How Can Category 4 Tinnitus and Hyperacusis Patients Improve?

If someone is a “Category 4” and experiences a worsening of their tinnitus and hyperacusis as a result of exposure to normal, everyday sounds, how can they expect to improve?

It seems that you would reach a new and aggravated level of hyperacusis and tinnitus with each exposure and never get on track for going in the right direction. I am using above the ear sound generators but the exposure to normal sound without any protection seems to be more of a factor in the worsening of the tinnitus with each day, week, and month.

The hyperacusis started in September of 2020 and the tinnitus followed several months later. I have not noticed any improvement. I have worn the sound generators for approximately four (4) months.

Also, if you have hyperacusis, wouldn’t even the quiet noise emitted by the sound generators potentially cause regular spikes given that the sound is so close to your auditory system?

I have made an effort to go about my life and not overprotect. My ears are now feeling somewhat sore which is a new sensation (although hearing any noise does not necessarily cause me immediate pain). I am getting frustrated by the fact that I seem to be getting worse rather than better, but I have read a lot of success stories by people who took years to improve and they seemed to have fairly severe cases.

 

Not exactly. My theory is that hyperacusis may improve if damage hair cells die. This produces hearing loss and tinnitus but reduces the reactivity of hyperacusis to medium sounds. Very loud sounds (even common sounds for traffic) are still hard to deal with, but not totally unbearable as they were at the beginning.

Does hearing, let's say, a car horn, or a siren, or a power tool far away, cause an immediate reaction involving pain or extreme pressure inside the ears?

Do you feel anxious when you do normal activities like going to the supermarket without hearing protection, or going for a walk around traffic?

 

I do not feel pressure or pain from a car horn, a siren, or a power tool if they are “far away.” I might feel some pressure and an uncomfortable startle reaction if they were close by but not necessarily pain.

I can go to the grocery store without protection but yes, it does make me feel anxious. I am becoming increasingly concerned about the worsening of my symptoms as I experience normal, everyday sounds without protection. It was my understanding that the brain would adjust if you went about your day without overprotecting your hearing and the hyperacusis would improve with time. This has not been the case for me over the past fourteen (14) months.

 

I'd recommend to up the protection a little bit if it has been getting worse. The medical establishment wants us to believe that protection to moderate sounds are to over-protect, but that isn't true.

I got loudness hyperacusis right after my acoustic trauma. I began protecting when driving, in public places and from moderate sound. My tolerance didn't drop, but instead get better, to the point where it was almost completely resolved. But then I started use protection literally 24 hours a day in February, and I think that has screwed me over completely. So I think, unless you protect literally 24 hours of the day, there's no need to worry about "over protection". If any sound feels too loud or is uncomfortable to you; plug up. We don't gain tolerance to sound by being exposed to uncomfortable sound, we instead risk having the tolerance dropped further.

Wish you well,
Stacken

 

Thank you for the response. Have you ever used sound therapy in the form of sound generators?

 

My personal experience is that bad hyperacusis does not improve. It changes and morphs into other hearing problems, like hearing loss, tinnitus etc.

If you have been trying to live normally for 14 months and there is no habituation, I would try to change my lifestyle. Actually, I have been exactly where you are, but with severe pain hyperacusis, pain that lingered for weeks after one single brief sound exposure (for instance, a car horn around, close, and wearing earplugs and earmuffs). I had to adjust my life to this, everything.

If you have not done tests yet, try getting a CAT scan. It's silent. Also a proper extended audiogram (over 8 kHz) and speech in noise test. Eardrum test too. Do not go for an MRI unless there is reasonable suspicion of something being wrong; an MRI is a very loud test. It could kill your ears.

The brain cannot adjust because daily sounds that are common place are too loud, and our ears are not designed to cope with them. Normal ears suffer and over time people lose hearing if they are exposed to noise often. Damaged ears just cannot be around noise. Noises produced by traffic, machines, also cheap speakers, cellphones etc are the worst, all the artificial noises, sounds that do not belong to nature.

All those therapies, like sound therapies, or TRT etc will not work, because you will find noises in real world situations that exceed the decibel levels that are considered safe, and these noises happen all the time, every day, in a typical city... loud motorbikes, sirens, roadworks etc.

No therapy will be able to get you used to these very loud sounds because your "new damaged ears" cannot tolerate them, just cannot be exposed to them without getting further damaged.

 

I have had three (3) hearing tests/ audiograms over the past twelve (12) months. They were identical and showed minor hearing loss (worse on the left) consistent with age. My word recognition scores were 100%. I believe that my eardrums were tested at that time and showed no abnormalities. I have not had a CAT scan.

Has your hyperacusis resolved but you now experience increased hearing loss and tinnitus? Have you habituated to that tinnitus?

 

I have collected a lot of success stories from people who have experienced significant improvement from what appeared to be fairly severe hyperacusis and tinnitus. It appears that they did not formally treat it with TRT, CBT, etc. but that the passage of time (some up to four (4) years) resulted in significant improvement. I do not state this to argue with your post, but it came to mind when reading it.

 

Correct me if I’m wrong, but you didn’t even have tinnitus when your hyperacusis was at its most severe?

 

... and by normal, everyday sounds, I am referencing turning the lock on a door, hardwood floors squeaking as you walk across them, talking on the phone, the crinkling of a paper bag, running water in the sink, etc. I am not referencing truly loud sounds such as a siren, a dog barking near you, or a leaf blower close by. The exposure to normal, everyday sounds without protection, in the aggregate, seems to have made my hyperacusis and tinnitus worse. As suggested by another person, I might start protecting a little more without going overboard. The problem is that a truly loud sound might occur without prior warning. This happened recently when a dog barked at me from a somewhat close distance when I was not aware of the dog’s presence.

 

I’m proof of worsening without protecting.

 

I think that depends on which type; only in terms of volume(loudness) or with ear pain. Simply "hyperacusis" can be misleading. I've read countless stories of loudness hyperacusis being severe and resolving almost completely, some with sound enrichment, others without. There seems to be fewer stories of pain hyperacusis improving or resolving, and it's pretty clear that sound enrichment do not work for that type.

 

Mindfulness activities; anything that induces a flow state in the brain. Drawing, reading, journaling/writing, quiet music (if you can handle it), pink noise therapy, exercise (not running), and medications like Zyprexa can help. Dissociatives and psychedelics are potentially worth looking into as well.

 

Yep, me too. My tolerance dropped after a 2 hour conversation in March. It seems to be a balance. But I think we can protect to quite an extent without getting any bad effects. It's when we protect literally all hours of the day when I personally believe things can get a little weird.

 

Hello @Athens, I am also using in ear sound generators and I am slowly building on the time using them.

Every day I increase by a couple of minutes to gently get my ears use to them.

I have had tinnitus for 26 years but habituated.

My tinnitus magnified followed by hypercusis six months ago.

I have found the custom ACS earplugs have helped immensely as they don't occlude all sound.

Also I have the radio on throughout the day.

 

This is very important, because in case there is a normal audiogram and poor speech recognition, there could be a peripheral auditory neuropathy.

I have less bad hyperacusis, but it is not gone. For instance, if someone clapped hands around me, hyperacusis would flare and pain linger for a while, very loud sounds still kill my ears and trigger tinnitus and are producing progressive hearing loss and poorer speech recognition. This is why I said hearing problems change but in my case they do not disappear.

I had severe pain hyperacusis at the beginning.

 

This depends on what you call "improvement".

This is like a broad timeline for my particular case:

- Severe hyperacusis: would be able to hear someone talking normally, with my back turned to them, wearing earplugs and earmuffs. Needed hearing protection at all times to go anywhere. Very loud sounds would set me back despite double protection and I would need to spend a lot of time at home afterwards for my ears to be stable again, for pressure and pain to subside.

- My hearing starts getting slightly worse. Progressively. Songs do not sound the same, a bit of distortion, etc

- And now I have to focus on what people are saying, I actively have to pay attention or I miss bits from sentences, and with background noise it is even worse... so functionally my speech recognition does not seem great, although I did not go to take the speech in recognition test in the last year. Hearing TV is not very easy... I use subtitles etc. On the bright side, I go out more (still have problems around traffic though) and can do more things. I can go to the grocery store, with ears plugged and later on will not have a setback due to blaring speakers everywhere (this is Spain, it's very loud).

Maybe it does not sound that encouraging, but for me it does make a difference to go out cycling (very quiet area), go to the supermarket, go for a walk (park or beach). A few years ago one single loud sound during this activities would have produced weeks of pain.

The downside is my hearing got a lot worse and that's something that really pisses me off... it takes so much effort just to understand what people are saying, understand in noise etc... tinnitus does not bother me too much, I just ignore it... tinnitus is a piece of cake compared to severe pain hyperacusis, which means one single sound can produce easily 3 weeks of pain.

 

No, I did not have tinnitus at the beginning. It happened a few years later.

 

Yeah, it's the passage of time that helps.

 

Those sounds cannot harm you. Door locks are tricky because some of them are loud. Slamming doors are very bad due to vibration on top of a loud sound. Bags are very annoying but not dangerous. Those sounds make hyperacusic ears react, but you can be around them without hearing protection.

You need to have your ears plugged before any of this happens, and that's the problem. As you said, all this can happen without a prior warning, and many times it happens too because we do not have visual contact with the sound source (i.e. neighbour doing gardening behind their fence).

 

I was referring to pain hyperacusis, which means pain lingers for a long time after sounds stop.

 

Thank you for the post. Can you please give an idea of when you reached these various points (six months, one year, two years, etc.)?

I must have annoyance or loudness hyperacusis. I do not feel pain when experiencing various modest sounds (turning a lock, running water, opening a plastic or paper bag, squeaking floors, etc.). It is really more of an annoying, startle, uncomfortable type of response. I have started to feel like my ears are a little sore, but this is a new feeling and it goes away. I have felt some pain in one ear a few times at night for a few minutes but it goes away quickly.

 

Thank you. Did something cause the worsening tinnitus or hyperacusis?

My hyperacusis started one morning after several months of sleep deprivation and stress. I played live music for decades without protection but had not played a show for several years. I believe that the stress and sleep deprivation brought the hyperacusis to the surface. The tinnitus started several months later.

 

Not many cases like yours happen often, do they? When someone has hyperacusis, it usually is accompanied with tinnitus... I think I read somewhere how 85% of people with hyperacusis will have tinnitus alongside it...

 

I spent around 3.5 years with severe hyperacusis, then 3 years with hearing slightly getting worse, but not so noticeable, and from there hearing seems to be going downhill (3 years more and counting), at least in terms of speech recognition...

 

It is possible that I had some tinnitus at the time that I first developed hyperacusis, but the tinnitus became very noticeable in a quiet room several months later.

 

Yes, that's what the statistics say, that hyperacusis is often coupled with tinnitus. But this was not my case. Tinnitus appeared years later.

 

I have my own business and can work from home during the pandemic. Have you been able to work since you developed these auditory issues?

 

I had medical leave (around 8 months) when it all started. Hyperacusis was severe, very very bad.

But other than that I have been working all the time. It's been painful, but I need to work.

 

How has your sleep been since the onset of these issues? I have really struggled with it and one of my theories is that stress and sleep deprivation caused all of these issues.