The Tinnitus Experts

[Michael Leigh]

The Tinnitus Experts

I first got tinnitus twenty one years ago and along with it, severe hyperacusis. This was caused by listening to music through headphones at too high a volume, although at the time I wasn't aware I was causing harm to my auditory system. I had TRT which required wearing two white noise generators for up to 10 hours a day and used a sound machine at night for sound enrichment. The treatment lasted two years and fortunately, the tinnitus reduced to a low manageable level and the hyperacusis, was completely cured and has remained so till this day.

In 2008 my tinnitus increased severely. I believe this was caused by a second noise trauma, although I'm not completely sure. One evening I was listening to some classical music through my Hi-Fi system. Afterwards I went to bed and the next morning I woke with the tinnitus much more intrusive. This grew louder over the following days and weeks requiring me to return to the ENT. I started TRT for the second time and it took four years for me to habituate.

I have counselled people with tinnitus on the telephone, corresponded with them by email and on tinnitus forums. Many things can cause this condition and therefore I do not consider myself a tinnitus expert. Neither am I medically qualified in this field but I want to explore tinnitus when it was caused by "loud noise" and not an underlying medical condition and those we seek for help with it. The most common cause of tinnitus is loud noise exposure. It is frequently brought on by using headphones at high volume and regularly attending venues where high sound levels are easily reached. Clubs, concerts and even the cinema.

I have mentioned the above as I wanted to convey my personal experience with "noise induced tinnitus" and the people that have contacted me for help with it. Anyone that has read my posts on headphone use and tinnitus, will know I am resolute in my belief, that those with noise induced tinnitus should not use headphones, earbuds, earphones or any type of headsets to listen to audio even at low volume. Although some people with noise induced tinnitus use headphones and have no adverse effects, I believe there is always a risk of making the tinnitus spike, resulting in it becoming louder and more intrusive. I have read many emails and posts from people regretting returning to headphone use after they have habituated, and notice their tinnitus increased and will not reduce to its previous manageable level.

I have every respect for ENT doctors and other health professionals that work in the ENT field that are committed to helping people with tinnitus to have a better quality of life. I was once told by an ENT doctor, he is a physician, not a tinnitus expert. When there is no underlying medical problem causing the tinnitus, the patient is usually referred to a Hearing Therapist or Audiologist that specialises in the treatment and management of tinnitus. It is not unusual to find some of these health professionals were either born with tinnitus or acquired it at some time in their life. They will usually have a level of understanding of tinnitus and be able to empathise with a patient in a way that ENT doctors can't.

Michael

 

[Forever hopeful]

Hi @Michael Leigh,

You may have mentioned this in one of your many posts and I may have missed it, but do you have measurable hearing loss?

Also, how do they treat hyperacusis when the only symptom is that your tinnitus is reactive to certain frequencies? I understand from reading your post that the fact that my tinnitus spikes at certain frequencies, it is a form of hyperacusis. However, I experience no sensitivity or pain in reaction to external sound. All I have for symptoms is that when I try to use my sound app at the higher frequencies, it used to blend my former tinnitus, but it no longer works and just seems to make my tinnitus louder and more noticeable.

What I've read about hyperacusis treatment, is that the patient is exposed to periods of sound incrementally over a period of time to decrease their sensitivity to it. Unless I've missed something along the way, I'm not sure how this would work for somebody in my situation.

Thanks in advance.

 

[Michael Leigh]

do you have measurable hearing loss?

Hi Forever hopeful,

When I got tinnitus with severe hyperacusis 26 years ago at the age of 36, my ENT doctor informed me my hearing was above normal. Over the years I have had further hearing tests that indicated there was no change. Three months ago, my audiologist fitted me with two new Oticon white noise generators and I had another hearing test. I was told my hearing had reduced but only slightly due to my age and was not a matter for concern, so wouldn't require hearing aids. They come fitted into the white noise generators as standard but have been deactivated.

Also, how do they treat hyperacusis when the only symptom is that your tinnitus is reactive to certain frequencies? I understand from reading your post that the fact that my tinnitus spikes at certain frequencies, it is a form of hyperacusis. However, I experience no sensitivity or pain in reaction to external sound. All I have for symptoms is that when I try to use my sound app at the higher frequencies, it used to blend my former tinnitus, but it no longer works and just seems to make my tinnitus louder and more noticeable.

I believe your tinnitus was originally noise induced. Hyperacusis or having some oversensitivity to sound often (but not always) accompanies this type of tinnitus. A person can habituate to the tinnitus but if the hyperacusis or oversensitivity to sound, doesn't improve or is not cured with or without specialist treatment under the care of an audiologist, oversensitivity to sound will usually become a long-term problem. It can manifest itself in many ways and no two people will experience it the same.

Although a person may not experience full-blown hyperacusis with or without pain, usually they will be sensitive to some sounds which can result in the tinnitus spiking. Some people use the term reactive tinnitus, I have expressed my opinion on this many times and will say again that I believe there is no such thing. This terminology was made-up on tinnitus forums many years ago and has become common place. The only way to treat this oversensitivity to sound if it doesn't heal naturally, is using sound therapy which is administered through white noise generators and to be under the care of an audiologist as counselling is advised. I have covered this in many posts on my started threads.

What I've read about hyperacusis treatment, is that the patient is exposed to periods of sound incrementally over a period of time to decrease their sensitivity to it. Unless I've missed something along the way, I'm not sure how this would work for somebody in my situation.

I do not agree with increasing the volume in increments as you have suggested and which some audiologists advise tinnitus and hyperacusis patients to do. This often irritates the auditory system and can make the tinnitus and hyperacusis increase or spike.

Many people have contacted me, who have followed their audiologist's advice and increased the white noise generators in increments, only to find their tinnitus and hyperacusis is made worse. When they have followed my advice, in the way I was trained by my audiologist, to always introduce the WNGs slowly and keep the volume always below the tinnitus, they have found their tinnitus and hyperacusis are successfully treated. I have covered this in my TRT posts on my started threads.

Some people can treat their hyperacusis or oversensitivity to sound using self-help which I have covered in many of my articles on my started threads. However, some people may need specialist help. If you are listening to your sound apps through any type of headphones, it's something I don't advise as you risk aggravating your auditory system and can make your sound sensitivity worse even at low volume. You need to use the proper devices that are meant for treating hyperacusis or oversensitivity to sound and that is white noise generators, preferably having counselling with an audiologist, that also has tinnitus.

Michael

 

[Forever hopeful]

Hi Forever hopeful,

When I got tinnitus with severe hyperacusis 26 years ago at the age of 36, my ENT doctor informed me my hearing was above normal. Over the years I have had further hearing tests that indicated there was no change. Three months ago, my audiologist fitted me with two new Oticon white noise generators and I had another hearing test. I was told my hearing had reduced but only slightly due to my age and was not a matter for concern, so wouldn't require hearing aids. They come fitted into the white noise generators as standard but have been deactivated.

I believe your tinnitus was originally noise induced. Hyperacusis or having some oversensitivity to sound often (but not always) accompanies this type of tinnitus. A person can habituate to the tinnitus but if the hyperacusis or oversensitivity to sound, doesn't improve or is not cured with or without specialist treatment under the care of an audiologist, oversensitivity to sound will usually become a long-term problem. It can manifest itself in many ways and no two people will experience it the same.

Although a person may not experience full-blown hyperacusis with or without pain, usually they will be sensitive to some sounds which can result in the tinnitus spiking. Some people use the term reactive tinnitus, I have expressed my opinion on this many times and will say again that I believe there is no such thing. This terminology was made-up on tinnitus forums many years ago and has become common place. The only way to treat this oversensitivity to sound if it doesn't heal naturally, is using sound therapy which is administered through white noise generators and to be under the care of an audiologist as counselling is advised. I have covered this in many posts on my started threads.

I do not agree with increasing the volume in increments as you have suggested and which some audiologists advise tinnitus and hyperacusis patients to do. This often irritates the auditory system and can make the tinnitus and hyperacusis increase or spike.

Many people have contacted me, who have followed their audiologist's advice and increased the white noise generators in increments, only to find their tinnitus and hyperacusis is made worse. When they have followed my advice, in the way I was trained by my audiologist, to always introduce the WNGs slowly and keep the volume always below the tinnitus, they have found their tinnitus and hyperacusis are successfully treated. I have covered this in my TRT posts on my started threads.

Some people can treat their hyperacusis or oversensitivity to sound using self-help which I have covered in many of my articles on my started threads. However, some people may need specialist help. If you are listening to your sound apps through any type of headphones, it's something I don't advise as you risk aggravating your auditory system and can make your sound sensitivity worse even at low volume. You need to use the proper devices that are meant for treating hyperacusis or oversensitivity to sound and that is white noise generators, preferably having counselling with an audiologist, that also has tinnitus.

Michael

Thank you, Michael, for your very thoughtful response. I am happy to hear that you did not have hearing loss. I'm sure you've mentioned it somewhere but I don't know how old you are but it sounds like you have done a very nice job of keeping progressive hearing loss at bay.

For clarification, what I meant by incremental noise to desensitize the auditory system, I actually meant that the people were exposed to the noise for longer periods of time during the day, not at increased volumes. I will, however, keep that distinction, as you have advised, as I work to meet with an audiologist to discuss my options.

I do still hope deep down inside that the spike will heal over time and then I will at least experience a reduction in the noise. I would settle for that. I had fluctuating tinnitus before so it's not like this is brand new to me. The increase is however new.

I would never use earbuds or headphones. Haven't in years. As a matter fact I work remotely and when I do have to go into the office, I personally ensure that I do not have any meetings I have to take in my cube because I would need to put earbuds in my ear, nor will I use over-the-ear headsets which they provide to us. I listen to meetings and participate in meetings solely through my computer audio. Thankfully, I can work from home. It actually drives me crazy that they give our kids earbuds to go with their Chromebooks at school. I strongly discouraged my children from using them at all.

 

[Michael Leigh]

Thank you, Michael, for your very thoughtful response. I am happy to hear that you did not have hearing loss. I'm sure you've mentioned it somewhere but I don't know how old you are but it sounds like you have done a very nice job of keeping progressive hearing loss at bay.

You are welcome Forever hopeful.

I am 62 years of age but have been told by many people I look 15 to 20 years younger. I believe this has something to do with regularly walking and working out on my elliptical/crosstrainer machine and keeping to a healthy diet.

For clarification, what I meant by incremental noise to desensitize the auditory system, I actually meant that the people were exposed to the noise for longer periods of time during the day, not at increased volumes. I will, however, keep that distinction, as you have advised, as I work to meet with an audiologist to discuss my options.

Thank you for the clarification. Taking things slowly and introducing yourself to normal everyday sounds for longer periods is the right approach and I wish you well with it.

Being under the care of an audiologist is a good idea and something I advise people to do that have difficulty habituating to tinnitus or their hyperacusis and oversensitivity to sound is problematic. Please keep in mind that counselling with an audiologist cannot do all the work. The patient has to make a conscious effort to reinforce positive thinking into their life and I have covered this in posts: Tinnitus and the Negative Mindset and Acquiring a Positive Mindset, on my started threads. Find a new interest or hobby as this will help to take away your focus on tinnitus and hyperacusis. Both these conditions are affected by our mental and emotional wellbeing.

I do still hope deep down inside that the spike will heal over time and then I will at least experience a reduction in the noise. I would settle for that. I had fluctuating tinnitus before so it's not like this is brand new to me. The increase is however new.

Use low level sound enrichment, especially at night, with the help of a sound machine. Please read my threads: The Habituation Process, How to Habituate to Tinnitus. Print and refer to these articles, that way they help to instil and reinforce positive thinking. I cannot impress upon you enough how vitally important it is to always be looking outwards and not to get bogged down with mundane and negative things. I am not saying never to feel negative for life is problematic, but everything needs to be kept in balance.

It seems you have been doing the right things by not using any type of headphones or subjecting your hearing to overly loud sounds. Therefore, if the increase in your tinnitus or the new sound that you're hearing isn't noise related and not caused by an underlying medical condition within your auditory system including hearing loss, which I advise you to get checked, then stress could be a factor. As I have mentioned many times in my posts, tinnitus is an integral part of our mental and emotional wellbeing and cannot be separated from it. Stress has to be kept under control, so it's something to consider.

By chance I have recently stumbled on something that I believe has helped reduce my tinnitus even further, and you might also find it helpful. I will be writing this piece in Health Talk.

All the best,
Michael

 

[Greg Sacramento]

@Forever hopeful, in brief, noises can mess with synapses between inner hair cells and auditory nerve fibers, without causing hair cell loss or lots of hearing loss. Sustainability - a diffuse of 30% damage to the outer hair cells can happen before a decrease in hearing is even evidenced on a hearing test, because of synapses. Since you have remarkably recovered twice with limited distress, before most recent exposures, synapses is likely. Not likely much inner or outer hair cell death. Your spike and non-reactive hyperacusis will probably be temporary. Try to relax yourself and not focus on your sounds.

I discussed your recent postings with a retired MIT auditory researcher, after I gave you a hug on one of your posts a couple of days before.

 

[tniuf]

The treatment lasted two years and fortunately, the tinnitus reduced to a low manageable level and the hyperacusis, was completely cured and has remained so till this day.

Hi @Michael Leigh, thanks for the interesting thread. I have looked around but I don't think you've ever elaborated on this:

The first time it took you 2 years to habituate. What I am wondering is did the tinnitus fade to such a point that you could hardly hear it, or did your mind simply decide not to pay attention to the sound? I believe you mentioned it fading; If indeed the sound faded, did it take an entire 2 years for this to happen? Did it happen gradually with more and more good days, until you realised it didn't bother you any more? I think this is the best possible outcome second to full remission. Do you remember the timeline of your improvements in more detail?

Also the second time, 4 years until habituation. If you still experience bad days, have you been able to identify the causes, and what did the timeline of your improvements look like?

 

[Michael Leigh]

Hi @Michael Leigh, thanks for the interesting thread. I have looked around but I don't think you've ever elaborated on this:

HI @tniuf,

I put a lot of thought into my threads in the hope that someone will find them helpful, so I appreciate your kind comments. I have elaborated on my tinnitus experience in my posts over the years and covered the questions you have asked, but I realize you might find access to them a little difficult.

The first time it took you 2 years to habituate. What I am wondering is did the tinnitus fade to such a point that you could hardly hear it, or did your mind simply decide not to pay attention to the sound?

My tinnitus began in April 1996 and was caused by using headphones, at too high a volume over a long period of time. It was very severe and I also had very painful hyperacusis, so bad I had to ask people to lower their voice during conversation as my ears hurt a lot. I began TRT in November 1996 and started wearing white noise generators, and had regular counselling with my audiologist. The treatment lasted 2 years. My tinnitus and hyperacusis gradually reduced over time. After treatment, the tinnitus reduced to such a low level that I forgot about it and the hyperacusis was completely cured.

The mind does have a major part to play in the habituation process. I believed I was cured of tinnitus and sought to help people that had difficulty managing it through a tinnitus organisation. In 2008 I had a second noise trauma. Please go to my started threads and read: My Experience with Tinnitus. It explains how my tinnitus changed to variable, and the difficulties I had that lasted 4 years.

Also the second time, 4 years until habituation. If you still experience bad days, have you been able to identify the causes, and what did the timeline of your improvements look like?

Please read my thread: Can I Habituate to Variable Tinnitus? My tinnitus is now variable. It can be quiet, mild, moderate, severe and very severe. According to my ENT consultant and audiologist, they rarely see patients with my type of tinnitus. It follows no set pattern and therefore, it's completely random, in level of intensity. This type of tinnitus and variants of it, mostly affect people that have suffered a second noise trauma. More about this is explained in my post.

Hope this helps.

All the best,
Michael

 

[VitaminBike]

HI @tniuf,

I put a lot of thought into my threads in the hope that someone will find them helpful, so I appreciate your kind comments. I have elaborated on my tinnitus experience in my posts over the years and covered the questions you have asked, but I realize you might find access to them a little difficult.

My tinnitus began in April 1996 and was caused by using headphones, at too high a volume over a long period of time. It was very severe and I also had very painful hyperacusis, so bad I had to ask people to lower their voice during conversation as my ears hurt a lot. I began TRT in November 1996 and started wearing white noise generators, and had regular counselling with my audiologist. The treatment lasted 2 years. My tinnitus and hyperacusis gradually reduced over time. After treatment, the tinnitus reduced to such a low level that I forgot about it and the hyperacusis was completely cured.

The mind does have a major part to play in the habituation process. I believed I was cured of tinnitus and sought to help people that had difficulty managing it through a tinnitus organisation. In 2008 I had a second noise trauma. Please go to my started threads and read: My Experience with Tinnitus. It explains how my tinnitus changed to variable, and the difficulties I had that lasted 4 years.

Please read my thread: Can I Habituate to Variable Tinnitus? My tinnitus is now variable. It can be quiet, mild, moderate, severe and very severe. According to my ENT consultant and audiologist, they rarely see patients with my type of tinnitus. It follows no set pattern and therefore, it's completely random, in level of intensity. This type of tinnitus and variants of it, mostly affect people that have suffered a second noise trauma. More about this is explained in my post.

Hope this helps.

All the best,
Michael

Michael,

What was it that constituted a second 'acoustic trauma'? I know most people report acoustic trauma as cause for their tinnitus but unless they were exposed to an explosion or work in a night club (chronic source), I'm curious what caused it for this group. I'm a frustrating, maybe adverse drug reaction vs. late onset long COVID-19 symptom vs. TMJ vs. idiopathic case, so I'm having a very hard time figuring out what my trajectory might be but I have a pretty even spread of good days and bad days.

 

[Michael Leigh]

What was it that constituted a second 'acoustic trauma'? I know most people report acoustic trauma as cause for their tinnitus but unless they were exposed to an explosion or work in a night club (chronic source), I'm curious what caused it for this group.

Hi VitaminBike,

As I explained in my previous post to @tniuf, when I first habituated around 1998, my tinnitus reduced to such a low level I rarely heard it. As the years passed, I began to think I was completely cured of tinnitus. Unfortunately, a lot of people that have habituated to noise-induced tinnitus make this mistake. Although I never returned to using headphones, I enjoyed listening to music through my Hi-Fi. On reflection there were occasions the music was too loud but I wasn't affected.

One evening I was listening to some classical music and turned up the volume on my Hi-Fi and thought everything was fine but it wasn't. The next morning my tinnitus returned with a vengeance for I hadn't heard it in years! As the days and weeks progressed, it got louder and more intrusive requiring me to talk to my doctor and get a referral to ENT, then onto Audiology, to start TRT with an audiologist.

When a person habituates to noise-induced tinnitus, they need to realize their auditory system has been compromised and will never be quite the same again. This doesn't mean they can't lead a full and active lifestyle and enjoy listening to music, they certainly can, but one has to be careful. They might not have any hearing loss and their tinnitus could reduce to such a low level that it is rarely heard. If they had hyperacusis, this may also be cured as in my case. However, their auditory system is likely to be vulnerable to overly loud sounds or using any type of headphones even at low volume.

Please read my threads: Can I Habituate to Variable Tinnitus? My Experience with Tinnitus. I explain what can happen after a person habituates to noise-induced tinnitus in more detail.

Michael