Audiology — What NOT to Do?

Hello everyone,

Been taking a bit of a break from the forum and trying to "distance" myself from thinking T all the time - sometimes with success, more often not... Anyway, next week I have an appointment with an audiologist and I am a bit nervous since I remember reading here that A) hearing tests made someone's T worse or even B) someone got T from such test. So I want to be prepared.

What I want to ask from you guys is:

• Which tests are essential to take? I already got a basic hearing test done back in September, when my worsened T started. Got no change in hearing compared to my old records...
• More importantly: which tests should I NOT take?

My T is VERY reactive and I think my ears are still extremely sensitive. Let me give you some examples... My last - more or less permanent - spike came from going to the movies with -30dB earplugs on. I also get spikes that last days just by going to a friend's place and people talking loud etc. normal noises. I am thinking to perhaps to forbid them to blast anything louder than 70 dB in my ears... I have read that at least the "speech recognition test" with white noise that becomes louder & louder is bad. Also that there is some "hearing sensitivity" test in which they try loud sounds.

But yes, would help a lot if you guys could give tips!

 

I was thinking the same thing since I will be having another test soon. What I was thinking I would do (if they could accommodate) was to have them run the whole test with me holding the plugs a few inches from my ears. Any of the tones I am able to hear at this distance they should NOT play when the plugs are in meaning I can obviously heard them okay. I have never tried this nor do I know if any audiologist would accommodate but it sounds like a safe way of doing it.

The scary thing is that many audiologists mainly encounter people with mild T and no H. They are mostly older folks with a good degree of hearing loss. The last audiologist I saw was basically talking so loud he was shouting as if I was deaf even after I told him I had H.

 

@NimQ
After tests are carried out on your auditory system, you need to be referred to a Hearing Therapist or Audiologist that is trained in dealing with tinnitus and hyperacusis. The reactive tinnitus that you have is actually Hyperacusis, sensitivity to sound. One of the best ways to treat this is with sound desensitisation using white noise generators. More is explained in my article: Tinnitus, A Personal View. Click on the link below to read. The second link is about hyperacusis which is what I believe you have in addition to your tinnitus.

Best of luck at your Audiology appointment.
Michael

https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/

https://www.tinnitustalk.com/threads/hyperacusis-as-i-see-it.19174/

 

Thank you for your response @Cal18 - it isn't quite right that we have to feel afraid of audiologists. They should really be the experts of hearing and know a lot about tinnitus and hyperacusia as well. Let's hope that we both get an expert who understands our special needs and how absolutely necessary it is to keep decibels low.

@Michael Leigh Thank you for the tips. I do agree that I have at least a mild hyperacusis, since some every day noises indeed "hurt" my ears. But I think on top of that my T really is reactive, especially the one in my left ear. I can really notice it getting A LOT louder after for example spending a bit noisier evening at a friend's house or so. It isn't just in my head, since a volume that would usually mask my left T doesn't suffice and I need to put the volume louder because of the spike.

 

With all due respect @NimQ When you say that your tinnitus is reactive, it is "sensitivity" to sound that makes it reactive and this is called: Hyperacusis. Reative tinnitus is caused by Hyperacusis. It is when the auditory system is hypersensitive to sound. I have explained in my article how hyperacusis is treated and also in my other link that I gave you.
Michael

 

with all due respect, you're not an audiologist or a neurologist last I checked, and this is yet another example of you waxing intellectual about things that I believe you don't actually have a clue about. For instance, I have reactive tinnitus. I don't have hyperacusis: I ride motorcycles, I shoot guns, I play electric guitars, and do all sorts of other dumb, hedonistic bullshit that people with actual hyperacusis would never consider. And, I have experienced hyperacusis, closer to onset and during severe distress and magnesium deficiency.... since I've had both conditions, together and in isolation, I'm pretty good at differentiating between the two in the context of my own experience

It may be that your experience of hyperacusis is connected to your experience of reactive tinnitus, but the plural of anecdote is "anecdotes", not "tautology" or data. I am not aware of any good, evidence-based, peer-reviewed reason to believe that there is a definite and more importantly constant connection between the two conditions. Are you? If so plz share.

@Cal18 personally if I were in your shoes, I might chill on seeing audiologists or other pros for a while and just work on stress management and lifestyle changes. I would definitely avoid any testing that can be loud or uncomfortable; very little usually comes of excessive consultation with audiologists in any case; mostly they cannot really diagnose or help us outside of a handful of rare, specific causes.

 

@linearb I agree, my neurologist recommended it because he was worried about progressive hearing loss which freaked me out (he's actually a tinnitus neurologist, I have no idea how I actually found one). I really couldn't care less about the test results, I just want my T to be lower and I know for the most part, I'm the only one that can make that happen. But if I do end up doing the test, there's no way I will let them conduct it without a test run first.

 

Within the past year, I have probably had more audiograms than most people have in a lifetime. Like anything else, there are good and bad audiologists. I would say your best bet is to have your hearing tested in a clinic that is part of a hospital. Private offices usually want to sell you hearing aids or maskers even if you don't need them. From there, I would say that you want an audiologist who has a PhD. Then again, I once had an audiologist with a PhD tell me that I shouldn't have another hearing test unless I picked up the phone and couldn't hear, even though my Dr had ordered them more frequently. Plus, I'm deaf in the other ear, so I would hardly need to wait until I picked up a phone to realize that there was a major problem. Anyone with just a touch of common sense might have been able to figure that one out. At any rate, if you find someone you like, keep them in mind and try to schedule with them again. Good luck.

 

@linearb When you learn to have manners then I will think about explaining @NimQ condition to you. I don't normally correspond with rude people but in this case I've made an exception but won't be commenting further. I suggest you do some more research and you will find out that there is no such thing as "reactive tinnitus". It is a term that has been made up on many tinnitus forums. I also suggest you wash out your mouth with soap.
Goodbye.
Michael

 

I must agree with you. I do feel that there is a clear difference in hyperacusia and reactive tinnitus, even when I do understand that in some cases they can intersect. I can clearly notice the fluctuations in my T and compare it to masking volume, and thus notice how certain things really do affect my T sounds. My mild hyperacusia might get triggered by a plate dropping, but my reactive T gets triggered by a longer exposure - like spending an evening in louder environment. I don't overprotect my hearing, even when the spikes can last a couple of days. How would you describe reactiveness of your T?

Consequently, I agree that there are very different experiences on the same condition, hence my next comment:

I recognize the need to state that I am not quite comfortable with @Michael Leigh talking about "explaining my condition".:/ It simply doesn't feel right to diagnose people without the qualification and data to do so. Even professional specialists wouldn't diagnose anyone without tests and thorough examination of the case. That being said, it is very much okay and even welcome to say one's opinion and present a theory. We are all trying to make sense of T and the types of it, while even the experts are presenting dissenting theories. Therefore while doing theorizing and stating opinions here in the forums, it must be alright for people to disagree and say it doesn't really apply to them and their condition. We should be equals in discussion.

 

I think there probably is a large grey area between tinnitus and hyperacusis. When I first got tinnitus, any kind of white noise would set of my tinnitus like crazy. So the usual 'listen to white noise' would totally backfire on me. I couldnt even shower without my tinnitus flaring up. I never felt this was clearly hyperacusis. Rather, looking back, I think my brain was simply on overload. The stress from tinnitus, combined with the actual tinnitus and my constant focus on it set my brain to be incredibly in tune to the white noise sound of my tinnitus. I could see how this could be an adaptive strategy for human survival. Your brain perceives a dangerous sound, so you become acutely aware of that sound whenever you hear it. My bad luck was that my tinnitus was very much like many every day white noise sounds like shower and rain.

 

@Michael Leigh I would like to sincerely apologize to you.

I stand by the contents of my post -- but there was absolutely no need for me to be a jerk about it, and that has everything to do with the headspace I was in at the time, and very little to do with you. Overall I think you are one of the most consistently positive-message posters on this board, which is certainly something we need more of.

I just wanted to say that; I have no interest in discussing our fundamental disagreements about this issue further, because I do not think it is necessary that we agree about this (nor, I suspect, will we ever, no matter how thoroughly we attempted to dissect the issue - as I've already done my own research, and then some.)

I hope you can accept my apology; in the future I will endeavor to hold my tongue if I can't say things nicely. I realize that there is a certain irony in the fact that I tend to really berate people on here for "excessive negativity", yet that's exactly what I dragged in here, for no good reason.

 

I accept your apology @linearb and I also respect your opinions. I abhor the use of bad language and therefore don't use it especially in writing.
I wish you well.
Michael

 

Anyone that disagrees with with Michael Leigh gets called rude.

 

I think it's pretty common for disagreements on the internet to get into "rude" territory pretty quickly, for a number of reasons, and chronic illness boards have the added problem of a population of people prone to be unhappy, stressed and therefore trigger happy.

Speaking for myself, I was a jerk in that post, no good reason for it. He accepted my apology; since I can't edit/delete my posts here to just remove this whole messy derail, let's just try to move on!

 

Anyway, back to the topic. I'm gonna tell my experience so if someone else who has questions about these tests comes here, there's now info about it. So here goes:

I had the tests done today. As I was really nervous about it and was still not sure what to do, I googled people's experiences during weekend and decided to not do speech recognition and volume threshold tests. That didn't help much though, since the audiologist was just pushing me to the booth and was in a hurry, just stating that "it is a regular hearing test, that's all there is to it". So this is the first thing one needs to prepare for - they might be in hurry and it can be hard to discuss things in peace.

However, I did refuse to enter the booth without first stating that volumes absolutely must be kept low and we came into some sort of compromise: the audiologist refused to start from "lowest volume until I hear it" for some reason, so we agreed that based on my former hearing chart she'd only use volumes a bit higher than my already measured hearing levels. Probably because of this the basic hearing test went fine, no problem at all.

Then she started to put white noise in my better (right) ear to measure my left ear. This is when things started to get uncomfortable... The white noise would get quite high, just about tolerable - so I completed this part of the test. But then headphones were taken off and she put this bone conduction device on my left ear and in-ear headphone in my right ear. She said that again she'd put white noise to my right ear. Yet this time the white noise through the in-ear device was just horrible and really loud.:/ Since the former white noise was at about 50-60 decibels, this felt more like 80-90 decibels, but cannot be sure. Very possibly the noise would have still gotten higher, since at this point I just pulled the in-ear piece out of my ear and stopped the test. We agreed it's prolly more harm to continue and I left.

I did get a bit of scare, since the white noise was so loud and am still wondering why I didn't stop as soon as this whole white noise ordeal started... Dunno what it is about those situations; one just feels like "I need to go through this, it's not a big deal" or something else stupid. I am happy I put a stop to it though and am now trying not to be in anywhere silent since I'd surely focus on measuring my T. I really hope this didn't screw up anything and am now taking extradoses of magnesium, nac, l-carnosine and vitamins just in case.

 

My audiologist uses 40 db white noise for the bone conduction test, but I have had some audiologists that insisted on using 70db-80db. There is no reason for having that loud unless your hearing thresholds are really high.

 

Really? Somehow this doesn't surprise me that much. For me the audiologist just said that the white noise test needs to be done in certain way or not at all, i.e. that the volume needs to be loud. And when I took the in-ear piece out and said it is crazy loud, the only solution was to cancel the whole thing then. This 40 dB your audiologist uses sounds very reasonable and wouldn't it make more sense to do it that way than not at all... Oh well!

 

That is a very good point, and one everyone should do their best to keep in mind, whether poster or responder.

 

We have to be aware of the vibrotactile response when doing bone conduction tests. Also, if one ear is suspected to have more damage than the other, then masking should be applied to the opposing ear to avoid crossover (when the opposing ear picks up the sound but appears to send the information to the other side).

It can be difficult for people to differentiate between the vibrotactile response and true hearing, so you need a good audiologist who knows what they are doing if you want good accuracy. The problem occurs when you start to blur the lines between feeling the vibration and actually hearing something. Everybody has a different vibrotactile threshold but it's usually much more acute in the lower frequencies. I believe the average is 25db at around 250hz for example. The higher the frequency the harder it usually is to detect the vibration.

Unless there's some hearing loss the bone conduction doesn't usually go above 35db.

 

In my personal experience Michael Leigh is a bully and has a very bizarre understanding of tinnitus. Both his own condition and others. It took a while for me to realize this as his posts are ironically "polite" and "positive", but generally if he can't sell you on TRT, and WNG, Ginkgo Biloba, etc. Or if you dare say those treatments do not work for your condition, he will say your condition worsens because you are "negative". And that some people are negative and "can not be helped" he will proceed to talk down to you and treat you passively aggressively on the forum. Funnily enough he has his own little crew here, which if you ever give him any backtalk, will all come to his aid and say how aggressive and rude you are. This is my experience. Weird stuff.

Note how he gets to avoid explaining himself by accusing anybody who questions him as being, rude, or negative, and that he does not reply to rude or negative people. Very convenient.

 

@SilverSpiral ,
Wow that's a lot to get off your chest !
Think Michael's ears will be burning.

We must remember everybody's opinions are equally important and yours and not put anyone down to other members.
Debates are good

Love glynis

 

Some Tinnitus Talk rules

I.
Be sensitive to, and respectful of, other members' feelings.
Treat others with respect, kindness and empathy.

II.
Do not judge, belittle, harass or insult your fellow members or their conditions thereof.
Such action will result in either a warning or ban, depending on the severity.
There is no place for hostile comments on Tinnitus Talk!

 

Like clockwork... I've never received any warnings or anything, so I don't know why bringing that kind of rule stuff up. If you want to talk about insulting other members, calling people who want to actively discuss the logic and efficacy of treatment plans "rude" and "negative" and suggesting that people who do not get better is because they are "negative" is the real insulting, but there is obviously some bizarre sort of social hierarchy stuff going on. Anyways, as far as what @NimQ is asking regarding audiology tests, I guess talking to an audiologist and establishing trust with them is the best thing to do. If you really are concerned about getting audiology tests, and do not medically need them immediately, I would never be comfortable suggesting you should do it. However in some cases you may not have a choice but to take audiology tests. I got SSNHL and I had to take audiology test at the place that could get me in that day flat, so that my doctor could make decision on treatment course. And yes, the audiologist was understanding of my condition, and did not make me do some of the tests, but his voice was actually the loudest part through the earphones, it was very uncomfortable. But if you get SSNHL or something rapidly changes in your condition you sometimes have to take the tests, but a competent audiologist should not expose you to excessively loud sound... but at the same time I have heard horror stories here, and have encountered some really really horrible audiology testing equipment setups, it seems that when you are primarily working with the elderly/hard of hearing, they don't exactly design these things with quietness in mind. Audiograms are incredibly limited and archaic anyways.

 

My tinnitus began in the evening of the day when I had an audiologist do tests on my ears. The audiologist had performed a bone-conduction test, but it was not loud at all...

I doubt the audiologist did anything to cause my tinnitus, but it is certainly a bizarre coincidence.

 

do you think the bone conductance test heightened your Tinnitus. I got onne done and it wasn't loud at all but the audiologist was incredibly rude to me even when I didn't want a tympanic test. Now I feel that my T has gotten much louder and I wonder if it can be due to the bone conductance.

 

I have no words.

I completely forgot that my own audiologist had conducted a bone conductance test... I thought that it was some other test...

I didn't get a spike - I got T that began on the evening of the day when I saw that audiologist. That test might have Given T to me. Our experiences seem to indicate that that test is likely very unsafe as far as T is concerned...

 

@Bill Bauer Do you have/Did you had tinnitus in one or in both ears?

 

During the first 9 months it was only in one ear (the one that was subjected to the acoustic trauma 10 days before my appointment with an audiologist and the onset of my T). Then T spread to both ears.

 

TESTS TO AVOID:

• ECOG
• Microsuction
• CVEMP/OVEMP
• Caloric Test
• Acoustic Reflex
• ABR