Why Has Damage Been Ruled Out as a Cause for Hyperacusis or Ear Pain?

[Sen]

A fundamental part of sound therapy is that hyperacusis and ear pain are not indicative of damage. This means sound therapists have ruled out damage as a cause for either hyperacusis or ear pain.

My question is this: how can damage be ruled out if an actual cause has not yet been identified?

And moreover, why are damaging levels of sound used as the metric for what can or cannot worsen hyperacusis if hyperacusis is not caused by damage?

 

[Canador]

A fundamental part of sound therapy is that hyperacusis and ear pain are not indicative of damage. This means sound therapists have ruled out damage as a cause for either hyperacusis or ear pain.

My question is this: how can damage be ruled out if an actual cause has not yet been identified?

And moreover, why are damaging levels of sound used as the metric for what can or cannot worsen hyperacusis if hyperacusis is not caused by damage?

The answers to your questions would be obvious to most people. However...

The medical field contains large numbers of people who've spent most of their lives in rooms with books. Common sense is not mandatory.

 

[Sen]

The answers to your questions would be obvious to most people.

I'm not sure what you mean by this.

I don't feel that the answers are obvious at all, at least not to me. Hence why I'm asking in the first place.

 

[Juan]

A fundamental part of sound therapy is that hyperacusis and ear pain are not indicative of damage. This means sound therapists have ruled out damage as a cause for either hyperacusis or ear pain.

My question is this: how can damage be ruled out if an actual cause has not yet been identified?

And moreover, why are damaging levels of sound used as the metric for what can or cannot worsen hyperacusis if hyperacusis is not caused by damage?

My feeling is hyperacusis in some cases, for instance when caused by exposure to very loud noise, could be a result of damage to the outer haircells. The outer haircells regulate the amount of sound that they let in to the inner haircells and that is transmitter through the auditory nerve. In this sense the outer haircells amplify very low sounds (for instance when reading in a quiet room, or library) and they inhibit or try to dampen the transmission of loud sounds. The outer haircells may be like a shield from sound. Once this protection is lost, the results can be H, hearing loss, T, etc Maybe H is a result of damaged outer haircells, and that is a physical damage that I personally dont think can be corrected, amended or improved significantly with sound therapy or TRT.

 

[linearb]

A fundamental part of sound therapy is that hyperacusis and ear pain are not indicative of damage. This means sound therapists have ruled out damage as a cause for either hyperacusis or ear pain.

I'm not sure this is correct? Almost everything I've read about H cites noise trauma (damage) as a significant cause / onset factor. So, having hyperacusisdoes often indicate that damage or trauma has occurred.

The more controversial question of whether noise which is not damaging to healthy ears might still be damaging to already impaired ears, is perplexing and needs more study. Certainly, I have read wide and varied anecdotes over the years from people whose H was improved or eliminated with maskers or other acoustic therapies, and there appears to be a substantial body of peer-reviewed research which comes to the same conclusion. However, I have certainly seen other anecdotes from less fortunate people who found that such therapies exacerbated their condition. Cynical, snarky doctors are quick to dismiss these as "anxiety disorders", however, that phrase rather offends me: I think it's a catch-all label which is often applied to people whose condition is not well understood, who are suffering and very reasonably feel anxiety as a result of their predicament. My uneducated guess is that "hyperacusis", like tinnitus, is just a symptom which might arise from different causes, and therefore, that some people may benefit from particular therapies which might actually be destructive to other people.

 

[Marie79]

I'm not sure this is correct? Almost everything I've read about H cites noise trauma (damage) as a significant cause / onset factor. So, having hyperacusisdoes often indicate that damage or trauma has occurred.

from what I've been told by at least 3 doctors is that TRUE H is very rare. That most of the time it is something we do to ourselves. That is not to say that ANYONE here isn't suffering from true H. It could be for people here and I do not know. for me while I called it H...it wasn't true H because it went away by following the directions that the doctor told me. I also know that when I obsess about my T too much it comes back and it always goes away when I follow those directions.

 

[Mithrandir]

Is there a true and a false hyperacusis ?

 

[Mithrandir]

@linearb

51% of hyperacusis comes from noise. I can give you the origins of my figures. H can come from acoustic shock or acoustic trauma, it's very different and different part of the ear can be damaged.

 

[linearb]

I think we may be conflating different things.

When my anxiety spikes, tinnitus generally spikes too, and my sound tolerance plummets: I end up reaching for earplugs around stuff like traffic noise and especially high-pitched electronics noises, because they literally seem painful even though at other times I can almost 100% ignore these noises. In my case I believe this is probably just a symptom of being in an anxiogenic state where all my usual sensory information is being turned up to 11 by the fight-or-flight adrenaline reflex. I don't think it's "hyperacusis" even if the endgame is similar.

 

[bill 112]

I'm not sure this is correct? Almost everything I've read about H cites noise trauma (damage) as a significant cause / onset factor. So, having hyperacusisdoes often indicate that damage or trauma has occurred.

The more controversial question of whether noise which is not damaging to healthy ears might still be damaging to already impaired ears, is perplexing and needs more study. Certainly, I have read wide and varied anecdotes over the years from people whose H was improved or eliminated with maskers or other acoustic therapies, and there appears to be a substantial body of peer-reviewed research which comes to the same conclusion. However, I have certainly seen other anecdotes from less fortunate people who found that such therapies exacerbated their condition. Cynical, snarky doctors are quick to dismiss these as "anxiety disorders", however, that phrase rather offends me: I think it's a catch-all label which is often applied to people whose condition is not well understood, who are suffering and very reasonably feel anxiety as a result of their predicament. My uneducated guess is that "hyperacusis", like tinnitus, is just a symptom which might arise from different causes, and therefore, that some people may benefit from particular therapies which might actually be destructive to other people.

The view on H has dramatically shifted in the last two years I found.

I remember after my noise trauma in 2014 literally everything that turned up on Google or elsewhere all pointed at the brain being responsible and many visits to audiologists and neurologists here confirmed this,not one mentioned damage,not one.
That coupled with all the amazing success stories with TRT on YouTube etc all painted a pretty picture of what H was and how it could be"cured"with sound desensitisation therapy.

Funny thing is if you google H now nearly everything that pops up mentions the cochlear nerve being affected or"cochlear Hyperacusis"

These pages did exist back a few years ago but they were hugely overshadowed by all the TRT and CNS theories and as such their voice couldn't be heard.

If we look at 2016 I went to two audiologists and they all mentioned the auditory nerve being responsible as research was starting to point that way,a complete turnaround from only two years ago.

I don't think there's a a fine line between H and Phonophobia and as such the two are often coupled together.

 

[Lex]

Is there any way to check if the hair cells (both inner and outer) are damaged?

 

[Canador]

I'm not sure what you mean by this.

I don't feel that the answers are obvious at all, at least not to me. Hence why I'm asking in the first place.

Sen, I thought you were asking rhetorical questions—questions that you already knew the answers to, but were using to start a discussion.

Your points are thoughtful. I think the challenge is that you are wanting *sensible* explanations for flawed theories.

For example, no responsible practitioner would "rule out" hearing damage as a factor in hyperacusis. With today's technology, it's not even remotely possible.

So your questions can't be logically answered. Certain practitioners are creating theories--and endangering others' hearing--based on "facts" that are impossible to obtain.

 

[bill 112]

OAEs and DPOAEs test outer haircell function.

 

[linearb]

Is there any way to check if the hair cells (both inner and outer) are damaged?

sure, once a person is dead you simply dissect the neck so that the cranial nerves are exposed, then make incisions following their pathway into the skull, removing the flesh of the ear, then remove the cochlea and examine it under an electron scanning microscope or some other extremely high-resolution device.

Doing it on someone who is still breathing without vivisecting them is more of a challenge, maybe in a couple hundred years they will have a way...

OAEs and DPOAEs test outer haircell function.

this is the correct, and much more boring, answer. Though, those tests are loud as f*#!!, I will probably never have another one voluntarily because I don't think the information gleaned is that interesting or useful.

 

[Dutchy]

A fundamental part of sound therapy is that hyperacusis and ear pain are not indicative of damage. This means sound therapists have ruled out damage as a cause for either hyperacusis or ear pain.

My question is this: how can damage be ruled out if an actual cause has not yet been identified?

And moreover, why are damaging levels of sound used as the metric for what can or cannot worsen hyperacusis if hyperacusis is not caused by damage?

That's the problem with this phantom pain.They can't see damage so they rule it out "and nothing can be done".
In a diagnostic outcome you're technically better off with a loss of limb because.. well that's hard to miss.

There is damage,they just have nothing that can measure and conclude it as such.(Like i said before,you really have to be hard of hearing before they even consider hearing loss so let alone actual damage)

 

[Lex]

Though, those tests are loud as f*#!!

Oh, sad to know they're loud! I was hoping there's a way to find out if my hair cells are indeed damaged because I don't really know the cause of my H. It coincided with a really bad sinus infection, but my love for loud music may already have taken its toll by then.

 

[Canador]

those tests are loud as f*#!!, I will probably never have another one voluntarily because I don't think the information gleaned is that interesting or useful.

And after they've sent your tinnitus permanently through the roof with a useless test, they will tell you that nothing can be done to fix it.

 

[linearb]

Oh, sad to know they're loud! I was hoping there's a way to find out if my hair cells are indeed damaged because I don't really know the cause of my H. It coincided with a really bad sinus infection, but my love for loud music may already have taken its toll by then.

a problem is that you don't have a set of pre-hyperacusis numbers to compare to. So, even if we could look and see with certainty "Lex has lost 3% of her high-frequency hair cells", we still wouldn't really know how that relates to your predicament, because it's quite possible that a test performed a year and a half ago would have shown the same thing.

Personally, if dealing with H, I would be inclined to avoid the loud tests for the moment, and just try to rest your ears, eat well, sleep well, relax, meditate, etc. Certainly, if your condition worsens, you should go see an audiologist -- but the very likely situation is that you slowly improve over some period of time. Do not let horror stories scare you, I think there are a lot more people who have suffered through bouts of hyperacusis and come out on top of it, than people who have been permanently harmed.

Are you quite sure the sinus infection itself has been treated adequately?

 

[linearb]

And after they've sent your tinnitus permanently through the roof with a useless test, they will tell you that nothing can be done to fix it.

I take a dim view of needless or pointlessly stressful exams, but I think the risks of being permanently damaged by these tests are incredibly small. They are performed on a constant basis by thousands of doctors filing reports, and you can bet that nearly every particular doctor who has ever encountered a patient who seemed to be severely damaged by a test, has written and thought deeply about it.

Doctors can be clueless and the medical infrastructure in most "first world" countries has all kinds of serious problems with it, but doctors aren't, as a general rule, evil or particularly stupid.

That said, there is no thing in this world which you can do, which does not carry some amount of risk. The world is dangerous, and full of a thousand billion things that want to eat you up or kill you, no one gets out alive, etc.

 

[Dutchy]

I take a dim view of needless or pointlessly stressful exams, but I think the risks of being permanently damaged by these tests are incredibly small. They are performed on a constant basis by thousands of doctors filing reports, and you can bet that nearly every particular doctor who has ever encountered a patient who seemed to be severely damaged by a test, has written and thought deeply about it.

Doctors can be clueless and the medical infrastructure in most "first world" countries has all kinds of serious problems with it, but doctors aren't, as a general rule, evil or particularly stupid.

That said, there is no thing in this world which you can do, which does not carry some amount of risk. The world is dangerous, and full of a thousand billion things that want to eat you up or kill you, no one gets out alive, etc.

Well a side of all of your legit examples,when it does make your T worse there's no " sorry " that will ease your mind.I think that's his point.

 

[bill 112]

Well a side of all of your legit examples,when it does make your T worse there's no " sorry " that will ease your mind.I think that's his point.

My audiologist completely screwed me,my H had gotten way better if not cured since its onset in 2014.
After three extremely hectic months at the end of 2015 my ears just felt completely worn out and tired,I was under a lot of pressure and busy and my ears needed a lot of rest.

A month or so later and I was feeling a lot better but I had an appointment with my audiologist just to make sure things were still OK in there.
He done the speech recognition test on me,insanely loud at that and everything just went to shit ever since.

T is gone crazy and H is just unbearable ever since,I'm no longer working and all I got was a simple"whoops"when he played it too loudly for my ears,he was well aware I had suffered from H.

Everyday I wake up I wish I had of skipped that appointment,little did I know what was coming from such a simple check up.

 

[Dutchy]

My audiologist completely screwed me,my H had gotten way better if not cured since its onset in 2014.
After three extremely hectic months at the end of 2015 my ears just felt completely worn out and tired,I was under a lot of pressure and busy and my ears needed a lot of rest.

A month or so later and I was feeling a lot better but I had an appointment with my audiologist just to make sure things were still OK in there.
He done the speech recognition test on me,insanely loud at that and everything just went to shit ever since.

T is gone crazy and H is just unbearable ever since,I'm no longer working and all I got was a simple"whoops"when he played it too loudly for my ears,he was well aware I had suffered from H.

Everyday I wake up I wish I had of skipped that appointment,little did I know what was coming from such a simple check up.

To me this is solid information,not just to me but others as well.Sure we can't stop or prevent things getting worse
but when you can listen to yourself when it comes to your health you should do it.That includes everyone,your family,your work etc etc.Try to live as much as you can but do not push your hearing and therefore your luck.
It's easy for those that do not have our condition,it really tests your sanity at certain points and it will physically and emotionally exhaust you to the point you think there's no way out ( I have seen many on this forum that are desperate and i fully understand that feeling)

Know this,only you can help yourself or let others help you that are going trough the same thing.Ironically those i turn to for help do not have it and have no idea what it feels like.
Then again they do not know what it means to deal with PTSD as well.So i try to listen to myself,regardless of the medical industry telling me " you can live with it and protecting your ears with ear buds will not harm you "
Those were tested with hearing that wasn't " damaged " yet so sorry for not taking your standards too seriously.
Not even the tests are conclusive so i doubt the protection to be much better.

Stay strong and listen to yourself at times (and your ears they're always listening)

 

[Canador]

...I think the risks of being permanently damaged by these tests are incredibly small.

I know of people whose lives have been completely ruined by hearing tests. If my limited knowledge were extrapolated across the country, I would guess that this happens a lot more than anyone would think.

The public is generally aware that errors, incompetence, and negligence occur in hospitals. The people in this forum need to be aware that such things happen in the audiology department as well.

 

[linearb]

I can assure you otherwise.

an assurance without any actual evidence, or even a possible mechanism by which a routine DPOE could be physiologically damaging, doesn't do a lot for me. I can assure you of any number of things. I assure you I am a martian shoe salesman, and my color is Red.

 

[Canador]

My audiologist completely screwed me... He done the speech recognition test on me, insanely loud at that and everything just went to shit ever since.

Everyday I wake up I wish I had of skipped that appointment,little did I know what was coming from such a simple check up.

Sorry.

This is an unfortunate example of the injuries we continue to hear about. What would be the purpose of doing such a test on someone with your history?

 

[bill 112]

Sorry.

This is a good example of the injuries we continue to hear about. What would be the purpose of doing such a test on someone with your history?

I have no idea,my audiograms and OAES were all normal so he wanted to see how I picked up sounds in noise to see if that had been affected.

At first it was ok then it suddenly jumped way too loud for me,I pulled off the earphones and refused to do anymore tests.When I got home the sound of the shower was hurtful and distorted and I've only gotton worse since then from little noises.He ruined any chance of a meaningful recovery.

 

[Dutchy]

an assurance without any actual evidence, or even a possible mechanism by which a routine DPOE could be physiologically damaging, doesn't do a lot for me. I can assure you of any number of things. I assure you I am a martian shoe salesman, and my color is Red.

OMG Al Bundy moved to Mars?

 

[Lex]

Are you quite sure the sinus infection itself has been treated adequately?

I'm not sure. I still get clogged sinuses, and my H worsens whenever that happens. When I take Allerta, my sinuses clear up a bit and my eardrums flutter less.

Also, when I really had bad sinusitis in the first week of December, most sounds hurt me. When I got that under control, my H returned to baseline.

Based on what I've been experiencing, it looks like H was caused by sinusitis in my case. But I also used to go to clubs and festivals a lot and I listed to music at a high volume so I also think I ruined my ears through noise exposure. That's why I wish there's a way to know for sure.

 

[Mithrandir]

@Lex You can use a neti pot and follow the thread of LA_engineer on TT

 

[Juan]

Oh, sad to know they're loud! I was hoping there's a way to find out if my hair cells are indeed damaged because I don't really know the cause of my H. It coincided with a really bad sinus infection, but my love for loud music may already have taken its toll by then.

The thing is that even if you found out through some test that there is damage to the hair cells, as of today the medical profession can do nothing about it, nothing to fix it really. That may be the reason why many doctor are so apathetic at dealing with patients with H or T who go back to visit them regularly to see if a new treatment came up or if their doctors learned something new in the meantime.

Some people with rare diseases (not only H) end up knowing more about the condition than their doctors, and that does not say much in favour of the medical profession, which sometimes seem like mere dispatchers of drugs, like subsidiaries of pharma companies.