How Do You Know If Sounds Are “Ear-Damaging Loud” or Just “Hyperacusis Loud"?

This is nonsense. And the reason why we know its nonsense is because me. It's really very simple. I will underline it:


Me. Went to a concert. Got tinnitus. After that, went to a night club, got hyperacusis. However, before going to the concert, I had been to nightclubs and never got hyperacusis.

@japongus

LOL. Says who? Hazell and Jastreboff deny what they're being accused? Well, I'm sure Charles Ponzi did the very same thing. It's obvious the statistics on improvements have been faked by extracting positive answers from patients through CBR and pharma. Proof: me. I saw it with my very own eyes. Proof: common sense. Proof: the tinnitus handicap questionaire is something that CBR addresses, not sound therapy. And CBR addresses it through social engineering, not physical objective improvement.

The difference is that Jastreboff and Hazell were successful in the 80s-90s, when Doctor Shemesh was also successful. Back then there was no way patients could talk back at them like they can do these days on forums like this one. Back then they were the source of authority and their jaw-droppingly flawed logic couldn't be questioned.

 

Er, sorry if this seems combative, but I don't think this proves anything. For one thing, auditory damage is generally cumulative: all the prior times you'd been to nightclubs probably were damaging, but you weren't aware of it until you'd crossed some thresholds.

More importantly, nightclubs are not what's being discussed here -- the comment you're replying to is about "Sounds that do no damage to the auditory systems of people who do not have hyperacusis ". Nightclubs are incredibly damaging, to healthy people and hearing impaired people alike! Nightclubs can have sound spikes up to 155db, and it's very common to have sustained sound in the 110-125 db range... that's incredibly loud, and definitely damaging to anyone. The comment you're addressing isn't about nightclubs, it's about whether 75-80db ambient noise levels can ever cause physiological damage.

I realize TRT doesn't work for everyone, but comparing Jastreboff to Shemesh is kind of silly. Shemesh is clearly a scammer, and I've never seen a single independent account of someone who was helped by his clinic. I've communicated with a lot of people who have been helped by TRT.

This is kind of a bizarre comment; CBT is a fundamental part of TRT, and Jastreboff and Hazel don't have a monopoly on TRT.

 

Interesting thread,

I have asked this question to several audiologists and ENT's and they all assure me that our ears are not more prone to damage than 'normal' ears.

There are very little sounds that can do instant damage to our ears, one aidiologist said to me that if I lived in a warzone like Syria or Iraq that it is wise to not leave the house without earprotection, but everyday normal sounds, like traffic noise are perfectly safe, our ears are used to these sounds and build for it.

Even if you have severe hyperacusis normal everyday sounds can sound very loud and unpleasant but it is the brain that fails to process these sounds correctly, it does not mean that these sounds physically are damaging to your ears somehow.

When my T first hit me it was accompanied by H, sounds sounded distorted and very unpleasant, I could barely leave the house, sounds that other people perceived as normal sound, 70 Db I would perceive like 90 Db or worse, and as a result I plugged my ears almost all the time.

I had to force myself to gradually leave the plugs out and expose myself to normal sounds again, this was very hard as I had to find the right balance, expose myself too much and I will get worse, expose myself too little and I will not make progress, , I learned it with trial and error, more error though !

Today I am doing much much better, I still worry alot about car horns, sirens etc, especially screeching sounds in high frequencies are a hell, metal on metal, screeching breaks, I guess this will stay that way but I can live with that, it takes a mind game to remind myself that the sounds might be unpleasant but not damaging. Is what it is.

 

The problem is that there is no proof, it's just their opinion, that's it.

 

Is there any actual data to support the idea that people with hyperacusis are not prone to actual damage from sounds which are not damaging to other people? I cannot find any.

 

Aaahaaa? I thought the comment he was addressing was car horns at 95-105 Db, not ambient noise. Lol.
If you are going to challenge a member, then be precise please and do not twist peoples words.

 

That may be true, there is no real hard evidence for this claim, but there is no proof of the contrary either.

Why do you think that damaged ears are more prone to further damage? On what do you base that belief ?

Do not get me wrong Telis, I totally understand your point of view.

 

Well, if 'usual' sounds were damaging, it would have to be some mechanism, and the only possibilities I can think of are:

* actual physical trauma to the cochlear mechanism -- this seems pretty unlikely to me, because it's been studied reasonably extensively, the biology is pretty well understood, and damage is something which can be assessed pretty easily.

* downstream excitotoxicity - someone with H processes sound incorrectly, so, something which would cause a normal nervous system response in a healthy person, causes excess stimulation in an H patient to the point where enough glutamate is released to cause synaptic damage. As a total layman, this seems at least plausible on paper -- this is the same mechanism by which benzodiazepine withdrawal can cause brain damage, for instance. It's much harder to assess; in really extreme cases you might eventually have brain lesions you could visualize with specialized imaging, but in a more minor case where you only kill a few dozen cells, it's not really possible to prove that one way or the other with available technology.

Finally, there's the obvious corrolary that stress itself can literally be neurotoxic -- so even if something isn't "physiologically" damaging, exposing yourself to an extreme stress state for a period of time is going to be detrimental to your nervous system, and if simple day to day sounds are capable of generating that extreme stress for you, then it's unhealthy. And, I think this is what CBT and all the other exposure therapies are stabbing at -- desensitizing people so that ordinary stimuli don't provoke an extreme stress response.

As I said before, I remain open to the possibility that people with H can be damaged by sounds that healthy people cannot be damaged by, and I think it's an interesting question, but all we really have is speculation and intuition.

I think the only proof they can cite besides whatever their personal experience with patients is, is the longitudinal studies which overall tend to support the idea that tinnitus is not a progressive disease for the majority of patients. Obviously there are outliers in all such studies.

Maybe one or two, I don't know? Sorry if this sounds snarky, but in general this forum is not a place I associate with a lot of people who are doing really well and feel that their condition is managed and not a big obstacle to their lives. On the other hand, I've read a lot of tinnitus threads other places (motorcycle forums, reddit, firearms forums, etc), and in general people those places are more likely to have a cheerier outlook and report some degree of success with management / habituation strategies.

 

There isn't any conclusive proof that normal sounds that do not damage people without hyperacusis also don't damage people with hyperacusis. But we sure do have a lot of reports from people with undulating hyperacusis talking about how they have setbacks on a day out on the town. The reason we're discussing this is because Jastreboff and Hazell poisoned the atmosphere 30 years ago with their psychological-cognitive model of H and T, where part of their puffed up statistics consisted in convincing H patients to get out of the house, after which they'd respond positively to the Tinnitus handicap questionnaire but they hadn't really improved. The patients were alienated and they proceeded to correct what they were saying with their own circular reasoning and their own doctoral authority. Just like 19th century doctors dealing with parkinsons.

Placebo tests weren't carried out. J wrote a whole book accusing other treatments of not carrying out placebo while he forgot to carry it out on his own treatment. Numerous gold standard tests weren't carried out. One of which was the severe hyperacusis sufferers which weren't likely to deliver temporary improvement statistics and they didn't improve. Nor were they likely to have their startle reflex improved by turning on Jastreboff's pink noise without being informed of the difference between startle reflex H and loudness H. And I think it was Hazell or an australian TRT doc Marsha Johnson who admitted a couple of important things, like they knew very very few severe H patients, and that their TRT had never really worked on severe H. Jastreboff and his wife never even considered the idea that H could be like a muscle that tenses up, that hurts most at the start of the tensing up than it does when its already tensed, with Margaret Jastreboff openly proclaiming it a phantom pain, whereas now there are doubts that the pain could indeed by a muscle inside the ear or near it that's tensing up. J tried to apply classical conditioning theories of psychology to H without taking into consideration the startle reflex and how applying pink noise improves the pain not because of psychological conditioning, but because the startle reflex isn't being elicited. There are just too many complaints that one can come up with, and there's no time here.

Not my post. It's an example of how icky the boundaries have gotten, where people really think that J got his results without putting the patients inside a shrink's office to talk it off or get talked down on.

 

Good post. I agree with you on these hypotheses. For a big chunk of it, I agree with the neurophysiological model of tinnitus and hyperacusis. I also suspect that for normal sounds, the damage is just slow and imperceptible, and that the TRT claim that sound exposure is good when I went to a pub with T and came out of it with H is bs. I just think that in a condition where so many people improve naturally (an israeli doc once said 85% of his IDF patients come once and never come back to his office or complain again) , where there are people with herpes or vestibular balance disorders, or cervical or neck muscle tenseness disorders, or facial muscle T as a result of dentistry getting T and H, and there are people hustling ridiculous success statistics without having differentiated them from people with possible cochlear or neurological disorders, one has to be very skeptical. Look at the laser bunch, they also claim amazeballs success but they're also too lazy or cretinesque to make a thorough poll of their patients.

 

@Bart, the audiologists and ENTs who assured you that the ears of someone with tinnitus or hyperacusis are no more prone to damage than normal ears are 100% correct and there is a great deal of evidence to support these views. (The perspective offered in this thread - that no evidence exists to support this view and that audiologists and ENTs are merely stating their opinions - is false. This belief is sometimes espoused on Internet support settings by individuals who are struggling with tinnitus, hyperacusis, phonophobia, and similar challeges.) As one audiologist said to you, if you lived in a war zone it would be unwise to leave home without hearing protection, but traffic noise is safe and our ears are built to accommodate it. Furthermore, while someone with hyperacusis would experience normal sound as uncomfortably or painfully loud, this is because the brain processes sound differently than it once did, not because of auditory function. I am very glad you are doing much better. Finding a desentization strategy that works for you will help mitigate the difficulty you continue to have with high-frequency sound.

@linearb, CBT is an entirely different approach from TRT. CBT is not a fundamental part of TRT or a supplemental part of TRT. If you have any doubt about that, you may wish to contact Dr. Jastreboff at Emory University and ask him yourself. I respect both approaches, but they have nothing to do with each other. Dr. Jastreboff would likely say that a TRT patient using the techniques applied in CBT for the purposes of habituating tinnitus are contraindicated, as the patient would be consciously engaged with thinking about tinnitus.

@Zimichael and @japongus, calling anyone's post garbage or nonsense isn't helpful. By law, car horns are not loud enough to cause damage to anyone's auditory system. Using emotionally-charged words like "ludicrous" or "garbage" or "nonsense" is a belief in search of a reasoned discussion. People with tinnitus and hyperacusis sometimes believe exposure to normal sound causes damage. It doesn't cause damage and you haven't referenced a single study that proves otherwise.

On edit: @linearb, according to OSHA, one would need to be exposed to the someone "sitting" on a car horn that emits 120 dB for 1/8 of an hour for it to damage our ears. For a 90 dB horn to damage one's ears would require an exposure of approximately 8 hours.

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9735

japongus, the acronym is you mean is CBT, not CBR. The broadband noise used in TRT is white noise, not pink noise. The Australian clinician you mean is Myriam Westcott, not Dr. Johnson (an American). The Neurophysiological Model of Tinnitus doesn't go back 30 years. TRT, and other forms of desensitization, can be very effective for individuals with severe hyperacusis. By "startle reflex hyperacusis" (not a correct term), you might be referring to the overengagement of the tensor tympani, which can be induced by misophonia or phonophobia and is not treated by broadband noise, but by other means.

here2help

On edit: @linearb, I suggested you ask Dr. Jastreboff because he created TRT and there are a number of clinicians who do not correctly administer his approach. I'll stand by saying that CBT is not a fundamental or supplemental part of TRT. Regarding the evidence for the views I wrote about on non-damaging levels of sound, this is standard stuff that any experienced audiologist or ENT can support and explain in more detail. If you are looking for more information about these things, I suggest you ask your own doctor to recommend a standard audiology text to you.

 

Okay, let's see your "great deal of evidence", please!

What he believes is of little interest to me; he's one person and he's just as capable of being wrong or dogmatic as anyone else. I do not elevate particular people to some kind of idol status.

This simply isn't true; some car horns are 120db if you're right on top of them, that's clearly damaging. 90 db horns can be damaging if you're exposed to them for a long enough period of time.

 

Some excellent posts there Linearb - keep it like that ;-)

Also how would we know in advance if a car horn is gonna be 90db or 120db when we walk by a car!

 

I especially like that post...

 

Also for the record, I'm not trying to disrespect Jastreboff per se! I think he is a brilliant man who did a lot of great work, had some really revolutionary ideas, some of which have been helpful to a lot of people. Where this breaks down for me is when we try to apply the "one size fits all" mentality to tinnitus. Tinnitus is a symptom, not a disease... so to me, implying that everyone who has tinnitus should fit in the same mold, is just sort of crazy. Think about headaches... I get a headache if I skip my coffee for a few days. Other people get headaches from a concussion, or an aneurism. If someone with an aneurism follows my advice to "have a nice warm cuppa joe", it's not going to help them.

But, if there's longitudinal, peer-reviewed clinical data I'm not aware of which shows that people with hyperacusis will not suffer any physiological consequences from being exposed to 80db noise levels for 8 hours straight, I would definitely like to see it! @here2help seems to be implying that not only does such data exist, that there's a wealth of it, which is surprising to me, and I would really like to know what research supports that claim.

 

I think OSHA standards are woefully inadequate. The EPA's guidelines are much more stringent, something like 10db lower for anything over 60db. So, the EPA 8 hour limit is something like 75db which seems reasonable to me in general, but, all auditory systems are not the same!

Are you suggesting that literally everyone everywhere has the same tolerance for noise, and that noise which is not damaging for one person, can never be damaging for another person? If so, why do you think that? Is it not the case that for any given noxious environmental stimuli, there's a wide variation in phenotype responses? For instance, given the same exposure to the same carcinogen, some people will develop cancer, and others will not. Isn't this a logical way to view any damaging input?

You can stop it with the condescending pandering, I have read it all many, many times. I'm fortunate to have finally found a rational and qualified ENT, but I have definitely communicated with ENTs who do not have a solid grasp on any part of this condition. Just because someone has gone to school for six years and studied standard texts does not inherently mean that they have a reasonable or correct view on these things.

Again, I do not elevate particular practitioners to idol status. Doctors are wrong about things all the time. I am sure that I am also wrong about things all the time. The best doctors I have ever worked with are the ones who are capable of saying "I don't know".

Once more - You have made the claim here that there is "a wealth of data" to support the idea that usual sound levels cannot be damaging to people with particular diseases; I am asking you to please support that with the data you're suggesting, and not just oblique links to questionable OSHA guidelines or general comments that "any audiologist can tell you this". Any priest can tell me that Jesus is the son of God, but they would be hard pressed to support that claim with peer-reviewed, evidence based data.

 

People really need to stop following OSHA guidelines regarding noise. 85 db is starting to getting pretty loud. If you are exposed to this level of noise constantly for days on end you will have hearing problems.

Noise levels as low as 50 db at night have also shown to have negative effects on human health.
https://en.wikipedia.org/wiki/Health_effects_from_noise#cite_note-euro.who.int-9

 

wow, that's pretty interesting, though not terribly surprising. Just copy/pasting this over:

But, now we're getting into systemic effects of noise exposure, which are a bit different than hearing loss from noise exposure.

That said, this is one of the biggest reasons that I think living in a city is bad for me. When I get out into the country for just a few days, my tinnitus doesn't go away, but I feel a lot better -- and I'm angling to move from the city into a more quiet environment over the next six months or so.

OSHA guidelines at this point are more about making a distinction between what is a legally actionable toxic workplace, than they are about making people as safe and happy as possible. This is not a useless distinction: any number of industries which operate fully within OSHA guidelines, still have some detrimental health effects on workers.

 

I think OSHA standards are woefully inadequate. The EPA's guidelines are much more stringent, something like 10db lower for anything over 60db. So, the EPA 8 hour limit is something like 75db which seems reasonable to me in general, but, all auditory systems are not the same!

@linearb, the EPA noise level recommendations (which date to 1974), represent an average of acoustic energy over a given period. The EPA recommendation notes, "occasional higher noise levels would be consistent with a 24-hour energy average of 70 decibels, so long as a sufficient amount of relative quiet is experienced for the remaining period of time." By the EPA standard, being exposed to a car horn for a few seconds would not be dangerous to a person's auditory health.

Are you suggesting that literally everyone everywhere has the same tolerance for noise, and that noise which is not damaging for one person, can never be damaging for another person?

No, I'm not. In a thread you participated in last week, I said there was evidence to suggest that everyone does not have the same tolerance for noise.

You can stop it with the condescending pandering

You have made the claim here that there is "a wealth of data" to support the idea that usual sound levels cannot be damaging to people with particular diseases; I am asking you to please support that with the data you're suggesting,

A little advice. The next time you want someone's help in finding information, you may want to think about leaving out the part about condescending pandering.

here2help

 

Hey, this is the third time you've replied to me here, and you still haven't cited any of the data you say exists and is abundant. How should I interpret that? It seems to me that if you're really sitting on a goldmine of highly relevant facts to support the opinion you keep broadcasting here, you would want to share that?

I understand that many audiological professionals have this same opinion, and therefore, having someone reiterate that many audiological professionals have this same opinion isn't giving me any new information. Put differently, I am not convinced that the opinion that many audiological professionals have on this matter is correct, and I have yet to see any longitudinal studies, imaging data, or other empirical information which would cause me to change my own opinion. In a prior post, you said

So, very simply, what I am asking you is, "why is that false, and what is the great deal of evidence to support these views". I think that's pretty straightforward.

I am sorry if my prior response was a bit snarky, I definitely don't mean you any offense, and I also respect your right to disagree with me on this point. I am just trying to understand why it is that you disagree, what things have factored into the opinion that you have. Science is doing experiments, coming to conclusions and then doing further experiments to either re-affirm or call into question those conclusions. Anything else is just dogma, which bores me.

 

This is interesting:
http://well.blogs.nytimes.com/2014/12/01/when-everyday-noise-is-unbearable/

 

Hey Bart,

I'm just going by my own experience. I expose myself to "normal sounds" all the time, it doesn't help me, it just makes things worse. I guess everyone is different.

 

I am aware that he claims that anything that isn't abnormally amplified sound going from the cochlear to the brain is misophonia/phonophobia. But that's rubbish. Jastreboff invented the word ''misophonia''. That's pretty absurd.

Astrid's experiences at chat-hyperacusis.net shows that we don't know which one it is that causes H and T in the reflex startle hyperacusis. In my case, this muscle or something near it, was activated from exposure to a nightclub after having had T activated by a concert that was too loud. Therefore the resistance of T/H patients falls and in loud situations we are more vulnerable than people with normal ears.

Jastreboff goes on to claim that this doesn't apply to normal loudness, without a shred of proof. A car horn will take less time to break your ears if they're already injured, but who wants to go through that test in a lab? Who'll be paying out damages?

Jastreboff treats his ''misophonia'' by sending the patients to CBT, to ''correct their thoughts''. Its all just circular thought, a self-fulfilling prophecy.

Just because Jastreboff invents a word, doesn't mean hoards of people going to nightclubs have to go on the defensive about how they developed a hatred of sound.

And yes, Jastreboff goosed up his success results. Yes he used the tinnitus handicap questionaire to define improvement, and that doesn't specify if it's helping to cope with the injury or the injury itself that improves, it doesn't separate CBT from TRT. We're overrun with cases of fake goosed up results because of many reasons, some of which I spoke above. Put Jastreboff and the laser tricksters side by side, and they both look like Tom Cruise on an Oprah Winfrey couch getting pwned by the internet.

Hazell and Jastreboff were hilarious on the topic of silence and they took it to their own logical conclusion by saying that prehistoric man actually saw silence as a threat. The only reason we're discussing the somewhat absurd difference between nightclub sounds and normal sounds is because of their opinion and how it was key to sustain their white noise and their CBT.

 

Misophonia and H aren't even remotely the same thing, who cares who invented the word. My wife has misophonia, to a degree that causes her some issues: she's literally incapable of concentrating around specific kinds of environmental sounds. No one likes the sound of someone else chewing, for instance, but for her she cannot filter it out, and in order to carry on a conversation while that's going on, she has to plug her ears or she cannot maintain focus on her stream of thought.

As far as I'm concerned, that is misophonia. She has no tinnitus or hyperacusis. She routinely tolerates rock shows and bars which I cannot tolerate even with earplugs.

 

Misophonia should be like an obsession with particular sounds, or a form of dementia, or an obsessive compulsive disorder, or something used to living in luxury might have. But there is such a thing as startle reflex. This can lead to doctors like Jastreboff thinking that this is an obsession because the complaints about pain of, say, typing on a keyboard, don't come up if music is mostly drowning it out.

Jastreboff in his book on the neurophysiological model of tinnitus uses various analogies to prove his point. He says wall clocks are deemed loud by misophonists but because they don't notice the wall clock when the TV is on, this proves they have the obsession because the brain is rewiring itself incorrectly.

A startle reflex is designed to do just that: startle, and if you get hyperacusis, even if it's just a little, you will probably have a drastically lowered startle reflex. Even if you don't have hyperacusis, you could have ear muscles reacting to sound and causing you pain, as a result of an acoustic shock or exposure. A startle reflex may make the diagnosis seem random, and therefore misophonia, but if you take into account the definition of what a startle reflex really is, it cannot be misophonia.

 

But why couldn't we diagnose this with tympanometry?

 

Good question.

Jastreboff iirc makes allusions to having argued with patients over their misunderstandings about the ''middle ear'', giving them tympanometries.

I have not been diagnosed with myoclonus in an immitance/impedance/tympanometry test by one doctor. I have not gotten a second opinion yet. In an electocochleography test he made he didn't seem to have seen increased amounts of sound leaving the cochlea, so he was pretty convinced, or clueless, that what I had was anxiety.

I have also not read the key works on startle reflex yet, like ''Anticipation of loud sounds'' Borg 1984.

But I do have a symptom that is extremely similar to when you tense the muscle of your leg and you feel it a lot more when you're tensing it than when it's already tensed. And I do have some of the symptoms that have been recognized to be consistent with TTTS.

Some doctors sectioning or adding botox to the stapedius/tt I can't remember right now, were making the claim that even though they didn't see anything weird in these tests, they did see muscle movements through endoscopic examination on the operating table. I'm quite sure I read this but I will have to go over my files to make sure who wrote it.

Maybe some doctors don't know how to interpret those tests. It will take time for me to improve my knowledge on that question.

 

hey @here2help, I really would like to see the research you're referencing in your posts above.

 

ahh Telis..LOL..my sentiments exactly!

 

I am sorry but TRT is OLD news..this isn't just a personal opinion....but carry on..

and yes my ex has misophonia..14 years I said it was OCD, who knew at the time what it was, NO ONE....kinda like H..now..It isn't H, not related to H and the TRT model is bogus for a true H sufferer. Throwing miso and phono into the mix only further confuses the true sufferer and causes worsening of emotional and thus physical symptoms.

CBT..for miso? seriously. . I will let my ex know and report back.