Hyperacusis Getting Worse — Is It Turning Into Noxacusis?

[Gateway]

Preface: I have really never dealt with what I would call hyperacusis until recently. I have had tinnitus for a little over five years now, and I was doing good until I had a tinnitus spike in September of 2023. The tinnitus spike is honestly much better, and I would say it is 90% back to baseline. With that spike, I noticed some hearing sensitivity increase, but not that bad; I was still able to go to restaurants without earplugs and such, for example.

I guess it just kind of got worse in December a little; then the sucky thing is that around New Year's, I had a really loud day where my friend's dog barked right in my ear, and some other loud things happened, and the next day I noticed I had a greatly increased hearing sensitivity.

It feels like it has just gotten worse, and now I have to plug up whenever I am out of the house with 25 dB earplugs.

Yesterday, I went to get a head and neck massage for my TMJ, and the lady laughed loudly, like two feet from my ear. I didn't have my earplugs in. Now, I feel like someone punched me in the eardrum, and I am having facial and neck tingling. My ear feels like it's throbbing, full, and super achy right now.

Is this turning into noxacusis? I have had ear problems for a long while, and the hyperacusis is so much worse than the tinnitus that I have experienced. I don't know what to do.

I have some Clomipramine; should I try it? I am just scared it will make my tinnitus worse. I have had tinnitus for a long time, and the hyperacusis is so much worse than the tinnitus; I am just so debilitated right now, and I feel like my life is over.

 

[Hardwell]

I am no expert on hyperacusis; to be honest, none really exist. However, I have read countless accounts on Tinnitus Talk to gain a good understanding. So, I'll give you my brief take.

Hyperacusis is a tricky one; it would appear that most people have a level they can safely operate that doesn't exacerbate it. The only way to raise this level is by gradual exposure, and there are a number of methods this can be done. Some opt for doing this in the comfort of their home by playing audio at X amount for a duration of Y amount, increasing one or both variables gradually. Others opt for exposure to natural sounds, raising the duration gradually. There's no right or wrong way, as it's dependent on the person. Some, including myself, are intolerant to digital audio, so I chose the latter primarily but did work on digital audio exposure eventually and made some good progress. The most important thing of all, regardless of what method you choose, is that you do it in a predictable and controllable environment.

Even if you've made good progress by gradual exposure, if you expose yourself to something too loud or for a duration too long outside of your 'safe operating level,' you're liable for setbacks and resets. That may have been what happened with your loud noise exposures during New Year's.

Please note I am only advising you on hyperacusis relating to loudness.

Your facial issues and ear pain are all fairly common with TMJ, and having a massage in those areas can certainly bring on and exacerbate the symptoms you are currently experiencing. The laughing in the ear could have played no part at all.

For the Clomipramine, I would avoid taking it for now as it'll just make you more anxious, which can certainly worsen TMJ symptoms.

Wishing you all the best.