On Hyperacusis/Noxacusis Setbacks and Recovery

Two weeks ago I had what I consider to be my most serious hyperacusis and noxacusis setback in about 2 years.

As of today I feel about 80% recovered from this setback. I’d like to write a longer post about the steps I took to recover quickly in hopes that others can apply similar approaches to their own situations. Keep in mind what works for me might not work for you. Be careful and exercise caution.

First let’s talk about what happened:

I’ve been increasingly “pushing my luck” with my hyperacusis over the past month or so. There’s a dance between protection, avoidance, and exposure that I have to get just right in order to improve. If I just avoid and protect, I recover from acute injury but I don’t get beyond a minimal threshold. I hit a ceiling and stay there.

My hyperacusis and tinnitus were both caused by dangerously loud electric guitar at a show in 2019, and this is the one sound that seems to set me back no matter what. About a month ago I decided to make another focused attempt at desensitizing myself to this sound. I do this by watching electric guitar demos on YouTube at low volume for about a minute, then waiting 2 days, watching for a little longer, waiting 2 more days, etc. I gradually increase the length of time and reduce the frequency of rest days until I’m listening for several days in a row for about 10-15 minutes. I don’t mess with the volume too much, maybe a small boost for a few seconds here and there.

After a lot of success with this I started playing my own guitar at low volumes without issue. Then I got to medium-low volume. At this point I made a bold/reckless decision two weeks ago: I went to an actual music store to test out electric guitars. I wore musicians’ earplugs but brought heavier earplugs.

When I walked in the door there were two guys playing electric guitars at reasonable levels, no distortion. The sounds were still instantly too loud for me. And at this point I should have turned around and walked away. But I took out my decibel reader and saw that the sound wasn’t that loud, so I decided to push through. I had to test my ears and just see where I’m at and if there’s a chance that I can go back to normal. So I went to the back of the shop and switched my earplugs to the heavy earplugs. I then came back, picked out a couple beautiful Fender Stratocasters and tested them on a Fender amp about 4 feet away from me at low volume for about 45 minutes.

Towards the end of my session, it was very clear that my ears were super fatigued and starting to hurt badly from the sounds happening around me, both from my guitar playing and from the music and sound happening around me. At that point I made the decision to immediately leave. I could sense that a different type of fatigue and pain were setting in beyond what I was used to. It’s important to pay attention to the particular degree of ear fatigue or burning or stabbiness, I listened to my body and did not try to push through beyond the 45 minutes. This is the biggest difference between this setback and prior severe setbacks.

Over the next several days the dreaded noxacusis burning returned for the first time since summer 2022. It was clear I had set myself back, and I started to panic thinking it would take another 6 months to recover. However I know this condition a lot better now than I did in years past, so I put some of my recovery techniques to the test. Thankfully it looks like they have worked and I’ve bounced back quicker than ever before. Here’s what I did:

1. Double protect my ears and avoid ALL loud sounds and ALL digital or artificial sounds for several days in a row. I started this immediately after leaving the guitar shop, and increased the protection when it was clear I’d had a setback. I believe this and leaving the shop were the two biggest factors. There seems to be around a 10-day window after a setback where you can bounce back quickly if you protect against stacking multiple setbacks day after day. The vicious cycle of setback upon setback is what gets people like me to severe levels of noxacusis where they are trapped in their rooms because their LDLs are so low that even the quietest sounds set them back every day. If you can quickly break that cycle up for even 24-48 hours it will help massively.

2. Consume *tons* of ginger, much more than I have been. For me this stops the burning and gives me some relief. It feels like it allows me to get a grip on the situation.

3. Visualize loud songs and guitar feeling good. This is extremely difficult when you’re going thru a setback and I have no clue if it actually helped me or not, but I’ll include it. I’m not here to debate about CBT, I’m here to just relay info and try and help folks.

4. Get as much sleep as possible. Sleep resets my “sound allowance.” Over the years I’ve learned how it specifically feels when my sound allowance runs out and when that happens I protect immediately and aggressively for the rest of the day, before giving it another shot the next day. If I don’t get much sleep I protect hard. If I get a lot of sleep I’m more relaxed about my exposure.

5. Realized that I’ve always improved over time and I’ll improve again because I wasn’t objectively hurt by the sound. Again this is a CBT angle but I’ll include it. Basically I accepted that if I lose another 6 months then I lose another 6 months but eventually I’ll be ok.

6. Controlled re-exposure after extreme protection: After several days of extreme protection I switched from having heavy earplugs in both ears to just my right ear, which is my bad ear that burns more with nox. The left ear was allowed some more exposure to regular noise but it was still protected with a musician earplug which is lighter protection. I continued to avoid objectively loud sounds but started watching TV again at low volumes for about 15 minutes per day, gradually increasing each day I felt good and resting each day I felt bad. Eventually I switched the right earplug to a musician’s earplug and continued exposing and resting.

As of today I feel basically the same as I did 3-4 weeks ago. There’s slightly more stabby hyperacusis and my ears still get a little fatigued in the day but the improvement has been remarkable, given the fact that something far more innocuous than 45 minutes of electric guitar set me back for 6 months during my last major setback of 2021. I continue to completely avoid playing my electric guitar or listening to the guitar videos on YouTube. There’s zero reason for me to risk spiraling out of control at this point. This is where people who say “just push through bro” have cost people like me dearly. Noxacusis is not just loudness hyperacusis, and it’s not stabby pain hyperacusis either. To me those are 3 separate conditions, what works for loudness recovery hurts noxacusis recovery. Avoid advice from anyone who does not understand this.

Anyways it’s safe to say my music store days are over until there are treatments available for these conditions. That’s kind of a bummer, and I’ll never consider myself fully recovered if I can’t do stuff like that, but it’s a small price to pay if it means not having to be in agony for months at a time...

Hopefully this helps someone. I’ll try to answer questions but one thing that helps me is avoiding the forums so it may take a while for me to respond. Good luck everyone out there.

 

It's just good to know that you've managed to find a methodology that gives you good results. There aren't that many positive stories where hyperacusis in its various forms are concerned. Well done!

 

Hi,

Did you have any pain associated with your hyperacusis?

Since I got hyperacusis my mild right ear tone has grown very loud and fluctuates wildly and dramatically in volume, tone and pitch.

Do you experience something similar?

 

I've never experienced actual pain of the sort I'm aware you and others like Brian and David Treworgy of Hyperacusis Research write about. It's so difficult to articulate but mine feels like the ultra high-pitched tinnitus sounds are pressing into my eardrums if that makes sense. It's an intrusive, invasive sensation. I also experience a lot of recoil in the form of wincing to various frequencies but not necessarily volume so it's a bit of head-scratcher.

What I would call my initial noise trauma that led to an awareness of this loudness hyperacusis occurred two years ago, but my tinnitus was already crazily off the charts by then and had been for about two years prior to that. It was behaving in exactly the same way you describe; very loud and wild fluctuations of tone and pitch on a daily, sometimes hourly basis. Really quite disconcerting at times. When I explained this to an audiologist she said; yes, we often hear reports of hyperacusis aggravating tinnitus.

 

Thanks for explaining. My hyperacusis is getting better but not good enough. I am able to drive and just went to a bar tonight with earplugs and stayed away from louder parts. Still cannot work.

Yes, the most annoying part of my tinnitus is how insane the fluctuations are, seems to be common in people with hyperacusis.

Let me also ask you this, I know it is very individual, but do you go to bars or places that have similar volume levels with earplugs?

It is impossible for me to tell if something is spiking my tinnitus because it goes up and down and changes all day.

 

Basically, I now only go to pubs (the sort that are often referred to here as 'old men's pubs' (great eh?)) where the volume is generally sensible. I don't tend to wear earplugs in the pub, however, if we're going out to a restaurant I always have musicians' earplugs on hand just in case. I often find restaurants quite loud.

I think it's easier for me to be a bit more conservative these days because I'm in my mid fifties. I really feel for you younger guys because I know what I was like back then and I would have found having to balance my life in this way extremely challenging. To be honest, even now managing sound can be quite a challenge.

 

I got most of my partying out in college but yes it still sucks.

 

What do you attribute your recent increase to? I believe you said it was in 2018?

 

Yep, around then. Reckless use of enclosed headphones over a 3 month period or thereabouts. One day it was like something in my ear just broke and overnight the tinnitus got progressively louder and more dynamic.

The overt sensitivity to sound didn't rear its ugly head until a couple of years after that, but I now attribute those initial changes in pitch and volume to an early manifestation of (loudness) hyperacusis intersecting with the tinnitus.

 

Did you give your ears a break from hearing protection? Perhaps opted for a safe space for your ears?

After the setback, did you double protect 24/7, even whilst brushing teeth/showering, eating and sleeping?

 

I double protected at all times except while sleeping.

 

How are you now? Do you still get pain? How often do you use hearing protection?