When Am I Overreacting and When Have I Actually Been Subjected to an Acoustic Trauma?

[Katarina]

Dear Dr. Nangler,

I live in a country where hearing therapists - namely those who treat tinnitus and hyperacusis patients - do not exist. So please allow me to ask a question, which keeps nagging me - and thank you at the same time for the enormous help that you offer to all of us who suffer with T and H.

How can I tell when I am just overreacting to sound and when I have actually been subjected to an acoustic trauma (which requires immediate treatment)?

I never know and as a result, I am never quite sure whether I should just rest it out or run to the nearest ENT specialist, have my hearing tested and accept treatments like intravenous steroids or 10-15 daily sessions of HBOT (Hyperbaric Oxygen Therapz to try and ward off further damage!?

Obviously, the answer to me is not clear. From what I have gathered using this forum, it is generally advised that sounds which do not hurt other peoples' ears cannot hurt mine but my doubts arise from a personal experience. My ears cannot withstand sounds which other peoples' ears can bear quite comfortably.

I have had tinnitus since I was 11 but it only became a problem when I was 35 (4 years ago) and when my ears suffered a blow as a result of the administration of the Acoustic Reflex Threshold Test (whereby loud sounds are introduced several times inside the ear). The test - which I assume other people have had done without negative consequences - changed my tinnitus from a homogenous, white noise type of head tinnitus to a medley of irritating sounds (from morse codes to mosquitoes and crickets), different in each ear, which keep changing all the time, react to loud and sudden sounds, and make it impossible for me to function in silence and to sleep.

This very same test also made me develop hyperacusis: since that day, I've become oversensitive to sounds, unable to withstand normal (loud) noises like a dog barking, a child screaming, music, traffic, etc.

Exposure to sounds of an intensity, which overwhelms me, result in a tinnitus spike (sometimes accompanied by aural fullness and heightened hyperacusis), which can last anything from a few hours to weeks and even months. Sometimes however I get the impression that the worsening is permanent …

Like this time. A month ago I was doing well, sleeping at night, without having to mask my tinnitus. Then I had a series of what I call acoustic traumas, which would probably not be classified as acoustic traumas by people with "normal" ears.

1. My car broke down on a very busy highway - I had to get out of the car and spent some time there - 5-10 mins, exposed to the thunderous sounds of cars and camions rushing by on 6 lanes ….. I did wear earplugs but only the custom made ones, which reduce the sound by 15-20 Db at the most.

2. A few days later, I started having a treatment whereby for 5 mins at a time I had to withstand the piercing loud whistling sound of a faulty compressor. I wore loose ear plugs the first 3 times, then I started wearing ear plugs and ear muffs for another 3 days … Mind you, these sounds, which were horrendously loud for me, did not bother anyone else: others did not bother to protect their ears at all!

3. A few days later I was in a room when a super loud phone rang out once (then I plugged my ears). It was about 3 meters away, but in the silence of the room, its piercing 90-100 Db sound really "stabbed" my ears. (I was sleeping .. )

As a result of these "traumas"., my tinnitus spiked up and has stayed bad for the last month.
I did get a normal audiometry done and my hearing - of the basic frequencies - is fine. I've been taking Gingko Biloba and Cavinton, to little effect.

So my question is: what should I do? (or what should I have done?) Rest it out some more and prey that it will pass or urge the ENT to treat me for an acoustic trauma (in my country, at this point, Hyperbaric Oxygen Therapy is probably my only option … too late for steroids I think)?

Please let me know your thoughts and thank you in advance.

K.

 

[Dr. Nagler]

How can I tell when I am just overreacting to sound and when I have actually been subjected to an acoustic trauma (which requires immediate treatment)?

Katarina, I am very sorry to read about what a difficult time you have been having.

The issue of overreacting to sound is problematic under any circumstances. I mean who wouldn't try to avoid something that makes you so uncomfortable! It's a basic human protective response - so I really don't see that as overreacting. Rather, I see it as doing what makes perfect sense.

So my question is: what should I do? (or what should I have done?)

Well I don't think it ever helps to reproach yourself for not doing what you should have done - but especially in this case because I really don't think you did anything wrong!

As to what I think you should do at this point in time, in my opinion that depends on your diagnosis - and from reading your post I am not certain what that diagnosis is. You describe what I would call decreased sound tolerance as well as sound-sensitive tinnitus - but I do not exactly know why. Is part of the problem hyperacusis? Or is it actually a form of misophonia? Or is it both? What you do about your decreased sound tolerance really depends on that diagnosis. Moreover, what you do about your sound-sensitive tinnitus has to be designed with the diagnosis of your decreased sound tolerance in mind. At least that's how I see it.

The challenge, as you said in your post, is that you live in an area where hearing therapists who treat individuals with these sorts of problems do not exist - or of they do, you have not located them. That being the case, if I were you, I would arrange to go for a few days to a place where they do exist, so you can have a proper evaluation that will yield an accurate diagnosis upon which a treatment plan for you can be designed, one that will hopefully provide you with considerable relief. Since you live in Prague, you might start by contacting Gabriele Lux-Wellenhof in Frankfurt, Germany. Explain your situation to her over the phone, and ask her if she thinks it would be of value for you to spend a day or two in Frankfort so you and she can sort all this out. I do not know Gabriele Lux-Wellenhof personally, but I have heard some very good things about her. Anyway, that's where I'd start my search.

Please let me know your thoughts and thank you in advance.

You are most welcome. I hope it works out for you.

stephen nagler