by Neil Bauman, Ph.D.
A lady wrote,
How can I tell when I’m just over-reacting to sound, or when I have actually been subjected to an acoustic trauma (which requires immediate treatment)?
I never know, and as a result, I am never quite sure whether I should just wait it out or run to the nearest ENT specialist, have my hearing tested and accept treatments such as steroids or HBOT (Hyperbaric Oxygen Therapy) to try and ward off further damage?
From what I have gathered using a tinnitus support forum, it is generally advised that sounds which do not hurt other peoples’ ears cannot hurt mine, but my doubts arise from personal experience. You see, my ears cannot stand sounds that other people bear quite comfortably.
I have had tinnitus since I was 11 but it only became a problem 4 years ago when my ears suffered acoustic trauma as a result of taking an Acoustic Reflex Threshold Test (whereby loud sounds are produced several times in the ear canal). This test, which I assume other people have had done without any problems, changed my tinnitus from a white noise type of tinnitus to a medley of irritating sounds (from Morse code to mosquitoes and crickets). The sounds are different in each ear and keep changing all the time. They also react to loud and sudden sounds, and make it impossible for me to work in quiet places and to sleep.
This very same test also resulted in my developing hyperacusis. Since that day, I’ve become oversensitive to sounds, unable to bear (without pain and negative consequences) normal (loud) noises like a dog barking, a child screaming, music, traffic, etc.
Sometimes I think I am doing well—sleeping at night without having to mask my tinnitus—then a series of “acoustic traumas” makes things worse again. These acoustic traumas would probably not be classified as acoustic traumas by people with “normal” ears. Here are two examples of such sound traumas.
1. My car broke down on a very busy highway. I had to get out of the car and spent 5-10 minutes exposed to the thunderous sounds of cars and trucks rushing by on a 6-lane highway. I wore earplugs which reduced the sound by 15-20 dB at the most.
2. A few days later, I started having a treatment whereby for 5 minutes at a time I had to withstand the piercing, loud whistling-sound of a faulty compressor. I wore ear plugs the first 3 times, then I started wearing ear plugs and ear muffs for another 3 days. Mind you, these sounds, which were horrendously loud for me, did not bother anyone else. The people around me did not bother to protect their ears at all!
As a result of these and other “traumas”, my tinnitus has flared up and has stayed bad for the last month. I had my hearing tested and my hearing is fine.
My question is, “What should I do? (or what should I have done?) Should I wait some more and pray that it will pass, or should I urge my ENT to treat me for acoustic trauma”. Please let me know your thoughts. I have always valued your
What started off as an unwanted side effect from a simple acoustic reflex test has now escalated to consume your life. This is not good. You need to get things under control as quickly as possible so it doesn’t continue to get worse.
Unfortunately, your experience with this test is not unique. I’ve heard from other people who also have experienced much the same things as you have from taking this test. Obviously, the acoustic reflex test either needs to be modified or dumped so it doesn’t continue to damage people in this way.
Now lets get to the heart of the matter—how to know whether a loud sound is really “ear-damaging” or only seems that way because you have hyperacusis (where normal sounds now seem too loud).
You are missing one vital piece of information and that is understanding the difference between real sound loudness and perceived sound loudness.
Real sounds are what your ears actually pick up. They may be soft or loud or extremely loud based on the amplitude of the sound waves that strike your ear drums.
In contrast, perceived sound levels are the loudness at which you “hear” these sounds after your brain processes them. Perceived sound levels may or may not bear any resemblance to real sound levels.
This is because all sounds are filtered through your limbic (emotional) system. Your limbic system adjusts the volume of what you hear based on any emotional “flags” associated with that sound.
Let me give you two examples to show how this works out in real life. First, think about the noise your fridge makes. Your ears hear it all the time, but I’ll bet if I asked you right now, “Is your fridge on?” you’d have to stop and specifically listen to see if you can hear your fridge running. This is because the sounds your fridge makes are totally unimportant to you.
Your ears hear the real sounds your fridge produces, but before you hear the sound, your limbic system checks its database of “flags” to see how emotionally important that sound is to you. Since you don’t care at all about the sounds your fridge makes, your limbic system has flagged its sounds as being totally unimportant to you. All sounds with this flag set have their volume turned way down. Thus, you typically aren’t even aware your fridge is on. Your ears hear the real sound level (at its normal volume) while you hear the perceived sound level (at a greatly reduced volume). That’s the way God designed your ears to work for sounds that are totally unimportant to you.
Now let’s consider another (opposite) example. Let’s pretend you are a “sweet young thing” and live alone in a ground floor apartment. It is summer and you have your bedroom window half opened and you are sound asleep.
At 2:00 AM your ears hear a very faint, furtive footstep right outside your bedroom window. (Note: your ears never sleep.) What happens? Your ears pass this very faint sound on to your brain. There, your limbic system checks its database to see how this sound is flagged. It finds this sound is not flagged as “totally unimportant< but that it is flagged as “extremely important” to you emotionally. Essentially, it is flagged with a big red (bogeyman) flag.
To your limbic system, a red flag means “emergency” and so it immediately cranks up your internal (perceived) volume to “full volume” and blasts you with perceived sound. You spring from your bed from a dead sleep ready to fight or run.
Now get this. It wasn’t the volume of the real sound that bolted you awake (remember, it was a very faint sound). Rather it was the enormous volume of the perceived sound that blasted you out of your bed. Again, your ears hear the real sound level (at its real almost inaudible level) while you hear the perceived sound level (in this case as very loud). That’s the way God designed your ears to work for sounds that are emotionally very important to you.
As you can now see, you never hear the real sound levels. You only hear the perceived sound levels. In any case, if you have normal hearing, for most sounds the real and perceived levels are about the same.
However, if you have hyperacusis things go all screwy. Your ears still hear sounds at their normal loudness levels. That isn’t the problem. The problem is that your limbic system has your internal volume control set much too high.
This often happens when you are a “high-strung” type of person and worry about everything. When you are anxious about something, your body goes into “fight or flight” mode until it can determine if there is a threat to your well-being. In “fight or flight” mode, among other things, your limbic system cranks your internal volume up so you can hear faint (possibly threatening) sounds better.
Normally, this just happens for a few seconds at a time, but when you are anxious all the time, your limbic system is stuck in the “flight or fight” mode and the internal volume remains at a higher level than it should be. The result is now you notice many normal, everyday sounds are just to loud.
In reality they are the same volume they always were, but you now perceive them as being much louder than they really are. This is one cause of hyperacusis.
Another cause of hyperacusis is sound trauma. Sudden, very loud noises can also result in your internal volume becoming stuck on “high”.
As you can appreciate, if you have both—you are high-strung to begin with, and you experience a sudden loud sound (like the acoustic reflex test you took), you can experience a “double-whammy” that results in what you are now experiencing.
When you hear everyday sounds, you jump and/or wince because you perceive these sounds as being so loud that you actually experience pain in your ears. Thus you (logically) conclude that they MUST be damaging your ears.
This pain is real, make no mistake about that, but it comes, not as a response to extremely loud sounds, but because you perceive these sounds at an extremely loud level.
That is why you question, “Is that loud sound you hear really too loud (and you need to protect your ears now), or it is just a normal sound that you are perceiving as too loud?”
At this point you need to consider the source of the sound to see whether logically it could be ear-damaging or not.
One way is to observe those around you. Are they wincing, jumping or otherwise reacting to the sound? If not, then it probably isn’t an ear-damaging sound.
Another way to know how loud sounds really are is to use a sound level meter and “take a reading”. If the sounds are less than 80 dB, you know they are not ear-damaging, no matter how loud they seem to you. (If you have a smart phone, there are sound level APPs you can use for free that turn your phone into a reasonably-accurate sound level meter.)
Therefore, if someone is setting the table and the clattering cutlery is so loud it hurts your ears, you know it has to be your perceived loudness causing you problems, because these ordinary, everyday sounds are not bothering anyone else.
Since you have hyperacusis, you do not want to expose your ears to sounds louder than you can handle, and you definitely don’t want to expose your ears to ear-damaging sounds.
The current sound level standards say that you can expose your ears all day to sounds that are under 80 dB. However, once the sound level reaches 85 dB, it is only safe to listen to for 8 hours.
Above that, as the sound level increases by 3 dB, the safe time exposure reduces by half. Thus at 88 dB your safe time exposure limit drops to 4 hours. At 91 dB it drops to 2 hours. At 94 dB it drops to 1 hour. At 97 dB it drops to 30 minutes, and so on.
Note, these figures are for the average person. Some people are more sensitive so their ears may be damaged by shorter exposure times at those levels.
In contrast to the above sustained sound levels, a sudden, sharp, sound, if loud enough, can cause instantaneous damage. The result can be as you have found—noxious tinnitus and hyperacusis. Fortunately, most, people do not get hyperacusis from such episodes.
As you have found, living with hyperacusis is often even worse than living with tinnitus. Once you have hyperacusis, it can feed on itself, just like tinnitus can. What happens, as we have seen, is that your emotional (limbic) system gets involved. The more you focus on, and worry, about your tinnitus and hyperacusis (and this is what you have been doing), the more your limbic system increases the emotional flag level for those sounds. Thus, they became ever louder and more intrusive.
You need to work on not allowing this to happen if you want to get your tinnitus and hyperacusis under control. The way you do this is to learn to be emotionally neutral towards your tinnitus and hyperacusis (difficult to do, to be sure). The result is that your limbic system will then “unflag” this sounds and consequently turn down the internal volume.
However, each time you expose your ears to loud enough sounds, your tinnitus will spike and your hyperacusis will get worse again as you have found.
Thus, when you had several acoustic trauma events in short order, each one builds on the previous one and the result is raging tinnitus and unbearable hyperacusis.
It takes time to recover from such events. I liken each acoustic trauma event to getting “whacked” resulting in a bruise. It takes time for a bruise to heal. If you get “whacked” on the bruise before it has fully healed, it hurts even more than it did originally and takes even longer to heal.
What your ears need more than anything at this point is several months of relative quiet in which to heal. During this time you want to be careful not to expose them to louder sounds. Thus you need to wear ear protectors when around louder sounds. but, and this is very important, you must not overdo this. If you forget and don’t take the ear plugs out when the sound level drops to normal, you will make your condition even worse.
Here’s why. If you don’t take the ear plugs out as soon as sounds return to normal, your brain turns up its internal volume trying to hear normal sounds again. Then, when you take the ear plugs out, everything is now too loud. So the trick is to always protect your ears when sounds around you would cause you more ear trauma, but the second that is not true, take the plugs out.
I know it is virtually impossible to protect your ears from everything because unexpected loud sounds occur from time to time. In these situations, quickly cover your ears with your hands. The best way is to push on the fleshy prominence (tragus) at the entrance to your ear canal to seal your ear canal. I’ve found this gives the best and quickest protection.
Your tinnitus and hyperacusis may get worse for a time. You’ve suffered a set back in your progress. Do not be discouraged but continue on. You are on the road to recovery. It will just take longer.