Hyperacusis: More Prone to Hearing Damage or Not?

[MSF]

Hi all, dealing with hyperacusis for years now and have recently made it (as well as mild tinnitus) worse over last few months by working in a noisy market/kitchen environment (pans clanging/dropping, carts rolling by, general conversation/environmental noise). Background noise levels are only around 75 dB, but I haven't checked occasional clang-induced peaks, which happen maybe 4-5 times during the day at about a meter or two distance and I'm guessing clock in at 110 dB or more. I can whack earplugs in occasionally, but I also have to deal with customers so there's no happy medium unfortunately.

My actual hearing was confirmed to be fine before I started this job, but now I've been concerned that the general noise exposure my be hurting my hearing in addition to making hyperacusis worse--I'm sure we've all felt that way when our ears are feeling particularly full or painful!

So the question is: I understand that hyperacusis is the result of nerve damage that would normally help reduce the "stress" of these sounds, but does this in turn make hyperacusis sufferers more prone to actual hearing loss? Everything I have read on the medical side suggests no, but I see comments on this forum that might suggest otherwise. Looking for any evidence-based research people might have come across, or if people have confirmed this with audiograms.

 

[Contrast]

My actual hearing was confirmed

How did they test your hearing, an outdated tonal audiogram?

Recent research indicates that hearing test used at most audiology clinics and ENTs are extremely inaccurate, they only test for hearing loss within the human voice range, learn more here about hidden hearing loss and how this can lead to tinnitus, noise induced pain, and abnormal amplification of noise.

http://hyperacusisfocus.org/innerear/

https://www.sciencedirect.com/science/article/pii/S0378595516302507

 

[Contrast]

Is your hyperacusis defined as pain, burning, fullness, aching, numbness? (this is believed to be neurotrophic pain)

Or do things sound amplified (too loud!) or both? (this may be a brain disorder or hair cell damage)

All these things have connections to hearing loss especially from noise abuse.

 

[uae96]

Is your hyperacusis defined as pain, burning, fullness, aching, numbness? (this is believed to be neurotrophic pain)

Mine is like that. What does it mean? Is there any hope for treatment?

 

[Contrast]

Mine is like that. What does it mean? Is there any hope for treatment?

treatments for other forms of neurotrophic pain in the near future might be applied to hyperacusis with pain.


also regenerating hearing cells in the near future "may" possibly help.
https://hearinghealthmatters.org/he...ing-restoration-drug-trial-enrollment-fx-322/
https://clinicaltrials.gov/ct2/show/NCT03616223

However these options are not available and will not come for atleast 5-10 years if they succeed in the clinic


Sound therapy also helps but it's results are somewhat controversial, we need to demand better options.

 

[MSF]

How did they test your hearing, an outdated tonal audiogram?

Recent research indicates that hearing test used at most audiology clinics and ENTs are extremely inaccurate, they only test for hearing loss within the human voice range, learn more here about hidden hearing loss and how this can lead to tinnitus, noise induced pain, and abnormal amplification of noise.

Well yes, but I requested that they go up to 16 Khz, and my hearing was actually pretty decent in these higher frequencies (one ear is worse than the other). Actually, it was ironically funny because the ENT, who clearly was not super familiar with H suggested that sounds were so loud to me BECAUSE of my excellent hearing!

The article you posted is interesting--I will have to take more time to read it but it didn't immediately suggest that hearing loss and H are directly connected?

Is your hyperacusis defined as pain, burning, fullness, aching, numbness? (this is believed to be neurotrophic pain)

Or do things sound amplified (too loud!) or both? (this may be a brain disorder or hair cell damage)

All these things have connections to hearing loss especially from noise abuse.

Combination of both--very loud sounds, >100 dB close to my ear cause pain/fullness/numbness for a few hours to a day(s). But I am also quite sensitive to certain sharp-piercing sounds (glass on glass, plates/pans clanging) on bad H days; again, I'm guessing these sounds are usually those over 100 dB, so there seems to be a kind a sensitization threshold. Lower volume sounds are not an issue.

All these things have connections to hearing loss especially from noise abuse.

Yes, I have no doubt of this! But my lingering question remains, does exposure to short but loud (i.e., under NIOSH exposure limits) pose any more of a threat to H sufferers than to those without it? I.e., am I working my way down a steeper NIHL gradient than the average person?

 

[Juan]

Well yes, but I requested that they go up to 16 Khz, and my hearing was actually pretty decent in these higher frequencies (one ear is worse than the other). Actually, it was ironically funny because the ENT, who clearly was not super familiar with H suggested that sounds were so loud to me BECAUSE of my excellent hearing!

That's the silly thing bad or inexperienced ENTs say.

If you read medical literature about hyperacusis you will find articles that say that hyperacusis can evolve into major hearing issues, includding sudden deafness.

A tonal audiometric test serves for nothing, since it does not measure your ability to understand language and it does not measure either if you are hearing a certain tone at the right pitch.

 

[MSF]

That's the silly thing bad or inexperienced ENTs say.

If you read medical literature about hyperacusis you will find articles that say that hyperacusis can evolve into major hearing issues, includding sudden deafness.

A tonal audiometric test serves for nothing, since it does not measure your ability to understand language and it does not measure either if you are hearing a certain tone at the right pitch.

Agreed, it was not funny to me at the time. This is my second experience with an ENT who did not really know what H was, and it made me realize how uncommon it actually is.

They ran a full hearing test--all speech related tests were fine. I am also a musician, so acutely aware of things like pitch/tone (which may be irrelevant from a medical standpoint, but I have not had issues in this regard).

If you can link to any studies that discuss what you are mentioning, that would be helpful (I will also give your original article a thorough read). Do these suggest that the hearing loss is a natural evolution of H or that ongoing low-level exposure damage exacerbates it? This is the point I'm still not clear on.

 

[Contrast]

100 dB close to my ear cause pain/fullness/numbness

unofficial statistics show different results, most say normal hearing people feel pain around 120-140db
regardless noises above 80db for several hours or so exposure can still damaged hearing.

the hypothesis is that damage to the inner ear lowers the pain threshold from noise abuse, 140db, 120db, 100db, 80db, 60db, and in specific frequencies people notice hyperacusis defined as pain.

 

[MSF]

the hypothesis is that damage to the inner ear lowers the pain threshold from noise abuse, 140db, 120db, 100db, 80db, 60db, and in specific frequencies people notice hyperacusis defined as pain.

Yes, this jives with my own experience and what I have read. But ear pain (which goes away) is not synonymous with hearing loss (which doesn't). And actually, reading that article more closely, it sounds (again) like they are not directly related: "As research has shown reduction in cochlear output can result in gradual overcompensation of gain within the brain, this has potential to explain hyperacusis in those without hearing loss."

 

[Contrast]

reduction in cochlear output

Are you saying you have no hearing loss?, or not sure if you have hearing loss?

What they said is that the individual still does have hearing loss, it just doesn't show up on the outdated standard test.


It said the synapses die that allow hair cells to decipher complex loud noises. For example, music with high pitch notes sounds enjoyable until it is at a loud volume then the high frequencies start to mush and get buried by low frequencies. Normal audiograms don't detect that form of hearing loss.

The hair cells lose ribbon synapses that allow them to hear the high pitch in background noise, the audiotory brain increases actvity to respond to this loss of hearing.


To read more about the central gain mechanism and it's role and tinnitus and hypothetical role in hyperacusis read here. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208401/

 

[Johan_L]

However these options are not available and will not come for atleast 5-10 years if they succeed in the clinic

Maybe less....

Regarding the 5 to 10 year timeline, breakthrough drugs average 4.8 according to the link below. 17% of approved drugs have been classed as "breakthrough", so its not something "unique" that happens once i a thousand years.

FX-322 started some 1.5 years ago, so IF it works I think we can actually reasonably expect it in maybe 3 years. (It is a breakthrough if it works).

"The study, from researchers with the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital in Boston, MA, found that breakthrough drugs reported the shortest development time at 4.8 years — a rate 32% shorter than fast-track drugs."

https://www.mdmag.com/medical-news/need-for-speed-the-effects-of-an-expedited-fda-approval-process

 

[Juan]

Agreed, it was not funny to me at the time. This is my second experience with an ENT who did not really know what H was, and it made me realize how uncommon it actually is.

They ran a full hearing test--all speech related tests were fine. I am also a musician, so acutely aware of things like pitch/tone (which may be irrelevant from a medical standpoint, but I have not had issues in this regard).

If you can link to any studies that discuss what you are mentioning, that would be helpful (I will also give your original article a thorough read). Do these suggest that the hearing loss is a natural evolution of H or that ongoing low-level exposure damage exacerbates it? This is the point I'm still not clear on.

The article I was referring to was published by Carlos Herráiz. I read it a long time ago, and the basic point was that hyperacusis is unpredictable and it can lead to other hearing problems, some of which may appear suddenly or quite fast, like sudden hearing loss. Herráiz was working with tinnitus and hyperacusis sufferers for many years, and followed their progress (or absence of progress) so he could refer to cases where hyperacusis changed into other things like meniere, sudden hearing loss, vertigo etc. He also reported cases of improvement a long time after the onset of hyperacusis. The reasons that lead to worsening or improvement are not very well understood.

Please be aware that nowadays no serious ENT is going to refer to sound therapy, TRT or similar bullshit as a realistic method or therapy to treat hyperacusis, unless they want to get your money for nothing. TRT is widely regarded nowadays as a scam, and it is surprising that the people who endorsed it and charged for it have not been sued, or a lawsuit about it has not gone public.

The old books about "living with hyperacusis", "tinnitus" etc are really outdated and full of wrong statements.

Hearing loss can happen fast if you are not careful with sound exposure. In my personal case I have had hyperacusis for many years and my last hearing tests show a dip in high frequencies, down from a loss of 15 dbs at 2000 to a loss of 45-50 dbs at 8000. Five years ago my loss at 8000 was like 25 dbs and at 2000 it could be maybe 5 dbs. At 4000 I used to hear at 5-10 dbs and today I hear at 25-30 dbs depending of the audiometer. Hearing loss progressing this fast is not normal, even less with my lifestyle and taking into account that I am really careful with noise and use hearing protection when needed.

8000 is not really an important frequency unless you are a musician and really need to hear the right pitch of sounds. 4000 is kind of important, and lower frequencies even more.

The points I wanted to make are (i) hyperacusis is poorly understood by doctors and very unpredictable and there are cases when it worsened very fast and (ii) hyperacusis can lead to hearing loss (my personal case and medical literature also talks about it).

An additional point is hyperacusis caused by noise trauma, by very loud sound, is the hardest to cure. Also, those people who say on youtube things like "I got cured from hyperacusis in 2 weeks... or in 3 months" didnt really have hyperacusis caused by sound trauma (maybe they had some nerves or were stressed, but did not have hyperacusis), and this is another factor that misguides doctors when they deal with people who genuinely suffer from hyperacusis.

 

[Red]

I don't know about hearing loss, but going by this forum and others, it definitely seems to be the case that the lower your LDL, the easier it is to permanently increase your tinnitus.