Been reading a lot on how T&H can occur and/or develop. The list of causes has been published here several times but when I read stuff like "Hyperacusis may develop with a number of conditions affecting the auditory pathway, including acoustic shock injury" I ask myself what is acoustic shock injury? I never found a common answer. Is it a physical shock to the inner hair cells, the cochlea or the cochlea nerves? Or could acoustic shock injury mean that a sudden loud or frightening audio signal has turned the central nervous system "out of order" - in a constant fight or flight mode? If looking at my own case I felt extremely nervous and tense in the months prior to my T&H and it escalated in the days and weeks after. It is very much there right now. I also feel some pain that reminds me of the good old ear ache. This leads me to think that some sound exposure have set me into a nervous shock. That I didn't expect the sound (for instance a fire alarm) to come and that it kick started a process that in turn lead to the acoustic shock injury. How many of these shock injuries can be said to be all physical? Could the central nervous system be the main catalyst in this and the inner ear damage be a secondary cause that in turn don't create T&H on its own? I would also like to mention the fact that I do feel a physical sensation in my ear, like dry snow are crushed very close to my ear. It's like a cramp feeling, especially when sounds are unpleasant or too high pitched. When I read about this on http://www.hyperacusis.net/hyperacusis/tensor tympani syndrome/default.asp its explained like this: "In the middle ear, the tensor tympani muscle and the stapedial muscle contract to tighten the middle ear bones (the ossicles) as a reaction to loud, potentially damaging sound. This provides protection to the inner ear from these loud sounds." I also have read that the audiotary cortex in the brain is responding in a wrong way, like it's too switched on or something. In other words, physical sensations can be generated by the brain where there's no actual physical damage. Same things can be said about ear aches. It's really hard to know what to think about this but if TRT is based on mainly mental training to re-train the brain to create new neural connections, it could be that acoustic shock also could be something perceived by the brain and the central nervous system, thus pushing the effects further down to the ear. Anyone?!