by Neil Bauman, Ph.D.
© November, 2020
Being hypersensitive to sound is not particularly high on my list of enjoyable activities to put it mildly! When you are hypersensitive to sounds, you discover to your consternation that certain sounds, many sounds or all sounds are so loud that they make you wince, jump, cry out with pain or even lose your balance. Yet the truth is, these sounds are often normal, everyday sounds that are not even particularly loud. As a result, you may become annoyed, angry or fearful of sounds, find it difficult to live in our noisy world and thus ultimately withdraw from society.
You may seek help from professionals whom you think should be able to assist you, but as so often happens, the doctors you consult know even less that you do about your condition. Unfortunately, the truth is, few doctors know much, if anything about the various hypersensitivities to sound that we have to endure. As the founder of the Hyperacusis Network once lamented, “Ear Nose and Throat doctors (ENTs) are renowned for misdiagnosing our condition [hyperacusis], giving poor advice and/or subjecting our ears to tests which collapse our tolerance to sound even more.”
Even fewer doctors know how to effectively treat these conditions. There is little good information on the subject. Therefore, you typically have to take charge and learn what is safe for your ears on your own. Unfortunately, when you have hyperacusis, you instinctively choose what seems to be the logical treatment—wear ear protectors to protect your ears from the painfully-loud sounds you now hear. Unfortunately, this coping strategy is often exactly the opposite of what you should be doing. Over-protecting your ears just makes your hyperacusis progressively worse, not better.
Since these wrong or inappropriate treatments leave you worse off than you were before, you sink into deep depression. You think you’ve just been given a life sentence with no hope of parole on the horizon.
Many people with hyperacusis are desperate for help. At this point what you need more than anything else is hope, and along with hope, a plan to successfully get your sensitivity to sound back to normal. Hyperacusis may seem to be a rare condition, but in reality, people with hyperacusis inundate me with their pleas for help. Seldom a day passes without someone contacting me for help.
Since there is so little good information readily available on the various kinds of sound hypersensitivities, I have spent the past four years researching this subject. I have distilled what I have learned into a comprehensive book entitled, Hypersensitive to Sound? Successfully Deal with Your Hyperacusis, Recruitment & Other Sound Sensitivities that was just released this month (November, 2020). This book teaches you what the various sound hypersensitivities are and what you can do to free yourself from these strange conditions and get yourself on the road to recovery.
There are a number of different hypersensitivities to sound. If you are hard of hearing you have probably heard about/experienced recruitment. That is one kind of sound sensitivity. You may even have heard the term “hyperacusis” and know it has something to do with perceiving sounds as much too loud.
However, you probably don’t realize that hyperacusis is not just one condition, but is actually a whole family of disorders lumped together under the umbrella of “hyperacusis”. What you likely don’t know, and really need to know, is that each of the various “kinds” of hyperacusis have their own specific treatments. Using the wrong treatment just makes things worse. Thus, you need to have an accurate diagnosis of you specific kind of hyperacusis before trying to treat it.
Furthermore, you may find that you may have just one kind of hyperacusis, or more likely, you may have two or more kinds at once—for example, you may have a combination of loudness hyperacusis and pain hyperacusis at the same time (a fairly-common combination)—yet each kind needs its own specific treatment.
Not only does each condition need its own treatment, but when you have more than one condition, each one needs to be treated in the correct order depending on which conditions you have. Using the correct treatments, but treating them in the wrong order, or treating them all concurrently can be a recipe for disaster as numbers of people have found out to their sorrow.
Just teasing apart the various disorders can be a challenge in itself. Making matters even worse, other conditions that can have similar symptoms such as Tonic Tensor Tympani Syndrome (TTTS), Stapedial Myoclonus, Acoustic Shock disorder (ASD), Superior Canal Dehiscence Syndrome (SCDS), Third Window Syndrome (TWS) and so on are often intertwined with them.
To help you figure out what sound sensitivity disorders you may have, I have briefly outlined below the 10 conditions that are often lumped (in whole or in part) under the single term “hyperacusis”.
1. Loudness Recruitment
Loudness recruitment is often just referred to as “recruitment”. It is a byproduct of having a sensorineural (inner ear) hearing loss. If you have a sensorineural hearing loss, you will have recruitment to some degree or other whether you realize it or not. Recruitment results in an abnormally-rapid growth of perceived loudness for those sounds located in the pitch region of your hearing loss.
Here is an example of recruitment kicking in. You are talking with a person and you can’t quite hear them so you ask him to speak up a bit. He complies with your request, and raises his voice slightly. However, to you it now sounds like he is shouting at you. You retort, “You don’t have to yell at me! I’m not deaf!” If this is your kind of experience with sound, you have loudness recruitment. As one person succinctly put it, “With recruitment, your auditory system goes from too little to too much too fast!”
2. Loudness Hyperacusis
Loudness hyperacusis is where you have a lowered tolerance to sound such that you can’t stand sounds as loud as you used to be able to. This is typically the kind of hyperacusis people really mean when they say they have hyperacusis.
When you have loudness hyperacusis, you perceive some or all normal sounds as being too loud, much too loud or even painfully loud. For example, if you have severe loudness hyperacusis, a car whizzing down the road past you may sound to you like a jet plane screaming past you at take off.
Typically, you get loudness hyperacusis when you expose your ears to excessively loud sounds—it could have been a loud concert, a sports event, a gunshot or any sudden, loud sound. After the event, you notice that sounds now seem muffled, and your ears ring (tinnitus). A few days later, you realize that your ears are becoming more and more sensitive to sounds. This is how loudness hyperacusis often begins. You can also get loudness hyperacusis from taking any one of a number of ototoxic drugs that have this nasty side effect.
3. Reactive Tinnitus
Reactive tinnitus occurs when you have both tinnitus and loudness hyperacusis (although you may not even realize you have hyperacusis and just think you have a weird kind of tinnitus), and your tinnitus interacts with your loudness hyperacusis such that when you hear (louder) sounds, your tinnitus also gets louder. Now you have two nasty conditions to deal with instead of just one.
Note that trying to treat the tinnitus component or reactive tinnitus without first treating the loudness hyperacusis component just makes things worse.
4. Amplification (Hearing Aid) Hyperacusis
Amplification hyperacusis (hearing aid hyperacusis) occurs when your hearing aids (or other assistive listening devices) are not programmed correctly for your specific hearing loss and fail to accommodate any sound sensitivities you may have. Thus your hearing aids over-amplify certain frequencies of sounds such that they shoot through the ceiling of your dynamic range at that frequency.
Whenever this occurs, you perceive these particular sounds as being so loud that they hurt and you wince, jump or rip your hearing aids out of your ears. However, when you are not wearing your hearing aids, those same sounds do not bother you.
Therefore, if you are wearing hearing aids, and clinking cutlery or a glass being set on a hard surface, or a door slamming causes you to wince or “blows the top of your head off” because it sounds so loud and “sharp” to you, but not to those around you, you are experiencing amplification hyperacusis.
5. Annoyance Hyperacusis
Annoyance hyperacusis (also known as misophonia), is where you have developed a conditioned reflex—an abnormal negative emotional reaction—to specific sounds (called trigger sounds). Whenever you hear even a single occurrence of these trigger sounds, this conditioned reflex instantly and automatically jerks a strong, irrational emotional reaction out of you.
For example, you may rage at your spouse or a parent for smacking his lips, yet he is eating quietly—but that’s not how you perceive that horrible sound.
Therefore, if certain sounds a given person makes instantly make you annoyed, disgusted or angry at them—even though these sounds are relatively soft, you are experiencing annoyance hyperacusis (misophonia).
6. Fear Hyperacusis
Fear hyperacusis (also known as phonophobia), is where you have developed a phobia to some or all sounds such that whenever you hear those sounds, they fill you with fear or terror. You are literally afraid of those sounds because of what they do to you emotionally. For example, you may be afraid to go to work or go into the noisy cafeteria or be around loud sounds. Even the thought of being around such sounds may terrify you. This fear of sound may cause you to avoid social situations.
Fear hyperacusis can grow out of untreated loudness hyperacusis or pain hyperacusis.
7. Pain Hyperacusis
Pain hyperacusis, is exactly what it sounds like. You feel pain when you hear certain/all sounds. If you have pain hyperacusis, certain sounds at modest intensities can cause you to feel pain or cause painful headaches and migraines. For example, when some people hear what to them is a louder sound, it feels like someone has just stabbed them in their ears, or shoved a red-hot poker in their ear canals. These pain sensations occur at much lower sound levels than would typically prompt pain.
Pain hyperacusis is itself comprised of a number of somewhat-related conditions that cause pain, all collected under the umbrella term of pain hyperacusis. These conditions include disorders such as Tonic Tensor Tympani Syndrome (TTTS), Acoustic Shock Disorder (ASD), Eustachian Tube Dysfunction and Stapedial Reflex Dysfunction (stapedius myoclonus).
Sometimes two or more of these conditions are intertwined and thus may occur together. For example, if your voice sounds both loud and muffled, and you experience pain in your ear(s), you may have tonic tensor tympani syndrome (TTTS) or Acoustic Shock Disorder or both.
8. Vestibular Hyperacusis
Vestibular hyperacusis is where (louder) sounds cause balance problems such as dizziness or vertigo. In extreme cases when you hear a sudden, loud sound, you may drop to the ground as if you had been poleaxed.
When you have vestibular hyperacusis, your cochlea has a “third window” in addition to the normal oval and round windows. This third window lets auditory signals sneak into the vestibular areas of your inner ear where your brain interprets them as (spurious) balance signals that mess up your balance.
There are a number of third window conditions. The most common of these is Superior Canal Dehiscence Syndrome (SCDS), often called Tullio’s phenomenon.
9. Conductive Hyperacusis
Conductive hyperacusis, technically conductive hyperacute hearing, is not the typical kind of hyperacusis due to a decreased tolerance to sound. Rather, conductive hyperacusis is a form of “true” hyperacusis—where, due to various middle and inner ear conditions, you actually hear various body-generated sounds/functions amplified via bone conduction. The result is that you hear these body sounds louder than normal. This can be very annoying.
In some cases, conductive hyperacusis can be totally weird because your audiogram shows you have an air-bone gap indicating that you have a conductive hearing loss, but you don’t. You actually have a conductive gain (pseudo-conductive hearing loss). That’s enough to make any audiologist scratch his head.
If your voice sounds abnormally loud to you, or if your breath is a loud whooshing sound, or chewing your food sounds more like thunder than chewing food, or you hear your joints creaking or your vertebrae clicking or your eyeballs moving, then you have conductive hyperacusis.
Two conditions that fall under the conductive hyperacusis umbrella include patulous Eustachian tubes and otosclerosis.
10. Sensorineural Hyperacute Hearing
Sensorineural hyperacute hearing is where your hearing (particularly in the very high frequencies) is naturally so sensitive that you can hear softer sounds than can people with normal (“perfect”) hearing. Two groups of people that often experience hyperacute hearing include those with extreme reverse slope hearing losses and those with autism.
For example, if you have extreme reverse slope hearing loss, you can hear sounds at levels too soft for most people with normal hearing to hear, yet at the same time, you are functionally deaf in the speech frequencies. That is hyperacute hearing in action.
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In this book, there are chapters (or two or more chapters) on each of these various kinds of hypersensitive hearing conditions. Not only will you learn what each kind of hypersensitivity is and what causes it, but even more importantly to you, you’ll learn the latest strategies for successfully dealing with them.
If your ears are hypersensitive to sound, you don’t have to let these sound sensitivities control your life. Don’t lose hope. In some cases, medical interventions can largely fix your problems. However, in many cases, it is up to you to take control, and though hard work—guided by knowledgeable professionals—get your ears (and your life) back on track again.
You can get the book Hypersensitive to Sound? (printed or eBook format) from the Center’s website.
Thank-you Dr Bauman for this blog as you understand this better than most. Your writings are helpful. Thank-you
Hi thank you for this helpful website. My right ear seems to wince at any sound and i feel I need to avoid sound. Also same ear has been vibrating loudly for 3 months, it was constant but now intermittent. It’s terrifying. When I lie down to meditate before going to bed the vibrating eventually stops and starts up again next day when I get up. Night time I am kept awake by loud roaring in my ear. At times I can hear my own voice. This started with an adverse reaction to a drug and my ET filled with fluid and eardrum retracted. I’m in hell with this. I’m waiting to see an ent consultant and I’m desperate for help. Thank you
Hi Joanne:
Tell me more about your ear problems starting with what drug(s) seems to cause these problems. How long ago did this happen? Did you also expose your ears to any loud, especially sudden, unexpected loud sounds–even just one loud sound?
The more you tell me, the better I can understand your situation.
Cordially,
Neil
Hi Neil,
I’ve recently (around 9 months ago) become aware of some strange phenomenon with my left ear, whereby when I hear certain high pitched sounds I will hear what I perceive as the faint tapping or scraping of a wineglass.
The tapping happens really fast, like “tingtingtingting”. This tapping and scraping happens when I hear high brass notes, high string notes, high organ notes,etc.
What is so strange about this is that I only hear it on the F notes in the upper octaves.
When I play an organ note at the highest F or second highest F I will get a “tingtingtingtingting” sound whilst it is playing and then I will hear a “chrrrr bzzzzz” as the sound decays.
Why is this only the F note? It makes no sense to me and I am so confused by this.
I won’t let this destroy me but I am pretty depressed about this because some degree of musical material has been affected.
It is not as severe as it was when I first noticed it, and there has been some improvement, be it modest.
I also notice it with even higher pitched sounds in my right ear, and it does distort some of the sounds that are very high up as well, I get a fuzziness/really fast stuttering, but it is less noticeable than the problem with the left ear.
Could this be some kind of hyperacusis or some kind of tinnitus? Or could it be something else?
I will also add that my left ear started a really high pitched ringing but the loud ringing had turned into a soft hiss by the next morning. This was in January.
I begin to wonder if these two things are related to each other.
I have no idea what is happening but it does concern me. Is there anything that I am not aware of that could be causing this? I have not changed medications or anything along those lines.
However, I must add that I do have autism spectrum disorder. Would this cause the phenomenon that I am experiencing?
Hi Benjamin:
To me, what you describe sounds like high-pitched tinnitus with the possibility of some hyperacusis mixed in–what can be described as reactive tinnitus.
Since it is in the very high frequencies, you probably also have a hearing loss in these very high frequencies. Typically you are tested to 8,000 HZ, but not above that, yet your hearing typically extends to around 20,000 Hz. Thus hearing loss up there can result in high-pitched tinnitus and sound distortion.
Cordially,
Neil
Thanks Neil, another thing I notice is when I play a pure tone (sine wave) between say 5700Hz and 6100Hz, that when I stop the tone I get a “ting” sound that lasts about a second.
I don’t know what this is but it is disturbing to say the least.
Hi Benjamin:
You may want to read my article on diplacusis and other strange “double sounds” that may be more to what you are experiencing. The link is https://hearinglosshelp.com/blog/diplacusisthe-strange-world-of-people-with-double-hearing/
You’ll also find good information in the questions and my replies below this article.
Let me know whether this rings a bell with you (no pun intended)! LOL
Cordially,
Neil
I don’t think this is diplacusis. It’s just a tinnitus tone that plays for a second after the tone stops. It also happens ver quickly, there is no “soft start” it’s a “ting” sound, like someone hitting one of those metal triangles that people hang from their hands and hit with a stick.
I don’t think this is diplacusis, which is why I wanted to ask some questions.
But I do get some distortion in that range, so I have no idea what it could be.
This website is a blessing in a sea of contradictory information on sound sensitivity conditions. I bought your book on hyperacusis. I have learned a lot and it has been very informative. Unfortunately, I have not come across my exact circumstances. I am a 46 year old musician and I developed loudness and pain hyperacusis the day after an acoustic shock event (gunfire with no ear protection). I went to audiologist who treats tinnitus/hyperacusis and offers sound retraining therapy. She confirmed hyperacusis and conductive hearing loss. She is reluctant to start sound retraining therapy because the hearing tests were puzzling to her. She performed the test multiple times and said there were inconsistencies each time that concerned her, so she referred me to an ENT to get a CT scan.
After examination and CT scan, the ENT doctor found
Patulous eustacian tube on right ear, and superior semicircular canal dehiscence on the left ear.
The ENT wasn’t sure how to proceed so has referred me to a surgeon. I’m planning to try drops for the patulous eustacian tube of right ear, but I’m reluctant to treat the left ear surgically as I do not seem to have vestibular issues like dizziness or vertigo. My balance seems to be just fine as well. This all started after a single acoustic event and my only complaint is sound sensitivity/hyperacusis. 6 months has passed since the hyperacusis started, and it seems to improve every few weeks but then I will have set backs that put me back to square one or maybe slightly better. I listen to low volume TV, fans, and white/brown noise as often as possible, and I only protect my hearing with musicians earplugs temporarily for very loud events like driving or using blender. I’m trying to stay positive and would like to know if I am still a candidate for sound retraining therapy. I know this can take years to resolve, which I’ve learned to accept as long as I know I’m on the right path. Any info, thoughts or advice would be sincerely appreciated.
In gratitude,
Darren
Hi Darren:
I’ll bet your audiologist was confused when she saw you showed an air-bone gap on your audiogram so she expected to see some degree of conductive hearing loss, but instead you have conductive hyperacusis which she does not understand. You can read the section on Inner Ear (Third Window Syndrome) Conditions in Chapter 20 for a better understanding of this condition.
And the previous section in Chapter 20–“Eustachian tube dysfunction (Patulous Eustachian Tubes)” explains what is going on with your Patulous Eustachian tube.
I’m not sure you want to do sound therapy in the traditional sense that your audiologist is thinking because of your conductive hyperacusis.
Doing what you have been doing seems to be working, but as you say, you are suffering setbacks all the time. Give me examples of the sounds/situations that are causing these setbacks. Can you think of practical ways to avoid them that don’t totally mess up your life?.
Study Chapter 20 so you clearly understand what is going on with your ears. You may even want your audiologist to read this chapter or at least the section on the third window syndrome so she understands why her readings are “inconsistent”. Then, get back to me with any questions you have.
Cordially,
Neil
Sincere thanks for your quick response. I will bring your book to my next appointment. Is SSCD progressive? Do I risk further opening of the window or a worsening of my condition/symptoms every time I hear a loud noise, or strain or exercise?
Hi Darren:
If it isn’t hereditary, often superior canal dehiscence syndrome results from trauma of some kind–a blow to the head for example. In your case, it may have been from the loud gunshots too close to your ear as it seems to have originated then.
If you really strain in exercising that builds up internal body pressure and could also cause it or cause it to worsen. So could forcefully blowing on brass instruments. An ear specialist that is familiar with SCDS would be the best person to ask.
Cordially,
Neil
Hi Dr Bauman,
On Sept 25, I was exposed to high caliber gun shots, my ear plugs did not protect.
My hearing is very muffled, I have ringing, when I touch my ear or hiccup I have a fluttering sound. My ears still hurt along with normal sounds like ice machine hurt or are just too loud. Sirens, high pitch are distorted.
My ENT on day 3 put me in prednisone. I’m on day 7 with little improvements.
My base line test showed severe loss in both ears.
Im so scared. Should I be doing anything else at this point for recovery? Acupuncture, steroids shots?
I’m due to fly on a plane in a week but I’m so scared to damage further. Doctor said ok to travel and could be 8-12 weeks before I see improvements.
This blog has been helpful. Thank you in advance.
Hi Leslie:
If your ear protectors didn’t protect your ears, either you didn’t have ones with a high enough protection factor, or you didn’t have them inserted or seated properly. Note that you can only get about 33 dB of protection wearing foam ear protectors and then wearing ear muffs on top of them.
The more shots your ears were exposed to, the worse the damage too.
Your ear suffered acoustic shock. Hence you have the hearing loss, muffled hearing, tinnitus and loudness hyperacusis (your sensitivity to sounds, particularly high frequency sounds).
Some of these symptoms will take a number of months to heal–so you have to be patient. In the meantime, you need to protect your ears from louder sounds as they heal. And keep away from truly loud sounds. Your ears can’t stand them at this point.
If you had contacted me the same day as the shooting, I would have told you to take N-acetyl-cysteine (NAC) in high doses for a couple of weeks–but once several days have passed, its too late to get much help from NAC.
What you need now is patience and protecting your ears from louder sounds.
Cordially,
Neil
Thank you so much. I did start NAC, should I stop?
My hearing test showed mild to moderate loss but I feel my hearing is worse.
I did not travel on plane and am protecting my ears. I’m on another round of steroids and gabapentin to help nerve settle. Should I just wait and pray at this time?
I purchased your hypersensitive book, what section should I review?
Was also considering trying chiro to help the auditory nerve and fluttering I get when I push on ears or hiccup.
Your blog has been a blessing to understand what is happening.
Lastly … what type of specialist works with retraining sound therapy ? I’ve not located any in my area.
Again … Thank you so much and Gob Bless
Hi Leslie:
I sure wouldn’t hurt to keep taking the NAC for two weeks or so if you are taking higher doses. You can take low doses (600 mg/day “forever”. I take NAC daily just for enhancing good health.
Acoustic shock typically takes time to resolve–so you need to be patient for some months.
I’d suggest you read two sections in Chapter 18 for a starter such as
Tonic Tensor Tympani Syndrome (TTTS)
Acoustic Shock Disorder (ASD)
And the section on Loud Noise in Chapter 5.
Chapters 4 and 6 will help you understand what is going on with your ears so I also recommend them as well.
Before you try a chiropractor read those sections I mentioned in Chapter 8 and see whether you think it appropriate for you at this time.
If you want to sound therapy, typically you’d go to an audiologist that specializes in tinnitus at a tinnitus/hyperacusis clinic.
Cordially,
Neil
Thank you so much – you are a Saint!
One last question:
Could the prednisone cause tinnitus ringing to worsen? Or does this type of injury continue to decline 15 days out despite steroids?
Promise – last question and I will read sections you’ve noted.
Hi Leslie:
In some people, Prednisone can cause tinnitus/make tinnitus worse, but I don’t think it too likely in your case.
Acoustic shock injuries can take awhile to develop, and even longer to heal. So 15 days isn’t necessarily long enough to see the end of your acoustic shock. And taking steroids doesn’t necessarily stop the acoustic shock in its tracks. It may help some, lots or none. It all depends.
Don’t make a promise you can’t (or subsequently don’t want to) keep.
Cordially,
Neil
Neil, recently I have struggled with a minor problem – some frequencies especially higher ones create a slight sizzling sound on top of the sound making it sound etched and fairly unpleasant at times. This recently happened in my left ear and is much more noticeable on the left side.
Does this eventually go away in a few months? It’s been more than a months since I noticed this. At the start of the year my left ear started ringing between 5 and 6kHz all of a sudden whilst watching TV at home. The ringing got louder over a few minutes. Taking Clonazepam settled it down and next morning it was fine and mostly gone. But since then other things have been noticeable. A high pitched pinging sound in response to sounds at that similar pitch.
I am sure this will become less noticeable but just how long does this take? I have heard it can take many months and in some cases up to 3 years for this to eventually subside.
It is really frustrating as it affects music quality and some higher pitched female voices. It’s mild but noticeable. I wish there was an answer to this.
What would you say about this? Is it fixable? I really appreciate your responses to so many other questions on this board.
Hi Benjamin:
Let’s see if I have this right. Back in January or so you got tinnitus right out of the blue. Then more recently when you hear certain higher-pitched sounds, your tinnitus turns to a pinging or sizzling sound on top of the words/sounds you are hearing. When the words/sounds stop, the sizzling/pinging sound goes away and comes back when you again hear that frequency range of sound. When this is not happening, your tinnitus remains a high-pitched ringing sound. Is this all correct?
What brought your tinnitus on in the first place? Did you listen to music too loud? Attend concerts and loud venues without ear protection? Expose your ears to sudden loud sounds? Things like these?
It almost sounds like you have reactive tinnitus, and the above are typical things that precipitate reactive tinnitus, and then it is made worse by anxiety and worry.
How long it lasts depends on several factors. It is not time itself, but what you do with the time that makes the big difference. It seems you are worrying about it and this can make it stick around, whereas if you ignore it and focus on other things, it has a much greater chance of fading away in time.
Cordially,
Neil
Hi Neil,
I did expose them to a sudden loud noise but it was not that loud and that was 6 months prior to the left ear suddenly ringing. I am not sure what else caused this.
I cannot hear any tinnitus in that ear unless I block it so it’s very low otherwise but external sounds set it off and it lasts anywhere from a few seconds to maybe a minute before it disappears.
But it does “distort” certain high pitched sounds.
Does it take 6 months for tinnitus to occur after a single noise exposure? I would presume it happens in a matter of days.
Hi Benjamin:
When you get sound sensitivity, it is more the suddenness and unexpectedness of the sound, rather than the volume that can cause the sound sensitivity. In other words how strong your startle reflex kicks in. This does not have to show up right away. It usually shows up in 2 weeks or so, but it can be longer.
I would have expected it to show up before 6 months have passed, so that may not be related to your current problem, or it might have set the stage for it.
Are you anxious or high-strung and startle easily? If so, that can also affect how long this reactive tinnitus.
Cordially,
Neil
Dr…I genuinely appreciate your blog posts & insights. Wanted share my story…. I went to a very loud concert about 2 1/2 months ago. After the concert I had achy ears & muffled hearing for a week & noticed I had sound sensitivity with high frequency sounds like dumping bottles on top of other bottles in my recycling bin & loud music. The sensitivity is quite jarring. It might be painful or it could be my reaction/fear of the sound.
A month later I developed a head cold which layered on intermittent tinnitus & ear pressure. When the cold passed one ear popped the other is still full & the tinnitus stayed.
I went to an ent. They did a hearing test & it came back normal, also ear drum was flexible. ENT said ear canal was fine. Told me I had acoustic trauma, dropped the term ,hyperacusis and to give it a couple months. Did a round of prednisone.
A month later with no progress went to see an ear specialist at the local hospital. I described my symptoms & case. After reviewing my hearing test from the ENT, He told me I have high frequency hearing loss & recruitment is responsible for my sound sensitivity. I am going back for more extensive tests in 2 weeks that extend beyond the typical test.
I imagine I will have high frequency hearing loss come back on the test because I have taken quite a few online test and my hearing stops picking up sound between 10-11k hertz (45 years old).
I have been wearing ear plugs around the house due to very loud children.
Long story short I am trying to figure out the best next steps because the ENT & Ear Specialist have the same recommendations: in time it might get better. Avoid loud sounds. Get some ear plugs. I feel like there has to suggestions to try that might provide some relief or perhaps might be a better course of action.
Any suggestions?
Thank you,
Scott
Hi Scott:
I doubt that recruitment is your problem. Loudness hyperacusis is. Few doctors could tell you the difference between them. You WILL have some degree of recruitment at the frequencies of your sensorineural hearing loss. There is no doubt about that. But those sharp sounds were due to loud noise exposure and that caused loudness hyperacusis which you now have.
Wearing ear plugs when you don’t absolutely need to wear them is counterproductive as it just makes your hyperacusis worse. So wear sound protectors when the racket is too much for you ears, but take them off as soon as it dies down. If you leave them in, your brain turns up its internal volume and you’ll notice when you take the noise protectors out, everything is now louder than it should be.o
Time alone doesn’t fix things. It’s what you do with the time that makes the difference.
Your doctors are correct in that you want to avoid louder sounds while your ears heal and that can take several months up to 2 or 3 years. And depending on how bad your loudness hyperacusis is, you might want to surround yourself with sound 24/7. The idea is to begin with a very low background sound and slowly increase the level as your ears improve their tolerance to that level of sound, until finally, your ears have returned to their normal dynamic range.
Cordially,
Neil
Thank you Dr Bauman. My next step is more expansive tests.
In your experience , do independent audiologists typically have the same testing equipment & capability for testing a patient’s complete range of hearing that an ENT’ office or a hospital does? If so my thought is to find an independent audiologist to run the same tests because I feel like they might take me more seriously & may have a few more recommendations than the ENT & hospital will not.
In particular I want to drill into sounds that actually cause me pain vs sounds that I have convinced myself that cause me pain….but actually do not cause me pain. ie. am I building a prison in my head that is not real.
Does it sound reasonable to shift over to an independent audiologist for this type of scenario?
Thank you!
-Scott
Hi Scott:
Normally, I think that independent audiologists have the same equipment as ENT offices, but a hospital (especially a teaching hospital) may have more high-end equipment. Most audiometers used only go to 8,000 Hz, but some go to 12,000 Hz and only a few have ones that go to 16,000 Hz or higher. So you have to ask. The hospital may have one that goes up to 20,000 Hz, but maybe not.
I prefer going to an independent audiologist as they are free to tell you what they think/recommend, etc. An audiologist that works under an ENT can’t do that. The ENT has to tell you the results, and since he is not an expert in audiology, you may get less complete information than from an independent audiologist.
Pain is a perception–no matter how loud the sounds are. If you had normal ears, then it is considered that sounds above 120 dB or so cause pain. However, when you have hyperacusis, you can perceive sounds causing you pain even if they are relatively soft–only 50 dB in severe cases for example.
In either case, you perceive the pain as real.
Be aware that hearing professionals of all kinds are typically not very well versed in the nuances of loudness hyperacusis, so you want to find one this is particularly knowledgeable in this area.
Cordially,
Neil
Thank you very much! Your perspective is very helpful.
-Scott
Hi Neil
I’ve suffered from tinnitus since 2012 following an acoustic trauma with loud noise in one ear through a pair of headphones. It left me with mild (-10db hearing loss). The tinnitus hasn’t bothered me since and I have always worn -25/22db earplugs when out or working (I’m a promoter/DJ). However in feb following a loud gig (without earplugs – I know) I had a spike. While noticing in a quiet room it was ok – just a strong ringing tonal tinnitus. However whilst setting up in march the sound engineer unexpected played some very loud music for about 10/15 seconds. It made me wince but didn’t think anything of it until next day when I work up with muffled hearing, headache, and really high pitch fizzing tinnitus. I also am now sensitive to percussive sounds and high pitch frequencies – (hyperacusis?). I’ve cancelled all my work and trying (with difficulty) to find an audiologist that has some experience in Scotland with this kind of thing. I know there is little that can be done apart of patience and time and removing myself from loud sound. I just wanted to know (difficult as it maybe through this message) what my prognosis maybe? In time will this settle? Will I be able to get back to Djing ? Not having the best time at the minute to some clarity may help me. Best, Cameron
Hi Cameron:
Your ears can only stand so much loud sounds before things go bad. Your ears were damaged in 2012 and largely recovered. But the loud gig in Feb, followed by the episode in March–before they had healed from the Feb incident, just caused things to become even worse. You definitely now have loudness hyperacusis.
How long it will take your ears to get back to near normal depends on a lot of factors. Obviously, you have to protect your ears from loud sounds in the future.
The standard treatment for loudness hyperacusis typically consists of listening to soft background white or pink sounds 24/7 and slowly increasing the volume over a period of months as your ears can stand it. You slowly push the envelope to increase your dynamic range until it is back up to where it was before.
I know what you mean by not many audiologists understanding hyperacusis. The best place to go for help is an audiologist that has a tinnitus (and hyperacusis) clinic–not just an audiologist that fits hearing aids.
You can learn pretty much everything you need to know in my comprehensive book “Hypersensitive to Sound”. You can get this book from our website at https://hearinglosshelp.com/shop/hypersensitive-to-sound/ . Get the eBook version as the postage to Scotland is more than the cost of the book itself. The eBook has the identical information (same layout) as the printed book.
It should answer all your questions about what you can expect going forward. After you have read it, if you have any more questions, you know where to find me.
Cordially,
Neil
Hi Dr. Bauman. I am panicking right now. Ten years ago I suffer a traumatic event, a gun shot 5 meters away from me, I had no hearing protection. I suffer PTSD and symptoms of ttts but with no pain, just the fluttering sensation.
I got used to it and didn’t think about it for 9 years. one month ago I got a MRI which was very loud. I was panicking inside the machine and after I started to be hypervigilant with my ears, my right ear was sore, I started having pain with noises and the constant burning pain didn’t go away . Can TTTS cause constant burning pain? Thank you.
Hi Elias:
You always want to wear ear protectors when you are having an MRI–especially if you have or have had sound sensitivity issues (Hyperacusis).
The short answer is yes, TTTS can result in burning pain. Or perhaps a better way of looking at it is that acoustic trauma can result in both TTTS and ear pain (and a number of other side effects).
All of these conditions are psychosomatic so panicking and being hypervigilant to sounds just makes things worse. That is why it is so important to “keep your cool” when dealing with such situations.
Cordially,
Neil
Thank for your response. I had protection both only earplugs because it was for my jaw. I had to keep my mouth wide open for 15 minutes during the MRI. They found arthritis in my jaw. Can TMJ(TMD) cause these symptoms also. Do the burning sensations that I have from sound can heal? Thank you
Hi Dr Bauman
I got very bad tinnitus and loudness hyperacusis after an ultrasound toothcleaning in november 2021.
I can’t sleep without Phenergan 25 mg and I don’t sleep every night even if I take pills every evening.
My tinnitus have some different sounds and sometimes it is louder than other times.
But it is audible both night and day.
If I for exampel watch tv sometimes my tinnitus goes up trying to drown out the tv sound.
I can’ t be social and I can’t go shopping because my tinnitus gets louder and it takes a long time to quiet down again.
I react to a lot of sounds which worsen my tinnitus.
Can I hope for both tinnitus and hyperacusis to go away again or will I have to live with it and get use to it?
Three weeks ago I went out and a child screemed loud just beside my ear. Since that it has been even worse. It it fatel to get another injury?
I have ordered two of your books but it will take a while because I live in Denmark. I look very much forward getting them.
In Denmark no one talks about reaktive tinnitus and neither my ent or other professionals understands my tinnitus and hyperacusis problems.
They don’t understand that I have setbacks of sounds.
Regards Ulla
Hi Ulla:
You now have reactive tinnitus–a combination of both tinnitus and loudness hyperacusis. This does not have to be a lifetime sentence. If you do the right things and persevere in doing them, you can bring both your tinnitus and hyperacusis under control so it no longer bothers you. You may not get totally back to normal, but you should achieve 90%.
When the child screamed by your ear, you experienced a setback. Setbacks are a pain for sure, but you can recover from them. You just keep on the program, but because you have taken a few steps backward, it will just take longer to achieve success. Setbacks are a part of life, but you want to minimize them if at all possible.
Realize that you are PERCEIVING sounds louder than normal. The sounds typically do NOT harm your ears–but because you perceive them as so loud, you would sure think they would and thus worry about harming your ears. This is not true unless the sound is so loud it would damage everyone’s ears who hear it. So you can calm down. You won’t lose your hearing because of this.
Once you get my books and read them, if you have any questions, feel free to email me.
Cordially,
Neil
Thank you so much for your help and I am looking so much forward to read your books and find out what to do.
Regards Ulla
My Apple AirPod headphones malfunctioned a couple months ago while I was listening to music and created a very loud screeching sound. It caused my ears to feel full and muffled for a short time, and there was also some ringing afterwards. My left ear was most affected, and I worried that I had damaged my hearing and given myself tinnitus.
In the weeks that followed, I became very aware of loud noises and started having anxiety every time I was exposed to a loud sound.
Shortly thereafter, I noticed that I would feel a shockwave sensation in my left ear whenever there was a loud sound around me, even something as innocuous is pouring dog kibble in a stainless steel dish.
About two weeks ago, I (39M), noticed that my left ear muscle started twitching or fluttering at random times. I notice it most often after I yawn, or when I bend over to pick something up, and then it resolves on its own.
I do suffer from stress and anxiety, and don’t get as much sleep as I should (sleep apnea). I also grind my teeth at night, but use a night guard.
I am thinking that I may have developed hypercausis and misophonia, which I’m thinking may have brought this on.
I saw and audiologist who said my hearing is fine, and she removed some earwax. Any thoughts on what this could be and how to address it? If I treat the misophonia, is it reasonable to expect that things improve?
What kind of treatments work best for hypercausis and minsophonia?
Thanks!
Hi Scott:
Sounds like you experienced noise trauma from that episode. The side effects you experienced are consistent with that.
Your anxiety over this incident and any other loud sounds has made things worse and worse for you. If you had been able to shrug it all off at the beginning, you may not have developed these other conditions.
Your anxiety likely brought on the shock wave sensation and fluttering sensations–which is Tonic Tensor Tympani syndrome (TTTS). It is basically the startle reflex that has gone into overdrive.
It can be brought on by activities that enervate the trigeminal nerve such as yawning and moving your jaw, etc. At other times, just seemingly random–but often precipitated by sudden sounds.
TTTS is a psychosomatic condition–meaning there is a physical component and a psychological component. The psychological component is often the major component. That is why it is so important to get your anxiety under control.
From what you have said, I don’t see any evidence that you have misophonia, but if you keep the anxiety levels high you may develop phonophobia. You basically had acoustic shock that has as its prime symptom TTTS. You may also have some degree of loudness hyperacusis.
As far as treatments go, you need to calm down and get your anxiety under control. You also need to calm down your trigeminal nerve too. You might want to try GABA (gamma-amino-butyric acid) which is your body’s main calming neurotransmitter.
And you might find that supplementing with magnesium threonate if your magnesium levels are low will help.
Cordially,
Neil
Thank you so much, Neil, for taking the time to provide such a thorough and thoughtful response.
What’s ironic about this whole situation, and frankly, quite sad, is the fact that I brought these problems onto myself by trying to prevent them.
When I first learned about tinnitus, while listening to a radio program, several years ago, I developed an anxiety about loud noises, and never wanted to put myself in a situation where I might develop such a condition. And now here I am with something that I’ve tried to avoid,
One thing that will help me reduce. My anxiety is knowing that this can be fixed. If I were to try the treatments, you recommended and reduce my anxiety, do you think I’d be able to return to a place where I was before this started also, what are your thoughts on sound therapy as a way to treat hypercausis?
Thanks again for being such an incredible asset and support for people like me!
Hi Scott:
When you get your anxiety under control, you should be close to normal again. Below I’m quoting from my book “Hypersensitive to Sound” some parts relating to TTTS and how it is so tied into your stress and anxiety. This is why the “cure” is also so tied into reducing your anxiety and stress.
“Learning that TTTS is really just a psychosomatic condition resulting from stress is of great help.”
“The more you worry about your tinnitus, hyperacusis and resulting TTTS symptoms, the worse they get. But the good news is that getting your stress and worry under control, you can also help bring your TTTS under control.”
“Good coping strategies such as relaxation and anxiety reduction need to be standard practice if you have TTTS because physical relaxation therapy is so often found to be effective.”
“Muscle spasms tend to be inextricably linked to a magnesium deficiency in your body. Thus, just as with leg cramps, a magnesium deficiency can cause muscle spasms, twitching and cramping in the muscles in your middle ears.”
“The tensor tympani reflex is a startle reflex which is exacerbated by high stress levels.”
“The psychological context surrounding an acoustic incident generally determines the degree of trauma you will experience….Furthermore, preexisting stress/anxiety, as well as the fear of experiencing more acoustic shock incidents in the future seem to increase your vulnerability to TTTS.”
“TTTS is typically associated with loudness hyperacusis, that is, your symptoms are triggered or made worse when you are exposed to sounds you perceive as too loud and thus are intolerable. However, the underlying cause is related to your anxiety/trauma response to sound.”
“The main job of your tensor tympani muscle is to react to sudden loud sounds—thus producing a startle reflex. Note that this startle reflex is made worse if you are particularly stressed or anxious because the tensor tympani muscle is particularly vulnerable to spasms when you are stressed.”
“Tonic Tensor Tympani Syndrome is fundamentally an involuntary, anxiety-based condition causing reduced startle reflex thresholds. Normally, your tensor tympani reflex springs into action when a sudden, strong, or threatening sound produces a startle reaction. However, when this startle-reflex triggering level is reduced (a softer sound can now trigger this reflex), you may experience frequent spasms of the tensor tympani muscle.”
“Furthermore, when your threshold for TTTS is lowered, you can cause your TTTS to activate just by thinking about it or by anticipating loud sounds. This is especially true if you already have loudness hyperacusis.”
“Once Tonic Tensor Tympani Syndrome has become established, you may become hypervigilant to sounds around you and may develop an exaggerated startle reflex—one that activates at much lower sound levels. These sounds may become increasingly intolerable if your TTTS symptoms become worse following exposure to sounds. When this happens, the range of sounds that cause your involuntary responses expands to include more and more everyday sounds.”
“Thus, if you have loudness hyperacusis, being hypervigilant can make your hyperacusis worse. Furthermore, you may also experience conditions such as phonophobia (fear hyperacusis), headaches, fatigue, anxiety, and depression—particularly if you are not given an adequate explanation of what is happening to you and if you are not properly diagnosed with TTTS.”
As you can see, anything you do to lower your anxiety and stress and take your mind off focusing on your TTTS/hyperacusis is good.
Sound therapy for loudness hyperacusis is certainly a good option when used correctly. No everyone needs sound therapy, but if you do, go for it. Just be sure to go to someone that is experienced in treating loudness hyperacusis and not just tinnitus. Otherwise, they may set the volumes of the sound therapy to fix your tinnitus and these may be much too loud for your loudness hyperacusis and thus will make your loudness hyperacusis worse.
The rule is that initially you treat the loudness hyperacusis first without regard for whether it will help your tinnitus. As your loudness hyperacusis improves, eventually the sound therapy will also help your tinnitus. Just never do it the other way and treat tinnitus first.
Cordially,
Neil
This is so, so helpful. Everything makes perfect sense and I found myself doing a lot of nodding while reading your reply.
At this time, my TTTS only seems to be activated when I yawn, which does have me thinking about the connection to my bruxism, which I imagine has only intensified during these times of punctuated stress and anxiety.
But knowing that I can treat these symptoms by managing stress and anxiety, automatically helps reduce stress and anxiety for me. The idea of developing a new and permanent condition was weighing heavily on my mind, so hearing that things can be improved, and or reversed is the kind of reassurance I needed to hear.
You are a tremendous asset to people like myself and I can’t thank you enough for your support!
Scott
Hi Scott:
I agree that your yawning and bruxism and TTTS can be connected since your trigeminal nerve is activated to some degree for those 3 things if I have it straight.
So now you can work on becoming “calm, cool and collected” .
Cordially,
Neil
Hello
I am glad that I found this website, a lots of great information here.
I am 47yo male and this just happened to me 1.5 days ago:
I went to see fireworks. I was maybe about 70 meters away from the guy who fired them to the sky. Strangely I felt some mild pain in my ears during those loud boom -sounds in the sky. I didn’t expect that at all. I was puzzled by that and looked around if other people were fine – and they seemed to be. The fireworks lasted maybe 10 minutes and we left.
The pain seemed to mostly pass and we went to see another fireworks but this time the distance was like 1 kilometre and I didn’t feel pain there because the sound wasn’t loud at all (last year we were in the same place watching fireworks and I had no problems then.)
But 1 hour later at home when I turned on the computer I noticed that I can’t tolerate sounds from youtube videos (music, people talking etc) and I totally freaked out! I also had slight tinnitus in my left ear and mild ear pains. I still have these issues now 36 hours later. Tinnitus and pains seem to mostly stay away if avoid sounds as much as possible.
I just took my first NAC 600 mg pill about 1.5 days after the exposure and hope it still helps. Do you have any other suggestions what might help? I also took vitamin C and E. Thank you so much.
Hi JP:
Some fireworks make very loud peaks–those flash-bang fireworks–and that can be enough to mess up your ears causing acoustic shock. If things don’t resolve in a few days, it develops into acoustic shock disorder. You experience things like you have now–hyperacusis, ear pain, hearing loss and tinnitus.
Taking NAC is good–but you need to take a therapeutic dose which would be 1,800 mg or so. The 600 mg dose is a standard maintenance dose, which is what I take daily just for good health. You need a much stronger dose in order to really help you ears.
The same goes for vitamin C. If it’s not strong enough, it doesn’t really help you. For example, I take 1,000 mg of vitamin C every day for good health. You can go much higher to get a therapeutic dose.
You also want to protect your ears from loud sounds in the future, and particularly while your ears heal which could take several months.
Another very important thing is not to obsess over your ears. The more you focus on your hyperacusis, etc., the worse things will become. Therefore, control your anxiety and focus on the loves of your life, not on your ears. When you think of all this as a threat to your well-being, it becomes a self-fulfilling prophecy. On the other hand, if you treat it as a useless, background sound that is safe to ignore and then ignore it as much as is possible by focusing on other things, you will find that it fades away in time.
Cordially,
Neil
Thanks for the quick reply!
I should add that I was injured by quinolone antibiotic many years ago and as you probably know, they can cause severe CNS adverse reactions for some people including tinnitus. I had and still have all kinds of CNS problems including anxiety and tremors from it but I never got much tinnitus like many people get. Anyway I guess this made me more vulnerable to react like this to loud noise. Before the adverse reaction I had no problems with much bigger fireworks than this one.
Do you think if it would useful at all to see an ear doctor in this situation?
Thanks
Hi JP:
Medical doctors look for medical problems. Since Acoustic shock disorder isn’t technically a medical problem, most doctors won’t be able to help you as they don’t understand it nor how to effectively treat it. They’ll probably just throws drugs at it–and that is not the answer. I personally wouldn’t waste my time and money going. That’s just my opinion.
Cordially,
Neil
Hello again
Is it wise or helpful to do any kind of hearing test in this situation? I am just afraid that I might make the sensitivity worse by listening to those beeps on headphones. Even normal beeps from phone are too loud for me now.
And is there any type of testing that would reveal, what kind of hyperacusis I have now? For example some say listening to pink noise is good for only loudness H, not pain H. Is this even true? If it is, I would need to know which type I have so that I won’t cause myself harm.
I guess there is more info about all of this in your book?
Thanks
Hi Joni:
When you have loudness hyperacusis, listening to louder sounds can make things worse. So you want to limit hearing testing to sounds that do not cause your hyperacusis to kick in. Thus, if your hearing is tested by starting at very soft levels and gradually increasing them until you can just hear them should not be a problem.
However, if they start at a louder level than your hyperacusis permits and slowly lower the volume until you can’t hear that tone, the initial starting point may be too loud. So get them to do it the opposite way.
And NEVER let them test you for your uncomfortable loudness levels the normal way as they can start a levels which are much to loud for your hyperacusis. However, if they start at the lowest level of the audiometer and slowly increase the sound until your hyperacusis just begins to kick in, then that should be ok too.
You don’t need to “test” for the various kinds of hyperacusis. You can tell them your symptoms and that can tell what is going on. For example, you know when you have loudness hyperacusis–ordinary sounds are now too loud. With annoyance hyperacusis, certain sounds instantly trigger a negative emotional response. With fear hyperacusis, you are afraid of certain or all sounds. With pain hyperacusis, you feel pain as the level of sounds increase. With vestibular hyperacusis you have balance problems as the sound levels increase.
You are correct that listening to pink noise or a number of other sounds is one way to help treat loudness hyperacusis. The other kinds of hyperacusis have other treatments. And you are right, I explain them all in my book “Hypersensitive to Sound?”
You’d do well to read this book so you have a good understanding of what you are experiencing before you go to an ENT or audiologist so you know what kinds of tests to refuse or have them modify to meet your needs.
Cordially,
Neil
Thanks to your article about reverse slope hearing loss, my siblings and I now know how to describe our hearing loss. The loss appears to be genetic since all six siblings, my father , grandfather and niece all have the same issue.
I have become very sensitive and anxious around certain sounds and noisy situations to the point that I have withdrawn from many activities. I will be ordering your book to learn more about how to deal with this.
Presently, I have been seeing multiple ENTs regarding the interaction of my sinuses and my hearing. I am prone to sinus infections and the fluid in my sinuses seem to impact my hearing to the point that I become virtually deaf. My ENTs do not see the connection if there indeed is one. One ENT is now recommending sinus surgery which I will do if it will help. Your guidance on this issue would be much appreciated.
Thanks for being so helpful to so many folks dealing with these unusual issues.
Hi Christy:
If you have a severe reverse-slope loss, the likelihood is that it is hereditary. It’s unusual for everyone to have it. Normally about 50% have it. But the luck of the draw is that indeed everyone in a given generation could get it. It’s like flipping a coin and having it come up heads six times in a row–not likely, but entirely possible.
What kinds of sounds bother you? Do this sounds trigger instant responses from you or what? If so, that could be Annoyance hyperacusis–chapters 15 and 16 in my Hypersensitive book.
If the sounds are higher-frequency sounds that don’t bother others, it could be recruitment or amplification hyperacusis due to your reverse-slope hearing. I always had that problem when wearing hearing aids or using assistive listening devices. Technology has advanced and for the first time in my life, my new hearing aids do not cause amplification hyperacusis.
Like your ENTs, I don’t see a connection between your sinus problems and the sounds that are bothering you. But clogged sinuses and related issues can certainly cause conductive hearing losses.
I need to know much more about your situation before I can really guide you. You can email me privately–see bottom of webpages for my email address.
Cordially,
Neil