When to Run for the Hills in Noisy Environments?

[Autumnly]

I am so sick of the misinformation opinions on here that are talked about like facts. I am actually so sick of it that I will be asking researchers and experts in the field of tinnitus in my interviews these types of recurring questions we see on here to put these to bed once and for all. If you seriously think that anecdotal reports are worth more than the opinions of cutting edge tinnitus researchers who research this stuff for a living, your literally insane and equivalent to a flat earther or antivaxxer in my mind.

There are tinnitus 'experts' who have said that the people who don't habituate are simply anxious and just need to let go of their tinnitus. Are we now going to say that tinnitus can't be debilitating? I'd be a bit wary of what those 'experts' say. Don't get me wrong, there are definitely people whose anxiety is a bigger issue than their tinnitus. But my tinnitus has gotten worse permanently several times and I basically did what the European guideline for tinnitus said and I don't know why my tinnitus and hyperacusis got worse so significantly.

Some people seem more likely to develop temporary and permanent spikes (whatever the reason for those spikes is) and while the majority of people with chronic tinnitus seems to have relatively stable tinnitus, we can't ignore the stories and struggles of the minority.

I wanted to believe what my doctors had told me so badly I kept pushing myself to the point where I broke down with severe pain hyperacusis and severe tinnitus. And now those same doctors are telling me it's just stress. They told me my tinnitus would get better, that the spikes were temporary, that I should just go out there and live my life.
However, I'm obviously against claiming that, for example, 75DB can hurt someone with tinnitus as a fact. But I also wouldn't call it a fact that it can't hurt anyone with tinnitus.

I'm looking forward to the interview with Richard Tyler but I'm worried, I'm worried he'll perpetuate the myth that everyone can learn to tune out their tinnitus and it will further stigmatize the people who can't live a normal life with it. Richard Tyler has made statements before that make tinnitus look like a mental health issue and indicated that loudness doesn't matter at all.

 

[Ed209]

Acoustic instruments and electronic instruments, regardless of how the volume reads - ARE NOT the same thing. It's mainly because of processing, artifacts, and whether or not the system is properly mixed (it may be redlining)

The only two things that matter when measuring noise/sound is the frequency bandwidth and the amount of air that's being pushed. Granted, if you're dealing with amplified PA systems then a 12k system redlining is going to sound terrible compared to a 28k system that has abundant headroom. Distorted speakers sound terrible.

What you and some people don't understand is that some people, especially people on this forum, suffer from anxiety related issues. These anxiety disorders can affect our judgement and make some think irrationally. This hinders their ability to properly access situations regarding sound because the anxiety of it getting worse can make them feel uncomfortable more than the sound, BUT they don't realize his. This leads people to developing bad habits regarding this tinnitus.

How do I know? Because was one of those people who let the anxiety around it dig into me. It wasn't until I stopped listening to the fear mongering that is present on this forum that started to get better mentally as well as my tinnitus. I started to stop over protecting and I realized that some of the advice on here is unscientific bullshit. Overprotecting was making me worse and it wasn't as extreme as some people on here.

My point saying this is that at one time I felt that my body was telling me certain sounds were uncomfortable and "dangerous" when in fact they were not dangerous or uncomfortable at all. It was my anxiety regarding them that made it so. A significant amount of people on here show signs of classic anxiety disorders, which is understandable because tinnitus can do that. Some people let this anxiety consume them and makes them think and feel irrationally. A lot of people are so deep in the rabbit hole they don't realize this and live in constant "dangerous" sound. So listening to ones body is bullshit when some people suffer from anxiety because the anxiety can make you think irrationally. Also listening to ones body is bullshit because when you went to loud damaging venues when you had healthy ears you didn't get an "uncomfortable" feeling, it just was loud. It is now uncomfortable with tinnitus because it is loud. All loud sounds are uncomfortable to people with tinnitus because they are loud and we think they can make tinnitus worse. Does feeling uncomfortable make them dangerous? NO! The Decibel level makes them dangerous.

Also, anxiety plays a HUGE roll in how we perceive tinnitus, which could be causing a lot of the "spikes" we see on here. So when people say things like, "I dropped a spoon and it made a loud noise and now I am spiking." We don't know if it was the sound of the anxiety surrounding it. How don't we know? Because it is anecdotal and we don't have a control to compare it to.

People don't take the anxiety aspect of spikes seriously at all which leaves us with random experiences causing spike. A perfect example is @Flamingo1 going to a rocket launch being excited and happy and not having an issue. A ROCKET LAUNCH... (120 dB) which had a low rumble aka lower frequencies. FYI low frequencies are harder to protect against with hearing protection. That's why good hearing protection fine print will state that it has less protection at lower frequencies and that should be taken into account while wearing it. Now compare to this recent experience at 75 dB for 2 hours with 20+ NRR plugs within a frequency range the plugs should offer better protection to and that caused a spike? How do we know it wasn't a delayed reaction from the rocket launch? How do we know there aren't other factors besides the 75 dB? We don't, which again shows that this anecdotal report is flawed.

Also, if 75 dB is dangerous without ear plugs, you wouldn't be able to drive a car or take a shower. This is not the case with the majority of people with tinnitus. I understand everyone is different but you guys keep throwing around 70 environments are dangerous for tinnitus ears. This is again bullshit because I know MANY people with tinnitus who can take showers and drive their cars without it affecting their tinnitus.

I am so sick of the misinformation opinions on here that are talked about like facts. I am actually so sick of it that I will be asking researchers and experts in the field of tinnitus in my interviews these types of recurring questions we see on here to put these to bed once and for all. If you seriously think that anecdotal reports are worth more than the opinions of cutting edge tinnitus researchers who research this stuff for a living, your literally insane and equivalent to a flat earther or antivaxxer in my mind.

It's also my experience, Jack. It's well documented on here that I was miserable when I fell into the rabbit hole, monitoring this and monitoring that with earplugs constantly stuck in my head. I've noticed a fair few have come forward and said the same. Spikes are ubiquitous and often have no meaning at all, but that doesn't stop us looking for the last thing we did to blame.

One time I told a friend I couldn't make his party, back when I was really struggling and miserable, and the next day I had a massive spike. I was so relieved that I didn't go, because I immediately knew that I would have blamed the party and then blamed myself for going. The guilt is the hardest thing to handle sometimes.

The truth is we don't know what's going on, but I am convinced that many of you have heavy involvement from your limbic system. I was the same until I stopped reading all the crap that gets posted on here. Not all of it, obviously, but some of the stuff I read is way out there.

There's a difference between looking after your ears and being phonophobic, with additional anxiety issues, and sometimes even OCD. There is almost an element of some form of PTSD going on as well for some people, "sound caused the problem so I need to stay the hell away from all sound" often becomes the mindset. But, this is a toxic way of thinking, and if left unchecked, you will slowly walk down a path that leads to extreme misery.

I am not saying what people should or shouldn't do, but if I see something I disagree with I'll say so. That's what forums are all about.

 

[Jack Straw]

There are tinnitus 'experts' who have said that the people who don't habituate are simply anxious and just need to let go of their tinnitus. Are we now going to say that tinnitus can't be debilitating? I'd be a bit wary of what those 'experts' say. Don't get me wrong, there are definitely people whose anxiety is a bigger issue than their tinnitus. But my tinnitus has gotten worse permanently several times and I basically did what the European guideline for tinnitus said and I don't know why my tinnitus and hyperacusis got worse so significantly.

Some people seem more likely to develop temporary and permanent spikes (whatever the reason for those spikes is) and while the majority of people with chronic tinnitus seems to have relatively stable tinnitus, we can't ignore the stories and struggles of the minority.

I wanted to believe what my doctors had told me so badly I kept pushing myself to the point where I broke down with severe pain hyperacusis and severe tinnitus. And now those same doctors are telling me it's just stress. They told me my tinnitus would get better, that the spikes were temporary, that I should just out there and live my life.
However, I'm obviously against claiming that, for example, 75DB can hurt someone with tinnitus as a fact. But I also wouldn't call it a fact that it can't hurt anyone with tinnitus.

I'm looking forward to the interview with Richard Tyler but I'm worried, I'm worried he'll perpetuate the myth that everyone can learn to tune out their tinnitus and it will further stigmatize the people who can't live a normal life with it. Richard Tyler has made statements before that make tinnitus look like a mental health issue and indicated that loudness doesn't matter at all.

We aren't arguing habituation here though (psychological), but actual danger levels of sound (physical damage). This is much more easily measured and quantified.

I understand some "experts" in the past have not said the best things regarding tinnitus, but I feel it is unfair to discredit them all or all future statements. If we can not go by what experts who study this day in and day out, what reliable source is there?

I also think there is a vastly different level of expertise between doctors and researchers. I don't think doctors are the best source when it comes to a condition like tinnitus.

 

[Autumnly]

The truth is we don't know what's going on, but I am convinced that many of you have heavy involvement from your limbic system. I was the same until I stopped reading all the crap that gets posted on here. Not all of it, obviously, but some of the stuff I read is way out there.

Okay, let's go with that logic and say the people are struggling, do so because of their limbic system not working properly. Does that mean they are more likely to develop a temporary or permanent spike? And if they are more likely to develop a permanent spike compared to other people, shouldn't that mean they need to be more protective of their ears?
As you both have said, we don't know for sure what causes those spikes. Also, what's the solution for people whose limbic system is out of whack - CBT, mindfulness? And if those don't work you get told it's your attitude? Let's find a balance between keeping fear-mongering to a minimum and not ignoring everyone's experience that doesn't fit the majority model.

 

[Ed209]

I wanted to believe what my doctors had told me so badly I kept pushing myself to the point where I broke down with severe pain hyperacusis and severe tinnitus. And now those same doctors are telling me it's just stress. They told me my tinnitus would get better, that the spikes were temporary, that I should just out there and live my life.
However, I'm obviously against claiming that, for example, 75DB can hurt someone with tinnitus as a fact. But I also wouldn't call it a fact that it can't hurt anyone with tinnitus.

I feel for everyone who is suffering otherwise I wouldn't have bothered hanging around. Don't forget that hyperacusis can also be a problem with people who have tinnitus.

I make no apology at all for making that point and incidentally in terms of the cinema db level we are talking of noise levels of up to 95 or 100 dbs - not the 75db which you keep repeating.

You're doing it again! With earplugs, the exposure in UK cinemas is not dangerous. There is no reason for anyone to worry if earplugs are used. The obvious caveat here is that people with sensitivity or hyperacusis may want to stay away. Although, a side point here is that many people cause their own sensitivity/hyperacusis by over-protecting for an extended period of time. Our ears are not designed to be constantly deprived of all sound.

 

[david c]

I wanted to believe what my doctors had told me so badly I kept pushing myself to the point where I broke down with severe pain hyperacusis and severe tinnitus. And now those same doctors are telling me it's just stress. They told me my tinnitus would get better, that the spikes were temporary, that I should just out there and live my life.

Indeed and there we have the real human cost - people with severe tinnitus being told that their sensible aversion to noise is just anxiety. It's not phonophobia for someone with severe or even moderate tinnitus to wish to minimise or cut out completely the amount of time they spend in very noisy environments. It's just common sense.

 

[david c]

@Ed209 So I have severe tinnitus (to which I have habituated) and hearing sensitivity - not hyperacusis which is a reaction to noise at normal levels not 95 dB levels. I therefore will not be going to a cinema again as I know that they have a negative impact on my tinnitus and are likely to for anyone with severe tinnitus and hearing sensitivity.

Don't tell me ever, ever again that you know better than I do what impacts on my tinnitus. I really would not recommend you doing that.

 

[just1morething]

@Ed209, With your beard you look sorta like a young Paul Allen. He was a good old sport like you.

 

[Jack Straw]

Indeed and there we have the real human cost - people with severe tinnitus being told that their sensible aversion to noise is just anxiety. It's not phonophobia for someone with severe or even moderate tinnitus to wish to minimise or cut out completely the amount of time they spend in very noisy environments. It's just common sense.

I am not sure we are on the same page. Do you agree with Jazzer and Bill that 70-80 dB environments are dangerous?

What dB level do you believe is "very noisy"?

 

[Bam]

I'm looking forward to the interview with Richard Tyler but I'm worried, I'm worried he'll perpetuate the myth that everyone can learn to tune out their tinnitus and it will further stigmatize the people who can't live a normal life with it. Richard Tyler has made statements before that make tinnitus look like a mental health issue and indicated that loudness doesn't matter at all.

Jesus. That's all we bloody need. This condition is so shit it's not even true. It's like being a paraplegic with everyone badgering you day and night to just get off your lazy ass and walk already.

 

[just1morething]

just get off your lazy ass

Our lazy ass is grass and tinnitus is the lawnmower.

 

[david c]

I am not sure we are on the same page. Do you agree with Jazzer and Bill that 70-80 dB environments are dangerous?

What dB level do you believe is "very noisy"?

So in answer to your question - there are a number of variables. One is sound duration. I certainly wouldn't recommend that anyone with severe tinnitus spends a longer period of time in a 70-80 dB environment. And anything over 80 dB - which includes cinemas- I would regard as very noisy. But the key point is that every tinnitus sufferer is going to be different - that's why I believe - unlike you - that they should listen to their body and their ears and not be persuaded to risk long-term loud noise exposure which they are finding is making their tinnitus worse because someone else says it's fine.

 

[PeteJ]

I need advice and this seems like an applicable thread to ask in. I want to have some ear plugs on hand but not sure which ones to get.

My ear canals got red from wearing what I had too much. I had two kinds:
3M Classic and some orange ones.
Has anyone suffered red/irritated ear canals here? I'm using muffs for the time being.

I live downtown and I can't help being anxious. I hear traffic outside including ambulance sirens and the odd fire truck siren. I don't know what to do about this. I applied to move to a different apt location but have to wait for a vacancy. I need some ideas for this problem.

Also, am I in danger from the outside traffic? I was using my ear muffs if I hear a siren but it's hard to be prepared all the time.

Anyway, I am experiencing a spike at the moment. I came in after a walk with the dog. I had my muffs with me and only put them on a few times. I might need new ones. They are uncomfortable. I still have discomfort with my left ear. I am really concerned about that which is increasing the anxiety.

 

[Jack Straw]

So in answer to your question - there are a number of variables. One is sound duration. I certainly wouldn't recommend that anyone with severe tinnitus spends a longer period of time in a 70-80 dB environment. And anything over 80 dB - which includes cinemas- I would regard as very noisy. But the key point is that every tinnitus sufferer is going to be different - that's why I believe - unlike you - that they should listen to their body and their ears and not be persuaded to risk long-term loud noise exposure which they are finding is making their tinnitus worse because someone else says it's fine.

I never said everyone's tinnitus is the same. My entire post is actually attacking blanket statements saying that all tinnitus sufferers must adhere to these rules of sound levels, which Bill keeps discussing.

Classic straw man argument..... I more than anyone have always promoted that fact that everyone's tinnitus is different and that what does or doesn't work for one person may or may not work for another.

 

[linearb]

I have musician's earplugs that I always wear in those environments However, even with the 25 dB plugs, 72 dB still seems dangerously loud for someone with 2 year-old noise induced tinnitus.

strongly, strongly disagree. 70s is fine with no protection for periods of time for most people including most people with tinnitus. We're all different and we have to find our own sensitivities, and I'm not telling you what to do, but I probably know 20 people in my real life with tinnitus, more than half of them are pretty aggressive with earplugs, and I doubt any of them would plug up in a Panera Bread (which is probably 70s range dB).

I will say that my decibel tolerance, as far as "what makes me psychologically uncomfortable", got a lot better once I moved out of the city into the woods. I think overall I find noise stressful (as does everyone, at a cellular level, studies have been done), and so now that I deal with a lot less of it in general, it fazes me a lot less even when I need to do really loud things like split wood with a maul or swing a chainsaw around. (Of course, I use earpro for that stuff, but a chainsaw or motorcycle through earpro is still probably 60s-70s range).

 

[Flamingo1]

People don't take the anxiety aspect of spikes seriously at all which leaves us with random experiences causing spike. A perfect example is @Flamingo1 going to a rocket launch being excited and happy and not having an issue. A ROCKET LAUNCH... (120 dB) which had a low rumble aka lower frequencies. FYI low frequencies are harder to protect against with hearing protection.

I never got a spike from the rocket launch. And I'm pretty sure it WAS NOT 120 dB from where I was sitting. And if it was, apparently my ears are not damaged in thatfFrequency range so it did not bother me. There are, however, certain frequencies that I am sensitive to, and I think that goes for everyone on here. At those frequencies I suspect my hair cells and /or synapses are damaged and therefore can withstand a much LOWER threshold of VOLUME. This explains why everyone's tinnitus is different.

 

[GSC]

I need advice and this seems like an applicable thread to ask in. I want to have some ear plugs on hand but not sure which ones to get.

My ear canals got red from wearing what I had too much. I had two kinds:
3M Classic and some orange ones.
Has anyone suffered red/irritated ear canals here? I'm using muffs for the time being.

I live downtown and I can't help being anxious. I hear traffic outside including ambulance sirens and the odd fire truck siren. I don't know what to do about this. I applied to move to a different apt location but have to wait for a vacancy. I need some ideas for this problem.

Also, am I in danger from the outside traffic? I was using my ear muffs if I hear a siren but it's hard to be prepared all the time.

Anyway, I am experiencing a spike at the moment. I came in after a walk with the dog. I had my muffs with me and only put them on a few times. I might need new ones. They are uncomfortable. I still have discomfort with my left ear. I am really concerned about that which is increasing the anxiety.

Plenty of people suffered from irritated canals and drums from overuse of ear protection. I'm not sure which plugs are best to use. But I see the majority tend to like foam, musician, and molded. I have foam plugs on hand. But I use my muffs for idle, too loud noises. What is your question though? Traffic? Walking by it? If you have H then maybe start off slow with exposing yourself to such noise... because if you have h there can be a loudness abnormality to it and your T will react to it.

 

[PeteJ]

Plenty of people suffered from irritated canals and drums from overuse of ear protection. I'm not sure which plugs are best to use. But I see the majority tend to like foam, musician, and molded. I have foam plugs on hand. But I use my muffs for idle, too loud noises. What is your question though? Traffic? Walking by it? If you have H then maybe start off slow with exposing yourself to such noise... because if you have h there can be a loudness abnormality to it and your T will react to it.

I don't think I have h. I just want to protect my hearing because I don't know what state my hearing system is in now. I want improvement but I'm surrounded by noise.
There is traffic when I go outside and I am wondering if it's good to wear ear protection then or if it's over protecting.

 

[GSC]

I don't think I have h. I just want to protect my hearing because I don't know what state my hearing system is in now. I want improvement but I'm surrounded by noise.
There is traffic when I go outside and I am wondering if it's good to wear ear protection then or if it's over protecting.

How often do you wear protection, Pete? If you wear them rarely while you're indoors and such and other places, then I PERSONALLY don't see the issue of wearing them outside by running traffic/cars especially if you're experiencing a spike from doing so.

 

[Ed209]

Okay, let's go with that logic and say the people are struggling, do so because of their limbic system not working properly. Does that mean they are more likely to develop a temporary or permanent spike? And if they are more likely to develop a permanent spike compared to other people, shouldn't that mean they need to be more protective of their ears?
As you both have said, we don't know for sure what causes those spikes. Also, what's the solution for people whose limbic system is out of whack - CBT, mindfulness? And if those don't work you get told it's your attitude? Let's find a balance between keeping fear-mongering to a minimum and not ignoring everyone's experience that doesn't fit the majority model.

That's the million dollar question, Autumnly. Nobody knows. I think many here show classic signs of anxiety and/or other comorbidities and I strongly believe it is contributing to their symptoms and problems. This is not a blanket statement, however, and I'm not suggesting this is the case for everyone. Others may have undiagnosed hyperacusis and/or a genetic problem, although, as far as I know, no genetic link has been found/proven yet.

All I can say is that I believe there's a hidden problem with severe phonophobia and that more people are being swept in based on what they are reading here on a daily basis. It's literally messing with people's minds. I'll add that nobody as far as I know is advocating that one should not protect their ears, but there is information on here that pushes the boundaries into a unhealthy relationship with all sound.

It's not phonophobia for someone with severe or even moderate tinnitus to wish to minimise or cut out completely the amount of time they spend in very noisy environments. It's just common sense.

I've got severe tinnitus and I was that phonophobic person and it was hell on earth. It's how very noisy is being defined that's the problem, David. I've got people coming to me regularly who are just lost and can no longer do ordinary stuff and it all starts with the slippery slope that we see here when people's heads are filled with misinformation. Messages that state that sounds around 70 dB are bad for your ears (which pretty much rules out most things in life) are an issue. What you don't realise is that some people take this stuff far more seriously than anybody here seems to realise and they are completely isolating themselves from society. The end result of this is inexplicably bad and heartbreaking. This is my motivation and I couldn't care less about winning silly internet arguments.

Don't tell me ever, ever again that you know better than I do what impacts on my tinnitus. I really would not recommend you doing that.

You seriously need to take a few deep breaths and relax. It's not all about you, David. This is a very problematic subject.

 

[david c]

@Ed209 but in fact it is about me personally from your point of view as you have a long-running grudge against me which has necessitated deletion of a series of abusive posts by you about me on Tinnitus Talk - it's definitely worth others knowing about this as it puts the argument in a context.

@Flamingo1 I should keep on as you are doing as you appear to have a very sensible attitude around noise. Do be careful of accepting advice from those who on other threads have disclosed dependency on benzos to cope with their tinnitus - that is exactly what can happen if you are not sufficiently careful around noise.

 

[annV]

 

[Jazzer]

But on this thread we are talking about something completely different - impact on tinnitus of someone whose cochlear are already damaged, and compromised.

I've got it!
I've really got it !!
Knowing as we do, that noise was what did devastating damage to our cochleae, which will now affect us for the rest of our lives, how about we all get out there, just take a gamble, and advise everybody else to do the same.
What d'you reckon fellas ??

 

[Ed209]

but in fact it is about me personally from your point of view as you have a long-running grudge against me which has necessitated deletion of a series of abusive posts by you about me on Tinnitus Talk - it's definitely worth others knowing about this as it puts the argument in a context.

I have been very civil with you whilst you haven't exactly been friendly. I don't hold grudges because I've got better things to worry about, but blatantly you do.

And don't act like you're all high and mighty after all the stuff you've pulled. Most other people wouldn't be anywhere near as amiable.

 

[Flamingo1]

All I can say is that I believe there's a hidden problem with severe phonophobia and that more people are being swept in based on what they are reading here on a daily basis. It's literally messing with people's minds.
... Messages that state that sounds around 70 dB are bad for your ears (which pretty much rules out most things in life) are an issue.

Phonophobia does NOT explain the fullness in my left BAD ear that I felt after listening to a band with ear plugs in an indoor venue that registered between 72-79 dB on my phone app sound meter. I got a course of prednisone last night from the doctor and am plugging my left ear until the fullness subsides.

 

[Ed209]

Phonophobia does NOT explain the fullness in my left BAD ear that I felt after listening to a band with ear plugs in an indoor venue that registered between 72-79 dB on my phone app sound meter. I got a course of prednisone last night from the doctor and am plugging my left ear until the fullness subsides.

The mind can create all sorts of problems if the belief is strong enough and this is well documented. The nocebo effect is one such example and conditioning is another.

https://www.psychologytoday.com/gb/...effect-negative-thoughts-can-harm-your-health

Spikes and phonophobia go hand in hand.

 

[Jack Straw]

I've got it!
I've really got it !!
Knowing as we do, that noise was what did devastating damage to our cochleae, which will now affect us for the rest of our lives, how about we all get out there, just take a gamble, and advise everybody else to do the same.
What d'you reckon fellas ??

Come on @Jazzer you know that we are not advocating for people to harm themselves with damaging sound levels.

 

[Ed209]

Come on @Jazzer you know that we are not advocating for people to harm themselves with damaging sound levels.

Exactly this. We need to think about the wellbeing of the majority and that definitely doesn't include telling people to do dangerously loud stuff.

 

[Gman]

@Ed209 @Jack Straw Out of interest, have either of you ever had any other ear related malady beyond bog standard tinnitus? Hyperacusis (any of the kinds), reactive tinnitus, TTTS, MEM, acoustic trauma leading to autonomic trigeminal nerve activation or neuralgia etc.?

 

[Ed209]

@Ed209 @Jack Straw Out of interest, have either of you ever had any other ear related malady beyond bog standard tinnitus? Hyperacusis (any of the kinds), reactive tinnitus, TTTS, MEM, acoustic trauma leading to autonomic trigeminal nerve activation or neuralgia etc.?

Yea, I've had mild hyperacusis, reactive tinnitus and symptoms of TTTS. I used to get the typical TTTS spasms and thudding all the time and this was especially apparent when I was phonophobic which makes sense as it's linked to anxiety.

Excerpt below:

Tonic tensor tympani syndrome is an anxiety-based condition. People who experience tinnitus and/or decreased sound tolerance (hyperacusis, misophonia, or phonophobia) are at greater risk for developing TTTS.

https://www.everydayhearing.com/tonic-tensor-tympani-syndrome/