasing and getting worse because you are focusing on your ears so much. Typically, the more you focus on your tinnitus (and other ear problems) the louder you tinnitus becomes. Fortunately, the opposite is also true so if you ignore your tinnitus and focus on things unrelated to your ears, your tinnitus tends to get softer and not so intrusive and bothersome and can fade away.
I’ve had tinnitus for more than 70 years now, but I am so habituated to it that whether I hear it or not makes no difference to me. BUT whenever I write or speak about tinnitus it comes roaring back–like right now I’m hearing it pretty loud. But as soon as I finish this post, within 5 minutes I probably won’t even be aware I have tinnitus.
Cordially,
Neil
Hello Neil,
Thanks for the reply.
Yes, the analogy with the blown speaker is about right, albeit that if one played a scale, some notes would sound worse than others, even though at the same volume. I have just been listening to the first movement of Beethoven’s Pastoral Symphony, and when the strings play a certain note, I can hear an almost shreiking in my head, though the more I listen, the less it seems to get.
Of course, I still have the effect of a sudden loud noise, like a knife on a chopping board, or someone shouting, which causes me to flinch with momentary discomfort/pain. Also, headaches, which are more over to the left side of the head, which are getting far more frequent and constant.
So the question is, does my condition seem more like loudness hyperacusis or like recruitment (as well as having tinnitus)?
The next question is then what I can do about it, for instance, I understand that with tinnitus and hyperacusis, sound therapy and CBT can help, but if it is recruitment then there is less that can be done?
Many thanks again for the time you are giving me in answering my questions.
Kind regards,
Phil.
Hi Phil:
I think you have loudness hyperacusis, not recruitment. One of the things about loudness hyperacusis is it can be accompanied by tinnitus and headaches/migraines. Here is a quote from my book on hyperacusis.
“Loudness hyperacusis is generally accompanied by a plethora of other symptoms with tinnitus being the most prevalent. In one study, the most prevalent symptoms experienced following the onset of loudness hyperacusis were: tinnitus (92%), feeling of clogged ears (50%), hearing loss (49%), headache (40%) and pain in the area surrounding the ear (28%).”
Both tinnitus and loudness hyperacusis are psychosomatic in nature. This means they have a physical component and a psychological component. Of the two, the psychological component is the more important component. That is why effective treatment for these conditions uses sound therapy for the physical component and psychological counseling such as CBT to address the psychological component.
If you are interested, you may find my book, “Hypersensitive to Sound?” really worthwhile. Since the cost of shipping it to the UK is more than the cost of the book, I’d suggest you get the eBook version and read it on your computer, tablet or cell phone (or all three if you want). You can get it at https://hearinglosshelp.com/shop/hypersensitive-to-sound/ .
And if you want to learn more about tinnitus, you might want to read my tinnitus eBook at https://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/
There is ever so much information on these two conditions in these two books.
Cordially,
Neil
Hello Neil,
Many thanks for your help, which is much appreciated. I have purchased both your books, which at first glance certainly seem very comprehensive and I look forward to reading them.
I am also awaiting an appointment with Audiology at the local hospital.
I will let you know how I get on.
Kind regards,
Phil.