Can Overprotecting Permanently Worsen Hyperacusis?

[WilliamS95]

I have pretty severe hyperacusis due to tapering down from benzodiazepines. My taper lasted about 3 months, during which I protected my hearing pretty rigorously (earplugs in the car, shower, while having conversation). Now that my taper is done, I'm slowly easing up on the ear protection. I no longer wear earplugs in the house, but continue to do so while driving my car/walking in the city etc.

Can this kind of overprotection actually do permanent damage? Or do the ears adjust once they're exposed to normal sound levels?

 

[astaff14]

I don't think overprotection is really a thing. Your ears need to heal and you may always need to wear earplugs in louder environments even as you are more able to handle regular sounds. I didn't protect myself as well as I should have (wore ear plugs only half inserted for a good portion of my shifts) and my H is so much worse now. You'll regret underprotecting much more than over, I promise. It seems like you're headed in a good direction.

 

[Juan]

I have pretty severe hyperacusis due to tapering down from benzodiazepines. My taper lasted about 3 months, during which I protected my hearing pretty rigorously (earplugs in the car, shower, while having conversation). Now that my taper is done, I'm slowly easing up on the ear protection. I no longer wear earplugs in the house, but continue to do so while driving my car/walking in the city etc.

Can this kind of overprotection actually do permanent damage? Or do the ears adjust once they're exposed to normal sound levels?

I think it is very reasonable to wear earplugs in the car, since some of the loudest sounds are noises from traffic, car horns, bikes, sirens, etc

As long as you dont use earplugs at home, listen to music, to TV, and can be out at quiet places without them you are already getting your ears used to normal sounds. Some common sounds, that we hear daily, are really loud and can hurt ears, and people dont think about it just because those sounds are common, not because they cannot make any damage. Think of the ton of stuff we use daily that produces very loud sounds, from an electric coffee grinder to motorbikes passing by, to the vacuum cleaner, car horns, sirens etc..

 

[Ed209]

I don't think overprotection is really a thing. Your ears need to heal and you may always need to wear earplugs in louder environments even as you are more able to handle regular sounds. I didn't protect myself as well as I should have (wore ear plugs only half inserted for a good portion of my shifts) and my H is so much worse now. You'll regret underprotecting much more than over, I promise. It seems like you're headed in a good direction.

I can assure you that over-protection is a thing and that there are many on this site and elsewhere who have fallen victim to it. Ears don't heal. I'm not sure why this message keeps getting repeated on here as it has no scientific basis. If one damages their ears, they will stay damaged forever, unless that person happens to be a bird. The tiny hair cells in the cochlea do not regenerate. If they did, there would be no need for the millions of dollars that's currently being invested into regenerative therapy.

Time and time again, I see people on here advising others to protect their ears so that they can "heal." What does that even mean? What usually happens is that people become obsessed with all sound and they start protecting at all costs regardless of how loud something is. This is the beginning of a toxic and unhealthy relationship with all environmental sound, and it starts to look like a lot like OCD.

I've heard some truly heartbreaking stories during my time here relating to phonophobia but the subject is never taken seriously. Many have gone through therapy to try and correct the problem as they begin to realise how paralysed and afraid they are. This can lead to suicidal thoughts and can be extremely crippling and not to mention really bad for one's tinnitus! For some, merely leaving their house is a massive deal because they are afraid something loud might happen. This can descend into people wearing double protection around the clock and to them being afraid to talk to people in small groups. It can become a mental illness in its own right. Personally, I think there should be a podcast episode on the matter as many here are phonophobic.

Constantly depriving the auditory system of sound is not a good idea for tinnitus and/or hyperacusis sufferers, and there are good reasons for this.

 

[Mister Muso]

@Ed209

Respectfully, if "ears don't heal" then why do people report improvements in their symptoms?

Both my tinnitus and hyperacusis are less severe now than when I first got severe noise induced tinnitus 8 months ago.

If that's not healing, then what is it?

 

[Ed209]

@Ed209

Respectfully, if "ears don't heal" then why do people report improvements in their symptoms?

Both my tinnitus and hyperacusis are less severe now than when I first got severe noise induced tinnitus 8 months ago.

If that's not healing, then what is it?

Because it's a problem in the brain. It's down to maladaptive plasticity; changes that are not beneficial to us. There are various theories as to how this comes about, but the brain remains plastic, so it can still change and adapt as time goes by.

Positive changes do not occur because one's ears have miraculously healed. That in itself would be a pretty significant world-first discovery.

 

[Mister Muso]

Because it's a problem in the brain. It's down to maladaptive plasticity; changes that are not beneficial to us. There are various theories as to how this comes about, but the brain remains plastic, so it can still change and adapt as time goes by.

Thanks Ed that's helpful. When I first joined this forum I would get quite despondent sometimes at posts which seemed to say that, because my damage is permanent, there is no hope of recovery and it could even get worse etc. etc. It's easy to get into a downward spiral of despair by focussing on those type of thoughts. But by wife is a doctor and always says "the body has a remarkable ability to heal itself". As you say, that doesn't (so far) include the ability to re-grow lost hair cells. However the brain takes control and somehow seems to "dampen down" the symptoms where it determines they have no benefit. By getting on with our lives and taking certain precautions where necessary, perhaps we train our brain into taking that action.

Back to the topic of the thread, I believe it is possible to underprotect as well as overprotect. It's a balance as with many things. I had reached the point where I no longer needed to protect my ears from the sound of my power shower, which I've always enjoyed in the mornings. On one of the first few mornings when I showered without earplugs, I dropped my back brush onto the floor. The hard plastic made such a noise as it struck the ceramic shower flow that I felt fullness in my ear for two days. So even at home there are risks. It keeps us busy alright, trying to anticipate them all.

 

[Jack Straw]

When I first joined this forum I would get quite despondent sometimes at posts which seemed to say that, because my damage is permanent, there is no hope of recovery and it could even get worse etc. etc. It's easy to get into a downward spiral of despair by focussing on those type of thoughts.

This is a big problem on Tinnitus Talk. People posting misinformation and theories as fact. Eventually people believe it to be fact because it has been repeated so many times. Can't always listen to people on the internet and take what they say as fact.

 

[david c]

Wearing hearing protection in situations that are likely to involve reasonably high levels of noise exposure is only sensible. That doesn't, of course, mean wearing hearing protection all the time or even the majority of the time. Repeated loud noise exposure is one of the things which is guaranteed to make people's tinnitus worse (particularly if the tinnitus was caused by noise in the first place).

Wearing hearing protection isn't fundamentally about letting ears "heal", it's about preventing tinnitus from worsening - and over time sensible hearing protection can help to reduce tinnitus "intrusiveness"/loudness in many cases.

 

[Marceline]

My doctor told me, that overprotection isn't a good thing. He also added, that sometimes, a little bit loud voices would be "healthy".

 

[astaff14]

I can assure you that over-protection is a thing and that there are many on this site and elsewhere who have fallen victim to it. Ears don't heal. I'm not sure why this message keeps getting repeated on here as it has no scientific basis. If one damages their ears, they will stay damaged forever, unless that person happens to be a bird. The tiny hair cells in the cochlea do not regenerate. If they did, there would be no need for the millions of dollars that's currently being invested into regenerative therapy.

Time and time again, I see people on here advising others to protect their ears so that they can "heal." What does that even mean? What usually happens is that people become obsessed with all sound and they start protecting at all costs regardless of how loud something is. This is the beginning of a toxic and unhealthy relationship with all environmental sound, and it starts to look like a lot like OCD.

I've heard some truly heartbreaking stories during my time here relating to phonophobia but the subject is never taken seriously. Many have gone through therapy to try and correct the problem as they begin to realise how paralysed and afraid they are. This can lead to suicidal thoughts and can be extremely crippling and not to mention really bad for one's tinnitus! For some, merely leaving their house is a massive deal because they are afraid something loud might happen. This can descend into people wearing double protection around the clock and to them being afraid to talk to people in small groups. It can become a mental illness in its own right. Personally, I think there should be a podcast episode on the matter as many here are phonophobic.

Constantly depriving the auditory system of sound is not a good idea for tinnitus and/or hyperacusis sufferers, and there are good reasons for this.

I feel like you're playing at semantics here honestly - okay ears don't heal in terms of the hair cells being regrown and hearing coming back, but symptoms do improve for a lot of people. If sounds seem too loud for people and are painful then their ears need to be protected in those situations.

Really my original comment was wrong though, it all depends on the person and their specific tinnitus as to what they should be doing. I appreciate your correction on my comment though because in many ways you are right

 

[TheDanishGirl]

Whether your for overprotection or not, it's all theory, cause lets be honest........in reality all us of know nearly jack shit about this condition. Even the so called "experts"

If I try to switch on my rational thinking, it makes sense to me that hyperacusis can worsen permently from sounds that are not generally deemed dangerous. If you've hurt your leg or your arm, activities that are otherwise normal and healthy, could aggrevate the damage further......why should our ears behave any differently? I have personally read enough stories of people ending up much worse from seemingly harmless noises to realize there IS a risk.

My theory is that it's about keeping things in balance: overprotection could be problematic but so could underprotection........where that perfect balance is, is the toughest question with this condition.

 

[Zugzug]

Whatever your opinion is on over/under protection, all that I ask is that you don't ignore data points that don't fit your narrative.

The idea that the problem can't physically improve is ridiculous. My (severe) hyperacusis is caused by an autoimmune disease. For months, I tried sound therapy and noise exposure. Nothing - even got worse. Then I started taking immunosuppressants and my problem has improved a lot in just 3 weeks. Trust me; my mentality didn't change. I still track decibel levels like I used to. I think about hyperacusis a lot. Yet the problem is much, much better. The idea that hyperacusis is greatly influenced by how much you're thinking about it is untrue.

What I'm sure is true is that after one recovers from hyperacusis, there's probably a lot of residual obsessive behavior that is unnecessary and needs to be worked through using CBT.

Another thing is that acoustic therapy (which I'm doing in case it helps) is loaded with correlations. You hear story after story of "so and so got better while living their life like they used to." Yet, in all likelihood, they were only able to do this because their hyperacusis was getting better. Like I said, you can't ignore the fact that I was doing sound therapy and getting no results. Just because I can tolerate more sound now, that doesn't prove it's the sound therapy. The gung-ho TRT people will make excuses like "you weren't doing it for long enough" or whatever. Just be real about the fact that it helps some people, but not others.

With all of this being said, no one knows what they're doing. The whole reason why I'm continuing to do acoustic therapy is because I respect the fact that it may be helping. But I certainly have no proof of this. In fact, if I were to track the data honestly, it may reflect the opposite.

 

[Ed209]

I feel like you're playing at semantics here honestly - okay ears don't heal in terms of the hair cells being regrown and hearing coming back, but symptoms do improve for a lot of people. If sounds seem too loud for people and are painful then their ears need to be protected in those situations.

Really my original comment was wrong though, it all depends on the person and their specific tinnitus as to what they should be doing. I appreciate your correction on my comment though because in many ways you are right

I understand your reasoning here, but your original comment of saying "I don't think overprotection is really a thing" just touched a nerve with me because it very much is a thing. It's not down to semantics. I spent years here trying to help various people (via email and PM) who were chronically overprotecting. They were a mess and their lives were at a crisis point because of the psychological aspect of how they were fearing sound. It also made their ears more sensitive.

It often gets downplayed on here and when I speak about it I feel people can take offence, but if you could see some of the stuff I've been sent over the years you'd understand why I'm so outspoken about it.

We should always protect our ears from damaging noise. The line gets crossed when people start using ear protection just to function (this is overprotection). For example, some people wear double protection in their own house, pretty much 24/7. This is whilst showering, talking to people, watching tv, etc, etc.

Once this line is crossed you start to see a pattern of dramatic decline and it's heartbreaking to witness first hand. I've noticed over the years that this problem is quite a hidden one in that people are mainly vocal about it in private and not so much on the forum. You only have to see some of the patterns of behaviour people develop and how they spike all the time to know that severe phonophobia can be a ruthless condition in its own right. And when I say spike all the time, I mean to things that aren't even remotely dangerous and this is whilst they are protecting (often double protecting).

 

[Alue]

Permanently worsen, as in doing further damage to the auditory processing system, no.

It can make you more sensitive to loud noises once the protection comes off, though. The problem lies that what is safe and does not cause exacerbation for one person isn't guaranteed to be safe for someone else with hyperacusis. Where do you draw the line between over-protection and just taking reasonable protection? I don't think anyone has an answer to that.

Being in a loud area with earplugs may not do permanent damage to my ears, but I know certain noise levels will make my tinnitus spike for days afterwards and it's just not worth it. On a few occasions, I've also developed permanent new tones so that's some sort of indication of additional damage.

 

[Juan]

The idea that the problem can't physically improve is ridiculous. My (severe) hyperacusis is caused by an autoimmune disease. For months, I tried sound therapy and noise exposure. Nothing - even got worse. Then I started taking immunosuppressants and my problem has improved a lot in just 3 weeks. Trust me; my mentality didn't change. I still track decibel levels like I used to. I think about hyperacusis a lot. Yet the problem is much, much better. The idea that hyperacusis is greatly influenced by how much you're thinking about it is untrue.

What inmunosuppressants do you take? And how was your hyperacusis diagnosed as coming from an autoinmune disease? What tests did you take to find out that?

 

[astaff14]

I understand your reasoning here, but your original comment of saying "I don't think overprotection is really a thing" just touched a nerve with me because it very much is a thing. It's not down to semantics. I spent years here trying to help various people (via email and PM) who were chronically overprotecting. They were a mess and their lives were at a crisis point because of the psychological aspect of how they were fearing sound. It also made their ears more sensitive.

It often gets downplayed on here and when I speak about it I feel people can take offence, but if you could see some of the stuff I've been sent over the years you'd understand why I'm so outspoken about it.

We should always protect our ears from damaging noise. The line gets crossed when people start using ear protection just to function (this is overprotection). For example, some people wear double protection in their own house, pretty much 24/7. This is whilst showering, talking to people, watching tv, etc, etc.

Once this line is crossed you start to see a pattern of dramatic decline and it's heartbreaking to witness first hand. I've noticed over the years that this problem is quite a hidden one in that people are mainly vocal about it in private and not so much on the forum. You only have to see some of the patterns of behaviour people develop and how they spike all the time to know that severe phonophobia can be a ruthless condition in its own right. And when I say spike all the time, I mean to things that aren't even remotely dangerous and this is whilst they are protecting (often double protecting).

Yeah you're right, and it wasn't fair of me to say that because really I was going off my own anxiety at that moment in time and thinking how under protecting had personally affected me, i.e. by making my tinnitus spike somewhat and exposing my self to loud sounds that wouldn't have felt as bad if I had just protected my ears a bit better. I do apologize for that and am going to aim to be more conscientious because there are certainly people here, including yourself who have worse tinnitus than I and have dealt with many more people with this affliction.

Do you think that level of phonophobia can be reversed if one starts exposing their ears to every day sounds? I'm personally in a strange place right now where I cringe at a lot of noises, especially any beeping, dishes clanking, things slamming, loud voices, and I wear ear plugs any time in public. It's such a hard thing to balance, I'm always so scared that I'm going to hear a loud noise that'll fuck me over but you're right, wearing ear plugs all the time isn't beneficial. Tinnitus is so tricky.

 

[Ed209]

Yeah you're right, and it wasn't fair of me to say that because really I was going off my own anxiety at that moment in time and thinking how under protecting had personally affected me, i.e. by making my tinnitus spike somewhat and exposing my self to loud sounds that wouldn't have felt as bad if I had just protected my ears a bit better. I do apologize for that and am going to aim to be more conscientious because there are certainly people here, including yourself who have worse tinnitus than I and have dealt with many more people with this affliction.

Do you think that level of phonophobia can be reversed if one starts exposing their ears to everyday sounds? I'm personally in a strange place right now where I cringe at a lot of noises, especially any beeping, dishes clanking, things slamming, loud voices, and I wear ear plugs any time in public. It's such a hard thing to balance, I'm always so scared that I'm going to hear a loud noise that'll fuck me over but you're right, wearing ear plugs all the time isn't beneficial. Tinnitus is so tricky.

You sound like me 3 years ago. It's really tough adjusting to severe tinnitus; I had all the same problems and I drove myself insane with it all. I used to wear earplugs everywhere and I'd severely panic at every loud noise I encountered. If I heard something I thought was dangerous I'd immediately check my tinnitus and panic which would inevitably spike it. This went on for a long time.

Eventually, I ditched using earplugs in this way when I realised they weren't helping me and in fact, they were making things worse. I still use my muffs to mow the lawn and use my custom plugs at the cinema and in loud bars, etc. I just don't constantly protect like I once did. I realised I was developing phonophobia and knew I had to nip it in the bud.

Our auditory system is not designed to be shielded in this way and occasional bangs are not dangerous to our hearing. Overprotection leads to over-sensitised hearing and the potential for a vicious cycle of hearing a clang (or sudden sound), ruminating, and then ultimately spiking which strengthens the feedback loop and the stranglehold it has over you.

I'm only telling you my experience and you can freely discount it. Whatever path you take I wish you all the best and I hope you can put all these problems behind you.

 

[Juan]

Do you think that level of phonophobia can be reversed if one starts exposing their ears to every day sounds? I'm personally in a strange place right now where I cringe at a lot of noises, especially any beeping, dishes clanking, things slamming, loud voices, and I wear ear plugs any time in public. It's such a hard thing to balance, I'm always so scared that I'm going to hear a loud noise that'll fuck me over but you're right, wearing ear plugs all the time isn't beneficial. Tinnitus is so tricky.

I am not sure of whether that is phonophobia. I have been at the same place as you are now, but in my case with severe hyperacusis, and in hindsight I think my level of fear from sounds was justified, since I have lost hearing due to sounds that were ok to people who were with me when I was exposed to those decibels. They were ok after it, and I lost hearing.

 

[Zugzug]

What inmunosuppressants do you take? And how was your hyperacusis diagnosed as coming from an autoinmune disease? What tests did you take to find out that?

This is a bit complicated and technically speaking, I don't have a diagnosis. But I've had classical autoimmune symptoms for 5 years now (long before I developed inner ear issues): bodily pain, neuropathy in my arms, legs, and back, GI problems, energy problems, and many more symptoms.

Stressful periods tend to bring on my flare ups. This time around, I didn't get the usual bodily pain and instead developed balance problems, tinnitus, and hyperacusis.

All of my doctors basically agree that it presents like an autoimmune disease, but I don't have enough blood markers that are positive yet to be exactly sure what it is; one suspicion is early Sjogren's syndrome, but I don't present with extreme dryness, only mild. I am currently taking CBD (an anti-inflammatory and immunosuppressant). I have steroids on hand, but I am riding out the improvement with the CBD since it's much better for the body.

Yet another piece of evidence that it's autoimmune is that the CBD is helping me immensely. Just 3 weeks ago, I had LDLs in the 30's. Now it's more like 80. I know how miraculous this is. There has to be a disease being treated since I know from my research that CBD isn't known as a universal fix for hyperacusis.

 

[MattR]

Everyone is different and the reason for ear issues may stem from different things. With that said, I think walking around always worried about ear protection and loud noises only exacerbates the issue and basically turns your life into a game of avoiding everything and constantly worrying.

I wouldn't say my ear pain has gotten much better since it started, however my attitude towards it has certainly changed and I live my life similar to how I did before. I just avoid places with loud music (like clubs) and arenas. It bothers at times but I don't feel like I want to just fall asleep and not wake up anymore.

I think it's important to understand it is HIGHLY unlikely that sounds as low as 30 or 40db are actually causing some sort of damage to your ear even if there is pain. Sounds above 100-110db? That's a little more feasible.

 

[Bill Bauer]

Or do the ears adjust once they're exposed to normal sound levels?

They do.

 

[chuto]

[QUOTE=" This is the beginning of a toxic and unhealthy relationship with all environmental sound, and it starts to look like a lot like OCD.

I've heard some truly heartbreaking stories during my time here relating to phonophobia but the subject is never taken seriously. Many have gone through therapy to try and correct the problem as they begin to realise how paralysed and afraid they are. This can lead to suicidal thoughts and can be extremely crippling and not to mention really bad for one's tinnitus!

Constantly depriving the auditory system of sound is not a good idea for tinnitus and/or hyperacusis sufferers, and there are good reasons for this.[/QUOTE]

You described me, yes unfortunately personally I think overprotecting leads to obsession and not good for ears to be able to adjust to everyday sounds..

 

[Ed209]

Everyone is different and the reason for ear issues may stem from different things. With that said, I think walking around always worried about ear protection and loud noises only exacerbates the issue and basically turns your life into a game of avoiding everything and constantly worrying.

I wouldn't say my ear pain has gotten much better since it started, however my attitude towards it has certainly changed and I live my life similar to how I did before. I just avoid places with loud music (like clubs) and arenas. It bothers at times but I don't feel like I want to just fall asleep and not wake up anymore.

I think it's important to understand it is HIGHLY unlikely that sounds as low as 30 or 40db are actually causing some sort of damage to your ear even if there is pain. Sounds above 100-110db? That's a little more feasible.

Hyperacusis makes everything so much more difficult.

 

[Juan]

All of my doctors basically agree that it presents like an autoimmune disease, but I don't have enough blood markers that are positive yet to be exactly sure what it is; one suspicion is early Sjogren's syndrome, but I don't present with extreme dryness, only mild. I am currently taking CBD (an anti-inflammatory and immunosuppressant). I have steroids on hand, but I am riding out the improvement with the CBD since it's much better for the body.

But there are markers to identify that disease since birth:

"Sjögren–Larsson syndrome is an autosomal recessive form of ichthyosis apparent at birth.[1]:485[2]:564[3] Sjögren–Larsson syndrome is a rare autosomal, recessive, neurocutaneous disease. This disease can be identified by a triad of medical disorders. The first is ichthyosis, which is a buildup of skin to form a scale-like covering that causes dry skin and other problems. The second identifier is paraplegia which is characterized by leg spasms. The final identifier is intellectual delay."

 

[Juan]

Yet another piece of evidence that it's autoimmune is that the CBD is helping me immensely. Just 3 weeks ago, I had LDLs in the 30's. Now it's more like 80. I know how miraculous this is. There has to be a disease being treated since I know from my research that CBD isn't known as a universal fix for hyperacusis.

CBD is for cannabis?

 

[Zugzug]

But there are markers to identify that disease since birth:

"Sjögren–Larsson syndrome is an autosomal recessive form of ichthyosis apparent at birth.[1]:485[2]:564[3] Sjögren–Larsson syndrome is a rare autosomal, recessive, neurocutaneous disease. This disease can be identified by a triad of medical disorders. The first is ichthyosis, which is a buildup of skin to form a scale-like covering that causes dry skin and other problems. The second identifier is paraplegia which is characterized by leg spasms. The final identifier is intellectual delay."

Sjogren's syndrome is not the same as Sjogren-Larsson syndrome. As far as Sjogren's syndrome, the time to diagnosis from onset of symptoms averages over 4 years. Autoimmune diseases are often not the kind of thing you walk in and get a diagnosis.

 

[Juan]

Sjogren's syndrome is not the same as Sjogren-Larsson syndrome. As far as Sjogren's syndrome, the time to diagnosis from onset of symptoms averages over 4 years. Autoimmune diseases are often not the kind of thing you walk in and get a diagnosis.

Tests like these can give false positives:

"Blood tests can be done to determine if a patient has high levels of antibodies that are indicative of the condition, such as antinuclear antibody (ANA) and rheumatoid factor (because SS frequently occurs secondary to rheumatoid arthritis), which are associated with autoimmune diseases. Typical SS ANA patterns are SSA/Ro and SSB/La, of which Anti-SSB/La is far more specific; Anti-SSA/Ro is associated with numerous other autoimmune conditions, but are often present in SS. However, Anti-SSA and Anti-SSB tests are frequently not positive in SS"

https://en.wikipedia.org/wiki/Sjögren_syndrome

I personally dont know anyone with that disease.. it seems very rare.

 

[Zugzug]

Tests like these can give false positives:

"Blood tests can be done to determine if a patient has high levels of antibodies that are indicative of the condition, such as antinuclear antibody (ANA) and rheumatoid factor (because SS frequently occurs secondary to rheumatoid arthritis), which are associated with autoimmune diseases. Typical SS ANA patterns are SSA/Ro and SSB/La, of which Anti-SSB/La is far more specific; Anti-SSA/Ro is associated with numerous other autoimmune conditions, but are often present in SS. However, Anti-SSA and Anti-SSB tests are frequently not positive in SS"

https://en.wikipedia.org/wiki/Sjögren_syndrome

I personally dont know anyone with that disease.. it seems very rare.

I don't want to hijack the original post. I'll just say that I've tested positive for SSB four out of four times over the course of 5 years. Anyways, it's not clear which disease I have; like I said, Sjogren's is the best guess, but it's not guaranteed.

 

[Ed209]

@astaff14, these were the plugs I was referring to incase you were unsure:

https://www.acscustom.com/uk/products/hearing-protection/pro-series/pro-impulse