Is My Pain Hyperacusis All in My Head? Am I Making It Worse by Anticipating Pain?

[MusicTeacher]

Hey gang. I've had tinnitus and hyperacusis for about 15 months now. Wondering if anyone has had the same experience. I was home loading the dish washer (which normally kills my brain) and was totally engrossed in something that happened during the day - I wasn't thinking about the dishes clinking and banging. Half way through, I noticed there was no pain.

My tinnitus and hyperacusis vary from day to day, but that was really odd and made me think... Am I making this worse by anticipating pain? Don't get me wrong, some days the hyperacusis is terrible and others, not so bad.

Also - are there any people here who have had success with noise therapy? I have a program and hearing aids with white noise, etc... but I've gotten spikes from this in the past, so decided to stop using them.

Thanks,
Tom

 

[Michael Leigh]

Hi Tom,

You have had tinnitus and hyperacusis for quite a while and may need professional help to alleviate your symptoms. If you've had tests at ENT and nothing untoward has been found, other than you have noise induced tinnitus and hyperacusis? I think you should see an Audiologist that specialises in tinnitus and hyperacusis treatment. Please click on links below and read my posts: Hyperacusis, As I See It and Tinnitus, A Personal View, to see what this involves. You could also try self help which is also covered. I advise that you don't use headphones, earbuds or headset even at low volumes.

All the best
Michael.

Hyperacusis, As I See It | Tinnitus Talk Support Forum
Tinnitus, A Personal View | Tinnitus Talk Support Forum

 

[Orions Pain]

I'd say it depends on the pain. If your "pain" is like a head punch/loudness sensation than it could be that it's related somehow but if it's a physical sensation of burning or stabbing directly in the ear or down the side of your jaw, I don't see how you can imagine that.

 

[MusicTeacher]

@Michael Leigh, thanks for your response. I have read your posts in the past. I did see a specialist who set me up with hearing aids that would deliver sound therapy.

I'm not sure how that's different from wearing ear buds or headphones. Am I missing something?

She thinks it's safe, but the last time I used them my tinnitus spiked and it lasted for about a week. I'm just nervous to make things worse. Open to suggestions. I would say at this point, 15 months in, the hyperacusis is often more bothersome than the tinnitus. Can't believe I'm saying that.

 

[MusicTeacher]

@Orions Pain, my pain is a little different. No burning or jaw pain. It's more like,volume comes in much louder than you'd anticipate... and it feels like the inside of the ear is trembling with small speakers/crumby audio.

 

[Michael Leigh]

@Michael Leigh, thanks for your response. I have read your posts in the past. I did see a specialist who set me up with hearing aids that would deliver sound therapy.

She thinks it's safe, but the last time I used them my tinnitus spiked and it lasted for about a week. I'm just nervous to make things worse. Open to suggestions. I would say at this point, 15 months in, the hyperacusis is often more bothersome than the tinnitus. Can't believe I'm saying that.

Tom, with all due respect to the specialist that you saw who is probably a qualified Audiologist, but do you know if she has tinnitus? Unless you have hearing loss which would have shown up on your audiogram, then you shouldn't have been issued with hearing aids. These are not the correct devices to deliver sound therapy to the ear and auditory system unless, they are dual purpose units, meaning they have a hearing aid fitted and white noise generator?

A lot of health professionals believe it's safe for people with noise induced tinnitus to use earbuds and headphones, as long as the volume is low. This may be true for some people but unfortunately, many experience spikes when using them as you have found. Since you have read my posts then you probably know, I advise people with noise induced tinnitus not to use earbuds or headphones even at low volume.

There is a difference between hearing aids and earbuds, headphones. I have written a post about this elsewhere on the forum. Briefly, hearing aids and white noise generators have a small opening (aperture) at the end of a thin plastic tube, where sound emits into the ear. Earbuds, headphones and headsets use a speaker or diaphragm, which is much larger in comparison. As the speaker/diaphragm moves soundwaves are generated in the ear canal and they only have one place to go and that's directly towards the eardrum - this can cause irritation to the inner ear making tinnitus spike for some people with noise induced tinnitus.

All the best
Michael

 

[Orions Pain]

I know exactly what you mean by that loudness sensation. That's mainly what my hyperacusis was at first.

With that I feel like there are two components - it's not necessarily all in your head as something originally triggered it, some kind of unique damage to the hearing causing a central gain sort of sensation.

Since you've had it for a while it could be that maybe it's improving? In my opinion it's a combo of both anxiety and actual damage.

If you feel the inside of your ear trembling it could be the tensor tympani. I get that too. Not referring to thumping or clicking but with some audio like crumbling up a paper bag or water splashing around when I rinse after brushing my teeth, it's like something in my ear is trembling just like you said.

 

[Zugzug]

Hey gang. I've had tinnitus and hyperacusis for about 15 months now. Wondering if anyone has had the same experience. I was home loading the dish washer (which normally kills my brain) and was totally engrossed in something that happened during the day - I wasn't thinking about the dishes clinking and banging. Half way through, I noticed there was no pain.

My tinnitus and hyperacusis vary from day to day, but that was really odd and made me think... Am I making this worse by anticipating pain? Don't get me wrong, some days the hyperacusis is terrible and others, not so bad.

Also - are there any people here who have had success with noise therapy? I have a program and hearing aids with white noise, etc... but I've gotten spikes from this in the past, so decided to stop using them.

Thanks,
Tom

1) Way more likely that you weren't thinking about the dishes because you weren't in pain than the other way around.

2)It's possible that you're fading in and out of the condition. I would never not wear hearing protection while working with dishes. There are stories of people dropping glass and their hyperacusis is permanently worse afterwards.

3) Noise therapy does absolutely nothing for pain hyperacusis, other than possibly make it worse. It's not sexy, but probably the best thing you can do is avoid injuries and give it time.

Also, it sounds like your issue could be TTTS. If I'm wrong and your pain really did go away when you relaxed, that would explain it. Also, the fluttering that you describe and type of pain is more consistent with TTTS than noxacusis.

 

[Aaron91]

@Michael Leigh, thanks for your response. I have read your posts in the past. I did see a specialist who set me up with hearing aids that would deliver sound therapy.

I'm not sure how that's different from wearing ear buds or headphones. Am I missing something?

She thinks it's safe, but the last time I used them my tinnitus spiked and it lasted for about a week. I'm just nervous to make things worse. Open to suggestions. I would say at this point, 15 months in, the hyperacusis is often more bothersome than the tinnitus. Can't believe I'm saying that.

@Zugzug is right. You were likely not thinking about it because you weren't in pain, not the other way round.

I actually remember you posting back in August. I'm glad to hear you eventually dropped the white noise generators, which will have given your ears some of the rest they need to recover. Keep protecting, take things easy and whatever you do, don't listen to Michael Leigh, because clearly his advice, as usual, doesn't work.

Generally speaking, I would just encourage you moving forward to spend time doing your own research and become well-versed in all the latest medical discoveries that are coming out in regards to this condition. Ignore the doctors and boomers such as Michael when it comes to this condition - they are decades behind the research curve, stuck in the old dogmatic ways of the late 1980s.

 

[MusicTeacher]

Thanks everyone. If I can ask one more question...

Is there a difference between pain hyperacusis and hyperacusis? I assumed there was pain/discomfort involved for everyone. No?

 

[Zugzug]

Thanks everyone. If I can ask one more question...

Is there a difference between pain hyperacusis and hyperacusis? I assumed there was pain/discomfort involved for everyone. No?

Yes - very big difference. Both are capable of being mild or severe. Pain hyperacusis is usually worse, but it's far from uniformly true. It really depends on severity and symptoms.

Medically, they are completely different conditions. Pain hyperacusis is caused by the sensitization of type II afferent nerve fibres. This usually occurs due to outer hair cell damage and ATP leakage, caused by a noise injury.

Loudness hyperacusis (what I have) is generally believed to be a "more" straightforward sign of hidden hearing loss, though not always. The brain undergoes maladaptive neuroplasticity in an effort to compensate for hearing loss. This condition has a wide range of symptoms and severity. Commonly, the brain not only rewires to amp up the volume, but also to send stronger signals to the amygdala. Hence, sounds cause extreme overstimulation of the limbic system in a way that one can't just "ignore" it. It's totally disabling.

You're right that hyperacusis almost always involves some kind of pain, but there's a difference between pain being the main feature and a secondary symptom. For example, I haven't talked in a normal voice (or conversed in a normal voice) in over a year. When I do, I get headaches from my muscles involuntarily tightening up. I also find that my facial muscles tighten up, causing pain. However, this isn't pain hyperacusis, which is a stabbing or burning.

From a treatment perspective, loudness hyperacusis may have better results from sound therapy, although it doesn't work for me. Sound therapy doesn't even make sense for pain hyperacusis. The goal of sound therapy is to help the brain rewire to reduce central gain in loudness hyperacusis. In pain hyperacusis, it doesn't really make sense to "toughen up" the type II afferents.

Also, I should add that it's somewhat common for people to have some elements of both, usually caused by the same source of injury.

 

[serendipity1996]

Yes - very big difference. Both are capable of being mild or severe. Pain hyperacusis is usually worse, but it's far from uniformly true. It really depends on severity and symptoms.

Medically, they are completely different conditions. Pain hyperacusis is caused by the sensitization of type II afferent nerve fibres. This usually occurs due to outer hair cell damage and ATP leakage, caused by a noise injury.

Loudness hyperacusis (what I have) is generally believed to be a "more" straightforward sign of hidden hearing loss, though not always. The brain undergoes maladaptive neuroplasticity in an effort to compensate for hearing loss. This condition has a wide range of symptoms and severity. Commonly, the brain not only rewires to amp up the volume, but also to send stronger signals to the amygdala. Hence, sounds cause extreme overstimulation of the limbic system in a way that one can't just "ignore" it. It's totally disabling.

You're right that hyperacusis almost always involves some kind of pain, but there's a difference between pain being the main feature and a secondary symptom. For example, I haven't talked in a normal voice (or conversed in a normal voice) in over a year. When I do, I get headaches from my muscles involuntarily tightening up. I also find that my facial muscles tighten up, causing pain. However, this isn't pain hyperacusis, which is a stabbing or burning.

From a treatment perspective, loudness hyperacusis may have better results from sound therapy, although it doesn't work for me. Sound therapy doesn't even make sense for pain hyperacusis. The goal of sound therapy is to help the brain rewire to reduce central gain in loudness hyperacusis. In pain hyperacusis, it doesn't really make sense to "toughen up" the type II afferents.

Also, I should add that it's somewhat common for people to have some elements of both, usually caused by the same source of injury.

This is a really good summary.

Regarding the overlap between the two, it's been reported that the majority of people with pain hyperacusis also have loudness whereas the opposite isn't necessarily the case. It seems to me that if you have pain hyperacusis caused by a noise injury, then in all likelihood you will also suffer from loudness as well as tinnitus and maybe distortions too.

 

[TheDanishGirl]

1) Way more likely that you weren't thinking about the dishes because you weren't in pain than the other way around.

2)It's possible that you're fading in and out of the condition. I would never not wear hearing protection while working with dishes. There are stories of people dropping glass and their hyperacusis is permanently worse afterwards.

3) Noise therapy does absolutely nothing for pain hyperacusis, other than possibly make it worse. It's not sexy, but probably the best thing you can do is avoid injuries and give it time.

Also, it sounds like your issue could be TTTS. If I'm wrong and your pain really did go away when you relaxed, that would explain it. Also, the fluttering that you describe and type of pain is more consistent with TTTS than noxacusis.

I still have to wonder if I actually have noxacusis or if it TTTS... or both? I don't have burning/stabbing pain. My pain can best be described like a muscle contracting, coupled with a soreness feeling. I also have ear fullness a lot of the time, in various degrees, but not instantly after a sound, but more at random times.

 

[Zugzug]

I still have to wonder if I actually have noxacusis or if it TTTS... or both? I don't have burning/stabbing pain. My pain can best be described like a muscle contracting, coupled with a soreness feeling. I also have ear fullness a lot of the time, in various degrees, but not instantly after a sound, but more at random times.

It's your body, but I think noxacusis is specifically burning/stabbing. Obviously, pain is pain and it sucks, but I think of pain caused by the body's reaction to sound and pain caused directly from sound as being different disorders. I'm pretty sure TTTS is more treatable than noxacusis through relaxation techniques.

 

[Michael Leigh]

Is there a difference between pain hyperacusis and hyperacusis? I assumed there was pain/discomfort involved for everyone. No

Hyperacusis, like tinnitus can vary in intensity. I am referring to hyperacusis that accompanies noise induced tinnitus. Some people have it mild, moderate or quite severe where pain is felt. I don't think it's a good idea to focus on terms like pain hyperacusis, noxacusis too much. Psychologically a person can convince themselves their symptoms are so severe they will not improve with any kind of treatment. I once had very severe hyperacusis with acute pain. It was treated by me, under the care of a Hearing Therapist as part of TRT. I wore white noise generators for two years, at the end of treatment the hyperacusis was cured and remained this way for over 20 years.

Michael

 

[TheDanishGirl]

It's your body, but I think noxacusis is specifically burning/stabbing. Obviously, pain is pain and it sucks, but I think of pain caused by the body's reaction to sound and pain caused directly from sound as being different disorders. I'm pretty sure TTTS is more treatable than noxacusis through relaxation techniques.

Maybe you're right... I don't know. I lack some serious research on this. I have never been diagnosed with TTTS but I would bet that I have it. I also get fluttering in my left ear, and sometimes balance issues, although I am on antidepressants which could also cause this... and the ear fullness. But from my understanding TTTS is purely anxiety based, and I have days where my anxiety is much better, but my symptoms and pain level is the same, so I don't know.

I wish I could get an answer to what exactly is wrong. A proper diagnosis. If I don't even have that, then how am I supposed to treat it correctly I'm sure we all have these thoughts.

 

[Orions Pain]

But from my understanding TTTS is purely anxiety based

This is not true at all, lots of people have TTTS appear for different reasons without any history of anxiety. Ear infections, trigeminal neuralgia, acoustic trauma all tend to trigger it. Some women even have it appear after childbirth/epidurals.

To me it seems like it's related to an actual physical trauma to the middle ear or the nerves that innervate the muscle

 

[Orions Pain]

Yes - very big difference. Both are capable of being mild or severe. Pain hyperacusis is usually worse, but it's far from uniformly true. It really depends on severity and symptoms.

Medically, they are completely different conditions. Pain hyperacusis is caused by the sensitization of type II afferent nerve fibres. This usually occurs due to outer hair cell damage and ATP leakage, caused by a noise injury.

Pain Hyperacusis (deep ear stabbing) could also be a sensitized Geniculate nerve - nervus intermedius. Geniculate neuralgia also produces a deep inner ear ice pick stabbing pain. Similar to how the facial nerve gets sensitized for some, I don't think it's far fetched for this nerve to be effected with an acoustic trauma as well. It's not often discussed in these groups for some reason.

Pressure issues in the middle ear and eustachian tubes can also produce really painful stabbing ice pick sensations.

And of course sensitization of the afferent nerve fibers.

 

[TheDanishGirl]

This is not true at all, lots of people have TTTS appear for different reasons without any history of anxiety. Ear infections, trigeminal neuralgia, acoustic trauma all tend to trigger it. Some women even have it appear after childbirth/epidurals.

To me it seems like it's related to an actual physical trauma to the middle ear or the nerves that innervate the muscle

It just says so on many articles, like on this one - but I guess it's just another case of clueless doctors. Wouldn't surprise me much.

 

[Orions Pain]

It just says so on many articles, like on this one - but I guess it's just another case of clueless doctors. Wouldn't surprise me much.

That's what "specialists" say but it honestly makes no sense for it to be purely anxiety in my opinion. Plenty of people here with severe anxiety due to their tinnitus and hyperacusis, but have no TTTS.

Sounds like just another case of we don't know what causes it so we're going to blame it on your mental health.

Similar to the story attached below.

 

[MusicTeacher]

There's a lot to think about here. I know I have a slight loss in hearing around 6 kHz and based on what my audiologist said, there is damage to my outer hair cells.

Guessing this is probably pain hyperacusis. Based on all of the different opinions, it's hard to know where to go from here. My tinnitus seems to improve, then worsen, then improve... trending toward improvement. My hyperacusis is sometimes terrible (like now) and other times not so bad. I'm going to let time do its thing for a bit longer and see what happens.

I'm guessing if sound therapy does work, it won't matter if I try it further down the road.

And thanks everyone!

And the very last thing....it's so odd what bothers my ears vs not. You'd think it would be all Big Bang stuff, but more often than not it's the small stuff.

 

[SibilantRange]

It's the small stuff with me too.

Dishes, chips bags, dropping small things like a pen on a table etc.
Most things between 3 kHz and 6 kHz.

Sometimes I'll hear a tone in music, it would be like a long tone and it almost tingles my brain and I get slightly nauseated and feel weird for a few hours... Whatever that is... I'm at a loss...

Also when I look at the sky or something very bright for a while, I start to sneeze...

Maybe I am going crazy...