If a person has hyperacusis or noxacusis and chooses to overprotect their ears using hearing protection, they risk making these conditions worse, by lowering the loudness threshold of their auditory system which will make it more sensitive to sound. Some people believe staying at home in a quiet environment is the answer to heal their oversensitivity to sound but unfortunately it isn't. In most instances they will make their situation worse. If they are not careful, other problems can develop, such as phonophobia and misophonia. I have covered this in my thread: The Complexities of Tinnitus and Hyperacusis.
Anyone reading this thread that has noise-induced tinnitus, with or without hyperacusis and naxacusis, my advice is not to overuse hearing protection and deliberately staying at home to avoid normal everyday sounds in the outside environment, this is not the answer because all you are doing is making your condition worse. The auditory system needs to be desensitised, the only way to to do this is to use sound therapy.
Use low-level sound enrichment which I have covered in my thread: Hyperacusis, As I See It. Wearing noise reducing earplugs can be beneficial but they must be used with prudence. If self-help doesn't work for you then try to see an audiologist that specialises in tinnitus and hyperacusis treatment.
I once had very severe hyperacusis that was extremely painful, it was completely cured in two years wearing white noise generators and having counselling as part of TRT. I have been hyperacusis free for 26 years.
Michael
Michael, you give some people good advice but you don't have noxacusis and you have never had noxacusis. Stop telling people false information about these conditions. If you have what I have, you're not exposing to sound or doing TRT - I'm sorry to say it. The hyperacusis community is plagued with TRT and Jastreboff and mild sufferers telling severe people they need to expose to noise and TRT cures everything. Obviously not. I've seen a lot of your newer posts and do my best not to say anything. You can say whatever you want about loudness hyperacusis but you don't have any evidence more noise helps noxacusis. Yeah obviously, if people are mild and expose to sound, nothing will happen.
My life has been ruined because of severe noxacusis. Don't come on here and tell lies and gaslight people. Mild cases don't need to avoid noise but being in silence does not make tinnitus and hyperacusis worse. If you define worse as your tinnitus being 5% louder or ears being 10% more sensitive to noise for a short period of time, which reverses when the person is exposed to noise, then ok. I have never heard a single case in history of a person getting permanently worse from silence, but I have seen pretty much every person getting worse from noise.
Some cases of hyperacusis can be in the brain for sure but some are middle and inner ear related and these theories have been proven. The problem with your Jastreboff theories is you expect exposing to sound to work for everybody which obviously it doesn't or there wouldn't be thousands of people in support groups and hundreds of people in bed who've had severe noxacusis for decades.
It's so cute when you think I haven't tried exposing to noise. I do it every day. Know what happens? Feels like a chainsaw is going through my left ear with burning poison knives being deeply shoved into my ears. It is excruciatingly painful and the pain lingers for days. The only time I've had any relief in two years is when I finally soundproofed a room. Now I can play games and talk for a bit, go for runs at night, brush my teeth without pain, eat without pain, but guess what? Because I read your false theories and worked with Ben Thompson to "desensitize" my ears, my noxacusis became permanent and it's been over a year since my left ear has been hurting nonstop on silence. I was literally pain free in my home but decided to believe the mild cases who say they were severe who were cured by sound therapy. Now I have to take low dose Naltrexone, CBD, ice my ear twice a day, soak in garlic oil, run most nights, and be in silence just to deal with the pain. I expose to noise that doesn't feel like razor blades going in my ears. My worst offending external noises are high pitch, especially door screeches, artificial audio, sirens, birds, and frequencies in that range. Completely avoiding those sounds and resting my ears I eased my way into being able to tolerate the buttons on my Xbox controller with no protection and being able to talk with no protection. Exposing to my bad frequencies makes me worse, period.
Now I remember when you said you were so "severe" you had to ask somebody to lower their voice. That is not severe. That's mild moderate. You say your ears were in pain but don't mention specific pain sensations. That is not noxacusis. That's what every person with loudness hyperacusis says; that their ears hurt so bad, that sound hurts them.
Now do not compare your case to mine because I've tried exactly what you did and got worse. I cannot imagine if I "cured" my severe neuralgia from exposing to more sound. You were never homebound, you didn't have neuralgia, you didn't have lingering pain (if you did, it was super mild). I've gotten very good at reading hyperacusis cases at this point. You had moderate-to-severe loudness hyperacusis with barely existent noxacusis. Now bear in mind I have read many cases who get a little ear discomfort, go on forums, read horror stories and become afraid to leave their homes. Then when they try TRT or sound exposure, they're like omg, I'm cured!
No brother, noxacusis is a very serious illness and not a joke. You can say what worked for you all you want but don't be going on support forums gaslighting people, mentioning misophonia and other mental issues dealing with sound intolerance. I don't care about not liking sound, I don't give a crap about being sensitive to sound, I don't care about hearing every noise 100x louder. I care about severe neuralgia pain I get deep in my left ear that makes me vomit and go absolutely insane from how painful it is. I don't care what you think you had, but you don't have what I have, I promise you that. If you think you're tougher than me or you can take more pain than me, you are sadly mistaken. I've been shot before, torn my peck off the bone, almost died from an infection, broke many bones, tore many muscles, I have experienced very painful things in my life and still nothing comes close to this pain. Noxacusis is neuralgia in the ear - did you know the most painful condition known to man is trigeminal neuralgia? It's on every signal medical page across the internet, go look it up. Noxacusis for some people is that pain in their ears and it does not go away with more sound.
I just love how there's both sides of extremes when it comes to hyperacusis. You're on the gaslight, sound therapy, TRT, positive mindset side that takes things way too far to the point to where it's offensive to many of us. And there's people on my side who take things too far and tell everybody to be afraid of sound, to never leave their homes again to never protect from noise. That's not true either, I even tell people who get this that they don't have to protect from every noise unless they're getting really bad pain. Very few people actually have to do what I do to be able to manage severe noxacusis. It's also very funny how Dr. Silverstein told me specifically that TRT and sound therapy doesn't work for severe cases and told me just not to try it in general. Funny how I've seen 5 neurotologists and 7 audiologists who all told me the same exact thing, if sound is causing me severe pain, I should avoid it and do my best to protect my ears, and expose to sound only when it's not causing me pain. So I'm guessing they're all idiots, right? But you're going to listen to Jastreboff who isn't even a doctor.
If you can find me specific research studies with data and specific evidence testing sound therapy on hyperacusis sufferers and hyperacusis sufferers only, be my guest. But you won't. There's one study they did on "healthy" ears of college students who wore earplugs for a week whose hearing got more sensitive by 10 dB. Then it went back to normal after the study. These were healthy ears, not damaged ones. That's science 101. Now you can keep giving your amazing success story on how TRT "cured" your "severe" noxacusis but don't you dare say it should work for me or you know better than me. Not every case is the same and consider yourself lucky you don't have what some of us have.