Recruitment & Hyperacusis

March 24, 2015: 7:23 am: Recruitment & Hyperacusis

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.

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July 27, 2012: 12:02 pm: Musical Ear Syndrome, Recruitment & Hyperacusis

by Neil Bauman, Ph.D.

A lady wrote,

I came across your website while researching the term ‘recruitment’ which the audiologist mentioned to me this week. She tested me and I have mild/moderate hearing loss. The reason I had hearing tested is because I have sensitivity to noise and also tinnitus (low drum/bass sound). I live in a condo and I hear snoring below and lot of movement above from neighbors. I have developed a really huge intolerance of noise especially motor sounds and a sleep disturbance.

I started using Bose noise-cancelling headphones and thought I had discovered Paradise—for a few months—until I started having post-nasal drip and my left ear started with tinnitus. Now there is no getting away from noise.

I expect the tinnitus will resolve when the post-nasal drip clears and I can resume my ‘Paradise world’ with the Bose headset. I was shocked when my audiologist strongly advised against using the headset and mentioned something about recruitment. She told me my problem will get worse if I wear the head set. Now what do I do? I paid $299 for these and thought they were the best thing ever. Do you have any thoughts on this situation. I am perplexed.

Personally, I don’t think your problem is recruitment like your audiologist says. Recruitment is when certain sounds become too loud abnormally fast. Recruitment is not a supersensitivity to sound in general. Furthermore, recruitment is always a byproduct of a sensorineural hearing loss. The worse the hearing loss, generally the worse the recruitment.

Rather, I think your problem is that you have two other conditions. The first one is somewhat similar to recruitment and people often confuse them—namely hyperacusis. Hyperacusis is a supersensitivity to all sounds, not just certain ones that recruit. (Incidentally, you can have hyperacusis whether you have a hearing loss or not.)

The second condition I believe you are experiencing is Musical Ear Syndrome or MES for short. MES is where you hear phantom non-tinnitus sounds. Often the sounds are musical, but as in your case it can sound like snoring or people moving around upstairs.

My question is why are you hearing these sounds now? You didn’t hear them in the past, so why are you hearing them now? Also, why are you only apparently sensitive to these sounds, and not all other sounds? This is why I believe you have Musical Ear Syndrome in addition to hyperacusis.

Assuming your tinnitus is caused by your post nasal drip, I agree that when your sinuses clear up, your tinnitus may also go away.

However, I’m with your audiologist on your not wearing the noise-canceling headphones. Noise-canceling headphones have their place to be sure—and that is when you are in noisy surroundings where you need to protect your ears or go deaf. That is where you should wear them—not in your bedroom where it is relatively quiet. Here’s why.

God made our ears to hear sounds. When you wear your noise-canceling headphones, that cuts out all the faint sounds your ears normally hear—and you need to hear these sounds to keep your brain happy. When you wear the noise-canceling earphones, they starve your brain for sounds.

In addition, you have a mild to moderate hearing loss that is also starving your brain for sounds. As a result, your brain does two things. First, it cranks up your internal volume control to try to hear more sounds. When it does that, you now can hear fainter sounds—and regular sounds are now louder. In other words, you are more sensitive to sound. This is hyperacusis.

The more you starve your brain for sounds by wearing the headphones, the more your brain turns up its internal volume, and the more sensitive you become to sound. This becomes a vicious cycle. If you keep on doing this, you will likely drive yourself “buggy”, and you’ll have difficulty tolerating any sounds.

At the same time, because your brain is not hearing real sounds, it begins to manufacture phantom sounds. I think this is what is happening when you say you hear people snoring below you and moving around upstairs. I doubt that those are truly real sounds. Yes, they may sound like real sounds, and that is why you are being fooled, but they are phantom sounds generated in your brain.

To separate real sounds from the phantom, you have to ask yourself if it is even possible for a person with normal hearing to hear those ‘upstairs’ sounds from your apartment? Many apartments are built with carpeted, concrete floors. Sounds like snoring and people walking around just do not penetrate those floors.

For example, I know of people who are mad at their neighbors for making a lot of racket, when in actual fact, the neighbors are very quiet people and walk around in slippers on a carpeted floor. There is no way anyone can hear the upstairs neighbors walking around, yet the person below swears they hear them. One of the interesting things is they hear them even when the people above them are not home! That is another proof that these sounds are phantom.

I really think this is what is happening in your case. Continuing to wear the noise-canceling headphones will only make matters worse and Worse and WORSE.

I think you have another problem. You haven’t said so specifically, but I suspect that you are either particularly stressed, anxious, worried, or depressed. Any of these emotional conditions can trigger what you are experiencing. For example, anxiety can easily cause hyperacusis, while stress, worry and depression can result in Musical Ear Syndrome.

So what can you do? First, you need to give your ears real sounds to listen to. Rather than wearing noise-canceling headphones to block out all sounds, you should listen to some soft sounds—sounds that you enjoy—while you fall asleep. As an example, this may be a CD of calming music, or one of environmental sounds such as rainfall, waterfalls, waves lapping on the beach, etc.—whatever you like.

Doing this will give your brain real sounds to listen to. As a result, your brain will slowly begin to turn down its internal volume so you won’t be so sensitive to sound. In addition, the real sounds will also keep the auditory neurons in your brain busy so they won’t have so much time to generate the phantom sounds you are now hearing.

You may find it most helpful to read my articles, “Here’s Why Chronic Anxiety Can Result in Tinnitus and Hyperacusis“, and “Musical Ear Syndrome“. In addition, there are a number of other tips for dealing with Musical Ear Syndrome in my book, “Phantom Voices, Ethereal Music & Other Spooky Sounds“.

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April 19, 2011: 7:25 am: Recruitment & Hyperacusis

by Neil Bauman, Ph.D.

A lady explained:

My audiologist says I have severe recruitment and hyperacusis—sound really hurts my ears.

I’ve worn ear plugs most of my life, not so much to guard my hearing against sounds that would do more damage (though it’s common sense to wear ear plugs during those events that would damage your ears—concerts, air shows, shooting firearms, etc.), but because sound hurts my ears. I’ve “blown the top of my head off” often! The audiologist I had with my last hearing aid trials told me that I needed to expose myself to the sounds that hurt, even though they hurt, to get used to the hearing aids.

Unfortunately, I just couldn’t tolerate wearing hearing aids. My brain would be fried at the end of the day. I always had a headache, was always wincing at sound and my tinnitus would become unbearable. People even commented that I looked distressed. Is there anything you can do for recruitment and/or hyperacusis?

You betcha. It’s not easy, but you can slowly—and I emphasize very slowly—retrain your brain to reduce its sensitivity to sound.

When you have recruitment as I have, or hyperacusis, all or certain sounds seem to “blow the top of your head off”, give you headaches, make you wince or jump and/or make your tinnitus worse as you well know. That’s the bad news. Now for the good news. Such sounds do not physically damage your ears. It just seems like they do.

If a sound is not so loud that people with normal hearing wince, jump, etc. then it almost certainly won’t physically damage your ears either. You won’t lose further hearing from a sound that recruits and sounds dangerously loud because in reality, it isn’t anywhere’s near as loud as you perceive it to be.

My article, “Recruitment from Hearing Loss Explained“, explains why you now perceive normal sounds as much too loud.

When you wear ear plugs when you don’t absolutely need to wear them, especially if you have recruitment or hyperacusis, you are doing yourself a disservice. Here’s why. Your brain wants to hear sounds and when you wear earplugs to block the sounds, your brain turns your internal volume up more to try to hear through the ear plugs. Ultimately, this just makes your hyperacusis worse and worse.

Thus, your audiologist is basically right—you may be overprotecting your ears. The solution is to only wear ear protectors when you really need them. One way to do this is to use your hands—clap them over your ears whenever sounds get too loud for you, but take them away as soon as the sound level drops. You can do this at a railway crossing for example. A train is going by—cover your ears—when the train is past, uncover them again.

You should also carry several strengths of ear protectors, but only use the minimum strength you need at any particular time.

Over time (and this can take a couple of years or more) you will slowly build up your tolerance for louder sounds again. This is what you need to do.

Begin to learn to tolerate sounds a bit louder than you are now—not loud sounds, just a tiny bit louder—and when you can tolerate those sounds, a little bit louder sounds, and so on.

Incidentally, recruitment only affects people with a sensorineural hearing loss. Hyperacusis can affect anyone whether they have a hearing loss or not.

If you have recruitment and wear hearing aids, you need your audiologist to set the maximum output on your aids by frequency. In order to do that, first she has to test you for recruitment by frequency (which audiologists almost never do—they typically use an overall average—and this just doesn’t work well at all) in order to see exactly where your recruitment kicks in. Then she needs to set the compression on your hearing aids a few decibels below that level. If she does this properly, you should be able to stand almost any volume of sound as your aids will keep them all below the level at which they would recruit.

Unfortunately, when you do this, it causes a certain amount of distortion. As a result, you may not understand speech as well as you would otherwise. This is the tradeoff—understand speech better but yank your aids out because certain sounds recruit, or have the compression set so sounds won’t recruit, but not understand speech as well as you should.

I walk a fine line here. I have the compression set on my aids such that they work for me in most normal listening situations but if certain frequencies of noise are present, I have to take my aids off as they still recruit. I then either rely 100% on speechreading or I speechread and use various assistive listening devices.

At the same time, just setting the compression as much as I have costs me 12% in lost discrimination. Thus, when I wear my aids I still have to speechread to try to fill in the “mushy” words I miss. Nothing is perfect, but I’ve found this trade-off typically works for me.

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September 26, 2009: 12:10 pm: Recruitment & Hyperacusis, Tinnitus

by Neil Bauman, Ph.D.

A lady explained:

I find that my tinnitus is worse if I am stressed about something. Sometimes the pitch changes and sometimes I can hear more than one sound at a time. My tinnitus is always worse when I’m trying to get to sleep and that’s when I get anxious. I can hear it in the day too, so it’s there all the time. When I wake up in the morning it can be very loud and I have to get up straight away or I can become panicky. I have always been noise phobic from when I was a small child. I just can’t handle fireworks or loud noises. When I was very young I became very upset by the scratching of the needle on a record. Is this part of the profile of someone with tinnitus?

Very much so. Stress and anxiety are two triggers of tinnitus. If you are a high-strung, anxious type of person, often you will find that not only do you hear tinnitus, but you also may have hyperacusis—where you hear some/all sounds louder and more intrusive than normal.

I was helping a lady recently that had much the same experiences as you—she was high-strung, anxious and had just gone through a very stressful situation. Her tinnitus was now much louder than normal, and she was worried that it would stay that way. In the past when she would stress over something, her tinnitus would get louder, but subside in a day or two. This time it wasn’t—hence her call to me for help.

I explained to her that when we are anxious, this puts our bodies in the “fight or flight” mode. Extra adrenaline surges through our arteries giving us more strength to fight or flee. At the same time, our senses become more acute. Thus we actually hear better than normal during such events—especially fainter sounds.

When you are anxious all the time, your body becomes stuck in this fight or flight mode, which includes the increased acute hearing. The result is that you perceive certain sounds to be annoyingly loud such as your phonograph needle. At the same time, loud sounds are then much too loud (such as fireworks).

The usual reaction to this increased sensitivity to sound is to avoid all noisy places and wear ear protectors most of the time. This actually proves counterproductive because when you wear ear protectors all the time, you brain becomes “starved” for normal sounds. As a result, it cranks up its internal volume control. This just makes the situation even worse—because when you take the noise protectors off, sounds are louder and even more annoying than before.

On top of this, your tinnitus is also louder because, with the increased internal volume, your brain is now hearing more of the random firings of the neurons in your auditory system—which some researchers think we hear as tinnitus.

The way to resolve this problem is not to overprotect your ears. Yes, clap your hands to your ears if there is a sudden loud sound around you (a siren going past you, or a truck blasting his air horn), but otherwise do not overprotect your ears so your auditory system will always have adequate stimulation. This will cause your brain to turn down the internal volume.

At the same time, you need to learn how not to be so anxious. You need to learn to be calm and “hang loose”. That will get you out of the “fight or flight” mode. This alone will let your brain turn down its internal volume.

When you do this, you will find that your tinnitus often becomes less intrusive and fades into the background. You will also find hat those sounds you found annoying before now don’t bother you much, or at all.

I’m not saying this is easy to accomplish, but it is necessary. There are a number of books available that teach you how to relax and calm down. If you need further help, see a therapist that specializes in helping people work through their anxiety problems without using drugs.

The end result will be reduced tinnitus, reduced hyperacusis and more enjoyment in your life. That makes it all worthwhile, doesn’t it?

If you have tinnitus, my book, “When Your Ears Ring—Cope with Your Tinnitus—Here’s How” teaches you a number of things you can do to help yourself successfully live with your tinnitus.

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March 6, 2009: 11:06 am: Noise-induced Hearing Loss (NIHL), Recruitment & Hyperacusis

 by Neil Bauman, Ph.D.

A man wrote:

I have extreme sensitivity in my hearing and some distortion as well. My ears buzz slightly to my own voice and others that have a deep tone in their voice. I believe this was sound-induced from my iPod and loud video gaming with head phones. My hearing is good except most everything with a high frequency hurts my ears and causes me distress. I have had this for a month and a half. Do you think it is permanent?

I think your extreme sensitivity to high frequency sounds will slowly go away if you protect your ears from louder sounds from now on. It may never completely go away, but it should be a lot better given enough time.

Very often exposing your ears to loud sounds results in damage to your ears such that you now perceive some sounds as being much too loud—in your case, the high-frequency sounds. This is called hyperacusis.

The problem can result from just one loud sound, but the “fix” often takes several months. It is generally a slow process. Think of it like a sprain—you get it in one sudden wrench—but healing takes weeks or months—slowly getting better. However, if during this time, if you wrench it again, you have to start all over again.

Your ears are the same way. That is why you must be so careful not to expose your ears to those damaging levels of sound again. Wear ear protectors in such situations if you can’t turn the sound down.

At the same time, don’t overprotect your ears by wearing ear protectors all the time, or you can make the situation even worse. I can’t emphasize this enough. Your ears need adequate sounds reaching them all the time to keep your hyperacusis under control—just not too loud.

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August 4, 2008: 9:27 am: Hearing Loss, Recruitment & Hyperacusis

 by Neil Bauman, Ph.D.

A man wrote:

I’m curious about some increased ringing in my ears and a peculiar off again, on again, sensation that is quite distressing, namely when I am at work, if I open a map for instance (I work with maps all day), just the process of opening the maps, can give me a harsh metallic tinny noise in my ears, particularly my right ear. A similar feeling occurs when I lay a pen down on a glass surface or even sometimes when I am typing on the keyboard. This might go on for a day with my ears feeling stopped up somewhat, and then it will disappear and the next day I will be fine.

What you are describing sounds like recruitment kicking in. Recruitment is a by-product of sensorineural hearing loss, and makes you perceive normal sounds are louder (harsher) than normal. Since you have a high frequency hearing loss (to whatever degree), because of recruitment, you now perceive the high-frequency component of the sounds the maps make, the high-frequency component of the sound of the pen clinking on glass and also the high-frequency component of the keyboard clicks, or your fingernails on the keyboard—not at their normal level—but as much louder than normal. Thus, they sound harsh. If you have severe recruitment, they can sound so loud that they will hurt.

When your ears are feeling stopped up, you are experiencing additional hearing loss—and with the extra hearing loss, your recruitment would be kicking in worse, hence the annoying component to everyday sounds.

You need to try and figure out what is causing the stopped-up feeling by reviewing the sounds you exposed your ears to the previous day. No doubt, you are listening to something louder/longer than your ears like.

The man then asked, “Do you think it is safe to continue to wear earbuds while listening to audio books on my iPod for an hour or so a day? Are the deep in the ear ones a better choice because the volume doesn’t have to be turned up as loud?”

It doesn’t really matter what kind of earphones or earbuds you use with your iPod—the key is to keep the volume at a comfortable level. Those deep in the ear ones require less volume—that is true—but only because they are closer to the eardrum. In actual fact they vibrate your eardrums just as much as any other earbuds IF you set the volume so that what you hear sounds to you to be at the same level.

Note: you will not hurt your ears if you listen to your iPod (no matter what kind of earbuds you use) at approximately the same level as you hear people around you talking—so that is a good rule of thumb to follow.

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February 19, 2008: 10:21 am: Balance Problems, Recruitment & Hyperacusis

by Neil Bauman, Ph.D.

A veteran wrote:

My hearing loss and tinnitus is service-connected. I was exposed to constant cannon fire while in the Marine corp. No hearing protection. Marines were expected to tough it out. Now I’m paying for that silly theory with my hearing problems.

I am trying to explain to the VA doctors and audiologists about my severe sensitivity to sound. Some loud sounds hurt my ears really bad. This is causing me to have anxiety and panic attacks secondary to the loud sounds.

The VA has said that my problems are psychological so I’m now seeing a psychologist. I am very depressed because of my inability to hear well, and my tinnitus is extremely loud. I sometimes think that there are mice in my ears scratching to get out. The tinnitus and combined hearing loss is very depressing, but so also is the sensitivity to loud sounds.

Loud sounds cause me to become disoriented and dizzy and I lose my balance. Several times, upon hearing loud sounds, I have fallen. I realize that this is caused by my anxiety reactions and panic reactions to the pain of the loud sounds. My problem is that I can’t seem to make the VA medical people understand.

They just think I have to get over the depression. They think the depression is causing the problem and that when the depression goes away so will the tinnitus and sensitivity to sound. I also hear phantom sounds, which I know are a part of my hearing loss and tinnitus. But again the VA is saying no. They want to blame it on psychosis? The bottom line is that the depression, anxiety and panic disorder are secondary to my hearing problems.

Fear of sounds is called phonophobia. In your case you perceive the sounds as so loud they hurt. No one wants to be hurt—whether it is loud sounds or anything else.

However, I think that rather than having phonophobia, you have hyperacusis—where you perceive normal sounds as too loud. Hyperacusis is often the result of having your ears damaged by loud noise such as you were exposed to in the Marines.

Living with loud tinnitus day in and day out can lead to depression. Actually, this is sort of a Catch 22 situation. Depression often leads to louder tinnitus—so you want to get your depression under control in order to help control your tinnitus, but on the other hand, loud tinnitus leads to depression, so you want to get your tinnitus under control if at all possible.

You can learn to live and enjoy life even though you have tinnitus and can’t hear much. I don’t hear much at all now, and I’ve had tinnitus day and night for 35 or more years—but I don’t let it affect my happiness. My book, “When Your Ears Ring—Cope With Your Tinnitus—Here’s How” has helped many.

It’s interesting (not nice, but interesting) to note that loud sounds also cause you to lose your balance. I don’t see how it relates to anxiety reactions like your doctors think it does. To me, it seems you have a condition called Tullio’s Phenomenon in which people lose their balance from loud sounds—not from anxiety or panic.

Another name for it is Superior Canal Dehiscence Syndrome. Basically what happens is that you have a hole or thin spot in the bone separating the balance system from the hearing system. Thus when you hear a loud sound, the sound wave travels via the hole to act on the balance system. Since it is a sound signal and not a balance signal it sends false balance information to your brain. This totally confuses your brain and the result is loss of balance. Some people drop to the floor like they were knocked out. Others have vertigo and some dizziness and imbalance. Sometimes doctors can patch the hole and cure this, but other times not.

If this is what you have, then the psychologist is wrong in trying to treat you for anxiety and panic. Yes, you need to get those under control too, but you also need to have an otologist check you out for things that cause Tullio’s Phenomenon such as Superior Canal Dehiscence Syndrome.

You have several ear related problems and each one needs the proper treatment by the appropriate professional. Blaming it all on you just isn’t going to help!

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October 19, 2006: 9:11 am: Recruitment & Hyperacusis

by Neil Bauman, Ph.D.

The parents of a hard of hearing boy wrote:

We had a weird experience this last weekend and wanted to see if anyone else has had something similar happen to them or their child. Our son (age 10) has a mild to moderate hearing loss in his left ear, and a moderate to severe hearing loss in his right ear. He wears 2 hearing aids.

He has always complained that certain loud sounds are physically painful in his ears, particularly high pitched ones. It usually comes up in the context of one of his younger sisters shouting or screaming near him, especially when they do it in the car (a practice we discourage but can’t always prevent). He has complained about it, but it is not the kind of thing that happens often, nor has it prevented him from doing anything he wanted to do, until now.

We took him to see a football game last weekend, an occasion where 110,000 people all get together and scream as loud as they can at the same time. We lasted about ten minutes and finally had to leave the game because he was so miserable. What’s going on with his ears?

This experience of your son’s hearing distress is not weird at all. Actually it is very common in people with sensorineural hearing losses such as your son has.

What is happening is that he is suffering from recruitment. With recruitment, as the sound level increases certain frequencies of normal sounds all of a sudden become much too loud and hurt.

Note that the physical volume of this sound typically isn’t damaging to a person’s ears (apart from the roar at the football game)—so it will not cause more hearing loss, but it does cause pain, and in some people, tinnitus. Both of these sensations are generated in the brain, so think of it as the brain’s psychological response to a real stimulus.

There are three things you can do if you have severe recruitment.

One (and I do this all the time since I have severe recruitment is to yank your hearing aids out when recruiting sounds occur (or just turn them off). In my case, I find that almost no sounds recruit if I am not wearing my hearing aids. Therefore, in noisy situations, I just leave my hearing aids in my pocket. Then I can enjoy whatever activity is going on. Your son may want to try this and see if it works for him also.

Two is to get his hearing aids adjusted properly so they won’t recruit. The problem is that few audiologists really understand recruitment so don’t adjust hearing aids properly for it. Just to prove a point, in all my 55 years of wearing hearing aids, I’ve never had an audiologist test me properly for recruitment except the last one—and this was at my specific request.

The proper way to test for recruitment is to use the audiometer and test each individual test frequency. To do this, the audiologist keeps turning the volume up for that tone until you wince or jump, your eyes blink or you otherwise react to the sound. After the audiologist does this for all test frequencies, then you will know exactly which frequencies cause recruitment.

The next step is to properly adjust his hearing aids. The audiologist needs to set the compression on the bands that cover those recruiting frequencies such that the sound can never come close to, or exceed, the recruiting volumes. When this is done, he won’t have much of a problem with recruitment anymore. (Note that a few people have such severe recruitment that it is beyond the hearing aid’s capability to control it.)

Three, avoid sounds that you know will recruit. This doesn’t just have to be the 100,000 screaming fans in the stands. For example, just setting a glass on the table will hurt me because it sounds so loud with hearing aids on. To a person with normal hearing it is just a quiet “thunk” or “clink.” To me it has always been a very sharp painful sound when I am wearing my hearing aids. Without them on, I hardly hear it either. With my new hearing aids adjusted specifically to control recruitment, I can finally almost stand this sound! (In my case, if I have the hearing aids properly adjusted to control my recruitment, then it degrades speech so much I don’t understand much of what I am hearing—so I tread the fine line between understanding speech and recruitment.)

If your hard of hearing child complains of sounds being too loud (and you know they are not), take his complaint seriously. Your child has recruitment and these sounds are painful to him.

If you want to understand more about recruitment click here to read this article.

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March 23, 2006: 2:10 pm: Hearing Aids, Recruitment & Hyperacusis

by Neil Bauman, Ph.D.

A lady asked:

In your article of December 5, 2005, Super-Sensitivity to Sounds you discussed recruitment, from which I suffer severely. I have been unable to find an appropriate hearing aid, although audiologists have said that newer aids might benefit even my profound deafness. Would you tell me the type of hearing aid you use, so that I could try that make and model. I am quite desperate, unable to converse even with my family, and terrified of cochlear implantation-any advice would be welcomed.

When you have a profound loss, recruitment can really be a problem. For some people, as soon as any sound becomes loud enough to hear, it is already too loud to stand. If that is your situation, then hearing aids won’t help you.

However, if you have a bit of dynamic range in which to play (even 20 or 30 dB) then properly fitted hearing aids should be able to help you. (Your dynamic range is the area between the softest sound you can hear and the loudest sound you can stand for any given frequency.)

In order to have hearing aids properly adjusted for you, you need a recent audiogram and you need to have your recruiting levels measured for each frequency and plotted on your audiogram. (In 50 plus years of wearing hearing aids, I think I’ve only had this done once!)

To find your recruiting level at each frequency, your audiologist uses the same pure tones used to find your degree of hearing loss, and continues to raise the volume until all of a sudden your recruitment kicks in and you blink/jump/wince/whatever. They plot these results on your audiogram.

Whoever fits you with a hearing aid then knows that they have to set the compression on each frequency band so that the output of that band never exceeds this figure. In fact, it should be set a bit below this level.

Once you have your recruitment levels plotted on your audiogram, you can go to the same place I got my hearing aids. You likely won’t be able to use my exact model as it won’t have enough power for a profound loss. Mine are medium power (MP), not high power (HP) aids. Mine are also WB–wide band–aids as I have a reverse slope loss and can take advantage of my hearing in the frequencies above 8,000 Hz. (These aids can amplify sounds up to 16,000 Hz.)

I got my hearing aids from America Hears. Look over their website. They produce the Freedom line of hearing aids. All their hearing aid models and prices are listed there–no hidden charges. You’ll want the BTE aid, but the HP model, not the MP model I have.

Email audiologist Kelly Malick at America Hears and tell her I sent you, and that you have severe recruitment like I have. You’ll also have to either mail or FAX her your recent audiogram with all the above info marked on it. (You could phone her at 1-800-492-4515 if you can hear on the phone.)

When she gets your audiogram, she can tell you whether their hearing aids can likely help you or not.

One of the things I like about this company is that they don’t charge you anything if they can’t help you–no restocking charge for returned hearing aids for example.

Another nice thing is that their hearing aids are only about half the price of comparable hearing aids from other companies so you can expect to save $2,000.00 or more on a pair of aids.

Still another nice feature is that they can program your hearing aids over the Internet so you never have to physically go there to be “fitted.” It can all be done on your computer, and over the Internet, and, if you can’t hear on the phone–via email. This is a wonderful (and unique) service. In addition, if you are computer savvy and want to tweak your hearing aids, you can do this yourself on your own computer. However, if you are scared to do this, they will do it for you, and then you can immediately download the new programs into your hearing aids. I love this service.

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December 5, 2005: 10:31 am: Recruitment & Hyperacusis

by Neil Bauman, Ph.D.

A lady wrote:

A few years ago I had a virus that apparently attacked my vestibular system. Besides various balance-related problems, I now have hearing issues. I was told that I had some hearing loss on the left (I don’t remember how much) but I also find that I am very sensitive to certain sounds and pitches (clapping, crowds, high pitches). Because of the hearing loss, my husband wants me to go to an ear specialist, but I feel that there is nothing they can do for me, and the sound sensitivity would be worse with any sort of hearing aid. I’m not sure whether to pursue these issues. If there is anything that can be done, and if I do peruse them, what sort or specialist I should see? Can you point me in the right direction?

You bet. I’ll tell you which specialist you should see in a moment, but first, I’d like to address some of the interesting points you bring up.

Viral attacks can indeed cause balance problems. In addition, they can cause hearing loss and distorted hearing. Sometimes the balance system is harder hit, and other times the virus mostly attacks the hearing system. In fact, viral attacks can result in massive hearing loss. Fortunately, your hearing loss isn’t as bad as that.

However, you have another problem besides just not hearing as well as formerly. You are now super-sensitive to various normal sounds that never bothered you before. This is a real pain–literally.

The fancy names for these kind of conditions are hyperacusis and recruitment. Recruitment accompanies hearing loss, whereas hyperacusis can occur whether you have a hearing loss or not.

In any case, the result is basically the same no matter which one you have–certain normal sounds now sound much too loud. If you want to learn more about recruitment see my article “Recruitment Explained.” In addition, you might want to read a short book called “Supersensitive to Sound? You May Have Hyperacusis.”

Recruitment is no fun. I know. I have severe recruitment myself. Just putting a glass on the table can blow the top of my head off (figuratively speaking of course) as it sounds so loud to me.

The hearing specialist you want to go to is an audiologist (Au.D)–not a medical doctor (M.D.) Your audiologist will do a complete audiological evaluation and can recommend (and fit) hearing aids if they are appropriate.

The surprising thing is that hearing aids (properly adjusted) can actually help your sound sensitivity–assuming you have recruitment associated with your hearing loss. Your audiologist can set your new hearing aids to “compress” the recruiting sounds so they no longer bother you.

For example, I just got new hearing aids in the last month or so, and for the first time in 50 years of wearing hearing aids I can now stand certain sounds that always were too loud before. I’m still working on “tweaking” them to cut out all recruiting sounds. So far, I’ve eliminated about 90% of the formerly troublesome sounds. You may find the same thing happens with you with the right hearing aids. The latest technology is amazing.

At the very least, you should investigate whether this will work for you too. I think its well worth a trip to an audiologist.

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