The ENT Told Me Not to Protect from Everyday Sounds by Using Earplugs

[Martin G]

I'm aware that ENT's don't have the greatest reputation on this Forum.

I went to one myself shortly after getting tinnitus & hyperacusis, about 6 months ago... and was definitely less than impressed.

However, 6 months later and my boss is so concerned about my condition that he used some contacts (his brother is a Doctor) and made an appointment on my behalf (without my knowledge), with a very highly regarded ENT. He is booked up until March... but my boss got me an appointment for January 7th.

I was a little apprehensive, but wasn't going to say 'no thanks', when he'd gone to all the trouble of setting it up. I mean... better having a boss who's concerned than one who doesn't care, I guess.

I Googled this ENT and he had an average rating of 3.9 out of 5.0 stars, from 33 patient reviews... with many saying he literally saved their lives. Only reason it wasn't higher was that a lot of them said he was abrupt and had no 'bedside manner'.

So anyway, I had the appointment yesterday and actually found him very good to deal with.

For whatever reason... he didn't even mention or ask about my tinnitus. He just concentrated on the hyperacusis... which was fine by me.

He looked at all my previous tests. Blood Test/Audiogram/CT Scan/MRI/Ultrasound.

Bottom line is, he is sending my back to the Audiologist to look at getting a White Noise Generator for my bad ear. I didn't have any specific problem with that. Although I asked him what would happen if I was walking along with this in and went past some kind of loud equipment? Would I still be able to put my finger in my ear or block my ear in some way, to protect it? He said no... as it would fit inside my ear, filling the ear cavity. But he said I wouldn't need to protect my ear in that instance anyway... as this device would detect the sound and cut it out or reduce it, somehow. So it sounds pretty hi-tech. I'm wondering if anyone has had experience with this style of device before?

However, the main reason I'm writing, is his overall view of hyperacusis... which is actually counter-intuitive to the way I have been dealing with it up to this point.

My approach so far has been to try and strike a balance between protecting and over-protecting. I always have ear plugs and Bose Noise-Cancelling Headphones at the ready, should either (or both) be required... which is pretty often. But on the other hand... I also consciously try to slowly increase exposure to normal everyday sounds when I can... to hopefully desensitize my hyperacusis. I take a lot of 'nature walks' to that end... where I don't use any protection. Unless I'm going past some obnoxiously loud birds or insects. Then I'll pop in an ear plug while passing them.

Anyway, the ENT said . . . NO EAR PLUGS!

He said I should obviously use protection for very loud sounds... but said I should not be protecting from everyday sounds... and that by using ear plugs during 'everyday life', I was making my hyperacusis worse.

He said that years ago... the advice would have been to use ear plugs... but that now they know better.

I said that if I couldn't use ear plugs... I would never be able to go into my kitchen again... as the sound and horrible distortion from plastic and plates and cutlery and sizzling food etc. would kill me!

He said that these 'normal' sounds won't cause any kind of damage... that the ear is very 'hardy'... and basically I just had to find a way to 'grin and bear it'.

I've noticed that protection vs. over-protection seems to be an ongoing debate in these parts... and I don't really want to open that whole can of worms... but unless anyone has some actual, factual, biological, medical, scientific proof that what he is saying is incorrect I'm guessing that maybe I should take his advice and consider this approach.

 

[Hariz Nonis]

I feel that ear plugs can cause your hearing to be more sensitive to noises. You should probably wear them if, and only if you are really uncomfortable with your hearing at the time. And also, I saw a Youtube video that states "noise cancelling headphones should not be worn if you have hyperacusis". I'll try to find that video, and link it here.

 

[Vincent R]

I've noticed that protection vs. over-protection seems to be an ongoing debate in these parts... and I don't really want to open that whole can of worms... but unless anyone has some actual, factual, biological, medical, scientific proof that what he is saying is incorrect I'm guessing that maybe I should take his advice and consider this approach.

The problem is that you can't always predict when very loud sounds are going to appear. Lots of tinnitus sufferers have had their condition aggravated due to sudden noise exposure, caused by fire alarms, a kid popping a ballon, ambulance sirens and what have you.

If I were you, I would keep using earplugs in environments that are unpredictable as far as noise goes. Save from that, I can neither verify nor falsify the ENT's take on hyperacusis. Due to his profession, it makes sense to assume that he knows what he's talking about.

The security aspect might be something you wan't to take into account. I personally think it's being underestimated by medical professionals.

 

[Digital Doc]

The problem is that you can't always predict when very loud sounds are going to appear. Lots of tinnitus sufferers have had their condition aggravated due to sudden noise exposure, caused by fire alarms, a kid popping a ballon, ambulance sirens and what have you.

If I were you, I would keep using earplugs in environments that are unpredictable as far as noise goes. Save from that, I can neither verify nor falsify the ENT's take on hyperacusis. Due to his profession, it makes sense to assume that he knows what he's talking about.

The security aspect might be something you wan't to take into account. I personally think it's being underestimated by medical professionals.

Yup, these intermittnet noise expsoures are the most challenging. Now on two separate occasions, in a parking lot outside of a store it got quite loud. The first tme it was a semi truck blasting his air horn several times, I have been to that store hundreds of times through the years and this never happened before, but I was pushing a cart in traffic and was not quick to cover my ears.

Yesterday, had a very loud car go past with a performance exhaust. Was damn loud, and I would guess as loud as a motorcycle, about 90 db. Same with pushing the cart, and did not cover ears.

In neither case was there time to put earplugs in that I had with me just in case.

The ENT's advice is simple, but perhaps not the most practical. I also do not want to wear foam plugs while shopping for these random events, and believe it can make hyperacusis worse, but worry about a tinnitus spike, although has not happened AFAIK.

 

[Emperor-Drax]

You just need to use your better judgment. I keep a set of muso earplugs on me at all times, but mostly I never have to wear them. They're just my insurance now in case I find myself in a noisy place that my injured ear doesn't like. And I've found that sudden bursts don't seem to hurt me anymore, but everyone is different.

 

[Bill Bauer]

Anyway, the ENT said . . . NO EAR PLUGS!

He said I should obviously use protection for very loud sounds... but said I should not be protecting from everyday sounds... and that by using ear plugs during 'everyday life', I was making my hyperacusis worse.

It is good to find a volume level that you are ok with (say on a TV), and then gradually increase the volume. But to throw all caution to the wind has a chance of working out horribly. Listen to the signals from your body. I had been protecting my ears, and ended up being happy with the outcome. My H went away, despite me protecting my ears in everyday situations.

It is common for doctors to be great at treating the top dozen or two of the more popular diseases, and know very little about the treatment of any of the less common complaints.

He said that these 'normal' sounds won't cause any kind of damage... that the ear is very 'hardy'... and basically I just had to find a way to 'grin and bear it'.

He might be right - there might not be any damage to your hearing. This doesn't mean that there won't be a permanent T or H spike.

unless anyone has some actual, factual

Here are some actual factual case studies that can give you an idea of what might happen should you decide to "play with fire":

With regards to noise exposure that isn't dangerous to most people, I developed a new tone in my right ear after a noise exposure at work back in October. I spent about half an hour in an area that I would estimate was at most 90db, but it was probably less than that. I had deeply inserted large foam earplugs at the time, but apparently that was not enough protection. That tone has not gone away, and it's not some psychosomatic spike. Spikes in volume are somewhat relative in my opinion, they can be attributed to stress, lack of sleep, noise exposure, diet, etc., but completely new tones that do not go away are something different.

What is safe for you may not be safe for me. And the fact is there has been no good study done assessing the vulnerability of already damaged auditory systems. The gold standard for dangerous noise levels is based on old data from OSHA where they looked for permanent threshold shifts of 10db or more at 2000, 3000, or 4000 Hz. As we know now, you can have fairly significant auditory damage without having a permanent threshold shift in those three ranges. There is also a lot of industry push-back when OSHA tries to make safety guidelines more strict (I haven't seen this with noise levels, but I have seen it with chemical safety guidelines). Moreover, it's very likely that some people are more genetically predisposed to hearing damage than others.

I was told not to wear hearing protection for normal everyday situations but look where it's got me.

I'd like to say its improved, but the noise has actually got worse - a lot worse just lately as I've been exposed to a noisy office environment. Normal for everyone else but too noisy for my ears.

I tried the 'laissez faire' approach for that first period, where I didn't let myself be bothered by most sounds, except for 80db+ (when I started plugging the ears) and still went out and did all my old activities, but that ended up costing me dearly. I had a 'spike' (if it can still be called that) that hasn't gone away.

So, I'm currently experiencing a big spike in both ears that is not subsiding – and I don't know why – because it shouldn't have been a bad enough exposure to do this.

I used a heat gun to remove some old lino flooring for about 1-1.5 hours. I turned it off every 2-3 mins or so for about a minute – so it wasn't constant for the entire 1.5 hours. I used double ear protection the entire time – silicone earplugs fully inserted and 37dB Peltor X5 ear defenders on top. The heat gun basically sounds like a hair dryer, and my iPhone measures it at 72dB from the distance I was using it from my ears.

At no point did it feel loud or uncomfortable – my ear protection should be bringing down the exposure to 55dB (at worse!)

Following this, both ears have gotten worse – by a decent amount. Enough to unsettle me. It has been 8 days, and no real sign of improvement.

The fact that it is in both ears, feels like a different spike than normal, and has not subsided in the usual time has got me concerned.

To all members in this forum advising against so called "overprotection". I never exposed myself to sounds even remotely considered as being potentially harmful to healthy people but because of your advice I was exposed to sounds uncomfortable for me which eventually proved to be damaging.

At initial stages i was very weary about sound levels around me and used protection everytime I felt uncomfortable.

Only by reading TRT literature or some posts here I started to expose my self to sounds loud but never louder than 75-80 dB.

Whenever I was feeling like something is not right I was stupid enough to believe you these changes were part of "the natural process of healing".

Is this your healing? Every time you feel like giving this sort of advice have my case in mind.

medical, scientific proof

http://hyperacusisfocus.org/research/earplug-use-2/
"While there are over 2200 posts on hyperacusis setbacks in the patient forum on chat-hyperacusis.net, no academic papers could be found using a pubmed search.

Some clinicians will inform the patient that sound levels below 85 dB (equivalent to noise from heavy traffic) are safe as they are unlikely to cause long-term hearing loss. While this is comforting and good to know, the relevance to setbacks is unclear as long-term hearing loss (often outer hair cell loss) is not suspected to be related to hyperacusis setbacks. Sound levels that trigger setbacks may be dependent on baseline LDLs and the particular subtype of hyperacusis (pain or loudness). There is a glaring need for research into setbacks to assess the consequences of underprotection. Setback thresholds, duration, severity, and frequency should be studied in relation to long-term recovery. Only then should maximum "safe" sound levels be defined."

The fact that there have been no published studies regarding what causes permanent and temporary T spikes, means there is no scientific reason behind doctor advice to only protect your ears against noises that are known to damage the inner ear. They are basing this advice on studies that talk about what can damage healthy ears, whereas what can hurt us hasn't been studied (and the overwhelming number of testimonies on this site imply that sounds that can hurt us are Way quieter than the sounds that can damage healthy ears).

 

[dpdx]

I have earplugs near me all the time in case I damage my hearing further.

 

[Bill Bauer]

I have earplugs near me all the time in case I damage my hearing further.

And your T got worse after tests were performed on you by your audiologist, tests that ENTs still believe are safe for T patients...

 

[Hariz Nonis]

Found the YouTube video!

 

[Fally]

I also got told no ear plugs during normal day sounds by my ENT. He said walking next to traffic and in trains is fine. So I followed his advice. My tinnitues spiked majorly and still hasnt gone down four months later. They then realised my ears were more sensitive then they realized and decided on a process to gradually ween me off them. They screwed big time and soon realized the damage they had done because i became more panicked, more anxious, protecting more and now its a harder time to ween me off them.

Use caution if it hears your ears protect them, thats all i can say.

 

[cj5suzy]

Use the earplugs. Use your own judgement not the ents. I use the kind with the filter. Just dont use them in situations where u know it to be fairly safe for your ears . In that case just cover your ears. I was in a store where a close br obnoxiously loud woman blurted out something to her friend. Ouch! I quickly put my fingers in my ears! I dont care who is watching! We live in an extremely noisy world not a wonder why so many of us are in this situation!

 

[DEC]

I'll put my hand up and state we are in the business of HP however I'm also a tinnitus sufferer. We've worked with a few hyperacusis sufferers, you're ENT is correct however most are not aware that hearing protection is available in a wide range of attenuation levels. As a company we supply filters providing 5, 10, 15, 20, 25 and 28 dB of attenuation, linear (flat) and non linear.
We've provided sets of filters to help train hyperacusis suffers change from high attenuation foam to no protection at all by reducing the attenuation in stages. PM me if you'd like further information.

 

[jjflyman]

I used to wear foams every time I went out. Now I only wear them at the Gym (they sometimes have the music too loud) and the Casino (I measured the decibels at 85-90, depending on where I was).

I don't really consider either of these places "everyday noise", but I no longer wear them going to a restaurant or a store.

PS... in December my wife had a lot of time off to use up, so we went to a Casino multiple times in a few days span, spending around 2 hours their each time. My tinnitus did spike up noticeably for a about 2 weeks, even with 32 dB foam plugs fully inserted the whole time we were there.

 

[Digital Doc]

@jjflyman
There has been plenty written about gym exercise classes with loud music, and how the instructors are now getting hearing damage from it. Ear plugs are needed for everyone if the gums persist in this practice.

@Bill Bauer

Agree with the total paucity of studies in the area of T response. I am quite convinced, both from your references, as well as personal experience, that once you have T, that the respike can be triggered from noises that are under 85 db, the typical threshold quoted to induce NIHL per OSHA regs here in the USA (although probably too high as parts of Europe go with 80 db).

For example, a few weeks ago, my alarm clock which I measured at 75 db went off in my ear, and triggered a spike that lasted for over 2 weeks. Same alarm clock I have had for over 20 yrs, and never had any problem with it before.

Clearly us T folks have been primed to get injured at much lower thresholds of sound. It is disappointing that research and the medical profession has not caught up to this.

 

[Bill Bauer]

Found the YouTube video!

I think you had accidentally posted this into a wrong thread.

 

[dpdx]

And your T got worse after tests were performed on you by your audiologist, tests that ENTs still believe are safe for T patients...

Yes my T got permanently worse. I did the ear tests January 15, 2018 and today is January 8, 2019. One year has passed and it has not gotten better. I still have severe h. I have bad dial tone tinnitus which makes the left side of my head vibrate. Hearing Tests damage your hearing 100%, tests like ECOG, CVEMP, OVEMP, Acoustic Reflex, Caloric Test, etc should be outlawed.

 

[jjflyman]

There has been plenty written about gym exercise classes with loud music, and how the instructors are now getting hearing damage from it. Ear plugs are needed for everyone if the gums persist in this practice.

I totally agree. My wife takes different "classes" (spin, body pump, ect) and the music is so loud and the instructors voice is so loud she always puts in ear plugs. She actually is a board member at the local YMCA, and has talked to to the instructors, and has addressed the board, and they kinda blow her off like it's not a problem. Most of them have never heard of Tinnitus.
My wife doesn't have Tinnitus, but see's what it has put me through and does everything she can to protect her ears, so do my kids.
She measured her spin class at 95 decibels!

 

[Digital Doc]

https://www.healthyhearing.com/report/52418-Dangerous-decibels-and-exercise-classes

Yes, it is seriously scary the volume they play the music at in these places. Some of this noise exposure is harder to prevent, but these gyms are 100% responsible for endangering hearing help of their members if they allow this to go on. Your wife is smart to bring ear plugs before she has a problem. If only we all would have done that as well!

 

[New Guy]

Protect your ears, if you want to experiment listen for a short while without the plugs and see how you do. Don't go from nothing to everything all at once, that's a mistake.

There are so many different levels of t it's impossible to give one recommendation to everyone. Put yourself first if you have t, your ears come first.

 

[Arseny]

If you have noise induced tinnitus then you must protect your ears. Don't listen to anybody who tells you otherwise.
Damaged ears are prone to more damage:

https://www.ncbi.nlm.nih.gov/pubmed/25972177
https://www.ncbi.nlm.nih.gov/pubmed/?term=16481444
https://www.ncbi.nlm.nih.gov/pubmed/?term=19906956


Personally I had mild tinnitus in my left ear probably from ETD (audiogram showed conductive hearing loss) and then it quickly got to moderate levels with "normal" noise exposure (driving motorcycles, using headphones on safe volumes) and then it got severely aggravated by a brain MRI with double protection.
There's a definite link in each aggravation since I experienced a spike within 2 hours after each exposure.

 

[Martin G]

Found the YouTube video!

Hey, thanks for the video.

The only reason I actually bought the Bose was for an international flight. My T & H subsequently worsened to the extent that I unfortunately had to cancel the trip . . . so I didn't get to use them.

Hopefully I can make enough improvement that I can travel next year instead.

In the meantime . . . I do use them at work in certain situations.

Other than that . . . at home I mainly just use them without actually turning them on. Like if I go into the kitchen and I know I'll be doing something that would aggravate my H . . . it's quicker to just put them on my head than it is to insert ear plugs.

Still . . . thanks again for the YouTube clip. That's good info to have.

 

[Hariz Nonis]

Personally I had mild tinnitus in my left ear probably from ETD (audiogram showed conductive hearing loss) and then it quickly got to moderate levels with "normal" noise exposure (driving motorcycles, using headphones on safe volumes)

Do you still have the conductive hearing loss? And also, was it like regular tinnitus, or dysacusis?

 

[Martin G]

The problem is that you can't always predict when very loud sounds are going to appear. Lots of tinnitus sufferers have had their condition aggravated due to sudden noise exposure, caused by fire alarms, a kid popping a ballon, ambulance sirens and what have you.

If I were you, I would keep using earplugs in environments that are unpredictable as far as noise goes. Save from that, I can neither verify nor falsify the ENT's take on hyperacusis. Due to his profession, it makes sense to assume that he knows what he's talking about.

Yes . . . I can personally relate to the sudden, unexpected noise exposure thing . . . thanks to a super-loud security alarm a couple of months ago.

I definitely want to keep prepared (at least as much as is possible) for things like that.

 

[Martin G]

Yup, these intermittnet noise expsoures are the most challenging.

You're right. I think I should continue at least having protection 'on standby'.

 

[Martin G]

You just need to use your better judgment. I keep a set of muso earplugs on me at all times, but mostly I never have to wear them. They're just my insurance now in case I find myself in a noisy place that my injured ear doesn't like.

I'm getting the impression that's the way to go. Plus . . . 'insurance' is always a good thing to have.

 

[Martin G]

It is good to find a volume level that you are ok with (say on a TV), and then gradually increase the volume. But to throw all caution to the wind has a chance of working out horribly. Listen to the signals from your body. I had been protecting my ears, and ended up being happy with the outcome. My H went away, despite me protecting my ears in everyday situations.

Thanks Bill. This is the methodology I was already following . . . and I think it's looking as though it may be prudent to continue doing so.

Here are some actual factual case studies that can give you an idea of what might happen should you decide to "play with fire":

Compelling stuff! Thanks for throwing all those quotes together. I never would have found them on my own.

http://hyperacusisfocus.org/research/earplug-use-2/

Well . . . that's the decider right there.

That's the most informative thing I've read in a long time.

It looks as though, despite this ENT's rep and credentials . . . he appears to be taking liberties with things which simply have not been studied enough to be able to make informed decisions on.

Thanks again for that Bill. Looks as though it's best to just continue doing what I'm doing. Slowly reintroducing my ears to slightly greater sound levels over a period of time . . . and using protection for anything I find painful or too loud . . . based on my own personal thresholds and not on what people with undamaged ears would view as 'normal'.

 

[Martin G]

I have earplugs near me all the time in case I damage my hearing further.

Me too. And it looks as though I'm going to keep doing that.

 

[Martin G]

I also got told no ear plugs during normal day sounds by my ENT. He said walking next to traffic and in trains is fine. So I followed his advice. My tinnitues spiked majorly and still hasnt gone down four months later. They then realised my ears were more sensitive then they realized and decided on a process to gradually ween me off them. They screwed big time and soon realized the damage they had done because i became more panicked, more anxious, protecting more and now its a harder time to ween me off them.

Use caution if it hears your ears protect them, thats all i can say.

I hear you.

Really hope you get over your spike soon. I've only had one spike so far. It lasted 3 weeks . . . and that was long enough.

 

[Martin G]

Use the earplugs. Use your own judgement not the ents. I use the kind with the filter. Just dont use them in situations where u know it to be fairly safe for your ears . In that case just cover your ears. I was in a store where a close br obnoxiously loud woman blurted out something to her friend. Ouch! I quickly put my fingers in my ears! I dont care who is watching! We live in an extremely noisy world not a wonder why so many of us are in this situation!

Thanks. I'm with you all the way.

 

[Fally]

I hear you.

Really hope you get over your spike soon. I've only had one spike so far. It lasted 3 weeks . . . and that was long enough.

Hopefully, praying to eventually goes down but we will see, now im just protecting all the time to let it heal in the hopes it will.