Calling All Hyperacusis Aficionados…

[stophiss]

Thought I would join the fray and ask a question perhaps similar to others asked on this forum.

Will my hyperacusis go away? Chicken and egg. Which came first? H or T…or T then H?

So, there are bonafide experts on here that know as much cause and effect as many medical doctors about hyperacusis and tinnitus and so thought I would ask the unanswerable question. What are the odds of H going away? Is H always the result of an internal hardware or brain deficiency? Can the brain adjust to a hardware deficiency and lower H?

First a quick definition of H…most here know what it is. A hypersensitivity to sound…perhaps targeted frequencies. For me it is clear I have H when I get out plates in the morning for breakfast and just setting them on a granite counter creates a pretty large clank. Don't believe I have severe H or T. Maybe moderate to mild…hard to know what level I have relative to others. But sounds do seem magnified to me. For some reason, my brain has turned up the gain on my hearing and certain sounds are louder than I believe they should be. A loud truck going down the road I am standing next to sounds too loud for example…to the point I want to cover my ears.

Begs the question, why H exists? Is it damage to my hearing apparatus aka cochlea or auditory cortex and the brain turns up the gain to compensate? In fact is H actually a precursor to T…maybe the very definition of T? Because T is essentially the increased volume of noise I have always had in my auditory track but for some reason my brain has turned up the gain, now I notice it and remember it and reversing this pattern is difficult.

So would love to hear from those that believe or have experience their H actually subsiding and/or relate any correlation to their T as a result. Or share what they believe to be the relationship between H and T and if in fact, they maybe even proportionate and relational?

Many thanks

 

[Michael Leigh]

@stophiss
Hyperacusis can be completely cured in my opinion but needs to be treated, although not in all cases. My hyperacusis was so severe, that I had to ask people to please lower their voice when talking to me as my ears hurt so much. That was nearly 20 years ago and was cured using white noise generators and sound enrichment at night using a sound machine. I was on a TRT treatment programme. You might find the posts below helpful.
Michael

Hyperacusis.

Two questions often asked about tinnitus are: How long does it take to habituate? How do I know if I have hyperacusis?

One of the main causes of tinnitus is exposure to loud noise. Quite often though hyperacusis, (sensitivity to sounds) accompanies the condition. This is because the nerves in the auditory pathway have been subjected to noise trauma and thus become highly sensitised. Hyperacusis can be extremely painful. It can cause tinnitus to spike sometimes making it last for days until it settles down again. Within this time the person affected can be in a lot of discomfort.

Music that was once pleasurable to listen to through a home music system or radio is now an ordeal so one prefers not to listen to it. The closing of doors, washing up of kitchen plates and cutlery is enough to send a person running for cover, as it can feel like a pneumatic drill is piercing through your ears and head. It can become such a problem a person is afraid to venture outside their home in fear of road traffic noise sparking an increase in their tinnitus due to their sensitivity to sound.

One of the best ways to treat hyperacusis is by using "sound enrichment". This can be achieved in many ways but I one of the best to wear white noise generators. Two should be worn to keep your auditory system in balance. The sound level of these devices must be adjusted correctly so as not to cause further irritation to a person's auditory system, which can make the hyperacusis and tinnitus worse. It is best to always make sure their sound levels are set just below the tinnitus. Wngs are usually worn for up to ten hours a day. Two things are achieved over time.

The hearing system is constantly subjected to low-level non-intrusive white noise, which will help to desensitise it. Secondly, they help the brain to focus less on the tinnitus and push it further into the background making it less noticeable. This form of treatment is also known as TRT.

An alternative to wngs is to use a tabletop sound machine that plays nature sounds. This can be used for sound enrichment to help the healing process of hyperacusis. Again it is best to set the sound level just below the tinnitus. As previously explained sound machines can be very useful at night by the bedside and in the day used to fill in the background ambiance in room.

Treating hyperacusis takes time as there is no quick fix and everyone will respond to treatment differently.
Please bare in mind that a person with tinnitus and hyperacuisis, if the hyperacusis is left untreated sensitivity to sound will always remain a problem. In some cases hyperacusis can get better naturally without using sound enrichment but there is no guarantee.

A word of caution. Some people use earplugs to help suppress external sounds because of their sensitivity to sound. Earplugs are available but should only be used when in noisy surroundings and not to suppress normal every day sounds, as doing so can prevent the healing process of hyperacusis.


Habituating to Tinnitus.

Habituating to tinnitus often seems shrouded in mystery for the more seriously affected people that are in distress and have had to seek help at ENT. It can be particularly difficult for people that are new to tinnitus to comprehend. How does one know when they have habituated to their T and more importantly what does this actually mean?

The following doesn't apply in every case of tinnitus for there are some people that have large fluctuations in their T and every day can be a different experience. This is one of the most severe forms of tinnitus and medications may be required to help cope with the condition. Habituating to this type of tinnitus is still possible to an extent but does present additional problems.


To others I will say this: You'll know when you have habituated to your T regardless of whatever treatment you are using via ENT etc as your brain will over time push it further into the background so it becomes less significant, in a similar way to the people that have mild tinnitus. Although your T may be present and on occasions it will spike, over time it will cease to be so much of a problem unless you deliberately focus on it and bring it to the forefront of your mind.

What is Reactive Tinnitus?

A word often used in tinnitus forums these days is: "Reactive" tinnitus. People affected will say something like: " I have habituated but my tinnitus is reactive to certain sounds" or " I have reactive tinnitus". I believe there is some confusion here and will explain.

Someone that has tinnitus especially when caused by loud noise exposure hyperacusis (sensitivity to certain sounds) is often present. If hyperacusis isn't treated the auditory system will always be sensitive to certain sounds even after habituation has been reached. It is for this reason the use of white noise generators (wngs) is recommended to help desensitize the auditory system. White noise generators are used as part of TRT (tinnitus retraining therapy) and must be adjusted correctly as not to irritate the inner ear (cochlear) when wearing them. This treatment is best done under the care of a Hearing Therapist.

When a person says they have "reactive tinnitus" in my opinion, they are not aware they have hyperacusis, which is causing their tinnitus to spike when they hear certain sounds. Although hyperacusis can improve by itself with time, without treatment there is no guarantee. For this reason I often recommend a person to use sound enrichment (sound therapy) as it helps to desensitize the auditory system.

Inside the human body is noisy place but our brain has learned to filter out much of this sound so it doesn't focus on it. Anyone with tinnitus that sleeps in a quiet room, risks making their tinnitus more intrusive as the brain and auditory system never switch off. If the brain hears silence while we sleep, it has the ability to increase its background activity, and at the same time increasing the tinnitus making it louder and more intrusive. A person might not notice this immediately as it's usually a gradual process.

When we are in deep sleep a sound machine supplies the brain and auditory system with sound enrichment. Over time, the tinnitus is pushed further into the background making it less intrusive and will help make the path to habituation easier. It is usually best to have the sound machine playing in the background at a low level (slightly below the tinnitus) without drawing attention to itself unlike a radio. For this reason music is not the best source to use at night as it draws attention to itself.

Michael

 

[stophiss]

Thanks so much Michael. Is hyperacusis almost always a companion of tinnitus? In other words, is hyper sound sensitivity perceived to be a root cause of tinnitus which is the brain turning up the gain on certain frequencies which naturally occur in the auditory track...but hyper sound sensitivity magnifies these sounds which by definition is tinnitus...the magnification of sound present in all...inherent noise due to the acoustics of the hearing apparatus that is now recognized as tinnitus because the brain turns up the gain?

Thanks again.

 

[Sen]

Most clinics that treat hyperacusis with TRT based sound therapy claim anywhere between an 80-90% success rate. I can't recall offhand how "success" is defined in this context, or how much long-term followup is conducted. Keep in mind that these figures are also not based on real scientific study, but numbers tracked by clinicians, and do not include individuals who are turned down for treatment by the clinician, or who discontinue treatment due to worsening.

Nobody really knows why hyperacusis happens. Nobody knows why sound therapy helps, or why in some cases it does not help. Nobody knows if sound therapy cures the underlying mechanism, or if it just habituates the brain to its new perception of sound. Nobody knows if there are different types of hyperacusis, or if it all falls under the same umbrella. There are even clinicians who now believe that low LDLs can indicate misophonia, without any hyperacusis being present at all.

There is a lot of conjecture and hypothesis, but no solid answers or standardized consensus among those in the field. It's a highly under-researched area of auditory function, even less so than tinnitus.

 

[stophiss]

Thanks a lot Sen. I appreciate your insight.

 

[lymebite]

@stophiss, you may find it worthwhile to read the Hyperacusis Research newsletters posted here:

https://www.tinnitustalk.com/threads/hyperacusis-research-newsletters.15271/

They will give you a sense for where the medical researchers stand with respect to your questions. Unfortunately, it is all consistent with what @Sen has said - really there are still more questions than answers and much, much more research is needed. But the newsletters will show you which universities are doing work with hyperacusis and what they have discovered so far.

 

[Michael Leigh]

@stophiss
I agree with @Sen. Nobody really knows why sound therapy helps tinnitus and hyperacusis. I suggest you read the TRT (Tinnitus Retraining Therapy) book written by Professor Pawel Jasterboff and Jonathon Hazell. It is available from Amazon.

To be brief. It explains, when the brain and auditory system are exposed to loud noise (trauma) the end result is often tinnitus and hyperacusis. The hyper sensitivity is caused when the auditory gateways (receptors) in the brain have been opened up by the noise trauma. The theory to correct this: is to supply the brain with "sound enrichment" usually with white noise generators and sound machine at night, to close down the auditory receptors which will over time desensitise them.

I have the book and it is very detailed and uses a lot of medical terminology. It explains all about the auditory system and brain, and where they believe tinnitus is generated in the part of the brain called the limbic system. I think you'll find it educational. Written for Hearing Therapists who practice TRT and for others in the medical field and for anyone wanting to know more about tinnitus, hyperacusis and treatment. I believe sound therapy cured my hyperacusis and helped my tinnitus and will continue using it.

Michael

 

[stophiss]

Two further quick questions if I may:
1. If you were to suggest a single sound enrichment aka white noise generator machine to sit on the dresser at night as I sleep (I currently sleep well without sound enrichment however would like to reduce if not eliminate my H) what brand machine and model would you recommend?...recognizing that choice of machine is a personal selection?

2. If there is clear linkage between H and T and they seemed to be companions if not interrelated, if one can reduce H through sound enrichment therapy over time, will there likely be a companion decrease in T as well...at least anecdotally reported based upon the known linkage between H and T?

Thanks again

 

[Michael Leigh]

@stophiss
The best sound machines are made by Oasis: http://www.soundoasis.com/ . They are specifically made for people with tinnitus. There are a variety of sounds to choose from on their machines so you don't have to only use white noise. I use stream and Ocean surf. Oasis sound machines can also be connected to a pillow speaker.

In my opinion, anyone that has tinnitus and sleeps in a quiet room they are not helping themselves. Using a sound machine at night will treat hyperacuis and tinnitus.

I know that I keep on about the benefits of using sound enrichment during the day and night and avoiding the use of headphones. This is based on years of personal experience and helping people with tinnitus and hyperacusis. I have a lot of respect for ENT doctors and other health professionals that work in ENT. They are able to treat the ear and auditory system medically or surgically. However, the majority of them have never experienced intrusive tinnitus to the degree that many people at tinnitustalk have and therefore, know nothing about it.

You might find the post below helpful
Best of luck
Michael

Sound Machines

I have recently been asked about the benefits of using a sound machine after someone read my post on another thread, please find it below.

Sound Oasis makes the best sound machines in my opinion and they are specifically designed for people with tinnitus although anyone will benefit using one. The quality of their digital sounds will be far superior to any homemade sounds that you compile if your intention is to use them for sound enrichment.

A sound machine can be used night and day but do their magic best when we are in deep sleep. It supplies the brain and auditory system with sound enrichment. Over time, the tinnitus is pushed further into the background making it less intrusive and will make the path to habituation easier.

I have three Oasis models. The S-650 is very popular and the one I usually recommend people buy. It comes with a variety of sounds on two sound cards. Additional cards can be purchased. The S-850 travel, is more expensive and compact. It has 18 on-board digital sounds and doesn't use cards. Some people might be bothered by the clock's blue backlight at night-time. It dims but cannot be turned completely off; the S650 backlight can be set to switch off automatically.

My S-3000 deluxe, was bought over the Internet but has been replaced by the S-5000. Both are similar but have different colours. Silver & black. These models are much larger and sophisticated than the others and can only be mains operated. They use a three-speaker system, that has a subwoofer for increased depth and definition to the sound. According to Oasis, over 140 on-board sound combinations are possible. They have FM/AM radio and an external sound source can be selected via the auxiliary input. There are a host of other features.

The purpose of using a sound machine is to have it playing in the background without drawing attention to itself unlike a radio. For this reason, music mustn't be used at night for sound enrichment, as it will draw the Brain's attention and delay habituation.

In my opinion and the advice of Professor Pawel Jastreboff, developer of TRT. Sound enrichment particularly at night should be used by anyone that has intrusive tinnitus. I would go as far to say, it is imperative to do so if you want to help yourself. Over time you will get used to having sound around you both during the day and night. I find it strange to be in a very quiet room now having used a sound machine for so long.

Michael

PS: Many people have contacted me after they have habituated to their T and stopped using sound enrichment at night, only to find their tinnitus becoming intrusive again. The rule of thumb: avoid quiet rooms and surroundings especially at night by using a sound machine.

 

[Sen]

Two further quick questions if I may:
1. If you were to suggest a single sound enrichment aka white noise generator machine to sit on the dresser at night as I sleep (I currently sleep well without sound enrichment however would like to reduce if not eliminate my H) what brand machine and model would you recommend?...recognizing that choice of machine is a personal selection?

2. If there is clear linkage between H and T and they seemed to be companions if not interrelated, if one can reduce H through sound enrichment therapy over time, will there likely be a companion decrease in T as well...at least anecdotally reported based upon the known linkage between H and T?

Thanks again

1. I personally use a pair of good PC speakers with a 10 minute loop of lossless .flac quality pink noise. Here is a link to the files I use: https://archive.org/compress/TenMinutesOfWhiteNoisePinkNoiseAndBrownianNoise/formats=24BIT FLAC&file=/TenMinutesOfWhiteNoisePinkNoiseAndBrownianNoise.zip

This .zip also contains white and brown noise .flac files.

This is the best quality of pink noise you can get, significantly better than anything you will find in a sound machine, in-ear WNGs, or on youtube, but you need something that can play .flac files, and also play it on repeat seamlessly. If you can't play it on repeat seamlessly, you will hear a break in the sound every 10 minutes. I don't have the audio engineering knowledge to splice it together for the purpose of making it last longer without experiencing a loss in quality when encoded, but this is an option as well if you have the know-how.

The software I use to play .flac files is VLC media player, but most modern PC media players should be able to support this file type.

You can also probably burn it to a CD to play on a stereo or something, but I'm not sure how that type of encoding would affect quality.

2. H and T often exist comorbidly, although there is no consensus on exactly how common this is. My opinion is that most hyperacusis sufferers have tinnitus, but much fewer tinnitus sufferers have hyperacusis. There is no evidence that sound therapy will reduce the volume of your tinnitus, but there is adequate evidence that sound therapy can help you habituate to tinnitus.

 

[lapidus]

H and T often exist comorbidly, although there is no consensus on exactly how common this is.

I think I've read that well over 80% of everyone with H claims to also have T and Dr. Rich Salvi has a theory that everyone with T also have H altough most of them have it in such a mild form that they don't know about it. This theory goes well with the recent research about hidden hearing loss/nerve fiber damage.

 

[Michael Leigh]

@stophiss Whatever sound enrichment system you decide to you use, make sure the sound doesn't mask your tinnitus. Using sound therapy at night takes some getting used to for some people, so keep this in mind. The sound therapy should not be set on a timer, instead set it to play throughout the night until morning.
Michael

 

[stophiss]

Thanks so much everybody....
Michael: You continue to offer great help with your informative posts. I listen very carefully to your advice as I believe it to be the voice of great experience and knowledge about a subject you have studied and know so much about. Thank you for sharing your knowledge.

Sen: Sen, I want to tell you to stay strong and choose hopefulness in what appears to be a morass of uncertainty. Your posts explain your suffering and I feel for you. You are so young and so bright and I know you feel hopeless. I implore you to fight. Fight for yourself and those that care about you. You have so much to offer. Thing about suffering is it many times creates great insight searching for answers and also great empathy for others because you understand their suffering. I too have suffered with Trigeminal Neuralgia and now tinnitus...likely even related. In spite of your personal struggles, you make a point to help others increase knowledge about this disorder. I am much older than you. A cure for tinnitus or therapeutic intervention to directionally reduce if not eliminate symptoms may not come in my life time but I believe with great conviction, that help will come in your lifetime and you will gain relief from your suffering.
So fight because that's what men do for what they believe in. Fight for love of self because you know you possess great insight that many in society lack and fight for those that care about you and we care about you and also understand on some level your suffering.

 

[Michael Leigh]

@stophiss Thank you for your kind comments. Tinnitus is a very complex condition. Not because many things can cause it, it also comes in many forms and intensities and no two people experience it the same. When hyperacusis is present it complicates matters further. One of the best ways to treat both conditions when they were caused by noise trauma is with sound enrichment.
Michael

 

[stophiss]

And Michael...that is your gift to this forum...to explain why TRT aka sound enrichment has a positive influence on habituation which also somewhat comports with logic, i.e. distracting the brain toward other sound signatures thereby redirecting the mind away from tinnitus.
Thanks again for teaching this important lesson.

 

[BrianC]

WNGs can get expensive. I bought this set of earphones on Amazon ($150) and ran it from my phone with the Hear and Tinnitus app. Over the course of a month I found my tinnitus to sound a bit more like white noise. Maybe a slight improvement on the H, can't tell if that's from time or treatment though...

https://www.amazon.com/gp/product/B007CJWE5Q/ref=oh_aui_detailpage_o04_s00?ie=UTF8&psc=1

 

[Irish]

Thanks to all of you for the very useful and informative contributions in this thread.
I've learned quite a bit just from reading this thread alone.
I'm one of the less common people whose Tinnitus is practically gone but whose Hyperacusis stubbornly refuses to get much better (only about maybe 20% improvement since the start of this year).
Added to that I have daily clicking in my ears(mostly in left), an unpleasant pressure & sensitive feeling in my ears when the volume of peoples' voices around me rise above a certain point and almost daily low level pain/tenderness, particularly in my left ear, although as I write this, I notice it has improved a bit in recent days.

The question I have for all of you, particularly @Sen & @Michael Leigh, is do you know if sound enrichment can also help with these related issues like ETD/TTTS/Stapedius Myoclonus/Patulous Eustachian Tube?
I have not been diagnosed with any of the above (aside from Hyperacusis & Recruitment) but from the symptoms I have, it does point to some form of one of the above conditions.
My last appointment with an ENT specialist was of very little benefit, perhaps a small hearing loss around 4 KHz mark (but even that was uncertain, could be just a 'testing error' he said), otherwise both ears healthy aside from the nuisance & unpleasantness of H.
I plan to see another specialist soon, who can hopefully nail down what else is going on with my ears aside from H.
But in the meantime, I will see what I can do in terms of starting a sound enrichment regime, and this thread has been immensely helpful in pointing me in the right direction.
Many thanks gents for all the information you've provided here.

 

[Michael Leigh]

@Irish Thank you for your very kind words. As far as I know sound enrichment only treats hyperacusis and tinnitus. I have no knowledge whether it can treat the medical conditions that you mention. I have read the TRT book written by Professor Pawel Jasterboff & Jonathon Hazell. If memory serves me correctly, there is no mention of those medical conditions in it.
Although sound enrichment using a sound machine or another sound source is good. The best method is to be under the care of a hearing therapist and wearing white noise generators as part of TRT.
Michael.

 

[Sen]

do you know if sound enrichment can also help with these related issues like ETD/TTTS/Stapedius Myoclonus/Patulous Eustachian Tube?

No idea. I guess it couldn't hurt though.

 

[Irish]

1. I personally use a pair of good PC speakers with a 10 minute loop of lossless .flac quality pink noise. Here is a link to the files I use: https://archive.org/compress/TenMinutesOfWhiteNoisePinkNoiseAndBrownianNoise/formats=24BIT FLAC&file=/TenMinutesOfWhiteNoisePinkNoiseAndBrownianNoise.zip

This .zip also contains white and brown noise .flac files.

This is the best quality of pink noise you can get, significantly better than anything you will find in a sound machine, in-ear WNGs, or on youtube, but you need something that can play .flac files, and also play it on repeat seamlessly. If you can't play it on repeat seamlessly, you will hear a break in the sound every 10 minutes. I don't have the audio engineering knowledge to splice it together for the purpose of making it last longer without experiencing a loss in quality when encoded, but this is an option as well if you have the know-how.

The software I use to play .flac files is VLC media player, but most modern PC media players should be able to support this file type.

You can also probably burn it to a CD to play on a stereo or something, but I'm not sure how that type of encoding would affect quality.

2. H and T often exist comorbidly, although there is no consensus on exactly how common this is. My opinion is that most hyperacusis sufferers have tinnitus, but much fewer tinnitus sufferers have hyperacusis. There is no evidence that sound therapy will reduce the volume of your tinnitus, but there is adequate evidence that sound therapy can help you habituate to tinnitus.

Hi @Sen, are you still using these noises to help your ears and have they improved since you started with this?