@Irish
Yes, I think you have TTTS, now confirmed. But what you call "hyperacusis" is a consequence of TTTS, not a cause.
It seems that I haven't been clear enough. I will try to explain a bit further.
There is not such a thing as a mental sound discomfort previous to TTTS. That idea is ridiculously wrong. What causes discomfort is the increased tension in the tensor tympani, the "elevated tensor tonus", ad Klockhoff put it. And the level of discomfort, in general, is proportional to the level of tension or physical abnormality.
I can guarantee you that when the TTs are relaxed, your hearing experience is exactly as before. Probably you have already experienced this, temporally. Or at least you have experienced certain fluctuation of the symptoms, as you described in your posts. I am sure we can agree that an "aversion to sound" (Jastreboff's "misophonia") couldn't fluctuate so easily and without any reason, nor an abstract and undefined discomfort previous to TTTS (Westcott's "hyperacusis"). Not even the cochlea could be damaged in a certain way that as a result it tenses the tensor tympani, and suddenly it gets repaired, without any logical reason, and then magically it gets damaged again. The fact is that only the muscle tension itself is responsible for the discomfort (with or without sounds). And, besides, why would we complicate our thoughts and go against common sense? (a question that should be raised to audiologists and to patients that accept easily any kind of nonsense)
Jastreboff, who has no idea about this subject, thinks TTTS is a consequence of "misophonia". And this is incredible wrong. If your TTs are tensed, and you hear a car horn next to you, it is bothersome because of the tension itself, not because your father was kissing a woman different from your mother when you were a boy, at the same time that your mother saw him from her car and sounded the horn, or because you developed a particular aversion for horns for unknown reasons, or because you lost that "love affair with sound", as Dingaling suggested.
Myriam Westcott, the audiologist who wrote the text that you linked, thinks TTTS is not a consequence of "misophonia", contradicting his teacher Jastreboff, but a consequence of "hyperacusis". She didn't have TTTS and so she doesn't know how it feels like. And she is assuming that there is an abstract discomfort previous to TTTS, maybe related to a sound processing problem, without any reason whatsoever to reach such a conclusion. She negates what is obvious, the fact that having a tight or vibrating muscle and tendon against the eardrum causes discomfort (with or without sounds), and also ignores what Klockhoff, the man who discovered this pathology, wrote in his paper. Or maybe Westcott thinks that the previous discomfort appears first and then it is added the TTTS, uncomfortable too, but the problem is that she can't define this first discomfort, or if she tries to do it, she would end up describing TTTS itself, what would be the proof of the inexistence of this previous "hyperacusis".
Moreover, all the characteristics of the discomfort related by sufferers are the ones which belong to TTTS. Not only the evident physical particularities (fullness/tension, pain, thumps, and so on), but also two key particularities which are not analyzed in any medical texts. These particularities are : 1- the special discomfort provoked by certain sounds with a fast attack and with certain texture, even more if they are loud and close to the ears (a discomfort proportional to TT abnormally); 2- the comings and goings of the discomfort, and the so-called "setbacks". These two circumstances are another proof that there is only one problem, TTTS, and that "hyperacusis" as a previous and mysterious dimension doesn't exist.
We can accuse Klockhoff for being brief and maybe cryptic, and for not mentioning a lot of things. But he never mentioned anything about an aversion to sounds, about conditioned reflexes, about a sound processing disorder, or about any link between the increased tonus and a cochlea pathology. He thought TTTS was merely a psychosomatic problem. And he was right, because only mind activity that could be consider as part of Psychology is what tenses the tensor tympanis. Psychosomatic, psycho-physiological, psycho-tensional, or whatever, call it what you want. It is what it is: the TTs got abnormally tensed, and then you repeat that operation, complicated by the slow-tonic nature of the muscles. Definitely this mechanism and these tiny structures are very delicate and not something to play with.
The abnormal tension can be caused by a single sound incident (e.g. acoustic shock), or by different and cumulative incidents (e.g. someone who listens to music on headphones loud and often). And also it could be caused by reasons different from loud sounds.
We don't know if Westcott really doesn't understand (mainly because she is too much influenced by the TRT theory), or she is just compromised by the business of TRT. I think it is about the former, but the latter is functional to the former. Think that she did the course with Jastreboff to get this supposed sophisticated knowledge (in fact, it is a wrong and precarious knowledge) and she wins a lot of money from offering the service. By reading her texts, I think she was about to understand the problem, but then accommodated her ideas to her practices.
When I first wrote her by email, she answered me, but when I replied again saying how things really are (i.e. the self-sufficient nature of TTTS) she didn't reply again, even if I was giving her important and first-hand information. So I don't know if I convinced her. Now, if she writes something about the non-existence of a previous "hyperacusis", probably you will remember me.
And keep in mind that Westcott is not a TRT purist, because, as I said before, she thinks TTTS is seen in "hyperacusis" patients, not in "misophonia" ones ("hyperacusis" and "misophonia" are the two alleged branches of sound discomfort according to Jastreboff). But this sound intolerance is a consequence of TTTS, not a cause, for the aforementioned reasons.
"Acoustic shock disorder" is another quite useless concept. It is presuming that there are TTTS symptoms only possible after a very loud, close, and unexpected sound. Maybe burning pain is more often to happen after an acoustic shock? Maybe. My point is that there is nothing entirely different. For Westcott, now you have "acoustic shock disorder", "hyperacusis", and "ttts", when, from a medical point of view, you only have TTTS. It is not clear, really. You can get complicated TTTS-related symptoms without an acoustic shock, as I wrote before. Look all the different and terrible symptoms in the Klockhoff paper, all associated to the same phenomenon.
If TTTS persists, it is not because "hyperacusis" or "ASD" is developed, as Westcott believes. It is because of TTTS itself. In the words of Klockhoff: "As regards therapy reassurance comes first: Information that the neurotizing symptoms need not signal a dangerous disease which the patients often have suspected with a circulus vitiosus as a result."
This is why some people recover in two days, and others have the problem for several years. But I don't think the persistence of the problem is limited to the lack of "information that the neurotizing symptoms need not signal a dangerous disease", though that is very important.
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