Unravelling the Mystery of Hyperacusis with Pain

[RunningMan]

Even then the damage is likely to be mostly temporary in most scenarios. 140 dB is 200x louder than 120 dB. It's a sound you'd likely never hear in your life, or at least most people won't more than once.

A 20 dB (120 dB to 140 dB) difference would be 100x louder in actual intensity and perceived by people to be about 4x as loud.

 

[MadeleineHope]

From personal experience, and also based on conversations with ENTs and other people with hearing problems.

The typical episode that produces hearing loss is not necessarily a long noise exposure, but a brief very loud noise exposure (like a power tool, siren, car horn, mic or radio feedback etc), that can be combined with other issues that may affect hearing perception as well, like having a cold, a blocked nose or throat etc.

Thanks for your reply, Juan. Can you share what reasoning the ENTs have given you as to why people with hyperacusis are more likely to lose hearing from the very loud, brief sound exposures?

My understanding is that the sounds you describe, if over a certain decibel level, are capable of producing immediate damage to anyone's hearing. Of course, noise damage is cumulative as well, so it makes sense that if you have two people, one with more hearing damage than another, & they both expose themselves to the same levels of high noise, one is more likely to have more hearing loss earlier on than the other. But I don't see how hyperacusis in and of itself would make one more susceptible, if you know what I mean! Maybe if the mechanism behind someone's hyperacusis is a physically compromised dampening system?

If you have hyperacusis, your nerves are damaged. Hitting your ears again with a loud exposure can cause further damage, potentially creating dysacusis/noxacusis.

Hitting them AGAIN on top of dysacusis/noxacusis could cause hearing loss. That hearing loss could take months to gradually manifest.

That's my experience anyway.

Wouldn't this be the regular progression of noise-induced hearing loss though (that we all go through)? Just trying to make some sense out of all of this, since it's pretty much impossible to protect yourself from the odd brief, really loud sound!

 

[Jupiterman]

If you have noxacusis, has the hearing loss helped with the pain? Or helped with the sensitivity and tolerance?

My noxacusis was mild. My hyperacusis/dysacusis were originally more prominent.

With some hearing loss, the above issues reduced.

Wouldn't this be the regular progression of noise-induced hearing loss though (that we all go through)? Just trying to make some sense out of all of this, since it's pretty much impossible to protect yourself from the odd brief, really loud sound!

No, I don't believe it was. The dysacusis and mild noxacusis began within days of exposure, the partial hearing loss followed in the next few months.

If I hadn't have had that particular exposure, I'm pretty sure I'd still have my complete hearing. The chronology of events screams at this being the explanation.

Remember, this is only my experience; yours will likely be different.

Your ears may be more resilient.

No two people suffer this the same.

 

[Juan]

Thanks for your reply, Juan. Can you share what reasoning the ENTs have given you as to why people with hyperacusis are more likely to lose hearing from the very loud, brief sound exposures?

Two ways: (i) already damaged hair cells, this is inferred from previous sensorineural hearing loss (hyperacusis caused by noise); (ii) through the hidden hearing loss mechanism + brain turning up volume.

In hyperacusis caused by noise the brain looks for a lost frequency. The brain wants to perceive sounds like it did before noise damage. Then it turns up volume for all frequencies trying to get more quality on a frequency that is damaged or irreversibly lost. It's possible to get more volume but not more sound quality, due to noise damage: that frequency is already damaged.

My personal sensation before and after hyperacusis:

Before: when a loud sound happens, the perceived "impact" is lower than after hyperacusis. It is like the sound vibration is distributed among different frequencies.

After: the sound is perceived very loud, but "off key". A high pitched sound can be perceived louder but lower in pitch, or distorted in pitch. My personal feeling is this has to do with cochlear damage.

I sometimes imagine sound is a hammer and hair cells are a bed made of nails. If you have perfect hearing, the bed has a lot of nails, it is very dense, the hammer hits them and the impact is distributed among the nails. If there are less hair cells or damaged hair cells, then you have a "bed of nails made of less nails or made of nails that are bent", and the impact feels stronger, and can cause more damage...

For people with recruitment, the sound perception is also altered. There is hearing loss with recruitment. This means: (i) some very low sounds cannot be heard due to the hearing loss; (ii) some medium volume sounds are perceived ok but not at the right pitch; (iii) louder sounds and loud sounds are perceived louder than a normal person. That's why partially deaf people can tell they do not hear a person and when that person raises the volume they say "don't yell at me, I am not deaf."

 

[MadeleineHope]

Two ways: (i) already damaged hair cells, this is inferred from previous sensorineural hearing loss (hyperacusis caused by noise); (ii) through the hidden hearing loss mechanism + brain turning up volume.

In hyperacusis caused by noise the brain looks for a lost frequency. The brain wants to perceive sounds like it did before noise damage. Then it turns up volume for all frequencies trying to get more quality on a frequency that is damaged or irreversibly lost. It's possible to get more volume but not more sound quality, due to noise damage: that frequency is already damaged.

My personal sensation before and after hyperacusis:

Before: when a loud sound happens, the perceived "impact" is lower than after hyperacusis. It is like the sound vibration is distributed among different frequencies.

After: the sound is perceived very loud, but "off key". A high pitched sound can be perceived louder but lower in pitch, or distorted in pitch. My personal feeling is this has to do with cochlear damage.

I sometimes imagine sound is a hammer and hair cells are a bed made of nails. If you have perfect hearing, the bed has a lot of nails, it is very dense, the hammer hits them and the impact is distributed among the nails. If there are less hair cells or damaged hair cells, then you have a "bed of nails made of less nails or made of nails that are bent", and the impact feels stronger, and can cause more damage...

For people with recruitment, the sound perception is also altered. There is hearing loss with recruitment. This means: (i) some very low sounds cannot be heard due to the hearing loss; (ii) some medium volume sounds are perceived ok but not at the right pitch; (iii) louder sounds and loud sounds are perceived louder than a normal person. That's why partially deaf people can tell they do not hear a person and when that person raises the volume they say "don't yell at me, I am not deaf."

Thanks for the extra details @Juan. It makes sense that having less hair cells/damaged hair cells at particular frequencies would mean quicker hearing loss as compared to someone without this damage (assuming both people were exposed to the same levels of noise & that there were no genetic differences in susceptibility). But couldn't the same be said for someone with the same level of hearing loss, but no hyperacusis? I'm just having a hard time seeing how hyperacusis in particular makes one more susceptible. It seems that it's the underlying hair cell loss/damage which does. As in, people with hyperacusis usually have this damage, & that damage then increases one's risk of hearing loss in the damaged frequencies down the line.

No, I don't believe it was. The dysacusis and mild noxacusis began within days of exposure, the partial hearing loss followed in the next few months.

If I hadn't have had that particular exposure, I'm pretty sure I'd still have my complete hearing. The chronology of events screams at this being the explanation.

Remember, this is only my experience; yours will likely be different.

Your ears may be more resilient.

No two people suffer this the same.

Yeah, that makes sense to me, because hearing loss only shows up after a certain percentage of hair cells have been lost. So at the beginning, you probably had some hearing loss or damage, but there were still enough hair cells intact at certain frequencies for your hearing to show up on an audiogram as being the same. Then, with further harmful noise exposure, eventually enough hair cells at particular frequencies died for the auditory damage to be visible on an audiogram.

I think we're actually on the same page, haha!

 

[Juan]

It seems that it's the underlying hair cell loss/damage which does. As in, people with hyperacusis usually have this damage, & that damage then increases one's risk of hearing loss in the damaged frequencies down the line.

Yes, it is due to the hair cell / cochlear damage and most people with hyperacusis from noise trauma will have that sort of damage, that may be evident immediately or may be a bit disguised or hidden (brain processing and hidden hearing loss mechanisms compensate for some hearing loss) and show up over time.

For some people life after an initial noise trauma that triggers hyperacusis can be "more or less ok", and they go around without hearing protection trying to cope with sounds that feel uncomfortable (or damaging in some cases). They try to deal as best as they can with the anxiety that all that produces. The hidden hearing loss and the brain's processing mechanisms make up for some of the lost sound quality, so some of those people will say "ohh... sounds felt uncomfortable, and there is hyperacusis, but I am doing ok." and that's so wrong...

...because if there is true damage, anxiety will be constant and in time it will increase up to the point when one has to take measures and do what should have been done from day one: wearing hearing protection, to feel more comfortable around sounds, to reduce anxiety and to gain a bit of control over an unpredictable sound landscape. And from there one can improve and get better.

 

[MadeleineHope]

Thanks for clarifying @Juan! I agree that the protection piece is important.