Does Reactive Tinnitus Always Lead to Hyperacusis?

Hey guys!

I’m Shoon and I’ve been a long time lurker here at Tinnitus Talk. I’ve had tinnitus for 5 months and all of a sudden it became reactive. I don’t believe I suffered an acoustic trauma. I would hear a chirp after every word a person said to me, just extended to getting these chirps from something as simple as swiping my hand across a bedsheet.

Everyone I have talked to told me I have early signs of hyperacusis and that I need to protect myself at all costs, as well as getting some silence. I took two weeks off of work to sit in silence in a hotel because I live next to a train plus I have very noisy upstair neighbors.

Having come back to work for two weeks, I’m double protecting as I go into the office and have to drive, and using singular protection at home.

At this point, I’m unsure as to what kind of progress, the reactivity has gone down in terms of it reacting to slight sounds but I still hear it when people talk. I don’t have any loudness or pain hyperacusis, but tons of people say it will develop soon if I suffer an acoustic trauma, which we all know could happen at any given time or moment.

I’m afraid I’m giving myself a phobia of sounds now and that if I were to try and go back to normal, it would just shock my system and make everything worse. I hear conflicting opinions on this and was just looking for any insight, as I’ve literally been cooped up doing nothing for about a month now.

Thank you.

 

Hi @Shoon.

The first thing to do is to stop talking to people that know nothing about noise induced tinnitus and hyperacusis, as this will cause you more stress and the phobia that you speak of. Exposure to loud noise is one of the most common causes of tinnitus. If you were a regular user of headphones, earbuds or headsets, then any of these could have been responsible for you developing tinnitus, because people are often not aware they are listening to audio at too high a volume through them. My advice is not to use any type of headphones even at low volume.

I do not believe there is any such thing as reactive tinnitus. Tinnitus can and does react to sound which is often caused by noise trauma and a person may experience some oversensitivity to sound or hyperacusis. Like tinnitus, no two people will experience hyperacusis the same and it comes in different levels of severity. The advice you have been given to protect your ears at all times and immerse yourself in silence is wrong. If you continue doing this then you risk lowing the loudness threshold of your auditory system, which will make your ears more sensitive to sound. Keeping away from normal everyday sounds there is also the risk of developing phonophobia. Please click on the links below and read my posts.

All the best,
Michael

New to Tinnitus, What to Do? | Tinnitus Talk Support Forum
Hyperacusis, As I See It | Tinnitus Talk Support Forum

 

Hi @Shoon.

Sorry to hear about your recent onset of reactive tinnitus.

How long do these chirps usually last after exposure to sound? If they're present only during the exposure, but ends immediately or slightly thereafter, we're most likely dealing with what we call "sound distortions". Then there's "spikes" which can last anywhere from minutes to hours, days, weeks, months, and so on. We don't really know what causes these symptoms, but sound distortions seems related to nerve damage, while spikes may be related to loudness hyperacusis or a general sensitivity of the auditory system.

Sound distortions can improve, as mine did completely resolve after a few weeks on their own following my acoustic trauma. The spikes on the other hand are a different story.

Wish you well,
Stacken

 

Hey Stacken, thank you for your response.

So it is just a distortion from the noise itself with it subsiding immediately, I do not have tinnitus spikes or anything from those. Before I went into an acoustic lockdown, I spent some time at home without protection, I would play videos games with my friends at moderate volume and either I didn’t hear the reactivity or it was masked by the sound. Regardless of that, I didn’t feel a spike in my tinnitus or anything of that sort during that time. But then I started looking into more and was just blatantly told to protect my ears and get into silence. My reactivity did get better in silence but as soon as I came to work, I got the same thing, just a distortion or a “chirp” when people talked. My tinnitus has changed slightly but not in volume at all. At this point, I’ve totally forgot about my normal tinnitus and was only really focused on whether or not the reactivity has worsened. I can work and drive with double protection, but I don’t know if I’m just making it worse without realizing. As it really seems, there’s too many factors to approach this straightforward.

 

In my personal opinion, that could be a good thing. As I said, I've had experience with distortions following my acoustic trauma, albeit rather mildly, but I was able to ignore them rather quickly since they didn't get even worse from everyday sound. Luckily enough, they did resolve completely, but it took some time. Spikes, and a climbing baseline volume is what's kept me in real isolation.

I think protecting is a wise choice as your distortions could improve because of it. I'd just like to add that using single or double protection literally all hours of the day has made me very sensitive to sound. On the other hand, I think we should live a quiet life from now on and avoid loud venues completely and protect from e.g. traffic noise. It's a balance you'll have to find. I'd still say; rather over-protect than under-protect, but things can get a little off if we protect literally all hours of the day.

If I were you, I'd gracefully continue the activities while being careful and monitoring the distortions. If they get a little worse, I'd try to accommodate the circumstances. My distortions did not worsen, but improved, even though I protected very scarcely during that time. But there's a few members on the forum that has gotten worse, so we have to be careful. There's quite a few threads on the subject of "sound distortions", so you may look into it.

Wish you well,
Stacken

 

My take on reactive tinnitus is that it is a subset of hyperacusis. In other words, it's a grade of sound sensitivity.

As you put it yourself @Shoon, for you it gets better when in silence, but as soon as you expose yourself to sounds, it gets temporarily worse.

 

I second this, as far as I understand, if you hear sounds on top of external noise, it is hyperacusis coupled with recruitment. You get amplification of a small range of frequencies around your 'lost' frequency. Recruitment often accompanies this, meaning that instead of the lost frequency you hear the nearby hair cells activate, so you end up getting a slightly different sound.

I too get beeps and hums from running my hand across the bedsheet. It started happening after my MRI, which is very sad, because before that I had very few distortions.

Now if your tinnitus gets worse due to external noise, stays that way for a bit, and then subsides, this is what I would call 'reactive tinnitus'.

 

My tinnitus was like this... I tried to not use protection around everyday noises in the beginning and I was careful. I had a 10 minute walk to my school through traffic, and class activity with 3-4 children so there was moderate noise. They were quiet most of the time... quiet in general sort of saying. That was around 2 months and made my tinnitus worse I think. It was bit by bit so I couldn't realise from the beginning.

Now I go out with double protection when there is more traffic, more people talking. Still almost all the time my tinnitus goes to static high hiss when I come home. I' m out for 3-4 hours for work. I work one to one with a child, so no noise there, just traffic and when I go in the class for 5 minutes, I always use protection.

 

Loud sounds that, despite being loud, are common, like traffic, car horns, motorbikes etc can produce setbacks.

 

Do you have any hearing loss?

 

Hi Guys,

At the beginning I did not have any hyperacusis and my tinnitus was not reactive by any means. I developed hyperacusis I think when I went to a football game with around 200-300 people cheering up. It was really early days so I was completely unaware of the consequences that loud noise can cause. I only wanted to get some distraction of the horror I was experiencing since I noticed the high pitch ringing in the ears. This is when I found out that my hyperacusis got gradually worse to the point that my ears hurt and I am not able to stand everyday noises such as poring water or slight knocking or tapping. Conversations with people seem to hurt my ears as well.

For example, yesterday I went for a walk next to the traffic but I wore hearing protection the whole time. When I returned home, my tinnitus was several levels up as well as my hyperacusis kicked in again. It stayed that for hours.

I did notice though, that when working from home in a quiet environment, my tinnitus is better, although it is again spiking for no clear reason ... It appears that it is sometimes triggered by the slightest things and sometimes by nothing - it just goes up in volume.

It feels very strange because since the onset (around three weeks ago) I am experiencing worsening in both ears. A dog barked in my right one a week ago and I have a new electric tone ever since. Also - muffed hearing which I will check with an audiologist tomorrow.

Left ear - one morning it suddenly got louder for no appearing reason.

The initial high pitched hiss in both ears is now going to ringing through the day. I only hear the hiss when I wake up in the morning and it lasts for an hour. If it is silent around for another few hours - the hiss is still there more or less. Although If I open the window and listen to the traffic for example- the tone changes to ringing. Furthermore, there is one lingering siren sound which goes from one ear to the other, and sometimes both. There are times, which it is not audible. Recently though, it became more intense in sound.

What am I doing wrong? I already received some advice from members of the forum and I am following them:

- I leave my ears to rest and use ear protection when outside . I do not expose to loud noises and even watch TV on low volume. I do not go to bars, restaurants, discos etc.

I take the following supplements and medications:

- Magnesium, Zinc, Vitamin C. I had one course of B complex vitamins due to my disc herniation two months ago so I suppose I have sufficient amount in my blood, although I have seen it might help with tinnitus. Also took Turmeric for several days but stopped to see if the spikes were caused by it. I am considering taking NAC but I am not sure if I can safely take it with Grandaxin.

- Grandaxin and Atarax

- I try to sleep without masking now so I can get a little bit used to it. However, I wake up often and once I hear the sounds, it is almost impossible to fall asleep again so I just lie in bed as long as I can.

Any suggestions would be welcome guys. Thank you for reading!

Kind regards,
Freerunner

 

Update - right ear has a 10 dB dip on 250 Hz.

Furthermore, my left ear started having this same sound (like an electric circuit) and it is just awful to bear).

@Michael Leigh, I would really appreciate any thoughts and advice you could share.

It is worth mentioning that I had a caloric test which messed my ears so bad.

 

Hi @Freerunner.

Please can you give me more details of when you first heard tinnitus? Were you are regular user of headphones, earbuds or headsets? I ask this because the most common cause of tinnitus is exposure to loud noise and using headphones regularly, because a lot of people do not realize they are listening to audio through headphones at too high a volume.

The caloric test you had may have exacerbated the tinnitus that was already there. This is the reason I am asking if you have experienced tinnitus before this test and regularly used headphones etc.

Once I have this information, I maybe able to give you some advice.

Take care.
Michael

 

@Michael Leigh, thanks for replying back.

I was using my headphones for MS Teams meeting in work and watching movies when my girlfriend was asleep. I always listened to low/moderate volumes. I almost never listened to very loud music from my earbuds. So I would say I was not a heavy user.

I never went frequently to discos or bars. May be several times per month - to a restaurant or an open bar occasionally.

I always remember having some kind of hissing tinnitus but only when going to bed, but it was not by any means bothersome and it is nothing compared to what I am experiencing at the moment. What I had before I would not even call tinnitus - it did not spike, it did not change volumes or tones, it was just there through all my life. Most evenings I was not even noticing it. And when I did - I was not focusing on it for more than seconds. I even enjoyed sleeping with hearing buds because I liked silence too much and unfortunately I was taking it for granted...

This year I had issues with muffed years and issue was solved by ear wax removal.

I should not have allowed the caloric test, because I am 101% this is the reason for my condition. The test itself was administered more than 3 weeks ago.

 

Hi @Freerunner.

Thank you for the additional information as it helps.

At the moment you are experiencing noise induced tinnitus. Whether it was caused by headphones, the caloric test or both doesn't really matter, because you now need to stop it getting worse and this is not too difficult. I recommend that you do not use any type of headphones including earbuds, AirPods, headsets, noise cancelling and bone conduction headphones. Don't even use them at low volume.

You are in the early stages of noise induced tinnitus. This type of tinnitus usually improves over time and I'm confident that yours will. For this to happen, I strongly advise you to follow the advice above and don't be tempted to use any of the devices mentioned. I also advise that you stop using hearing buds when you sleep. The reason being they will cause an occlusion effect, by blocking outside sound from reaching your inner ear and auditory system. This will force your brain to focus more on the tinnitus which you don't want as it can become louder.

Therefore, I recommend you place a sound machine by your bedside at night and use this for sound enrichment. The idea is for your brain and auditory system to be treated with low level sound enrichment throughout the night until morning. More about this is explained in the link below titled: New to Tinnitus, What to Do? Please be patient and give yourself up to 8 weeks to get used to it. Oasis Sound Machines are one of the best. Model S-650 is popular. It can be connected to a pillow speaker for privacy.

Please click on the link below and read my post: Tinnitus, A Personal View. Go to my started threads and read: The Habituation Process, Hyperacusis, As I See It. If you are able to print the posts then I advise that you do. Take your time and read them and refer to them often. By doing this you will be more informed about tinnitus and hyperacusis. Take things slowly and use low level sound enrichment whenever possible during the day. Don't try to cover up the tinnitus.

Tinnitus can make people feel stressed and anxious in the early stages this usually improves with time. However, have a talk with your doctor if things are getting too much for you. I don't recommend you starting any form of tinnitus treatment at this time. If your doctor recommends an antidepressant for lowering stress that's fine or counselling, if you feel that you need it. Things will get easier.

All the best,
Michael

New to Tinnitus, What to Do? | Tinnitus Talk Support Forum
Tinnitus, A Personal View | Tinnitus Talk Support Forum