Occlusion Effect While Wearing In-Ear-Monitors and a Subsequent Spike in Tinnitus

[Matthew E]

Hi All,

This is my first post, and it seems like a great community here.

I'm a musician and have had tinnitus for 20 years, with ups and downs. Sometimes it spikes, sometimes it settles. However, the last few years have become increasingly challenging. After being sick and starting a tour last year, I developed a new tone in my left ear, which had never had issues in the previous 19 years.

For the last 20 years, I've always worn custom earplugs while playing. Last year, I had to start using in-ear monitors (IEMs). I was initially excited about the possibility of things being much quieter, but it hasn't worked out that way. The main issue is the occlusion effect I experience when my ears are plugged with IEMs. This is manageable on festival stages and outdoor events, but it's a nightmare in clubs and theaters where there's a significant buildup of sub-frequencies. Loud sub-bass resonates heavily in my head with the IEMs in, and despite decent isolation from the IEMs, I experience a massive spike in my tinnitus due to head resonance. The new tone in my left ear is now almost twice as loud as it was last year, and the tinnitus in my right ear is as loud as I can remember.

Currently, I wear my IEMs (with approximately 20 dB reduction) along with a pair of Honeywell 35 dB industrial earmuffs over them while I perform. Although this setup doesn't eliminate the occlusion effect completely, I now use slightly looser-fitting tips on my IEMs to allow my ear canals to vent. I know I'm not the first musician to wear industrial muffs in a loud band, but I'd prefer to use ambient IEMs if any exist with good isolation. To my knowledge, however, such models aren't available and, by design, they're not suitable for loud environments.

Has anyone had experience with the occlusion effect while wearing IEMs? Any insights on ear damage due to loud head resonance with occlusion?

My tinnitus has become so severe that I'm considering stepping back from touring, not only for next year but possibly for good. Music is my life and my joy, so it's difficult to process the thought of ending this work.

I'd appreciate any advice or shared experiences.

Thank you,
Matthew

 

[Bill Arsenault]

Maybe try going without the earmuffs to see if it helps. I realize this isn't ideal for overall noise, but in my experience, hard plastic earmuffs can make low-frequency rumbling even louder unless they're fitted uncomfortably tight. For me, they only seem effective against sharp, higher-pitched noise.

Do the in-ear devices go into the ear canal? If not, try using foam earplugs first, with the in-ear devices over them. You may find that sound can transmit through the foam earplugs if kept in flush contact. It may seem counterintuitive, but not much about tinnitus makes sense sometimes.

You could also try bone conduction headphones so you can keep your ears plugged. I've used bone conduction headphones over my earplugs, and the sound transmits right through them. If the foam earplugs sit too deep to make contact, try placing silicone putty swimming earplugs over the foam plugs to bring everything flush with the outside of your ear. This way, the sound will transmit through both layers but at a much less harsh level.

I know this might sound ridiculous to some, but sometimes you have to keep trying different solutions until you find what works. Maybe one of these ideas will lead you to something that helps.

Good luck, man.

 

[Matthew E]

Maybe try going without the earmuffs to see if it helps. I realize this isn't ideal for overall noise, but in my experience, hard plastic earmuffs can make low-frequency rumbling even louder unless they're fitted uncomfortably tight. For me, they only seem effective against sharp, higher-pitched noise.

Do the in-ear devices go into the ear canal? If not, try using foam earplugs first, with the in-ear devices over them. You may find that sound can transmit through the foam earplugs if kept in flush contact. It may seem counterintuitive, but not much about tinnitus makes sense sometimes.

You could also try bone conduction headphones so you can keep your ears plugged. I've used bone conduction headphones over my earplugs, and the sound transmits right through them. If the foam earplugs sit too deep to make contact, try placing silicone putty swimming earplugs over the foam plugs to bring everything flush with the outside of your ear. This way, the sound will transmit through both layers but at a much less harsh level.

I know this might sound ridiculous to some, but sometimes you have to keep trying different solutions until you find what works. Maybe one of these ideas will lead you to something that helps.

Good luck, man.

Thanks for the comprehensive reply, Bill. You've shared some great ideas.

I've actually had some success using foam tips on my IEMs that don't fit perfectly, and then adding earmuffs on top to improve isolation while relieving pressure. You're right, though; industrial earmuffs can sometimes amplify the low end, which isn't always ideal.

Right now, I'm waiting on a new set of custom IEMs from 64 Audio. They have a built-in module that relieves sound pressure, so I'm hoping they'll help with isolation. All of this is happening in the middle of a national tour, so it's been a bit of a challenge!

Thanks again, mate.

 

[Bill Arsenault]

Make sure to enjoy yourself out there, and rest assured you're protecting your ears as best you reasonably can at the moment—certainly much better than most people do. Tinnitus tends to gradually worsen with age and time despite our efforts, so don't drive yourself crazy over it right now. Just keep going and reassess after the tour.

Passive noise and vibrations may aggravate it, but that doesn't mean you've done anything to make it permanently worse. It took me years to realize this. I lived like a recluse for about six years, then finally had enough and recently bought a motorcycle because driving a car with earplugs was so depressing.

Now, I'm having a blast, just protecting my ears as best as I can with plugs and a great helmet. This change in attitude has helped me start living a bit more in every area. I'm even playing my guitar again more than ever. The guitar was never the issue; it's the excessively loud world we live and work in.

Remember, don't let people's careless actions ruin your ears. Don't just stand there and tolerate it—cover them up and walk away if you need to. Who cares what anyone thinks?

Take care.