by Neil Bauman, Ph.D.
A doctor explained,
I am a pediatrician with progressive hearing loss, due primarily to loud noises, and also a mild congenital deficit. I have been in practice for 33 years. An unavoidable part of my job includes very loud, screaming children. It is especially loud when I look in their ears! As my hearing loss worsened I developed hyperacusis. I learned to use my stethoscope as earplugs for noise protection while examining uncooperative young children. I went to hearing aids, but could not find relief from the screamers, nor could I use my stethoscope for protection. I abandoned them. There is also need for amplification of the stethoscope itself. Any suggestions?
When kids scream in your ears, don’t you just wish you could “put a sock in it”?
You may have hyperacusis, but since you have significant hearing loss, you will also have some degree of recruitment—when sounds rapidly become too loud as the volume increases. Whether you have recruitment and/or hyperacusis, the result is basically the same—loud sounds are now much too loud. In such situations using amplification (hearing aids) can be torture.
Using your stethoscope as ear plugs helps, but as you found, it only goes so far. Now you need more help. Here’s what I think I’d do if I were in your place.
First, you need hearing aids (I’d suggest behind the ear [BTE] aids) that have really good compression so you can limit all sounds above your recruitment threshold. Be warned that “screwing down” the compression will affect discrimination so you won’t understand speech as well this way—but at least the babies screaming shouldn’t hurt you anymore. There is a fine line you’ll have to find between the degree of compression you need that avoids the pain of loud sounds and how much amplification you need in order to be able to understand speech.
Second, I’d use non-vented full-shell ear molds so outside sounds can’t get in (like screaming kids). Essentially, the ear molds will act as wonderful ear plugs. The downside to having occluding ear molds is that voices will sound like you are talking in a barrel. Again, a trade-off. You might find you’d like a tiny vent in your ear molds—enough to help prevent occluding, but not enough to let much screaming through. (I have ear molds with a large vent hole—and a series of plugs with different sized vents in them so I can go from nil to small to large vents all with the same ear molds.
Third, I’d get hearing aids with good t-coils and have the t-coils set up properly (this is seldom done, unfortunately).
Fourth, I’d get an amplified stethoscope that can use silhouettes, Music Links or a neckloop so you can listen via the t-coils in your hearing aids. (We carry a couple of these kinds of stethoscopes).
What I’d do is switch my hearing aids off as needed so you’ll not hear the screaming kids nearly as loud (only via bone conduction since your ear canals are blocked by the occluding ear molds). You can then examine screaming-kids ears in peace as your ear molds are now essentially acting as ear plugs. You switch your aids back on when you want to talk to the parents (and if the child is still pretty loud, the compression should make the sound level bearable.)
When you want to use your amplified stethoscope, you hang the silhouettes on your ears, plug them into your stethoscope, switch your hearing aids to t-coil mode and hear via the t-coils in your hearing aids. This way you won’t hear much else since the microphones are off and the ear molds block sounds coming in. This leaves you free to concentrate on the sounds through your amplified stethoscope.
This solution won’t be perfect, as I’ve explained above, but I think you’ll find it ever so much nicer than what you are experiencing now.
Dear Dr. Bauman,
Since I developed loudness hyperacusis in 2020 from the stress of the pandemic, I have experienced a lot of improvement from the methods you recommended to me–protecting my ears only when objectively necessary (when sounds are above 85 decibels) and continuing to expose myself to safe levels of sound. Naturally I still have trouble tolerating very loud noises so I’m writing to ask your opinion on how I should manage my hyperacusis if I decide to have a baby. I read that a crying child can expose parents to sound pressures as high as 120 decibels and that continuous exposure to this amplitude may cause auditory discomfort/pain and potentially some hearing loss. Would you recommend that I protect my ears whenever the baby cries (which would be many times a day), or would that be a form of over-protection that could make my hyperacusis worse even though the sound would be objectively loud? I assume I’d be protecting my ears more often than the pediatrician in the letter above. I’m very worried about my condition regressing–the first year of having hyperacusis was the sharpest misery I’ve ever known and so I’m very relieved to have it improve a lot. I would rather not have my hyperacusis get worse and not become a parent than become a parent and risk being in extreme pain again. Lastly, if you do recommend that I consistently protect my ears from such sounds, are noise-cancelling headphones sufficient or would it be necessary to use custom-mold earplugs? I had a pair of those made and they were very uncomfortable, so I’ve stuck to using noise-cancelling headphones. As always, I greatly appreciate any advice you have.
Sincerely,
Steph
Hi Steph:
You will probably always have problems with very loud sounds in the future so you need to wear ear protectors in such situations (but then everyone should be doing the same).
Having a baby/growing children will definitely expose your ears to excessively loud sounds for your ears. Thus, as I see it, you have three options.
1. Choose not to have children. (I don’t recommend this option though.)
2. Put off having a baby for a year or so and let your ears continue to improve so your hyperacusis won’t be much of a problem then.
3. Have a baby now, but make provision for how you will protect your ears as needed.
You might decide to do option 2–probably a wise decision–unless there is a pressing reason to have a child now.
As you know, babies can be LOUD, and that is especially true when you are trying to comfort them and their head is right up by your ear. In such cases, you will NEED to wear ear protectors.
As you know, you want to wear ear protectors as little as possible, so when you have children, that will mean putting them on and taking them off many times a day. That’s just the way it is.
If you leave them on all the time/most of the time you risk your hyperacusis becoming worse and worse instead of better and better. So resign yourself to letting your ears have hours each day of normal hearing interspersed with times where you have to wear your ear protectors.
As you know the trick is to let your ears hear normally most of the time and wear ear protectors as needed. If you wear noise cancelling headphones to much, my fear is that there will be too much time when your ears won’t be getting enough normal sounds, but wearing noise-cancelling headphones in lieu of ear protectors or your custom-mold earplugs should be a good solution. Just remember to take them off as soon as the racket quietens down–so you’ll be doing that many times a day.
Cordially,
Neil