What Should I Do? A Spike After Going Out

[MiaX]

Hi guys!

Last night I had a party at someone's house. It was not very loud, because there were neighbours. The only thing that was a bit loud, were voices and even that was not really loud. To illustrate: I could a lot of times not even hear what they were singing on the radio, because the volume was down. I wore my -25 db earplugs.

Sometimes I left the room with people and I felt like my tinnitus spiked. I really thought that it was the alcohol, because I felt pretty soon pretty drunk (hadn't eaten much ).

After 2,5 hours we went into town and the bars were pretty loud, so I only stayed 40 minutes (with a break of 5 minutes).

When I came home, my t was pretty loud, but I was pretty drunk too.

I fell asleep and two hours later, the spike settled down a lot.

Right now tinnitus is still a bit spiking, but I had only 6 hours or sleep and it always spikes when I sleap not good.

Still I am worried and I think I might need get prednisone (but pretty sure they won't give it to me). I am also very afraid of the side effets.

Before I jump to conclusions: what do you guys think? Can it be the alcohol/hangover /lack of sleep?

I need to add that my t is probably not noise related and it almost never spiked due noise.

And while thinking about it, the first hour the music was a bit loud, but definitely not concert/club/bar - loud.

 

[Michael Leigh]

I think I might need get prednisone (but pretty sure they won't give it to me). I am also very afraid of the side effets.

Hi @MiaX

I believe you are better off keeping away from Prednisone and agree it is not worth risking side effects. Raised sugar levels for example. Though you say your tinnitus wasn't originally caused by "exposure to loud noise" it sounds to me that it could have been. Prior to its onset did you regularly listen to music through headphones?

The bars where you attended and the music was loud in hindsight I don't think was a good idea. At least you should have been wearing noise reducing earplugs that have in-built filters. Music doesn't have to be a club and concert levels to spike tinnitus or make it permanently worse believe me. You need to be more careful. I advise you to read the post below and click on the links at the bottom of the page. If things don't calm down it probably best to get a referral to ENT and then see a Hearing Therapist. More is explained in my articles below. In future be careful of loud sound and invest in some "noise reducing earplugs" They are affordable and can help save you a lot of misery. However, this does not mean that you can be cavalier about loud sounds levels, prudence is still required. More is explained in the articles below.

All the best
Michael

Are spikes from loud noise permanent?

Someone recently asked me, whether a spike in tinnitus caused by loud noise would be permanent? I don't think there is a definitive answer, because tinnitus is a complex condition and if hyperacusis is also present it can complicate matters further. Some people habituate to tinnitus but their hyperacusis hasn't fully cured and this can cause tinnitus to spike.

When a person first develops tinnitus and it was caused by loud noise they have to be careful in future. Tinnitus can and does spike for many people and this is not necessarily caused by loud noise or sounds. After a while it usually returns to baseline or into its normal rhythm. Danger can present itself after a person habituates and the tinnitus has reduced to mild or moderate levels for most of the time. If one isn't careful, it can be easy to forget and slip back into the old lifestyle of: listening to music through headphones. Attending clubs, concerts and the cinema where sound levels can be quite high.

I believe a person with tinnitus should attend clubs, concerts and the cinema if they want to, providing they use noise-reducing earplugs to protect themselves. However, one should remember that nothing is one hundred percent safe. My advice is to stay clear of large standing floor speakers and if you're at a concert don't go to near the front stage where the music is likely to be booming out at high sound levels.

In many instances people will get a warning when visiting these places. If the decibel levels are too high their tinnitus might spike. Usually the tinnitus will return to baseline. However, some people do not pay attention to these warnings and continue to subject their ears to loud sounds and think they are perfectly safe because they are wearing earplugs. Under these circumstances the tinnitus might spike again and this time it might become permanent. I am saying might because nothing is for certain. In my opinion a person with tinnitus needs to follow the warnings their auditory system and tinnitus is telling them.

Regarding headphones. Many people have contacted me after they have habituated to tinnitus and returned to using headphones and listened to music through them at low volume. All of them have noticed an increase in their tinnitus. Some of them noticed their tinnitus spiked but carried on listening to music through headphones and then the tinnitus increased to a higher and more permanent level. It must be said that some people with tinnitus use headphones and have no adverse effects and that is perfectly fine. My opinion on this is, anyone that has tinnitus shouldn't listen to any type of audio through headphones even at low level.

It saddens to say, if a person doesn't heed the warning signs their auditory system and tinnitus is telling them, then they will eventually feel because tinnitus is very unforgiving. It is fine when some people are telling others what they want to hear: "listen to music through headphones because life is for living". "Go to the club as often as possible you're safe with earplugs. If your tinnitus increases you will be the one that will be in the suffering.

I have read many posts in tinnitus talk, where people had habituated and the tinnitus is low. They returned to listening to music through headphones and clubbing during the week and weekends. Some are now regretting this because their tinnitus has increased and they are in distress. Just because a person habituates doesn't mean they can forget everything and carry on in some instances recklessly. You can of course do this but my advice is to do things in moderation and not to excess, because the end result is often returning to ENT for help and visiting tinnitus forums because you are unable to cope.

https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/
https://www.tinnitustalk.com/threads/hyperacusis-as-i-see-it.19174/

 

[MiaX]

Hi @MiaX

I believe you are better off keeping away from Prednisone and agree it is not worth risking side effects. Raised sugar levels for example. Though you say your tinnitus wasn't originally caused by "exposure to loud noise" it sounds to me that it could have been. Prior to its onset did you regularly listen to music through headphones?

The bars where you attended and the music was loud in hindsight I don't think was a good idea. At least you should have been wearing noise reducing earplugs that have in-built filters. Music doesn't have to be a club and concert levels to spike tinnitus or make it permanently worse believe me. You need to be more careful. I advise you to read the post below and click on the links at the bottom of the page. If things don't calm down it probably best to get a referral to ENT and then see a Hearing Therapist. More is explained in my articles below. In future be careful of loud sound and invest in some "noise reducing earplugs" They are affordable and can help save you a lot of misery. However, this does not mean that you can be cavalier about loud sounds levels, prudence is still required. More is explained in the articles below.

All the best
Michael

Are spikes from loud noise permanent?

Someone recently asked me, whether a spike in tinnitus caused by loud noise would be permanent? I don't think there is a definitive answer, because tinnitus is a complex condition and if hyperacusis is also present it can complicate matters further. Some people habituate to tinnitus but their hyperacusis hasn't fully cured and this can cause tinnitus to spike.

When a person first develops tinnitus and it was caused by loud noise they have to be careful in future. Tinnitus can and does spike for many people and this is not necessarily caused by loud noise or sounds. After a while it usually returns to baseline or into its normal rhythm. Danger can present itself after a person habituates and the tinnitus has reduced to mild or moderate levels for most of the time. If one isn't careful, it can be easy to forget and slip back into the old lifestyle of: listening to music through headphones. Attending clubs, concerts and the cinema where sound levels can be quite high.

I believe a person with tinnitus should attend clubs, concerts and the cinema if they want to, providing they use noise-reducing earplugs to protect themselves. However, one should remember that nothing is one hundred percent safe. My advice is to stay clear of large standing floor speakers and if you're at a concert don't go to near the front stage where the music is likely to be booming out at high sound levels.

In many instances people will get a warning when visiting these places. If the decibel levels are too high their tinnitus might spike. Usually the tinnitus will return to baseline. However, some people do not pay attention to these warnings and continue to subject their ears to loud sounds and think they are perfectly safe because they are wearing earplugs. Under these circumstances the tinnitus might spike again and this time it might become permanent. I am saying might because nothing is for certain. In my opinion a person with tinnitus needs to follow the warnings their auditory system and tinnitus is telling them.

Regarding headphones. Many people have contacted me after they have habituated to tinnitus and returned to using headphones and listened to music through them at low volume. All of them have noticed an increase in their tinnitus. Some of them noticed their tinnitus spiked but carried on listening to music through headphones and then the tinnitus increased to a higher and more permanent level. It must be said that some people with tinnitus use headphones and have no adverse effects and that is perfectly fine. My opinion on this is, anyone that has tinnitus shouldn't listen to any type of audio through headphones even at low level.

It saddens to say, if a person doesn't heed the warning signs their auditory system and tinnitus is telling them, then they will eventually feel because tinnitus is very unforgiving. It is fine when some people are telling others what they want to hear: "listen to music through headphones because life is for living". "Go to the club as often as possible you're safe with earplugs. If your tinnitus increases you will be the one that will be in the suffering.

I have read many posts in tinnitus talk, where people had habituated and the tinnitus is low. They returned to listening to music through headphones and clubbing during the week and weekends. Some are now regretting this because their tinnitus has increased and they are in distress. Just because a person habituates doesn't mean they can forget everything and carry on in some instances recklessly. You can of course do this but my advice is to do things in moderation and not to excess, because the end result is often returning to ENT for help and visiting tinnitus forums because you are unable to cope.

https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/
https://www.tinnitustalk.com/threads/hyperacusis-as-i-see-it.19174/

Thank you for your message. No, I never listen to music through headphones! And I have noise reducing earplugs, they are made especially for my ears and I wore them the whole night! (except when I left the room with music)

My spike settled down even more, so I think I will not go get prednison, at least not today.

I realise you may be right, that I am taking a risk. But I just don't know, going out is so important for me, it really changes my everyday mood. And I really doubt if it will make my T worse. One night I realized I had T and the drama began, but if I had just moved on, I wouldn't be afraid right now and I really think that my T would stay the same.

 

[Michael Leigh]

I realise you may be right, that I am taking a risk. But I just don't know, going out is so important for me,

There is nothing wrong is going out in fact it is good to socialise as I've said in my post above. Be under no illusion, even the best earplugs in the world will not stop "external sound" reaching your inner ear and making tinnitus worse if the sound is loud enough. This is because sound can pass through your skull and be transferred to your inner ear by bone conduction. Please read the post below written by an Audio Engineer who's a member of this forum. I think you will be surprised by what he has to say.

Michael


@Bill Weir

Hi!
I'm an audio engineer and now have T. I hate to have to tell you this but there are no earplugs that can protect you in the typical nightclub environment. The best protection will only lower the Sound Pressure Level (SPL) by about 30 db. Assuming the sound is typical, it's going to hover around 105 db A when measured using long term averaging, slow response on a meter. This means there will be peaks well in excess of 120 db"A" weighted. Weighting the scales of measurement on the sound meter gives more accurate readings. "A" weighting approximates what your eardrum is sensitive to... meaning sound with the deep bass filtered out. "C" weighting includes the bass and is generally 15-30 db higher than an "A" reading.

So, 105 db A (typical nightclub or major concert translates into 130 db "C" or more including the bass. How long do people generally stay in the average nightclub? Too long! 4 hour stay is average. A concert is generally 2.5 hours. Many people will stay in the club all night until they are "OK" to drive and be back in public LMAO. The drugs people do screws up their judgement and desensitizes them to physical sensation and people damage themselves without realizing it.

Sound levels pretty much everywhere are TOO loud IMO. Instead of the industry standard 105 db A (Live Nation SPL cap) I like to keep it at 96-98 for people. Why so loud? Above 96 db the fight or flight response begins to kick in and you get that rush of excitement you get at a concert. It's a lot of what people pay for. Deep bass goes in through bone transconductance. You don't "hear" it with your eardrum you feel it This is how it is possible to have bass with headphones. If this transconductance did not occur, the long wavelengths that make bass would not have enough distance to unfold when using headphones. So, earplugs DO NOT protect you from low frequency damage. Not even a little bit.

So, on the one hand, you're going to have 100db + peaks getting through your earplugs in the range above 100 Hz (low note on a 4 string bass guitar is 41.7 Hz) and the bass below will pressurize your cochlea like nothing is even there, straight through the bone. Some of the subwoofer arrays I have installed in places must have security grating around them to keep people from getting within ten feet of the subwoofer array because the array produces well over 150 db down at 35Hz at 1 meter distance and would make them nauseous or in some extreme cases even worse than that.

I can say this definitively from direct personal and professional experience. If you value your hearing and do not want your tinnitus to increase, avoid these places or if you must go limit your exposure considerably.

 

[MiaX]

There is nothing wrong is going out in fact it is good to socialise as I've said in my post above. Be under no illusion, even the best earplugs in the world will not stop "external sound" reaching your inner ear and making tinnitus worse if the sound is loud enough. This is because sound can pass through your skull and be transferred to your inner ear by bone conduction. Please read the post below written by an Audio Engineer who's a member of this forum. I think you will be surprised by what he has to say.

Michael


@Bill Weir

Hi!
I'm an audio engineer and now have T. I hate to have to tell you this but there are no earplugs that can protect you in the typical nightclub environment. The best protection will only lower the Sound Pressure Level (SPL) by about 30 db. Assuming the sound is typical, it's going to hover around 105 db A when measured using long term averaging, slow response on a meter. This means there will be peaks well in excess of 120 db"A" weighted. Weighting the scales of measurement on the sound meter gives more accurate readings. "A" weighting approximates what your eardrum is sensitive to... meaning sound with the deep bass filtered out. "C" weighting includes the bass and is generally 15-30 db higher than an "A" reading.

So, 105 db A (typical nightclub or major concert translates into 130 db "C" or more including the bass. How long do people generally stay in the average nightclub? Too long! 4 hour stay is average. A concert is generally 2.5 hours. Many people will stay in the club all night until they are "OK" to drive and be back in public LMAO. The drugs people do screws up their judgement and desensitizes them to physical sensation and people damage themselves without realizing it.

Sound levels pretty much everywhere are TOO loud IMO. Instead of the industry standard 105 db A (Live Nation SPL cap) I like to keep it at 96-98 for people. Why so loud? Above 96 db the fight or flight response begins to kick in and you get that rush of excitement you get at a concert. It's a lot of what people pay for. Deep bass goes in through bone transconductance. You don't "hear" it with your eardrum you feel it This is how it is possible to have bass with headphones. If this transconductance did not occur, the long wavelengths that make bass would not have enough distance to unfold when using headphones. So, earplugs DO NOT protect you from low frequency damage. Not even a little bit.

So, on the one hand, you're going to have 100db + peaks getting through your earplugs in the range above 100 Hz (low note on a 4 string bass guitar is 41.7 Hz) and the bass below will pressurize your cochlea like nothing is even there, straight through the bone. Some of the subwoofer arrays I have installed in places must have security grating around them to keep people from getting within ten feet of the subwoofer array because the array produces well over 150 db down at 35Hz at 1 meter distance and would make them nauseous or in some extreme cases even worse than that.

I can say this definitively from direct personal and professional experience. If you value your hearing and do not want your tinnitus to increase, avoid these places or if you must go limit your exposure considerably.

I already read it! I am very careful: if it is too loud, I will leave or stay not longer than 20 minutes. I also take a lot of breaks.

By the way: I will see a hearing therapist next week!

 

[MiaX]

I am going bowling tonight and I am kinda afraid. I know bowling isn't very loud and I will wear my earplugs, but still...

 

[MiaX]

Ok, googling wasn't really a good idea, because now I am more afraid, haha.

I will see, hopefully it will not be too loud.

 

[lolkas]

Hi guys!

Last night I had a party at someone's house. It was not very loud, because there were neighbours. The only thing that was a bit loud, were voices and even that was not really loud. To illustrate: I could a lot of times not even hear what they were singing on the radio, because the volume was down. I wore my -25 db earplugs.

Sometimes I left the room with people and I felt like my tinnitus spiked. I really thought that it was the alcohol, because I felt pretty soon pretty drunk (hadn't eaten much ).

After 2,5 hours we went into town and the bars were pretty loud, so I only stayed 40 minutes (with a break of 5 minutes).

When I came home, my t was pretty loud, but I was pretty drunk too.

I fell asleep and two hours later, the spike settled down a lot.

Right now tinnitus is still a bit spiking, but I had only 6 hours or sleep and it always spikes when I sleap not good.

Still I am worried and I think I might need get prednisone (but pretty sure they won't give it to me). I am also very afraid of the side effets.

Before I jump to conclusions: what do you guys think? Can it be the alcohol/hangover /lack of sleep?

I need to add that my t is probably not noise related and it almost never spiked due noise.

And while thinking about it, the first hour the music was a bit loud, but definitely not concert/club/bar - loud.

I am glad to see that you are enjoying yourself, despite having T.

Now, you have 25 dB custom earplugs and you wore them whole night. Were you having conversations during time you were wearing them? Since you could not hear radio over voices which means you would not hear other people well and spoke loudly.

This is the problem with custom earplugs - most cases there is significant gap between eardrum and earplug which creates what is called "occlusion effect", read about it.

I own ACS customs 26 dB myself, they are great! But not in social places. Best thing I found is classic ~32 dB NRR foam earplugs. You can buy them in different color and ultimately match your skin. Put them in your ears and get a feel for how much will be sticking out (it should not stick out more than 1/4). Pull them out and cut excess. Now if you put them in - they are invisible, provide more then 26 dB protection and no occlusion effect.

 

[MiaX]

I am glad to see that you are enjoying yourself, despite having T.

Now, you have 25 dB custom earplugs and you wore them whole night. Were you having conversations during time you were wearing them? Since you could not hear radio over voices which means you would not hear other people well and spoke loudly.

This is the problem with custom earplugs - most cases there is significant gap between eardrum and earplug which creates what is called "occlusion effect", read about it.

I own ACS customs 26 dB myself, they are great! But not in social places. Best thing I found is classic ~32 dB NRR foam earplugs. You can buy them in different color and ultimately match your skin. Put them in your ears and get a feel for how much will be sticking out (it should not stick out more than 1/4). Pull them out and cut excess. Now if you put them in - they are invisible, provide more then 26 dB protection and no occlusion effect.

Thanks for your reply!!

I don't really think I spoke too loud, because when I wear earplugs, I tend to speak softer because I hear voices better (they filter out the music) and I forget that for people who don't wear earplugs, my voice isn't really clear.

edit: But when I think about it, I spoke pretty loud, because people didn't really understand me (because I tend to speak softer, etc.), so you might be right, maybe I talked to loud.

Why are foam earplugs better? Because the occlusion effect will still be there, right?

For me, the problem with foam earplugs is that I am too afraid I will not put them in correctly (my ear canals are small), so I don't really dare to use them.

I think I figured out why my T spiked: it was the alcohol and my earplugs don't really stay in place. I think it's because my jawmuscles have a great impact on my ear canals. I am going back to the store where I bought them, but I don't really know what they can do about it... I don't really dare to go out again, which makes me kinda upset.

 

[MiaX]

How do people here deal with not be able to go out and stuff? Because I know the majority of the people here don't go to bars, clubs, a party, etc. Don't you miss it? I really find it difficult dealing with this, even more difficult than the T itself.

 

[lolkas]

@MiaX occlusion effect is miminal to non when foam earplugs are used. This is because gap between earplug and eardrum is small (imagine yourself in small room with closed door: if you yell - no echo, right ? There is no "space" for sound to rezonate. Now try to go to cave and yell - bunch of echo). Trust me, if you follow my suggestion, everything will be fine. Try yourself. Get them plugs, cut 1/4 of outter, roll/squish untill they are thin and insert so tgat they are in. Make sure you have tweezers on you so tgat you could pull them out (slowly with twist). First time, slowly put them all the way so that you get a feel on when end of plug is close to your eardrum. Take them off any try few times. Shortly you will know how deep they should go in your ear canal. In any scenario they should not stick out at all from ear canal (giving that you did cut 1/4 off).

 

[Alue]

@MiaX occlusion effect is miminal to non when foam earplugs are used. This is because gap between earplug and eardrum is small (imagine yourself in small room with closed door: if you yell - no echo, right ? There is no "space" for sound to rezonate. Now try to go to cave and yell - bunch of echo). Trust me, if you follow my suggestion, everything will be fine. Try yourself. Get them plugs, cut 1/4 of outter, roll/squish untill they are thin and insert so tgat they are in. Make sure you have tweezers on you so tgat you could pull them out (slowly with twist). First time, slowly put them all the way so that you get a feel on when end of plug is close to your eardrum. Take them off any try few times. Shortly you will know how deep they should go in your ear canal. In any scenario they should not stick out at all from ear canal (giving that you did cut 1/4 off).

Also foam doesn't reflect the sound as well as smooth non-porous surfaces.

 

[MiaX]

@MiaX occlusion effect is miminal to non when foam earplugs are used. This is because gap between earplug and eardrum is small (imagine yourself in small room with closed door: if you yell - no echo, right ? There is no "space" for sound to rezonate. Now try to go to cave and yell - bunch of echo). Trust me, if you follow my suggestion, everything will be fine. Try yourself. Get them plugs, cut 1/4 of outter, roll/squish untill they are thin and insert so tgat they are in. Make sure you have tweezers on you so tgat you could pull them out (slowly with twist). First time, slowly put them all the way so that you get a feel on when end of plug is close to your eardrum. Take them off any try few times. Shortly you will know how deep they should go in your ear canal. In any scenario they should not stick out at all from ear canal (giving that you did cut 1/4 off).

Why shouldn't they stick out?

Thank you for your message btw. To be honest, I am too scared to use foam earplugs, because it is possible to use them wrong and the chance to use molded earplugs is definitely smaller...

 

[lolkas]

Why shouldn't they stick out?

Thank you for your message btw. To be honest, I am too scared to use foam earplugs, because it is possible to use them wrong and the chance to use molded earplugs is definitely smaller...

@MiaX because they are visible from the side, but classic foam earplug should not stick out nor be visible from the front (looking straight at face). We are talking about how to make it COMPLETLEY invisible and "vanish" - this os why you would cut out 1/4 of OUTTER side.

I do this all the time and so far it worka very well.

P.S.

If you are going to club - use full blown 34db nnr foame