Excellent work, I worked on a similar document myself but forgot about it eventually. Here are some more possible treatment options, however, be sure to do your own research first before trying them. I am in no way saying that these will help, only that some users have experienced improvements employing these treatments.
Avoiding sound
Literature
— "Accidentally dropping dishes on the counter can produce high-frequency sounds with peaks of 109 dB, causing instant and long-lasting pain to the patient, who may consequently require medication and hours of rest. This kind of environment is best to be avoided as the patient makes progress in spontaneous recovery, medical treatments, counseling, and sound therapy… Using placemats with dishes and napkins with utensils may help in making sounds more tolerable. Alternatively, paper plates and plastic utensils can be used. The greater the sound experience without discomfort, the better. (Colucci, 2017).
Experiences
— "I find that the condition [pain hyperacusis] needs total silence as the only time I've worsened is by trying to 'desensitize'" (
member weab00, 2020.)
— According to member Croaker, the chances of recovering [from pain hyperacusis] enough to do things like school, work, etc and not be housebound is pretty low without prolonged periods of silence (
member Croaker, 2020.)
— Member serendipity1996's pain hyperacusis has improved significantly in 10 months. He thinks time and being very careful with noise exposure helped him get better (
member serendipity1996, 2020.)
— "Overall, I feel pretty confident that being cautious with hearing protection helped speed my recovery" (
member Tsmith28, 2020.)
— "To me pain hyperacusis is like more an injury, where sounds make that injury worse, that's why TRT isn't effective treating it and time in silence makes it better" (
member Horrorpopz, 2020.)
— "You need to rest your ears and try to be the most time you can without a setback. That's the way to build tolerance. Setbacks take you back to square one. Spending a long time without setbacks builds tolerance and this can be notice in recovery times after exposure to medium - loud sounds that used to trigger symptoms... either they dont produce symptoms any more or the recovery time it takes for symptoms to fade shortens. Those are indicators of being on the good track" (
member Juan, 2020.)
— "I've made more progress in 3 days over protecting my ears than I did in the 2 months since onset (
member ShaunR, 2020.)
Emoxypine
Experiences
— "Had pain from noise for 18 months now. Burning for hours after any sounds over ±50 decibels. No stabbing. Just pressure, fullness, burning. Emoxypine takes this away to a very significant degree. I've been taking it for 3 weeks now and I'd say my LDL is about 85-90 decibels now, after a year of no progress" (
u/Impossible-Stick7698, 2021). Cured both his loudness hyperacusis and his self-diagnosed noxacusis.
• Dose: Unknown amount of mg two times per day for three weeks.
Nicotinamide Riboside
Literature
— "Nicotinamide riboside protects noise-induced hearing loss by recovering the hair cell ribbon synapses…Nicotinamide riboside (NR) has been proved to protect the hearing… NR promotes the oxidation resistance to protect the synapse and the inner ear morphology" (Han et al., 2020)
Experiences
— My own experience: Tried two bottles of 90 x 300 mg capsules Tru Niagen about a year ago, with little effect on hyperacusis.
— "My hyperacusis has been improving ever since I started taking nicotinamide riboside…Today I was walking around the park in the city near where I work, where not that many weeks ago I had felt under siege by sound. And things sounded ok. Driving in traffic with no ear protection also ok (NC headphones at the ready in the seat next to me). Walking around a shopping centre for a little while - fine. I can listen to music through my computer speaker and phone speaker at a safe level. People, kids, things making sudden unexpected loudish noises - no T reactiveness - although I still don't like it…I do get tensor tympani cramping, but that's a different problem albeit also ear related. The main thing is my sound tolerance and H are getting better, which has been helping my T. As the weeks go by I find my ears have been getting less and less of that pain from when they've been exposed too much sound" (
member Gman, 2018.)
• Dose: Unknown.
— Reddit user u/DownloadTillTandava1 took a "daily high dose of NAD+ and NMN" for approximately a month in the winter of 2020. "I no longer have to shower with earplugs. Previously even 10 minutes of high frequency audio on the computer speakers would start to irritate me and no more than an hour of low to moderate volume TV…Now if I get any burning or any pain it doesn't last - sometimes minutes and much subdued, but usually seconds…The past week since Christmas I have been able to have 2 - 3 hours of TV and computer audio + another several hours of moderate noise with conversation and at the worst only got a mild tingle. I watched literally 8 hours of television from around 4:00pm to 12:00am with my parents, marathons for New Year's holiday, and didn't feel discomfort and left with no pain and I'm sitting here pain and discomfort-free now" (
u/DownloadTillTandava1, 2020.) In a later post around July 2021, u/DownloadTillTandava1 mentioned he considered himself cured. He says: "I'm able to do everything involving sound normally again pain-free and discomfort-free." There are only two things which he still won't do, which are going to the movies and wearing headphones (
u/DownloadTillTandava1, 2021.)
Vitamin B12
— Dietary supplementation including Vitamin B12 was prescribed to hyperacusis patients to assess the efficacy of multi-modal migraine prophylaxis therapy (Abouzari et al., 2019).
• Dose: 200mg twice per day
Applying Ice
Experiences
— "I've also noticed icing the ears 10-15 mins eases the burning for a while" (
member arctic loon, 2019.)
Low Level Laser Therapy
Literature
— Pain threshold improvement for chronic hyperacusis patients in a prospective clinical study. Positive treatment results on other inner-ear disorders, such as tinnitus, have been reported in laser-therapy studies and an improvement in hearing capacity has also been found. Light absorption in the petrous bone has been measured when irradiating the cochlea with laser light. Laser light also has effects on the tissue in the cochlea, which is a possible explanation for observed hearing improvements. Laser irradiation of the inner ear seems to have a clinically measurable effect on the central nervous system, and significant activation has been observed within the network of brain areas, corresponding well to results from previous PET scanning studies of patients with tinnitus.
Home-Practised LLLT Experiences
— "Well I ended up getting the Luci Basic because I'm always hearing negative stuff about the Konftec. For the first couple of weeks the laser has helped my hyperacusis but has had no effect on the tinnitus. I guess it'll take more time to notice an effect on the tinnitus. The doctor recommended 30 minutes per day but I wonder if it's safe to use it for an hour?" (
member Robert Aleman, 2019.)
• Device: Luci Basic / Availability: Unknown
• Dose: 30 minutes per day
— "I still use my Red Light Man LEDs and Konftec LASERs on an occasional basis. They by no means have cured my tinnitus or my noxacusis, but I find when my chronic ear pain in silence (one of the many awful constellation of symptoms associated with noxacusis) is particuarly bad, treatment with LLLT helps the pain to subside some" (
member lymebite, 2020.)
• Device: Infrared Mini 830 / Availability:
RedLightMan: Infrared Mini 830.
• Device: Red-Infrared Combo Mini / Availability:
RedLightMan Infrared Combo Mini.
• Dose: Unknown
— "Several months ago I felt I had received improvement in my hyperacusis with short sessions of about 5 min per day. I can't say for sure it was from the laser, but after I stopped it gradually got a bit worse but not to my initial level" (
member Cal18, 2018.)
• Device: Lux Spa Home Laser / Availability:
LuxSpaIbiza.com: Inner Ear Home Laser.
• Dose: 5 minutes per day
— "I've been using them (600, 700 and 800 range) now -not consistent- since May.
For me it helps against the H worsening after (normal) noise exposure" (
member Lisa2018, 2018.)
• Device: Konftec, specific model unknown / Availability:
Konftec.
— "My tinnitus used to be so bad I was up 2 nights in a row with triple dose of sleep meds when I first got it. I could not read a book and hyperacusis was so bad that turning a pill bottle slowly was very painful. They measured my hearing loss at 85 decibels at 8k Hz… The only time I protect nowadays is when I'm riding in a car. I've made massive improvements but it's hard to quantify them because the gains have been so gradual" (
member Soundb0und, 2018.)
• Device: Konftec emLas-520BCB / Availability:
Konftec emLas-520BCB.
• Dose: Both wavelengths 30 minutes per day.
Multi-Modal Migraine Prophylaxis Therapy
— "In a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications… Twenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB (
P < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment (
P < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7,
P < .001)… It is likely that, of the various types of hyperacusis including loudness, annoyance, fear, and pain,
migraine prophylactic treatment will best target loudness and pain hyperacusis (Abouzari et al., 2019).
Bibliography
Abouzari, M., Tan, D., Sarna, B., Ghavami, Y., Goshtasbi, K., Parker, E. M., Lin, H. W., & Djalilian, H. R. (2020).
Efficacy of Multi-Modal Migraine Prophylaxis Therapy on Hyperacusis Patients. Annals of Otology, Rhinology & Laryngology,
129(5), 421–427.
Cevette, M. J., Barrs, D. M., Patel, A., Conroy, K. P., Sydlowski, S., Noble, B. N., Nelson, G. A., & Stepanek, J. (2011).
Phase 2 study examining magnesium-dependent tinnitus. The international tinnitus journal,
16(2), 168–173.
Colucci, D. (2017).
Effective management of pain hyperacusis. The Hearing Journal,
70(2), 42–42.
Han, S., Du, Z., Liu, K., & Gong, S. (2020).
Nicotinamide riboside protects noise-induced hearing loss by recovering the hair cell ribbon synapses. Neuroscience letters,
725, 134910.
