Can Overprotecting Permanently Worsen Hyperacusis?

Would you say you have an obsession with driving at safe speeds, or an obsession with not becoming a victim of muggers or rapists? Is that a bad thing? In this case, it might not promote ears not adjusting to everyday sounds, but it is likely to reduce the chance of you developing new tones and/or louder tinnitus.

 

@astaff14, here’s some more relevant information which may be of interest to you. Remember that there can be some overlap with hyperacusis and phonophobia but neither condition is helped by overprotecting.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216140/

A video depiction:

Phonophobia

Here’s the typical medical description of what phonophobia is and what it can do to a person. I believe there are many people on this site who are phonophobic.

OVERPROTECTION - HYPERACUSIS - PHONOPHOBIA:

Hypersensitivity to everyday sounds leads some patients to develop phonophobia - an overwhelming fear of sound or noise. Patients with hyperacusis and phonophobia often spend an inordinate amount of time monitoring sound levels in their immediate environment. Some of these people mistakenly believe that exposure to low-level sounds can cause additional damage to their hearing. A majority of patients with severe hyperacusis overprotect their ears by wearing earplugs or earmuffs (or both) much of the time. Overuse of earplugs or earmuffs (that is, daily use even when the patient is not exposed to hazardous sound levels) can lead to further hypersensitization of the patient's auditory system. A vicious cycle of overprotection- hyperacusis-phonophobia (OHP) develops. Some patients stop going to movies, restaurants, religious events and other functions because sound exposures in these environments are perceived as painful or potentially harmful. Patients have quit working because anxiety about possible sound exposure at work was overwhelming. In extreme cases, patients become recluses, rarely leaving their homes. The vicious OHP cycle can have devastating consequences for a patient's personal relationships, self-image, lifestyle and quality of life.

What is Phonophobia? People with Phonophobia fears loud sound. Phonophobia is an anxiety disorder, not a hearing disorder.

And another:

Phonophobia is a fear of loud sounds. Phonophobia is also called ligyrophobia. The name “Phonophobia” originates from the Greek words for sound and fear. Phonophobia is not a hearing disorder.

Sudden loud and unexpected sound can cause anxiety attacks in a person who suffers from Phonophobia. People with Phonophobia may be fearful of devices that can suddenly emit loud sounds, such as alarms.

For example, listening to music that starts with a minute of silence and then suddenly goes into loud music would be extremely startling for most people, assuming they had no prior knowledge of the content of it. Being startled is in itself a normal reaction, but the key difference is that people with Phonophobia actively fear such an occurrence.

Another example is watching someone blow up a balloon beyond its normal capacity. This is often an unsettling, even disturbing thing for a person with Phonophobia to observe, as he or she anticipates a loud sound when the balloon pops.

Symptoms of Phonophobia

Phonophobia shares a number of symptoms with other anxiety disorders. Symptoms of phonophobia may include one or more of the following:

• Desire to flee
• Intense fear of loud sounds
• Excessive Sweating
• Irregular heartbeat
• Nausea or dizziness
• Panic Attack
• Fainting
• Severe mood swing after hearing the loud sound
  
  
• This is from the NHS website:
• 
  
• 

 

Dear Bill, my English is not good enough to understand whether your response intends to be sarcastic or not but anyhow.. My multiple Ts started 2 years ago after my own wedding party (what a chance) and my ex-husband who was a doctor misled me that this was not due to acoustic trauma, thats why I couldnt have protected my ears in the first period so after a few months my Ts have become so intense and high pitched that due to the regret of this initial period I then started to wear earplugs everywhere even in conversations with people. And unfortunately I have ended up with every sound disturbing my Ts to increase even with plugs, I had to quit my job and I cant leave the house most of the time (and I also live alone). Now I believe that making overprotecting an obsession leads to be more sensitive to even daily normal sounds that your life becomes very limited and insupportable.

 

With all due respect, Bill, I’m not sure how this helps Chuto? I don’t think you understand what phonophobia is or why, for example, you’d compare it to having an obsession about being raped?

Sometimes I read your posts and wonder what on Earth you are on about.

 

This is like an exact template for the many people I’ve spoken to over the years about this. There’s an initial acoustic trauma that leads to tinnitus but then there’s a gradual descent into chronic overprotection that makes everything much worse. It becomes a crippling vicious cycle that is incredibly difficult to escape from. The logic is understandable, however, as the initial trauma was caused by dangerous levels of noise.

I understand what you’re going through, Chuto, and you have my full sympathy. It’s hard work navigating each day whilst in constant fear of your environment. I don’t think many understand the full extent of how heavy this can weigh down on a person. It can be horrendous.

 

It was sarcastic.

What a tragedy... I am very sorry that you had to experience something like that.

It sounds like if you were to stay away from loud sounds during that period of vulnerability, your tinnitus might have ended up being quieter. Of course I am not talking about protecting yourself from the sound of a normal conversation. I am talking about protecting against and staying away from the moderately loud sounds (e.g., the sound of a vacuum cleaner or a hair dryer), and the sounds that spike your tinnitus.

 

It helps Chuto and others by making them feel better about fearing the things that can harm them, and protecting against the noises that can harm them.

Women take steps to not be raped (e.g., don't walk alone in bad parts of town after dark). Some might call it an unhealthy obsession, others call it common sense. This is very applicable to someone taking steps to not make their tinnitus louder.

 

I understood what you were trying to say but for people with phonophobia, the whole point is to eliminate the fear, not enhance it. This point seems to be lost with you.

There are people who are incapacitated by their fear of sound meaning that they are obsessed to the point of complete irrationality. It affects every moment of their life and you are basically telling them to continue doing it. It’s an anxiety disorder and has links with OCD and OCPD.

It has nothing to do with protecting one’s ears in a dangerous environment. There are people double protecting around the clock incase somebody laughs, or drops a spoon or something. They need help. They should not be reenforcing this behaviour by reading certain posts on this forum.

 

When we talk about taking precautions to not become a victim of crime or not get one's house burned down, some people will go all out and will end up doing unreasonable things (e.g., refuse to have electricity in their home to prevent electrical fires). The existence of those people doesn't mean that there shouldn't be public awareness campaigns.

 

But can't someone with damaged nerves grown new nerve endings over time? It is believed my hearing loss and onset of H and T are due to damaged nerves from dental work and not from noise exposure.

 

Not as far as I’m aware. Sensorineural hearing loss is permanent although there are various companies out there right now trying to reverse this process.

 

Did you ever read @Jason C's story of his severe tinnitus for 2 years after an alarm exposure? I think it's pretty clear that ears can heal after trauma.

 

There is maybe a small window of opportunity to help the cells recover from oxidative stress and ultimately death by using steroids and a hyperbaric chamber, or maybe powerful antioxidants, but even this is disputed in the literature. Once the hair cells or synapses die from loud noise exposure, it’s permanent. Damage can also occur to the auditory nerve itself. There is currently no known way of bringing back one's hearing, although, there are trials currently ongoing to try and achieve this, as we all know. People have been scammed on this site with the promise that their hearing could be restored at the cost of $18,000, and of course, it didn’t work.

Tinnitus is primarily a brain problem, and the posts you quoted of mine were specifically aimed at people who were over-protecting and had become phonophobic (which is a problem on this forum that isn’t addressed with serious consideration). This is not to be mixed up with protecting one’s hearing whilst in dangerously loud environments. I’ve been in contact with people who were stuck protecting their ears every minute of the day and had become extremely phonophobic to the point that they were paralysed with fear. In the end, they needed professional help to get their lives back in order. It’s not going to help your tinnitus if you protect your ears 24/7, but it could make it worse. There will be, however, cases where people will experience natural fading, but this has nothing to do with healing. These are neuroplastic changes that are not fully understood, and one could equally associate these improvements to wearing shoes every day.

There was a study done in Manchester that showed the overuse of earplugs can actually induce tinnitus and lower the auditory threshold by 6 dB over a matter of days. I found it interesting how some of the study participants described the way in which the tinnitus sounds emerged. There was quite a variation from train whistle sounds to pure tones, and hissing, clicking, creaking, etc. Here’s an excerpt from the study and a link to it:

Abstract

The occurrence of tinnitus is associated with hearing loss and neuroplastic changes in the brain, but disentangling correlation and causation have remained difficult in both human and animal studies. Here we use earplugs to cause a period of monaural deprivation to induce a temporary, fully reversible tinnitus sensation, to test whether differences in subcortical changes in neural response gain, as reflected through changes in acoustic reflex thresholds (ARTs), could explain the occurrence of tinnitus.

Forty-four subjects with normal hearing wore an earplug in one ear for either 4 (n = 27) or 7 days (n = 17). Thirty subjects reported tinnitus at the end of the deprivation period. ARTs were measured before the earplug period and immediately after taking the earplug out. At the end of the earplug period, ARTs in the plugged ear were decreased by 5.9 ± 1.1 dB in the tinnitus-positive group, and by 6.3 ± 1.1 dB in the tinnitus-negative group. In the control ear, ARTs were increased by 1.3 ± 0.8 dB in the tinnitus-positive group, and by 1.6 ± 2.0 dB in the tinnitus-negative group. There were no significant differences between the groups with 4 and 7  days of auditory deprivation.

Our results suggest that either the subcortical neurophysiological changes underlying the ART reductions might not be related to the occurrence of tinnitus, or that they might be a necessary component of the generation of tinnitus, but with additional changes at a higher level of auditory processing required to give rise to tinnitus. This article is part of a Special Issue entitled: Hearing Loss, Tinnitus, Hyperacusis, Central Gain.

https://www.sciencedirect.com/science/article/pii/S030645221930168X?via=ihub

I took this from my post on Bryan Pollard's Tinnitus Talk Podcast because I believe it gets straight to the point:

Earplug Use

The proper use of hearing protection is not well defined for someone with hyperacusis. If you do not use hearing protection, you run the risk of setbacks or social isolation. If you use hearing protection too often, you run the risk of lowering tolerances further or hindering recovery. Anxiety that often accompanies protection behavior may enhance hyperacusis symptoms as it heightens loudness and pain sensations to a degree. Earplug use is a complex, individual decision that needs to be made with careful consideration of the risks of overprotection. In general, it is more natural for someone with hyperacusis to wear earplugs more often than is necessary which is why emphasis is usually placed on reducing protection.

Overprotection

The overuse of hearing protection is almost universally discouraged based on evidence that it will lower loudness thresholds over time. Risks of overprotection include increased auditory gain, anxiety-induced hypersensitivity, and reinforcement of negative associations with sound. Positive results from studies of Sound Therapy & Counseling reinforce the notion that overprotection can prevent people from building sound tolerance. These treatments emphasize a gradual increase in sound exposure rather than sound isolation. It is often recommended that those with hyperacusis walk the fine line between setbacks and overprotection rather than follow a course of isolation and hypervigilance. Practically applying this guideline is not always straightforward.

Underprotection

Increased sound exposure can lead to setbacks. A setback is a sudden drop in sound tolerance as opposed to the gradual reduction in sound tolerance that occurs during overprotection. Setbacks are expected during recovery however they are an under-researched aspect of hyperacusis. Setbacks lasting several days are common. Setbacks lasting weeks, months, or years occur less often but can be deeply discouraging. Anecdotally, it seems setback duration and setback severity reduce to a degree in time. Setback duration and severity also seem to be correlated with hyperacusis severity. While there are over 2200 posts on hyperacusis setbacks in the patient forum on chat-hyperacusis.net, no academic papers could be found using a pubmed search. Some clinicians will inform the patient that sound levels below 85 dB (equivalent to noise from heavy traffic) are safe as they are unlikely to cause long-term hearing loss. While this is comforting and good to know, the relevance to setbacks is unclear as long-term hearing loss (often outer hair cell loss) is not suspected to be related to hyperacusis setbacks. Sound levels that trigger setbacks may be dependent on baseline LDLs and the particular subtype of hyperacusis (pain or loudness). There is a glaring need for research into setbacks to assess the consequences of underprotection. Setback thresholds, duration, severity, and frequency should be studied in relation to long-term recovery. Only then should maximum “safe” sound levels be defined.

Asymmetrical Protection

There are cases of hyperacusis that affect one ear more than the other. This quickly leads to the question, “What happens if I only protect my bad ear?” There is limited research on this topic. Studies suggest that auditory gain in the protected ear will increase. If the asymmetrical symptoms are related to a contraction of the acoustic reflex, sound into the unprotected ear can trigger the reflex in the protected ear as well, which would limit the effectiveness of protection. There are similar concerns about asymmetrical protection as there are for general overprotection.

https://hyperacusisfocus.org/research/earplug-use-2/

 

Anything in excess isn't good and this also applies to overprotecting the ears. I have written about this in many posts that are available on my started threads. It can lower the loudness threshold of the auditory system making the ears more sensitive to sound, therefore increasing tinnitus and hyperacusis. In addition to this it can seriously affect a person's mental and emotional wellbeing by instilling negative thinking and can cause problems like phonophobia and misophonia.

Michael

 

Her question wasn't about hearing loss, it was about tinnitus. People get over T all the time (ok, perhaps in most of those cases they can still hear it in quiet rooms if they listen for it, but that's pretty much equivalent to being cured).

Under-protection is the problem.

Here is a post that is addressed directly to YOU. I had taken the liberty to highlight two sentences.

There are countless posts like the one above where people lament listening to people like Ed. Here is one more just to give you a taste:

Unfortunately, there are many more posts like that for me to share. If you are considering taking Ed's posts seriously, even if it's just for a second, please let me know and I will post many of those people's experiences here, for us to learn from.

Ed is funny - he has been stubbornly abusing his ears (he refers to it as not over-protecting LOL) and predictably he has never gotten better. You do you, Ed!

 

Very true @Tara Lyons the ears can improve over time after a noise trauma and Jason is a good example of this. I and others in this forum worked closely with him when he was going through a very difficult time. He contacted me by private messenger and was pleased to hear of his improvement. I asked permission to include his messages in a post, as I thought they might be an inspiration to members. He agreed although his name was changed to Marcus. The link is below.

Michael

https://www.tinnitustalk.com/threads/from-darkness-into-light.22234/

 

The papers like the one above are the reason for poll results like this one:

https://www.tinnitustalk.com/thread...orum-more-useful-than-your-ents-advice.28006/

https://www.buzzfeed.com/joycecohen/noise-kills-when-everyday-sound-becomes-torture
Some quotes:

Regarding a person who had committed suicide as a result of tinnitus and hyperacusis:

It is true that you want a gradual increase. This should be increased over a period of years, and not over a period of months when one is still not ready.

The study found that the Healthy people who get an earplug in ONE ear, can start hearing tinnitus. Am I right? It is not the same as a study that looked at people who recently got tinnitus and let some of them "overprotect" and report the outcome.

In light of this study, one might think twice about wearing an earplug in one ear. Protect both ears.

I love it how your own quote contradicts all of your points. The part above says that people get setbacks all of the time, and that there hasn't been any research into it. Meaning that all of the nonsense advice regarding "overprotection" isn't based on any scientific studies.

In the absence of studies, one is to use one's own common sense (noise is what gave you tinnitus, your ears have now been compromised, so can handle even less noise than back when you were healthy), listen to the signals from one's own body (if it feels uncomfortable or if it gives you a spike, avoid it in the future), and also learn from other people's mistakes.

Yes some people report wearing earplugs 24-7 and then it getting debilitating. Just because some people feel compelled to wash their hands every 2 minutes, doesn't mean you should stay away from soap and water.

 

Dental work is is loud. Why don't you consider this noise?

 

I think the problem is that we tend to think of hearing protection as a binary thing (all or nothing) when in fact it's a spectrum. The truth, in my very limited experience, falls in between.

It has helped me a lot to use reasonable protection. I put earplugs in when I'm about to encounter obviously harmful noise (kids screaming, loud music, etc) but otherwise leave them out. I also preventively put them in whenever my ears are in pain or feel overworked.

 

This doesn't address the single most powerful positive disincentive to going without earplugs - spikes. There is literally an adverse physiological response taking place in response to sound, which neither you nor anyone else can explain. People I know who wear earplugs don't do it because of misophonia generally; they wear earplugs because showering without them leads to a huge increase in their ringing, as do other normal activities.

Until someone can explain exactly why this happens, and in doing so allow us to cultivate a strategy for management, everything you recommend around avoiding overprotection is just theoretical and ignores fundamental facts of the tinnitus phenomena and patient experience.

 

I think you're misunderstanding what I'm saying. I was quoted back into this thread with this comment: “I think it's pretty clear that ears can heal after trauma.”

Ears cannot heal. If they could there wouldn’t be companies spending millions on hearing regeneration therapy. Tinnitus is a problem that spans many areas of the brain and is incredibly complex.

There is a significant difference between using earplugs to protect one’s hearing from borderline dangerous sounds/dangerous sounds, and sitting in one’s house with earplugs and/or earmuffs (the double combo) when it’s quiet and/or near silent. And this is 24/7 for some. I’ve had personal experience with people who have suffered from this so badly that they contemplated killing themselves over it. They could not function without earplugs at all because they were severely phonophobic. It is no joke, but it is never taken seriously when in an open discussion on here. In fact, last time this subject came up, various members starting cracking jokes. It was sick and repulsed me knowing what some were going through with it. I haven’t been here for a while, so I may be wrong, but I haven’t seen any of the members in question post anything in a long time. I think this may be based on what outside advice is telling them.

I understand what you’re trying to say, though. I’ve had tinnitus for the majority of my life, and I sincerely understand how profoundly it can change one’s outlook, and how spikes can be random and utterly depressing. I gave up my passion because of it which destroyed part of my soul, and in some respects, that part of me will never recover. I’ve been to hell and back over and over again. The torment that tinnitus brings about is unreal and I truly believe that non-sufferers have no idea just how bad it can get. None at all. This is why I’ve tried to donate as much money as I possibly can to tinnitus research. I’d rather this condition be wiped off the face of the earth once and for all.

Spikes can happen for no reason at all or they can be triggered by sounds or stress. I that find sleep is probably the single most significant influencer in how loud my tinnitus may be. For example, if I have a nap, my tinnitus will always be insanely loud upon awakening. All I can say is that overprotecting, as in constantly blocking off your ear canals in all environments, regardless of sound, is never a good idea. The caveat here, of course, is that noxacusis is a different beast entirely and there is much more of a grey area involved.

Listen to the Will Sedley Tinnitus Talk Podcast. I think he goes over most of these points quite well regarding how the brain generates tinnitus, and what we know about it.

You can also disregard everything I’ve said and that’s also fine. We all live unique lives, and we ultimately have to find our own way and do what’s best for us. I think it’s healthy to debate these things.

 

Okay, leaving spikes aside, I suppose it depends on what you mean by heal. There are people here whose tinnitus has gone away; there are also people here for whom their hearing distortion has gone away, and people who have had marked improvement in their audiogram over extended periods of time, after initial insult/injury. Perhaps it would be appropriate to say, the experience of hearing is dynamic, and can improve after a deficit has been developed. I'm not sure how we define heal, but for every bothersome symptom we can find a case of that symptom abating. It may not be the majority of cases, but certainly, these recoveries do exist. Given that fact, what is it you wish to convey regarding healing, when you say ears do not heal?

 

I would consider healing in this context to be neuroplasticity. The brain can filter information or rewire itself to solve problems. I initially had worse distortion to sound than I do now, so in that respect my hearing is a lot better. I had what I’d consider to be reactive tinnitus to begin with and I also had many brain zaps, like an electrical storm in my head. This has also largely dissipated.

It’s interesting you noted improvements in audiograms, because mine also improved, but I mainly contribute that towards the archaic technology; there is quite a margin of error. There is also the possibility of bent hair cells recovering somewhat. This is the same as what happens when one experiences a temporary threshold shift after going to a concert, for example.

In cases where tinnitus has fully resolved, I consider this to be the brains plasticity at play, but it could be any multitude of things. It really depends upon what caused it in the first place and many people fail to go down the diagnostic route. Not through want of trying, though. It’s usually because it’s incredibly difficult to get a Dr to do tests in order to rule out various things.

Improvements happen a lot, so don’t get too discouraged. Your tinnitus is still new, so there’s every chance it could fade or disappear. You just never know with this condition as it’s so random.

 

I can testify to this. I had a very clogged ear for more than a month due to an external ear canal fungus. They treated it but my ear was still clogged, they didn't address that. So after a month of this I developed very bad tinnitus. It's still there after 2 years, sometimes more severe.

How can I reverse this? Sound therapy? My ear is sensitive to electronic devices, even when playing nature sounds.

 

I suffered from borderline moderate hyperacusis following my acoustic trauma. As I gradually, yet relatively quickly, exposed myself to mild sounds (avoiding moderate ones) it improved significantly over the first 2-3 months to where it became mild, almost nonexistent.

Then my tinnitus migrated to my good ear (I suppose it was a natural progression), and I became very anxious, so I began to severely over-protect (muffs and plugs for like 2 weeks in a 20 dB room). This severe over-protection definitely worsened my hyperacusis, so now even voices are uncomfortable to listen to.

I do certainly believe that protection is good, and I see no harm in protecting against moderate noises (like blenders, vacuums or car rides), but to protect constantly like I did, I found very unhealthy. Keeping in mind though that everyone's tinnitus and hyperacusis is different, this was just my experience.

 

I experienced hyperacusis when I was tapered off too rapidly from benzodiazepines and had tapered antidepressants before it. It resolved when I reinstated the benzodiazepines and then tapered slower. It took a lot of time though. The hyperacusis did not bother my life at all. The only thing that bothered me was sounds during the night and I woke up more easily and I wore earplugs when sleeping for years. I could go normally to places without ever thinking something is too loud. I never used earplugs during the day.

Then I was stupid and got myself an acoustic trauma from a gig because I forgot my earplugs and now I have horrible hyperacusis. I am also still tapering benzos. I had no issues going to gigs before with earplugs.

I have thought did using earplugs for many years while sleeping or the benzo taper make me somehow more sensitive to sound than the average person. And maybe the average person have would not have got these symptoms I got from the gig. I know I am more sensitive than average.

 

Yeah, this is how many of us got the severe type. We had mild hyperacusis and we pushed it too far.

Now it is severe and here to stay...

 

Quit the earplugs and carry a set of Peltor muffs with you when going places you think will be loud-ish. I mean we're in the era of everyone wearing surgical masks everywhere, so what's a set of muffs that look like headphones? Go for it.

 

I got moderate-severe hyperacusis after my MRI, with double (but pretty bad) protection: foam earplugs and foam pads on the ears.

 

Ohhh I had an MRI on my knee last year (another unfortunate accident!), and went in prepared with some Mack's earplugs, and that bugger was still loud af, but I came out of it okay. Might depend on where you head is located relative to the machine. My head was way outside of it while my leg was further inside.