Tinnitus and Fear of Noise (Misophonia)

Dr. Nagler,

Do people who have tinnitus have a greater risk of damaging their ears further by "regular" noise than someone who doesn't have tinnitus? I have noticed a lot of tinnitus sufferers get worried about things like watching movies, going to restaurants or hearing loud traffic. This is stuff that people who don't suffer from tinnitus ever really think about, but they regularly expose themselves to these types of noises without any repercussions. But tinnitus sufferers are much more conscious about these everyday noises. So how much of this is legit concern from tinnitus sufferers and how much of it is just more awareness/caution of our ears?

I had this idea that if a noise wasn't loud enough to give someone tinnitus in the first place, then it probably isn't loud enough to make someone's tinnitus worse. Is that not true? Is it that once someone has tinnitus, it's like the ear is so damaged that even "regular" noises just continue to cause further damage?

 

@MattK wrote:

Do people who have tinnitus have a greater risk of damaging their ears further by "regular" noise than someone who doesn't have tinnitus? I have noticed a lot of tinnitus sufferers get worried about things like watching movies, going to restaurants or hearing loud traffic. This is stuff that people who don't suffer from tinnitus ever really think about, but they regularly expose themselves to these types of noises without any repercussions. But tinnitus sufferers are much more conscious about these everyday noises. So how much of this is legit concern from tinnitus sufferers and how much of it is just more awareness/caution of our ears?

I had this idea that if a noise wasn't loud enough to give someone tinnitus in the first place, then it probably isn't loud enough to make someone's tinnitus worse. Is that not true? Is it that once someone has tinnitus, it's like the ear is so damaged that even "regular" noises just continue to cause further damage

...............

Noise and tinnitus, huh? Why don't you ask me an easier question - like, say, "What is the true meaning of life?"

Matt, I don't think anybody really knows the answer to your question. There are any number of things that can aggravate tinnitus while not causing actual damage to hair cells - stress, fatigue, congestion, Thai food (for me!), etc. So just because an entity or condition makes your tinnitus louder, that doesn't mean it necessarily causes auditory damage. So, too, there are insults that can potentially damage hair cells and that can aggravate tinnitus - loud noise is an example. Is it the damaged hair cells themselves that aggravate the tinnitus, or is it the noise that both damages the hair cells and aggravates tinnitus? And what about noise that damages hair cells but does not make tinnitus louder? I don't think that that question has ever really been worked out - especially considering the number of people with tinnitus who continue to lose hair cells due to the aging process (presbycusis), but whose tinnitus does not continually get louder over time or even may seem to become less loud over time. So since nobody knows, and the information is confusing, it becomes a question of philosophy.

Here's mine: I have decided to take all reasonable precautions in the interest of limiting noise-induced auditory damage completely irrespective of what the effects of noise might be on my tinnitus. In another thread @here2help referred to viewing tinnitus as an aural apostrophe, and I believe he has it exactly right.

Does the presence of tinnitus in-and-of-itself mean that my ears are more susceptible to auditory damage? I do not believe so. Does the fact that I already have auditory damage (as documented by my audiogram) mean that my ears are more susceptible to further auditory damage from excessive noise? Probably, because noise-induced auditory damage is cumulative (i.e., the next noise insult might be the "straw that broke the camel's back" for any given hair cells or group of hair cells.) And with all of the above as background, we come to your question: Does the fact that I already have auditory damage mean that my ears are susceptible to further auditory damage from noise that might not be considered excessive? My answer is that I do not know and moreover I have decided not to care. Specifically, I do not consider the avoidance of noise levels that would not be ototoxic to healthy ears to be a "reasonable precaution" (see paragraph above). I just can't see living my life in fear of what sound levels that would not be damaging to healthy ears might do to mine!

So even though I have tinnitus, and even though I have auditory damage, I use the exact same (Jack Vernon) guideline that I recommend for people with healthy ears: If I have to raise my voice in order to be heard by a person standing next to me, then the noise level in that environment is potentially damaging to my ears and to everybody else's in that environment. So I either protect my ears or leave the area. And beyond that I don't give it another thought.

Please remember that I have just described how I myself view the issue - more as a matter of personal philosophy than hard science. How you choose to view it is up to you.

Hope this helps more than confuses.

Dr. Stephen Nagler