Is My Hyperacusis Related to Middle or Inner Ear Damage?

[haha ear go eeee]

How do you know where exactly your symptoms are originating from? I get some pain from sounds, but my symptoms usually stem from my middle ear thumping or spasming to sounds, even though I don't necessarily feel pain to the sounds.

Also, how do you know if you have inner ear damage, as opposed to just middle ear? I can't tell if my middle ear is the main component or not?

 

[eagerUser]

How do you know where exactly your symptoms are originating from? I get some pain from sounds, but my symptoms usually stem from my middle ear thumping or spasming to sounds, even though I don't necessarily feel pain to the sounds.

Also, how do you know if you have inner ear damage, as opposed to just middle ear? I can't tell if my middle ear is the main component or not?

TBH, no one can answer you. Your tests may be normal, you may have above average hearing but after all what they offer you is CBT and sound therapy. Anyway, if you are new to this, do go to a good doctor and have your ears and hearing checked.

 

[MadeleineHope]

Hi there,

Unfortunately it's impossible to say because the mechanisms behind hyperacusis aren't really understood (especially those behind noxacusis), & different mechanisms can be at play for different people... even in cases where symptoms sound similar (e.g., the symptom of ear 'pain'). Even in one person, multiple things may be going on (e.g., someone may have noxacusis & TTTS, both of which may have separate mechanisms).

That said, it does sound like you have some TTTS going on, & there's an academic paper on this topic that you may be interested in reading to see how it makes sense (or doesn't) with your experience:

An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock

 

[haha ear go eeee]

@MadeleineHope, thank you for the link. What's the difference between middle ear symptoms and noxacusis?

 

[MadeleineHope]

@haha ear go eeee, some believe TTTS can lead to the pain described by people with pain hyperacusis, while others believe that the pain has a separate mechanism. I suppose it's also possible to have more than one thing happening. At the end of the day though, noone really understands this unfortunately.

 

[Nick47]

It can be both. Type 2 afferent nerve fibres in the inner ear (Megan Beers Wood) and problems with the middle ear muscles that control the eardrum and cause tension and spasms when external sound is present.

I read somewhere earlier today this should be treated in the same way trigeminal neuralgia is.

 

[Josh59]

It can be both. Type 2 afferent nerve fibres in the inner ear (Megan Beers Wood) and problems with the middle ear muscles that control the eardrum and cause tension and spasms when external sound is present.

I read somewhere earlier today this should be treated in the same way trigeminal neuralgia is.

Interesting information, @Nick47.

Hypothesis number 1, by Megan Beers Wood, would be more related to pain hyperacusis and therefore more difficult to treat?

 

[Nick47]

Hypothesis number 1, by Megan Beers Wood, would be more related to pain hyperacusis and therefore more difficult to treat?

@Josh59, is there any use looking at CGRP antagonists?

 

[MadeleineHope]

Interesting information, @Nick47.

Hypothesis number 1, by Megan Beers Wood, would be more related to pain hyperacusis and therefore more difficult to treat?

From what I understand, based on the Norena article, TTTS (or middle ear issues more generally) can also lead to pain hyperacusis:

In this article, we elaborate on the hypothesis that the tensor tympani muscle (TTM), the trigeminal nerve (TGN), and the trigeminal cervical complex (TCC) play a central role in generating these symptoms. We argue that TTM overuse (due to the acoustic shock), TTM overload (due to muscle tension), and ultimately, TTM injury (due to hypoxia and "energy crisis") lead to inflammation, thereby activating the TGN, TCC, and cortex.

The same thing in some more detail:

The initial TTM wound causes pain, which can spread through inflammatory processes, up to the middle ear mucosa, and may be amplified and persist beyond the tissue damage when peripheral and central sensitization mechanisms are at stake. The main TGN relay in the brainstem is the TCC, a crossroad structure that integrates sensory information from the head–neck complex. The broad integration of the TCC may account for referred pain outside the ear when the middle ear is injured. The sympathetic nervous system may also be involved in maintaining and amplifying pain, while the trigeminal-parasympathetic reflex may account for autonomic symptoms such as blocked nose and tympanum hyperemia.

 

[Juan]

Also, how do you know if you have inner ear damage, as opposed to just middle ear? I can't tell if my middle ear is the main component or not?

It is possible to deduce it from how the symptoms appeared, or better said, what triggered the symptoms.

For instance if you went clubbing and then you had hyperacusis, that's very likely inner ear damage. Pain hyperacusis in my opinion means, in most cases, inner ear damage, damage to the hair cells, cochlear damage.

 

[Josh59]

From what I understand, based on the Norena article, TTTS (or middle ear issues more generally) can also lead to pain hyperacusis:

The same thing in some more detail:

Yes, you're right. Perhaps I misspoke.

To date, no one can confirm this, but we would indeed like to know where the source of the pain hyperacusis induced by sound trauma comes from.

 

[MadeleineHope]

It is possible to deduce it from how the symptoms appeared, or better said, what triggered the symptoms.

For instance if you went clubbing and then you had hyperacusis, that's very likely inner ear damage. Pain hyperacusis in my opinion means, in most cases, inner ear damage, damage to the hair cells, cochlear damage.

My understanding is that a loud activity like clubbing could also cause acoustic shock, though? I imagine it's also possible for both types of damage to occur as a result of loud noise exposure (as I believe has happened in my case).

 

[Juan]

My understanding is that a loud activity like clubbing could also cause acoustic shock, though? I imagine it's also possible for both types of damage to occur as a result of loud noise exposure (as I believe has happened in my case).

From personal experience I think inner ear damage and a certain degree of middle ear dysfunction can go hand in hand, particularly when middle ear muscles spasm or get tense for no reason, or at the threat of possible loud noise.

An example of this happens with extreme hyperacusis when a lower sound that resembles in pitch a dangerous very loud sound triggers symptoms like full ears, pressure, headaches, that can be related as well to a hyperactivity of middle ear muscles in the presence of a "fake" stimulus that should not trigger that response.

Anyway, if you ask me, noise damage is primarily damage to the hair cells, that is sensorineural hearing loss, irreversible hearing loss. This is linked to the concepts of "hidden" hearing loss, the brain turning up volume and creating hyperacusis etc.

 

[Josh59]

Can we only have tonic tympanic tensor muscle syndrome when there is sound?

Because I don't have vibrations (Mycology) without sound input.

 

[haha ear go eeee]

From personal experience I think inner ear damage and a certain degree of middle ear dysfunction can go hand in hand, particularly when middle ear muscles spasm or get tense for no reason, or at the threat of possible loud noise.

An example of this happens with extreme hyperacusis when a lower sound that resembles in pitch a dangerous very loud sound triggers symptoms like full ears, pressure, headaches, that can be related as well to a hyperactivity of middle ear muscles in the presence of a "fake" stimulus that should not trigger that response.

Anyway, if you ask me, noise damage is primarily damage to the hair cells, that is sensorineural hearing loss, irreversible hearing loss. This is linked to the concepts of "hidden" hearing loss, the brain turning up volume and creating hyperacusis etc.

For my symptoms, it seems my middle ear has a different noise tolerance threshold than my inner ear. Last time I tested it, my inner ear responds to more high-pitched loud frequencies, like pots and pans or silverware.

My middle ear, however, responds to a lot of lower-pitched frequencies, like the wash or cars outside.

It's quite annoying.

 

[Josh59]

For my symptoms, it seems my middle ear has a different noise tolerance threshold than my inner ear. Last time I tested it, my inner ear responds to more high-pitched loud frequencies, like pots and pans or silverware.

My middle ear, however, responds to a lot of lower-pitched frequencies, like the wash or cars outside.

It's quite annoying.

How do you distinguish between middle and inner ear symptoms?

Is there a technique for telling the difference?

 

[haha ear go eeee]

How do you distinguish between middle and inner ear symptoms?

Is there a technique for telling the difference?

It's hard and I'm not sure if I'm right or not, but the pain and aching feeling doesn't feel that deep. It almost feels like a middle ear infection. And usually the pain is accompanied by thumping or spasms in my ear, which is a symptom of TTTS or MEM. It seems middle ear problems go hand in hand with pain hyperacusis. I'm almost positive the middle ear symptoms came after the inner ear pain though.

 

[Juan]

For my symptoms, it seems my middle ear has a different noise tolerance threshold than my inner ear. Last time I tested it, my inner ear responds to more high-pitched loud frequencies, like pots and pans or silverware.

My middle ear, however, responds to a lot of lower-pitched frequencies, like the wash or cars outside.

It's quite annoying.

Now I am intrigued. How can you test your middle ear independently from your inner ear?

 

[haha ear go eeee]

Now I am intrigued. How can you test your middle ear independently from your inner ear?

I'm not sure if this is correct or not, but my symptoms almost feel like a middle ear infection. I used to get them a lot when I was a kid because I have issues with my Eustachian tubes.

When I first got these symptoms, I could definitely tell there was no thumping or anything, the pain would come from high frequency sounds, and the pain would be instant sharp pain.

Now, it seems like I have mostly middle ear symptoms. When I get pain from a sound, it feels like it's in my middle ear. My middle ear will go crazy and they'll be this dull aching feeling in it afterwards. It doesn't feel that deep in my ear, and it's always accompanied by the thumping.

 

[Ngo13]

Can we only have tonic tympanic tensor muscle syndrome when there is sound?

Because I don't have vibrations (Mycology) without sound input.

Yes. I have TTTS thumping that is only triggered by sound. I have constant ear fullness though.

 

[Josh59]

In the context of hyperacusis and tonic tympanic tensor muscle syndrome, it has been suggested that the pathway controlling these muscles is serotonergic:

Serotoninergic innervation of stapedial and tensor tympani motoneurons

Do you think there is too much serotonin in the dorsal cochlear nucleus?

I ask this question because it has been suggested that too much serotonin in the DCN accentuates tinnitus, particularly somatosensory modulated tinnitus (e.g., jaw):

SSRI and Tinnitus - The American Academy of Audiology