Is Teletherapy Worth Risking a Hyperacusis Setback?

Hi everyone,

Long story short, I have hyperacusis/increased tinnitus induced by acoustic trauma. I'm almost 5 months in with no improvement to sensitivity or occasional pain. I probably have a good chance of some healing but I RUINED it by messing up my meds. I'm currently in what I assume is benzo withdrawal and hyperacusis/tinnitus are worse than ever. I will never forgive myself.

My mom wanted me to see a therapist due to severe panic/anxiety. I refused to do another car ride (I have done 2 recently due to withdrawal). I caved and did a tele-therapy appointment because my mom was understandably at her wits' end with all the crap I'm putting her through.

Apparently the therapist is/was an audiologist and had patients with tinnitus & hyperacusis. She is the first professional in the medical world (ENT/audiologist/psychologist/MD) that has actually understood the debilitating nature of this disease. She agrees it's a physical injury first and anxiety plays a part but isn't the cause. I was shocked. She spoke very quietly from the second we started - I didn't even have to ask. No recommendation of CBT, “be positive”, or any of that. Just believed me, listened, and is even helping me find a psychiatrist who will help with meds. My current psychiatrist doesn't believe I'm withdrawing despite vomiting, nerve symptoms, etc.

My worry is the digital noise. I refuse to take on the phone unless it is 100 percent unavoidable. I let my guard down and talked to her for an HOUR. Lowest volume, speaking voices were 60 dB or less for most of the convo. I didn't have hearing protection most of the time because I couldn't hear.

Did I make a HUGE mistake? My ears are hurting and feel warm. I would NEVER have done this before. If this causes a setback or permanent worsening, I will never forgive myself. It just felt great actually talking to a human being in person other than my mom or doctors. I got too comfortable - I told myself 30 minutes tops which is still dangerous.

Do I have a chance of recovering? I don't think I will do another appointment for quite awhile if at all. I would rather be alone and fighting the anxiety/panic on my own and upset my mom by not seeing a therapist vs. getting worse. I broke the rule of no digital audio and I pray to God that I didn't make the wrong decision.

My ears currently hurt and are burning. They usually never burn

 

It's fantastic that you found a therapist who is also a former audiologist! She sounds like she's worth her weight in gold.

You are unlikely to have a permanent worsening from this. Your voices were low the entire time, it's just that ears with noxacusis are extra sensitive to artificial audio, and that's totally normal. The burning pain will very likely subside in a day or two. And just think, if you hadn't spoken to her, you'd still be pining for a medical professional who understands how you feel. Be proud of yourself for having the courage to take this step. She sounds like a keeper.

 

Thank you so much. Yes, she was wonderful. I hate to say that part of me wonders if she said certain things just to calm my panic - it’s hard not to be skeptical. There’s a doubt like what if she really thinks it’s all anxiety secretly - but I don’t think that’s the case. Just a worry in the back of my head.

I feel so bad because I was a jerk to my mom about it and refused to do it for awhile. I said horrible things to her. My mom is an angel and just wants to help. She’s still rightfully upset with me about that and the meds, but hopefully we can move forward.

So you think it will be ok? Ears feel sore, should have stopped earlier. I’m scared I pushed my limit - praying it won’t cause any worsening.

Thanks so much, I appreciate you.

 

Well, we all react differently to noise, but speaking from my own experience (and that of many others I've seen on this board), these audio-induced spikes are nearly always temporary, which is why you'll probably be okay. It also helps to allow your ears to rest as much as possible afterward and maybe take some vitamins or supplements to speed the recovery, such as ginger and NAC.

I know how it feels to be afraid of artificial audio. Just last fall, I made the mistake of taking my audiologist's advice and listening to enjoyable music at home without any ear protection because, according to her, it would help me habituate. So I listened to YouTube for only twenty minutes, and I developed a burning pain and tingling sensation. My audiologist didn't know what to do about it, and I was really upset because it was suddenly obvious to me that she must not see patients with severe noxacusis very often, or she wouldn't have encouraged me to expose myself to music in such a careless manner.

I was in a lot of pain for a day or two, and then it subsided back to baseline, thank goodness. I then avoided all music for many months, and eventually I got to the point where I could listen to music again on my own terms without any problems. If my audiologist knew how long I took to get to that point, she probably would've thought I was being a coward, but I didn't care about her opinion because by then, I trusted the feedback I was getting from my own body more than I trusted her. I'm the kind of person who wants to put faith in authority figures, and so it was devastating to realize that when it comes to tinnitus and hyperacusis, there really aren't any authority figures out there. It was a huge lesson for me to realize that I would have trust my own experience and learn as I go.

So the point I'm trying to make here is that when your ears are really sensitive, it's natural to be highly selective about the situations you are willing to risk, and natural to second-guess yourself. You may be in a spot right now where you're still uncertain as to what your ears can tolerate and what they can't, and that's totally normal. Just prioritize accordingly.

Nothing in life is without risk. Knowing that your ears are sensitive to artificial audio, you obviously wouldn't listen to music for recreational reasons or even rehabilitative reasons just yet. However, because it is occasionally necessary for you to speak with a doctor, audiologist, or therapist via phone or Zoom, that is definitely a wiser use of your time and hearing. That's why I think you did the right thing today, and why I think you're being very brave to have taken this step. It was a huge, huge win for you to establish a working relationship with a professional who has a good grasp of what you're going through. So rest easy tonight, knowing that you took a step in a positive direction.

See how you're feeling in the next few days, and if you want to have another session with that therapist, look into the possibility of doing it over Zoom and using real-time captions so that you can lower the volume or mute it altogether. I bet it would feel good for you to connect with her again, once you have come up with some work-arounds to make it more comfortable for you.

As for your mom, I hope she'll be patient a little while longer. It's never easy for anybody to deal with tinnitus and hyperacusis, but you will both get through it.

 

I think that you will improve. I struggled for several years but can now talk on the phone, experience less hoarseness, and can be at a somewhat loud cocktail party without too much discomfort.

I am curious to know the name and location of your therapist if you are comfortable sharing it.

 

Why not wear noise reducing earplugs to attenuate sound by 10 to 15 dB when speaking to the therapist online?

As for if this person believes that tinnitus is (more) physiological than psychological, you'll know soon enough what she thinks.

There are people who have tinnitus who 'believe' it is PURELY an emotional (psychological) problem.

This physiological vs. psychological designation of tinnitus can be a very contentious issue.

The crux of this contention is there is no way to prove either way as it's impossible for technology to see inner ear damage via medical scanning and impossible for equipment to 'hear' tinnitus.

The condition is effectively invisible.

This makes it very easy for doctors to classify tinnitus as a psychological problem, namely because there is no proof of anything. It's a well known narrative in the medical profession: "We can't cure them and it's really bothering them so refer them to a psychologist or psychiatrist."

This leads to the next problem where tinnitus sufferers feel misunderstood and not believed by doctors that what they're suffering is a real entity that they have no control over.

There will come a day when technology advances enough that they will be able to scan the inner ear accurately and see the damaged cells and nerves. By that point they will probably have a cure for hearing loss and tinnitus too as it'll be easier to tell which experimental drugs are having an effect during research.

And when they get to that point (decades away IMO) where they can "see" tinnitus and cure it, do you really think they'll be calling it a psychological problem then?

 

Thank you so much. If I could do it again I might stop after 20 minutes, but what’s done is done. On the one hand, I’m glad to speak to someone as it made me feel a bit better mentally, but I’m worried I ignored the consequences. I think I will hold off on another appointment for awhile and think it over. I like your idea of using captions. Thanks again.

She said that she feels from an “ear” standpoint that no damage could have been done which I politely disagree with - that lets me know she is not 100 percent aware that even a whisper can hurt some people but I get the feeling she knows/understands more than most. Or maybe she just told me it was ok because she didn’t want to worsen my panic - who knows I don’t think I’ll meet up again for awhile unless captions can be used per @ECP’s suggestion.

You’re right, I should have used earplugs. I knew better. I tried using Loop Quiet earplugs and some random earbuds I had, but we were talking so low I couldn’t understand her. I messed up, didn’t I? My ears and entire face/head hurt terribly last night, it was scary. It’s better today - Praying there’s no return of the pain. I’ll have to do another video call w/ a psychiatrist office soon to straighten out my meds which might destroy my ears.

I truly wish that research was further along for the conditions. It’s inhumane for people to suffer without relief, then on top of that be treated as a head case like you mentioned.

Maybe some day.

P.S. Freaking out. It wasn’t worth it.

 

It seems as if you have your whole organism in a state of complete over-arousal and hyper-vigilance. Try and take the heat off yourself. Look outside yourself, it gives a better sense of perspective. Treat yourself the way you would like to treat someone you loved, by being gentle and considerate and thoughtful. It looks as if you have yourself in a thoroughly medicalised state. Reading a good book might help you. I'm reading "A Tale of Two Cities" by Charles Dickens. In that book you will find a beautiful example of how to treat another person with loving care. At the moment, that other person is you.

 

Try to use subtitles if they offer it. Zoom has it I think.

I have very severe noxacusis and I’ve learned my ears just cannot do artificial audio. The longer I listen, the more severe my pain gets and the worse my tolerance gets. I can talk to people now in person for short periods of time but a phone convo at half the volume will leave me in severe pain for days. I avoid it at all costs. My right ear, with more moderate noxacusis, can do short periods of super low volume, but the left ear won’t have it. I can’t say how many times I thought the TV was OK at super low volume and I kept pushing through it, just to make myself worse.

So was it causing damage? Maybe not the damage we or doctors think. 20 dB sounds are definitely not causing damage, there’s no way, but it’s definitely irritating the nerves. If I was causing more damage, I would be deaf by now or have catastrophic tinnitus. My tinnitus or hearing never gets worse in my bad ear.

Read about other people’s experiences with neuralgia conditions like trigeminal neuralgia. I try to think of it like that. They get setbacks from touching their face and severe lingering pain. Is it causing damage? No, but it’s irritating the nerve more just like sound does to us.

We all have our trigger sounds we must avoid so it’s up to us to figure out what to avoid and what to be around. Like the other day I heard really loud thunder, I was in my house with double protection and I didn’t get pain, later that day my bed frame creaked and I was in pretty bad pain the rest of the day. My bad noises are high-pitched squeals, squeaks, beeping, sirens, and artificial audio. I can say what most of us have in common, is we all have issues with artificial audio. It seems to mess a lot of us up.

 

I think even low decibel sounds can cause actual damage. Acoustic trauma causes inflammation in the ear, sometimes doctors can even see actual bruising of the eardrum. If 20-30 dB sounds are flaring up the symptoms, aren’t we adding to that inflammation? Once the inflammation becomes chronic, it can damage cells, soft tissue, cause scarring, etc in the ear.

 

Thanks everyone. I’m definitely not going to do a call again unless I can type responses and use subtitles with sound muted. I liked the therapist, but I can’t mentally or physically handle any worsening. I’m already withdrawing from meds because I’m an absolute idiot and the symptoms are rivaling hyperacusis. The tinnitus is so loud I can’t really gauge how loud things are and I’m worried I’ll think something is a “safe” dB level when it’s not. I honestly don’t know how (or if) I’m going to her back to functioning somewhat but I guess I have to try. I made my bed so I have to sleep in it. Anxiety has controlled me for years and now it finally backed me into a corner and I let it win.

Apologies for the drama. I need to get over myself. I’m not a victim. I caused this.

 

Since it's higher frequencies that cause problems for you, have you tried cutting down all high, maybe even mid frequencies from artificial audio? I wonder if that would help you tolerate it better. I don't have the condition or I would test it myself. But with my recruitment (or maybe it's even mild hyperacusis, I don't know) cutting the high frequencies allows me to watch TV and, kind of listen to music, though distorted guitars and cymbals still give me problems. I can listen to rap fine though as long as the drum track doesn't have any high-pitched snare sounds.

 

Yeah, I’ve cut all of it out for about a year. My ears were improving a little in other frequencies but I still can’t do it or I get bad pain. I don’t really get my tolerance back but my ears feel better overall.

Very tricky condition.

Maybe anything is possible with our crappy ears. It’s still very unlikely but I guess it can happen.

 

Update: Cancelled appointment w/ therapist and she was very understanding. I felt great talking about everything but my ears are screaming w/ tinnitus due to being reckless with meds.

Praying it goes back to baseline. Thanks everyone.

 

Benzos are also known for suppressing tinnitus, so I suppose it's also possible that the increase (or at least some of it) is attributable to simply no longer being on the medication (as opposed to a withdrawal reaction).

I sincerely hope it comes down for you!

 

Thank you, I really hope so. I’ve also seen people saying that Zoloft caused or worsened their tinnitus. I wonder if it was that instead of the benzo? Not looking good, those people said they still have it.

 

Hi everyone, in your opinion, is a drive to the doctor more or less risky than a telehealth visit? I have an appointment for my meds coming up and I’m worried.

 

How far away is the drive? And how sensitive are you to artificial audio with earplugs? For me, I choose in-person; I experience consequences either way, but with the drive it seems better.

So it all depends on what works better for you. Either way, after the visit, do your best to really protect your ears.

Oh, just had a thought - would you feel comfortable using a relay service? Then you could type to the operator, the operator would relay the info to the doctor, & would type back the response for you, to which you would then respond, etc.

Cheers,
Maddy

 

Ginger increases blood pressure, which may cause tinnitus to worsen.

The only way to avoid reacting to noise may be complete relaxation, without the artificial sounds of devices. Elimination of listening to music from receivers and watching TV. Hiking or a trip to the mountains may be good. Every time spent in nature. My audiologist recommended that I work on relaxation or do new tasks by shifting my attention and fully concentrating on the task at hand.

Burning ears may be a sign of hormonal changes or the effect of taking medications that dilate blood vessels.

 

If they can do the phone, then they can do Skype w/ video, or Zoom. That way you can see each other (up to 90 % of human communication is non verbal), and you won't have a phone against your ear. You can move closer or further away, and seeing people's faces means you can understand them even at low volumes.