Can You Habituate to Reactive Tinnitus?

Hi @Ela Stefan,

Sorry for late reply, had an exam I needed to study for the last couple of days, and I like to take time to consider what I'm writing when it comes to answering serious questions.

So, I was referring specifically to long-haul flights, when I mentioned difficulty travelling.

But anyway, the main reason I can't cope with long flights via plane is because I suffer ETD (Eustachian Tube Dysfunction) in my left ear.

On a normal day my left ear has difficulty regulating pressure. I wake up everyday with air trapped inside my middle ear, which takes about an hour, a lot of talking and swallowing, to rectify. Plus singing can push it to rupturing point (which is f*cked, because I'm a bloody immense singer). Therefore, at 36000 feet for several hours, "difficulty" becomes an understatement, and barotrauma becomes a very real possibility.

The other reason is, like you said, it's just a risk I'm not willing to take. Even if I didn't have the ETD that prevents me from flying for long amounts of time, I still don't think I would do long-haul air travel. Why? because I've read too many horror stories involving barotrauma in people that didn't even have ETD.

Flying to far away foreign countries is a frivolous (unnecessary) activity, and I'm a man with a severe disability that's finally managing to cope; why would I f*ck that up? years of habituation, gambled, just to go on a "holiday" I probably wouldn't even enjoy anyway?

All of that said, I have travelled on a plane post-tinnitus. It was a 1 hour flight to Dublin and back from London, to go to a wedding, and I was fine. I wore ear-defenders for the entire trip; train to the airport > plane to Dublin > coach to the hotel, but it was very uncomfortable, and I hated the entire "holiday/wedding" anyway, and didn't sleep one night in the hotel. That was 3 days (I went) without sleep. I wasn't happy until I got home and got back into my own bed.

So I can do short-flights, I'm just not inclined to do them, unless it's with good reason (like for my studies, or to start a new job abroad, for example). One thing's for sure, I'm certainly never going to take the risk for something as trivial as a "holiday" or someone's damn wedding ever again.

 

Is the sound inside the airplane cabin so loud btw?

I haven't flown since tinnitus, but I don't remember it being that loud? It's maybe 80-85 dB, so wouldn't be that loud?

 

I guess it depends where you're seated relative to the engines on the plane. There's often less noise in the front. 80 dB and above is loud, and if one's sensitive enough, a flight can cause a temporary or permanent spike. I guess using double protection should prevent this in most cases, but I don't know if the air pressures can equalize correctly with that protection.

Just my thoughts.

Stacken

 

I believe my tinnitus is unable to spike unless my ears are exposed to levels of noise that would hurt normal ears. I work with power tools and use Elgin Ruckus Bluetooth earbuds along with Optime 105 muffs. I think low level music or talk is key with the earbuds,so you don't block all noise out and listen exclusively to your tinnitus. Some days my tinnitus is louder or more noticeable than others. I think it's important to not be scared and to not noise isolate yourself too much. That being said I know everyone's tinnitus is different.

 

There are several threads where this was discussed on here @Ela Stefan, so maybe take a look at them too.

I personally wouldn't dream of travelling on a flight without hearing protection. People have said it's similar to "white noise" (well I don't like white noise anyway), but it felt more like being in a loud wind tunnel to me.

This is my post-tinnitus assessment, as pre-tinnitus, I never would have noticed or made a mental note of the noise on a flight.

Also, regarding dB level. I put absolutely no weight in those measurements. I do not subscribe to believe that sound only above a certain level is harmful to the human ear (let alone the compromised ear of a tinnitus sufferer).

If a sound is uncomfortable to you, then it may in fact be doing damage. I wholeheartedly believe this. Not always, but, for example, a colleague I worked with developed tinnitus (years before me) by sitting right next to a computer stack that hummed and droned, every day for a year.

I wouldn't have lived as long as I have (I don't think) if I explored every sound that might give me a temporary/permanent spike. But if it's a sound that I don't like or brings me discomfort, then I try to avoid it, and if I can't do that, I protect from it; that's my rule of thumb.

TL;DR: I think plane noise is potentially damaging to most tinnitus sufferers without protection, and don't factor dB levels into my decisions regarding what requires avoidance/protection.

@Stacken77, I only wore ear defenders for the flight (so "single" not "double protection" as you say), but my ears seemed able to regulate pressure alright for that one hour. Although given my ETD, I was probably having to equalise them (via swallowing and chewing gum) far more than the average healthy eared person on there with me.

 

I would think earmuffs make a suction on a plane. So I have wondered if just over the ear headphones would do the trick.

Let’s say on 5 hour flights?

But they don’t take a lot of noise out.

Even pilots got some earmuff look alike equipment...

Would a strategy be earmuffs but lift them ever so slightly off the skin every half hour?

Just by chewing you get some noise leaking in I’ve noticed.

 

So if I want to go to, let’s say Hawaii like an 8 hour trip, what do I use?

 

Much respect to all of you.

I’m on day 14 of constant loud ringing in ears and suddenly “high frequency hearing loss “. I want to blame booster COVID-19 vaccine shot, but I’m not anti vax.

This is extremely challenging. I’m barely hanging on.

 

I wouldn't rely on noise cancellation, as the technology is nowhere near as reliable as people think.

Not to mention, noise cancelling headphones are not designed to create a soundproof seal that actually protects from harmful noise. Ear defenders like Peltor 3M, on the other hand, were made specifically for people working in noisy places where an hour or two without protection might massacre the inner ear.

I see tinnitus sufferers recommending NCHs for air travel all the time, and it puzzles me, because:

A) they're not designed to protect your hearing in any way.

B) there are anecdotal reports of them actually causing/worsening tinnitus for some people.

C) even if statements A and B were untrue (which they're not), they still only neutralise static sound. So if you end up sitting next to a baby crying, for example, you're screwed.

As for the pilots, they're wearing the same thing helicopter pilots wear, which is ear defenders with speakers inside them, connected to a radio so they can talk to the other pilot (or passengers). It's effectively just a top quality noise isolation headset, like these: Aerotion PS2 Passive Aviation Headset - Aerotion Aviation

Yes, and suction. So when I was flying, I would remove the ear defenders every 20 minutes to chew menthol gum for 2-3 minutes. Then I'd put them back on.

For 5 hours? Yes I think that would be sensible. Not because of suction (again, I didn't experience any suction), but just to let your ears breathe; prevent an ear infection maybe(?) To be honest though, if you're not concerned about ear infections (I'm prone to them), you could afford to just leave them on the full 5 hours I think.

Ear defenders are a must. And not light ear defenders either, we're talking Peltor Optime 2 (30dB attenuation) and above.

Honestly I don't know about the "double protection" thing. If you wanted to combine foam earplugs with ear defenders, you would definitely further block out cabin noise, but you might also end up having difficulty regulating the pressure inside your middle ear, as @Stacken77 hypothesised, which could lead to barotrauma. So I'm in the dark on this, but I do remember reading years ago, that pilots doing this, still experienced the pressure change, just more slowly than those that didn't wear plugs and defenders together. So based on that article, some pilots do do it... but who knows, an article doesn't track people after it's written, for all we know all their ear drums burst later down the line...

Anyway, not being able to complete an 8 hour journey on a plane is half the reason I had to give up on my preferred career in the first place; because based on my susceptibility to ear infections and my ETD, I'm quite confident I'd arrive at the other end properly f*cked up, or best case scenario, having a week long panic attack from the fear I had arrived f*cked up.

 

Damn, so should I just not go? I’ll probably end up being blah by that time anyways haha. I’m going downhill pretty quick trying to gain traction.

 

By discomfort, do you mean kinda like hyperacusis discomfort? Like "this sound is a bit too loud"? Just curious. I really agree we should avoid those.

 

Well I wouldn't... but then I have equalisation issues.

I'm assuming you don't(?)

Therefore, the only question in your case is, can you handle the noise of/wearing ear defenders for, an 8 hour flight?

If you're not in a good place with your tinnitus right now, then maybe it's a no on that fact alone(?)

Anyway, take a look through these threads, and maybe some others like them; might help you weigh up your decision (same to @Ela Stefan).

Flying & Tinnitus | Tinnitus Talk Support Forum

Long Haul Flight in 4 Days | Tinnitus Talk Support Forum

 

For the most part, yes, but I'll make an exception for some sounds; like my parent's voices sometimes causing me discomfort (via hyperacusis) and occasionally triggering TTTS (mostly first thing in the morning after I wake up).

But apart from something like that, that my instincts tell me isn't doing any real harm, I avoid all sound that my ears don't like.

To me, volume is as good a method for predicting risk to the inner ear, and negative outcomes where our hearing is concerned, as this image would be at helping you to identify a pedophile:



For example, as I've once mentioned, I have a neighbour who plays drill rap for a whole day sometimes. The thing is, I find the music distracting, as in, it might interfere with my studying or sleeping; but I don't find it unpleasant. The music has no bass, it's mostly just a weak monotonous rhythm with someone "spitting lyrics" very quickly over the top. It never spikes my tinnitus, even when he plays it quite loud.

The fan noise in some of my old laptops on the other hand; would probably barely register on a decibel meter, but I got so many spikes from them back in the day, along with episodes of fleeting tinnitus. I'm convinced, had I been sensible enough to find a solution to laptop fans earlier in my post-tinnitus life, I'd have slightly milder tinnitus now.

 

@Damocles, have you ever tried over the ear headphones some metres away from a river or a hard running faucet? I find they take off quite a chunk of that white noise.

I’m not talking about noise cancellation, just dumb headphones.

But a plane is probably louder than those rivers, and it’s for many hours.

But I have equalisation problems in my bad ear so I’m worried about flying with earmuffs/defenders...?

You suggested taking them off some minutes, wouldn’t that be loud? So much so that good headphones on all the time is better...?

@Steph1710, what did you do on the plane?

 

Did you go to ENT to confirm your hearing loss? They would put you on steroids.

 

I use my custom made musician's earplugs with my 25 dB reduction filters in. I wear them for the entire flight except for takeoff and landing. For that I use EarPlanes. That way it reduces noise but allows air to circulate when you're experiencing the changes in altitude. Once we're at cruising altitude I switch them out and put my musician's plugs in. Then I switch back on descent.

 

I see... What if I just wore muffs and chewed gum, would that work? Or do I need those EarPlanes?

 

I want to be when’re you are!

Mine fluctuates wildly throughout the day. It’s usually the most quiet in the morning. Sometimes I can get till 10 or 11 o’clock in the morning before I notice it and on rare occasions, even later in the day. But it’s almost always the worst at night and I can’t figure out why.

The only thing I can think is that since my ENT thinks it’s related to my jaw and my neck and my allergies, maybe it’s just something that I’m doing that day that aggravates it.

Last night my right ear woke me up and kept me up all night. It was awful. I’m a side sleeper and not even my sound pillow works anymore because my tinnitus is so high-pitched. Over the past year and a half it’s gone away for months at a time. Like literally gone away or so quiet I could barely hear it and didn’t think about it for weeks or months.

I hate the unpredictability.

The reactivity is a whole new thing that just started. I had to take my son to a hockey game. I measured the decibel levels at around 80 to 85. I had my musicians ear plugs in with my 25 dB filters. That would bring the noise level down to 60 dB. I was so uncomfortable and my tinnitus just kept revving up and reaching higher and higher peaks I had to leave the game.

I don’t experience any hyperacusis and I could be sitting in any scenario where it’s 50 or 60 dB and certainly not be bothered at all. Mind boggling since you never know what you are going to be dealing with from day to day hour to hour.

 

Sorry, I haven't.

Yes they're quite different. Rivers give off a pleasant masking sound, whereas a plane cabin is much more like a sitting in a room with a vacuum cleaner for x amount of hours.

Ear Defenders won't cause any problems with equalisation, but they won't remedy them either. The only noticeable effect they have is to slow the pressure changes in the middle ear, and of course dampen the cabin noise, both static and dynamic.

Yeah it was loud, but we're talking about 2 minutes exposure every 20 minutes to an hour (depending on how long your flight is)... that's not going to cause any problems long term (and it didn't in my case). I mean, sticking with your 5 hour figure, you could take them off for 30 seconds every half-an-hour, just to swallow without them on (if you choose to forfeit chewing the menthol gum until after the flight). That would be just 10 times over a 5 hour period; that's going to do absolutely no harm to your ears.

The cabin noise on a flight isn't like the drilling you experience at home; that's a volatile sound that feels to me (when I experience it) like it can do lasting damage in a short period of time. Air cabin noise on the other hand is monotonous and wearing, it's not something I would expect could cause any harm unless sat through for a moderate period of time (on a case by case basis of course). To simplify what I'm saying: I've sat next to air con units for 20 minutes without protection and been okay. Other times I've sat next to air con units for around 3 hours without protection and had a 2 day long spike. With drilling, I've been trapped in an apartment with a drill vibrating through it for 2 minutes and been spiked for a week. You see my point?

In any case, I'm not going to recommend you or anyone else use headphones as a substitute for actual hearing protection on a flight. If you're going to do that you may as well just fly without hearing protection altogether, which some tinnitus sufferers can do, but I believe those are the monotone, non-reactive sufferers, usually without noise-induced tinnitus; which we're not.

 

Thanks for the post @Damocles.

Think I will try earmuffs if I ever fly again... I’ll just take a pinky under the earmuffs sometimes to let some air in and fix any pressure issues.

I walked past a roaring waterfall the other day, very loud, but a rounder noise overall than planes.

If you check out rtings.com review pages, they test headphones and TVs. High frequency noise is reduced significantly with dumb headphones if they sit well enough on the skull. I think they work okay for noises that are not high impact pulses. Like road noise or planes. But I agree it’s nothing like earmuffs.

Noise cancellation is just another noise to cancel out noise so that won’t protect hearing at all.

 

Do you think there were special frequencies at the hockey game that made your reactivity worse? Also do you usually stay in environments with 50 or 60 dB maximum only?

 

That's what I think too. I haven't been to a wedding in a long long time... they're noisy as hell.

High speed train is much better than planes in noise terms, and there is not the issue of barotrauma.

Edit: to say that train is also more environmentally friendly.

 

Would train need earplugs, like buses do?

 

The need for earplugs is totally relative to how sensitive you are, nobody else can tell. But if you're uncertain, do use them. I don't think my hair cells necessarily have to move for things like transportation, we get enough sound enrichment elsewhere. If we experience spikes, then; yes, we should probably use earplugs.

 

For me, yes, although high speed trains are usually quieter than ordinary slower trains. Anyway, I wear earplugs...

As for buses, the noisiest bus I have been into was in Lithuania... Vilnius... those horrible buses.

 

I have yet to find a train I didn't need to wear hearing protection on.

Sorry for the depressing answer.

You may be different, like @Stacken77 said.

 

That’s a great question. I didn’t think so. There was nothing really I could detect as a high frequency noise in the arena. My tinnitus is high frequency. Can’t mask it. I hear it over everything but the shower. The sound that they make at the area when the home team scored was so loud that a woman sitting in front of me jumped out of her seat. I think part of it is their noise level is very loud for a small arena. Had it been the Garden in Boston where the Bruins play and probably wouldn’t have felt as loud.

As to your second question, I do not limit myself to environments where the decibel level is only 50 or 60. I do attend my son’s hockey games and it’s usually about 75-80 dB in the rink and I don’t wear my earplugs.

I also have craniofacial pain. I clench terribly and tense my jaw muscles during the day. So I end up with tremendous pain all over my face and headaches. The ENT says that’s definitely contributing to my tinnitus.

 

Dear @Damocles mate, we have discussed the reactive tinnitus phenomenon to quite an extent here, with the spikes and all that crap. I just got spontaneously curious; how bad was your hyperacusis, and how is it now?

I guess hyperacusis or "sound sensitivity" is the main culprit behind the reactive tinnitus/spiking feedback, and it would be interesting to know just how bad yours was at its worst? I presume you only dealt with loudness hyperacusis, was it only to high frequency sounds that caused discomfort? Could you listen to a tap running without protection for instance?

I think mine is pretty bad now; I can't listen to a running tap at all, at least not with both ears. The 's' and 't' sounds are very uncomfortable when speaking. Sounds with a quick rise and high in frequency are the worst for me.

Just curious.

Stacken

 

Very bad.

Mild.

I think so.

I find it hard to distinguish the different types, but sound didn't feel like a knife stabbing my ear, if that's what people mean by "pain hyperacusis".

Some sounds did of course hurt though, like clanking plates and sirens etc.

That's a good question, unfortunately I never really thought much about it.

I just kept a mental list of things to avoid at the time, such as:

• Doors opening/closing.
• Dropping anything with any weight on the floor (heavy: metal, wood etc.)
• Sound of Televisions/Radios (without protection on to muffle the audio).
• Plastic Bags, Cling-Film and Coats, rustling.
• Shower running.
• More than one persons voice (other than mine) in a conversation.
• Anyone who spoke loudly.

As you can imagine, that's not a complete list, it's just what I can remember: because mostly I've tried to forget.

A tap in an ordinary sink would have been okay.

A tap in a bath, no. The distance between the faucet and the surface of the bath/sink would have made all the difference. The further apart they were = the greater the noise of the running water hitting said surface = the less I could bare the sound.

Just for perspective, I would always have to wear ear defenders to run myself a bath back then.

I also couldn't bear the sound of my own voice in echoey rooms. Actually I still don't like echoey rooms to be honest, but that's probably due more to a residual phonophobia, than any hyperacusis.

I hate to hear how bad your sensitivity has become. Has sound enrichment at home not helped at all?

I think I may have mentioned before, but my first step in the reduction of my hyperacusis began with watching TV at low volumes, and just turning the sound down quickly for unexpected noises.

Also, having conversations with my parents (only one at a time, not together) without protection on, began to change things. Maybe something you could put into practice while you're home with them for Christmas?

I know you'll get better mate, just remember it took me something like 5 years.

 

Thank you so much mate! Your response means the world to me.

Reading stuff like that is always reassuring. That things can go in the right direction.

I think I've already described what happens, but it's usually something like this; I begin to gently reintroduce sound, and in some markers I can see the sensitivity easing up (so I definitely think I can improve!); a few days passes by and boom; everything culminates in a more "serious" spike which forces me to retreat to silence in order to have it resolve. So I get back to "more silence" for a few days, and the progress with the sensitivity is erased. Back to square one, over and over again.

I also think there's a big mental barrier too, since I'm so damn scared of suffering another serious spike and raising the baseline, that I just hate sound, and reintroducing it is far from enjoyable.

I will definitely try some different things when I'm home and away from work. My room back home don't have a fridge humming 24/7, so then I could really try to reduce the protection. And as you, say I'll probably try conversation, at least with my high fidelity plugs with lower filters.

My hope for freedom remains. The day I lose hope is the day I die.