Does Reactive Tinnitus Stop Reacting?

[Michael Leigh]

I was wearing my custom earplugs

@NancyL
Sorry to hear about the increase in your tinnitus. I have written a post today on this and the dangers of loud sound even when wearing noise reducing earplugs, we aren't one hundred percent safe. If external sound is loud enough, it can pass through the Mastoid bone and reach the cochlear, in the inner ear and still cause damage. The Mastoid bone is the hard piece of bone behind each ear and is honeycombed with air pockets. If a person's tinnitus was caused by exposure to loud noise, the auditory system is much more sensitive to sound. Although measuring decibel levels is a good idea, it's not a certainty we are safe from sound spiking the tinnitus.

Michael
https://www.tinnitustalk.com/threads/are-spikes-from-loud-noise-permanent.18156/

 

[Karam]

@Michael Leigh what is your opinion on spikes, do you have a brief theory of why they are caused by loud noise apart from damage?

 

[NancyL]

@Michael Leigh Your warning about headphones is interesting but worrying to me, as listening to notched sound (at low levels) from AudioNotch has been instrumental in helping me return the noise level down to an imperceptible level any time it presents again.

I'll go see if you have other writings on this, as it's not really relevant to this thread. Thanks!

 

[Michael Leigh]

@NancyL I am sorry that my comments worry you about headphones. If you find benefit in using them with AudiNotch then please carry on using it because we are all different.

It is just my personal opinion and based on people that I've counselled whose tinnitus has been made worse by listening to audio through headphones even at low level.
Michael

 

[Michael Leigh]

@Karam

Hi Karam, thank you for asking me such a good question this morning which gave me the idea to write a post on the subject https://www.tinnitustalk.com/threads/are-spikes-from-loud-noise-permanent.18156/

I think the people that have a lot of spikes in their tinnitus hyperacusis (sensitivity to sound) is the cause of it. Some people call this Reactive tinnitus. I believe reactive tinnitus is hyperacusis. Like tinnitus, hyperacusis is variable in intensity: from mild to moderate and severe. If a person habituates to their tinnitus and the hyperacusis isn't cured they will always have a problem with sensitivity to sound which manifest as tinnitus spikes. Hyperacusis is treated using sound enrichment.
Hope this helps
Michael

 

[Starthrower]

Hey Michael, (and Karam)

I appreciate your knowledge and how you answer so many questions for people.

My experience with the cupped over the ear noise cancelling headset differs only when it comes to providing some safe guards in a loud environment as Karam wrote about at school in the hallways with all the sounds going on. I found great relief and was able to start going out again. I have had tinnitus since 2002 and it was a worse case situation. I was house bound for a year sat in a dark closet rocking back and forth so on and so on (blah blah blah).
Kinda hard to talk about it now. Remembering that time in life is SO emotional.

I would never never use in the ear buds of any kind. Ever.

Music therapy was my life saver and I worked at this very hard. Simply made recordings of songs that seemed to have instrumental or harmony that caught my attention because my tinnitus seemed to lessen in perception or whatever.

But I always and to this day use this therapy with the bose headset and tightly rolled cotton balls in my ears to absorb sound(s). One hour a day in the mornings.

I write this because tinnitus help can be a very individual situation. Finding what helps can differ in many cases.

Fourteen years for me now. Life is good for the most part.

 

[Michael Leigh]

@Starthrower
Sorry to hear that you have gone through such a difficult time with tinnitus. It's good to know you've overcome the worst and you're back on track. Keep using the sound therapy with the headphones as you know what you're doing.
Best of luck and thanks for your kind comments.
Michael

 

[Lorac]

@Starthrower ,
I agree. It can be so emotional to go down memory lane and revisit the trauma of tinnitus onset. I wish more doctors understood that tinnitus isn't just noise, especially in the beginning.
I also agree that learning to live with this is highly individualized. I am uncomfortable when talking on the telephone so I have no desire to use headphones of any kind but it seems that you and many others have no problem using headphones on low volume. Different strokes for different folks.
Have you listened to Bedtime with the Beatles? Very soothing instrumentals.

 

[Starthrower]

Hi Lorac,

We seem to have similar issues! I also have a hard time talking on the phone. What I have done is to use a tightly rolled up cotton ball in the ear I listen to the phone. Another problem is at my gym. I am there every morning. In the locker room several blow dryers are often going on at the same time. Girls talking and so on....I just quickly go in and out.

Thanks for the suggestion Bedtime with the Beatles. I am going to check this out tonight. Yes something about soothing instrumentals is what helps me. What I do is listen for single instruments and change it up. I focus on that aspect only. Then I will listen to all of them at the same time. Sorta a game for my tinnitus brain.

I hope you are doing well.

Thanks Michael! I really am doing okay after so many years. As you have had this for a long time also, we understand so many things now. I agree with someone in another thread who wrote about your ability to reach people. I forgot which thread it was in. I like that we can talk back and forth and may have different opinions but still respect each other's views. That is so important.

I just hope I can bring something of value to this forum. I am a bit rusty at support having been out of it for many years now. It has taken me a while to get up the nerve to jump in here. I respect what Steve and Marku have created for the tinnitus community.

Opps I rambled on. Sorry to go off topic.

 

[Michael Leigh]

@Starthrower
Everyone has something of value to give here Starthrower. Newbies as well as people that are seasoned to tinnitus.

 

[Ignacio]

@Michael Leigh I believe I asked you this on another thread but perhaps I left out nuances. I have hyperacusis (reactive T) - T is sometimes barely audible in silence. But noise gets it going in the form oscillating hiss, intermittent chirps, etc.

I started pink noise therapy two months ago and it's improved a bit. For example, train and car rides would leave me buzzing and hissing and would take an hour to calm down. Now I don't get buzzing nor that stream of hissing that would come with such activities. However, I am not in the clear yet as sounds still trigger the T, just not like before.

Now to my question: how do you feel about open-ear headphones just for pink noise, not music? Is pink noise benign enough to make these kinds of headphones ok for this? I chose open-ear because hyperacusis network recommended it. They say that you need to let outside sounds in as well as the pink noise.

Just asking because I sometimes worry.

 

[Michael Leigh]

Hi @Ignacio

Since your tinnitus started in September 2017, it seems to have made significant improvement going by what you have written in your post. Please remember tinnitus and hyperacusis can take many months to improve often up to 2 years. The amount of progress one achieves will vary between people because we are all different so try and be patient.

If you have read any of my posts on my "started threads," you will see that I don't advise anyone with tinnitus, especially noise induced, to listen to any type of audio through headphones including white, pink and brown noise for the treatment of tinnitus or hyperacusis. The reason being this type of audio cannot be finely tuned as proper white noise generators that are designed for this purpose. Invariably, white or pink noise played through headphones will mask the tinnitus (cover it up) so it can't be heard and this is not ideal. When treating tinnitus the white or pink noise should be kept slightly below it. The same should apply when treating hyperacusis; the sound level should be kept low. I know some Hearing Therapists and Audiologists, advise their patients to slowly increase the volume of white noise generators, when treating hyperacusis to desensitise the auditory system but I do not agree with this approach because it often causes spikes.

If you want to treat your hyperacusis then I believe that you should use proper devices meant for this purpose which are white noise generators. Their volume can be finely adjusted and set to a low level just below your tinnitus. However, there are exceptions in everything. Since you are only going to use white/pink noise played through headphones you could give it a try. Keep the volume very low and see how you get on. I advise you go to my started threads and read some of my posts on tinnitus, habituation and counselling.

All the best
Michael

 

[Ignacio]

@Michael Leigh Before I go on, I just want to say that I can't thank you enough for what you do for the community.

Re: the above, everything you've stated makes sense. I have one more question: do you define "reactive T" as T + hyperacusis? Or can there be cases where the hyperacusis and the sound intolerance is causing erratic sounds (my T)?

My symptoms have always struck me as strange when compared to other cases on here. I started out with a high-pitched reactive tone that has turned into a series of erratic hisses, chirps, static in the last few months - again, all reactive.

Sorry, another quick question: how detrimental is silence? I ask because I live both in CT and NYC, but spend more time in CT than anywhere (tired of the city). My house is very quiet aside from the radiators. Could that delay progress? I've been listening to pink noise at home to counter that, but I can't have it constantly on all day.

Cheers!

 

[Michael Leigh]

Before I go on, I just want to say that I can't thank you enough for what you do for the community. Re: the above, everything you've stated makes sense. I have one more question: do you define "reactive T" as T + hyperacusis? Or can there be cases where the hyperacusis and the sound intolerance is causing erratic sounds (my T)?

Thank you for your kind words @Ignacio they are much appreciated.

Tinnitus and hyperacusis will be experienced differently between people. I first want to say that there is no such thing as "Reactive tinnitus". This terminology was made up in Tinnitus forums. Please see the post below with website link. There you will read that that Reactive tinnitus is not used in the medical field but often mentioned by people in tinnitus forums.

Reactive tinnitus is "Hyperacusis" and is often (but not always) associated with tinnitus caused by loud noise trauma to the auditory system. Anyone that has tinnitus should try to avoid quiet rooms and surroundings by using sound enrichment. This can be whatever one finds suitable. Music, nature sounds etc. Try to keep the volume low. Quiet environments allow the brain to focus more on the tinnitus. Over time the tinnitus can become more intrusive. More is explained in posts on my started threads.

Michael


Definitions
What is Hyperacusis?

The lack of consistency in defining hyperacusis is frustrating for researchers and patients alike. The following are the most common definitions for terms related to hyperacusis and decreased sound tolerance.

Decreased Sound Tolerance- Present when every day sounds cause a negative reaction. This includes most of the conditions listed below.

Hyperacusis- Present when every day sounds are perceived as being uncomfortably loud or cause physical pain. Negative reactions to sound caused by something other than uncomfortable loudness or pain (e.g. fear, distortion, tinnitus, annoyance) is not defined as hyperacusis. Misuse of the term "hyperacusis" is common.

There is a push to replace the often misused "hyperacusis" with "pain hyperacusis" and "loudness hyperacusis" (Tyler 2014). This adds clarity to the meaning of the terms and splits into subtypes where detailed mechanisms will surely have differences. While these two types generally occur together, there is a portion of hyperacusis patients that present loudness hyperacusis without pain and a portion that present pain hyperacusis without increased loudness sensation.

Pain Hyperacusis- Present when sounds trigger pain in the ear below common pain thresholds (120 dB).

Loudness Hyperacusis- Present when moderately intense sounds are perceived as being uncomfortably loud.

The term hearing sensitivity is discouraged as the meaning is ambiguous and it can inaccurately suggests the ability to detect sounds that others cannot hear.

Misophonia- Present when everyday sounds cause a negative emotional reaction. Examples of emotions that can be triggered from sound include annoyance, rage and fear. Other researchers wish to drop usage of the term misophonia and instead split this into fear hyperacusis and annoyance hyperacusis in order to to simplify naming and make the terms easier to interpret by the general public.

Phonophobia- Present when everyday sounds cause fear (subset of misophonia). Other researchers wish to call this fear hyperacusis in order to make the term easier to interpret by the general public. For some, this is more directly linked to a fear of re-injury or long-term setback.

Vestibular Hyperacusis- Present when everyday sounds induce disordered balance or vertigo. This is commonly referred to as Tullio's Phenomenon.

Reactive Tinnitus- Present when everyday sounds increase tinnitus activity. This is not a term used in research literature but commonly used by tinnitus patients. Winding-up and kindling are terms sometimes used to describe similar effects.

http://hyperacusisfocus.org/research/definitions/

 

[Ignacio]

Thanks again, @Michael Leigh!

 

[Tinker Bell]

The above from Michael is directly from the Hyperacusis Focus web site. I realize there is a link at the bottom, but it is not credited. I wanted to make sure the original source was acknowledged as the author of the copy/paste text. On other forums I frequent, there is a word limit of what can be copy/pasted to avoid any questions of plagiarism.

I actually think the copied text lends credence to reactive tinnitus as a slightly different condition. The original formatting bullets reactive tinnitus on the same level as hyperacusis, misonophobia and phonophobia.

I have had both reactive tinnitus and loudness hyperacusis. The loudness hyperacusis went away over time, the reactive nature of my tinnitus did not. @Ignacio there are other threads on reactive tinnitus that you may want to search. You might find benefit reading from members who have experienced it, too.

 

[Ignacio]

@Tinker Bell Have you done sound therapy? Based on what I've read, sound sensitivity of any kind can persist if untreated and the way to treat is via sound therapy to desensitize your auditory system. I have already seen improvement since starting nearly two months ago. My hope is that with continued sound enrichment, the whole thing will dissipate.

 

[Tinker Bell]

@Tinker Bell Have you done sound therapy? Based on what I've read, sound sensitivity of any kind can persist if untreated and the way to treat is via sound therapy to desensitize your auditory system. I have already seen improvement since starting nearly two months ago. My hope is that with continued sound enrichment, the whole thing will dissipate.

I have seen multiple ear specialists (not just ENTs) and audiologists. Given how my tinnitus reacts by increasing in volume to particular noises, several advised against sound therapy with wearable white noise generators. Instead they recommended I give it time to let the loudness hyperacusis diminish. Their hope was that the reactive nature would decrease, too.

My tinnitus seems to react specifically to certain frequencies. Not all loud sounds will make my T ring louder. It seems pitch matters more than volume for me. One of my ear specialists felt this had parallels to recruitment, and no amount of sound therapy will help if that's the case.

My hearing loss is severe in one ear above 6k. If anything, a hearing aid is more likely the option I should pursue.

 

[Ignacio]

@Tinker Bell Mine also reacts to certain frequencies. I use pink noise because it's specially designed to cover an array of frequencies we encounter in everyday life. It does get my T going, don't get me wrong. But no permanent spikes - in fact, it goes down in a few minutes after turning it off. I'll keep at it and see where I am in another couple of months.

Re: hearing aid, that sounds like a good idea in general. Perhaps - and this is total speculation - your auditory system is so hard at making up for those lost frequencies that it's causing the hyperacusis.

 

[Tinker Bell]

@Tinker Bell Mine also reacts to certain frequencies. I use pink noise because it's specially designed to cover an array of frequencies we encounter in everyday life. It does get my T going, don't get me wrong. But no permanent spikes - in fact, it goes down in a few minutes after turning it off. I'll keep at it and see where I am in another couple of months.

Re: hearing aid, that sounds like a good idea in general. Perhaps - and this is total speculation - your auditory system is so hard at making up for those lost frequencies that it's causing the hyperacusis.

I think you're on the right track! There are studies of increased central auditory gain in response to hearing loss, and this could be a potential cause of loudness hyperacusis.

I prefer pink noise over white noise, too. Pink noise is more in line with how we hear, white noise makes frequency jumps. I noticed early on that white noise seemed to make my tinnitus worse, while pink noise did not. Currently, I use speakers with music during the day and switch to cricket sounds at night.

 

[Michael Leigh]

Mine also reacts to certain frequencies. I use pink noise because it's specially designed to cover an array of frequencies we encounter in everyday life. It does get my T going, don't get me wrong. But no permanent spikes - in fact, it goes down in a few minutes after turning it off. I'll keep at it and see where I am in another couple of months.

Re: hearing aid, that sounds like a good idea in general. Perhaps - and this is total speculation - your auditory system is so hard at making up for those lost frequencies that it's causing the hyperacusis.

Many things can cause tinnitus @Ignacio If your tinnitus was caused by "noise trauma" the treatment for it is sound therapy- counselling can help too. This type of tinnitus is different from tinnitus caused by an underlying medical condition and there are many. The typical ones are: Hearing loss, which is treated by the use of a hearing aid. Sometimes a dual purpose device is used incorporating a white noise generator with a hearing aid. Ménière disease is another. This is usually treated with medications and hearing aids sometimes incorporating white noise generators too. Otosclerosis. Treatment for this condition can be hearing aid/s or surgery called stapedotomy

Although the above conditions can cause tinnitus they were not brought on by "noise trauma" . This does not mean their tinnitus is less severe than those people that have noised induced tinnitus.

Michael

 

[Aegaeon]

Having "reactive" tinnitus for about 5 months already, I've noticed that listening to low volume pink noise for more than 12 hours per day through ear devices for almost two months so far, my condition seems to be better now compared to how I was when it started when even my voice would increase the tinnitus. Still increases but overall, the sound it's not so terrible and prominent as before. Maybe it got better on its own though, nobody knows.
I also have moderate-severe hearing loss in my left ear at and above 6 kHz caused by the diving incident. However, I feel that my hearing is almost the same in both ears. That's because most everyday sounds are up to 6 kHz. Ear specialists also told me that hearing aids are useless in such situation and would not offer anything. Recruitment only refers to the rapid growth of loudness in the region of hearing loss and has nothing to do with tinnitus.
I tend to believe that in "reactive" tinnitus there's more autonomic nervous system involvement rather than central.

 

[BuzzyBee]

I have seen multiple ear specialists (not just ENTs) and audiologists. Given how my tinnitus reacts by increasing in volume to particular noises, several advised against sound therapy with wearable white noise generators. Instead they recommended I give it time to let the loudness hyperacusis diminish. Their hope was that the reactive nature would decrease, too.

My tinnitus seems to react specifically to certain frequencies. Not all loud sounds will make my T ring louder. It seems pitch matters more than volume for me. One of my ear specialists felt this had parallels to recruitment, and no amount of sound therapy will help if that's the case.

My hearing loss is severe in one ear above 6k. If anything, a hearing aid is more likely the option I should pursue.

My doctors have said the same thing. One doctor said sound therapy could potentially make it worse.

 

[dm222]

Did the reactivity get better for you?

I don't have hyperacusis but my tinnitus spikes to daily noise like when I'm writing on a keyboard or have a fridge next to me...

Can't use sound masking at night as the tinnitus just goes louder and louder until it's louder than the sound masking itself...

This started long before I started to protect my ears... So it's not from overprotecting.

This is making me stay at home every minute I can. Only leave to work...

Don't know how to deal with this...

 

[Tessie]

Karam i give you a ton of cred man...T and still going to skool. Dont give up.

@Michael Leigh

Mike I thought you might find this amusing...i saw an audiologist on friday...he suffers from T as well and got it from listening to headphones when he was young...he looked to be in his 40s so he probably had it for quite some time....due to the fact that he was a long time sufferer and an audiologist i picked his brain....he actually told me it was ok to wear headphones as long as the volume was low. Said he does so even till this day. I totally disagreed but i couldn't believe that someone who is supposedly very knowledgeable and a sufferer would say that. I am getting custom fitted musician ear plugs in 2 weeks....should those be ok to just wear as a noise reducing ear plug?

Speaking of - which brand?

 

[Tessie]

I'll try and keep it short, but to make some sense of it, it needs a bit of background.

My tinnitus was caused by a prescription drug allergy. Not ototoxicity in the true sense, but effectively, I had systemic allergic symptoms to Levothyroxine which included typical allergic symptoms such as itching, hives, watery eyes etc., but also mouth ulcers, dry mouth, muscle twitches, fluctuating blood pressure, migraines with loss of vision etc. and of course tinnitus (although this didn't start for quite some while after the other symptoms). The tinnitus was further exacerbated because all the inflammation resulted in ETD as well. I was in and out of hospital for months without a diagnosis other than some strange auto-immune disease as a probable cause, but equally told repeatedly that it could not be connected to the Levothyroxine I had started 6 weeks before all this first began. Eventually, after nearly 2 years, I made the call myself to stop taking it in place of a substitute that is not listed on the MIMS in the UK.

Following this, within 3-6 months of stopping it, almost all the other symptoms gradually disappeared. Sadly tinnitus was not amongst them and in fact became a hundred fold worse to start with. It sounded like I had a jet engine taking off inside my head.

Eventually, now 16 months since I stopped taking it, I still have tinnitus, but it is not so severe as it was and all the other symptoms have improved or gone completely (unrelated huh!). I have not had a single migraine and my allergies have settled a lot. I still have ETD as my right ear regularly clogs up throughout the day and especially at night - when lying down to sleep and I always wake in the morning to a lot of squelchy noises in that ear if I yawn or hiccup or similar.

The reactivity isn't totally gone, but being in an office is not enough to set it off. I'm still very cautious with my hearing and wear ear defenders when vacuuming or anything of a similar amplitude.

I still need a TV on in the background to fall asleep, but I think a lot of this is to do with my brain seeking out some sort of noise all the time and without some sort of background noise, it keeps amplifying the tinnitus I do have.

Equally however, I do have moments - quite regularly - when the tinnitus disappears - and I mean totally. These periods of silence have been getting longer and longer. Sometimes, lasting several hours at a time. However, I still have flare-ups for no apparent reason that can be very intrusive and distressing - in some ways, the huge amount of variance I have makes it worse for me to cope as I can be on a real high, tinnitus free, busy and engaged and suddenly, out of the blue, my hearing is at it again and it knocks me right back down.

I still remain optimistic that it will continue to improve. Whether or not it will go completely is another matter, but I have no reason to believe otherwise. If I think about things daily, then it never gets better, but if I work in 3 month blocks, then every block has yielded an improvement over the last.

It is now close to 2.5 years since the initial onset of tinnitus.

What are "ear defenders"?

 

[Tessie]

I have been getting complacent after finding a protocol that helped me manage my T: almost daily aerobic exercise + AudioNotch.com playlist of notched sound, also almost daily.

Then last Friday I joined a group of friends to see Hedwig and the Angry Inch (rock musical) after dinner together. OMG what a mistake. (Great show, don't get me wrong, but unbelievably, damagingly loud.)

I was wearing my custom earplugs, believe me. We were sitting up in the mezzanine level in the theater, so pretty much in the middle of the space, from an auditory perspective.

I was tired, as it was a Friday night after a long week. I was being super careful by wearing the protection. I didn't actually take out my phone to measure the sound volume, but now I wish I had - because it was horrific. My T has been moderate to loud since then, though it has responded to aerobic exercise and I have listened to AudioNotch sound at a low level daily since.

I know - or believe - that with persistent exercise especially I'll be able to reduce the volume again to a low level. But it was a sobering reminder that I cannot allow myself to be caught out like that, even for a social setting that I would normally enjoy a lot.

Not sure how I will find out the max decibel level of Broadway shows in the future - I would hate to think that I could no longer see any. I'll be calling the box office for any show I consider though.

Be careful out there, is all I can say.

What's the connection between exercise and tinnitus?

 

[weab00]

Newsflash: reactive tinnitus is NOT solely a part of hyperacusis.

 

[Gman]

Newsflash: reactive tinnitus is NOT solely a part of hyperacusis.

There are researchers who believe they are separate too, albeit with some kind of cross over. It also is consistent with my own experience.

Waking up during a particular sleep stage determines whether or not I have a reactive tinnitus day or a very stable day.

When I had loudness hyperacusis it never just went away with sleep.

 

[Michael Leigh]

Newsflash: reactive tinnitus is NOT solely a part of hyperacusis.

I agree, reactive tinnitus isn't a part of hyperacusis because it's an invention and doesn't actually exist. It was made-up in tinnitus forums many years ago and promoted by some, that believe their tinnitus is worse due to having it more than those that just have tinnitus and hyperacusis. It is a sure way of never being able to habituate and move forwards with one's life.

Michael