by Neil Bauman, Ph.D.
© February, 2018
Introduction
Reactive tinnitus is a fairly new term. And as is often the case with new terms, there seems to be quite a bit of controversy in some circles over exactly what reactive tinnitus is and is not.
For example, some people are adamant that there’s no such thing as the term “reactive tinnitus”—that this is a meaningless and nonexistent term—and that we should use other terms. They hold this viewpoint because there are two other terms for this same condition that are sometimes used in the tinnitus literature. “Tom”, an audiologist, wrote,
The term “reactive tinnitus” is an attempt by folks who aren’t clinicians to explain what their tinnitus does in some cases (i.e., react to certain sounds or aural environments). But the term “reactive tinnitus” doesn’t exist.
“George” further explained,
There is no such thing as “reactive tinnitus”, What I mean is, it is not a medical condition. It was made up in tinnitus forums. The tinnitus literature doesn’t use the term.
Other people believe “reactive tinnitus” is not clearly defined and, as a result, is basically meaningless. For example, “Andy” explained,
In my opinion reactive tinnitus is a poorly used and greatly misunderstood term, which is why I do not believe it should be used at all. The reason I say this is that almost everybody’s tinnitus reacts to something—be it noise, stress, fatigue, waking from a nap, drugs, salt, sugar, alcohol, etc. So if we are going to use the term reactive tinnitus and have it mean something, everybody needs to agree on what their tinnitus is reacting to before we call it “reactive tinnitus”.
I couldn’t agree more. We all need to be on the same page. We need to define exactly what we mean by the term “reactive tinnitus”, because, unlike “Andy”, I believe reactive tinnitus is an excellent term to describe this kind of tinnitus. All that’s really missing is a precise definition of the term “reactive tinnitus”. Audiologist, Marsha Johnson also agrees. She wrote,
Reactive tinnitus is a perfectly good term and should be used if it describes the situation.
Part of the reason for this controversy is that there are already two terms that a few doctors have been using, and those opposed to using the term “reactive tinnitus” think these are better terms since they are medically sanctioned. These two terms are “kindling” and “winding up”.
However, neither of these terms is very intuitive. If someone tells you their tinnitus is reacting to sounds, you intuitively sort of know what they mean.
However is someone says their tinnitus is “kindling” or “winding up” you’d be left wondering exactly what they are meaning.
As “Percy” explained,
Reactive tinnitus is a much better term. Everybody who speaks English knows what it means. Nobody knows what “kindling” or “winding up” mean, or the fine distinction between them. I think “kindling” involves firewood and “winding up” involves a wristwatch.”
To me, “winding up” would be ending something such as “winding up an advertising or military campaign”. And because English is ambiguous at times, the terms “winding up” and “winding down” can mean exactly the same thing! So what, exactly, is our tinnitus doing when it is “kindling” or “winding up”?
The truth is, language is constantly changing and evolving. “Todd” explained,
Words have a way of changing their meaning or coming into existence. I first heard the term “reactive tinnitus” when I tried to find answers about why my tinnitus started increasing in the presence of noise. My audiologist used the term “reactive tinnitus” when I described it.
In the same vein, Marsha pointed out,
Life changes. We change. Words change. Language is a living entity. It really is alive, and if you don’t believe it, just check in with any teenager on the street and see if you can understand the current lingo. Science is slower, yes, and publications are even slower. If we just stuck with what has been written, maybe we would speak much more like Shakespeare and King James.
She added,
I have been a tinnitus clinician for a number of years and began to use the term “reactive tinnitus” more than 10 years ago. I have attended many different conferences and presentations during which scientists, clinicians, audiologists and physicians used the term freely and often.
Since “reactive tinnitus” is a perfectly good term; and since it is so much more intuitive and meaningful than “kindling” and “winding up”; and since it is being used freely among the tinnitus community and by a number of hearing professionals; therefore, it just makes sense that we embrace this term, rather than squabble about which term to use.
Where Did “Kindling” and “Winding Up” Come From?
“Kindling” and “winding up” are terms that Dr. Pawel Jastreboff, the father of Tinnitus Retraining Therapy (TRT), borrowed from the neurological literature where they were used in fields totally unrelated to tinnitus, and applied them to tinnitus. Jastreboff only began using these terms around 2002. Even so, some experts do not agree with Dr. Jastreboff that these terms have clinical relevance in understanding tinnitus.
Kindling
“Kindling” is a term that is used in the field of epilepsy to describe the phenomenon that occurs when a weak stimulus that initially does not evoke a seizure evokes epileptic seizures after being presented repeatedly over several weeks. (1)
In relation to tinnitus, “kindling” supposedly describes the prolonged worsening of tinnitus and/or hyperacusis (where normal sounds seem much too loud) due to exposure to moderate to loud sounds for a relatively short time.
To “Charles”, kindling means how outside noise stimulates tinnitus such that even when the offending noise dies down, the tinnitus is left ringing, at least for a while afterwards. As he says,
I’ve noticed this effect since my tinnitus has gone down a bit. Now I can see what gets it back loud—outside noise, loud conversations and construction noises—not short duration bangs or smashes although those are aurally offensive.
Winding Up
In contrast to “kindling”, “winding up” describes the prolonged worsening of tinnitus and/or hyperacusis due to continuous exposure to fairly low levels of sound over a long period.
Also, in contrast to “kindling”, which came from the medical field in relation to epilepsy, Jastreboff took the term “winding up” from the field of chronic pain because the sensations of chronic pain and tinnitus often have many underlying similarities.
“Winding up” describes a situation where the second presentation of a painful stimuli causes a stronger reaction than was caused by the first presentation. It also describes the situation where a stimulus presented for limited time (e.g. a few minutes) does not induce pain; but when it is present for a longer duration, it becomes painful.
Painful stimuli are detected by nociceptors (pain receptors), consisting of mostly free nerve endings that are embedded in peripheral tissues. On receiving a painful stimulus, both a fast, sharp pain and a slow, dull pain ensue. The slow or “second” pain is transmitted by unmyelinated C nerve fibers.
Winding up is caused by instances of severe and persistent injury that cause the C nerve fibers to fire repetitively. This results in a gradual increase in the response of central pain-mediating neurons. The changes in synaptic transmission that are elicited by these central neurons are long term. (2)
This is similar to what occurs when a sound, which initially is without any effect causes a worsening of tinnitus or hyperacusis after the sound has been presented for a longer period of time. These phenomena are particularly observed in people with certain medical problems, such as after a head injury, brain surgery, Lyme disease, or symptoms associated with hormonal changes (for instance, in women during menopause). (1)
“Norman” explained how his tinnitus slowly “wound up” or reacted to a constant background sound that wasn’t initially a problem. He wrote,
I drove 100 miles to my summer place. When I got there I noticed a slight raise in my tinnitus, but I didn’t panic. I just reminded myself that it’s just a temporary increase. As I opened my summer place, moved the boats and had some fun, I could tell that my tinnitus was going back down to its normal level. This is an example of how “winding up” works.
Later that night, I drove the same 100 miles back home. By the time I got back, my tinnitus was really loud. It had wound up again. Again I did not panic (and make my tinnitus even worse). I reminded myself that its only temporary—that after a good night’s sleep I will be OK. I went to sleep and in the morning my tinnitus was back to its normal level.
Note: we can’t force ourselves to not feel anxious or stressed when our tinnitus gets louder. However, like “Norman”, we can choose to think in more realistic ways and remind ourselves that this louder “wound up” tinnitus is just temporary.
“Dan”, when asked, “When your tinnitus kindles or winds up, how long does it take, on average, before your tinnitus drops back to its normal level?” replied,
Sometimes it can be an hour. Sometimes the increase lasts for the rest of the day and goes down overnight having been reset by sleep. It varies.
“Bill” added,
Typically kindling and winding up result in a quantum increase in tinnitus loudness that settles back down to the usual unpleasant level after a period of time.
To summarize, a temporary increase in your tinnitus from a relatively-short, louder sound is “kindling”, while a temporary increase in your tinnitus from a longer-duration, lower-level sound is “winding up”.
Both of these terms are describing two slightly different nuances of what many people now call “reactive tinnitus”.
According to audiologist Marsha Johnson, you could think of “kindling and “winding up” as terms that describe how your tinnitus reacts. You could say they are verbs and the term “reactive tinnitus” is a descriptor of a state of being. In other words, “kindling” and “winding up” are two subtypes of reactive tinnitus.
What Reactive Tinnitus Is Not
Not all tinnitus that increases in volume is defined as “reactive tinnitus”. Yes, your tinnitus may “react” to certain stimuli such as taking ototoxic drugs, tiredness, increasing anxiety or tight muscles in your face and neck so it truly is “reacting” to certain stimuli—but these factors are not included in our definition of “reactive tinnitus”.
Furthermore “reactive tinnitus” is not tinnitus that gets louder because you have just exposed yourself to ear-damaging levels of sound. That’s not reactive tinnitus. That’s just plain foolishness.
In addition, “reactive tinnitus” does not refer to a random spike (or sudden increase) in your tinnitus that happens occasionally.
Nor is “reactive tinnitus” the increased volume you perceive your tinnitus at when you think about it. For example, you may go for hours without being aware of your tinnitus. Then, when you think about it, or someone mentions tinnitus, immediately you hear (perceive) your tinnitus as being much louder.
To summarize, your tinnitus can react and get louder from a lot of factors, but the above are not included in the definition of reactive tinnitus.
What Reactive Tinnitus Is
Up to now, the term “reactive tinnitus” often has been used in an over-generalized, inexact way. As we have just seen,
Nearly everyone’s tinnitus reacts to something. Some folks’ tinnitus reacts to stress; some tinnitus reacts when we wake up from a nap or a night’s sleep; some tinnitus reacts when we are tired, or do not get enough sleep. Furthermore, some tinnitus reacts when we consume alcohol, coffee, or salt. Some tinnitus reacts when we take medicine, or eat too many sweets.
Although tinnitus reacts to all sorts of things—to stress, to anxiety, to sleeplessness, to waking up—still the term “reactive tinnitus” is not about any of these things.
Therefore, before we use this term, we need to precisely define what we mean by “reactive tinnitus”. Simply put, “reactive tinnitus” is tinnitus that temporarily gets louder as the sounds around us get louder. In other words, “reactive tinnitus” reacts only to sound—not food or any other stimuli.
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Definition of Reactive Tinnitus Reactive tinnitus is tinnitus that temporarily gets louder in response to sounds around us, and typically returns to baseline levels sometime after those sounds stop. |
Furthermore, when the sound that our tinnitus is reacting to stops, our tinnitus typically stays at this new level for a period of time—minutes, hours or even days—before it reverts back to its old baseline level. However, some fortunate people report that their tinnitus instantly (or very quickly) drops to baseline after the background sound stops.
Marsha pointed out,
Reactive tinnitus occurs when your tinnitus loudness reacts to an external stimulus such as noise, a sharp sound, music, or even vibration. Reactive tinnitus can be quite distressing and it can stay elevated for short or long periods of time. Most often, it does tend to settle down over time, but for some people, this is not the case, if one believes their subjective reporting and complaints.
What makes reactive tinnitus different from “normal” tinnitus is that reactive tinnitus is combined with hyperacusis so that we perceive our tinnitus as getting louder as the surrounding noise level increases. As one ear specialist explained, “Reactive tinnitus is a subset of hyperacusis and is due to a collapsed tolerance to louder sounds.”
What this means is that if your tinnitus was the result of noise trauma, very often, you also get hyperacusis as well as tinnitus. As a result, sounds that become too loud due to your hyperacusis may also cause your tinnitus to increase at the same time. The result? You now have reactive tinnitus.
In contrast, “normal” tinnitus more or less stays constant no matter what volume sounds are around you. To be sure, in quiet situations, your tinnitus sounds louder, but this is because the contrast between your tinnitus and silence is much greater, so it just seems louder.
In like manner, if you have normal tinnitus, when there are louder sounds around you, your tinnitus seems softer (not louder like reactive tinnitus does), not because it changed in volume, but because the contrast to surrounding sounds is less, or it may even be masked by those sounds so you don’t hear your tinnitus at all.
A good analogy is comparing the difference between using a flashlight at midnight (where the light it makes seems very bright) and using the same flashlight at midday (where the light it produces seems so dim as to be almost non-existent).
Reactive tinnitus is quite common among those who are bothered by their tinnitus and seek professional help. Dr. Jastreboff explained,
More than 50% of patients report that their tinnitus becomes worse for some time after exposure to sound (loud, moderate, or even soft). This time is in the range of minutes to hours for most individuals with tinnitus and typically affects hyperacusis or misophonia (where you have a dislike or aversion to certain sounds) more than tinnitus. Some patients report that the effect persists through the next day, even after a good night’s sleep, or it may even last several days. This observation can be due to two scenarios and has profound impact on the diagnosis and treatment: (1) it may involve functional plastic changes in the nervous system that occurs as part of the “kindling” or “wind up” phenomenon or (2) strong misophonia. (1)
Here’s another interesting point. Marsha notes that,
The person with reactive tinnitus or reactive hyperacusis is often prone to have other inflammatory bodily conditions and symptoms. They can include various skin diseases such as psoriasis or eczema, joint or connective tissue diseases such as arthritis or plantar fasciitis, or muscle-nerve diseases such as fibromyalgia or lupus. Often these other conditions can be mild and many people do not realize they have them or see the connection.
These inflammatory conditions result in hypersensitive nerves that send a barrage of signals to the brain that over-stimulate the brain. Hyperacusis, and thus reactive tinnitus, can be one result.
What Reactive Tinnitus Is Like
Reactive tinnitus reacts to noise and gets louder. However, just as with regular tinnitus or hyperacusis, each person’s experience is different to some degree.
Audiologist Marsha Johnson explained,
Tinnitus can be reactive and fluctuate wildly in certain people, and this is extremely distracting as you can imagine. A steady-state, tonal tinnitus or hissing tinnitus is much easier to become used to (habituate to), because it does remain constant. In contrast, reactive tinnitus, or reactive hyperacusis for that matter, is often much more difficult to treat. It is even difficult to evaluate since the testing done to assess the tinnitus or hyperacusis, including the Loudness Discomfort Level (LDL) test can set off the reaction.
Therefore, if you have reactive tinnitus, do not let your audiologist or hearing aid dispenser test you to see how loud sounds can be before you perceive them as too loud. If you don’t refuse the LDL test, your tinnitus may react to these louder sounds and you could be left with screaming tinnitus. This is not what you want! I’ve heard from numbers of unfortunate people who had this happen to them.
Here are some real-life examples of people who have experienced reactive tinnitus.
“Sally” explained,
My tinnitus goes totally up with noise. If I have a loud day—when I am around noise—it goes up terribly. If it is an average day, it goes up a bit, but not as loud. A quiet day, which is very seldom, noise does not affect it. For me, I can go in a quiet setting and it will come down some.
“John” noted,
I have tinnitus and it is made worse by sound. To control it, I need to be where it is quiet, which is almost impossible. I hear mine over everything.
“Debbie”, who has severe reactive tinnitus explained,
I broke a couple of ribs a few days ago and stayed in the house Thursday and Friday. Didn’t get out of my bathrobe—read a book, worked on the computer, and did not turn on the TV or have any sound around. Guess what? I was not aware of my tinnitus for two days at all. It was barely there—even if I listened for it. Today I got dressed, drove to town, met a bunch of people for breakfast and wham!—the tinnitus is back!
“Audrey” gives an example of how her reactive tinnitus disrupts her life.
I was at a baby shower two days ago. I had quiet tinnitus when I arrived. However, by the time I left after four hours of 25 people all talking over each other, my tinnitus was screaming but you have to smile and pretend it’s okay. I left there exhausted and my tinnitus didn’t go down until the next day. This is very hard on someone who is trying to have a good time and yet also battles a hearing loss that makes hearing more difficult.
“Dave” explains how his reactive tinnitus “works”.
If I expose myself to external sounds, I experience an immediate increase in my tinnitus. The amount of that increase is variable. (Note: fatigue, alcohol, certain drugs such as beta blockers all contribute to my tinnitus getting louder.) The introduction of external sound then compounds these effects I’ve already experienced. If I remain in the environment with the external noise for longer periods, eventually my tinnitus increases until it becomes intolerable—not intolerable that I want to throw myself off the nearest cliff—just extremely uncomfortable mentally and emotionally. This increased tinnitus does not subside until I enter a quiet environment. Then it can take around half an hour to an hour to lessen and eventually settle back to its base level.
“Tony” declared,
My tinnitus greatly increases due to external sound. There is simply no way to mask it.
This brings up another point. It is hard to mask reactive tinnitus as “Tony” explained. When you try to mask reactive tinnitus it often reacts to the masking sound itself and gets louder.
As “Gail” explained,
I can’t mask my tinnitus because typical masking sounds increase the ear ringing.
“Sarah” has the same experience. She affirmed,
Reactive tinnitus cannot be masked at all in my case. It only happens in traffic/downtown/when I pick up the kids at school and daycare and other kids are screaming, etc. Once the external noise is over (traffic, fans, etc), my tinnitus goes back to baseline right away.
Interestingly enough, not everyone’s tinnitus reacts to the same sounds.
“Christine” noted,
As for specific sounds, one that comes to mind for me, is violins. They cause a terrible increase in my tinnitus while a double bass doesn’t have much effect on it at all.
“Cheryl” added,
I have been finding that certain environments (supermarkets with their refrigeration units, various forms of public transportation, the acoustics in various places) tend to aggravate my tinnitus—in some instances to uncomfortably high levels. In quite a few of these situations, the overall noise level has not been especially high. Nevertheless, this phenomenon keeps happening. For example, I just left a computer training session after lasting 30 minutes in a room where the fans were exacerbating an already loud ear day.
“Chuck” has both “normal” and reactive tinnitus. He explains how they differ in his case.
My ordinary tinnitus never bothers me. For example, if I enter a silent room, I hear nothing. Sometimes I can hear my normal tinnitus in silence. Sometimes my tinnitus is a bit louder, but not bothersome. However, as soon as other sounds get involved—my computer running, ventilation or air conditioners running—then I hear this annoying background sound coming with it. The moment I shut one of these things off, my tinnitus goes away almost entirely. If I’m on the street and a car passes by, I get that background “whissling” noise. As soon as the car has left—silence. I was at my friend’s apartment today. His play-station was on and it’s sound caused an annoying background sound all the time. As soon as he shut down the play-station, I was so relieved—silence. My normal tinnitus doesn’t bother me at all (with exceptions). It’s only the reactive tinnitus that bothers me.
I’ve also noticed my reactive tinnitus is different from others. Many people say that reactive tinnitus is when you get exposed to sounds and their tinnitus stays up for hours afterward. My tinnitus never stays loud. The moment I shut off whatever is causing my reactive tinnitus, it disappears.
Furthermore, it doesn’t react to all sounds. For some reason, it doesn’t react to music. It reacts mostly to “machine sounds” like the air conditioner, computer, play-station, cars, etc.
I wonder if “Chuck” is experiencing reactive tinnitus, or if, instead, he is really experiencing audio pareidolia. This is where your brain tries to make sense of constant background sounds by forcing a pattern-match that, in “Chuck’s” case, sounds similar to his tinnitus. One of the characteristics of audio pareidolia is that when the background sound stops, instantly the matched sound do so too—exactly as it does in “Chuck’s” case.
You can learn more about audio pareidolia in my article Apophenia, Audio Pareidolia and Musical Ear Syndrome .
“Jolene” also has “selective” reactive tinnitus. She wrote,
My reactive tinnitus rings louder to specific noises, and only while that noise occurs. It rings louder to water, which is especially annoying. Water and high-pitched sounds are triggers for me. It’s odd that my tinnitus is not fazed by sudden very loud, low-frequency noise, yet when I turn on a faucet, it reacts immediately. I find it’s reactive nature far more annoying than my normal tinnitus.
“Mary’s” reactive tinnitus is different still. She explained,
I have reactive tinnitus. Two years ago I had sudden hearing loss in my left ear from an ear infection and only got back 50% of my hearing in that ear. At first, my tinnitus sounded like a high pitched siren, a water faucet running and a loud hissing noise. Every time someone would speak or other noises—especially the sound of the TV—the hissing sound of the tinnitus would get louder and seemed to react to every word that was spoken.
It’s hard to describe these sounds that are going on in your head. Now I only have the annoying hissing sound but it is still reactive. If someone is making a lot of noise with paper at work or if the printer is printing a lot of copies the hissing gets louder. It also still happens when people are speaking to me. Sometimes I notice it getting louder and other times I don’t. I sometimes think that it has to do with what I am doing at the time. If my mind is really involved with something I don’t notice it at all.
This brings up another important point. When you ignore your tinnitus by focusing on something else, you typically find that your tinnitus doesn’t bother you as much, or at all. This is true of people with “normal” tinnitus and as “Mary” notes, it can be just as true for people with reactive tinnitus.
Winning the Psychological Battle with Reactive Tinnitus
If you have reactive tinnitus, you may feel you have a special kind of tinnitus for which there is no treatment, and thus you lose hope.
For example, “Abigail” explained,
My husband suffered sudden sensorineural hearing loss, and as a result, has developed reactive tinnitus as well as hyperacusis. This has severely impacted his quality of life. I understand that sound therapy is a crucial element in treating tinnitus and hyperacusis. His dilemma is that sounds increase the volume of his tinnitus. He is unable to listen to music, the television, or a white noise machine. Even the sound of our furnace coming on, or driving in the car, will increase the level of his tinnitus. My husband is running out of hope as he feels the tinnitus he has is special (because it gets worse with sounds), and that it can’t be treated.
If you give in to this mindset, you just put yourself on a downward spiral until you totally lose hope.
Since both tinnitus and hyperacusis have an emotional component, it is important that we think about these conditions correctly and not give in to our negative emotions.
“Henry” said it well when he wrote,
Some people with reactive tinnitus believe that their chances of successfully dealing with their tinnitus are significantly worse than for someone whose tinnitus does not react to sound. And in believing this, they are setting themselves up for a miserable ride.
We should never underestimate the power of what we tell ourselves when it comes to tinnitus. Most folks who believe their reactive tinnitus is untreatable are unaware that many tinnitus sufferers with reactive tinnitus have successfully dealt with their tinnitus. It is not true that people whose tinnitus reacts to sounds have worse tinnitus than people whose tinnitus doesn’t react to sounds. It is also not true that people whose tinnitus reacts to sounds can’t habituate to their tinnitus and feel better.
If you have reactive tinnitus, don’t for a moment believe that your tinnitus is not fixable. The truth is that just as there are successful treatments for “normal” tinnitus and for “normal” hyperacusis, so also, there are successful treatments for reactive tinnitus. It is not unique and untreatable.
Remember that both tinnitus and hyperacusis are essentially psychosomatic conditions. There is the physical component plus there is the psychological or emotional component. In many ways, the psychological component is the more important component in successfully dealing with tinnitus (including reactive tinnitus) and hyperacusis.
Reactive tinnitus is treatable. It’s just that you have to work harder at it than otherwise as you are dealing with two conditions—tinnitus and hyperacusis.
As Marsha explained,
People with reactive tinnitus are harder to treat than those with steady-state tinnitus. This it is not a hard and fast rule, but it is mostly a true reflection of reality.
“Sam” agrees that people with reactive tinnitus are more difficult to treat than those with “normal” tinnitus. He explains why.
People with reactive tinnitus are indeed more difficult to treat than others. The question is “Why”? The answer, in my opinion, is that deeply-held beliefs can have a profound impact on a person’s recovery from reactive tinnitus.
We hear from those who are so afflicted and who deeply believe that they are harder to treat. We also hear from clinicians who believe as they do.
What makes people with reactive tinnitus more difficult to treat is their belief system. So, of course people with reactive tinnitus are more difficult to treat—but it isn’t because of their tinnitus! It is that this closely-held belief system is standing in the way of progress and not any particular characteristic of the tinnitus itself.
I disagree with “Sam” in part. He forgets that reactive tinnitus also includes a hyperacusis component, which makes dealing with it that much harder.
However, he is right on target about our beliefs regarding tinnitus. As Henry Ford once said, “Whether you think you can, or you think you can’t—you’re right.” Thus, if we believe we can successfully deal with our reactive tinnitus, we can—and vice versa.
People who understand the power of the psychological (emotional) component in their reactive tinnitus put it to work in their favor. For example, “Richard” has the “winding up” form of reactive tinnitus where his tinnitus gets louder and louder when he is exposed to a relatively soft sound over several hours. He explained,
I just took a long car drive and experienced a perceived raise in my tinnitus. But I kept telling myself over and over “It’s just a temporary increase. I will be fine in the morning after a good night’s sleep”. And that’s exactly what happened. I went to work in the morning, and when I got to my desk, I just said to myself “It’s the same as before that drive I took yesterday.”
I went on with my day—that’s the trick—go on with your day and keep busy so you don’t focus on your tinnitus. Busyness really helps. Also, try and keep a positive attitude. I’m a firm believer that attitude is a big player in successfully dealing with tinnitus.
“Richard’s” story is an example of how people with reactive tinnitus may experience prolonged worsening of their tinnitus due to continuous exposure to a fairly low level of sound over a longer period of time (the “winding up” kind of tinnitus). It’s also a great example of how we can talk back to our tinnitus and think more realistically about it, even when our tinnitus “reacts”.
“Frank” wisely explained,
When I was distressed about my tinnitus—it was as loud as an angle grinder, drill, jet engine. I was totally down about this thing. My mantra was “what a decrease in quality of life”. This is actually quite understandable and I really empathize with anyone feeling this way. What I ended up learning (by doing) is that the less distressed I am, the less I hear my tinnitus. I now go about my days without hearing it. Of course, if I choose to listen for it, I can hear it over many sounds, but it’s all about our reaction. As soon as I really, really don’t care, it recedes. We literally have our fingers on the fader-slider.
“Wayne” totally agreed with him. He noted,
We can work on our psychological [emotional] reaction to reactive tinnitus to produce habituation. I’ve also found that the less I care about my tinnitus, the less I notice it.
This is the biggest key in treating tinnitus, hyperacusis and reactive tinnitus—not caring about it because it is not worth caring about. This is another way of saying that we understand these conditions are not a threat to our well-being, and thus are not worthy of wasting any effort on them. When you reach that level of acceptance, you have won the war with your reactive tinnitus.
This is not to say you won’t have a number of battles along the way (having bad days at times), but you are winning because you choose not to let your reactive tinnitus control your life.
Treating Reactive Tinnitus
Tinnitus Retraining Therapy (Hyperacusis Retraining Therapy)
If you need professional help to deal with your reactive tinnitus, the most successful program is the Tinnitus Retraining Therapy (TRT). In spite of its name, it can be modified slightly to also deal with hyperacusis and misophonia (and thus reactive tinnitus). The same principles apply—teaching you how to reduce your emotional reaction to these various conditions so you can let them fade into the background and cease to be a problem for you.
You can find clinics that deal use Tinnitus Retraining Therapy by searching for “Tinnitus Retraining Therapy Clinic” on your favorite search engine.
If you just need some help in implementing a program you can do yourself, my book, Take Control of Your Tinnitus explains how you can get control over your tinnitus. If you need more help, it explains the many tinnitus treatments available, including TRT.
The upcoming 4th edition of my book, Hypersensitive to Sound?—Successfully Deal with Your Hyperacusis, Recruitment & Other Sound Sensitivities (available end of September, 2020) will show you how you can similarly gain control over your hyperacusis (and misophonia).
Setting Hearing Aids to Not Aggravate Reactive Tinnitus
If you have reactive tinnitus and are hard of hearing and need to wear hearing aids or use other assistive listening devices in order to hear, you can be in a tough situation.
When your hearing aids amplify sounds, your tinnitus reacts to these sounds and they hurt, so you quickly rip your hearing aids out of your ears. This does nothing to solve your communications problem.
However, if you have your hearing aids carefully set specifically to deal with your reactive tinnitus (or hyperacusis), to a large extent, you can get some benefit from wearing your hearing aids without totally aggravating your reactive tinnitus.
If you have a sensorineural (inner-ear) hearing loss, you will have some degree of recruitment (where you perceive sounds as getting abnormally loud very fast). And if you also have reactive tinnitus (where your tinnitus increases as sounds increase), you have to keep all sounds below both the levels where they cause reactive tinnitus as well as below the levels where recruitment becomes noticeable. This just adds another level of complexity to successfully fitting (and wearing) hearing aids.
As “Lisa” explained,
I have tried several different brands of hearing aids over a period of years. These are high-cost name brands, but none are helpful because they make my tinnitus worse to the point of giving me an ear ache. My hearing is declining so much that I’m hoping that some type of hearing aid would help. I have had tinnitus and recruitment for over 25 years.
If you have reactive tinnitus (along with hyperacusis, misophonia or recruitment), you need to limit the volume of sounds you hear via your hearing aids to a level that keeps these conditions under control. Sounds above that level will make your reactive tinnitus and hyperacusis louder so that it hurts.
If this is your situation, the way to get around this is to instruct your audiologist to set the maximum gain and compression for each frequency (channel) on your hearing aids. You may find that your tinnitus and/or hyperacusis only reacts to louder sounds at certain frequencies—so you need to identify those particular frequencies and have the gain and compression set appropriately to a few decibels below where those sounds begin to cause you problems.
Your audiologist may balk at this because she will tell you that you need more amplification for your degree of hearing loss. She will be right (as far as that goes)—but in this case, amplification isn’t the only consideration. You also need to avoid aggravating your tinnitus and hyperacusis, so you may choose to give up hearing optimally in order to keep your tinnitus under control.
Thus, you have a choice—hear well and have your reactive tinnitus get louder (not to mention your hyperacusis going through the roof) so you yank off your hearing aids and thus hear nothing, or hear “less well” to some degree, although better than before, but not aggravate your reactive tinnitus (and hyperacusis). Since reactive tinnitus and hyperacusis can bother you all day and all night and wreck your sleep, you may choose to sacrifice optimal hearing for less racket in your head. This is perfectly acceptable.
You are the boss. This means you are in the driver’s seat. Therefore, tell you audiologist to adjust your aids the way you want them, or find someone who will. I choose not to aggravate my tinnitus or recruitment/hyperacusis over hearing better. In my case, I use speechreading to help fill in the missing words.
Go for It
The good news is that reactive tinnitus is a condition over which you can successfully gain control. Only you can do it. It is not something that others do to you, or for you, although they can certainly help you. This is because your emotions play an important part. If you learn that your reactive tinnitus is not a lifetime sentence, that it is not a threat to your well-being (unless you allow it to do that), then you are in the driver’s seat. The result is that (perhaps with professional help), you can slowly overcome your reaction to your reactive tinnitus and it will fade away. It may not be easy or happen particularly fast, but if you persevere, you can do it—and return to your normal life again—and that makes it all worthwhile!
____________________
(1) Jastreboff, Pawel. 2011. “Tinnitus Retraining Therapy”. In: Chapter 73, p. 586 of the book Textbook of Tinnitus edited by Moller, Aage, et. al. (pp. 575-586). Springer. ISBN: 978-1-60761-144-8.
(2) Jastreboff, Pawel, et. al. 2002. Assessment of Patients for Treatment with Tinnitus Retraining Therapy. In: Journal of the American Academy of Audiology. Volume 13, Number 10. Pp 523-544 November/December 2002. P. 526.
Very helpful – I am encouraged because I can take control…
How will curing my reaction to reactive tinnitus “treat” or “cure” it? People with a baseline tinnitus that never changes can use ambient noises to mask it, but people who have hyperacusis and reactive tinnitus only find their ears getting more and more fatigued. How do I retrain my psychological response to physical pain? Our brains are deeply ingrained to negatively respond to physical pain, and H is a result of inflammation. I don’t see how any medical professional can make me enjoy music again when all I hear are intense sound distortions. How do you habituate to something that intensely effects your very perception of it. I’m personally banking on cures like FX-322 or Hough in the next few years.
Hi Brendan:
Curing your reaction to reactive tinnitus IS part of the treatment and thus part of the cure.
You don’t want to mask tinnitus–that doesn’t cure it. You want to use sound therapy such that the sound is set a bit lower than the level required to mask your tinnitus in order to habituate to it. The same holds true for hyperacusis. You set the sound level below the level that will cause your reactive tinnitus to react.
You don’t understand what this article is saying. I think you’ve read too much on the negative on-line boards so have closed your mind to the reality of what you have to do in order to gain control over your reactive tinnitus. You want somebody to do something to you (like the FX-322 or Hough) rather than somebody help you to do what you alone need to do in order to reprogram your brain so neither tinnitus nor hyperacusis are a problem anymore.
Cordially,
Neil
Hi Neil,
Great info! By the way, is there a need to use hearing protection(earbuds, etc.) for reactive tinnitus and if yes, then what type and how to use them?
I live next to a busy street with some busy traffic noise at certain times of the day and plus screaming kids at home. Worried if all this would increase my tinnitus further.
Hi Shyam:
You only should wear ear protectors when sounds around you are so loud they make your tinnitus react. As long as your tinnitus remains at its base level don’t wear anything or you can make things worse. The type doesn’t matter as long as they protect your ears from sounds that react. And you don’t have to have a high protection factor either. Just enough to bring down the loud sounds so your tinnitus doesn’t react to them. And take them off as soon as you don’t really need them–don’t forget. The goal is to get your ears back to normal, so you should not have to wear ear protectors as much as time goes by.
Cordially,
Neil
You said in the comment above to only wear ear protection when the sounds “are so loud that they make your tinnitus react”. But what if pretty much any level of noise makes your tinnitus react?
I only recently got tinnitus. It wasn’t from exposure to a loud noise, but rather something physical. I strained my neck while twisting my body awkwardly, and suddenly there was a loud ringing. One month later, the ringing still there. And I’m much more sensitive to loud/high pitched noises, so there is hyperacusis. The ENT put me on a course of steroids, and then said we should just wait.
My tinnitus basically drops VERY low when I’m sleeping in a quiet room. (My “base level” is so low I can hardly hear it.)
But, in the morning, almost any sound can cause it to start. Turning on a gentle fan, or turning on the radio at even the lowest volume. The exact moment the sound begins, I instantly hear a high pitched buzz or “eeeee” sound added on top of the sound.
In the morning – if I take away the noise (e.g. turn off the fan), that ringing goes away pretty much instantly.
But by afternoon (after I’m exposed to normal/moderate sounds throughout the day), the ringing will stay even after the noise is removed. (And the ringing will be louder than it was in the morning. )
So back to my question – if basically ANY level of noise makes my tinnitus react, what should I do? Obviously I wouldn’t always wear ear protectors. Do I just lean into exposing myself to soft/moderate sounds even though they do trigger the tinnitus? I’m just trying to figure out what to do to give me my best shot of things improving over time. I would really appreciate any advice.
Hi James:
The first thing I’d do, since you tinnitus resulted from twisting your neck, is see an upper cervical spine chiropractor (you can find one at http://www.upcspine.com/ and then click on practitioners) and make sure your C1 and C2 are in proper alignment, and the rest of your cervical vertebrae too of course. I suspect your tinnitus is the result of a pinched nerve. If it’s at C1/C2, it would be the auditory nerve, otherwise, it would be one of your somatosensory nerves that can cause tinnitus.
Once your chiropractor certifies that you are in proper alignment and is holding its correct position, I’d see how your tinnitus is doing. I’m betting it will be much better or have faded away.
I say this because your tinnitus goes away at night and comes back more as the day goes on. This is often the case when you have a “tight” neck and various nerves are “pinched”. At night you relax and the “pinching” is less so your tinnitus goes away, but when you get up and the weight of your head causes the muscles to tighten and pinch the nerves more, your tinnitus comes back and gets worse.
So rather that trying to fix your hyperacusis now, I’d do the above and see if it fixes the problem and thus your hyperacusis will fade away.
Cordially,
Neil
Hello Dr. Bauman,
I very much appreciate your reply.
I agree with you that a pinched nerve or something similar is likely the root cause of why I developed this.
Unfortunately, I am not a candidate for chiropractic therapy. A major contraindication to receiving chiropractic therapy is having any issue that may cause unstable joints. I have Ehlers Danlos where I am hypermobile/hyperflexible. (This condition probably also contributed to why I was able to twist/strain into a position where my nerve was damaged.) Doing joint manipulations on someone like me introduces the risk of the catastrophic outcomes you occasionally hear about with chiropractic therapy manipulations. (And the bad outcomes involving the upper cervical spine are truly bad.)
I don’t know if you’ve heard of any other treatment options? I tried doing some searches for research studies, and it looks like some people with “somatic” or “somatosensory” tinnitus might have had some benefit from either physical therapy or TENS therapy. Have you heard of either of these working? (Or anything else?)
James
Hi James:
I understand. But I did not suggest going to a conventional chiropractor that manipulates your neck. I suggested an upper cervical chiropractor. These guys just gently push the bones in place. No manipulation. The most gentle of these use the Blair method–they only use their hands–and precisely push the bones where they need to be for proper alignment.
If you can find one that uses the Blair method and has experience, he will first take precision xrays to see exactly what is out and which way. Then he will gently push the appropriate bone where it needs to go.
You might want to consider this (or not)–it’s your choice.
As regards physical therapy, I’d be cautious as some of these people push pretty hard and if your bones move easily, they may push them out of place. You’d need someone experienced in your condition so they know what they should and should not do.
As far as I’m concerned, TENS therapy can work if the nerves are hyperactivated for some reason other than being “pinched”. If they are pinched, the obvious treatment is to properly align the vertebrae so they are not pinched–but done very carefully in your case.
Cordially,
Neil
what a beautiful article, complete and encouraging. Thanks Neil, I am in this same situation of reactive tinnitus. The sound of the water, the hair dryer, the frying of a dish, increase my tinnitus.
In an audiology center here in italy, doctors have suggested me to use a track of pink noise at low volume during the night while I Sleep.
What do you think about it?
Thanks in Advance
Hi Giuseppe:
Since you have reactive tinnitus, you have hyperacusis and one of the tenents of hyperacusis treatment is that your ears always need to hear sounds. So your doctor is correct it saying you should hear sound at night. Keep the volume loud enough so you can hear it, but it doesn’t have to be loud. The sound you listen to can be pink noise, or white noise or fractal music, or other sounds–environmental sounds, or music–but you want it to be relatively constant and at the same volume all the time. Pink noise fits the bill–but other sounds are also acceptable.
Cordially,
Neil
Hello Dr. Bauman
Thank you so much for taking the time and energy in writing this! I have been searching high and low for information on my symptoms. Your information on reactive tinnitus is EXACTLY what I am experiencing! This article has given me the sense of control over this ailment that has mystified me for just over a month. I thank you greatly for this.
Now I do have a few questions to help me understand this:
1.) Am I damaging my ears or anything else when I am in situations where my reactive tinnitus spikes? Mine usually spikes a bit when there is elevated conversation between multiple people and it REALLY spikes in a setting like a sports bar/restaurant even without a band playing. The big spikes usually subside within an hour or two and sometimes by the next day.
2.) Will I ever habituate to the mild/large spikes or will it ever fade over time with healing? Will simply learning to live with it be my only outlook from here on out?
3.) It seems to get bad only in my left ear. My ENT said I had hearing loss in only the highest range of hearing in that ear. The rest of the chart was fine and he said I wouldn’t really miss those high pitches anyway. Does this indicate something special? Extra precautions?
4.) Is this more related to tinnitus or hyperacusis? Will exposing myself to normal sound levels that are not damaging (above 80db) help my habituate or desensitize to it over time?
I really really appreciate your time and efforts in this field. Again this article has let me gain a sense of control over this. I will be looking into a tinnitus/hypercusis professional in my area to confirm my findings but I would really appreciate any help as I cannot see them for over a month and I will be overseas. Thank you and I hope you have a great day!
Hi Anthony:
To answer your questions.
1. With hyperacusis and reactive tinnitus (which is half hyperacusis so to speak), you want to give your ears real sounds to hear and slowly increase the volume of sounds before your ears react to it. So you are no hurting things by being in SLIGHTLY noisier situations that cause your tinnitus to begin to spike. However, I would NOT recommend being in loud venues such as sports bars, and sports venues and places with loud music without ear protectors. This is just asking for more trouble. That’s how you probably got your reactive tinnitus in the first place.
2. You can habituate to your reactive tinnitus just like you can to any other kind of tinnitus. But you need to “follow the rules” for that to happen. There are several. One is to ALWAYS protect your ears from loud sounds. Two is to give your ears real sounds to listen to all the time–backgound sounds don’t have to be loud–just loud enough that you hear them. Three, you don’t think of your tinnitus as a threat to your well-being. If you do, you cannot habituate to your tinnitus. Four, Focus on things others than your tinnitus. The more you focus on it–the louder and more intrusive it gets.
3. 90% of the people with hearing loss have more hearing loss in the high frequencies than in the lower frequencies. This is normally the way it occurs. So you are not different in this respect. Basically, all this indicates is that you have exposed your ears to loud sounds that are destroying your hearing, or have taken ototoxic drugs that are doing the same. That is why in the future, you need to limit your ear’s exposure to loud sounds by either staying away from loud venues or wearing adequate ear protectors in such situations.
4. It’s half and half. You slowly expose your ears to louder sounds as your tinnitus does not react to that volume of sounds. But you should no,t be exposing your ears to sounds over say 90 dB without wearing ear protectors in the future. You can get over your reactive tinnitus, but if you expose your ears to loud sounds in the future, it may come back even worse. You want to prevent that.
Cordially,
Neil
Hello again and thank you so much for your response! It means a lot to me and you are helping me get through the early stages of this in my life. For that, I cannot thank you enough.
I have a few followup questions if you have the time.
1.) Regarding the first answer, does this usually mean that the reactive tinnitus will never get better in those louder situations? I’ve read that over time and gradual increase in sound exposure hyperacusis lessens for some. Right now I can hear the high pitch hiss get louder during things like a car ride. It’s not too bad but I can tell. I don’t really have pain in the louder settings but the hiss becomes very loud when there are a lot of people around talking with or without music. I have musicians earplugs on my key chain now and they help out a lot. Just wondering if this will be a forever type of thing.
2.) Can you expand on the “always have background sounds on” part? Is this to desensitize the brain over time ? Will this help the reactive tinnitus go down? I do find that pink noise helps me calm down after a spike in an office setting. Should I be listening to pink noise all 8 hours of my workday? Everyday?
As a side note, I have noticed alcohol (1 IPA beer) takes my tinnitus and hyperacusis away completely while it is in my system. Some have told me it is just because I am probably relaxed then and that helps. But it happens so quickly (hour or less) that it makes me strongly think there is something chemically going on in the brain to cause this rapid disappearance. Once the alcohol is out of my system it is back to my baseline sound. Do you have any insight on this phenomenon?
Thank you again for all your help! You are keeping me sane during these turbulent times!
Hi Anthony:
1. You can effectively treat hyperacusis so that’s good news. You don’t have to have it all your life. Normally you would treat hyperacusis and tinnitus at the same time–but with treatments appropriate for each condition. Some people are able to basically ignore their hyperacusis and tinnitus and over time habituate to them. Others need professional help.
2. According to Pawel Jastreboff, the father of tinnitus retraining therapy and also an authority on treating hyperacusis, if you have hyperacusis you should have background sounds on ALL the time day and night to give your brain something real to listen to. And yes, it helps desensitize your reaction to louder sounds.
If your reactive tinnitus is bothering you, then your pink noise is a good idea since it is helping you.
3. Alcohol is an interesting chemical. It revs up some people and calms down others. If alcohol calms you down, then it can also calm down your tinnitus at the same time as you have found. If it revved you up, you’d have found your tinnitus even worse. So in your case, a little alcohol may be just what you need at times.
Cordially,
Neil
Hello, Dr. Bauman.
7 Days ago I had a long motorcytcle ride, that same day when I got home I didn’t feel anything out of the ordinary, but the night of the day after was a nightmare, VERY loud and long high frequency beeping sound that didn’t let me sleep.
Today, a week later no change whatsoever and my hearing is super sharp and sensitive, I went to my ENT and explained him what happend, he sent me to an urgent hearing test to see if any damage is done to my hearing and the hearing test turned out completely normal, no hearing loss at all.
I’m absolutley petrified that this is here to stay forever, it caused severe anxiety to the point I’m extremely nauseas and haven’t ate in 2 days, I can’t concentrate on my uni professor lectures, can’t sleep, its always there.
My ENT said it will go away with time, I sure hope so.
Also thought I should mention, I started having jaw problems in the recent year, a lot of clicking and popping that caused a few seconds tinnitus, still a lot of clicking and clenching, can it also be the case?
and btw, should I should also mention I did probably abuse my ears a lot while being younger (i’m 24 now)
I did go to parties, even served in the army and served beside shooting tanks, mortars guns and what not, but that was years ago, and recent hearing test shows no hearing loss (guess I’m lucky?)
My hearing became Super sharp, I can hear every little thing happening even at the end of my street where I live, but it does not reach a point where it hurts like others experience, its like my brain doesn’t filter background anymore, yet it isn’t painful just VERY distracting. (the beeping does hurt though)
Thanks in advanced for any sort of advice and I’m sorry if it turned out longer than I expected.
Hi Ofir:
I think that what is happening is that your ears are finally succumbing to the years of abuse you’ve heaped on them by exposing them to loud sounds. The result is that you now have both a (hidden) hearing loss and hyperacusis (making your hearing seem acute) and tinnitus.
Just because some hearing tests have shown you have normal hearing doesn’t mean you don’t have hearing loss. You have almost certainly suffered various hidden hearing losses. For example, normal hearing ranges from 20 to 20,000 Hz, yet they only test you from typically 500 to 8,000 Hz. Thus you could have (and likely have) massive hearing loss above 8,000 Hz, yet normal hearing tests give you a clean bill of health because they never test your high-frequency hearing. And typically, hearing loss begins in the high frequencies and works its way down the frequency spectrum over time. Your brain notices this decline in high-frequency hearing and often the result is tinnitus.
Another likely source of hidden hearing loss results from damage to the supporting structures underlying the hair cells in your inner ear–namely the spiral ganglion. When synapses in the spiral ganglion are damaged or destroyed, they cannot convey the signals from your hair cells to your auditory nerve and thus you don’t hear some sounds even though the hair cells themselves may not be damaged. You notice this mostly when trying to hear a person speaking in the presence of background noise. If you are interested in this aspect of hidden hearing loss read my article on the subject at http://hearinglosshelp.com/blog/hidden-hearing-loss/ .
Very often noise damage is accompanied by hyperacusis so some sounds now seem louder and sharper.
What can you do about all of this. First and foremost, you need to protect your ears from loud sounds in the future. This means wearing ear protectors (the foam ones are fine) whenever you ride your motorcycle. Wearing a helmet doesn’t sufficiently dampen the wind noise to prevent ear damage. When you are in loud venues–anything over 80 dB or so, wear ear protectors. When you listen to music, keep the volume down to about the level you hear people talking–not way up like so many people do. This is just asking for trouble.
Second, you need to calm down. It is a shock to the system to realize that you have damaged your hearing. Accept that fact, and then calm down and calmly work on a plan how you will cope in the future. This will bring stability to your life. You can still have a successful and fulfilling life even if you have hearing loss and tinnitus. I know–I’m doing that and I am now functionally deaf and have had tinnitus for more than 60 years–but I choose not to let it bother me.
Third, get your tinnitus under control so it no longer bothers you. There are many things you can do. I explain them in detail in my book “Take Control of Your Tinnitus” which you can get at http://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ . Particularly carefully read chapter 16.
Also, you might want to read my article on reactive tinnitus at http://hearinglosshelp.com/blog/reactive-tinnitus/ .
Cordially,
Neil
Thank you for your reply.
I know damage to hair cells is irreversible, alteast for now, but what about the synapses? can they heal on their own? can they even be tested to see if they’re the culprit?
Hi Ofir:
Sometimes the synapses heal on their own and then all is well. But those that do not heal result in the cell dying and thus the hair cell ultimately also dies if I understand it correctly.
There are sophisticated tests they can run to see if you have synaptopathy.
Cordially,
Neil
Hi Dr I just found this forum that’s why I’m sorry for the late consultation I hope you sees this my name is Robert and this is my history more or less I have unilateral tinnitus since I have 14 years old do to acoustic trauma one single tone very high pitch and very mild never bathers me music career no problem and playing music for 30 years no problem but unfortunately 3 years ago another acoustic trauma and now I have very severe strong tinnitus bilateral 5 or 6 different noises high and low pitch very strong electric power transformed in my head very severe some time I can even open my ayes the noises coming from every where every single second differen forms and pitch I’m going crazy many doctors and audiologist and nothing but unfortunately I know is nothing more I can do the other thing I going to ask you and this is the main reason why I’m trying to get contact with you is I have very severe hyperacusis and also reactive too but more I realize my is different than every one every time someone brake a piece of plastic or spoon in the plate or coins falls on the bathroom sink immediately a very severe strong high pitch sound ramp to my ears the same way when people shake hands close to me is more but I can mention everything can you please explain me what you think about thanks you in advance and sorry for the long text.
Hi Roberto:
I understand that since your noise trauma 3 years ago you now have reactive tinnitus and hyperacusis. But I don’t understand what you are saying about your eyes and about shaking hands. How is that affecting your tinnitus/hyperacusis?
How bad is your hearing loss? What does your audiogram show?
I need more information on your situation so I can figure out what may be going on–so anything else you want to share with me may be helpful. You can email me privately if you don’t want to share things here publicly. My email is at the bottom on any page on this website.
Cordially,
Neil
What would you call it when you have the opposite of this? My eardrum feels like its vibrating all the time (maybe its just a low pitch hum), but when there is a noise in the room, the vibration stops. When the noise in the room stops there is a split second of silence and then the vibrating starts again.
I had an ear infection 9 months ago in my right ear and since then I have had a pile of different things going on with my ear. First was noise distortion / sensitivity and full ear feeling, really loud tinnitus, then there was a bunch of popping and clicking, more noise sensitivity, full ear feeling again and now I have some very faint tinnitus, but with a constant vibration/humming happening along with the clicking and popping of the eustachian tube.
I was diagnosed with ETD by and ENT, but I think the ETD is just a result of something else. MRI and CT scans were clear. The nasal apo-mometasone spray keeps my eustachian tubes clear enouph that my ears don’t plug up, but it doesn’t fix the crackling and popping or the vibration issues. Whatever this is hasn’t gone away now for 9 months and I’m not sure what to try next.
Dear mr Bauman,
Thank you so much for your definition and explanation of reactive tinnitus. I fit exactly one of the forms of reactive tinnitus described.
What I have is the following a hissing sound (had it since my tinnitus started back in 2013), normally this was rarely noticeable unless in very quiet places. But since last week I flew with the plan and I noticed my hiss started to react to the sound engine of the plane. After arrival I noticed it reacting to sounds like the sea, waterfalls, aircondition sounds and loud restaurants.
It happens to me once before two year ago and slowly subsided. I’m not sure what set it off but I did have a throat infection for weeks with might have something to do with it.
Point is my vacation is pretty much ruined and I feel horrible. When the sounds (that my hiss responds to) get quiet so does my hiss. It settles to its old level directly after the external sounds stop.
My question is what is the best way to treat this? Should I just go about my day and spend the day by the beach for instance or should I do the opposite and not go?
Since it went away the first time two years ago is that an indicator that also this will pass again and what is the best way to treat this kinda thing?
I don’t want to hang around forums to much because they give me anxiety and stress. The thing is I read contradicting statements. One says it’s good to give your ears a rest others say you should go about your day and gradually your ears get used to the sounds and the interaction from tinnitus (in my case the hiss) with external sounds will go.
Please could you give me some advice because I don’t want my vacation to be completely spoiled and I’m in need of some advice.
Thank you so much in advance!
Sincerely yours,
Amir
Hello Dr Bauman,
Thank for your article, it describes my reactive tinnitus perfectly. I got tinnitus about 5 years ago after a loud concert when I took ear plugs out for only 15 minutes of a 2 hour concert,
It was reactive from the start but after about 2 years the reactivity reduced and I became habituated. Unfortunately after watching a film about 2 years ago at about 85dbs my tinnitus and the reactivity returned, at a worse level. Subsequently over the past 2 years it has got worse and worse as a result of what would be considered normal situations, like a toilet seat slamming, dropping a mirror on a hard floor. I went to the dentists for some work a month ago that required drilling and my tinnitus and the reactivity again increased to levels I couldn’t have imagined 5 years ago. Any level of noise from a distant plane, to the tv at 60db now causes very loud reactive tinnitus, different in each ear, like a mad stereo effect. Clinking crockery or banging two pans together makes my tinnitus instantly react. Frankly any noise at any level makes it react. If I go to a quite place with no sound to speak of, it returns to a base level, higher than itbused to be but which I can cope with as it’s a constant sound.I am now totally lost as to what to do. I have worn earplugs in environments like driving at high speed for long periods, noisey restaurants, walking by busy roads (I have a dB meter and check if the noise is over 80db and if it is put in ear plugs). But now I’m at the point where any noise causes reactive tinnitus and a one off loud noise like a toilet set being dropped makes my tinnitus and reaactivity permanently worse. I now don’t know if I should wear my ear plugs permanently, as any sound causes reactive tinnitus, or whether I should stop wearing plus except when the noise is over 80dbs and just let my reactive tinnitus get worse and worse as it reacts to everyday sounds. For example I watch some sport on the TV at a low level and my tinnitus goes nuts. It’s very distressing, and after 5 years it’s just got worse and worse after the initial short period where I seemed to have habituated. Any help appreciated.
Hi Robert:
You’ve definitely got tinnitus and hyperacusis, and thus reactive tinnitus. Overprotecting your ears with ear plugs is the wrong approach. You need to slowly expose your ears to more and more sound as they are able to handle it in order to reverse your collapsing dynamic range. You need to expand it again.
I think you need professional help to get things going on the right track. I don’t know where you live in the UK, but if you are anywhere near London, I’d suggest you see Jacqui Sheldrake. She is quite expert in dealing with tinnitus and hyperacusis. If you are too far away, she may know where you could go for good treatment.
Here is her contact information.
Jacqui Sheldrake
Tinnitus and Hyperacusis Centre
32 Devonshire Place
London W1G 6JL
United Kingdom
44 207 487 2701 tel
44 207 486 2218 fax
j.sheldrake@ucl.ac.uk
tamia@audiology.fsnet.co.uk
http://www.tinnitus.org
Cordially,
Neil
Thanks for such a prompt reply Neil. I live in Budapest at the moment but it’s easy for me to fly to London so I intend to make an appointment to see Jacqui.
Thanks once again. Best wishes,
Rob
I have the exact same problem. But I am 23. For me my “offending incident” was simply going to a busy restaurant. Now it has been 6 months with severe reactive tinnitus and category 4 hyperacusis. I am also at a loss on how to proceed 🙁
I have no medical insurance so no one can help me. Can you update us on what they told you?
Hi, thank you for this well written article on the topic. I have been trying before to treat my tinnitus with methods for hyperacusis (trying to increase sound exposure and so on) but it has not worked for me, most types of sound no matter the volume triggers my tinnitus and then it stays bad for days (sometimes weeks).
I have one “normal” tinnitus that is just a high pitched noise that is there no matter what I do, and one “reactive” low rumbling sound, like an airplane engine, that sometimes is completely gone but immediately reactivates to certain sounds and frequencies. I am especially sensitive to the sound of the piano and the Tv (especially if it’s newer with more bass and “better” sound), speakers with bass, computer and cellphone sound ( no matter how low I set the volume to I will still react… ). However some speakers at restaurants playing background music will not trigger my tinnitus so much ( I thought it might be because of those speakers usually play through mono and not stereo?) , also going to concerts outside is sometimes fine, but never indoors… I can also sometimes play guitar outside without my T being triggered significantly. I tried to watch TV on a low volume, or sometimes I have just been in a room where someone else watches TV, not thinking about my tinnitus at the time, and then afterwards when I’m in silence I realise it is triggered again. Sometimes this lasts for days or weeks before it goes away. The last two years I have been trying to avoid sound, which has made my tinnitus so much better (almost don’t notice it at times). According to treatment plans for hyperacusis I should expose myself to sound however (at all times!?), but since this has always triggered my tinnitus I wonder if this might really work for me, or if my tinnitus is just of a different kind? And if it has to get worse before it gets better, when do I know if I’m on the right path or just simply making it worse?
Thankful for comments from the author or someone else with similar experience.
Kind regards
Hi Carl:
I have tinnitus similar to yours–a high-pitched constant whine and sometimes a low rumbling sound. However, my low rumbling sound is not reactive. It just appears sometimes and then go after a while.
Is your reactive tinnitus frequency dependent–and triggered by low-frequency sounds, or all frequencies of sound?
You never want to avoid all sound, but perhaps the kinds of sounds that make it react and then slowly build up from there.
If you can watch the TV with someone and not focus on your tinnitus so you don’t even realize it has reacted until later, this is good. And I notice you mention you then only notice it when it quiet–which indicates to me that even though it has reacted, it is still a low volume. This again is good.
Remember that reactive tinnitus is a psychosomatic condition and your emotional mindset (beliefs) about your tinnitus has a lot to do with it reacting. The trick is to not believe that reactive tinnitus is a threat to your well-being in any way. This gives your limbic system permission to not focus on it and to let it fade away.
So in the above scenario, after watching TV with someone else so you don’t focus on your tinnitus, don’t go into a quiet room to see if you can still hear your tinnitus. Better to have a bit of background sound on that doesn’t bother your tinnitus–and continue to focus on things other than your tinnitus. I think you are on the road to gaining control over your tinnitus/hyperacusis (reactive tinnitus).
Cordially,
Neil
Thank you for your reply Neil! Yes, my tinnuts is frequency dependent, and I’m especially sensitive to lower frequencies… Sometimes I don’t notice it except in silence and sometimes it activates at a higher volume that is really uncomfortable so it kind of depends (which sound I exposed myself to and how loud it was). I guess it’s a good thing I can still do some things without noticing the tinnitus at the time (however it will still be activated), but my worry is mainly that I will make it a lot worse by exposure and destroy something that will not heal by waiting. A few years ago my tinnitus was activated and remained incredibly loud for weeks afterwards and didn’t completely go away for another 6 months (!). During this time, especially the first weeks, I had trouble sleeping because of the sound and promised myself I wouldn’t risk it again… And it also got a whole lot better since I started avoiding sounds (sometimes I don’t hear it at all, which is great! ) But at the same time there are things I would like to do again, like playing and recording music like I used to before. But I guess it’s all about finding a balance, and perhaps a “low volume” activated T is okay to live with in the background for being able to live life more fully, than for it to be completely silent to the price of avoiding everything… ! After all, even when it was at it’s worst it always eventually got better (so far) so I suppose I just need to have some faith in that that’s how it will be in the future as well.
I also want to add that background noise (wether it’s the radio or white noise or something else) also activates my T, so I have kind of concluded that this is not ideal for me. Do you think that this type of reactive T could benefit from using background noise, and that it could become less activated from these sounds in the future? Or that it is more about me mentally getting used to the activated T and not being bother by it? Thanks!
Hi Carl:
Your kind of reactive tinnitus is not common. At least I’ve never come across it before. I’ve been thinking about how you might deal with it so it eventually goes away. Since you’ve already found that it is mostly low-frequency sounds that activate it, here’s what I think might work for you.
In order to build your tolerance to sound back up to normal, rather than avoiding sound (which is ultimately bad and brings its own problems) is to listen to background sounds with no lows in them. You could choose music that is all higher-frequency without any low notes and play that in the background, and slowly add lower and lower frequency pieces as you find you are able to stand it.
Alternately, you could take a page from notched music protocols and filter out the low notes in music and then slowly over time as you can stand it, add in lower and lower notes. That way it is not all or nothing–just a wee bit more as you build up a tolerance to lower and lower notes.
At the same time, remember that reactive tinnitus is a mental/emotional condition so you need to work on yourself and learn that you can successfully deal with it. That neither the tinnitus or hyperacusis is threatening to your future life and so you can safely ignore it and focus on the loves of your life. This means you no longer get anxious or worry about your reactive tinnitus, but instead focus on the loves of your life.
Cordially,
Neil
Thank you so much for your reply Neil, I think this is really worth trying. I’ll react to some extent to all frequencies if loud enough but not at all as bad as to the low ones so I think it could work if I figure out a system for it. Thanks again for taking the time to answer so deliberately, it means a lot! I feel quite hopeful now that I might be able to fix it eventually. I’ll leave a comment later on and update you on how it went.
Warm regards – Carl
Dr. Bauman,
I have been searching and searching for what my problem could be and found your site; perhaps you might have some suggestions.
I’m a classical musician and play piano and cello. About a month ago I noticed that I was experiencing a fuzzy, buzzing quality in my left ear in reaction to the sound of the piano, and a bit with the cello. I went immediately to an ENT doctor, who said it was tinnitus and there was nothing really I could do about it. But I am not hearing this at any other time. It feels like there’s something in that ear somewhere that’s vibrating to certain frequencies. I’ve tried: cleaning wax out of my ears, using a Neti Pot, and ear plugs – no help. I’m using a prescription steroid nasal spray once a day. My sinuses feel pretty clear. I don’t have allergies that I know of. They tested my hearing and it’s okay. I haven’t been sick.
Do you know what this could be and if there’s any solution? Thank you any insights.
Hi Harriet:
What happened in the days before your ear began acting up? Were you exposed to louder sounds/music or for longer times than normal? Were you stressed or anxious at that time?
What frequencies of sound does your ear react to?
Do you have a copy of your audiogram? If so, could you send me a copy. Attach it to an email. My email address is at the bottom of every page on the website.
I’ll then maybe be able to figure out your problem.
Cordially,
Neil
Not even sure where to begin.
I’ve had Noised induced T since 18(29 now). I believe loud venues at age 13-14 probably did some short term damage that the one concert I wen’t to at 18 was the final draw (temp. threshold shift and T). After that, I coped and years later around 25, a woodsaw outside woke me up and I slammed my window giving me now years of worse T, H and even further an issue of the last 2 years, reactive T. My reactive T is now bad, and I’m close to suicide.
What has occured, is that after age 25, I spent years staying home, getting mild noise from car drives, stores, home movies and games on speakers, but that’s it. It’s been brutal with up and downs, noise trauma’s, spikes and so on. During this time, I would occasionally get these episodes where my right ear would change and the tone would start sounding erratic, spiking up and down up and down, constantly. Never a baseline with the tone, so I couldn’t ever cope. It was unbearable. To top it off, it REACTED to noises. A.C, fans, faucet, normal day outside with tree and wind blowing. This was unbearable, but it would subside after a few weeks to a month. During the last few years, I’ve also battled normal Hyperacusis, things sounding loud and causing discomfort.
Now, as of Jan. 2018 I was feeling better. H wasn’t great, but tolerable as I kept around sounds lower than 90db. But, I had to start working and being active. Because of this, I got exposed to a smoke detector around 110db for some seconds before plugging, which gave me months of this reactive/spiking. It slightly got better around early october, but continues to go in the opposite direction with working. The noises of work and sudden loud sounds that aren’t even that high, are causing me to regress. Badly. More noise, enrichment ect., are not helping. My ears and tones are changing, the reactive in my ear is now sticking longer than I’ve ever had before and I can’t hold on anymore. I’m frequent on tinnitustalk and I know there’s no help in society with medical technology. So I’m just at a loss.
It took me 2-3 years when I was 25, to get to a state I could accept. Tinnitus I could handle in silence and sleep. I did this by staying away from most noises outside normal house/shopping noises. And I did this by when ever feeling my ears felt exhausted or worn, wearing ear muffs and resting my ears in silence. THIS WORKED for me. It may not have been living, but I got to a baseline I was ok with.
Now, I’ve lost years of progress because of moderate noisy work environments, and more occasional sudden spikes of noises like things dropping ect.. I’m at my end point here and I don’t know what to do. I cannot handle this reactive issue in my ear. I cannot spend months resting my ear to hopefully see it go away.
If you have any suggestions, I’m in southern california and terrified as I can’t hold out much longer. Regular T I can deal with, this I cannot. I cannot cope to it. I’m literally angry, bitter and upset all the time as I hear it and hear it react to noises I never had a problem with. It’s sharp/high pitch and because of the level/type it makes me physically cringe and ill.
I am lost on this. Exposure has not been helping me at all.
Hi Scott:
When you hang out on boards like tinnitustalk and others, you will typically find a preponderance of people who are not successfully dealing with their tinnitus–so they bellyache and moan–and everyone reading these boards thinks that nothing can be done. The truth is that the people that have successfully dealt with their tinnitus don’t hang out there because their tinnitus isn’t a problem anymore. They are getting on with their lives. You need to realize that there are people in your situation that have successfully dealt with their ear sensitivities, whether tinnitus, reactive tinnitus, hyperacusis, misophonia, phonophobia, acoustic shock, etc., etc. This should give you hope that you can do this too.
And you can. You have been doing it for the past decade–sometimes more successfully than others, but you are doing things to help you deal with your tinnitus and hyperacusis.
However, you are derailed and need some professional help to help you get back on track and pointed in the right direction again. Search out a good tinnitus and hyperacusis clinic in your area. They are typically run by audiologists. So ask around who is good and go there.
Remember that reactive tinnitus and hyperacusis, etc. are really psychosomatic conditions–they have a physical component and an emotional/psychological component. You have to deal with both components–and if I had to choose just one, I’d say the emotional/psychological component is the more important component, so that is where you need to focus most of your efforts.
I wish I had my new book on Hypersensitivity to Sound done. It would really help you, but unfortunately, it is still some months away.
Cordially,
Neil
Thank you for your reply. I’m trying to not give up, but there’a a threshold I can’t tolerate. I’ve only been “ok” because I got the tone to something I could handle.
Now, I can’t. I cannot stomach this. Not just emotionally reacting to it, but the sound itself it creates this high pitch ear piercing spike over noises. I’m almost better with my ears plugged with cotton and ear muffs on, because although I hear my regular T, and the sound on my right ear still does this half second spike up and down up and down, it’s on a lower scale compared to when I’m getting sound from normal day to day stuff.
I could handle T and H, but only at a certain level. I could only handle the T after 2 years from 27 to 29 because it didn’t do this constant up and down fluctuating and reacting to A.C, wind blowing outside ect.,
This is impossible to cope with. And I’m fearful it”s noise trauma to the hair cell or nerve and this is permanent.
Two things have happened, the firealarm which I never fully recovered from after months, but got slightly better and now recently because of an ETD issue that wen’t away on its on (and didn’t even really change my noise induced T at all) I wen’t into to ENT who performed a Tympomentry (or similar named) on my ear which has never felt the same since. The tone didn’t seem loud, but the pressure change it caused has seemed to negatively affected the ear and made the fluctuating reactive portion stick now, which is not going away or showing signs of progress.
I sadly have no support here. I don’t know why I’m regressing with worsening conditions other than I am not in silence 90% of the day anymore like I used to be.
I’ve tried to look around Southern California but I’ve found only bad people, uniformed and having no clue. I’m lost and I don’t know how much more I can hang on. My life already felt over, but at least my T was semi-bearable. Now, it’s like 3 years of recovery is out the window replaced by a fluctuating T that spikes up and down, reacts to noises and more sensitivity to noises and their perceived loudness.
If you know anyone that might know of someone that can help me in california, please let me know.
Also to clarify, the reactive portion is two-fold. It’s not as I read above where someone hears noise and it goes up for x amount of time.
Mine is 1 singular issue with a subset. There is now a tone I did not have before long term with years of T/H that constantly, even in silence goes up and down. It is less intense with silence. This issue is then ramped up with noise stimulation. It increases ten fold, and especially when noise enters the opposite ear(unaffected left ear), making it react heavily in the right ear.
I do not know if this is damage in the form of worse T now, or if H becoming worse has created this, or if that’s even possible. But the fact I had this before, on a smaller scale in the same ear must point to something. My fear is that either the haircells or nerves, what have you, may have been on the edge of being fully damaged and finally broke and that is why this has now stuck and not gone away like before.
Hi Ryan:
What brought your tinnitus and hyperacusis on in the first place–way back? Was it exposure to loud noise or what? What happened with the fire alarm episode? And also explain more about your ETD that came and apparently went.
The typmanometry the ENT performed was a bad idea if you have hyperacusis. I take it that this set you back too?
That’s one of the things about hyperacusis–you risk setbacks if you are around noise–but at the same time, you NEED to expose your ears to sounds or you will just make your hyperacusis worse and worse.
So, setbacks are a part of dealing with hyperacusis. You just need to pick yourself up again, and continue on. Yes, it is discouraging and takes longer, but if you persevere, you WILL get better.
I wish I knew someone in southern CA to recommend to you, but I don’t. Normally, you don’t go to an ENT for such issues, but to a tinnitus and hyperacusis clinic run by audiologists. You want them to have enough experience to help you and not inadvertently hurt you more.
I’ve not come across the situation with spikes to sound as you describe, but it is all related to your hyperacusis. You need to surround yourself with low-level sound–pink noise is normally what they recommend, but any continuous background sound should work. You start with the sound barely audible–just loud enough to hear–but not so loud that it spikes your hyperacusis. After you can tolerate that, then you turn the volume up a wee bit more and wait until you can tolerate that, and so on. This is not a fast process, but can take 2 or more years.
At the same time, you need to deal with the emotional/psychological side of hyperacusis. This is because the more you worry about it, the worse you can make it. You want to focus on the loves of your life and push through (push aside) the hyperacusis in the process.
The normal sounds you hear do NOT damage your ears in any way–even though it may feel like it. This is the difference between how loud the sound really is, and how loud you PERCEIVE it to be. Perceived sound levels do not cause physical damage to your ears–but they sure sound loud and “hurt”. I know what it is like too.
Tell me more about your situation and I’ll see if I can get you on the right track again. If you want, you can email me privately. My email is at the bottom of every page on the website.
Cordially,
Neil
Why can’t any doctor ever answer if reactive tinnitus is damaging me :(.
If I continue to live a semi-normal life and hear my reactive tinnitus at crazy intrusive suicide levels……is that technically okay to do to my body if I can handle it psychologically? Right now I can’t but in the future?
Because anytime I provoke my reactive T I get worse hyperacusis and visual snow and brain zaps. All of this from an acoustic trauma. I am 23. I am so confused.
Hi Layla:
Few doctors have a clue about reactive tinnitus so they don’t know the answer to your questions. To answer your question, reactive tinnitus will not physically damage your body, but letting your reactive tinnitus run your life is a good way to ruin your life as you have discovered. You can successfully deal with your reactive tinnitus. Remember, it has two components–tinnitus and hyperacusis. You have to deal with each component separately, yet both at the same time.
Tell me more about the acoustic trauma you suffered. It almost sounds like you have acoustic shock disorder and ocular migraines (visual snow) and the brain zaps.
Cordially,
Neil
Ever since I was 11 years old I would get migraines and I always feel it in my left eye. I’d get nausea and light sensitivity.
In college I went to bars a lot because that is where everyone would hang out but I never drank. It was during that time that I had multiple acoustic traumas. I’d wear earplugs to the bars (no one else would but I cared about my hearing) but I remember coming home with my ears ringing twice (stood too close to the speaker?).
I ended up having migraines almost every other day for three months that year. They were the worst I had ever experienced. I think because of the acoustic traumas.
This was in February of 2017. I also had an MRI and was given no hearing protection whatsoever. (it’s too late to sue)
In July 2017 I put in my earplugs before going to a bar and that is the first time I heard my chronic tinnitus. I couldn’t stop hearing it afterwards.
I refused to go to bars anymore but it was too late. My noise sensitivity progressed even when I would plug up in noisy situations (on the train and in loud movies). In july 2018 I used a Q tip and I remember my ears burned after. Which didn’t make sense since I didn’t impact any earwax. The next morning I woke up with a multiple tone T in my left ear instead of the normal ringing. I went in to work and all of a sudden I had reactive tinnitus. I walked out into a busy street and I just heard loud wind from my head over everything. My T reacted to air conditioners as well.
The next day I went to a busy restaurant to get my mind off of everything and my reactive T became so loud after a mere 4 minutes there…..that I couldn’t hear my own voice. I panicked. I ran and left. It started to go down but things were never the same after that incident.
The next 4 months were spent primarily indoors. I developed category 4 Hyperacusis and I could hear sounds in the negative decibel range. In that time I developed visual snow, palipnosia, and I suffered 2 brain zaps while I was asleep. At my worst, someone could turn on the shower and my T in my head would start loudly even if I was nowhere near the room. I NEVER used earplugs while indoors even when it would cause me pain. But I admit I never went outside.
I’m a lot better now in the sense that I hear my reactive T all the time but it’s not as intense as it was before. I go outside for daily walks now without earplugs but I keep my muffs on me for when a loud truck passes (and then take it off when it’s gone). But I can’t manage to get over the fear of going outside in public again. I have a female friend who is the same age with all the same symptoms. She slowly worked her way up again to endure sounds and now she goes outside everyday. But she gets brain zaps because of it and that frightens me.
I have no insurance and I don’t know what else to do except keep slowly exposing myself to sounds. But I just know that one day my tolerance is going to collapse again because it’s just too sensitive.
Hi Layla:
You are doing a lot of things right now. You are protecting your ears from louder sounds, yet not overprotecting your ears. That is important. You are trying to expand your decreased sound tolerance–and that is good. Just don’t go too fast. It takes time–so expect it to take 2 years–and if it goes faster, great. You are mostly staying in reasonably quiet situations (staying home) while your ears heal. Just be careful not to overdo it.
What you need to do that you haven’t mentioned. You should always have sounds around you day and night to help you expand your reduced sound tolerance. Keep the sound level down so it never hurts, but keep pushing the point where you feel discomfort a wee bit and slowly your tolerance will increase. It can be white or pink noise, CDs of environmental sounds of any kind, fractal music or pleasing music that is more or less of constant volume–you don’t want extreme volume changes in it.
Because of all the trauma you have been through, you have developed an unreasonable fear of being out where you can’t control the loudness of sounds you might encounter. Your friend is overcoming her hyperacusis–and you need to follow her example and keep on walking outside–and slowly work up to noisier areas from quiet neighborhoods.
Also, you are sabotaging your efforts because of your attitude–“I just know that one day my tolerance will collapse”. You DON’T know that. It may never come to pass. Yes, you may have some setbacks, but you will succeed if you persevere. So you need to change your thought from “I just know…” to “I WILL succeed, no matter how long it takes. I WILL do what it takes.”
And if you need help, you know where to find me.
I wish you well.
Cordially,
Neil
But hypothetically if my tinnitus stays at the level as before (where I can’t even hear my own voice)…..you’re saying I can technically just go on with life that way? That it won’t cause me physical harm?
Some might argue visual snow can’t hurt me (though I disagree a bit because it makes it impossible to drive and sometimes difficult to read)……but what about the brain zaps?
Aren’t those dangerous? And I didn’t even list all of the symptoms. I also get “auditory palipnosia” when I go outside which makes it very difficult to follow any conversation at all. And I also lose my balance. So I feel very stuck because noise always retriggers my secondary symptoms.
Hi Layla:
Technically, tinnitus won’t cause you physical harm, but because you have it, you could have other problems–I’m not doubting that. However, if you habituate to your tinnitus, then it won’t bother you and you won’t perceive it as that loud. Furthermore, tinnitus doesn’t stop you from hearing. It just makes it harder to pick out the sounds you want to hear from your tinnitus. When my tinnitus used to get very loud, I didn’t want to bother trying to listen to people. I just wanted to be alone until the volume dropped back to “normal” again.
Again, visual snow doesn’t technically hurt you physically, but because you have it, you could have other problems–like not seeing a car coming at you. And that wouldn’t be good.
Auditory palipnosia is often the result of brain lesions. This might also be the cause of your brain zaps and your migraines. And maybe your balance problems too. Have you seen an neurologist about all these symptoms over the years. Have you ever had brain scans, MRIs on your head, etc. to see if there is a problem that shows up? I’d think that would be a good course of action if you haven’t–but without insurance that could be a real problem.
Cordially,
Neil
Hi sorry i started a new thread. I got an MRI when my symptoms began but it was 4 months before my severe symptoms began. And it came back clean. So I’m hoping that was accurate enough because now my hyperacusis is too severe to get another MRI. And I suspect I have some sort of neuro-cellular issue rather than a structural issue. I know I’m not the only person with severe tinnitus that later developed visual snow and auditory palipnosia. We just don’t really know what to do about it.
Thank you so much for responding. I’ll at least continue my sound therapy.
Best,
Layla
Hi Layla:
I don’t think I’ve ever encountered a person with visual snow and auditory palipnosia subsequent to tinnitus, so I don’t know what to suggest either. Sorry.
Cordially,
Neil
That’s okay! I am going to buy your book so I can get more information on coping with reactive tinnitus.
Thanks,
Layla
Hi Layla:
My book, “Take Control of Your Tinnitus” available at http://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ will help you deal with tinnitus, however, it does not contain information on reactive tinnitus. I’ll correct that oversight in the next edition, but this article on reactive tinnitus contains the additional information you need.
Cordially,
Neil
Visual snow is often indicative of brain damage – or damage to neuroplasticity related to epilepsy. Given Layla’s obvious anxiety relating to this I’d strongly suggest she get on a tricyclic AD such as Nortripyline and utilize Loreazapam as needed.
One of the problems with the brain is it’s rather easy for it to get stuck in a self-reinforced negative feedback loop. And unless you’ve had training to engage your pre-frontal lobe in calming down your amygdala than chemically calming down is best untill one can get that training.
Never forget that the pathogenesis of tinnitus is the real problem. You have neural pathways that are keeping the condition going. And until they decay the condition won’t resolve.
This is why the best way forward for treatment is bimodal neuromodulation – and possibly vagus nerve stimulation. The Neuromod device coming out of Ireland this year will be an immense help to most T sufferers.
Works on the same principle as what Dr. Susan Shore is doing at U of M – resetting the fusiform cells with micoelectric bursts and creating new neuroplasticity entirely via the trigeminal nerves. Ir’s the way forward and the best bet to “cure” tinnitus.
I have T and PT and mine is most certainly reactive. I’d say I have a touch of hyperacusis too. Not so much volume as certain sounds – crinkling a plastic water bottle, showers, etc. are nail on a chalk board for me whereas they never bothered me prior to my T. Most things don’t bug me too much. One of the other issues however is that I have SSCD – the dehisance in my left ear. So I’m picking up more sounds that would normally be filtered out, My neurotologist feels my symptoms aren’t severe enough – yet – to risk surgery, but will be monitoring me with annual checkups from here on in to see if the dehisance is getting worse.
So, whilst that’s not the cause of my T it is a factor. I’ve got neck issues too – advanced disc degeneration, etc. a bit of hearing loss in the upper range but nothing unusual for a 50 year old male. All together that makes for somatosensory T. Mine is constantly modified by my neck and the surrounding muscles.
Mine is pretty much all over the place. Some days it’s barely there – thank god – other days it’s an endurance trial. Regardless of if it’s a good or bad day it’s absolutely reactive.
Driving, without question, always makes it worth, Besides the cortisol reaction from the stress of driving and the road noise, I’ve always felt that how we’re physically positioned in a car makes a difference too.
Interestingly enough alchohol really quiets it down considerably. I can go into a loud restaurant and it will make the T spike a in a big way. Yet, after a couple of drinks it starts coming back down. If I don’t drink it stays loud. So there’s something to be said there for how relaxing affect of alcohol on the body and brain shows how much T can be tied to neuromuscular inflammation and body chemistry.
Hi Halsy:
Alcohol is an interesting drug. For some people it revs them up and makes their tinnitus worse. For others, it calms them down and makes their tinnitus better. You’ve found how it works for you, but it doesn’t do that for everyone.
Cordially,
Neil
Hi Neil,
I would like your opinion regarding my situation. I wonder whether my tinnitus is psychosomatic or not.
At the very start of October, I was having quite frequent fleeting tinnitus in my right ear. Around the same time, there was a very negative news item about tinnitus (about that young Dutch mother who chose euthanasia because of tinnitus) and then there was also a newspaper article…yet again very negative. I was already struggling emotionally (under severe stress), so I was susceptible to God knows what.
Then, on October 4th, my 2 year old son was crying (screaming) on my right lap at night. I thought of those news articles and immediately felt panic.
After my son went to sleep, I went on my pc for a bit (I was kinda shaking off the thoughts of the news articles) and for some reason the pc fan was bothering my hearing. Panic attack set in, I hyperfocused on my hearing, put my fingers in my ears and heard a swoosh-y sound in my right ear. Panic, panic, panic. That continued on the whole night, all I could hear and focus on was that swoosh-y sound in my right ear.
Went to an ENT, had a hearing test and hyperacusis test, both came back completely normal. ENT was the usual horribly unhuman kind. Of course I went online after that and saw lots of horror stories, which only increased my panic and anxiety.
And here we are, in January. Over time, more sounds popped up. From a static noise in my head, to a high frequency sound. I don’t have the typical “beep”. It’s almost like I became overly aware of my inner noises and now I don’t know how to become unaware again.
But the tinnitus is also reactive. TV (with volume on 0…), cooker hood, pc/laptop fan, car engine, hair dryer, etc. All sets off this “winding up” effect or it makes the sound switch to a different one. And THAT is what makes me struggle and wonder whether is it psychosomatic or physical. Because if it’s all just stress and fear related, why would it be reactive?
At the same time, I’ve also experienced over and over again how much of an influence stress has on it. My son was in the hospital last week and the tinnitus went through the roof. Like an alarm going off in my head.
I started TRT on January 14th, but my TRT clinician believes that my case of tinnitus is ongoing because of fear, panic and hyperfocus. Because I’m staying in fight or flight mode instead of letting it go. I’m scheduled to start EMDR next week, to get my fear of the tinnitus down and hopefully the focus off it a bit.
There are times, like this morning when I was cleaning the kitchen, that I was actually unaware of my tinnitus. Getting the grub off the stove was on my mind, not the tinnitus, so I didn’t hear it. Then I had to go into our quiet washroom and I thought of it again and up it popped. I’m having short moments like that off and on recently, where it goes in and out of my consciousness.
See what I mean? I have no physical issue, no noise trauma. Yet I have tinnitus.
I’d love your opinion. Thank you so much.
Hi Suzy:
First, unless you have somatosensory tinnitus, such as hearing your heartbeat in unison with your tinnitus, all tinnitus is basically psychosomatic. So, yes, you do have psychosomatic tinnitus.
The Internet can be a blessing and a curse. It can be a wonderful source of information on tinnitus. I like to think this site is one of them. It can also be source of horror stories that leave you scared, not uplifted.
The people that write horror stories have not successfully dealt with their tinnitus. In fact a lot of them are not even trying. They have a “victim” mentality. Thus, they are waiting for someone to do something to them to get rid of their tinnitus.
In contrast, those people that have success stories about their tinnitus typically don’t post horror stories because they are too busy successfully dealing with their tinnitus. Thus you get a skewed opinion of tinnitus–that there is nothing you can do about it, and that you will be saddled with this condition for life.
Thus, many sites lead you to despair, not hope. That is not an accurate view of tinnitus.
I’m curious, were you on any drugs or medications back in October? I ask this because many of the psychotropic drugs have a side effect of causing panic and extreme reactions, rather than coming you down. Thus, for some people, taking such drugs can cause them to be in a worse state than they were before they began taking them.
Stress, anxiety, and panic can certainly cause tinnitus, or make your existing tinnitus worse as you are finding out in your life.
I’m with your clinician that your tinnitus is ongoing because of fear, panic and hyper-focusing on your tinnitus.
What you need to do is get out of fight or flight mode. Your limbic system is that part of your brain that puts you into fight or flight mode when you hear a sound that affects your well-being in some way, whether it be emotional, mental, physical, spiritual, financial, etc.
In order to take control of your tinnitus, you need to give your limbic system permission to ignore your tinnitus. It will only do this when you begin to treat your tinnitus as an non-issue. By this I mean you treat it like any other background totally unimportant sound, for example, the sounds your fridge makes. I’ll bet if I asked you right now whether your fridge is on or not you’d have to stop and specifically listen before you could tell me.
This is so, not because your fridge doesn’t make noise, but because it is in unimportant sound and your limbic system has observed that you take no notice of it, so it doesn’t either. It does not bring it to your attention, and thus it fades into the background and you often don’t hear it.
If you treat your tinnitus exactly the same as you treat your fridge noise, exactly the same thing will happen. It will fade into the background and often hours will go by without you even being aware you have tinnitus. The good news is that this is already starting to happen with you. For example, when you were busy scrubbing the kitchen, you were so focused on your work that you totally ignored your tinnitus, and thus you didn’t “hear” it.
However, when you think of your tinnitus immediately there it is! That is why you want to focus on other things and ignore your tinnitus.
For example, this morning, before I began answering your comment, I wasn’t even aware that I had tinnitus. But as soon as I started thinking about tinnitus, my ears began screaming at me. That’s just the way it is. It’s one of the hazards of having tinnitus yourself and helping people with tinnitus, because whenever you think about tinnitus, your own tinnitus acts up.
Now for the good news. Within five minutes of completing this comment, unless somebody else asked me something about tinnitus, my tinnitus will fade back into the background and I will be no longer aware that I even have tinnitus. This is because I choose not to let my tinnitus bother me. As a result, I am habituated to my tinnitus. You can do the same too.
What you need to do is treat your tinnitus as you do fridge noise, thus giving your limbic system permission to leave your tinnitus in your subconscious and not bother you with it. Then you will notice more and more hours will go by without your being aware of your tinnitus. Sometimes my tinnitus just pops up into my consciousness for whatever reason. I’ve never been able to figure out exactly why. When that happens I just ignore it, and continue on with what I was doing. In a few minutes it typically fades back into the background again.
That is what you need to do too. You might find reading my book “take control of your tinnitus” will help you understand what is happening and how to take control of your own tinnitus. Chapter 16 in this book will be a real help to you.
Cordially,
Neil
Thank you Neil 🙂 To answer your question, I was not on any medication back in October.
I just became incredibly scared of tinnitus after the fleeting tinnitus and the news articles. I was already struggling with panic at the time (for different reasons).
I am currently on a very, very low dose of Oxazepam 5mg twice a day. As I was going from panic attack to panic attack and my psychologist wants me to be somewhat calm for the EMDR.
I struggle with how much my tinnitus fluctuates. Both in sound as well as in volume.
As I am typing this, it sounds like an alarm.
With the EMDR, I’m hoping it will be a tool for me to get my fear to lower somewhat.
Hi Neil!
I wonder if you could help me with a Tinnitus question.
My story begins about 10 years ago (2009), i got Tinnitus in both ears, hissing, and sometime hypercausius but it switched on an off, and sometimes a ringing in the right ear.
For information i worked twice a week in a club but had ear protection, the small ones that u put in your ear.
I could listen to music but i used almost always the big earcups so i didnt need to turn the volume up.
Anyway, after 1-2 years my Tinnitus went completely away, then abou 2014 after i was on a 3 day vocation swimming and came back to sweden i lost my balance and it sometimes rotated, i was sick 3 months at home, and in the end it went away.
Now to today, i got tinnitus again some days before new years eve, its again a hissing but this time its louder, and sometimes a ringing in the right ear, but last days i felt that the ringing is activated by fan noise or other noises.
I went to ent and they tested my hearing, no hearing loss att the stadard 500-8kHz, now i dont know the higher freqs, as i said i love to listen to music or podcasts but always used big cups ear for the sound to isolate outside soud so i dont need to ramp it up.
i also have some problems with, my balance, not always but it seems when i turn my head fast it feels weird.
i forgot to mention, my first time i got T i had earinfection i think in the right ear and sonusinfection, i have sinus infection every year in the cold wintertimes, maybe 2-3 months, my ent sais i have an irritated nose, i try cortisonsprays but nothing helps.
dont know if the sinus infection contriubute to that.
And i read to much horrorstories on the internet.
Iam thankful for your time and cant be to thankful.
Hi Semir:
I’m having a hard time figuring out what is going on with your tinnitus and balance. Are you taking any medications?
Why do you get sinus infections for 2 to 3 months each winter? Is your immune system not working well? Do you get colds or other viral attacks when you have these sinus infections?
Under what circumstances does your tinnitus react to sounds? Are these sounds soft or medium or loud?
Is you neck tight? I’m wondering if your C1 and C2 vertebrae are out of proper alignment?
Anything else you can tell me about your condition? So far, I’m not having much insight into what is going on.
Cordially,
Neil
Hi NeiL!
And thank you that you take your time to reply.
I will try to give you so much detail as i remember.
Iam not taking any medication before at all, never really needed.
I have been meeting ents several times, when they did a scan on my sinuses, they say that the structure of my bones shouldnt give me any problems as its very wide.
So really i dont know, but its always in winter, one ent said to me that it probably is because of the cold air getting very dry up here in Sweden and the nose gets irritated and inflammation starts.
Its not always that i have colds before i get pain in my sinuses, but this year i got the Flu and was sick over 10 days, maybe 2 weeks after and i started to get small pains in my right side of face, as time went on it was getting worse.
Iam not new to this pains, when its really hurts i can’t speak because i get pain in my right joint and pain in right ear so its hard ti listen to sound.
I remember that one year i got it in summer but very short time and small attacks, i got so much pain that even light bothered me, but that was like short attacks of 1 hour and then goes away for the whole day.
The duration of the sinus problems can vary from year to year, one year i only had it for 2 weeks because i went to indoesia in winter for vocation, it was very warm and humid there, i think it helped my sinuses.
I think i only got one bacterial infection and it was in 2009, in the ear, i never get it in my sinuses, i checked with my ents, every time they look in my nose they say it looks dry and swollen.
Both the left and right cavities gets swollen, but i only feel the pain on my right side on the face, it starts first about my nose, goes over to my eye and to the ear, from the ear to my upper and lower right teeth.
This year, when i always got heavy pain, i somethimes got the ringing in my right ear but only like 1 second, that was several weeks before my tinnitus went permanent.
I had pain in my upper right teeths the last half year, i went to the dentist and they didnt see anything, they said maybe i grind my teeths.
I dont know if my neck is tight, but some people at my office had commented at my sitting position and that i look really stiff.
Well i forgot to mention some things.
When i did some physical active, i sometimes heard some hissing in my ears but it went away very fast, also if i didnt get much sleep and was wake long time the next day, but as soon i slept it went away.
I also started to work out in February 2018, the training schedule was 5×5, its 5 different positiones :
Overhead Press, Deadlift , Squat, Bench Press, Barbell Row.
And as i got better at it i put more weights on, can it be something with that?
because the last days before my T went back was that the hissing was higher then usual after the training.
I hope this will give you more insight.
Thank you in advance and you dont know how much it helps me to keep on fighting .
Hi Semir:
I’m no expert on sinus problems. That’s not ears and I specialize in ears and how to help people deal with ear problems.
I’m not seeing anything that jumps out at me. However, one possibility is that your upper neck vertebrae are not in proper alignment and are causing some of the pain, etc. What I’d do is see an upper cervical spine chiropractor (not a conventional one) and make sure your upper spine is in proper alignment. That could be a root of your problems, or maybe not. You’d have to try and see. You can find these special chiropractors by going to http://www.upcspine.com/ and clicking on practitioners.
Cordially,
Neil
Neil!
Sorry to give you my ear sinus problems, i just wanted to give you raw data as much as possible.
I forgot to mention, in the times when i was free from tinnitus, i could generate hissing sounds by pushing my teeths together hard, or if i lift something heavy and use my neck much, is that normal that people can do that ?
Hi Semir:
If you can change your tinnitus by clenching your teeth, turning your head all the way one way or the other, or tightening your neck, then you have what is called somatic (body) tinnitus. Since many people have their upper necks out of whack, this is fairly common in the general population, but it is not normal. If you have your neck and jaw adjusted properly, you won’t have this anymore.
This is one easy way to tell if you are “out of whack” or not.
Cordially,
Neil
Thank you for the answer about the somatic tinnitus, i was away awhile to concetrate on work and dont thinking about my tinnitus, after a while i felt it went down, when i started to train again again it became higher after working out my shoulders, so it must be something with this.
Thank you Neil, i can’t say thank you enough times.
Live Long and Prosper.
Dr. Bauman,
I have been dealing with Tinnitus & Hyperacusis for 7 months now. Although my Audiogram (only tested to 8khz) indicated ‘normal’ hearing . . . I assume I have some degree of noise-induced/age related hearing loss. Probably due mainly to loud music cruising in my car with the top down for the last 20+ years.
I don’t have a ‘baseline’ for my T. It has been constantly changing from the beginning . . . in terms of the number of sounds, types of sounds and behavior. At the moment, it is entirely different to anything it has been before.
My H was originally quite severe and I needed ear-plugs to survive most daily activities. Fortunately, it is in the process of improving. Mainly due to steps I have been taking to gradually increase my sound tolerance over time. In fact I am thrilled with the progress I’m making in that area . . . which even 2-3 months ago I would not have thought possible.
However, my biggest area of concern at the moment has to do with the ‘reactivity’ of my T to sound. This has always been the worst aspect of my symptoms.
Unlike the general descriptions of Reactive Tinnitus described on this website . . . my ‘reactivity’ takes the form of a horrible distortion which accompanies most sounds. Whatever my ‘T sound’ happens to be at the time, . . . that sound distorts, in reaction to certain frequencies and types of noise. Like if someone speaks to me . . . the T sound tries to compete with their voice . . . and it distorts up and down . . . coinciding with the fluctuation of their words.
It doesn’t make my T louder for minutes, hours or days after. I only experience it in direct response to sounds. It rises and falls with any changes in volume . . . and then it stops the instant the sounds stop. But it’s a horrible sensation . . . as whatever the volume of the particular sound it’s reacting to is . . . the T sound goes louder.
For whatever reason (not based on anything scientific or medical), I always assumed it was actually my H that was ‘reacting’ to these things . . . and that it was in turn, ‘triggering’ my T to distort.
That being the case . . . I was kind of expecting this ‘distortion’ to reduce, as my H got better. However, since my H has been improving . . . I haven’t noticed any change whatsoever in this ‘reactive distortion’. It’s the same as it’s always been. Maybe worse.
So now I’m thinking this reactivity is solely associated with my T and my H has nothing to do with it.
I was really hoping you may have some experience/input you could offer regarding this behavior.
Either way . . . thank you for your time.
Regards,
Martin.
Hi Martin:
I’m glad to hear your hyperacusis is improving as you slowly stretch your sound tolerance. That’s the way to do it, and as you found, it works.
One of the side effects of hyperacusis is distorted hearing, or distorted sounds. I’m thinking that your weird reactive tinnitus is based on your hyperacusis. It’s definitely different than most reactive tinnitus to be sure, but it is still a type of reactive tinnitus. And remember, reactive tinnitus is a combination of tinnitus and hyperacusis. So the underlying hyperacusis is very likely your problem.
Conventional wisdom says that you treat your hyperacusis first, then, when it is under control, you treat your tinnitus. That’s not to say you can’t treat your tinnitus at the same time, but typically you get better results once you’ve got your hyperacusis under control.
I’m afraid I don’t have any experience with your exact version of reactive tinnitus, but if you find something that helps it besides just getting your hyperacusis totally under control I’d love to hear your experiences.
Cordially,
Neil
Neil,
Thank you for your response.
Since I contacted you . . . I actually read someone’s post on a Tinnitus Forum, who described a ‘reactive distortion’ which was exactly the same as mine.
They said they have almost overcome their Hyperacusis . . . and that the distortion has gone as well. However the distortion didn’t resolve at the same rate as the H. It took longer to improve.
So I’m hoping that mine may take a similar path. If not . . . then I’ll have to deal with that when the time comes.
In the meanwhile . . . thanks again for your time. It’s appreciated.
If I experience any further developments worth mentioning . . . I will certainly let you know.
Cheers,
Martin.
Hi Martin:
I’d love to read the account of the person with the reactive distortion the same as yours. If you find it, please copy it into an email and send it to me. My email is at the bottom of every page on this website.
Cordially,
Neil
Hello Neil,
Just a comment on Reactive Tinnitus.
You mentioned TRT for treating it.
My experience with TRT was hearing aids with sound generators but didn’t work for me since the sound…pink noise, red noise, etc, made my T worse. When I took them off at bedtime I couldn’t sleep because of the heightened volume of my T. So with cases of reactive tinnitus, I don’t think TRT works? Or am I missing something.
Thanks for your time.
Bill
Hi Bill:
Since reactive tinnitus is basically both hyperacusis and tinnitus (although some authorities don’t agree with this), you normally have to treat the hyperacusis first and as you get it under control, typically your tinnitus lessens also. It sounds like you were treating your tinnitus first, rather than the hyperacusis component first.
Cordially,
Neil
Thank you for getting back to me Neil. Do any of your books address Hyperacusis treatments? I’ve not researched how to treat it since I didn’t think I had it.
I bought your Ototoxic Drugs Exposed book as well as the Special report on anti-inflammatory drugs…great information! Is there a drug you would recommend for mild headaches if natural methods didn’t work? LIke the least ototoxic pain med for occasional use?
Thanks again for your help.
Bill
Hi Bill:
I’m currently working on a revision of my book “Supersensitive to Sound”. I don’t recommend the old version as it is very out of date. The new book will have a whole section specifically on hyperacusis and how to treat it. Unfortunately it’s not ready just yet. It will still take me a few more months to finish it.
If you need a drug for occasional headaches, probably aspirin or acetaminophen are the least ototoxic.
Cordially,
Neil
Thank you Neil…I look forward to that book. I occasionally hear sounds that seem louder than they should, but not regularly, so I really have never given Hyperacusis much thought. My struggle right now is reactive tinnitus so I’m hoping to find a way to treat/cope with it. My tinnitus pulses 80% of the time and even low volume external sounds increase the pulsing volume.
Hopefully, with time, my brain will somehow decrease the intensity of the reactive element.
Thanks again Neil.
Bill
Hi Bill. Did it ever decrease? Mine is pulsatile after an acoustic trauma/irrigation (had acoustic trauma, no tinnitus, doctor cleared earwax 4 days later and that’s when tinnitus started that night). Mine is very alarming because it’s not just a ring, but like cicada or crickets sound that pulses and raises itself over any sounds. I’m curious if yours got better and if you had strange sounds other than just ringing that pulsated?
Wow what a great article, my tinnitus reacts to the the pitch of sound, for example with music, my tinnitus mimics the singers pitch, if they sing high notes my tinnitus increases with it,
If a dog barks “woof woof” my tinnitus increases with the first bark then settles then increases with the second bark,
It started a year ago and but I have had standard timing tinnitus for a long time.
Hi, thank you for the article. I think my tinnitus is similar to Chuck’s. I’m a singer and make music so this makes me super anxious. I’m wondering what could I do about it. My tinnitus sound (around 800 hz) reacts to even my own voice. And then stops as I stop speaking or sometimes it keeps ringing but then I can stop it my moving my jaw a bit. I also have bad bruxism. This new reactive tinnitus type of sound started about 2 weeks ago after an 10h flight. Or after that i started noticing. I wear earplugs during gigs.
Hi Ilona:
I think the first thing you need to do is learn techniques to relax. Being “super anxious” can certainly make tinnitus worse. This high level of anxiety can tighten your face and neck and pull your upper vertebrae out of proper alignment, not to mention your bruxism and jaw problems.
Second, if I were you, I think I’d go to an upper cervical chiropractor ( http://www.upcspine.com/ ) and have him make sure your C1 and C2 are in proper alignment. Also, going to a massage therapist and getting the muscles in your face, neck and shoulders relaxed will likely also help.
Once you have done that, re-evaluate how your ears are doing and hopefully the problems will begin fading away. The more your focus on them, the worse they typically get–so you want to learn to ignore your tinnitus and focus on the loves of your life.
Cordially,
Neil
Hi,
I want to thank you for taking the time to answer. I will definitely need to relax and thank you for mentioning the upper cervical chiropractor. The last couple of years have been very stressful so I wouldn’t be surprised if this is happening because I’m just so tense from head to toe.
Today I went to a dentist and he noticed that my night guard didn’t fit and caused me a bad bite. He polished it, so maybe, now that it fits, it will have a positive effect.
This week I also noticed that when I’m very relaxed (e.g. after a massage) and calm also mentally, my sound reacting tinnitus is less reactive and stays away longer time (even 10 minutes) in moderately silent places. The sound still starts ringing if I hear a louder noises and also often when I swallow but it is somehow easier to control and can be shut down by moving my head etc.
This type of tinnitus is so weird, I haven’t really found any information about it…
The mind can be so powerful so I will do my all to stay positive. Life is a beautiful thing. 🙂
Thank you!
– Ilona
Thanks, Neil for the link to this blog article in a comment I left on your “Bizarre World” blog.
[I have had sudden binaural (most likely sensorineural) hearing loss which led to my diagnosis of Susac (around 50 until approx 1500 herz when I pretty quickly leap up to normal hearing (10-15). That’s when my awareness of the tinnitus started.]
What I found most interesting in this piece in reactive tinnitus is that it seems to call into question the conventional wisdom that tinnitus is your brain making sense of what you aren’t hearing (am I safe in calling this recruitment?)
As someone whose tinnitus as I perceive it seems to get stronger with sound but who doesn’t experience hyperacusis or audio pareidolia and who hasn’t had a strong emotional reaction to it tinnitus (as mine is of the white noise variety and definitely stops or is not perceived in quieter environment so not hugely annoying per se), I’m still grasping at what I can do to address at least what I perceive to be difficulty hearing and comprehending speech when my tinnitus is active. You refer to “normal tinnitus,” but I’m not sure what that is. I’ve been trying to log my tinnitus events but so far I don’t have a strong sense of which frequencies are aggravating them (as a trained musician, I have a fairly decent grasp of the focused frequencies of focused sounds in a typical music range around me).
Do either your _Take control of your tinnitus_ or _Hearing Sensitivities_ books give more of a lit review of the scholarship on tinnitus?
Again, I _do_ really appreciate these blogs and apologize if I’m being nit-picky; that is not my intent.
Thanks, Liz
Hi Liz:
Tinnitus is not your brain trying to make sense of what you aren’t hearing. It is more just the results of the overactivity of the neurons that no longer have a job to do because of your hearing loss.
This has nothing to do with recruitment. Recruitment is not phantom sounds like tinnitus is, but is the unnatural rapidly increasing perception of sound due to a collapsed dynamic range. Think of it this way. In people with normal hearing lets say there are 100 steps in volume between the softest sound you can hear (0) and the loudest sound you can stand (100). So if you just increase the volume the minimum amount, that equates to 1 unit of increase. Thus you can slowly increase sounds in 1 unit steps. Each step is just a little bit louder than the previous one.
In contrast, a person with severe recruitment can’t hear soft sounds, so the range he can hear from the softest sound he can hear to the loudest sound he can stand is lets say 10. That means he only has 10 steps of sound increases from very soft to very loud. Thus each step (compared to the 100 steps a person with normal hearing has) actually covers 10 steps. This means that for each step up in sound, instead of him perceiving it as just a bit louder (1 unit), he perceives this same slight 1 unit increase in actual sound as much louder (10 units). So, for example, if a person is talking to him and he can’t quite hear him, he asks the person to speak up a bit. The person complies and he retorts–“Don’t yell at me”. This is because the person raised his voice say 10 units of actual sound, but the person with recruitment perceived the volume 10 times as much–in this case 100 units–and it is now as loud as he can stand.
What I refer to as “normal” tinnitus is the neurophysiologic tinnitus that is generated somewhere in your inner ears/brain (inside your auditory system) as opposed to somatic tinnitus which is generated somewhere in your body outside your auditory system.
My books are not written to be research books, but to interpret the results of research and put this information into practical terms that you can use to help yourself.
Even so, my book “Take Control of Your Tinnitus” contains 16 pages of references to literature I’ve cited. It contains 792 footnotes so it is well documented.
I would not recommend my book on hearing sensitivities at this point. It is grossly out of date. I am working on a MUCH more comprehensive/expanded and updated version that should be out sometime this year. It too will be extensively documented.
Cordially,
Neil
This is helpful. I think I linked tinnitis to recruitment, because I had read “The theory of recruitment is that as the hair cells in your cochlea become ineffective, they “recruit” their (still working) neighbor hair cells to “hear” the frequency the damaged hair cell was supposed to hear, in addition to the frequency the still working hair cell was supposed to hear. This increases the signal from the still working hair cells.” So I equated that with “overactive neurons,” but perhaps should have paid more attention to the acknowledgement that this is just a theory, and if it’s not contributing to my tinnitus, I can move on.
But can I press you in attempts to better understand? If ‘normal’ tinnitus is neurophysiologic and ‘reactive’ tinnitus is psychophysiologic then I’m still uncertain what I’m experiencing.
In your response you did a little clarifying, defining “somatic tinnitus” as “generated somewhere in your body outside your auditory system.” Maybe there’s a larger psychological piece of my tinnitus than I realize, but if not, I’d like to know what in my body is causing it (and yes, I suspect that many otologists have probably asked just that but perhaps haven’t come to a clear answer).
Living with my tinnitis another month, I’ve more precisely observed that it seems to be triggered by sounds. In quiet environments I’m not hearing that white noise (as if I’m constantly in my car driving on a county road at 55 or in a building where the HVAC is in overdrive). But, put me in one of the above situations or outside, the tinnitis is apparent and may take a few minutes to dye down. So I divide these two experiences (1) being in an environment where I suspect that I formerly [before my low-frequency loss] could distinguish all sorts of low-frequency sounds but now only hear a roar and (2) the lingering of this roar when I’ve moved into a quieter space. Which one is “reactive”? Which one is normal? Both seem to be physiologic, but which one has the more certain cause?
Any further thoughts/clarifications are appreciated.
Sincerely, Liz
Hi Liz:
The only link between tinnitus and recruitment is that they both are often a result of a sensorineural hearing loss.
You quoted, ““The theory of recruitment is that as the hair cells in your cochlea become ineffective, they “recruit” their (still working) neighbor hair cells”. I see two errors in this. First, the hair cells die (which certainly makes them ineffective!). Second, “they” do not recruit their neighbors because they are dead. It is your brain that does the recruiting.
The common neurophysiologic kind of tinnitus–what most people get from exposing their ears to loud sounds, or from taking drugs keeps its volume more or less the same day in and day out.
In contrast, reactive tinnitus gets louder in response to louder sounds and drops back to baseline when it is quiet. And reactive tinnitus has a hyperacusis component present that causes this increase in volume.
Since your tinnitus reacts to louder sounds, I don’t see that you have somatic tinnitus. Somatic tinnitus more reacts to body movements and/or nerve stimulation from other than the auditory nerve, and is not sensitive to sound as such.
Therefore, I’d think you just have reactive tinnitus.
Cordially,
Neil
Hi Neil
I hope you can help?
My story goes like this: In 1997 I had ETD which I had corrected by the insertion of grommets. At hospital I picked up a serious ear infection in my right ear which was treated with gentamycin ear drops. Couple of weeks later tinnitus [a high pitched whine] started which started off in my right ear, spread to my left and then in my head.
I’ve lived with this since and largely habituated to it. Some days were better than others, with the noise bouncing around all three.
In October 2018 I played a loud acoustic piano for an hour [I had been learning on an electric for a while] , like an amateur and the following day I woke up and instantly knew something was dreadfully wrong. My original tinnitus was louder and more intense and I had other noises going on as well. What followed was months and months of Hell on earth as I tried to cope with this, which settled down a bit into a more intense high pitched whine with other tones in each ear, like distant bells ringing or a wine glass being rubbed with a wet finger.
I had been on Venlaxafine since 2015 [35 to 75mg per day] up until about March 2019 and I questioned if this antidepressant was making matters worse so I switched to Fluxoetine 20mg. About 4 weeks after being on Fluxetine I started noticing that certain sounds seemed louder and annoying, not painful at all, just annoying. Sounds like cutlery banging together; plastic bags being crumpled etc. I also noted that my tinnitus seemed to react to these noises, but only as I heard them i.e. the increase in noise didn’t stay for long. If I was to plug my ears and make a mental note of my noise before scrunching up a plastic bag, then scrunch the plastic bag, I would then ‘feel’ it react but then if I plug my ears and listen to my tinnitus it would be the same as it was before I scrunched the bag up.
So I switched back to Venlaxafine just this week {i.e I took Fluxetine for a total of 8 to 9 weeks} in the hope that perhaps it was something to do with the Fluxetine. However this does not seem to be the case and I am wondering how best I can treat this reactive tinnitus?
If I could describe it for you I would say my tinnitus is loud and with me every day without fail and it can be heard over almost everything except a shower. The morning starts off at a particular level and as the day goes by which would involved getting showered, driving to work, sitting in a often noisy open plan office and by the time I come home my tinnitus is very loud and upsetting. In other words my tinnitus gets progressively louder as the day goes on. That tended to happen anyway before the incident in October 2018, just not as loud.
However there are some rare days when my tinnitus has been quiet all day and the same sounds do not aggravate it. I do not experience pain. I admit since October I was using hearing protection whilst hoovering and emptying a dishwasher, but that’s it.
What do I do to treat reactive tinnitus please?
I also have pulsate tinnitus in that I hear a low pitched hum in my right ear. I’ve had this for about 7 years, it comes and goes and I’m sure is related to my blood pressure. I’ve read that it is related to blood pressure pushing on the delicate structure of the ear. Sometimes when its bad and I hear certain sounds like a voice on a mobile phone on speaker my hearing seems to vibrate almost. Is that because I have pressure pushing on the ear and soundwaves hitting it, causing what feels like a vibration?
Can I ask when your new version of your book is coming out?
Thank you for any advice you can give me.
Hi Allan:
You should know that both Venlafaxine and Fluoxetine can cause hyperacusis, tinnitus and hearing loss. Hyperacusis and tinnitus are reported about 3 times as much in Venlafaxine as they are in Fluoxetine. There are about equal numbers of reports of hearing loss from these two drugs.
So it seems that you are not doing your ears any favors by switching back to Venlafaxine. You probably should get off both these drugs and not take any that can cause hyperacusis.
With reactive tinnitus, typically you treat the hyperacusis component first and often the tinnitus component quietens down as a result.
I see two possibilities why your tinnitus starts out low and gets louder as the day progresses. One possibility is that the cumulative effects of the noise causes your tinnitus to react more as time goes on–and then quiets down while you sleep and the house is quiet.
The second possibility is that your neck and shoulders tighten up with the stress of the day and the more they tighten up, the more it pinches nerves in your upper two vertebrae, making your tinnitus worse. Overnight as you relax, the pinching lessens and thus your tinnitus drops. In fart, it could be a combination of both.
Pulsatile tinnitus varies in unison to your heartbeat. You describe yours as a humming sound. To me, humming is a constant sound, so that wouldn’t be pulsatile tinnitus. Perhaps you mean more of a thrumming sound varying in unison with your heartbeat. What happens with pulsatile tinnitus is that with high blood pressure, the blood moves faster to get past constrictions in your blood vessels and this causes turbulent blood flow which your ears hear as pulsing sounds in unison to your heartbeat.
I think that the vibrating feeling you experience at times is more related to tonic tensor tympani syndrome where your tensor tympani muscles rhythmically pulls on your eardrum. You can read about it in my article at http://hearinglosshelp.com/blog/do-i-have-tonic-tensor-tympani-syndrome-ttts/ .
Which book are you referring to–the Ototoxic Drugs Exposed should be out in about 2 years. The book on sound sensitivities I hope to get out later this year.
Cordially,
Neil
Hi Neil
Thank you for the prompt response.
I’m shocked to read that about Venlaxafine! I’ve been on it since 2015 with no issues. Are there instances of this being reported however not astronomical however i.e 1 in 1000 people have reported this? May I ask…how are you aware of this please?
I’m sort of caught in a vicious cycle i.e my tinnitus makes me depressed so I take anti-depressants which might be in turn making my tinnitus worse which makes me depressed and so on and so on. So I don’t really know what to do as I’m fearful that I could slip into a deep depression. Are there any antidepressants you know of that don’t cause issues that I could ask my GP for?
If my reactivity is caused by either antidepressant, would it likely stop if I tapered off and got these drugs out my system?
Thing about my tinnitus is there are many days when I wake up and immediately its high and I know I’m in for a tough bad day ahead. I’ve even woken up in the night and my tinnitus is loud.
Thing about my pulsatile tinnitus is that when my blood pressure is high [and I have been known to be a heavy cigar smoker and inhaling…which pushes my blood pressure up] the ‘mmmmmmmmmmmmmm’ pause ‘mmmmmmmmmmm’ pause…sound goes up. But, when I exercise like cycling which really drops my blood pressure it goes away. When its bad that’s sometimes when this vibrating to certain noises starts. I thought TTTS happened all the time if you have it?
Sorry, the book I was referring to is Take Control of Your Tinnitus. I thought I read somewhere that you were revising it?
Thank you so much for replying.
Sorry…forgot to ask….if it’s the cumulative affects of noise, how do I deal with that? I have to work etc and can’t avoid noises and my understanding is using hearing protection for everyday noise can be just as detrimental. How do I treat this reactive component?
And just one more question if you’d be so kind….occasionally when I eat things like cereal and when I’m bring my jaw together My right ear make a shimmering sound, almost like something within the ear itself is being compressed and released when my jaw opens and I release the tension. Any ideas Neil please?
Hi Allan:
With reactive tinnitus, you need to keep the background noise down to a level just below where it reacts if that is possible. Thus, you may find that wearing ear protectors to get to that level is efficacious. But you certainly don’t want to go below that level. The aim is to increase your tolerance to sound, so you always want to be pushing the envelope a tiny bit. But too much is counterproductive. So you need to walk a fine line between making hyperacusis worse by overprotecting your ears and making your hyperacusis worse by exposing your ears to too much sound.
Your “shimmering” jaw problem sounds somewhat like people who can clench their jaw and make their tinnitus louder. Ditto when turning their necks hard a port or starboard. This is caused by tight muscles in the jaw/face/neck. Actually, a lot of people have tight necks or jaws to some extent so can generate transitory tinnitus from doing the above.
The solution is to go to a chiropractor and/or massage therapist and get your neck vertebrae and jaw properly aligned and your muscles relaxed so they don’t pull it out again. Then this kind of tinnitus goes away.
Cordially,
Neil
Hi Allan:
Venlafaxine is reported to cause hearing loss, tinnitus and hyperacusis in the Physicians’ Desk Reference here in the USA and in the Pharmaceuticals and Specialties in Canada. In addition thousands of people have reported to the FDA (Food and Drug Administration) website in the USA experiencing these and other ototoxic side effects.
I cannot tell you the incidence rate–i.e. 1 in 1000 or whatever as I don’t have access to such information. But I can tell you how many people reported a given ototoxic side effect to the FDA in a particular 9-year period. If only a few did, you may think it coincidental or whatever, but when hundreds upon hundreds of people report the same side effect, there must be something to it.
Furthermore, since few people report side effects of drugs to the FDA, these figures are grossly low by a minimum factor of 100 (0.01) and likely a factor of 1,000 (0.001) or more. Thus, you need to multiply these figures by 100 or 1,000 or much higher in some cases in order to come close to the real figures.
At the same time, you need to realize that not everyone by any means experiences these various ototoxic (or other) side effects, but these drugs can, and do, cause them in numbers of people.
Thus, you cannot just dismiss these side effects out of hand. Venlafaxine may have damaged your ears–it in might not have. But you have to consider the possibility when you can’t explain your ear problems from other sources.
If you are depressed, as far as I know, all prescription anti-depressants can cause tinnitus or make existing tinnitus worse. Thus, I suggest people consider a good herbal alternative that is not ototoxic. If you need an anti-depressant, I’d suggest you look at the herbal St. John’s Wort. It is not ototoxic, is available without a prescription at many drug stores, health food stores or On-line.
A number of studies have shown that it works as well as, or better, than prescription drugs for mild to moderate cases of depression.
If you choose to get it, just be sure it says on the bottle “standardized” and then give what it is standardized to. You want something that says, “standardized to 0.3% (or up to 0.7%) hypericin” which is the active ingredient.
There is a good chance that your tinnitus will fade into the background if you quit taking a drug that causes tinnitus, but it is no guarantee. Since tinnitus is a psychosomatic condition, it can take on a life of its own even when the drug is out of your system. That is why you mental/emotional condition is so important in treating tinnitus.
Your pulsatile tinnitus can very definitely vary with your blood pressure, so keeping your blood pressure under control is a good way to control your pulsatile tinnitus.
TTTS does not have to be constant. It can come and go. Typically anxiety makes it come, so getting your anxiety under control can let it go.
The latest edition of my tinnitus book is the 7th edition. It just came out in 2016 so still is current for most things. Of course, I’m slowly revising it on my computer as I find out new things, and will eventually publish an 8th edition–but that won’t be for a few years yet–at the rate I’m going. The main thing I’l be adding is information about reactive tinnitus–but you can read about that on-line in my comprehensive article on reactive tinnitus.
Cordially,
Neil
Thank you Neil, I am in the process of tapering very slowly off Venlaxafine.
Hi Neil
I just bought your Sensitive to Sound e-book and in it you say tinnitus that gets louder to sound is not hyperacusis and above you say that reactive tinnitus is treated in much the same way as hyperacusis, which I am gathering from your e-book is to NOT avoid everyday noise plus remove the anxiety that can be attached to certain noises. Am I in the right track?
Hi Allan:
That book you purchased is grossly out of date. I’m working on a new version that will be greatly expanded–about 40 TIMES bigger. So it will be far more comprehensive and right up to date and explain the various kinds of hyperacusis.
That statement of mine is not right. When I wrote that book 21 years ago, that was the current thinking, but today the understanding is that reactive tinnitus is a combination of both tinnitus and hyperacusis.
With reactive tinnitus, you should treat the hyperacusis component first and often the tinnitus comes under control in the process. And you can treat the tinnitus at the same time as the hyperacusis–but it is counterproductive to try to treat the tinnitus first. And yes, you want to remove as much of the anxiety that you have attached to certain sounds.
Cordially,
Neil
Thank you for your first response Neil. I dont seem to be able to respond to that directly.
I have now established two things.
In recent weeks I had noted that the sounds of shower water hitting the bath panel from my body seems to ramp up my tinnitus. Today I’ve been blessed with a quiet day and didn’t take a shower until 3.30pm. The moment I came out the shower, my tinnitus started to become noteable again. Again, no pain or discomfort in my ears, just my tinnitus starting to act up.
On days where I go into work, obviously I shower, then take the car [road noise] and then sit in a sometimes lively open plan office and there are days when I go home and my tinnitus is just raging.
Other days I wake up and my tinnitus is raging from the moment I open my eyes and that can be after a reasonable nights sleep and a quiet day the day before.
So I just don’t get it?
I’m also confused if this is a combination of hyperacusis and tinnitus or just reactive tinnitus as I have no pain or fullness, but from what you’re saying I shouldn’t expose my ears to noise that triggers the reactive component but as you can appreciate that can be difficult.
Am I interpreting this correctly?
Hi Allan:
If sounds cause your tinnitus to ramp up (and they are not really loud sounds that would cause anyone to get tinnitus), then you have reactive tinnitus. Reactive tinnitus is partly tinnitus and partly loudness hyperacusis.
Tinnitus has a mid of its own and like you experience, it can be quiet sometimes and loud other times and all for no apparent reason. (Obviously there must be a reason, but maybe no one knows the reason so it seems to be without rhyme or reason.)
Hyperacusis doesn’t have to have pain or ear fullness associated with it. It is basically just a reduced tolerance to sound–so you can’t stand sounds as loud as you once could. Having said that, there are 6 or more “kinds” of hyperacusis. You may only be experiencing loudness hyperacusis for example, and not pain hyperacusis or annoyance hyperacusis or vestibular hyperacusis, etc.
You want to put the odds in your favor as much as you can so stay away as much as possible from the sounds that cause you the most problems with your reactive tinnitus and slowly build up to those sounds again over time. You still have to live in the world so do what is reasonable as much as you can.
Cordially,
Neil
Neil,
Interesting article, do you know what the condition would be called when the “kindling” or “winding up” never returns to a baseline? When the perceived volume increase in the tinnitus is permanent, not temporary.
That’s the condition I’ve had for the last 4 years entering middle age – ever increasing permanent baseline changes in tinnitus from relatively brief exposures to sounds as “safe for normal folks” as in the mid 70s dBA wise. There’s also some mild hyperacusis (cring/discomfort type) that was diagnosed only within the last year as well now.
I have no detectable hearing loss across the last 20 years – I do have congenital deafness on one side and a congenital wide mid range cookie bite in the other so I didn’t start off life with normal hearing but what little I got has been stable for decades.
Several ENTs I saw felt it was most likely that the unique genetics around the congenital deficiencies combined with aging was the most likely explanation for what I now experience. They are “hopeful” it will level off at some perceived loudness level eventually over a few more years, as am I!
But I’ve never heard this reactive tinnitus phrase before, or these other words like kindling or winding up. So curious if there’s some science behind whether that this would be the right term for what I have as well.
Thanks,
Ed.
Hi Ed:
If your baseline tinnitus get worse after exposing your ears to louder sounds and it stays there, I’d just call it noise-induced tinnitus or “regular” tinnitus. Reactive tinnitus drops again after the noise goes away. Since yours doesn’t, its not true reactive tinnitus.
There could be other factors besides sound that are causing your tinnitus to escalate–for example, drugs/medications, or somatic tinnitus–from various body conditions. One example would be if your neck was “out”, it could increase your tinnitus.
Hyperacusis and tinnitus often go hand in hand.
I don’t buy into the aging causing tinnitus thing. It’s not aging as such, but the things that come with aging such as taking more drugs/medications, high-blood pressure, cumulative life-time noise exposure, etc.
And tinnitus almost always accompanies hearing losses–so you likely have a baseline tinnitus because of your hearing loss. I know I have had tinnitus all my life due to my genetic severe hearing loss.
As you get older you often lose more high-frequency hearing (above 8,000 Hz) that they never check for–but your brain knows about it and that can cause increased tinnitus.
Any of the above ring a bell with you?
Cordially,
Neil
Neil,
Thanks. Not taking any prescription medicines, no other health issues. Zero exposure to loud noise given a lifetime of protecting what little genetic hearing I have. If I have something with my neck out it would be news to me as I don’t have any complaints.
As you suggest the annual audiograms don’t check below 250Hz or above 8KHz so I wouldn’t know about losses outside the audiograms scope.
I also remain skeptical of the age / genetics driven diagnosis mainly because I never could find any research papers documenting this sort of thing. But this is a field where second or third opinions are hard to come by. 😉
Thanks for having your website here, perhaps someone with tinnitus similar to mine will stumble along this post and comment down the road.
Ed
Hi Neil,
Do you know when your new book on Hypercusis is going to come out? About four months ago, my ears became full/clogged and itchy after I went on I hiking trip. We had been in an area with ticks and I actually had my husband look to see if he could see one in my ear. While my ears were still clogged, I was exposed to loud music at a party. Immediately afterward, I heard a whooshing sound in both ears. My ears have begun to clear up after an ENT prescribed saline rinse and nasal steroids, but the whooshing has turned into two kinds of tinnitus. One is a constant white noise, that is usually fairly quiet and easy to ignore (although sometimes the volume seems to go up when I am exposed to louder sounds that are similar). The other sound is a high pitched annoying electrical static that seems to appear and grow louder in reaction to out sound noises (the gym, television shows, the grocery store etc.). Is this Reactive Tinnitus? In addition to the tinnitus/hypercusis which is much stronger in my right ear, I also have periods where the eardrum of the right ear feels like it is throbbing and fluttering (it is not related to how loud the tinnitus is). And the right ear also hears some sounds as distorted… especially if it is someone speaking in a microphone, coming from the car speaker, the noise of the wind hitting my ear, motorcycles. Sometimes where a person is sitting in relation to be will impact whether or not I have a vibrating/distrtion sound when they talk to me. live in the Los Angeles area a see that you do not know of anyone in this area, but do you know anyone in San Francisco or Sacramento (I would travel for help)? In the meantime, I’m going to get your book on tinnitus, but here are the main things I’ve gathered from your other comments:
– I should avoid loud noise (concerts, etc.). Does this mean not going to concerts, movies, sporting events etc. or just wearing hearing protection? What kind of ear plugs are good enough protection? I have musician high fidelity plugs (inexpensive ones) and am protected from loud noises but that doesn’t help with the moderate sounds that trigger my tinnitus
-I should try to deal with the reactive tinnitus first (hypercusis) by exposing myself to sounds that rigger it and trying to ignore them. My issue is that it seems to be the kind of sound rather than the volume (high pitched, staticky) and it is hard to go about my everyday life and control the sounds around me. Should I quit going to the gym? etc. Should I wear nice cancelling ear phones?
-Sometimes when I go to sleep at night and have only the white noise tinnitus, I can fall asleep easily, but if I turn on a background noise it and it has any type of high pitch tone to it (fans can to this) the high pitch squealing tinnitus comes back. Should I still have the back ground sound even if I get less sleep. I’m very confused about how to manage these various issues. My anxiety/emotional component of the situation is made worse because the ENT has not figured out what is going on with me and I have a few other symptoms (dizziness, headaches, increased blood pressure, sore throat) that I don’t know if are side-effects of the Flonase, anxiety-related, due to allergies, etc .
Am on on the right track with any of this?
Hi Rebecca:
I’m hoping it will come out in late spring of next year (2020). The limiting factor is how many emails, comments and phone calls I get every day that takes away from my time writing this book. I could get it out a lot faster if that was all I was doing.
You have two kinds of tinnitus as you already know. The white noise one is more or less steady tinnitus, while the high-pitched annoying one sure sounds like reactive tinnitus.
The vibrating/fluttering sensation you have at times sounds like Tonic Tensor Tympani Syndrome (TTTS) where the tensor tympani muscle rhythmically spasms and pulls on your hammer bone which in turn pulls on your eardrum causing this fluttering feeling. This is typically an anxiety-related emotional condition.
You want to avoid excessively loud venues where ear plugs don’t provide adequate protection. For example, ear protectors/ear muffs only provide around 30 dB of protection. After that, bone conduction keeps the volume up. So, for example, if you went to a noisy place where the sound peaks were 120 dB or more, ear protection won’t be enough as you’d still be exposing your ears to 90 dB of sound and obviously that level of sound is causing you problems. But if the sound was only 100 dB, then with 30 dB of protection, you’d be down to a safe 70 dB level–so that should be ok for your ears.
Hyperacusis typically is worse with higher-pitched sounds as you are finding out.
You want to deal with the hyperacusis component of reactive tinnitus first. If you just focus on the tinnitus component, you won’t have much success until you get your hyperacusis under control. That’s why you start with the hyperacusis.
When dealing with hyperacusis you don’t want to expose your ears to sounds that bother you–the idea is to expose your ears to background sounds just below where they bother you, and over time slowly raise this ceiling as your ears heal and are able to handle it. So keep the background sound to a non-aggravating level so you don’t make things worse.
When you are in environments that aggravate your hyperacusis, then wearing some degree of ear protection is appropriate. Remember, you just want to get the sound level to just below where it bothers you. And if ear protectors don’t do the trick, then the sound level is too high for you at this time and you should avoid those venues until your ears have healed so you can handle that level of sound again. But you should ALWAYS protect your ears from loud noise in the future. Your ears will probably always be somewhat “delicate” and you don’t want to risk getting hyperacusis again if you can avoid it.
My best advice is do what works for you. If fans cause more problems than they solve, then dump them. There’s nothing wrong with silence while you sleep if it doesn’t make your hyperacusis worse. Some people feel that silence is the cure, not sound. So, since everyone is different, you need to do what works for you–not what the conventional wisdom says to do.
Fluticasone (Flonase) is moderately ototoxic and I wouldn’t be surprised if it is causing you some of your symptoms. For example, thousands and thousands of people have reported Flonase causes them dizziness. And hundreds upon hundreds of people have reported hearing loss, tinnitus and hyperacusis from taking this drug. I don’t track non ear conditions, but I wouldn’t be surprised if the Flonase is causing your headaches, high blood pressure, etc. too.
If you don’t absolutely need it, you could try going off it and see whether these symptoms begin to fade away.
Cordially,
Neil
Hi Neil,
Thank you so much for your help and for all that your offer on your website. I had my ear fullness for about two months prior to my exposure to the loud music and development of tinnitus. Since then, I’ve had some other symptoms including dizziness. I had a VNG test but the audiologist was new and she seemed to be having a lot of trouble with the equipment (she couldn’t get the instrument that pushes air into my ear inserted properly), so although she reported normal results, I’m concerned about their accuracy. How do I rule out Meniere’s disease and/or Lyme? Also, since I most likely have hypercusis should I be concerned about getting an MRI? Thank you,
Rebecca
Hi Rebecca:
Since you had the ear fullness long before you exposed your ears to loud sounds, you can rule the ear fullness being from that episode.
From what you have said, it seems you suffered acoustic shock from the party after the tick episode and it has developed into tonic tensor tympani syndrome (TTTS). You have many of the symptoms, including the dizziness.
Nothing you have said indicates you have Meniere’s disease. I can’t speak to symptoms of Lyme disease in reference to your ears-I haven’t studied that. But I can tell you that your symptoms are much more consistent with TTTS than anything else you have mentioned.
I doubt that anything to do with hyperacusis will show up on an MRI.
I think your doctors are all missing the real condition you have. I’m currently working on the chapter on TTTS in my new book. I wish you could read it–but unfortunately, I need to finish writing it before you can do that.
Cordially,
Neil
Hi Neil,
I’ve had tinnitus for about 14 months now. Within days of getting it, it morphed into reactive tinnitus. I’m not sure what is the cause. I’m hoping anxiety, which I really haven’t been able to get rid of since the start of this journey, especially because of the reactiveness. Some machine noises (e.g. fans, driving in a car, heater, AC units, dryer, etc) and wind cause my ears to produce an extremely high pitch piercing whistle in my head. It’s very scary and intrusive. Once the sound is removed, my ears usually (but not always) go back to normal tinnitus or completely silent. Additionally, when I go outside at night when it is very quiet, I get a sharp dial tone aura noise in my head. When I step back indoors, which is even quieter, the dial tone noise fades. I notice the same thing if I’m indoors at night with the windows open. Although it’s quiet outside it’s almost like the atmosphere (even when it isn’t windy) kicks it up. I’m interested in trying Tinnitus Retraining Therapy. Do you think this could remove the reactiveness of my tinnitus? Is pink noise the best? Also, can anxiety cause reactivity? Have you ever heard of the reactiveness improving over time and how long it usually takes?
Hi Eric:
What happened 14 months ago when you got tinnitus? Was it because of exposing your ears to loud sounds? That would be a common cause for developing tinnitus and shortly thereafter it becoming reactive–which means you also have hyperacusis.
You want to go to a tinnitus AND hyperacusis center for treatment. TRT just used for tinnitus is not exactly the right treatment for hyperacusis. Normally, you treat the hyperacusis first or with the tinnitus–not the tinnitus alone as that doesn’t produce good results.
If you go to someone that is experienced in treating hyperacusis as well as tinnitus, you’ll have the best chance of success. They use a somewhat modified version of TRT when you have both conditions.
Some practitioners stay with white noise because of its greater bandwidth (and because it is the traditional sound treatment), but pink noise is more like our ear hear and is not so intrusive. You need a sound that doesn’t grate on your ears and thus draw attention to itself. I think pink noise has the edge here.
Anxiety can certainly make both tinnitus and hyperacusis worse, so if you are anxious, you need to work on that as well.
Yes, you can reduce reactive tinnitus and hyperacusis just like you can either of these two conditions if they occur separately, but when you have both as reactive tinnitus, it may take longer than if you didn’t have reactive tinnitus. So take hope, you can beat it–just be patient with your treatment.
How long does it take. It all depends on you. But you could expect it to take at least 6 months and up to three years. Your anxiety can play a big part in how long it takes, that is why you want to get it under control.
Cordially,
Neil
No I wasn’t around any loud noises. I did attend two concerts 20 years ago and listened to music and podcast through headphones for a few years on walks. I’m 40 years old now and developed tinnitus a year ago. It just started one day after a panic attack. Do you think the panic attack caused ear damage by reducing blood flow to my ears?
I meant to also say that I stopped listening on my headphones a year prior to developing tinnitus.
Hi Eric:
Tinnitus can certainly develop due to anxiety–and a panic attack is an extreme form of anxiety. So that could be a reason. If your anxiety caused tinnitus due to reduced blood flow, you’d expect it to go away when you relaxed again and normal blood flow resumed. Or didn’t you ever relax again?
Cordially,
Neil
Hi Eric I have exactly the same symptoms, please did it improve for you since the time? It’s making me suicidal.
Hi,
I have been dealing with “reactive tinnitus” for about 1 year now. It’s been challenging because I am a teacher in high school. I’m trying to figure out if I need to change my profession, because I can’t tolerate the chatter in the classroom. Some days, I go home with very loud tinnitus and it doesn’t resolve until the next day, and then I expose myself all over again to the classroom noise. I loved my job before, but I’ve become so uncertain now. Will the reactivity decrease over time?
Thank you,
Maggie
Hi Maggie:
What caused your reactive tinnitus to start a year ago? Any memorable loud noise episodes? Or was it just the cumulative effects of all the classroom racket that eventually brought it on?
Unfortunately, I don’t foresee your reactive diminishing with time UNLESS you make some changes. As I see it, you have several choices:
1. Quieten down your classroom. Whatever happened to “no talking in class” like it was when I was in high school more than 50 years ago?
2. If you can’t quieten down your classroom to a level acceptable to your reactive tinnitus, then maybe you could wear ear protectors that tone it down enough to just below where your tinnitus reacts.
3. Change to a school/class that keeps the noise down.
4. Take a different kind of teaching job–rather than being a classroom teacher, become a remedial teacher or tutor where you work with one or two students at a time in a quiet room, or become a resource worker–making up exams, marking them, making up lesson plans, etc. That kind of thing where you still use your teaching skills but in other ways than in the classroom.
5. Take a year’s sabbatical to get your reactive tinnitus under control, then go back to teaching.
6. Change your profession.
You can’t rush getting your reactive tinnitus under control. It takes time–slowly but surely is the watchword. As I see it, your ears NEED a rest so they can recover.
Cordially,
Neil
Hi,
I seem to have developed reactive tinnitus recently (last few months). I think this started by over use of headphones whilst listening to music at moderate to high levels. Now music through headphones
or speakers that are close hurts my ears and creates a high pitched ringing in my left ear. Other sounds can cause this too, such as power tools, but music causes it even
at low levels. This ringing never dissapears, but is certainly made louder by listening to music. I’ve read all of your replies on here but not really sure if I should be gradually phasing
in listening to music at low levels again, or just resting my ears completely for the time being? Thanks for any help given.
Hi Jack:
I’m sure you have damaged your ears by listening to all the loud music. You already know what you need to do–don’t expose your ears to loud sounds. That means turning the volume down and when in noisy environments or when using loud power tools like saws wear ear protectors.
As long as your ears are exposed to standard everyday sounds–so they are not starved for sound, giving your ears a rest is not a bad idea at all. Let them recover for a couple of months. If you want to listen to music keep the volume to the same level you hear speech–then it shouldn’t hurt your ears.
In the future, after your ears recover, you may find that they are not as “robust” and thus more sensitive to louder sounds–so just keep the volume down.
Cordially,
Neil
Hello Dr. Bauman
I have tinnitus in both ears for 7 years (but only damage in right ear (6000 kHz – 55 dB))
Several times it happened to my left ear that was “supposedly” healthy (no damage) a weird feeling like I had just come out of a nightclub (feeling like acoustic trauma) and every sound around me would amplify my tinnitus such previous feelings lasted for a short time about 20 to 30 minutes
My main question:
Today, when lying in pure peace, my left ear made a loud noise for a second and then again feeling like I was in a nightclub and every sound around me intensifies tinnitus (the sound of walking, cars, when talking – every sound provokes tinnitus to be stronger ) and it doesn’t stop.
When I put the plug in my left ear it helps me a little
Will it calm down? I have never had that feeling for so long. It happened all of a sudden without any trigger. Is there any therapy and how to deal with it if it does not pass. I beg you for help.
Thank you.
(Sorry for my english)
Hi Anthony:
How long has it been since you were in a nightclub, disco or other loud environment, or listen to loud music with earphones, or shot guns, etc.?
As you say, it sounds like the results of acoustic trauma. I wonder if it is a delayed reaction to an acoustic trauma.
You don’t want to wear ear plugs unless it is a truly loud environment. Certainly not at home where it is relatively quiet.
I need more background information about your ears and loud sounds, etc. before I can really help you.
Cordially,
Neil
Hi Dr. Bauman
The last time I was in a nightclub was two years ago with earplugs, I haven’t listened to music through mobile headphones since I developed tinnitus and I’ve never fired a firearm
I was in a quiet environment at home and started getting ready to leave when my left ear suddenly made a loud sound for 2 seconds and after that my ear became very sensitive to any sound around me, each sound provoked tinnitus to be louder and uncomfortable and lasted all day until I slept through the night
It used to happen to me in the past, but it lasted for a short 20/30 minutes.
I really don’t know why this happens for no reason, I don’t drink, I don’t smoke, I’m physically active, I take vitamins and magnesium
Hi Anthony:
What you are experiencing sounds like what Pawel Jastreboff describes as Category 3 in his tinnitus classification. The reactive tinnitus may persist for minutes or hours during the day, but goes away after a good night’s sleep.
That seems to be what is happening to you.
Think back to when the first episode happened. It only lasted for a few minutes. But what were you doing at that time, or in the day or so before it began?
How long ago was this first episode?
And how many times has it happened since–just a rough guess is fine.
Is there any commonality between each of these episodes in terms what you were doing at the time or in the day or so before they occurred?
Are these episodes related to something you ate or drank, or something you did, or in relation to your emotional state, etc., etc. They may seem to come out of the blue, but there is probably a reason they occur. See if you can find the trigger if you can. Anything pop up?
Cordially,
Neil
I am 60 years old. I have a history of psoriasis and tendonitis and I am on an elimination diet and various supplements. I went to many concerts and I always listened to loud music. I also recall a firecracker went off near my ear when I was about 12 and I had ringing for a couple days. I always had a clogged feeling when I flex my Eustachian tube muscles. If i went swimming without ear plugs I would get pain sometimes.
This year fall allergies. I tried a neti pot a few times. I suddenly started hearing sounds as if they were synthesized like a special effects voice. If i played music I heard weird sounds like when a tractor trailer squealed it’s breaks. I made an ENT appointment but the effects went away before the appointment but I reported elevated Tinnitus and he prescribed Flonase. My hearing test indicated a dip around 4Kz but otherwise I have very good hearing and word understanding. I can hear the tiny fan in my cable modem from across the room and i can hear lawn equipment 200 meters away.
Now that I have been monitoring my symptoms I notice the tinnitus is reactive to sound. It is also reactive to clenching my jaw or moving head/neck muscles. The tinnitus can best be described as violet noise and then goes to about 8Khz tone when it gets loud. The violet noise doesn’t really bother me and I believe I had had it for a very long time and never really paid attention to it. I remember it being loud the day after concerts but it always went away.
I am trying to figure out what i should tell my ENT or what tests I should get. On the one hand it sounds like Hyperacusis causing reactive tinnitus but it has the somatic component. Is it common to have a somatic component with Hyperacusis causing reactive tinnitus? If I go to an entirely quiet room the tinnitus goes to a very low level in about 10 minutes so it does not last a day like most reactive cases discussed here. One place suggested listening to tone near the tinnitus frequency and I listed to an 8kHz tone and tinnitus got worse immediately.
For the past few days I have been listening to TV at the lowest possible level I can understand it and that seems to reduce the Tinnitus level. I already had a pair of “eargasm” ear plugs so I will wear those outside the house until I get more information about what is going on.
Hi Jim:
The dip in your audiogram at 4K is what audiologists call the noise notch. This is caused by exposing your ears to loud noise—in your case the loud music you listened to probably caused it.
The wonderful hearing you appear to have shown on your audiogram is probably because you have loudness hyperacusis as a result of noise exposure, not because you really have good hearing.
When you clench your teeth and your tinnitus gets louder, that is somatosensory tinnitus, not what we call reactive tinnitus. True, it is reacting but it’s reacting to movement of your muscles it’s not reacting to sound. We define reactive tinnitus as tinnitus that gets worse as your ears are exposed to sound, not other sensations.
You can have both reactive tinnitus and somatosensory tinnitus at the same time. Often somatosensory tinnitus, like clenching your teeth to make your tinnitus louder, is a result of tension in the muscles in your neck, head and shoulders. chiropractic treatment and or massage therapy can often eliminate this kind of reaction to clenching your teeth or turning your neck all the way left or right. I know for myself I can tell whether my neck is tight or not and if it is when I turn my head right or left her clenched my teeth my tinnitus gets louder when everything is okay turning my neck or clenching my teeth might make my tinnitus a tiny tiny bit louder but it’s almost imperceptible. However, the worse my neck is the louder my tinnitus gets one I turn my neck.
It’s good that your tenant tinnitus drops back to its old level when you go into a quiet room and just takes 10 minutes. For some people that’s what happens but for many people it takes longer than just 10 minutes like it might take a few hours or until the next morning for example, but it depends on the kind of reactive tinnitus you have.
Don’t ever listen to sounds that make your tinnitus worse. It is true that they recommend listening to a tone or sound that can be close to the frequency of your tinnitus, but that is only if you have pure tinnitus, not reactive tinnitus. The problem is if you have reactive tinnitus, you need to treat the hyperacusis component first and not worry about your tinnitus.
Typically, the level of sound you use for reactive tinnitus is just below the level that your tinnitus begins to react, and that is typically much lower in volume than the sounds you use to treat tinnitus in things such as tinnitus retraining therapy.
When you listen to your TV at such a low volume you are keeping the level below what causes your tinnitus to react and that is good. The idea is that over time, you slowly increase the volume as your ears are able to handle it. Thus, you push the envelope but you don’t do it too fast and you make the increases in volume very small each time so that you don’t cause your tinnitus to react.
Don’t wear any earplugs unless you need them. The more you wear earplugs typically the worse your hyperacusis will become. Therefore, only where your ear protectors when sounds are much too loud for your ears to stand. If they just react a little bit to say traffic noise, that would be helping you push the envelope. Where you need to wear ear protectors would be if their are sirens truck horns and really loud traffic that bothers your ears. In those situations it is right that you need wear ear protectors. But as soon as you are passed the loud racket, take them off again.
Cordially,
Neil
It seems the reactivity to sound has lessened quite a bit but I still have regular Tinnitus. Clenching my jaw or moving head muscles makes it increase while I am doing that. It also turns out medical marijuana makes it increase significantly within minutes and the increase lasts a couple hours.
I has the initial tests at a tinnitus center and they measured loss at 12kHz. I have an appointment with the specialist next month. they said to try rain sounds using the Resound app. That worked a little but I found a video called “super deep purple noise” and that seems to work pretty good at masking. I will probably look into hearing aids that work at high frequencies once I see the specialist.
Hi Jim:
Typically, listening to water sounds which includes rainfall, is soothing and a good choice for dealing with your tinnitus. However, use what works best for you. If I had hyperacusis and tinnitus, purple noise (with far too much energy in the high frequencies) would be the last thing I’d want to listen to. But, if it doesn’t bother you, go for it.
Cordially,
Neil
hello Doc Neil, I want to ask if my tinnitus is reactive? when I try to play music to see my tinnitus, I hear my tinnitus jump when I start the song, after a while I pause it, immediately my tinnitus returns to the beginning.
Hi Ivane:
That sounds like a version of reactive tinnitus alright. Most people’s reactive tinnitus doesn’t drop back to baseline immediately like yours does. But I’ll bet most people wish theirs would do exactly like your does.
Cordially,
Neil
hello Neil, I want to ask a little about my Tinnitus ,Tinnitus I seem to start loud ringing when someone throws a firecracker near the road while I am riding a motorcycle with earplugs and helmet. could a single incident worsen this? thank you
Hi Oby:
If the sound was loud enough, it could give you instant tinnitus. But if you were wearing properly-fitted earplugs, I wouldn’t expect it to cause tinnitus. Did you tinnitus get worse at the time of the incident? If not, there could be other factors involved.
Cordially,
Neil
Hi Dr. Bauman
I have a terrible reactive tinnitus and medium hearing loss in low frequencies up to 1000hz in my left ear only. I’m not living anymore. I think this was a collateral effect of some antibiotics & painkiller I took for a bad fever.
It’s been six months now but it progressively got worse. At the beginning I only experienced very loud tinnitus (and when I say loud I mean like a fire alarm in my head, for hours) occasionally, then I began developing hyperacusis (discomfort with normal level sounds, including people’s voices), then the tinnitus began chronic (not at the fire alarm level) and it’s just like having some kind of alien spaceship idling, but if I expose my ears to sounds (almost any kind of sound) it begins accellerating. Impossible to ignore.
Do you have any advice? I’m followed by an ENT but I had no relief with his therapy. I’m not willing to live like this forever.
Thanks for any help!
Hi Angelo:
What therapy is your ENT giving you? Is he treating your tinnitus or your hyperacusis?
When you have reactive tinnitus, you want to treat the hyperacusis first and not do anything for the tinnitus component until you get your hyperacusis under control. The good news is that typically when you get your hyperacusis under control in the process you also get your tinnitus under control.
If you only treat the tinnitus, and not the hyperacusis, you can just make your hyperacusis worse and worse.
Normal treatment for hyperacusis is to surround yourself with the constant background sounds such as pink noise both day and night. You set the level of the pink noise to a level just below where it causes your tinnitus to react. This might be a very low level just barely audible, but that is okay. Then, over time, you slowly increase the level of the background sound by just a tiny bit as your ears are able to handle it. You may be increasing this background sound by the tiny bit may be every two weeks or might take a month. This is not a quick fix, it’s a slow process, but if you persevere, you can succeed.
Cordially,
Neil
My ENT gave me D vitamin, Biotin, folic acid (everyday) and Kenacort (1 per week). I am one month in this therapy.
I don’t think is treating my hyperacusis in any way, but I’m using a fan everyday to avoid total silence. It’s literally on 24/7 and it helps me a lot. I set it at the minimum level, and I dont know how I could decrease it’s sound.
I tried with other sounds but the only one working seems to be the real fan and not the simulations found on youtube.
Do you think this is gonna help in the long run?
Hi Angelo:
You said it is already helping you a lot–which is great. And I think that will help you in the long run too. How’s it going now? Are you still making progress?
Cordially,
Nei
Progress is a huge word. But I’m tollerating more sounds, even if they exacerbate a lot my tinnitus. The thing I hate the most and which is making me incredibly depressed is that I can’t stand people’s voices when there are more than 3 in the same room. This is gonna kill me. I was thinking about cochlear implant or cochlear nerve section but some doctors told me there’s no way that could help. Anyway I still would like to try, beacause I’m really on the edge.
That said, happy new year Doc and thanks for your time.
It’s a muscle spasm. There are muscles that are supposed to kick in to help cancel out very loud sounds. What is going on is that these muscles are being triggered too often. This is a problem that people can have anywhere in their body, in any muscle, if enough tissue around a nerve calcifies. The calcification disrupts the nerve signals and causes muscle spasms. Ultimately, this is caused by subclinical magnesium deficiency. It is hard to diagnose because the level of magnesium in your blood is no indication of the level of magnesium in your cells. Magnesium deficiency was declared a public health crisis in 2018, but almost no one noticed.
Every form of tinnitus is caused by one pattern of soft tissue calcification or another. Pulsatile tinnitus happens when tissue surrounding blood vessels calcifies. The calcified tissue conducts sound better, so the sound created by blood pumping is amplified. Normal tinnitus happens when calcified tissue resonates with different frequencies, OR when someone has autophony and they have chunks of muscles that are stuck “on” because of the aforementioned calcification disrupting nerve function. And then of course so-called reactive tinnitus is a spasm of the muscles designed to help cancel out very loud sounds that could harm the ear. The treatment for all of it is magnesium therapy.
Hi Clay:
I’d sure like to know where you got all this from because it doesn’t fit with the facts.
I do agree with you that our ears need adequate magnesium, but it is NOT true that “every form of tinnitus is caused by one pattern of soft tissue calcification or another”.
Are you telling me that a person getting a Furosemide IV that gives them tinnitus in just 7 minutes is because their tissue suddenly and miraculously calcified in just 7 minutes? Or that a nearby gunshot caused instant calcification so they got tinnitus? That does not fit the facts.
You are mixing up tonic tensor tympani syndrome (TTTS) and stapedius syndrome with other kinds of tinnitus. It is true when those muscles go into spasm you hear a certain kind of somatosensory tinnitus, but this has nothing to do the common neurophysiologic kind of tinnitus for example.
Reactive tinnitus is a combination of tinnitus and loudness hyperacusis–and loudness hyperacusis can involve TTTS as one of its symptoms.
You are making broad sweeping statements that are not true for much of tinnitus, reactive tinnitus, hyperacusis, TTTS and kindred conditions.
Cordially,
Neil
Hi Neil,
I understand you mentioned that one of the way to treat the hyperacusis is to set a pink noise level on the level just below when the tinnitus started to react, but what if the pink noise sound itself is irritating to my ear?
I have been sleeping using a fan as it helps me sleep easily, but now any fan noises or even the pink noises, started to sound a bit weird in my ear. I can hear a ‘whooshing’ and squeaky noises in my ear whenever I turn them on.
Any other suggestions on what to do here?
Hi Eric:
Listening to white noise can be irritating, especially in the higher frequencies. That is why pink noise is often less aggravating since it has the same energy distribution per octave as our ears have. However, this can still be irritating to some people. You could try red (Brownian) noise. It sounds like a dull roar much like a large waterfall sounds.
But you can try other sounds too. Water sounds–waves lapping on the shore, waterfall sounds, rainfall, babbling brook sounds–are natural sounds and are naturally soothing and relaxing. So you might want to try them out and see whether they work for you.
Another good choice is fractal music. It sounds much like wind chimes. See if that turns your crank.
Choose a sound that does not irritate your ears, because that is the last thing you want to do if you want to get better. The best sound is the one that works well for you.
You can download all sorts of these sounds from the Internet.
Cordially,
Neil
Thanks Neil, will give those suggested sounds a try and will see how it goes.
Rain sound definitely not a go for me, the sound of the real rain itself already annoys me.
Thank you for all the information on your page. I’ve been having high frequency reactive tinnitus for 3 years. Several frequencies in each ear and more are added every now and then.
I can deal with most of them but the very high frequency hiss is getting louder and broader in range (somewhere around 10kHz).
I have severe migraines that are in part caused by high histamine. The only medication I can take is Ibuprofen. Everything else increases histamine and makes me very sick and the migraines even worse.
Now, I am pretty sure the ibuprofen is adding to the tinnitus problems. I have tried Ketoprofen as well but it does the same. At this point, I’m devastated. I can’t live without pain medication, and if I keep taking it, my tinnitus becomes increasingly unbearable and I’ll probably lose my hearing as well. Is there anything I can do or am I as doomed as I feel right now? I’m 40 years old.
Hi Hannah:
Going back three years, what caused the onset of your tinnitus and reactive tinnitus?
Did you have the migraines before or after this happened 3 years ago?
Ibuprofen does indeed cause tinnitus in numbers of people, so if you are sensitive to it, it could be making your tinnitus worse. And so you know, Ibuprofen is also listed as causing hyperacusis (which is a component of reactive tinnitus as you know).
How long have you been taking the Ibuprofen–more than 3 years ago, or since then?
What percentage of your migraines are caused by high histamines? Is it a high percentage? I’m wondering about other possible causes that could be related to ears and if that could also be something that needs to be looked at.
What other drugs are you taking–any antihistamines or other drugs?
Get back to me with your answers and anything else you think might be relevant.
Cordially,
Neil
Hello Neil!
As many others here have stated,
thank you for the advice that you give in this space.
I wanted to ask you a few questions, and see what your opinion is about my case. I’m 21 years old, almost 22 now, and 7 months ago I had a pretty lame accident. Long story short, I made a bad judgment call in which I gave in peer pressure, and was exposed to about 40-80 9mm pistol shots unprotected. My right ear has never been the same since then. I went to an ENT/audiologist, and was diagnosed with moderate (~50 dB) SNHL at 6-8khz. Although this hearing loss is annoying, the worst part is the reactive tinnitus of the “kindling” sort you speak of. It gets worse with higher treble sounds (4-8 khz) as well as, strangely, 700-900 hz as I’ve discovered. It gets worse with those frequencies the most, then comes back to normal immediately after the sound is gone. I have baseline tinnitus as well that fluctuates sometimes in severity, but doesn’t bother me all too much most of the time. For someone like me with only one affected ear (I get very little tinnitus in the Lt ear, but have normal hearing) what do you think I should do? After about 3 months of religiously protecting my ears, I have let myself hear things normally unless they are super loud (>80 dB or so) after which I put plugs in. I still have many problems listening to music especially (playing the piano has lost much of its excitement, which has really brought me down). It’s also only been 7 months so maybe I should just wait and things may get better? Would love to “hear” your input! I’ve pretty much put my emotional cards into things like FX-322 to help me, but if I could do more now to help things out I’m all for it.
Hi Nicholas:
Are you saying that your “kindling” reactive tinnitus is not getting better slowly as the months go by, but staying the same?
Normally, you treat the hyperacusis component by having low-level background sound around you 24/7 and slowly increase the level as your ears can stand it so softer sounds no longer kindle. Then you increase the volume of the background sound and wait until that level of sound no longer kindles and so on.
If you are waiting for FX-322, you’ve got a long wait ahead of you. They are able to just increase high-frequency sounds by 10 or 15 dB. They need to get that up to normal and get the drug to work on the other frequencies.
Then you want to wait at least 7 years after it is released to the public to be sure there aren’t an nasty hidden side effects that may surface. Cancer is one possibility when you try to make cells grow when nature says “no”.
Cordially,
Neil
Hi dr Bauman.
My tinnitus is a mystery. I have the usual constant squeak in my ear, which, unfortunately, cannot be drowned out in any way, you just hear it in harmony with other sounds. The real problem is the phenomenon, something like reverberation, echo to the sounds of a kettle, a refrigerator, water, especially church bells, music. It is a very realistic sound, loud, metallic, in complete silence it is on a very quiet level, it intensifies with the sounds. What could it be?
I have no problems with loud sounds, apart from the metallic reverberation that comes with them. This sound disappears as soon as the normal sound stops. I had no acoustic trauma, only covid. Help.
Hi Pawel:
I think what you are experiencing is reactive distortion. I classify it as one of the three subtypes of reactive tinnitus. There is kindling, winding up and reactive distortion. What you are experiencing basically fits the reactive distortion subtype.
I explain all of this in Chapter 13 in my book, “Hypersensitive to Sound?” that you can get at https://hearinglosshelp.com/shop/hypersensitive-to-sound/ .
You basically treat it the same as you would reactive tinnitus.
Cordially,
Neil
I disagree that reactive tinnitus can be treated with TRT. Looking at comments on forums and in support groups, I have never once seen a person ever say that they improved with reactive T using TRT, and quite the opposite, as I can find many who said it made theirs worse. I doubt there’s a single person who has ever said on the internet that their reactive T was improved by TRT. I found one instance where Nagler said he had a patient who was treated this way, but there’s no evidence that this patient of his even exists. It seems that the medical profession does not want to acknowledge that this may not be working. I see many audiologists recommend TRT for reactive T on their blogs, which other medical professionals then read and assume it must work, but there are no stories from actual sufferers out there of this working. It seems it’s just something that gets passed around as a viable treatment between medical professionals without any care as to whether there’s evidence from patients to back it up.
Hi CJ:
Reactive Tinnitus CAN be treated using TRT, BUT the devil is in the details. The TRT program has to be modified a bit to effectively treat reactive tinnitus. When this is not done, its true that standard TRT the way it is used to treat tinnitus can make reactive tinnitus worse.
The big difference is that the TRT program has to be set to treat the loudness hyperacusis component first, and only after that is under control begin to treat the tinnitus component. When you set the levels to treat the tinnitus component first, they are often too loud for the hyperacusis component, and thus make it worse.
You also need to modify the directive counseling part of TRT to zero in on the special needs of a person with hyperacusis.
So you are partly right and partly wrong in your assessment. Unfortunately, too few hearing professionals have a clue how to properly treat loudness hyperacusis, let alone treat it when it is a part of reactive tinnitus.
Cordially,
Neil
Hi Neil,
Thank you so much for providing information on this topic. I have read through the article and every comment/response on this page. It has helped answer lots of questions that I have about reactive tinnitus/hyperacusis and prompted me to think more about my experience with it. I would really appreciate if you could take the time to read my story and give any opinion/advice you may have, as I find myself running out of options and getting desperate to be honest.
I’m 27 years old and am a music producer/singer that makes music in my studio. I rarely played music too loudly over the ten years i’ve produced in the studio, but there were occasional moments where I went too loud with mixing, nightclubs/festivals, and I did DJ maybe 4-5 times in clubs. When mixing in the studio, there were moments that I would notice typical ear fatigue, and increased sensitivity to sounds for an hour or so after the session. I never experienced tinnitus at this stage, nor did I notice any decrease in hearing ability as such. I have been known to have very critical ears, extremely sharp and analytical.
Just about a year ago, I developed a psychosomatic condition in reaction to a traumatic event that I went through. Initially, my symptoms were not related to the ears or tinnitus at all, so I will not divulge much further- although, it’s probably relevant to mention that I experienced a flurry of symptoms that initially started at chest/heart pain and constant dizziness for a month (saw a cardiologist -no issues), then changed to throat tightness/globus where I was taking reflux medication for a couple of months (saw a gastroenterologist/endoscopy – slight inflammation) then the energy “moved” upwards to my ears and thus started with all the ear issues.
I firstly noticed I started to develop patulous eustachian tube at this time (autophony) and this proved to be problematic as I am a singer and it affects my ability to sing freely. It was likely caused by the weight loss from the stress i was going through and to this day it hasn’t healed, although it has improved with good diet and hydration.
Secondly, I started noticing my ears heard differently (left was less clear than right) so was afraid that I had lost hearing in my left ear. I would constantly close one eardrum with one finger to listen to a sound, then would swap to the other eardrum with the other finger, while making noises/talking in different spaces to hear how well my ears could hear the reverberation in the room. This was in attempt to “track” whether the difference between my ears would increase over the next few months but I never got a really clear answer. I would also do many high-frequency tests to make sure I hadn’t lost any top end (I could hear up to 15-16khz in each ear, and that hasn’t changed to this day where I retested myself). Around this time, I was very isolated just living with my GF and not seeing any friends because I was very mentally unstable. I didn’t want to turn on the TV or talk to anyone in fear that I was losing my hearing and that interacting with people/speech from various sources would only validate this hearing loss, making me further depressed. I had a hearing test that came back with no loss whatsoever. Once I finally did force myself to talk again to people, I would always ask people to repeat themselves. I definitely had more trouble understanding people, and the TV. Eventually, after months of not being paranoid about it, I noticed that i could understand people more and stopped asking people to repeat themselves. I think it was a psychological fear and intense focus on every sound and this somehow altered my brain’s ability to naturally process the sounds i heard into speech due to my intense anxiety.
Thirdly, around this time, I noticed a 1khz tinnitus sine tone in my left ear. This was when the tinnitus all began – I was completely freaked out by it, and it didn’t go away either. I initially thought the left-ear tinnitus tone was somehow related to the left ear hearing compared with my right, but eventually, some more broadband noise entered my right. Also, I wasn’t listening to music or producing for 6 months before that, so I am unsure as to whether it was noise induced. Every time I put on headphones, I noticed the “white noise” tinnitus in my right ear increased and eventually it entered my left. Now, I have multiple tones, some that come and go more strongly, and some that stay the same.
At the beginning of this year, I tried to engage with music/mixing once again and started a project with a client who needed a mix done in the week. After day four, I had to stop because my ears were so sensitive/painful and my tinnitus floor increased by 20-30% each and every day (usually happened the night after mixing during the day). It was extremely worrying and depressing to know that maybe this increase in tinnitus related to the increase in cumulative damage I was doing to my ears. At the time, I was probably mixing a little louder, maybe 75-80 dB SPL.
I had to stop mixing/working with music due to fear that the tinnitus would increase and not subside, and induce noise damage, EVEN when I had the speakers now at lower levels. Just any sound that came out of a speaker, I had a negative reaction to, even phone speakers, certain voices, and the TV speaker (we’re talking levels less than 60 dB SPL).
—–
The current situation:
I started working in an audio-related job six months ago, and have always made a point to keep the speakers down to a bare minimum (approx 40-50 db SPL max). During this time, my tinnitus has not really spiked and seems to have mostly calmed down, although I notice some nights it is still there. Whenever I tried at work to listen to music with headphones, be “brave” as I call it, the tinnitus would increase no matter how soft the volume. With speakers, I also found that the majority of volumes (even less than 50 dB SPL) made my tinnitus worse (mostly the “sssss” sound in the right ear, and partly in the left). I think I have a negative reaction to speakers or something.
What is interesting is that I have verified with my SPL meter that the volume of conversations, driving my car, hanging out with friends/being in the kitchen, produces louder noises and transients than when I listen to the speakers at work or in my studio. It just doesn’t make sense to me.
After reading your article, I have started to believe more that my tinnitus and hyperacusis is largely caused by psychosomatic symptoms. I have as such decided to re-engage with mixing at levels below 60db SPL. It’s been 3 days now, and my tinnitus has increased every day. It usually comes during the night before bed, or halfway through the night. This is of great concern to me. My ears also feel very fatigued after short periods of time in the studio, but I am making it a point to push through as I am banking off the fact that 60db SPL cannot damage my ears. It is strange to note, that after half an hour of mixing/listening to music (even under this volume level) in the studio, my ears become super “focused” and “sharp” and I can hear details even better than I normally would. This focus/increased sensitivity and awareness and ear “tenderness” usually lasts until I am away from the speakers for an hour, then they return to sounding a little “duller”.
When transitioning to other environments that are louder than 60 dB spl, that does not damage my ears nor trigger tinnitus, so why should sound coming out of a speaker do anything different?
My greatest concern is that if I continue to “push” through the ever-increasing noise floor of tinnitus that increases every time after I listen to speakers at low volumes, that it is a sign I am damaging my ears. This is the last thing I would want to happen, and if this were the case then i’d rather call quits with producing and save what I have left. It would be a tragedy as music is my whole life purpose. I have hope though because according to everything that I read and hear about safe sound levels. Something just isn’t adding up, and for this reason I am reaching out to you to see what you think of my situation and how you would suggest for me to move forward.
I believe I may have a hidden hearing loss, but am not even sure about that to be honest. I am wondering whether any damage to my ears is the reason they have become so incredibly sensitive in the studio, and to speakers and certain voices, and that any specific sounds is further damaging them?
The main question I have is this – Is it possible that listening to music at safe levels (and even quieter than that) can damage your ears in any way, if you have any hearing loss (which i’m not even sure I have..).
My ultimate hypothesis after going through everything I have gone through is that I have developed some sort of negative psychological reaction to certain sounds (more mid range and high-end sounds), along with hyperacusis in the left ear, and reactive tinnitus even to low-level specific sounds like from speakers. If this is the case, I would just push on through the tinnitus, and hope that eventually it does not react. This would be the ideal scenario.
As a side note:
-I saw four different ENTS last year who basically said they couldn’t find any issues and that I needed to just deal with the tinnitus. I have had multiple hearing tests (all came back perfectly fine), CT angiogram/acoustic MRI with no issues at all.
-I had three hearing tests over the past year that have come back with no hearing loss at all.
-I went to a night club twice about 3 months ago (2 weeks apart). The first time, no hearing protection. Came home with massively loud tinnitus that mostly subsided the next day. The second time, used hearing protection and still came home with fairly loud tinnitus. This also mostly subsided the next day.
-Clenching my teeth increases the “bright white noise” aspect of my multi-layered tinnitus. It is the same noise that mostly increases after listening to speakers.
-I recently experienced two moments of “near silence”. Once, at 5am when I woke up today. I couldn’t place my tinnitus at all! After 5-10 minutes, it all came back again. A similar thing happened a couple of weeks ago. It was weird, and i couldn’t believe it. It kind of felt like a dream. Which has kind of given me hope to continue trying to make it work.
-The main issue i currently have is that even while producing music/listening to music at LOW levels, (60dB SPL – 70dB SPL MAX) I am finding my tinnitus increase about 6-12 hours after (sometime during the night) that may take 1-2 weeks or more to subside, if it ever even does.
I would call my particular condition a “noise source-specific and delayed” reactive tinnitus. If you got this far, I want to thank you so much for taking the time to read my story. I really do appreciate all the work you’ve done so far and taking your time to help the many that have posted here.
Warm regards,
Lee
Hi Lee:
What do you mean by “ear fatigue”? Are you not hearing as well at that point, or what? If so, I’d call that a temporary threshold shift–in other words, you have some degree of temporary hearing loss from exposing your ears to too much sound.
Remember that problems occur when you listen to sounds that are too loud and/or for too long a time. So a very loud sound for 1 second can cause the same problems (damage) as listening to a sound of lower volume for several hours. It’s volume times length of time. So when you raise the volume by 3 dB, you have to halve the time. Thus, listening to say 90 dB for 1 hour would give the same damage as listening to 93 dB sounds for 30 minutes.
No doubt, you have some degree of hidden hearing loss as a result of going to concerts without wearing ear protection. And as you know, hidden hearing loss doesn’t show up on a standard audiogram.
You say your audiograms all show no hearing loss. I’d like to see them because that is not all an audiogram shows. It can also show if your hearing is “too good”. In other words, whether you have loudness hyperacusis. One clue is if you have hearing at -10 dB or more (above the 0 db line).
And tympanometry should show if you have patulous Eustachian tubes.
If your ears hear “differently” that can indicate that one ear has a hearing loss or different degree of hearing for a given frequency than the other ear.
It is good that you are keeping the sound down when you are mixing/listening to music. Even so, you can stand normal household sounds at louder volumes than you can stand amplified music. I call this amplification hyperacusis. I experience this when I wear my hearing aids. Without them, even louder sounds don’t bother me, but when wearing my hearing aids, my ears are sensitive to many sounds. This is because amplified sound has different characteristics to natural sounds, often due to different compression techniques. This is most noticeable in the higher frequencies.
In order to overcome your hyperacusis and tinnitus, you need to do certain things. One is to protect your ears from louder sounds while they “heal”. Two is not to overprotect your ears by wearing ear protectors when you don’t really need them. Three is to give your ears “time off” so they can heal. Four is to quit worrying and being so anxious about your ears. This is just making things worse. Calm down–things will get better. You are doing a number of things right. It’s just that when you have hyperacusis, it takes time to return to normal. You can’t rush it.
It is good to “push” your sound envelope–the trick is not pushing too much or too hard. You do this as your ears can bear it. In your case, it seems that you need to give your ears more rest–not working with amplified sound for hours on end. Maybe you need to do one or two hours of work, then give your ears a rest for 2 or more hours before you expose them to amplified sounds again. Over time, you can length this time as you ears can bear it.
When you have both tinnitus and hyperacusis, you want to treat the hyperacusis first, then the tinnitus, not the other way around. When you do this, you’ll probably find your tinnitus becoming less of a problem as you successfully deal with your hyperacusis.
Keeping the volume down to 60 dB–it is true won’t damage your hearing mechanism–but if it is more that your hyperacusis can bear–your ears won’t heal. So even though you keep the sounds down to a good level, you have to consider how long you are exposing your ears to this level of sound while you slowly build their tolerance to sound back up to normal again.
The fact that your tinnitus has disappeared a couple of time is a good sign–it shows that your tinnitus does not have to be permanent. But by constantly focusing on your tinnitus is not good as it tends to make your tinnitus more persistent. You want to ignore your tinnitus as much as possible and focus on the loves of your life–not your tinnitus.
I think you will succeed. Just give your ears more “time off” each day while they heal and get your worry/anxiety under control by focusing away from your tinnitus/hyperacusis.
Cordially,
Neil
So I’m with tinnitus since 18 years now.
First years just left ear, mild ringing, no problem.
Then I had bilateral sudden snhl, high frequencies gone, basically deaf after 3.5-4 kHz, yes, I did prednisone IVs and oral, didn’t help.
Therefore the ringing got permanently louder and I got the same sound in my right ear too.
A year later both again gotten louder, permanently.
Another year later ssnhl again, left ear, completely deaf, corticosteroids again, some hearing came back (remember both ears were already damaged before), humming and hissing appeared, both sides, the ringing both ears permanently louder again.
Hyperacusis for a few months but got better.
Barely another year ssnhl again, this time my right ear. Added additional hearing loss, never got better.
Again a few more sounds and the ones I already had gotten permanently louder again.
2017, vestibularitis left side, first time I had vertigo, but no new hearing loss. I couldn’t stand, barely sit up for months.
It’s still damaged, my left starting to decline too. So I have more or less permanent dizziness or vertigo, sometimes more, sometimes less.
Of course they suspected Menieres. But it’s not, bilateral my vestibulochochlearis are demyelinating. Yep, that’s the cause for everything.
So I’m stuck with progressing hearing loss, progressive worsening of my tinnitus and zero balance.
I’m now at a dozen sounds, some permanent, some come and go, some reactive. All louder PERMANENTLY over the years and worsening seems to speed up.
So how should I treat this? It’s impossible.
Fun Fact: my facial nerves also demyelinating, facial weakness, dry eyes and: middle ear myclonus.
Facial nerves are responsible for the stapedius, tear and saliva glands right? It sucks.
I’m afraid that Cochlea Implants wouldn’t be an option because of this.
But tinnitus and reactive T. hyperacusis whatever are the most devastating thing EVER! It’s kind of ironic, hard of hearing and sensitive to noise. Oh, and always ear pressure/fullness.
Hi Hildebread:
I feel for you–having all the health problems you have. I’m sure you have more than what you have shared here. You need to find a doctor that can get to the root of your problems and fix it rather than just treating the symptoms.These are outside my areas of expertise.
However, no matter what causes tinnitus and hyperacusis (and reactive tinnitus), the treatment is basically the same.
You first work to bring your hyperacusis under control, then your tinnitus–not the other way around.
You want to habituate to your tinnitus–first to your response/reaction to your tinnitus, and second, to habituate to the volume of your tinnitus. This will not get rid of your tinnitus, but so it won’t have any effect on the quality of your life. When that happens whether you hear your tinnitus or not doesn’t matter.
You may find my books, “Hypersensitive to Sound” https://hearinglosshelp.com/shop/hypersensitive-to-sound/ and “Take Control of Your Tinnitus” https://hearinglosshelp.com/shop/take-control-of-your-tinnitus-heres-how/ will be a great help to you on how to achieve this.
Cordially,
Neil
Indeed, I have a neuromuscular disease, so my extremities are affected as well, that doesn’t bother me much tbh.
The affected 7th and 8th cranial nerves are what’s really hard to deal with.
Sadly, there isn’t any treatment. That’s why I’m pretty desperate, especially about tinnitus, hearing and vertigo. I couldn’t live with deafness.
Hi Hildebread:
Is your 5th cranial nerve (trigeminal) also bothering you? It can also be a source of somatosensory tinnitus.
If nothing can be done to remyelinate your nerves, then you are left with having to habituate to your tinnitus as I mentioned before.
Cordially,
Neil
Ive had tinnitus in one ear for 9 years i managed.. i took prednsione 50mg and thenci tested my hearing first time using headphones and sent a feedback and my ears started to ring like mad i panicked and doctor said stop the meds its effecting your ears and mental state and now im left with a slight whistle that reacts to sounds and my other ear has this slow cricket noise that competes with sound and driving in car it goes away when its off so i dont use the fan anymore . It really isnt fun im 36 days into this mess
my tinnitus is very weird, in the sense that any time I where headphones and listen to anything on them at even a low volume, it causes the tones to ramp up, yet if I listen through speakers, or have other sounds around me then it seems to suppress it’s self. I was trying to record some electric guitars for a music track, so I put the amp in another room miked it up, and played it from the room downstairs far away. then I put the headphones on and kept the music track at a very low level, as low as I could. I was probably hearing the headphones and the unplugged electric guitar sound, more then I was hearing the amp in the distance, and still my tinnitus ramped up. as soon as I stopped doing that activity, because I wasn’t happy yet with my parts for the song that I was recording, it went back down to it’s bass line level.
Hi Jeremy:
I agree, your reactive tinnitus is a mite weird. I’ve heard from others that have much the same problem with wearing headphones. I don’t know why this happens. It could be the headphones themselves. Have you tried different headphones or earbuds to see whether the problem is related to specific kinds, or all sounds from headphones/earbuds right at your ears.
If this is true, then if you turned your speakers way down and put you ear right up to the speaker, you should find the same thing happens. You might want to try this and report back.
Cordially,
Neil
Hi Neil,
I wrote to you on a different post a few days ago regarding my hyperacusis treatment, etc.
After doing more reading on your amazing site, I now know that I have reactive tinnitus (I described it to you as jingling sound over certain sounds of higher frequency, even if not that loud of a sound). It dies down after the sound stops, but sometimes when in a louder situation, like in a room with several other people for a while, it just stays around for a while at a steady loud scream.
I am receiving hyperacusis therapy and the level of pink noise going does not set it off. I know i should earplug when I am in a legitimately loud situation (per your advice, my audiologist says never to earplug – but I am going with what you say!). BUT, what do I do when a normal activity is setting off the reactive tinnitus (like frying something?). It sets off my reactive tinnitus to a great deal. Earplug or no?
Thank you! I also, after doing more reading, I do have this same screaming pitch when I open my jaw or move my head in certain directions? Is it possible to have ALL of these things at once? that would be somatosensory tinnitus. It doesn’t bother me as much but it seems to come around when eating or when more stressed or also when the reactive tinnitus is being triggered by many normal sounds (elevating my stress.)
Thanks again for your invaluable help.
One more question: Is it possible that a upper cervical misalignment could be causing all of these? I know I mentioned two louder things that happened around the time this came on, but I don’t think they were that loud to damage my ear. Maybe my ears were already slightly sensitive (due to spinal misalignment) and then those louder events sent me over the edge with sensitivity and reactive tinnitus?
I have found an upper cervical chiro who uses the Blair method in my city. He knows the doc that you referenced in one of your articles about that method. He described him as a “wild man” who does very good work.
I have had uneven hips for as long as I can remember, and my body/back/shoulders have been sore since giving birth to my son basically (2.5 years ago).
I met with him today and we will do imaging next week. What are your thoughts?
Hi Zoe:
Upper cervical misalignment, depending on which auditory nerve fibers get “pinched” could certainly mess up your ears. Thus going to an upper cervical chiropractor to make sure all is in proper alignment is a good idea. If everything was in proper alignment, then you know that wasn’t the cause.
I’d never call Dr. Burcon a “wild man”. Just the opposite. I think of him as laid back and congenial. But he is certain good at his work–the world expert in my opinion.
Since your hips, back, shoulders etc. are sore, that is an indication that your spine is not properly aligned so getting that taken care of will improve your health (whether it help your ears or not) so it is definitely not a waste of time getting yourself properly aligned.
Cordially,
Neil
Thanks so much Neil. This chiro definitely meant “wild man” as a term of endearment.
I wanted to mention that I did indeed try doing the MRI to rule anything else out and had to bail out halfway through due to how loud it was. Slightly annoyed I let myself go that route but proud that I got out of there. My advice to anyone reading this is NOT to get the MRI when you’re “in it” with hyperacusis, unless deemed totally necessary due to other symptoms.
Hi Zoe:
With reactive tinnitus your tinnitus changes in volume as the background noise level increases. From what you said, I thought that you heard new sounds as the background sound level increased. So that made me wonder whether you had reactive tinnitus or not.
If as your audiologist says never to use ear plugs, how are you supposed to protect your ears from louder sounds or sounds that are reactive. Without ear protectors, you just make your hyperacusis worse and worse.
I firmly believe there is a proper use of ear protectors and when used correctly help you successfully deal with your hyperacusis. However, many people wrongly use ear protectors and make their situation worse. So maybe audiologists are taught that it is better to say don’t wear them at all. I say, teach them to use ear protectors correctly to help you deal with your hyperacusis.
When normal sounds set off your reactive tinnitus you can decide how much your tinnitus is reacting and act appropriately. You want to push the envelope so if it is only a little louder, then grin and bear it. If it is really reacting, then you need ear protectors to just bring the sound down enough that you don’t have reactive tinnitus. And finally, you can allow it to react for a time, but when it begins to get to you, then put on ear protectors.
Whatever you do, just don’t make the situation worse.
Many people have some component of somatosensory tinnitus along with their “regular” tinnitus, so I’d be surprised if you all have some somatosensory involvement.
When you are stressed, your muscles/tendons, etc tighten and that puts more pressure on joints and can “pull” them further out of proper alignment–resulting in louder somatosensory tinnitus. So learning to relax in such situations is a step in the right direction.
Cordially,
Neil
Hi Neil,
I have had intermittent reactive Tinnitus for about 5 months now. I’ve had mild T for about 6 years after gunshot exposure.
Since another acoustic trauma in Jan, I have been very distressed with reactive T. Some days i wake up to silence (baseline hiss that I never notice), then other days I wake up with a higher pitch T that is reactive to everything. It seems to follow a pattern of one day on one day off. It can be mild/moderate inside, but the second I walk outside, or get in a car, it ramps up to compete with that noise.
I’m doing TRT and my audiologist suggests using white noise/pink noise at a low volume to where it doesn’t aggravate the T. The issue is, any level aggravates the T.
I read in I previous post having your audiologist limit the frequencies on your hearing aids that seem to aggravate the tinnitus. I have no hearing loss — is this still something you would recommend for my situation?
Also, should I be protecting my ears in any situation that aggravates the T? If so, that would be all day , or at least whenever I walk out the door.
Any other suggestions would be appreciated.
Dana
Hi Dana:
You say your audiologist recommends white or pink noise (typically pink noise is more natural sounding so is likely a better choice). You also say that it aggravates your tinnitus at even the lowest level. Just how low is “the lowest level”? It should be just at the threshold of your hearing. In other words if it was turned down any more, you wouldn’t hear it. I suspect the sound generators are producing sound louder than that. Is that right? That is the first thing to do.
Second, are you wearing the sound generators on your good days, or just on your bad days? I’d suggest wearing them every day, not just on the bad days.
Third, Are you getting adequate counseling. Too often, counseling gets the short end of the stick as compared to the sound therapy component. It needs to be the other way around. You need counseling to get your fears and anxieties under control since reactive tinnitus is just as much or more of an emotional thing than it is a physical thing. So, getting your emotions under control is paramount.
And no, don’t consider hearing aids if you don’t have a hearing loss. Sound generators of some sort are what you need.
If you want more help from me, email me privately and we can arrange a zoom session to more completely discuss your situation and how best to deal with it.
Cordially,
Neil
Neil,
I am actually only wearing them on the good days as my audiologist says there’s no reason why my auditory system couldn’t be getting used to fan noises and other noises that aggravate the T on good days. Aka using them on good days will also help on bad days. I will start using them on bad days at the very lowest setting, and if that isn’t low enough, I’ll get her to adjust them lower.
My only question I have left is protection. Some noises aggravate the T horribly such as my furnace at home and long car rides. Should I be wearing ear protection during these circumstances until they no longer aggravate the T as much? I’m hoping I can get the reactiveness down rather than just cope with it, but I understand coping is necessary either way.
As far as anxiousness and fear, I am starting to see a CBT therapist as I was a bit dooped with TRT. I am getting packets with CBT techniques but I need to speak with someone regularly.
Wow thanks so much for responding so quickly btw. If I have any other zoom questions I will certainly arrange a zoom meeting with you.
Hi Dana:
I’d wear sound generators every day so your brain gets used to consistent sound to use in rebalancing it’s internal volume.
Trying to tough it out when something is really aggravating your reactive tinnitus (really the hyperacusis component of your reactive tinnitus) is basically counterproductive. It’s sort of like whacking a bruise all the time and expecting it to heal. Instead you just make it worse. So there is a time to wear protection, but there is a fine line to not overprotecting.
Remember, the program is to slowly increase your tolerance to louder sounds by pushing the envelope whenever you can. One way to do this–using long car rides as the example–is to NOT wear protection (just your sound generators) at the beginning of the car ride and when the car/road sounds begin to bother you, put on your ear protectors. That way you are pushing the envelope as much as you can–but when necessary, you put on the protectors so you don’t go too far and make things worse. Over time, you should find that you can go longer and longer before you need to wear the ear protectors.
Furthermore, I’d wear over the ear earmuff type of ear protectors so you can still run your sound generators under them.
You can do the same with your furnace or other sounds that bother you. It may be a very short time before you need the protectors, but over the days and weeks and months you can slowly push the envelope.
As far as counseling, CBT can be good, but it is not a substitute for talking with a good anxiety/fear counselor who can “hold your hand” on the bad days and encourage you as you progress. You need to learn relaxation techniques that you can use anywhere and anytime you feel your anxiety levels rising.
Cordially,
Neil
Thank you again Neil. I will plan on setting up a meeting with you soon to discuss further.
I react to vibrations and cannot drive in a car at all. So it is a threat to my existence. Food, hospital, social, drug store, shopping centers (cloths), being able to work are all not possible. When I do anything that vibrates, drill etc my baseline increases permanently. So Im in an endless cycle of not being able to habituate it as my fear leads to more tinnitus. The above article does not cover someone like me.
Hi Douglas:
I’ve not come across someone whose tinnitus reacts to vibrations, but I think I know what you have and why it is happening. You have global hypersensitivity–meaning that your other senses can be involved, not just your auditory sense.
In your case it is tactile sense–your sense of touch or feeling. You feel vibrations and these sensation signals are sent to your brain via touch-sensitive nerves as usual. However, at the base of your brain, multitasking neurons there send these signals to your auditory system rather than to, or in addition to, your touch centers.
The result is that these touch or feeling sensations get piggy-backed on to your tinnitus and voila, you have reactive tinnitus to vibrations in your case.
Now that you know what is happening, you need to get your fear and anxiety under control because this just keeps making things worse and worse for you.
You may also be able to calm down the offending nerves that are busy sending these vibration signals to your brain. If they are hyperactive, this could be causing the neurons in the base of your brain to be overloaded and thus send some of the signals to your auditory system where you experience this as vibrational reactive tinnitus.
Cordially,
Neil
Thanks Dr Neil. I just met with a neurologist whom said global hypersensitivity would be unilateral, although I have some tinnitus and pulsatile in my right ear. He said it was inner ear vestibular disfunction and referred me to Boston eye and ear.
What your saying however makes a lot of sense, all ent’s said this shouldnt happen with vibration and they never heard of it. It would mean its indeed not a ear thing but auditory verve one. It would explain possibly why psychical activity exacerbates it when ent’s say exercise helps. My anxiety and fear are intense and creating a negative feedback loop in my limbic and autonomic nervous system I think too.
What suggestions do you have to “calm” stuff down?
Hi Douglas:
I don’t know why global sensitivity would be unilateral. I’ve never heard of that before.
Exercise can help, but when you exert yourself too much, that can hyperactive things–so moderation may be the key here.
To calm down your nervous system, you need to calm yourself down. Try calming exercises and breathing exercises and other calming techniques. There is a lot of information on the Internet. There are also calming herbals you can try such as valerian root. I’d stay away from drugs as they just cause other problems that can be worse than what you are trying to get under control.
You want to balance your GABA and glutamate. Think of these as the two teeter-totter guys. GABA is the calming guy and glutamate is the guy that revs you up. You want them to be in balance–the teeter-totter is level.
When the GABA guy is up and the Glutamate guy is down, you are revved up. So you need to increase your GABA to get things balanced.
Cordially,
Neil
Hi neil,,
I have already acoustic trauma tinnitus for 10 years, fixed and constant.
Two months ago, after a brief exposure to loud music, with earplugs, hyperacusis and another tinnitus was added and that I only hear when stimulated by other background sounds such as cars, air conditioners, refrigerators and ovens.
If I plug my ears or in silence I only hear the old tinnitus.
All the noises that used to help me cover up my old friend now create a new one
it creates anxiety, stress and moodiness in me.
Hyperacusis as almost healed.
I haven’t seen many cases similar to mine and I don’t know how to deal with it.
Hi Ivan:
If your tinnitus reacts to other sounds, then you have reactive tinnitus which is a combination of tinnitus and hyperacusis. So your hyperacusis is not almost healed. You still have it.
The way you deal with reactive tinnitus is to have background sounds on around you 24/7 such as white noise, pink noise, fractal music or water sounds. You set the sound at a level just below where your tinnitus begins to react and get used to the sound. Then, every week or two weeks or month or whatever works for you, you increase the level by a tiny bit and get used to it. You keep doing this and slowly you’ll find that it takes louder and louder sounds to cause your tinnitus to react. Eventually, you’ll be back to normal or near normal. THEN your hyperacusis will be healed. And as a side benefit, often you’ll find that you have habituated to your tinnitus in the process.
Cordially,
Neil
I read a lot of your really interesting articles, then I went to the Arches website to buy Arches Tinnitus formula and turning in their soto I noticed an article that talks about the damage caused by listening to white noise, I was a little surprised and I would like to know what do you think, I’ll put the link here:
https://www.tinnitusformula.com/library/white-noise-therapy-worsens-tinnitus/
I have read that you believe it is essential to make a sound enrichment to take advantage of brain plasticity and cure both hyperacusis and reactive tinnitus, after reading this article I would really like to know your opinion.
thank you
Sam
Hi Sam:
I’ve just posted an article on this subject that explains what this research means is a practical, everyday sense. You can read it at https://hearinglosshelp.com/blog/can-white-noise-therapy-worsen-tinnitus/ .
Cordially,
Neil
Dear Neil, this is a fantastic forum. I was recently diagnosed with Profound single Sided SSNHL and am still taking steroids As part of the work up I have to take an MRI in a week. Following my diagnosis I have developed reactive tinnitus. What kind of ear protection should I wear?
Hi Mark:
You want adequate ear protection. How much you need depends on you. To be sure you have enough I’d suggest foam ear plugs and then were earmuff style ear protectors over them.
Cordially,
Neil
Hi Neil,
Two weeks ago I went for routine ear cleaning (micro-suction) for the first time to clean out a lot of ear wax (one ear completely blocked). There were no complications during the procedure and it lasted around 10 minutes.
I have lived with tinnitus for over 20 years but it would have been considered very mild and unobtrusive (probably a TFI score of around 2% or 3%).
Unfortunately almost immediately after the procedure I noticed a dramatic increase in the volume, pitch and severity of the tinnitus, and every day since that point it has been getting worse and worse (current TFI score is 98%).
I have seen my GP, an audiologist and a private ENT consultant. I do have high frequency hearing loss but no further hearing loss against a comparison taken two years ago.
It almost feels I have two tinnitus’ going on – one is the ‘chirping’ I’m always used to which seems the same volume as it has always been, and now an additional second high pitched screeching sound that is reactive to sound (but reading this post and thread I may also have global hypersensitivity as it’s not just sounds that can cause spikes, which seem to be hourly at the moment).
My audiologist has suggested hyperacusis may be involved.
The tinnitus is extremely reactive to ANY sound. A whisper, the TV on volume 2 out of 100 and going outside the house is simply unbearable, and tinnitus is almost impossible to mask.
The baseline each day seems to be higher than the previous day, and my baseline today would be in comparison to the volume of a spike two weeks ago, when this first happened.
Two weeks ago I could control the tinnitus and spikes with ear plugs or noise cancelling headphones within 1 hour, and sleep became rest-bite from the tinnitus, as after sleep the tinnitus was almost was down to nothing, until noise started to creep in throughout the day.
This changed a week later to where I am now waking up from sleep to one of the worst points of the day in terms of tinnitus noise, and I wake up with it spiked. I live in a very quiet area and sleep with ear plugs.
Today, noise cancelling headphones and wax ear plugs can marginally help reduce a spike, but the baseline today is much higher than it was even just two weeks ago.
The tinnitus spikes are at unbearable levels, comparable to industrial vacuum cleaners beside both ears. This happens multiple times every day. Distraction and sleep are almost impossible.
My GP has little information or knowledge, my audiologist suggested trying to become accustomed to the noise to let my ‘ears and brain get used to it’, the ENT consultant suggested to continue having the ear plugs and noise cancelling headphones on as much as possible as the ‘body’ is healing, so as not to do not further damage.
I really feel completely at a loss with how to manage this for the best with so much conflicting information.
At the moment I am in living in almost complete silence with wax ear plugs and ear defenders in a room, on my own, with zero noise – as even a whisper from someone sitting across the room spikes the tinnitus from incredibly bad to unbearable – but as I am reading here, it seems to suggest that this isn’t the best course of action for someone with reactive tinnitus and hyperacusis.
I have sampled white, red, brown, pink and red noises as well as calming sounds, like waves, but these all trigger the tinnitus and cause an immediate spike.
Is there anything you can suggest?
Hi Dean:
When your hyperacusis continues to get worse and worse like yours is doing, you KNOW you are doing the wrong things although they may seem right to you at the time.
Let’s look at some of them.
First, you tried to mask your tinnitus. That won’t work when you have reactive tinnitus. You FIRST have to deal with your loudness hyperacusis. You set the sound generator level to work with your hyperacusis, NOT your tinnitus as the level needed to mask your tinnitus is far to loud (initially) and just makes your hyperacusis worse.
Second, you are overusing your ear plugs and ear protectors and this has made things worse and worse.
Third, you have focused excessively on your reactive tinnitus and the more you focus on it, the worse it gets.
I wish you had contacted me when this first started so we could have nipped these bad habits in the bud and got you started on the road to successful recovery. Now it will be much harder (but not impossible) as you have a much deeper “hole” to fill in, in order to return to normal or near normal.
You need to take control of your reactive tinnitus and not let it ruin your life. This may seem impossible, but it’s not. It’s difficult, I don’t deny that, but you need to first of all determine that you will NEVER give up, that you will persevere until you reach success.
You need encouragement that this is even possible. To this end, you should get my book, “Hypersensitive to Sound?” and read Chapter 12 and read the stories of four guys–all with severe hyperacusis like you have. One wouldn’t do what was needed–and you can read how his became even worse than you are now. This shows what happens when you don’t do what is necessary (and keep on doing it until you reach success). The other three stories show three different guys that determine to get better, and how they did it. This will give you hope and that is what you need the most right now.
You can get this book from https://hearinglosshelp.com/shop/hypersensitive-to-sound/ . Since you are in the UK, get the eBook version as the postage to the UK is between 2 and 3 TIMES the price of the book! With the eBook, you can read it on your computer, tablet, phone or on all three so you can read it wherever you are. It is in pdf format. And you can download it almost immediately and begin reading it a few minutes after placing your order.
Chapters 4 through 13 deal with loudness hyperacusis and how to deal with it. So those are the chapters you want to focus on as they specifically apply to your situation.
Another key principle is that reactive hyperacusis, which is a marriage between tinnitus and loudness hyperacusis, is a psychosomatic condition. (Actually both tinnitus and loudness hyperacusis are both psychosomatic conditions in their own right.) This means that there is a “physical” component and a “psychological” or “emotional” component. When push comes to shove, the psychological component is the more important one and the one you need to work on the most. Unfortunately, doctors focus on the physical component (sound therapy, etc) and largely ignore the psychological component and as a result they get dismal results.
I’ll be glad to help you on your journey, but you have to do your part if you hope to get well.
Cordially,
Neil
Hi Neil,
Many thanks for the reply.
Yes you’re right, at the time it ‘felt’ the right thing to do. It seemed to provide some element of control, but as time continued and that control reduced every day – whilst the tinnitus grew worse – it doesn’t feel right anymore.
I also wish I had found you, your site and this post at the start of this, as I’m sure many of these bad habits would have been avoided, and things not seem so bleak.
I have just purchased the book you have suggested, and will make a start reading today. I’m sure some of these case studies are just what I need to hear right now – and to know that there is at least the possibility of some light at the end of what seems a dark tunnel right now.
I am determined to tackle this, and to keep persevering to try and eventually achieve even some sense of normality again.
I would be most grateful and appreciative to take you up on your offer of any help or guidance you can give on this journey, particularly to help with the right paths so I can look to avoid more bad habits!
Thanks,
Dean
Hi Dean:
Read the appropriate chapters in the book and feel free to ask me any questions you have as you go. You can either continue to post publicly here on the blog, or if you want to go private, email me privately. I do both. My email address is at the bottom of every page on the website.
Cordially,
Neil
Hi Neil,
I have made a good start in to the book (specifically those chapters you mention). It’s been very helpful so far, and one of the first pieces of information I’ve read that seems to understands and relates to what I am going through.
I am going to delve deeper in to the chapters, but I did have two initial questions:
1. You mention that reactive hyperacusis is a ‘marriage between tinnitus and loudness hyperacusis’, which makes sense, but I am trying to understand whether it’s hyperacusis/loudness hyperacusis that I have.
Since the ear wax removal I seem to hear better than before and sounds being ‘louder’. For example, a recent visit to the hopsital for an ENT appointment, and the entrance lobby foyer area seemed very loud. Slightly bothersome and uncomfortable, but if it were not the negative impact it appears to have on my tinnitus I wouldn’t have felt the need for ear plugs to try to absorb it.
Does having reactive tinnitus naturally mean having hyperacusis/loudness hyperacusis, and therefore the treatment for slowly building sound tolerance is a good path to follow for reactive tinnitus?
2. One particular frustration is waking from sleep. Unfortunately I tend to wake up a couple of times in the night (I live in a quiet rural area, so there are no sounds) but each time I wake I have a second or so of no tinnitus before being hit with an immediate spike every time. It’s sounds and feels like a school firm alarm sounding. It almost feels as if my brain ‘wakes’ as I do, and hits me immediately.
Getting to sleep is a challenge (even with sleeping tablets) but getting back to sleep is incredibly tough. This seems as if it’s in addition to the reactive tinnitus, because at this time of night there are no sounds for it to react from.
Is this a potential symptom of the reactive tinnitus springing my central auditory gain in to overdrive – or is this just a standard symptom of tinnitus?
Many thanks,
Dean
Hi Dean:
I think you can relate to it because the stories are all of real people and their experiences. It’s not pie in the sky stuff by people trying to sell you something that they say works.
Ear wax causes some degree of hearing loss, so when it is removed, you should hear all sounds louder and clearer.
Thus, you need to decide whether the increase in loudness in the entrance foyer of the hospital was just louder because you weren’t used to normal loudness levels yet after the wax removal–it shouldn’t take more than a couple of days for you brain to get used to normal sounds again–or was there a sharper annoying quality to the sounds? If the latter and it affects how loud you perceive your tinnitus, then it is reactive tinnitus of some sort.
If you have reactive tinnitus then you do have both tinnitus and loudness hyperacusis. The treatment depends on how much your reactive tinnitus bothers you. If you are slightly annoyed and can learn to ignore it, you don’t need sound therapy–let it resolve on it’s own. However, if it is a problem, then for most people, using slowly-increasing sound therapy set to work with your hyperacusis is what works, as long as they have appropriate psychological counseling so they don’t focus on these problems. Always remember, it is the psychic component that is the more important component in successfully dealing with tinnitus and hyperacusis.
To answer you second question, you are correct, your brain wakes up and at full alert for “danger sounds” so it cranks up the volume. This happens because you use sound in order to monitor your environment for threats. When you are nervous or afraid, your brain can’t tell the difference between real danger and an imagined threat like tinnitus. As a result, you react as if the danger is real and experience a “fight or flight” stress response.
At this point, your brain is doing everything it can to redirect your attention to what it perceives as the source of the threat—the sound of your tinnitus.
Here is a quote from my book on tinnitus. “For numbers of people with tinnitus, it is common for them to experience increased tinnitus upon waking—either in the morning or after a “catnap”. The reason for this is because your sensory systems, including your auditory system, are put on high alert at the moment you wake up. At the same time your brain’s neuronal activity greatly increases.
The reason for this is twofold. First, threatening sounds are always amplified by your brain upon waking because these sounds might have woken you up so you could take immediate action in order to protect yourself (survival strategy). In the case of your tinnitus, your brain wrongly attributes the meaning of your tinnitus as a threat to your well-being. This is why it is so important to treat your tinnitus as an unimportant, background sound, not as a threat to your well-being. Once your tinnitus is not a threat, you won’t experience this anymore.
Second, in the early morning as you wake up, your environment is likely relatively quiet, so it is not surprising that you instantly notice your tinnitus as other sounds are not partially masking it like so often happens during the day. Thus, your tinnitus may seem especially intrusive at this time.”
So, as I see it, this has more to do with your tinnitus, and not your hyperacusis.
Cordially,
Neil
Hi Neil,
I have waited a couple of weeks, and have read through your book cover to cover.
Allowing sounds in appeared to increase the tinnitus, and cause the baseline to become increasingly louder each day.
Unfortunately I also had a set back at the weekend after trying to allow sounds back in – I placed one dish in a dishwasher, it ‘clinked’ against another plate, and it sent a shooting and what felt blinding pain in my right ear.
The tinnitus in that ear screamed for a few seconds, then 15 mins later my left ear screamed for 30mins.
Unfortunately it’s left behind a louder reactive sound, that still 72 hours later other sounds seem to react against and get louder.
My partner said it was loud but not ‘very loud’, although my ear was merely a feet or two away.
On the odd time I have ventured out without ear protection – i.e. a supermarket or medical appointment, almost all sounds are very muffled. Talking to someone in a room, and they sound muffled.
I am unsure if this is related to my hearing or if the tinnitus is simply so loud its over the top of other sounds ….. which it currently is.
The wind outside spikes my tinnitus, despite it being barely audible and certainly not loud enough to be uncomfortable and hurt.
I am unsure with the recent setback, and how the tinnitus is behaving whether this is a type of hyperacusis and I should continue to let sound in – or rest my ears to avoid further damage?
Kind regards,
Dean
Hi Dean:
Clinking cutlery and china sure can sound loud. It’s hard to believe that such sounds can “blow the top of your head off”–but that is the reality of loudness hyperacusis.
If sounds seem muffled, I assume that those sounds do not bother your hyperacusis. I assume that those sounds are lower-frequency sounds.
But then that flies in the face of the wind sounds causing your problems. To me, wind is a lower frequency sound and shouldn’t bother your hyperacusis.
It’s a tricky call–let sounds in and slowly increase them to get your ears to reset properly and get rid of loudness hyperacusis, or keep sounds out and let your ears calm down.
The problem with the latter choice is that you may make the hyperacusis worse, not better. But you can experiment and see which works better for you. Reread chapter 8, and particularly take not of the section in it called “Silence, Not Sound”. It could be that this is the right approach for you since we are all different. Just go slowly and learn which works for you.
Cordially,
Neil
Hi Neil,
Thank you for your reply.
I think the reason the wind has a greater affect on my tinnitus than a conversation in a room is due to what you describe in your book as ‘winding up’.
I struggle with continuous noise such as a light storm, TV, computer fan, fridge hum, dishwasher cycle etc… than I do conversations despite the lower frequency.
I will read chapter 8 again and try to take things slowly.
Thank you for your help,
Dean
Hi Dean:
I agree with you. If you have the winding up kind of tinnitus, then the wind could indeed cause more problems–assuming that it is constant at the time.
Cordially,
Neil
Hi there. For those of you that are desperately reading the comments on this page, searching for the magic answer, I just wanted to say that Neil Bauman is amazing and listen to his advice! He helped me start out on my road to recovery from hyperacusis/reactive tinnitus. I am nearly all the way better after a year. Believe it when you read that hyperacusis/tinnitus is mostly a psychosomatic condition. It’s true. Once you dial down the fear you can begin to live again and things calm down. Best of luck to you all!
Hi Dr. Bauman,
I’ve been searching for some information on a very strange symptom I’ve developed and cannot find anywhere online. I thought it might be a kind of reactive tinnitus but that doesn’t really track with what’s described here.
I’ve had relatively severe tinnitus in both ears since sequential sudden hearing loss a few years ago. Hyperacusis was bad for a while but it’s very much under control now.
I use cricket sounds and fan noise to sleep, and tend to keep a fan on in the background while at home.
What I’ve started to notice is that sometimes, my brain is adding a tinnitus tone to fan noise. Not just in my head, but it’s directional — so if there’s a fan to my left, I hear the humming of the fan, in addition to a single note on top of it, an it sounds like it’s coming from the fan.
Sometimes the same tone would overlay the cricket sounds I listen to, where every chirp would have this one tone on top of it — always the same tone.
This used to happen intermittently, and I attributed it to stress. However, it’s now been here for a few days in a somewhat more severe form, where this tone plays over lots of similar sounds, such as wind noise.
In silence, the tone does exist in a mild form my right ear, but if there’s a fan to the left, this tone will kind of “move over” to where the fan is. Very odd.
I’m trying to chill out about it, because it’s happened before as a temporary thing, but any time a previously-temporary thing starts to feel more permanent, it can be troubling.
For what it’s worth, ever since this latest flare-up, there have been periods where it’s been lower or (briefly) absent, and times when it felt severe, waking me up at night because the fan was making such a loud tinnitus sound on my left.
Any idea what sort of tinnitus this is? And whether I should do a period of no fans? That’s its own kind of stress of course, however.
Thanks for any thoughts you could provide!
Hi Ric:
From what you describe I think you have your own version of the winding up kind of reactive tinnitus. Remember that reactive tinnitus has both a tinnitus component and a loudness hyperacusis component and both conditions have a physical and a psychological component. Thus, when you say you attributed this to stress (really anxiety), I think you are correct.
It would appear your hyperacusis is flaring up again–and that is typically due to anxiety so you want to work to get your anxiety back down to where it should be. When you do that, I wouldn’t be surprised that your reactive tinnitus will calm down and fade away.
Since the winding up kind of reactive tinnitus is caused by relatively-low-level continuous background sounds, maybe you should stop the fans and substitute other sounds that are not so “continuous” such as water sounds of some sort or fractal music. Do this at least for a time and see what happens.
Cordially,
Neil
Hi Neil,
I have had reactive tinnitus for half a year. When bending down, the hearing in my left ear suddenly went away, and there was residual hearing, and at the same time the buzzing appeared. The strange thing is that if I plug my right ear with earplugs, which has perfect hearing, then I don’t hear the buzzing in my left ear as much, and the reactive buzzing isn’t that disturbing either. .Then my right ear is not normal either? Why does it reduce the noise? For me, the buzz causes an electric sensation on the left side of my head, the stronger the noise. What is the reason for this? It’s not the buzz that bothers me the most, but the tension in my head.
Cordially
Judit
Hi Judit:
You have some interesting symptoms, but you haven’t told me any of your history which is what I need to try to understand your situation. Tell me what caused your reactive tinnitus int he first place? What changed in your life in the weeks before your reactive tinnitus began? Etc., etc.
And explain fully what you are describing. For example, you said when bending down the hearing in your left ear suddenly went away and buzzing began. What you didn’t say was whether it came back when you straightened up. Nor did you say whether this happens every time you bend down, or just the one time, or was it several times.
Also, tell we about your drug history (if any), and noise history, and whether you were stressed or anxious (or high-strung) before this all began and your psychological state now.
All of this kind of information is “grist for the mill” so to speak. If you don’t want this information public, email me privately. My email is at the bottom of the pages on this website.
Cordially,
Neil
Hi Neil,
The relationship stress I experienced in the previous weeks, but I’ve been an anxious type all my life anyway. I’m still anxious now, especially about whether this reactive tinnitus will go away. I’m currently going to acupuncture, but it hasn’t worked yet. I’m also cheerful as long as everything is fine. it works, but now this has really turned the situation upside down. The hearing loss that occurs when bending down was diagnosed as permanent, neural hearing loss. Since then, I have been constantly hearing badly in my left ear, and there is a constant reactive buzzing. Already at the beginning, I felt that it was getting louder with sounds, I couldn’t enjoy a school graduation, it was difficult even with earplugs. So I can’t go to the cinema or the theater to events, that’s what worries me the most. My own speech also amplifies it, and I feel that conversation inside a building disturbs my ears more than outside.
And there is another strange symptom: When I lie down and start to relax (perhaps I am in an alpha state), there is a sudden buzzing in my ears like a nerve-wracking sound for a second, then it fades away. This happens several times until I fall asleep, every second. And in the meantime, I feel something running across my arms and across my back at the same time. I thought it could be of cardiac origin, or a nerve injury related to the cervical spine, but I don’t understand it. And sometimes I feel not only specifically in my ears, but also in my head, as if something is running through there as well.
I usually feel like my head is blocked, it doesn’t hurt, it just feels like it’s in a vise.
Cordially
Judit
Hi Judit:
You have loudness hyperacusis which causes certain sounds to seem to be unduly loud and annoying. And when “married” to tinnitus, you have reactive tinnitus. You need to take heart that you can get rid of it if you learn how to calm down. Your anxiety is your worst enemy at this point. That is why it is critical that you get it under control.
The nerve-wracking sound you experience as you are drifting off to sleep is called a hypnagogic sound. Here is an extract from my tinnitus book.
“During the semi-conscious state as you are just drifting off to sleep you may experience various auditory hallucinations where you “hear” weird, and often loud, phantom sounds.
If these occur as you are just falling asleep, you are having a hypnagogic experience. “Hypnagogic” is just a fancy medical term that denotes the transitional state resembling hypnosis preceding sleep, where auditory (and other) hallucinations may manifest themselves at that time.
What is happening is that your conscious brain is “shutting down” as you are drifting off to sleep. Many electrical changes occur at that point, and you may hear them as a form of tinnitus. These sounds may be frightening but they are completely harmless. For example, one man began to experience explosive and roaring noises that start just as he is about to drop off to sleep.”
As for the sensation of something running across your body at times, I’m wondering whether that is drug-related. Are you taking any medications at this time. Certain psychotropic drugs can mess up your nervous system and thus you may have such weird experiences.
Cordially,
Neil
Hi Neil,
Thank you very much for your detailed answer. My question is, should I use some practical method to eliminate reactivity in addition to reducing anxiety. I noticed that the disturbing effect of hyperacusis decreases after running, walking and swimming. The reactivity is still there, but it doesn’t make my head tense.
I only take medication to lower blood pressure (one lisonorm per day), which can have ringing in the ears as a side effect.
Could reactivity have anything to do with nutrition?
Could it be that human speech in a closed space makes more noise because the sound bounces off the wall, while in an open space it is further away and doesn’t bounce, so it seems quieter?
Can you recommend a book to solve my problem?
Cordially,
Judit
Hi Judit:
When you are busy doing some activity you enjoy, your mind is focused on that activity and your brain tends to let go of other things that are not important–like hyperacusis and tinnitus. Basically, you are distracted from these conditions because you are focusing on what I call “the loves of your life”.
Remember that hyperacusis is a psychosomatic condition so your emotional status at the time makes a lot of difference, thus doing things you love to do is a key strategy in getting it under control.
Human speech inside can bounce around for sure, whereas outside it dissipates. But also, when you are outside, you are typically busy doing something and thus you are not focusing so much on your tinnitus and hyperacusis and that is why it is not so loud/intrusive.
As for nutrition, tinnitus can become worse if you are deficient in certain nutrients. For example, magnesium, zinc and selenium are three minerals that your ears need. Some people are sensitive to too much sugar or caffeine oc salt, but these do not bother others. You have to see what makes yours worse, if any do.
As for books, the best book on the subject of hyperacusis and reactive tinnitus is called “Hypersensitive to Sound” written by yours truly. (I’m a mite biased). This book primarily deals with the various kinds of hyperacusis. But it also has a chapter on reactive tinnitus. Another good book, “Take Control of Your Tinnitus” deals primarily with tinnitus, but it also has a similar chapter on reactive tinnitus as does the Hypersensitive book.
You can get both books from this website–just click on the “Shop” button.
Cordially,
Neil
Hi Neil,
Thanks for your response. My question is, apart from reactive tinnitus and hyperacusis, tinnitus can also disappear over time?
Can the reactive nature and hyperacusis of tinnitus with neural hearing loss be reduced in the same way as tinnitus without hearing loss? I sometimes notice that the reactivity is always present in the same way, but the disturbing feeling of loudness in my head is not always the same. For example, yesterday the same sound conditions in the office were more annoying, they made my head tense physically, while today the reactivity works in the same way, but the disturbing effect of the sounds is not so much. This can be an improvement, or it can be influenced by the mood (for example, I was happy that you recommended the two books, and because of this, hope for change flickered). I’m very anxious on weekdays because I have to go to school tomorrow for a parent-teacher conference and I’m afraid of the noise. Unfortunately, sometimes even earplugs cannot provide a completely pleasant feeling of well-being against hyperacusis.
Cordially,
Judit
Hi Judit:
When you habituate to your tinnitus, it is a two-step process. First you habituate to the annoyance of your tinnitus. Then you habituate to the loudness of your tinnitus. I think the same holds true for reactive tinnitus and loudness hyperacusis. Of course, sometimes you habituate to both at more or less the same time.
Whether tinnitus disappears completely or not is of no importance if you habituate to it as it will not bother you even if you do hear it. For example, right now, I am hearing my tinnitus fairly loud, but it is just a “background” sound and does not bother me. Before I started replying to you, I wasn’t even aware I had tinnitus. That’s how it is when you habituate to your tinnitus. For me, whenever I think, talk about or write about tinnitus, it pops up and I hear it. Other times, for hours I’m not aware I have tinnitus.
However, because I do not let it bother me, it really doesn’t make any difference whether I hear my tinnitus or not.
For some people, as their moods change, so does the loudness/intrusiveness of their tinnitus. That is what is happening to you. So being calm, relaxed or happy tends to make your tinnitus annoyance drop or go away. However, when you are stressed, anxious, upset you tinnitus can come roaring back.
So you want to learn some tricks to remain calm like at your parent-teacher conference. Using relaxing breathing techniques can really help. You can calm yourself down in just 5 minutes or less when you do it right.
Cordially,
Neil
Hello Dr. Neil,
I used to have reactive tinnitus. Recently, I moved, and I was very hungry. I went into a chain restaurant where the music seemed a little loud. I checked my two phone decibel meters. Decibel X said it was around 73 decibels. dB master said 78. Awesomely, my tinnitus held steady and didn’t react, but I’m a little worried it could have hurt my hearing a bit. I was only in there for five minutes or so, though.
Also, regarding airline flights. Usually my decibel meter says they are around 82-84 dB,. Could they hurt your hearing? Should you wear ear protection on the plane? Thanks! -Josh
Hi Josh:
You don’t have to worry about damaging your hearing when the average sound level is below 80 db–unless you are in the place for 8 hours or more. But depending on where you are in your hyperacusis program 78 dB could set you back at bit. I doubt you will have any problems. Sounds like you are doing well in gaining control over your reactive tinnitus.
Normally, the sound level in planes won’t damage your hearing as you are not flying for more than 8 hours at a time. You only really need ear protectors if your hyperacusis is acting up, then you want to wear strong enough ones to bring the sound down to just below where your loudness hyperacusis kicks in.
Cordially,
Neil
Thank you, Dr. Neil. I really appreciate that. It lifted my spirit. I still have a bit of TTTS, and I think when I am exposed to music above 70 dB without hearing protection, it can act up, giving me a feeling of fullness in the ear which may seem like a hearing loss symptom, but I think it is TTTS, as the fullness usually subsides over time, I am finding.
I have become aware that time is just as important as volume when it comes to protecting your hearing. Some online sources say 70 dB can damage your hearing if you listen to it long enough, with I think the time limit being a full 24 hours, while 85 dB takes 8 hours, which is why it’s the maximum volume for a work environment without the employer being legally required to supply hearing protection.
I must admit I find this a bit puzzling. Why does it take so long for damage to kick in? Is it damaging your ears the whole time and it just takes eight hours to notice, or does it really take that long to start making a difference?
Best,
Josh
Hi Josh:
Ear damage is a product of volume and time. The relationship is for each 3 dB you increase the volume, you halve the safe time you are expose your ears to that level of sound.
According the EPA, you can expose your ears to an average of 70 dB “forever” without damaging your ears.
However, OSHA has a more liberal standard for the workplace–an average of 85 dB for a maximum of 8 hours–but this does not prevent hearing loss from noise–just minimizes it somewhat. And that does not account for all the other sounds and recreational noises you exposed your ears to when you are not working.
Note it is the average volume, not the maximum volume in both cases.
These standards are for the average ear. Some ears are more sensitive to sound and some less sensitive so they are really only a guideline. I’d prefer the EPAs standard as it is supposed to be safe and not slowly cause hearing loss as the decades roll by.
Ear damage can be instantaneous or near instantaneous if the sound level is up around 120 dB or higher, whereas hearing loss only becomes noticeable over a period of years or decades if you expose your ears to 85 dB levels.
Think of it this way. You have 30,000 or so hair cells in each ear. If noise levels are such that it kills say 5 hair cells a day while you work, it would take 6,000 days (about 16.4 years) for you to go totally deaf. But you would notice this gradual hearing loss much sooner–a few years, not right away.
You would not notice any hearing loss at the beginning as you can lose a considerable hair cells before you notice hearing loss, especially since hearing loss typically occurs in the very high frequencies first (where you don’t notice it) and slowly works it way down the frequency spectrum where it eventually becomes noticeable as the accumulated number of dead hair cells becomes significant.
Cordially,
Neil
Thank you, Dr. Neil. That is very informative.
So, I am to understand, the EPA says 70 dB is cool for about 24 hours, or is it really forever? Assuming it’s 24, that would make 73 dB okay for 12, 76 okay for six, 79 okay for three, correct? Ultimately, this would leave 85 dB at only 12.5 minutes. Unless I’m missing something or doing the math wrong, that seems like a HUGE difference when compared to the OSHA standard, or am I missing something?
Josh
Hi Josh:
The EPA says an average of 70 dB or less over your lifetime should not cause any hearing loss. There is no time limit.
Cordially,
Neil
Yes sir, but how long does the EPA feel it is safe to be exposed to 85 dB? I Googled it and they seem to think 8 hours as well?
Hi Josh:
The way I interpret it if it is 70 dB for 24 hours, then it would be 73 for 12 hours and 76 for 6 hours, 79 for 3 hours, etc. But maybe I’m all wet in interpreting it this way.
Remember, this is average sound levels, for theoretical average ears.
I’d always lean on the conservative side since over the years they have constantly been revising the safe sound levels downward. It used to be 90 dB, then 85 dB, then 80 dB and now 70 dB so who knows whether they will revise in downward more in the coming years.
Cordially,
Neil