by Neil Bauman, Ph.D.
A lady wrote,
For about 5 years now I have been unable to tolerate 2 sounds (1) meat frying and (2) water running. They honestly absolutely drive me crazy. Until I was diagnosed with, and started learning about, Meniere’s disease, I thought it was due to schizophrenia even though my psychiatrist couldn’t give me a reason that this would happen. Now, I know it is due to my Meniere’s.
In the last few months I’ve had to add loud fans to this list. Most fans I can handle but my parents have a heavy duty fan that, if it is on high, I literally cannot hear anything else and I get angry because I’m literally in pain.
I am lucky as I have a terrific family who believes me when I say it hurts so they try very hard to help keep the sounds low.
Actually, your symptoms are not due to Meniere’s disease as such. Rather they result from hearing loss—whatever cause—which, in your case, is very likely caused by your Meniere’s disease.
There are several different conditions that give somewhat similar symptoms.
First, there is recruitment. Recruitment only occurs in people who have a sensorineural hearing loss. With recruitment, due to your now reduced dynamic range (the range of sounds from the softest sound you can hear to the loudest sound you can stand without pain) as sounds increase in volume, they no longer increase linearly (i.e. a sound that is twice as loud actually sounds exactly twice as loud to you), but exponentially (you may perceive a sound that is twice as loud in actual fact as though it were 8 times as loud, for example.) That is recruitment. Recruitment is generally frequency-dependent meaning that the frequencies near your greatest hearing loss will recruit the most.
Second, there is hyperacusis. Hyperacusis is typically not frequency dependent. What typically happens is that your internal volume control is “changed” such that you now hear all sounds as too loud. Think of wearing hearing aids that are set properly. You hear soft and loud sounds—but they are all “normal”. Now if you increased the volume to a higher level—all of a sudden the softer sounds are now louder and the loud sounds are now much too loud and hurt.
Two common causes of hyperacusis are from taking certain drugs and from exposing your ears to loud sounds. There are a number of other lesser causes as well.
With hyperacusis you may have a hearing loss or have normal hearing. And if you are really “lucky”, you could have hyperacusis and one or more of these other conditions at the same time.
Third, there is misophonia—where you intensely dislike certain sounds—they drive you buggy. (Sort of sounds like you, doesn’t it?) For example, a “normal” person may get annoyed listening to others chew with their mouths open, while a person with misophonia will have a more extreme reaction—ranging from disgust to rage to panic—and maybe a combination of all three.
Furthermore, if you have longstanding recruitment or hyperacusis, you can easily develop misophonia to certain sounds.
Finally, there is phonophobia—a fear of such “hurtful” sounds. If sounds, whether from recruitment, hyperacusis or misophonia, “hurt” you enough, you may develop a fear of them, and now you can have phonophobia to boot.
As you can see, this is not a simple condition—but can be a complex situation.
It sounds like the heavy-duty fan is causing recruitment. This can happen right out of the blue. For example, I’ve only ever seen my wife react to recruitment once, and that was when we were near the MindBender ride in the West Edmonton Mall in Edmonton, Alberta. For whatever reason, the sound caused her to immediately clap her hands over her ears. To me (with my severe hearing loss) it was noisy, but did not recruit. (My hearing loss causes recruitment to other frequencies of sound. It is also one reason I have a hard time wearing hearing aids in noisy situations—the sounds often recruit and I’m in pain.) Fortunately for me, I don’t notice recruitment when I am not wearing my hearing aids.
You are indeed fortunate to have such an understanding family since it is so hard to understand why a sound at one volume is fine, but just turn the volume up a smidgen and wham—it’s now hurting you! But that is the way it works with recruitment.
Here’s another example. One time I was chatting with a piano tuner while he was working on a piano. As he went up the scale, two keys recruited and I wanted to punch him in the face every time he hit those keys because he was “deliberately” hurting me when he pressed them. Yet to him they were no louder or softer than the adjacent keys—just different in pitch.
This is a fascinating subject, albeit definitely not nice when you experience it in person.
Jessica says
Thank you! This information will go a long way in helping to explain to people why they can’t click pens around me. I’ve been having a terrible time getting them to take me seriously (they all think I’m just over-reacting when every click shatters my concentration and makes me flinch). This seems like another case of if they can’t see it, then you’re not really sick.
Dr. Neil says
Hi Jessica:
You are correct. To a person with normal hearing it is impossible to comprehend how a pen clicking would be so loud it would make you flinch and cause you pain at the same time. So you just have to tell them (time and time again) that this is indeed what is happening.
Cordially,
Neil
juan says
I’m perplexed as ever why there’s no mention of myoclonus as a cause for ”hyperacusis”. Both in Menieres, where a bunch of austrians recently looked up a 150 year old textbook and began to reapply a forgotten method of middle ear muscle tenotomy, and in the ”hyperacusis” world that’s dominated by oracular Jastreboffian nonsense, where lib and others at chat-hyperacusis cured their sound sensitivity with tenotomy of the middle ear muscles. For those of us with sound sensitivities and vibrations and low pitched tinnitus but no dizziness issues hence no Meniere’s, obviously a paradigm shift must be around the bend. Here’s what Professor Franz said about his method “From animal experiments it is known that an increase of inner ear pressure leads to a pressing out of the stirrup from the inner ear in the direction of the middle ear. The middle ear muscles recognize this pressing out and try to press the stirrup back into its original position inside. This creates a vicious circle which leads to a further increase in pressure of the inner ear. The tenotomy could in our opinion interrupt this vicious circle.” I bet that was the same mechanism involved in Aristides Sismanis patients who were getting dxed as myoclonus without the fanfare of proof on a tympanogram or on an eardrum, when going to another doc would have landed them with a dx of misophonia.
Neil Bauman, Ph.D. says
Hi Juan:
I think if you read my article “Do I Have Tonic Tensor Tympani Syndrome” at http://hearinglosshelp.com/blog/do-i-have-tonic-tensor-tympani-syndrome-ttts/ you will find that you have it all backwards. It’s the hyperacusis that causes the tiny tympani muscles to spasm.
Furthermore, I think Jastreboff is on the right track–it is not nonsense. Sure you can stop the TTTS by cutting the tendons of the two muscles in the middle ear–but that is like cutting off your leg just because you have a pain in your leg. The proper way to deal with it is to find the cause of the pain and treat that, not hamper your ability to walk for the rest of your life by cutting off your leg.
Those two tiny muscles have specific jobs to do and if you cut them, then they cannot do their jobs and you just create other problems for yourself.
In the case of Meniere’s, if Professor Franz is correct about the build-up of pressure in the inner ear, causing the TTTS, the proper way to deal with this is to find the cause of this pressure build-up and not cut the muscles causing the TTTS. The proper way to deal with endolymph build-up is almost certainly to have your upper neck properly aligned. See my article on Atlas Adjustments Alleviate Meniere’s disease for the proper way to do this.
Thus there are much better ways to treat these problems than to cut the muscles in the middle ear and do nothing to correct the underlying problems. And in cutting the muscles, you have just created other permanent problems for yourself.
Cordially,
Neil
juan says
Hi Dr Bauman,
I do apologise for taking so long to respond.
If it were hyperacusis of central origin, those muscles would be preventing the sound pain and perception from being worse. But that’s not the case from the little academic literature on the subject or from testimony like that of lib or JoeM. At least in the cases where the thumps can be felt, heard maybe as echoes and such, if not for cases of real misophonia where no sensation is felt in the ear in most cases according to Marsha Johnson if not all, or in other cases where people complain of electric feelings of pain and report no thumps and twitches in the ear. Therefore there’s something very dodgy about Jastreboff saying acoustic trauma causes H which causes misophonia without bothering to ask the patient if he feels things in the ear. Jastreboff probably doesn’t actually know that misophonia is not felt in the ear. It is also perfectly reasonable to suppose that quiet sudden sounds or certain specific sounds might not be appropriate for certain injuries inside the ear. So how is this remotely similar to people with electric obsessive anger management issues inside their brain known as misophonia sufferers who complain of specific sounds that don’t follow a pattern of pure loudness? In my opinion that’s huge misdiagnosis.
There are reports where eustachian patulous dysfunction caused sensorineural hearing loss, whether real or not, even a paper on it at tinnitus.org. There are reports that talk of meniere’s being helped by grommets or tenotomy because in the words of Franz and co, this might be releasing pressure created by the hydrops (even though we know so little about the middle ear he says something like that in his 2 papers on the subject). I don’t think I can see any central gain theory making sense in patulous, meniere’s and TTTS when they have been reported to cause at least a certain etiology of hyperacusis, if not the many that are poorly covered by the heavily Jastreboff-influenced Hyperacusis Khalifa questionnaire which seems obsessed with looking for psychological issues . And if the muscles or the veli palatini are in dystonic tension, then that’s more like a completely non-auditory thing that’s closer to parkinsons than it is to anything in the auditory system. We all have middle ears but when they become tense, pressured or tonic, then they hurt because we’re still using the ears like normal people. That is a far far cry from Jastreboff’s claims about a limbic system and central gain, in fact it’s the direct opposite. It’s like running with a muscle cramp. Why would we in the hyperacusis community be burdened with searching for the link between the limbic system and dystonia when even meniere’s specific functions is unknown or heavily disputed . Even you when it comes to meniere’s look for reasons in the spinal cord. So I don’t see why all sound sensitivity be fed to sound therapists when many of these peripheral injuries have no objective way of being diagnosed.
also, in addition to the reports of tenotomy and botox through of the muscles or through the tube, I am finding it very suspicious that according to Hain grommets would be working for hyperacusis. Maybe the same grommets Franz talks about, so similar mechanisms for meniere’s and for cochlear hyperacusis, even though many if not all meniere’s have their origin in the vertebra?
Kind regards,
Juan
Neil Bauman, Ph.D. says
Hi Juan:
I’m keeping an open mind on what you have said as I do further research in preparation to revising my book on hyperacusis. Once I get all that done, I’ll have a better idea whether I more agree with you or not. All is grist for the mill.
Cordially,
Neil
Janice Fox says
I am really trying to comprehend everything as it pertains to my Meniere’s that was just DX two weeks ago. Last night my ears went ballistic with tinnitus and I am exhausted today. About 4 months ago I thought I had an ear infection with increased dizzy spells every time I turned to my right. Sometimes I got shooting pain in my ear and always had a fullness wired feeling in my left ear. I had my hips replaced two years ago and everyone wondered why my balance was so bad I had/have to use two canes when my balance went out. I cannot afford a fall as it could cause me to never walk again. Finally with the tinnitus coming continually, fullness of ear, shooting pain in ear, sounds causing pain in my ears, and hearing loss I asked my doctor to check my ears as I thought I had an ear infection about 5 months ago. She put me on a sulfa drug of which I was allergic and changed to a penicillin. She seen a scrape on my ear drum and told me not to use q tips. I have always had this (what I thought was an allergy ) prickling itchy fullness in my ears from time to time that usually hit me when I was sleeping and would wake me up and I would use a q tip to relieve what I thought was from an allergy. So I had probably scrathced myear drum half asleep even though I know what it feel to touch your ear drum and I do not remember ever doing that more than once as it hurt so bad years ago. I am a retired RN and I know I did not scratch my ear drum but I am not going to argue with my Dr over it. Anyway I went back into my Dr. a month later as I see her every month due to chronic pain from arthritis (autoimmune) in every joint but my knees and elbows (lucky there) as I have had surgeries (both hips) and back c fusion and the circus goes on. I thought my balance issues were from the surgeries. (NEVER self DX) and all that goes with it. Any way that month she could not see anything in my ear but she finally put two and two together and sent me to an ENT. I had all the tests which showed low frequency hearing loss and Meneires. Now a lot of things make sense that I thought we just in my mind through the years. I cannot stand to sit in a restaurants or loud places because of the noise, bright lights kills me, I cannot turn my head fast or raise my arms above my head or I get vertigo. I am lost at this point. I knew that Menieres runs in my family and at least two have had surgeries which did not do much but never thought I would have it. Thank you for these posts as I am on a learning curve here. I am so tired or the fear of falling and loud noise that I have isolated myself slowly but surely and not knowing or understanding why. Now I know it has been this disease coming on slowly but I did not know until it hit full force 5 months ago and has not left. I am riding my first airplane ride since the DX and continuous symptoms and could use any hints as to controlling the ear pain. Going over the mountains in the car with continuous popping and ringing was bad enough so I do not know how this plane ride is going to hit me. I have ear plugs and window seat and all I can do but we will see. Does anyone’s balance ever get better? With my left ear with the greatest hearing loss is the cause that sudden moves to the right send me off balance I was told my the audiologist. Any way thank you for listening and the resources here.
Janice L. Fox retired RN age 64 years.
Neil Bauman, Ph.D. says
Hi Janice:
From what you have said, I think you can do yourself a lot of good (and even get rid of your Meniere’s) if you see an upper cervical spine chiropractor. To learn about what is going on with your ears and back, read my comprehensive article at http://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/ then take the appropriate action. Everyone that has done and has reported back to me has had positive results.
Cordially,
Neil