Hearing Testing, Straining to Hear and Tinnitus

by Neil Bauman, Ph.D.

A lady wrote,

Thank you for providing this blog. Many of your previous responses have provided so much helpful information to me already. I’m a musician and I’ve been conscious of taking care of my ears. More often than not, I wear earplugs when rehearsing. When playing live I will have one earplug in my left ear, which is usually facing the drum kit. I’ve worn earplugs to most concerts that I go to.

However, with all that, I know that there have been instances where I have been exposed to loud sounds. A week ago I had a hearing test at the same time I was getting some musicians earplugs molded. I was prompted to have the test because I was feeling as though my right ear was clogged, and that there was a slight difference in the volume of sound that I hear between my two ears. The hearing test was good and showed that my hearing was in a normal range for my age for both ears and I felt relief about that.

However, something strange happened during the test. When the audiologist triggered a tone, I had to click a button in response. However, apparently I was responding far more often than she was generating the tone and therefore generating false responses. She interrupted the test and instructed me to only beep when I was actually hearing the tone. I said, “I really thought I was doing that”.

She re-started the test, and I had to concentrate so hard to discern between what was an actual tone and what was one that I had imagined. The imagined tones seem to be mimicking the tones I had just heard.

When I told her how difficult it had been to differentiate between the real tone and the false one’s she said “that’s probably just your tinnitus.” I said, “I don’t have tinnitus”.

About two hours later, I started hearing a very high pitched, fuzzy electric tone. It hasn’t stopped since it started. It’s been a week now, and I’m so distressed about it. I’m worried that it’s never going to go away.

I know it’s tinnitus. I went to the hospital on the weekend, and the ear doctor said my ears and my hearing were healthy, and that what I was describing was tinnitus. I feel like the doctor might have been trying to calm me down, and avoiding the hard facts of actual damage as I was really upset. He said that it wouldn’t be anything too serious, because of the nature in which I noticed it—directly after the first mention of it in the hearing test.

I told him about an incident that occurred about 4 weeks ago. I had an accident while recording. I was wearing headphones that suddenly quadrupled in decibels whilst I was tracking and I didn’t remove the headphones fast enough because the tracking was going so well. This explosion of volume lasted about 20 seconds, but I could still feel it in my ears the next day.

I can’t stop thinking about this moment. I’m almost certain that this is what has caused the electric-frequency ringing in my ears, but why did it only start at the hearing test? I feel so confused, why do I have the clogged feeling if my hearing is okay? How can I tell if my cochlea is damaged? Is that what the clogged feeling is? Why do I have tinnitus if my hearing is okay?

I’m glad you’ve been taking care of your ears—at least most of the time. Accidents do happen, and sometimes we “have to pay the piper” when they do occur. When you feel one ear is clogged and that you can’t hear as well in it as with your other ear, very likely it is true no matter what the hearing test shows. Here’s why.

Human hearing goes from about 20 Hz up to more or less—depending on the person—20,000 Hz. When you have your hearing tested, your audiologist typically just tests your hearing from 125 Hz to 8,000 Hz. This is less than half of the frequency spectrum you can hear.

As a result, they don’t catch hearing loss in the high frequencies above 8,000 Hz. However, your brain knows it can’t hear like it used to and so you get the psychological feeling that your ear is blocked/clogged/plugged—however you want to describe it.

When your audiologist told you that your hearing was normal for your age—that doesn’t mean you don’t have a hearing loss. It just means that most people your age have the same amount of hearing loss. In actual fact, “normal for your age” could mean you have considerable hearing loss in the higher frequencies.

I wish they would say what your hearing loss really is (by frequency) as compared to no loss at all (0 dB SPL). That way you’d have a better idea of exactly where your hearing stands. For example, “they” call any hearing loss down to 25 dB “normal”, yet there is quite a difference between hearing at 0 dB and hearing at 25 dB.

As a musician you’ll notice it much more than the average person would. Now, you were told your hearing is normal “for your age” and, depending on your age, that could be even greater hearing loss than 25 dB especially in the frequencies from 5,000 to 8,000 Hz. And as I mentioned above, no one knows how bad your hearing really is above 8,000 Hz.

During the testing, when your audiologist realized you were having trouble distinguishing real tones from imaginary ones, or from your tinnitus, instead of having you straining to figure it out, she should have immediately switched her audiometer from straight “beeps” to double beeps—”beep beep”. It is easier to tell whether you are hearing a sound or imagining it when you listen for that short pause between the beeps.

Even better, your audiologist should have switched her audiometer to the warble tone. Warble tones are very easy to distinguish from the background and from tinnitus. I wish all audiologists would use the warble tone all the time.

In my opinion it would make hearing testing ever so much easier on the person being tested, and wouldn’t affect the test results—except to make them more accurate. (Unfortunately, not all audiometers have warble tones.)

Furthermore, our brains are great at letting us hear what we expect to hear and when you concentrate so hard, it is not surprising you were hearing “phantom” beeps. Another reason to use the warble tones.

Also, if you have tinnitus, testing at certain frequencies mimics the tones at which you hear your tinnitus. Thus you cannot distinguish between your tinnitus and the test tone—again making the test less than accurate.

I’ve had that problem too. However, when using warble tones, I’ve never had a problem distinguishing my tinnitus from the test tones.

Finally, when you concentrate so intently on the very faint tones, you are stressed, and this encourages your limbic system to crank up your internal volume so you can hear better. This produces an unwanted side effect—now you may hear tinnitus where before you didn’t, or it may make your existing tinnitus louder.

I believe this is why you began to notice constant tinnitus about two hours later. However, I don’t believe there was any actual physical damage. It’s more related to your limbic system’s response to your straining to hear during the testing.

Another factor is anxiety. The more stressed and anxious you become, the more your limbic system turns up the internal volume. As a result, you perceive this strange new sound as even louder and more intrusive. Thus begins a vicious cycle.

Your incident from four weeks previously, where you suddenly had “an explosion of sound” in your headphones, although it didn’t cause tinnitus then, it did cause an immediate negative response—because you could still “feel it in my ears the next day”.

I use the analogy of a bruise. The sudden loud sound “bruised” your hearing mechanism. As you know, it takes time for a bruise to heal and fade away. Most of the “bruising” was “healed” by the time you took the test, so you didn’t notice anything different, but your ears were still more sensitive than normal. Then taking the test and the stress and straining to hear associated with it was like hitting a healing bruise—and it came back with a vengeance.

Now, you have to wait even longer for your “bruised ears” to heal. I believe they will in time. It may take a couple of months or more, so don’t worry about it in the meantime.

You are also worrying about whether you’ve permanently damaged your cochlea. The truth is, if you have a sensorineural hearing loss at any frequency, then your cochlea is damaged at that point. What has happened is that some hair cells have died so you no longer hear the sounds that were governed by those hair cells. That is one reason for the clogged feeling. It should go away in time as your brain gets used to the new reality—but just because the clogged feeling goes away doesn’t mean that your hearing has returned—it’s just that your brain has accepted the new “normal”.

Tinnitus very often accompanies hearing loss. But you can get tinnitus for a number of other reasons. One reason is ear trauma. Another is anxiety and stress.

Now that you know what has happened to your ears, you need to stop worrying about your tinnitus and hearing. Instead, you need to work on getting your anxiety and stress under control. When you do this, your limbic system will turn down the internal volume and your tinnitus hopefully will fade away.

In addition, as the “bruising” heals, very likely your ears will return to their old level of robustness. It just takes time. However, if you continue to stress and worry about your tinnitus, your limbic system will turn up the volume and it will become ever louder and more intrusive. So the time to nip this in the bud is now.

After I had explained the above, this lady wrote back,

All of this makes so much sense. I was definitely straining substantially in that test to hear those tones. I remember at some point I became conscious that my facial expressions were very pained because of the fierce concentration to determine between the real beeps and the imagined ones.

I recall at that point thinking that this audiologist probably thinks I’m a bit ‘kooky’ taking this so seriously. I had so much vested interest in doing well on that test because I really didn’t want to hear her say that I had a significant hearing loss.

It’s a great relief to know that I didn’t just ‘invent’ my tinnitus at the mere mention of it. When I’d explained to the people around me what had happened and how it had started directly after the hearing test, the most common response was a gentle suggestion that it was probably psychosomatic or hypochondria. Except, I knew that it wasn’t because I can really hear this buzzing so clearly in my consciousness, and it came on unexpectedly when I was relieved and pleased that my hearing test was allegedly “good for my age,” which I now know doesn’t really count for that much.

Your wise counsel has been extremely helpful and comforting. Now I’m going to put this as far out of mind as possible, knowing that the tinnitus will probably fade the less attention I give it. I’ve definitely noticed this vicious cycle where the more I focus on it the more present it becomes.