by Neil Bauman, Ph.D.
A lady wrote,
How can I tell when I’m just over-reacting to sound, or when I have actually been subjected to an acoustic trauma (which requires immediate treatment)?
I never know, and as a result, I am never quite sure whether I should just wait it out or run to the nearest ENT specialist, have my hearing tested and accept treatments such as steroids or HBOT (Hyperbaric Oxygen Therapy) to try and ward off further damage?
From what I have gathered using a tinnitus support forum, it is generally advised that sounds which do not hurt other peoples’ ears cannot hurt mine, but my doubts arise from personal experience. You see, my ears cannot stand sounds that other people bear quite comfortably.
I have had tinnitus since I was 11 but it only became a problem 4 years ago when my ears suffered acoustic trauma as a result of taking an Acoustic Reflex Threshold Test (whereby loud sounds are produced several times in the ear canal). This test, which I assume other people have had done without any problems, changed my tinnitus from a white noise type of tinnitus to a medley of irritating sounds (from Morse code to mosquitoes and crickets). The sounds are different in each ear and keep changing all the time. They also react to loud and sudden sounds, and make it impossible for me to work in quiet places and to sleep.
This very same test also resulted in my developing hyperacusis. Since that day, I’ve become oversensitive to sounds, unable to bear (without pain and negative consequences) normal (loud) noises like a dog barking, a child screaming, music, traffic, etc.
Sometimes I think I am doing well—sleeping at night without having to mask my tinnitus—then a series of “acoustic traumas” makes things worse again. These acoustic traumas would probably not be classified as acoustic traumas by people with “normal” ears. Here are two examples of such sound traumas.
1. My car broke down on a very busy highway. I had to get out of the car and spent 5-10 minutes exposed to the thunderous sounds of cars and trucks rushing by on a 6-lane highway. I wore earplugs which reduced the sound by 15-20 dB at the most.
2. A few days later, I started having a treatment whereby for 5 minutes at a time I had to withstand the piercing, loud whistling-sound of a faulty compressor. I wore ear plugs the first 3 times, then I started wearing ear plugs and ear muffs for another 3 days. Mind you, these sounds, which were horrendously loud for me, did not bother anyone else. The people around me did not bother to protect their ears at all!
As a result of these and other “traumas”, my tinnitus has flared up and has stayed bad for the last month. I had my hearing tested and my hearing is fine.
My question is, “What should I do? (or what should I have done?) Should I wait some more and pray that it will pass, or should I urge my ENT to treat me for acoustic trauma”. Please let me know your thoughts. I have always valued your
opinions.
What started off as an unwanted side effect from a simple acoustic reflex test has now escalated to consume your life. This is not good. You need to get things under control as quickly as possible so it doesn’t continue to get worse.
Unfortunately, your experience with this test is not unique. I’ve heard from other people who also have experienced much the same things as you have from taking this test. Obviously, the acoustic reflex test either needs to be modified or dumped so it doesn’t continue to damage people in this way.
Now lets get to the heart of the matter—how to know whether a loud sound is really “ear-damaging” or only seems that way because you have hyperacusis (where normal sounds now seem too loud).
You are missing one vital piece of information and that is understanding the difference between real sound loudness and perceived sound loudness.
Real sounds are what your ears actually pick up. They may be soft or loud or extremely loud based on the amplitude of the sound waves that strike your ear drums.
In contrast, perceived sound levels are the loudness at which you “hear” these sounds after your brain processes them. Perceived sound levels may or may not bear any resemblance to real sound levels.
This is because all sounds are filtered through your limbic (emotional) system. Your limbic system adjusts the volume of what you hear based on any emotional “flags” associated with that sound.
Let me give you two examples to show how this works out in real life. First, think about the noise your fridge makes. Your ears hear it all the time, but I’ll bet if I asked you right now, “Is your fridge on?” you’d have to stop and specifically listen to see if you can hear your fridge running. This is because the sounds your fridge makes are totally unimportant to you.
Your ears hear the real sounds your fridge produces, but before you hear the sound, your limbic system checks its database of “flags” to see how emotionally important that sound is to you. Since you don’t care at all about the sounds your fridge makes, your limbic system has flagged its sounds as being totally unimportant to you. All sounds with this flag set have their volume turned way down. Thus, you typically aren’t even aware your fridge is on. Your ears hear the real sound level (at its normal volume) while you hear the perceived sound level (at a greatly reduced volume). That’s the way God designed your ears to work for sounds that are totally unimportant to you.
Now let’s consider another (opposite) example. In this scenario you are a beautiful young lady and you live alone in a ground floor apartment. It is summer and you have your bedroom window half opened and you are sound asleep.
At 2:00 AM your ears hear a very faint, furtive footstep right outside your bedroom window. (Note: your ears never sleep.) What happens? Your ears pass this very faint sound on to your brain. There, your limbic system checks its database to see how this sound is flagged. It finds this sound is not flagged as “totally unimportant< but that it is flagged as “extremely important” to you emotionally. Essentially, it is flagged with a big red (bogeyman) flag.
To your limbic system, a red flag means “emergency” and so it immediately cranks up your internal (perceived) volume to “full volume” and blasts you with perceived sound. You spring from your bed from a dead sleep ready to fight or run.
Now get this. It wasn’t the volume of the real sound that bolted you awake (remember, it was a very faint sound). Rather it was the enormous volume of the perceived sound that blasted you out of your bed. Again, your ears hear the real sound level (at its real almost inaudible level) while you hear the perceived sound level (in this case as very loud). That’s the way God designed your ears to work for sounds that are emotionally very important to you.
As you can now see, you never hear the real sound levels. You only hear the perceived sound levels. In any case, if you have normal hearing, for most sounds the real and perceived levels are about the same.
However, if you have hyperacusis things go all screwy. Your ears still hear sounds at their normal loudness levels. That isn’t the problem. The problem is that your limbic system has your internal volume control set much too high.
This often happens when you are a “high-strung” type of person and worry about everything. When you are anxious about something, your body goes into “fight or flight” mode until it can determine if there is a threat to your well-being. In “fight or flight” mode, among other things, your limbic system cranks your internal volume up so you can hear faint (possibly threatening) sounds better.
Normally, this just happens for a few seconds at a time, but when you are anxious all the time, your limbic system is stuck in the “flight or fight” mode and the internal volume remains at a higher level than it should be. The result is now you notice many normal, everyday sounds are just to loud.
In reality they are the same volume they always were, but you now perceive them as being much louder than they really are. This is one cause of hyperacusis.
Another cause of hyperacusis is sound trauma. Sudden, very loud noises can also result in your internal volume becoming stuck on “high”.
As you can appreciate, if you have both—you are high-strung to begin with, and you experience a sudden loud sound (like the acoustic reflex test you took), you can experience a “double-whammy” that results in what you are now experiencing.
When you hear everyday sounds, you jump and/or wince because you perceive these sounds as being so loud that you actually experience pain in your ears. Thus you (logically) conclude that they MUST be damaging your ears.
This pain is real, make no mistake about that, but it comes, not as a response to extremely loud sounds, but because you perceive these sounds at an extremely loud level.
That is why you question, “Is that loud sound you hear really too loud (and you need to protect your ears now), or it is just a normal sound that you are perceiving as too loud?”
At this point you need to consider the source of the sound to see whether logically it could be ear-damaging or not.
One way is to observe those around you. Are they wincing, jumping or otherwise reacting to the sound? If not, then it probably isn’t an ear-damaging sound.
Another way to know how loud sounds really are is to use a sound level meter and “take a reading”. If the sounds are less than 80 dB, you know they are not ear-damaging, no matter how loud they seem to you. (If you have a smart phone, there are sound level APPs you can use for free that turn your phone into a reasonably-accurate sound level meter.)
Therefore, if someone is setting the table and the clattering cutlery is so loud it hurts your ears, you know it has to be your perceived loudness causing you problems, because these ordinary, everyday sounds are not bothering anyone else.
Since you have hyperacusis, you do not want to expose your ears to sounds louder than you can handle, and you definitely don’t want to expose your ears to ear-damaging sounds.
The current sound level standards say that you can expose your ears all day to sounds that are under 80 dB. However, once the sound level reaches 85 dB, it is only safe to listen to for 8 hours.
Above that, as the sound level increases by 3 dB, the safe time exposure reduces by half. Thus at 88 dB your safe time exposure limit drops to 4 hours. At 91 dB it drops to 2 hours. At 94 dB it drops to 1 hour. At 97 dB it drops to 30 minutes, and so on.
Note, these figures are for the average person. Some people are more sensitive so their ears may be damaged by shorter exposure times at those levels.
In contrast to the above sustained sound levels, a sudden, sharp, sound, if loud enough, can cause instantaneous damage. The result can be as you have found—noxious tinnitus and hyperacusis. Fortunately, most, people do not get hyperacusis from such episodes.
As you have found, living with hyperacusis is often even worse than living with tinnitus. Once you have hyperacusis, it can feed on itself, just like tinnitus can. What happens, as we have seen, is that your emotional (limbic) system gets involved. The more you focus on, and worry, about your tinnitus and hyperacusis (and this is what you have been doing), the more your limbic system increases the emotional flag level for those sounds. Thus, they became ever louder and more intrusive.
You need to work on not allowing this to happen if you want to get your tinnitus and hyperacusis under control. The way you do this is to learn to be emotionally neutral towards your tinnitus and hyperacusis (difficult to do, to be sure). The result is that your limbic system will then “unflag” this sounds and consequently turn down the internal volume.
However, each time you expose your ears to loud enough sounds, your tinnitus will spike and your hyperacusis will get worse again as you have found.
Thus, when you had several acoustic trauma events in short order, each one builds on the previous one and the result is raging tinnitus and unbearable hyperacusis.
It takes time to recover from such events. I liken each acoustic trauma event to getting “whacked” resulting in a bruise. It takes time for a bruise to heal. If you get “whacked” on the bruise before it has fully healed, it hurts even more than it did originally and takes even longer to heal.
What your ears need more than anything at this point is several months of relative quiet in which to heal. During this time you want to be careful not to expose them to louder sounds. Thus you need to wear ear protectors when around louder sounds. but, and this is very important, you must not overdo this. If you forget and don’t take the ear plugs out when the sound level drops to normal, you will make your condition even worse.
Here’s why. If you don’t take the ear plugs out as soon as sounds return to normal, your brain turns up its internal volume trying to hear normal sounds again. Then, when you take the ear plugs out, everything is now too loud. So the trick is to always protect your ears when sounds around you would cause you more ear trauma, but the second that is not true, take the plugs out.
I know it is virtually impossible to protect your ears from everything because unexpected loud sounds occur from time to time. In these situations, quickly cover your ears with your hands. The best way is to push on the fleshy prominence (tragus) at the entrance to your ear canal to seal your ear canal. I’ve found this gives the best and quickest protection.
Your tinnitus and hyperacusis may get worse for a time. You’ve suffered a set back in your progress. Do not be discouraged but continue on. You are on the road to recovery. It will just take longer.
Does what you eat and drink effect the hyperacusis sound level?
Hi Sandra:
I really don’t know. It may be possible. I know what you eat and drink can affect your tinnitus, but I can’t remember coming across anything that indicated that hyperacusis responded the same way.
Cordially,
Neil
My wife is having a similar problem. She complains about noises hurting her ears. These same sounds I can barely hear. The ceiling fan hum, the dog in the back yard barking. The dishwasher running, two rooms and closed doors away. These things cause her pain.
She says she thinks it all started after having some dental work done. The dentist forced her jaw open too far and caused the discs to slip out of place, i belive it is called Temporomandibular Joint (TMJ) Syndrome.
Since that time (probably 12 yrs ago or so) she has had a very high sensitivity to sound. Anything that I would just call a noise, like a dog barking (outside, on the otherside of the house) or the dishwasher two rooms away, or even the air vent fan on my PC, these things would barely read on a sound meter, but they cause her great pain.
She has tried ear drops, ear plugs, I have even gone so far as to put a sound deadening curtain in the bedroom, and I sleep on the other side of it as my breathing hurts her ears, and no, not snoring at all.
So she has me scouring the Internet for answers. As often the case when you do this it brings up more questions. Hyperacusis is a new term for us.
If you can point me to any literature or websites that could help researching her problem, it would be very helpful.
Thank you
Bob Johnson
Hi Bob;
Hyperacusis is a very real problem and one that is hard for people to even believe–unless they have suffered from it themselves.
I’m sure that your wife’s hyperacusis was brought on like you suspect–from the dental work she had done. Not only could it be from opening her jaw too wide, but it could also be from her neck getting out of alignment at the same time, not to mention the sound of the drill. So it could be a combination of factors.
What’s the solution? First thing I would do is get her head, neck and jaw all in proper alignment. She needs all the muscles, ligaments and tendons to be relaxed and in proper alignment as well.
Personally, I’d start by going to a special kind of chiropractor called a upper cervical chiropractor (you can find one in your area by going to http://www.upcspine.com/ and clicking on “Practitioners” and selecting your state or province. Once he has got your wife’s neck and maybe TMJ back into correct alignment, she may have to go to a facial massage specialist or physiotherapist and get the facial muscles aligned and thus relaxed. I wouldn’t be surprised if that will be all it takes. Note that since she has been “out” for some years, it may take several months of treatments before the ligaments shrink and the muscles and tendons stretch/shrink to hold everything in proper alignment again.
Once she has done all that, if the hyperacusis hasn’t abated, contact me again, and we’ll go from there.
Cordially,
Neil
Hello Neil! I was very happy to see this homepage active and seeing you respond to these problems. It has been difficult to find good information on this matter, specifically on how to self-treat hyperacusis.
So my short story: I am a opera singer student who for the past three years have been singing in too small of a room – thus having my own singing voice reflected back onto my ears with quite some force. After many practice sessions I noticed ringing in my ears, but since they quickly vanished so I didn’t pay it much heed. Others around me have been doing the same thing as me for far longer without any problems.
About 1½ month ago during an unusually loud ensemble i noticed that the ringing I occasionally heard stayed for longer as a faded echo, tinnitus – it’s still there today. I immediately started protecting my ears better, using earplugs when I could during loud sessions. Not at all times though, I felt like the earplugs too much inhibited my ability to sing and to listen to the other singers and the piano, inhibiting my musicality. Stupid, I know.
A little more than a week ago I started noticing that my ears was getting tired very easily in a new weird throbbing, prickling kind of way. Weak pain, pressure, a feeling of ear exhaustion. This pain could arise from slightly louder noises very quickly, or being exposed to even very soft level of sounds for a longer period of time. I also feel like it takes less and less for the ears to feel like it’s “enough”. My tinnitus also gets temporarily worse during this feeling. I don’t feel like the world seems alot louder now than before and loud noises don’t fill my head with sharp needles, would you still classify it as hyperacusis?
I am completely drug free, apart from occasional use of Zolpidem 5mg, more often these days since the tinnitus and anxiety makes sleeping more difficult. I have a fairly tense neck and jaw despite stretching and training. Probably due to singing.
With all that out of the way; what I am most curious about iswhere to go from now: do you think I should give my ears some extreme rest, and if so for how long, or if it might be wiser to continue living everyday life, whilst of course protecting my ears from anything considered truly loud. This is what I didn’t quite understand from your wonderful response above: If I percieve what I know to be a very soft sound to be hurtful to my ears, should I avoid it or rather say “This is a safe sound which my ears need to get used to”? Also, when you write “several months of relative quiet” – is this percieved quiet or actual quiet? Specifically during this time so close to the outbreak of the symptoms.
On a sidenote: can the sound being transferred though the bone to the ear be harmful? For example your steps when running or the vibration of ones own voice.
Thank you again so much for your articles here on the homepage, and your dedication to helping people.
Hans
Hi Hans:
Were you using regular ear plugs or the special musicians ear protectors that allow you to hear music and singing normally–but at a lower volume. I would highly recommend these over regular ear plugs for your purposes.
From what you are saying, I’d say you definitely have hyperacusis. Some people have other symptoms s well as the unnatural loudness. It sounds like you are one of them.
Know that Zolpidem can cause tinnitus and hyperacusis too. So you want to go easy on this drug and definitely not build up a dependence on it.
If your jaw and neck are tight, then you need to get things back in proper alignment. That could help your ear problems. An upper cervical spine chiropractor and/or physiotherapist and/or massage therapist would be the people to go to. This is probably what I’d do next if I were in your shoes.
I don’t think you need to give your ears a total rest–meaning quitting singing. But definitely protect your ears from louder sounds for a few months. As I said, musicians ear protectors would be an excellent start. That way you could continue singing and still protect your ears adequately.
You need to protect your ears from actual loud sounds for sure. And it wouldn’t hurt to try to keep perceived sounds below where they cause problems too as much as possible.
Theoretically your own voice should not be too loud via bone conduction. This is because bone conduction is typically about 30 dB less than air conduction. But even with air conduction, you have the acoustic reflex God built in so when you talk it kicks in and lowers the volume of your voice to you so your own voice won’t damage your ears. Cool, huh?
Cordially,
Neil
Hi doctor, I was reading several posts at so many threads about hearing disorders to see what could be wrong with me and then I started with the need to see if I have Hyperacusis as well.
Well some morning went to a dentist for some treatment, but I just realized that GP used too much drill and I was left with sensitivity on my teeth, a week after that got a flu but I have had a chronic sinusitis since I can even remember.
After the end of this flu I felt that something sounded like clicking and after that I started with a very complex hypersensitivity to very high frequencies like dentist drill does, no pain yet and I hope it stays that way, but even the sound of rubbing certain clothes, folding grocery plastic bags increases this sensitivity and constantly bothers me a lot, and increases as well a Tinnitus that was developed a week after this symptoms started and coincidentally has a high tone and spikes higher when exposed to high pitch sounds or noises, also loud pitch noises bother me, but since I live in Ecuador there is nobody to tell me what it could be since only Tinnitus is known by ENTs or Psychiatrists and the term Hyperacusis known as a nervous problem as far they acknowledge.
On regard to this post respectfully and with afect I thank you doctor for your important comments and possible treatment the help coping in the future.
Hi Rodrigo:
The high-speed whine of a dentist’s drill can result in hyperacusis in some people. It’s never bothered me, but I have heard from people that have had problems after having the teeth drilled especially their upper back molars which are quite close to the inner ear.
Very often, tinnitus often accompanies hyperacusis as a result of noise trauma. So you fit the profile. probably the best way to deal with your hyperacusis is to protect your ears from loud sounds for the next few weeks or months and give your ears a chance to calm down. At the same time, don’t over protect your ears when you don’t have to, or you’ll just make your hyperacusis worse.
Hyperacusis also has an emotional component, so you don’t want to get annoyed with the sounds. Realize that they are not hurting your ears physically. It’s just that they sound so loud to you that you perceive them to hurt.
Cordially,
Neil
Thank you for putting some of my anxiety to rest. I am using regular plugs while waiting for the custom musician plugs to be shipped.
I’m going to follow your advice and pray for quick recovery. The fact that I can continue singing means alot to me.
Thank you again!
Hello Sir,
I hope my comment finds you. I have been suffering from a similar condition, though has not been formally diagnosed by the Doctors that i have met over the years. I have had the condition for over 6 years now.
The onset was brought about by spending too much time listening to music over headphones. Initially I would have these crackling sound in my left ear whenever I would hear some loud noise, or clinking of metal. In fact if I would brush my hand against my ear, it would evoke a similar noise. In the last 6 years, the problem hasn’t developed in my right ear, and has been restricted.
I believe hyperacusis amplifies normal sounds, but that doesn’t seem to be the case for me. My ear however, does hurt when I hear the loud sounds. Sometimes, the pain is relieved when I move my jaw sideways. In fact, there is a clicking sound in my left ear when I shift my jaw sideways. I am not sure to what the problem seems to be, but it is certainly not very comfortable
Hi Rajat:
When you hear crackling sounds in one ear, it typically means your Eustachian tube is partially blocked. Do you remember if you just heard these sounds when you yawned or swallowed? If so, what you were hearing is air trying to get though your Eustachian tube.
The clicking sound when you move your jaw is because you have a problem with your temporomandibular joint–the hinge point of your jawbone, often called TMJ or TMD. When it is out of place you end up with problems. You should go to a chiropractor or dentist that specializes in TMJ problems and get it properly aligned.
When your TMJ is out of alignment, it can also make hyperacusis type of conditions worse.
Cordially,
Neil
Hi Sir
I have had Tinnitus for years from noise at work.It was fairly low and eventually I got used to it and hardly ever noticed it A few months ago out of the blue the volume increased quite a lot possibly due to stress.It was bothering me and I was constantly using cotton wool,to stop it from increasing further. Then a few weeks later I woke up one morning and everything sounded so much louder,traffic noise,a lot of people talking together in a restaurant and so on.For the last few weeks I stopped using cotton wool for ordinary sounds but have not seen any change yet,does it take time?
Also something very strange has been happening.It happened
on several occasions. woke up at say 6 in the morning my T was almost zero I got up and I was T free all day and night.Next day same thing happened but decided to get an extra 5 minutes sleep and on waking up it got louder again .
Hi Tony:
Putting cotton wool in your ears is not very effective. MUCH better to use proper ear protectors that have a definite rating up to 30 dB or so. Cotton wool is rated very low–maybe 3 dB and not enough to really help protect your ears.
Your ears only stand so much “abuse” before they “rebel” and normal sounds can suddenly sound too loud. Once you reach that point you have to get serious about properly dealing with your ears if you want to get better. And this all takes time. It certainly doesn’t happen overnight. It can take months to 2 or 3 years to get hyperacusis under control.
Interesting about your tinnitus coming on after the additional 5 minutes sleep. I’ve not heard of that before. But the solution is obvious–no more dozing in for 5 more minutes. When you wake up, get up and get going–and hopefully you’ll have a tinnitus-free day.
Cordially,
Neil
Hi Sir
Thank you very much for your comments,I am sure getting hyperacusis was my fault for over protecting my ears ,even for conversation.
About T returning after a 5 minute nap ,I have seen it happening to other people in other forums.May be a specialist should look into it ,fit us with a brain monitor during sleep and at the right time activate an alarm clock. I have a suspicion If you wake up after less than 2 hours sleep which is non REM sleep your T starts up .If you wake up after more than 2 hours sleep which is REM sleep your T should not start up.
Hi Tony:
Why are you talking about 2 hours of sleep testing when the problem you are having was dozing off for just 5 more minutes?
Cordially,
Neil
Hi Sir
Because once I woke up 3 am was T free went back to sleep for hour and a half and woke up with High T.Other nights I slept uninterrupted for 5,6 or 7 hours and woke up T free
Hi Sir It is me again.Sorry I forgot to ask you at my above reply.With Hyperacousis over what db volume should we protect our ears.For example is busy road traffic safe to listen to without protection?And what about a noisy restaurant full of people?
Thank you again
Hi Tony:
It varies with your degree of hyperacusis. Certainly you want to protect your ears from sounds greater than 90 dB. But if your hyperacusis bothers you at a lower level, then you want to protect them more. For example, if your hyperacusis kicks in at say 80 dB and makes things worse, then you’d want to limit sounds to just under 80 dB. At the same time you always want to “stretch” your dynamic range so keep trying to move this number up to where it should be.
Overprotecting your ears is just as bad as underprotecting them.
Cordially,
Neil
Thank you Sir Your reply is very much appreciated God Bless You
Hi Sir
Actually in my case waking up acts as on or off switch for T.It never changes while I am awake.
Hi,Sir
Your explanation given to a lady at the top of the page is brilliant to say the least.Very informative and it really answered some of my questions.But I would be for ever grateful if you could reply to my case as shown above this comment
HEY DOC I HAVE NOT LISTENED TO ANY AMPLIFIED MUSIC (RADIO , RECORD PLAYER, CONCERT. FOR OVER 20 YRS, WHEN I CAN AVOID IT. SOME CHURCH SPECIALS GIVE ME PAIN AROUND BOTH TEMPLES. MY HEARING IS ABOUT GONE, BUT AIDS HURT AS MUCH OR MORE THAN HELP. I GOT THEM TO STOP TINNITUS BUT A CONTANT STATIC OR CRICKET SOUND IS ALWAYS IN MY HEAD..,
Hi Don:
If your hearing aids are not really helping you hear better and the sounds are too loud for you, it sounds like you have recruitment kicking in.
If the hearing aids don’t help your tinnitus, then you can turn that tinnitus function off.
Maybe it’s time for you to be evaluated for cochlear implants. Often they help dramadically with reducing recruitment and tinnitus.
It may be worth your while to investigate getting CIs.
Cordially,
Neil
I can empathize with your situation. Im mostly deaf with very bad tinnitus due to a bout of Rocky Mountain Spotted Fever. I can’t hear people talk without my hearing aids and even then i don’t always understand them. Even though i am nearly deaf, loud sound hurt me. a shot gun blast will make me collapse . a train horn will do similar, fire truck sirens leave me shaking and week. it’s like the sound waves are directly hitting my nerves system , even though i can’t hear.
Dr. Baumann,
Thank you for taking the time and effort to write your explanation of hyperacusis. I have had varying degrees of hyperacusis for about 40 years, but it has never been a debilitating problem until the last few months. Due to frequent, sudden loud sounds on the subway and train system in the city where we temporarily live, my hyperacusis has become severe (if it was possible, I would never leave our apartment). We will be going home in 2 months, and will be able to rest my ears then. In the meantime, I have become very proficient at using the tragus to plug my ears.
Thank you again for the reassurance provided by your article.
Great info .I am a 64 year old male involved with alot of vocal headphone recordings with music tracks pretty loud for quite awhile. Went in 2 weeks ago to lay down vocal tracks and the volume was full blast when i turned it on with my headphones. Then the next day smoke alarm went off in the house for 2min now i have total ringing in the ears and my ears are very sensitive to sounds .thanks for your help ..Rog
Hi Dr. Bauman,
Would you consider periodic dog barks to be dangerous to hearing for someone with tinnitus?
Thank you!
Mike
Hi Mike:
Dogs barking shouldn’t affect your tinnitus unless you also have hyperacusis. A barking dog should not be any worse for your ears than any other sound of that volume. Why do you ask?
Cordially,
Neil
Hi Dr.
The sound of my neighbor’s dogs barking seems to affect my tinnitus. I am also really emotionally triggered by the sound as I find it very annoying. Is it possible I have hyperacusis, and would plugging my ears every time the dogs bark help? It starts too suddenly for me to plan for it.
I sleep in earplugs because I’m noise-sensitive and also because the dogs barking will wake me up way too early if I don’t sleep in earplugs. Could sleeping in earplugs be making my hyperacusis worse?
Thank you.
Liv
Hi Liv:
Unfortunately, you are making your hyperacusis worse on a couple of accounts.
1. Wearing earplugs unnecessarily (while you are sleeping) is one reason why your hyperacusis is getting worse and worse. A better choice would be to have soft background sounds playing in your bedroom to help cover the sounds that you react to.
2. Have you talked to your neighbor about the barking dog issue? If he won’t do anything about it, does your municipality have a noise ordinance, or a barking dog ordinance? Have you talked to them about it? You need to do something. What is happening is that you are getting continually aggravated with the dog barking, and as a result, your emotional system is exacerbating your hyperacusis. So you need to get this under control. As long as you are upset by the barking dog, you are not going to be able to effectively deal with your hyperacusis and tinnitus. So it is imperative that you properly deal with this issue one way or another.
Just doing these two things can make an enormous difference to your tinnitus/hyperacusis, not to mention your peace of mind.
Cordially,
Neil
i damaged my ears in an indoor gun shoot.. my ear plugs not in properly. i now wear hearing aids.. loud noises cause my ears to rattle and hum. its severe pain. i can’t understand women or tv without an hearing aid.. and its still not very clear. low noises are extremely hurting to my ears. sometimes my ears ring for 2 or 3 days.. this has been going on for 3 years now.. i find it hard to deal with the loud noises
Hi Dr Bauman,
I experience tinnitus (both normal and reactive) and hyperacusis since three weeks ago. The event that caused it was a dinner at a restaurant with my partner. We would both use earplugs if we thought the volume was too loud but we found it comfortable, we could talk to each other in a normal tone and we were there for about 1,5 hour. When we came home my head was spinning, I had tinnitus and couldn’t settle to sleep good. The next morning I found myself very sensitive to normal sounds. What I think matters in my situation is that I have been suffering from insomnia for a couple of months before this night, something that has developed after having my second child in june. I have hade and still have a lot of anxiety and tension in my shoulders, neck and jaw and my doctor think I might suffer from depression. I’ve read your recommendations regarding hyperacusis and I now expose myself to normal sounds both day and night, saving the earplugs for noise over 80 db only. But I have some questions that I hope you could help me with. If I manage to solve my hyperacusis, what can I expect will happen to my tinnitus? I’m wondering about the reactive tinnitus mostly, since I read that it is connected with the hyperacusis? And I my case, having my problems debut after what I think was a situation where the sounds were below 80 db, how should I deal with similar situations before my insomnia and depression are gone? Can I be hopeful, thinking that better sleep and getting out of the depression and anxiety will minimize my tinnitus?
Thank you for taking the time,
Regards
Emma
Hi Emma:
I would expect your tinnitus to calm down as you deal with your hyperacusis. Getting more/better sleep and dealing with your anxiety and depression will certainly make your tinnitus less of an issue if it stays around, but you may find it disappears into the background and is not a problem. But it may come back at times if you are depressed or anxious.
This restaurant you went to–was there live music or what? I wouldn’t have expected only 80 dB sounds to have caused hyperacusis without some other factors involved. And it could have been your lack of sleep and anxiety at that time. Remember, hyperacusis is a psychosomatic condition as is tinnitus, so there is always an emotional/psychological component that you have to deal with.
Cordially,
Neil
Hi I am worried that my hyperacusis will cause me to progessively lose my hearing, they been sensitive for about a month now, but even normal sounds have been too loud for me recently. i just want to know if hearing these “normal” sounds that are normally healthy to normal people will make my hearing even worse? Will hearing low decibles that bother me make my hearing loss worse?
Hi Phillip:
You can set your mind at rest. Hyperacusis does NOT cause you to lose hearing. Your hearing is just fine. What happens is that you PERCEIVE these sounds to be too loud, but they really aren’t any louder than they always were. This is because your ears now have reduced sound tolerance.
You want to rebuild your tolerance to sound. One way is to always have softer background sounds around you–but never really loud sounds (you need to protect your ears from them because that was what caused your tolerance to collapse in the first place). For example, you could listen to pink noise at a level that is just below your discomfort level. Over time, you will find you can increase the volume a tiny bit and still not have discomfort. When this happens raise the level again. And eventually you’ll expand your tolerance again to near where it should be. This can take time–up to two years–so don’t try to rush it as that is counterproductive and you can set yourself back.
Cordially,
Neil
I have a loud buzzing sound in my ear that I only really hear at night – a constant buzzing sound. The weird part is that when the compressor in my refrigerator comes on, the buzzing sound goes away. I have been to see an ENT a few times for Tinnitus but with no clear results. This buzzing sound makes it impossible to sleep. What is your opinion on this. It only happens in my left ear and when I cover the ear, the buzzing stops. Why though would the compressor kicking in stop the buzzing noise. Thank you for any help.
Hi Chris:
Why do you only hear it at night? Because it is quiet so you hear it? Or because you are laying down?
Interesting that you can stop it by putting your hand over your ear, which would normally indicate that you are hearing a real sound, but your other ear doesn’t hear it so unless you have a hearing loss in that ear, it has to be a phantom sound.
It sounds like you have one of the many tinnitus sounds in your left ear. Do you hear the buzzing if your left ear is buried in the pillow (which should be the same as covering your ear with your hand)?
The reason you don’t hear it when your fridge kicks in is because the fridge sound basically either totally masks your tinnitus sound because the fridge sound is louder, so you hear the fridge, but not the tinnitus. Another possibility is that the fridge sound cancels out the tinnitus sound sort of using the same principle that noise-cancelling headphones use, but if that were occurring, then you wouldn’t hear the fridge noise either.
Cordially,
Neil
Hi Dr. Baumann
Thank you for this article.
I have been dealing with tinnitus since 2016, and developed a mild case of H in 2018 after some studio work with my music, wasnt loud at all though, and my tinnitus also got a worse i think, but
after this I started obsessing about my tinnitus like a mad person, and maybe overprotected and analysed sound like crazy. It has pretty much been all I have been thinking of since October 2018. I also have TTTS, which used to scare me but after your response on the TTTS thread it doesnt make me AS scared anymore. But hyperacusis do. It really feels different.
And a couple og months ago i started getting reactive t in my left ear (the worse hyperacusis ear), which is weird because normally i dont have tinnitus in that ear. I have loud normal tinnitus in my right ear which used to be my main problem in life but after the extreme hyperacusis with pain i experience in my left ear and the screaming reactive weird tinnitus i dont even care about my constant T and wish so badly I could go back to just having t.
Lately my hyperacusis with pain combined with reactive tinnitus that changes all the time has gotten so bad and my left ear is in constant pain. Whenever i have a day to relax my nerves i feel the symptoms sometimes get better and even if the reactive t is still there it is not that bad. Whenever i get extreme ear pain my reactive tinnitus gets much worse so in my case im sure they are connected.
I feel sound is too loud, but mostly for me it is the horrible pain I experience and my extreme phonophobia which I have been dealing with since 2018 that are my two main problems. My tinnitus from the start is noice induced but from april 2016 to October 2018 i didnt have any problems with hyperacusis or phonophobia.
So i have to add I am an extremely anxious person.
Since 2018 I jump at any loud sound, when people around me dont even notice the same sounds.
Ive been unsuccessfully dealing with my new worse tinnitus since 2018, and everything has just gotten worse while Ive been so extremely anxious thinking about it 24/7 and depressed over it. It has been all I’m thinking about.
I know you cannot get hyperacusis from anxiety or depression, but I feel in my case i have no new loud sound exposure or something like that to be the reason for the sudden extreme worsening the last couple of months. Do you think it is my nerves? All i do is monitor sound and my environment and possible sound coming.
To make things so much worse I have two kids. They are only 3 and 1 years old, I was pregnant with my second baby when i started this struggle in 2018.
The are not very noisy kids, but of course they are noisier than Id like my house to be when dealing with this. So Ive been living in fear at home for sudden happy baby screams that are just unavoidable in my situation. Everytime my one year old scream I feel like im jumping out of my skin and im just so scared to be around him. It is a horrible situation as of course all I want is to be with my kids without fear of sound.
So i was hopping you could give me some advice on what I could do in my situation.
I cannot avoid my children and their sudden scream (which can reach high decibels, at least for my ears), but i cannot overprotect at home all day long in case of a sudden baby scream. It doesnt happen that often. I try not to overprotect, but now their voices cause me pain and not protecting lately feels like im causing more hyperacusis. Its just getting worse on its own and then my anxiety is through the roof as feel i will soon not be able to be around my children. Of course i protect my ears when my children are angry and screaming for a while, its the sudden screams I cant avoid which are making me so nervous all the time.
I hope you can give me some advice on what I should do in my situation Dr. Do you think i would be a good candidate for TRT or should I at least try sound therapy of some kind? I already do try at home but maybe i should wear some over the ear plugs to wear all day playing pink noise?
Also my pretty extreme reactive tinnitus makes me so scared sound theraphy will make matters worse. It is reactive in direct response to sound, like if a car drives past me it screams, and when i talk i can hear it a little bit. That kind of reactive. And im scared playing pink noise all day will make it worse. Also, does TRT help with pain hyperacusis? Or only loudness H? Im scared it will not help in my case since my problem is mainly pain, and the jumping from loud sounds i feel is more my phonophobia.
Please if you have any advice in my situation Dr I would really appreciate it as my h is spiralling out of control and i dont know where to start to gain back control over it in my situation with small children.
Monica
Hi Monica:
Obsessing over sound and tinnitus can certainly result in it getting worse, and in developing hyperacusis and TTTS and reactive tinnitus. All these conditions are tied to your emotions such as anxiety/worry. In order to effectively deal with them, you need to get your anxiety under control. That is the first step.
As you have found, when you get a day to relax, things get better. This should give you hope. You’ve got to learn how to build relaxation and calmness into your lifestyle.
You CAN get hyperacusis from anxiety–that is exactly what drives it. And your ear pain can be from your TTTS or hyperacusis, etc.
And all your anxiety over sounds has resulted in your phonophobia. You are afraid of sounds because you know they will cause your ear pain to escalate.
I understand your problem when your kids scream or make loud noises. As a temporary measure, wearing ear plugs is a good solution. And you don’t want to wear them all the time as that just can make the hyperacusis worse. So I think you are wearing them wisely–when you know it is going to be noisy for a bit. But those sudden screams can catch you unawares. I’d suggest clapping your hands to your ears to cut out the sounds as much as you can. But they can happen when your hands are full and you can’t do that. This just makes things worse.
TRT and sound therapy are two good things to investigate. Note that TRT can be combined with hyperacusis therapy. You should surround yourself 24/7 with sound at a level that does NOT cause your tinnitus to react nor your hyperacusis to kick in. You want to have the sound just below that level–and over time you push the level up as your ears can bear it until your collapsed tolerance to sound is basically back to normal.
A key part of TRT or hyperacusis therapy is teaching you the truth about sound. That the sounds you are so afraid of do NOT physically damage your ears like you think they are doing. It’s all your perception–and that is what you need to change.
Again, I need to emphasize that with sound therapy, you NEVER make the sound so loud that it bothers you and sets off your hyperacusis or reactive tinnitus. You are in control and you set the level just below that so you KNOW it will not bother you.
There is no doubt that you need professional help in this until you get yourself under control.
And yes, you can get the pain component under control too as you work through these programs.
If pink noise isn’t pleasant to you, consider other sounds like fractal music (sounds sort of like wind-chimes) or nature sounds such as water sound–waterfalls, babbling creek sounds, waves lapping on the beach, etc. These are naturally soothing sounds. They will be good at night and help you relax and sleep as well as providing the sound you need for your hyperacusis therapy.
You need to seek out a tinnitus and hyperacusis center near you and get the help you need. If you don’t know of any, start by asking audiologists and see whether they know of one as these clinics are typically run by audiologists.
Cordially,
Neil
Dear doctor Baumann, I have had tinnitus for 26 years. And I habituated to it and got on with my life…. However 2020 has been dreadful for everyone and all of that year I was in constant pain had tests and frequented accident and emergency on several occasions… the pain was horrendous I eventually had my operation 13 April 2021 and was in surgery 4 hours due to complications. Had total hysterectomy and an operation on my bowel and adhesions plus to growths in my uterus one 7cm and one 4cm the pain that year was horrific….
However four eeeks after my operation I woke up with tinnitus and had sensitivity to sound…. It’s now four months… unfortunately I have a cold at the moment so it’s set me back
I’m going out everyday to the beach to get some sounds . I have the tv on low and a wave machine also on low…. I find sleeping in silence is best for me…. I wear plugs moulded ones with filter…. To go out as i get quite anxious…. I have started to remove my plugs for part of my journey in the car. However sometimes I find cutlery ok and crockery but sometimes it feels loud…. Is this normal
I also left the rear window down in my car slightly and I was driving…. I had my plugs in could this of make my ears worse…. It was for a good half hour…. I did feel uncomfortable…. That was five days ago… I am also speaking to a tinnitus counsellor once a week….
I also would like to mention before this started five days before my daughters dog barked and it hurt my ear . Could this of caused it and am I doing the right things in trying to get better
I’m so upset by it all…. I just thank goodness that my house is quiet and I do not have small children because that must be awful….
I have also seen an audiologist and ENT ad my hearing is fine
I am 56 years old… I must also add that I was extremely anxious to the extreme before my op. I have never been so frightened. Fortunately it was benign..
Doctors are saying it’s stress that’s caused this, I’m not sure…
Will this just take time…. It’s four months now or is this early days
Thank you
Jacqueline
Hi Jacqueline:
Any sudden loud sound, like the dog unexpectedly barking close to your ear can cause sound sensitivity (loudness hyperacusis). Anxiety makes it worse. So does overprotecting your ears from normal sounds.
You habituated to your tinnitus once–so you can do it again. You already know how.
Typically, you are sensitive to higher-frequency sounds. That is why cutlery and dishes clinking sounds seem so loud to you.
Like tinnitus, loudness hyperacusis is also a psychosomatic condition, so your emotional state plays a large part in how bad it gets and how long it persists. Thus, getting your stress and anxiety under control can make an enormous difference.
You only want to wear ear protectors when sounds bother you, not just in case they might bother you. So when out driving, its better to leave them off and only put them on if you find you need to. The same with your everyday activities. Of course, if you are in really noisy environments, you want to wear the ear protectors, but take them off as soon as the noise level drops. And don’t sleep with them in. I can’t tell from what you say whether you do or don’t. Just don’t. If you find you want it quiet in your bedroom for sleeping, that is perfectly ok. Some people need some sound, but if you don’t, don’t feel you need to add sound.
It takes time for hyperacusis to fade away, but much depends on your emotional state as I said. I’m focusing on the hyperacusis because you treat hyperacusis before you treat tinnitus. But often, getting your hyperacusis under control automatically brings your tinnitus under control at the same time.
Cordially,
Neil
Thank you for your reply,
However wouldn’t sounds perhaps magnify the tinnitus,,,, I don’t sleep in plugs and I have been gradually increasing the volumes at home…..
I perhaps am being over cautious
I must add that the anxiety was extreme before my op and I would wake up in panic….
I am however still anxious and I will try to settle this
Thankyou
Jacqueline
Hi Jacqueline:
If you have reactive tinnitus, then louder sounds can make your tinnitus louder. However, just having hyperacusis doesn’t mean you also have reactive tinnitus.
You are doing right by slowly increasing the volume at home as your ears can stand it. This is the correct treatment for hyperacusis. Just keep on pushing the envelope–but only as fast as your ears can stand it.
And keep on working on reducing your anxiety.
Cordially,
Neil
Hello….
Also my tinnitus seems loud sometimes I just don’t know if I will habituate again…. I’m so upset by it all…. Should I try in ear maskers to try and help….
Or will it settle
Thankyou
Jacqueline
Hi Jacqueline:
Tinnitus can fluctuate in volume (and pitch) from time to time throughout the day. Plus, you can have good days and bad days. When you have bad days, it is easy to be discouraged.
You don’t want to mask your tinnitus–that is, drown it out–as that won’t ultimately help and depending on the volume of your tinnitus, the sound may be too loud for your ears. The proper way is to set the volume of the sound generator to a level below the level of your tinnitus where it just mixes or blends with your tinnitus.
If you have trouble dealing with your tinnitus, sound generators that produce white or pink noise, fractal music or water sounds may help you. That is often half of the protocol for dealing with tinnitus. The other part is psychological counseling to help you properly deal with your tinnitus.
Cordially,
Neil
Hello
I’ve looked on the forums
And it truly am scared me people with hypercusis…..
I am so upset and struggling with all of this….
Thankyou
Jacqueline
Hi Jacqueline:
Unfortunately many forums are inhabited by people who will not follow successful protocols to treat their hyperacusis so instead of working to reduce their hyperacusis, the wallow in their misery and try to drag others down with them.
The people who successfully deal with their hyperacusis are not on the forums, but are busy living their happy, busy lives. You see, focusing on your hyperacusis is NOT the way to get rid of it–just the opposite.
Cordially,
Neil
Hello
Sorry to bother you but is ear fullness normal with hyperacusis… my ears are also sensitive tonight after such a good day
Why is this
Hi Jacqueline:
A feeling of fullness in your ears often accompanies loudness hyperacusis–and indeed a number of the other kinds of hyperacusis too.
You can have good days and bad days–or partial good days. So it is not uncommon for your ears to be more or less sensitive to sound depending on a number of factors. I’d say its nothing to worry about–and having good days or good times during the day is an encouraging sign that your hyperacusis is slowly healing.
Cordially,
Neil
Hello Neil….
I have sounds on low every day at home….
And I also take myself to the beach everyday to listen to natural sounds…. I find I get anxious going on supermarkets but I keep trying….
Is this the way to do it..
I am also having counselling
Hi Jacqueline:
Going to the beach is both good for your ears and also is relaxing and helps promote calmness which reduces your anxiety so it is a good strategy.
Why are you anxious when going to the supermarket? Once you know that, you and your counselor can work on that. Perhaps go to the store for only one or two items and get used to that, then go for longer and longer periods of time as you and your ears can stand it. You might also consider going when the store is almost empty to start with to show yourself there is no reason to be so anxious. Yet another strategy might bet to go to the store and carry ear plugs with you, then when the noise gets to be too much for you, wear the ear protectors for the rest of your time in the store–and constantly strive to make it longer and longer before you need your ear protectors.
The short answer is do whatever works for you AND promotes increased healing in the long run.
Cordially,
Neil
Hello Dr. Neil,
Thank you for taking the time to answer people’s questions. It is informative and very helpful. It is nice to talk to someone who really understands hyperacusis and tinnitus.
I ordered your book from amazon (Hypersensitive to Sound) and I can not wait to read it. I’m sure I will learn a lot.
My story in a nutshell. I have been suffering from loudness hyperacusis for many many years now. At first I didn’t even know what it was. I knew I was overly sensitive to sound but didn’t know why. I actually felt a little better when I found out about hyperacusis. At least now I knew what the problem was.
My hyperacusis is not the result of a noise exposure. I believe it’s a result of one of these two things. The first one being that I suffer from chronic migraines. (which I developed after being on birth control pills) I am sensitive to odors, light and sound all the time. Not just when I have migraines.
The other possible cause could be from when I became pregnant. In that first month I also developed an ear infection in both ears. Was given an antibiotic that I was allergic to. Plus I got the flu and had a fever of 104. All of this happened at the same time so I was pretty miserable at that time.
Regardless of how my hyperacusis developed I have been living with it for many years now as well as tinnitus.
I have many questions but I will hold off on them. I would like to read your book first. Maybe I will find some answers in the book.
I do have a pressing question though. In a few days (on Friday) I will be going to the dentist to have a crown done. It’s pretty scary. I am nervous about getting a crown. More nervous about a potential exposure to covid. (since I can’t wear a mask) Then scared to death about what the noise of the drill will do to my hyperacusis.
I spoke to the dentist and told her about the hyperacusis and that the sound of the drill is above my tolerance level. I explained that the recommended way to proceed is to drill for 5-10 seconds. Then stop and wait for 10-20 seconds to give my ears a break. Then continue with the stop/start method until the drilling is done. Fortunately she was understanding and agreeable to this.
To avoid being tortured by the sound I am also going to be anesthetized (as in asleep) for the procedure. My ears will still be exposed to the noise of the drill but at least I won’t be awake and in agony.
At the moment (of this writing) I am still working with the office of the anesthesiologist to make sure it is complete sedation (and not any form of conscious sedation) so that I am not aware of the noise. It’s hard to get people with normal hearing to understand that noise can cause total agony for someone with hyperacusis.
So my question is .. is there anything else I can do to get through this procedure? (and not aggravate my hyperacusis further)
Thank you and Best Regards,
Mary
Hi Mary:
Chronic migraines and pain hyperacusis often go together. So does your global sensitivity which is why you are not only sensitive to sounds, but to light and odors, etc. You’ll find more about this in chapter 18 on Pain Hyperacusis.
Your dental plan of intermittent drilling is right on the money. In addition, NEVER allow your dentist or dental hygienist to use ultrasonic tools on your teeth. This may also cause you excruciating pain. That’s the only other thing I can think of at the moment.
I’m curious to see how your plan to be “knocked out” during the dental work goes–whether this prevents your hyperacusis from getting worse or not since your ears never sleep even when you do.
Let me know how it goes.
Cordially,
Neil
Hi Neil,
Well I had my procedure today and I’m really really happy to report that all went well. (big smile here) My tinnitus and hyperacusis have not flared up at all. I am doing my happy dance!
I knew being anesthesized would not have any effect on what my ears had to endure. (like you said, the ears never sleep) The point of being anesthesized was just for my comfort. To be asleep and not enduring the torture of hearing the work done in my mouth.
I know that part of being anesthesized is that they give you stuff that affects your memory. Well I have a few fleeting memories of the work but that’s it. I have no memory of being tortured by the sound. Thank goodness. What a relief.
My friend was sitting in the waiting area and she could hear the dentist and she confirmed that they did do intermittent drilling. I did not wear any ear protection during the drilling. I did bring headphones with me and asked them if they would be kind enough to put them on me when they weren’t drilling. (just to protect my hears from any potential loud noise in the room) I also asked them to put the headphones on me when I was brought out of sedation. I figured that would be a good thing to do in case my ears were extra sensitive. I can not confirm if they removed the headphones during the drilling.
All I know is that I feel totally fine and my ears are in the same condition that they were when I went there this morning.
I wanted to share these results with you and the other readers. Especially if it can help ease someone else’s mind about their own procedure(s).
Have a great weekend everyone!
Mary
Hello Neil
Thought I was improving but this week the sensitivity has been up and down…..
What should o do
I’ve also had ear fullness why is this….
And ears feel twitchy
Ive cried every day this week I’m so upset by it all….
Will it get better it’s five months now
Hi Jacqueline:
It is natural to have good days and bad days while you are recovering. Continue to protect your ears from louder sounds and work on getting your emotions under control. The more you worry about and focus on your ear problems, the worse they can get and the harder it is to begin to habituate to your tinnitus.
Ear fullness and twitchiness can be results of loudness hyperacusis. As you calm down, you should find the twitchiness going away.
Your situation can (and will) get better in time, BUT you have to do your part as I’ve said above.
Cordially,
Neil
Hello Neil
Is it because I’ve harmed my ears…. And that’s caused the fullness etc
Crockery etc I have been sensitive to…. And these were getting better…..
Yes I find the whole experience frightening…. However I have had a quiet day today doing jigsaws and relaxing… peaceful in order to rest my ears
My in ear generators have arrived and I put them on the lowest setting as advised by audiology and they felt extremely loud .I used them for about 5 minutes….
I have been going out and I took your advise and I went to the supermarket in the evening without plugs and have built it up gradually also driving
I just feel upset in case I’ve made my ears worse
Thankyou
Jacqueline
Hi Jacqueline:
The drugs you took associated with your surgery, and the dog barking in your ear may have caused some degree of physical (biological) damage, but it was exacerbated by your emotional makeup (extreme anxiety). This has caused your brain to rewire itself due to maladaptive neuroplasticity.
The good news is that any changes your brain has made to its “wiring” can be undone. However, these changes take time and concerted effort on your part. They do not happen overnight. So you need to get your anxiety under control in order to allow this to happen.
The acoustic shock you suffered and/or ototoxic side effects of drugs have resulted in certain nerves, such as your trigeminal nerve to become hypervigilant/hyperactive and the results of that can cause the feelings of fullness. This can go away in time as you calm down.
You are doing good things and it is helping you. Just continue to do them. You will have setbacks when unexpected loud sounds bother you, but don’t give up. Just accept the setback and continue on with your program and keep moving forward.
Your sound generators NEED to be set so they won’t bother your hyperacusis (sensitivity to sound). In other words they obviously are set too loud for your ears at this point. Don’t wear them until they are turned down.
One mistake audiologists can make is they set the sound level to fit your tinnitus and this is WRONG if you also have hyperacusis. They have to be set to work with your hyperacusis first, and then as your ears can stand it (your hyperacusis is getting better) you slowly turn the volume up to a level that also treats your tinnitus. You must NEVER treat your tinnitus first!
Cordially,
Neil
Hello Neil
Thankyou for your reply
The in ear sound generators are set on the lowest they can possibly be set….
So I’m disappointed….
However I’m thinking of accessing a private clinic here in the uk
If I continue doing what I’m doing I may not need them…. The audiologist wasn’t really up on tinnitus and hyperacusis….
But I’m not disheartened I shall carry on
Thankyou for your advice
Since my last post I have been referred to a specialist who specialises I hyperacusis and tinnitus generators on the nhs….
There is a wait but I’m pleased and will be having a zoom meeting with them in a few weeks
Thankyou so much
Hello Neil
Is it at all possible over time
For this to fade naturally
Thankyou
Hi Jacqueline:
It is not only possible, it is a good possibility that it your hyperacusis will fade away in time. But that requires that you work on reducing your emotional/psychological “attachment” to your hyperacusis and also work on increasing the level of sounds your ears stand before hyperacusis kicks in.
Cordially,
Neil
Hello Neil
Could I make an appointment to speak to you via zoom or face time
Thankyou
Jacqueline
Hi Jacqueline:
Sure. I prefer Zoom.
Cordially,
Neil
Hello
How do I make an appointment with you
Thankyou
Hi Jacqueline:
I sent you a private email to set up an appointment via Zoom.
Cordially,
Neil
Hello, Neil.
First of all, thank you for your blog and your comments. They’re really appreciated.
I developed tinnitus last year in February, out of the blue (I don’t know the cause). I was prescribed clonazepam at 1.5 mg. daily. I was about to withdraw when I got muscle pain due to complications from an unrelated surgery and the surgeon suggested diazepam to keep the pain under control. Since I was already taking clonazepam, she told me to increase the dose to keep the pain under control. I took as much as 3 mg a day. The pain is gone, but I’m still getting off benzos. Right now I’m taking 0.25 mg twice daily (supervised by a different doctor), and tapering slowly.
I’m coping with increased tinnitus at times (and other unrelated symptoms). The problem is that over the last few months I’ve developed hyperacusis (I didn’t have any before), and it seems to be getting worse as I taper or because of clonazepam itself, I don’t know. Also, my ears often pop and sometimes hurt (the ear muscles seem to contract, especially after certain sounds, not necessarily loud). I’m praying that this hyperacusis will fade once I’m off benzos in a few months.
My questions is the following. In the meantime, should I start some sound therapy (eg. pink noise) to try and reverse the situation? Or should I wait and see if it gets better by itself once I’m benzo free? And even if it is benzo-related, is it ok if I start sound therapy now?
Thank you for your advice.
Hi Juan:
How fast are you tapering off the Clonazepam? I’m thinking whatever rate it is, it is still too fast for your body. A safe taper rate is 10% per month on the descending balance for the typical person. Even that could be too fast for some people.
You are in a bit of a tight spot. According to Dr. Jastreboff, you cannot habituate to your tinnitus/hyperacusis if you are taking Benzos until it gets down to a very low level. So, if you are above that level, sound therapy won’t really work for you. Thus, you want to focus on getting off the Benzos first, then do the sound therapy.
I don’t think the sound therapy will hurt, it just might not do much to help you at this point. If you want to try it, you need to set the sound level to just below where your hyperacusis kicks in. You don’t want to aggravate your hyperacusis by having the sound too loud. Then, slowly increase the sound level as your ears can take it.
Cordially,
Neil
Hi, Neil.
Thanks for your reply. Sound therapy won’t help much but won’t hurt either, so it’s good to know.
Like most benzo users, I do regret having taking this drug, especially for so long. I guess my tapering might be fast according to the 10% guideline you stated. I’ll be more precise.
Even though the family doctor said that I could taper more quickly, I’ve been following the Ashton Method, and cutting 0.125 mg (1/4 of a 0.5 clonazepam pill) every two weeks and since the end of last summer every three weeks. Changing to diazepam didn’t work last December (Klonopin is tough to deal with), and I haven’t tried again).
To make things worse, I got down to 0.5mg (from 3mg) last December first, and then due to muscle pain and spams (one last relapse from surgery), the surgeon recommended that I increase the dose again. I did at the beginning of this year (boy, do I regret it), and then back down again to 0.5mg (0.25 x 2), where I’m stuck now.
I didn’t know what “updosing” meant (now I know, unfortunately). Tapering this year has been much harder. I used to have some kind of reactive tinnitus, but no hyperacusis whatsoever until this past summer (and especially this fall).
Now the family doctor advises to slow down a bit, and make cuts every three to four weeks, or even hold longer if needed.
On the other hand, I’m eager to start working on the habituation process and, most of all, get rid of benzos as soon as possible to stop the worsening of the hyperacusis and other ear symptoms (as well as the suffering). So, like you said, not a nice spot to be in; it’s kind of a catch-22 situation.
I guess I’ll have to take it easy (easier said than done) and not rush through the end of the tapering process. At least now I know that sound therapy won’t hurt, and that the fact that I haven’t gotten much (or any) better is due to benzos. I’m keeping the faith.
Any additional comment or advice will be surely be appreciated,
Thank you again,
Juan.
Can I use a desktop generator for pink noise to heal from hyperacusis instead of earphones? Even if it takes longer?
Hi Deborah:
Sure, it is the constant background sound that is important, not whether it is via earbuds or earphones. However, when wearing earphones/earbuds it is easier to keep the volume at a constant level–but both ways should work.
Cordially,
Neil
Oh thank you. I have a sound oasis ans some pure pink noise on cell phone. Ok to listen without ear buds or earphones on those to? Thank you.
Hi Deborah:
Of course.
Cordially,
Neil
Listening to pink noise the tinnitis is louder. If trt does not work, will it die down in time to baseline so I can attempt to habituate again?
Hi Deborah:
For some people listening to white or pink noise makes tinnitus louder due to the stochastic resonance effect. The way around this is to listen to background sounds that are random, but are modulated to some degree. Good examples are water sounds–whether waves lapping on the beach, or pounding on the beach, babbling brook or fountain sounds, waterfalls or rainfall. Or you could listen to fractal music (which sounds much like wind chimes.
Also, make sure any sounds you are listening to are not as loud as your tinnitus. You are not trying to drown out your tinnitus, but to mix with it–so the right level is where your tinnitus begins to mix with the background sound of your choice.
Cordially,
Neil
You mean play the sounds with pink noise or after to heal hyperacusis? Thank you
Hi Deborah:
I mean dump the pink noise altogether and just play water sounds or fractal music in place of the pink noise.
Cordially,
Neil
Hi Neil,
I just tried covering my ears by pushing on the tragus, and it now and it didn’t feel very good. Not necessarily painful, but that area around my ear kinda hurts.
Is it normal to feel some discomfort from doing this? Is there any risk or danger associated with pushing or moving the tragus like this (I’m just overly cautious of my ears)
Thanks
Just to be a bit more specific, I’ve noticed some discomfort when I talk, and I have also had some ringing, but it hasn’t been constant.
Given the proximity to the jaw joint, I am just concerned about possible complications, and am very worried about developing tinnitus.
Hi Scott:
What do you mean “discomfort when you talk”? You mean your voice sounds to loud/sharp? Or do you mean the movements of your jaw, tongue, etc. when you talk is causing the discomfort?
If your tmj is out of proper alignment, this could cause tinnitus.
Cordially,
Neil
Hi Scott:
Pushing your tragus in to block your ear canals shouldn’t hurt or be uncomfortable. I don’t see any risk or danger to your ears from doing this.
However, if either your facial or trigeminal nerves are agitated/inflamed/hypersensitive for some reason, that could be a result. This could be because your neck, jaw, etc are not in proper alignment.
Cordially,
Neil
Salutare dmn Neil!De aproximativ două luni jumate mă confrunt cu zgomot în urechea stângă,am fost diagnosticat cu traumă sonoră survenită de la mediu zgomotos unde am lucrat o perioada scurtă de timp dar care se pare că ma afectat.De asemenea observ și o sensibilitate la zgomote.Medicul ORL mi a prescris un tratament pe baza de ginkgo biloba și mi a spus răbdare că îmi va trece.Un sfat vă rog frumos?
Hello Mr. Neil! For about two and a half months I have been experiencing noise in my left ear, I was diagnosed with sound trauma from the noisy environment where I worked for a short time but it seems to have affected me. I also notice a sensitivity to noise. The ENT doctor prescribed me a treatment based on ginkgo biloba and patiently told me that it would pass. Any nice advice please?
Hi Stan:
To be effective in treating tinnitus, the therapeutic dose of Ginko biloba is 480 mg and needs to be standardized to 22 – 27% flavone glycosides, 5 – 7% terpene lactones and 2.6 – 3.2% bilobalide, so any Ginkgo extract that is in this ballpark should be effective. If you only take 150 mg or so of Ginkgo, this isn’t enough to be effective.
Just be aware that Ginkgo does not work for all kinds of tinnitus, but it is good for noise-induced tinnitus, tinnitus caused by hearing loss and tinnitus caused by ototoxic drugs. You may have to take the Ginkgo for 1 to 3 months before you see any benefit, so don’t give up too easily.
Loud noise can certainly cause tinnitus. If the sound was sudden or too loud, it can also cause normal sounds to appear to be too loud. This is called loudness hyperacusis. If this is what you also have, you want to protect your ears from louder sounds while your ears “heal”. This can take from several months to a year or more.
Hopefully, it will return to normal in time, but you must not treat your tinnitus or hyperacusis as a threat to your well-being. Instead, you need to treat your tinnitus as a totally useless, unimportant sound that is safe to ignore and then ignore it by focusing on the loves of your life.
Cordially,
Neil