Hearing Loss Help  

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.

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.

 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.

 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.

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!

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.

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.

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.

by Neil Bauman, Ph.D.

I received an interesting email which read, in part, “My sister’s hearing has increased so much that she wears ear plugs during the day, especially when her children start crying or screaming. Every little sound bothers her ears. She also has some balance problems. If there is inner ear damage, wouldn’t her hearing be reduced, not increase?”

Excellent question. You would think inner ear damage would result in hearing loss and not increased hearing, wouldn’t you? Let me explain.

Your sister does not really have increased hearing. It just seems that way. What has happened is that her perception of sound has changed so that she now perceives normal, everyday sounds as being far too loud.

She has is a condition called hyperacusis. Hyperacusis can be brought on by various things. For example, exposing your ears to loud noise–such as a sudden explosion, or from taking certain ear-damaging drugs. It can also be result from head trauma or even surgery, and possibly by a virus attacking your inner ears.

A somewhat similar condition, called recruitment, only affects hard of hearing people. Recruitment is caused by the reduced dynamic range you get when you lose some of your hearing. However, the results are basically the same–you can’t stand certain normal, everyday sounds any more. They now sound so loud that they hurt.

People who do not have either recruitment (which I have) or hyperacusis don’t have a clue just how loud and painful these everyday sounds appear to be.

To learn more about hyperacusis, what causes it, and more importantly what you can do to help relieve it, point your browser to http://www.hearinglosshelp.com/products/books.htm#hyperacusis.