Above-the-Ear Sound Generators for Treating Hyperacusis — What's the Appropriate Volume?

[Athens]

I have had loudness hyperacusis for approximately eighteen (18) months. I do not have any significant pain, but many sounds, especially high frequency, are uncomfortably loud.

I have worked with an audiologist trained in TRT, and we have been using above-the-ear sound generators without any amplification (these are not hearing aids) since July of 2021.

The audiologists that I have consulted with indicate that I should just set it at a comfortable level, and that I do not necessarily need to gradually increase the volume. I believe that the lowest level might be 3 dB, and it has been suggested that I should set it at least at 6 dB. I significantly increased the volume one day, and the tinnitus seemed noticeably quieter later that evening. It may have just been a fluke, but I am too concerned about aggravating my condition by turning them up louder. Many people advocate setting them just below the tinnitus, but I am primarily using them for hyperacusis to coax the brain to turn the volume button down.

I am interested in hearing from people who had significant loudness hyperacusis who may have experienced success with this approach and how they set their sound generators. Someone once posted that setting them too low might result in an increase in tinnitus, but I cannot find this post.

Thank you in advance.

 

[Rockman]

@Michael Leigh I would think probably has the correct answer to your question.

I got Widex Zen a few months ago. I only tried them once without amplification, but when I wear them, they seem to make all sounds around me louder. So I haven't worn them since. Which is too bad, they weren't cheap.

 

[Michael Leigh]

Hi @Athens,

I have been using above-the-ear sound generators for many years and in-ear types as well. I first used them 25 years ago to treat noise-induced tinnitus with hyperacusis. My audiologist was trained in TRT and was also born with tinnitus.

Whether a person is using sound generators to treat hyperacusis or tinnitus with hyperacusis, one must be aware this treatment takes time and regular counselling with their audiologist for the duration of treatment is advised, which can take up to two years. If the patient is not having regular counselling then they are not having proper TRT.

I was taught to always keep the white noise just below the level of the tinnitus and leave them alone. Over time the brain habituates to the white noise and slowly pushes the tinnitus further into the background so its perception becomes less noticeable. In the process the white noise desensitises the oversensitivity to sound of the auditory system and thus treating the hyperacusis.

There is a tendency for some people to constantly adjust the volume of the sound generators particularly when outside, as sounds in the environment can make it more difficult to hear the white noise. This should not be done, by constantly adjusting the volume of the white noise will make it more difficult for the brain to habituate to it and can, delay or completely stop the habituation process.

Some audiologists advise tinnitus patients to slowly increase the volume of the white noise in order to treat the hyperacusis first. This is not always a good idea because many people that I have corresponded with who have tried this method, notice it causes irritation and the hyperacusis and tinnitus increases. When they have followed my advice in keeping the white noise low, there is no increase in the tinnitus or hyperacusis and have been much more successful wearing their sound generators for the duration of treatment.

Sound generators should be introduced slowly when first starting treatment to cause the least amount of irritation to the tinnitus and hyperacusis. Start off wearing them for for just one or two hours, then take them off for the same duration. After the elapsed time put them on again and continue this throughout the day and the first week. Slowly increase the wearing time until you are able to wear the sound generators for 8 to 10 hours a day.

When retiring to bed at night, sound generators should not be worn. Instead, place a sound machine by the bedside keeping the volume low, so it doesn't draw attention to itself. The sound machine supplies the brain with sound enrichment while a person is asleep and helps prevent it, increasing its background activity which will often increase the tinnitus. The hyperacusis will also treated using sound enrichment.

Michael

 

[David S]

@Athens, I am starting to use my sound generators and struggling a little. My tinnitus is quite bad and also reactive. For me to try to set just below the mixing points I think would be a bad idea. I can hear my pink noise on the lowest setting so I use that or 1-2 steps up. Just to get warmed up. I will slowly increase volume but it will take months. I think I am 5 dB above my hearing now. To get to the mixing point would require 50 dB. No way I can take that now.

 

[Michael Leigh]

@Michael Leigh I would think probably has the correct answer to your question.

I got Widex Zen a few months ago. I only tried them once without amplification, but when I wear them, they seem to make all sounds around me louder. So I haven't worn them since. Which is too bad, they weren't cheap.

Try to continue with the sound generators @Rockman. My advice on first starting to use sound generators in reply to Athens is an example. If you can only manage 10 or 15 minutes wearing time, then do that.

I have corresponded with people that once had a lot of difficulty wearing sound generators. When they tried the suggestion mentioned above, they were able to continue wearing them and gradually increased wearing time to 8 hours a day.

Please try again and take things very slow.

Best of luck,
Michael

 

[Michael Leigh]

To get to the mixing point would require 50 dB. No way I can take that now.

Whilst some people might be able to cope with setting sound generators at the mixing point @David S, unfortunately many people find it irritates the tinnitus and hyperacusis. Setting the white or pink noise slightly below the tinnitus is often preferred.

Michael

 

[Athens]

@Athens, I am starting to use my sound generators and struggling a little. My tinnitus is quite bad and also reactive. For me to try to set just below the mixing points I think would be a bad idea. I can hear my pink noise on the lowest setting so I use that or 1-2 steps up. Just to get warmed up. I will slowly increase volume but it will take months. I think I am 5 dB above my hearing now. To get to the mixing point would require 50 dB. No way I can take that now.

Do your sound generators go up to 50 dB? I will have to check the maximum for mine, but I believe that it is much less. It has been suggested that I listen to mine at 6 dB to 10 dB.

 

[David S]

@Athens, I have these:

They can generate quite a lot of sound. I also think it is confusing. I think it is 2 diffident approaches. One is to set them 6-10 dB above your hearing threshold. Which should be very safe I assume. The other approach is to set them just under where it would mask your tinnitus. For me that would be quite a lot of noise and I am far too sound sensitive for that by now.

@Michael Leigh, what thoughts do you have about this? If it is pure tone tinnitus, then I think it is easy. If hyperacusis is involved, it gets a little bit more complicated.

 

[Eleanor89]

Hello @Athens and @Michael Leigh, I started using my in-ear generators in October for loudness hyperacusis.

I was apprehensive at first and wore them with no sound for a week to get used to them.

I then started gradually using them a minute, then two minutes and have gradually built up to two hours at the moment. They are set on barely audible.

I find them soothing. I got them off the NHS. I also have counselling but this is through private.

 

[Michael Leigh]

I find them soothing. I got them off the NHS. I also have counselling but this is through private.

Well done @Eleanor89. Continue with the counselling and incorporate positivity into your life and this will help to take your attention away from tinnitus and hyperacusis. Counselling certainly helps but it can't do it all. A person has to make a conscious effort to involve themselves in doing things they like to do or take up a new hobby or interest.

Michael

 

[Michael Leigh]

@Michael Leigh, what thoughts do you have about this? If it is pure tone tinnitus, then I think it is easy. If hyperacusis is involved, it gets a little bit more complicated.

Your sound generators seem to be quite adequate @David S and I wish you every success with them. Treating hyperacusis and tinnitus is a little more complicated but try not to dwell on this as it can instill negative thinking, which is something you don't want.

Try to keep the white noise below the level of the tinnitus. If your hyperacusis is aggravated just take things slower and keep trying.

Michael

 

[DaveFromChicago]

I have finally learned how to fully incorporate Michael Leigh's endless admonitions about achieving total positivity;

I am going to go around the whole day dressed in a Ronald McDonald's Clown Suit with an everpresent fatuous grin, no matter how invasive or undermining my tinnitus is.

 

[David S]

I have finally learned how to fully incorporate Michael Leigh's endless admonitions about achieving total positivity;

I am going to go around the whole day dressed in a Ronald McDonald's Clown Suit with an everpresent fatuous grin, no matter how invasive or undermining my tinnitus is.

I hear you loud and clear. I have a wonderful wife, kids and a very good life in general. I have no other option than staying positive. This is my hardest setback so far. Need to get out of the fight or flight mode. I wish so bad that there were some other treatment options, but there isn't that many. For now, I have to trust that sound enrichment in any form will be a good alternative for me. I'll try to live as healthy as possible and once I feel a little better, I will start some fasting. We adults do not heal as fast as the youngsters. I do not want to stay on drugs for the rest of my life. I hope that time and the natural healing power will be there again for me.

 

[DaveFromChicago]

I hear you loud and clear. I have a wonderful wife, kids and a very good life in general. I have no other option than staying positive. This is my hardest setback so far. Need to get out of the fight or flight mode. I wish so bad that there were some other treatment options, but there isn't that many. For now, I have to trust that sound enrichment in any form will be a good alternative for me. I'll try to live as healthy as possible and once I feel a little better, I will start some fasting. We adults do not heal as fast as the youngsters. I do not want to stay on drugs for the rest of my life. I hope that time and the natural healing power will be there again for me.

The only reason for my sarcasm is that the Jastreboffean / TRT / Michael Leighs constitute an utterly obsolete, outmoded model for successful habituation.

Jastreboff developed this in 1992 (and has apparently changed very little); was the term PTSD with all of the resultant, crucial discoveries about what affected brain physiology even in existence back then?

It is apparent that the proponents of TRT have never acknowledged that such discoveries compel us to completely rethink what enables each individual's capacity (or lack thereof) for habituation.

I just finished the journalist Liz Rodman's "The Babysitter: My Summers With a Serial Killer" (2021), and in an attempt to understand such criminality there is a very insightful analysis by a psychiatrist regarding the chemical imbalances and permanent psychic haywiring that can occur from childhood trauma, migraines, or even from (as many researchers now believe) a genetically inherited predisposition towards such behavior.

The obsolescence of TRT in its disregard for such factors reminds me of how before 1973 the American Psychiatric Association classified being gay as a mental illness, and would browbeat any gay client for "not trying hard enough" to change into heterosexuality. This now appears to us as outrageously cruel and stupid, but during the Freudian Era the existence of DNA was not yet even known.

Michael Leigh's blanket insistence on everyone's full capacity for total habituation (and if you don't succeed it's entirely your fault for not having tried hard enough) without consideration for any of the abovementioned factors that alter the brain's functioning beyond our conscious control is similarly cruel and stupid. Notice that he always blames anyone's difficulty with TRT as resulting from some sort of character defect and never from any factor regarding brain physiology that is beyond the individual's conscious control.

This is the worst form of emotional blackmail, and in its odiousness is equivalent to that example regarding psychiatry's former approach to being gay.

 

[Athens]

@Athens, I have these:

View attachment 49954

They can generate quite a lot of sound. I also think it is confusing. I think it is 2 diffident approaches. One is to set them 6-10 dB above your hearing threshold. Which should be very safe I assume. The other approach is to set them just under where it would mask your tinnitus. For me that would be quite a lot of noise and I am far too sound sensitive for that by now.

@Michael Leigh, what thoughts do you have about this? If it is pure tone tinnitus, then I think it is easy. If hyperacusis is involved, it gets a little bit more complicated.

I have these same sound generators from the same company, but I might have a different model. I will have to check to see how high the decibel level can go. A representative from the company responded to my audiologist on this issue.