Hyperacusis Spikes After Trying to Start Living Normally

Hi everyone - I've been experiencing tinnitus since early June after a music festival.

Recently, my baseline tinnitus has become manageable, and I've slowly tried to get back into living normally. But I've found that when I overdo it (noise, or more recently exercise) I get intense hyperacusis spikes that can last for days.

Is this normal? And does anyone have any tips on this?

 

It sure is, but it does improve with time. It's like your ears start to get more "tolerant" of some noise exposure, but it never goes back to the way it was, so caution and knowing your limits is important.

Note your exposure times to loud environments. Also, keep earplugs handy when in loud environments.

 

Yes normal, they are called setbacks.

Hopefully they will last less and less time and then happen less often.

Maybe you can get some musician's ear plugs for the gym and take a slower time exposing to normal sound, like over a few months.

With loud stuff like power tools, use earplugs and also earmuffs at the same time. Helps me.

Make sure you know how to insert the foam earplugs.

Best thing is to avoid loud noise for a while entirely IMO

Don't worry too much though, you will probably heal but it is going to take a longer time than a month or two.

 

That experience applies the vast majority of hyperacusics, we call it a 'setback'.

You went too fast. You should push your limits ever so slowly and gently, painfully slowly. Eventually, (and that's the key word) you'll be able to tolerate normal noise that you never could now.

 

Take it easy for a few months til your hyperacusis gets better or subsides.

 

That's how hyperacusis works. If you have spikes it means your ears do not like the sound exposure... maybe you are around too much noise or for too long.

Hyperacusic ears do not like sudden changes in volume either.

 

What kind of hyperacusis do you have? Burning sensation around the ear area, stabbing pain directly in reaction to sounds, discomfort? What is it exactly that you feel? Which kind of noises specifically have you noticed that have given you hyperacusis spikes?

The first thing I would advise you to do is cut out "digital" sound, such as music from speakers, as much as possible from your life. No ifs or buts, just cut it out completely. No more listening to music and no more watching movies with sound for the next four weeks.

If you have the discipline to do that for the next month, you're probably home free.

On a side note, maybe it's just me but the Wikipedia page on hyperacusis seems much more complete than it did when I last visited it, particularly on the subject of pain hyperacusis as being distinct from loudness hyperacusis.

 

I feel a lot of discomfort and a fullness/warmth in my ears when I hear knives/forks clinking, doors closing, plates being placed on glass tables etc. I don’t think I’d call it a stabbing pain but it’s a really vulnerable sensitivity accompanied by some ringing that forces me to leave the room.

I haven’t seen cutting digital sound out recommended before - is that something that worked for you / you were told by a specialist?

 

You have TTTS. And your sound intolerance/”hyperacusis” is a consequence of that.

I think TTTS is the most common cause of “hyperacusis”.

It is just a little muscle, the tensor tympani, which is in contact with the eardrum and is tensed up.

TTTS persists psychosomatically, mainly focusing your attention on that problem. And it also depends on the particularities of the tensor tympani.

 

Okay interesting. Is there anything that can be done to improve that? Just similar advice to the above (i.e. take it easy for a few months)?

 

Muscle relaxers will help it. Cyclobenzaprine is the bomb and Botox the nuclear option from an otologist.

Ultimately when they act up, plug up. The muscle is contracting for a reason beyond your control (damage).

This is very normal for this to happen during the recovery phase. They will desensitize on their own. Don't force them by exposing past your limits in volume. And also wherever in your audiogram there was damage, try to avoid that frequency. A loud bass drum is different than a loud hammer on metal.

Speaking from experience. I can handle low frequencies like planes, but hammers will make my tinnitus instantly go crazy and deafened. Snaps and crackles, and my eardrum flexes. My damage is at 6 kHz so this makes sense. This has generally improved a lot over time and by being careful.

If you're in earplugs a lot, it will tend to flutter more often, but only for a day or so. This is still safer to plug up, especially around your damaged frequency.

 

I am sensing a bit of skepticism here.

To answer your question, yes it has worked for me, it has also worked for a lot of other people on here too, and no, a "specialist" will never make that suggestion to you, ever.

I have no idea why it works this way but you must believe me.

Just try to go 2 weeks without digital sound and see if your symptoms have improved by then.

 

Yup, I've experienced the same thing. For whatever reason, speakers are just worse for hyperacusis, no matter the sound.

 

Hello. Basically, I think it is important to understand the problem as much as possible. And, when it is necessary, to avoid sounds that are too bothersome for you, or to reduce their volume with earplugs.

Also, I don’t think this abnormal behavior of the tensor tympani is related to cochlear damage, as Matchbox suggested. A lot of people lose hearing for one reason or another. All of us are losing hearing gradually. But this so-called TTTS is very rare. It has nothing to do with hearing loss.

And I don’t recommend taking any drug.

 

I am not so sure I would agree with this.

In my own experience, TTTS is a consequence of nociceptive hyperacusis, not necessarily a result of.

The muscle only seems to tense up when I am dealing with a setback and my pain threshold has been lowered.

Once the hyperacusis is improving the muscle relaxes again.

 

Fair enough. I appreciate the tip as I wouldn't have heard of that otherwise! The tricky thing now is trying to drown out the ringing without the use of white noise / sound from a speaker at night. I'd imagine everyone has that issue when avoiding digital noise and there's no way around it really.

 

What exactly do you mean by TTTS?

Where do you feel pain? And what do you think is the cause of that pain?

 

Yeah I'd highly recommend finding a way to fall asleep without the use of sound generators, or other background noise for that matter. Might be difficult at first, it takes some practice to find out what works best for you, but it is definitely possible. The key to do this in my opinion is to prevent the awareness of tinnitus from causing anxiety within you. When you lay in bed you could focus on your breath for instance.

Why do you ask me that when you've literally stated what TTTS is in your previous posts?

I feel stabbing pain in my ear in reaction to sharp sounds, the reason for that lowered pain threshold is the activation of type II afferent neurons in response to outer hair cell damage (see the summary below).

https://hyperacusisresearch.org/2016-aro-symposium-pain-hyperacusis/

The tensor tympani muscle contracts because of pain or other types of uncomfortable sensations related to cochlear damage. It is not the other way around.

 

Because I wanted to know what symptoms you have. There are a lot of symptoms associated to TTTS.

Do you have the fullness or pressure sensation?

I experienced that and without pain or any other symptom, so in my case it is not a consequence of pain. You can see in this thread that there are three people who think it is psychosomatic, and in fact it is psychosomatic in a superficial way, it activates just thinking about it in a certain manner. This is easily verifiable. But what happens is that the muscle doesn’t relax immediately, it is like it is swollen or something (and maybe the Eustachian tube functions is altered somehow).

And Ross97, the OP, doesn’t have pain either.

So, supposing the same thing happens to you, one possibility would be that your pain makes you more self-conscious about your ears, and that is what tenses up the muscles.

And another possibility is that in fact everything is the same problem. Your tensor tympani mechanism and the nerves around it are altered, and pain is a consequence or symptom of this abnormal situation, which is like a vicious circle.

Pain is mentioned as a symptom in every TTTS description. And “stabbing pain” and “burning pain” are usually associated to trigeminal nerve irritation or other nerve or tissue sensibility around that middle ear zone.

I haven’t read the article you mentioned, but I did read some of those papers some years ago.

You know, Fuchs found this supposed type II neurons, and only later associated them to “pain hyperacusis”. The same thing happened with Liberman and his nonsense “hidden hearing loss”. These guys know nothing about this problem, they are just lab nerds, and they want their “discovery”, which is basically a microscopic observation, to be meaningful. And so Liberman tried to associate it with “pathologies of unknown etiology”, like tinnitus, “hyperacusis”, auditory disorder, age-related hearing difficulties, you name it.

And Liberman, at least some years ago, had some money invested in research for drugs and “treatments”.

These type II neurons remain intact when hair cells die, and Fuchs can’t explain what is important, that is: what is changed in people with “sound-induced” pain, or how this nerve cells became more sensitive. So the relationship between this type II afferents and pain is remote (or inexistent). Also, he can’t explain why symptoms change all the time, or why sufferers get better, or have setbacks, or recover completely, or why certain sounds with rapid attack are more problematic, or why almost all of them have tensed or moving tensor tympanis.

Also, why this “pain hyperacusis” is rare when deterioration of the cochlea and hearing loss is very common. And why someone who is hit on the face can develop this “hyperacusis” too, without any intervention of loud sounds.

So, probably you are overestimating the suppositions of these guys.

In the TTTS field, things are not perfect either. In fact, the original paper by Klockhoff is quite mysterious. And only twenty years later an Australian researcher called Robert Patuzzi associated TTTS to acoustic shocks, because he saw the syndrome mentioned in a book. He didn’t contact Klockhoff, even if he was alive. Patuzzi told me this by email.

Anyway, TTTS seems to explain everything or almost everything. But I didn’t have stabbing pain in reaction to sharp sounds, so, you know more than me about it. And maybe what you have is different than what I had and we are talking about different things. I am just saying that what you have is also mentioned by TTTS “specialists” as a symptom of this issue.

I imagine that this type of pain must be very uncomfortable. So I am sorry about that and I hope you feel better soon and the pain never returns.

 

@Aleph, thanks for your post, you mention a lot of interesting points.

You've obviously done more research than me on this subject so I am not really sure I can respond adequately to the arguments you've made.

That is quite a big statement you make here. Could you elaborate on this further?

 

Thanks for the response Aleph, I’ve read one or two of your posts on other threads and it seems like what I’m experiencing is similar to what you experienced in 2015.

Would you be able to summarise in a few points what helped you to get better? Essentially avoiding noise until symptoms reduced and then plugs / stress management?

 

I can't speak for Aleph but I think something important to note about the type II afferent theory is that it is completely experimental. In the 2015 Fuchs study, they ruptured OHCs from excised rat cochlea using a needle - a so-called "proxy" for cochlea trauma. Even if you accept that as a legitimate way to replicate cochlea trauma in vivo, it does not explain why some with cochlea trauma end up with hyperacusis and others don't. Cochlea trauma is far more common than hyperacusis, and yet hyperacusis is much less prevalent than trauma-induced hearing loss. Why?

I know I sound like a broken record, but I do think Norena's model is much more plausible, as a middle ear model necessitates the various co-factors that can explain why some people develop hyperacusis and others don't, such as ETD, TMJ, histamine release (which is implicated in many types of neuropathic pain), stress/anxiety, neck issues, TTM overload/muscle fatigue etc. The symptoms many of us experience are also much more consistent with a middle ear pathology - fullness, neuralgia, "clicking" ears etc. The paper Norena released with Fournier a couple of weeks ago for me was pretty conclusive, because they developed a new ear sensor that detects TTM and stapes abnormality, which was positive for all hyperacusis patients regardless of overall symptom presentation. I strongly believe this sub would benefit if more of us used the Norena model as a basis for experimental treatments.

 

Do you have any specific treatments in mind?

And what do you think about potassium channel openers, which, according to Fuchs model, could help with noxacusis?

 

I'm not convinced by potassium channel openers because I'm not convinced by the Fuchs model in general (although if you look at my post history going back a year or two, I was the biggest proponent of the type II afferent theory, so I'm open to being wrong).

Regarding treatments, I think anything that truly addresses the co-factors listed in the Norena model could help. In some cases that would mean multi-modal treatment i.e. addressing multiple co-factors at the same time. This is antithesis to what many of us sufferers often look for (I include myself in this), which is a silver bullet.

In Norena's latest paper, one the patients' symptoms completely resolved from botox to the tensor veli palatini. That's not surprising when you consider that muscle shares a tendon with the TTM and is innervated by the mandibular nerve, which is a branch of the trigeminal nerve. But looking at the various co-factors, there's enough anecdotal evidence of cases who have improved from addressing those co-factors. I'd have to do some digging and find all the cases, but there are people who got better from using a nightguard, from strengthening (as opposed to stretching) their neck muscles, from creatine, strict low histamine diets, SNRIs, ambroxol, pure oxygen and many more. Lets now look at how any of those anecdotal cases are consistent with Norena's model:

• Creatine isn't surprising because it plays a role in ATP and muscle fatigue. ATP energy crisis is part of the Norena model.
• Low histamine diet isn't surprising because histamine inflammation is rather unique to the middle ear and histamine is known to play a role in neuropathic pain
• SNRIs are not surprising because norepinephrine has been shown to activate nociceptors, not to mention the effect on the sympathetic nervous system
• Oxygen treatment isn't surprising because hypoxia is also accounted for in the Norena model. However, pure oxygen can easily go the other way and cause damage through free radicals, so I think it's too high risk to try.
• Ambroxol has been used in multiple studies to drain middle ear fluid. Norena's model explains that a chronically inflammed TTM can lead to fluid from middle ear mucosa. It's not just a sodium channel blocker, which blocks pain in the trigeminal.
• Botox. If muscle overload leads to an overactive TTM, and if you consider the tensor veli palatini and the TTM a combined functional unit (as per Norena), then stopping that muscle from activating will allow it to rest and break the cycle. This also explains why some of us see benefit from high dose ionic magnesium. I find it interesting that many people with noxacusis complain of "burning", because that is the feeling you get in an overused muscle due to lactic acid. It's not a stretch then to think that maybe this issue is related to muscles in the middle ear.

I've posted this photo from Norena's paper before but I'm sharing it again because I think it is very helpful in helping to understand what I mean by co-factors and how so many things can affect the cycle.



Anecdotally, and in my own personal experience, my symptoms have been at their best when I've tried to address all these co-factors through a combination of ambroxol, neck strengthening, creatine supplementation, stress relief, muscle relaxants and more. I truly believe this is for most of us a multi-faceted problem that requires a complex solution.

 

The one who is making quite a big statement is Fuchs, proposing that these neurons are responsible of “pain hyperacusis” without any kind of proof. First, he should explain why these neurons get more “sensitive”. And then he should answer all the other questions I made in my previous post.

That symposium took place in 2016. Has he found out something more interesting recently? I don’t know, you could ask him.

 

I copy and paste a fragment of a guide I wrote some months ago. I will have to create a new thread for the whole text.

I don’t know exactly how this pain in direct reaction to sounds related by StoneinFocus is. It is probable that is part of the same mechanism and it follows the same logic. But I don’t know if it is convenient to manage pain differently.

I had some small sensations of pain, but it was always a consequence of TTTS. And one day, in 2015, I was still using earplugs on the street but I was trying to quit them. I was waiting for the bus without earplugs because it was night a quite. And then, out of the blue, a drunk man threw a big TV against a tree just a couple of meters from me. The sound was incredible strong to me and I startled. The next two days I had a kind-of continuous pain (so it was a delayed and continuous pain, independent of sounds). That was my biggest experience with ear pain.

8- PROTECTION AND OVERPROTECTION

If I have TTTS and this state of “hyperacusis”, do I have to protect my ears or use earplugs or cotton balls? In this state, your cochleas are not more sensitive to sounds than when your ears were normal. That is, normal everyday sounds are not going to harm your cochleas and produce hearing loss.

Having said this (and this is something that most doctors and audiologist don’t understand), in this state, your tensor tympanis are not normal, and you could have a subjective sensation that sounds are louder than before. So you have to respect your sensations and perceptions. Your purpose is to relax this middle ear mechanism, and as I told you, the best way is to stop being afraid and stop thinking about it. And gradually (or maybe immediately) it will get better.

But if your tensor tympanis are tensed up, you could protect your ears if sounds are too bothersome for you and repeated, or if they are going to be there for a long time. You could use earplugs for that moment and then take them away. Or if it just a brief sound (an ambulance, a dog barking, etc.) you may use your fingers or hands to cover your ears and avoid the inconvenience, or go away from the place if it is necessary. What you have to avoid is that your tensor tympanis get too tensed, or avoid, if possible, specific sounds that bother you (and if symptoms increase after the sounds, it is important to avoid thinking obsessively about the sounds or the temporal discomfort).

Just remember this: if the tensor tympanis are completely relaxed, the experience of hearing is exactly as before. If they are a bit tensed up, certain sounds could be annoying. If you are doing things good, you will recover more or less soon, or you will oscillate between being normal and having a bit of tensor tympani tension once in a while (and gradually thinking less about the problem and getting better).

Using earplugs all the time even if they are not needed will increase your sensation of loudness in general, and of course this is wrong. But also, it is reasonable that if you are in this state of TTTS/hyperacusis and you don’t know how to control it, you avoid places with very loud sounds, like rock concerts, parties with loud music, cinema, etc. Unless you know that with earplugs, earmuffs or whatever you are okay and don’t get afraid or paranoid about the situation. But if you are unsure, you’d better not do it.

Don’t do strange things, like being very annoyed about sounds, and sustain an unbearable situation, trying to negate the discomfort and “be normal again”, or get paralyzed about the situation, because of embarrassment or whatever. Just cover your ears or go somewhere else. And remember this is temporary and maybe the next day or week you could listen to the same sounds without any kind of discomfort.

If you are neurotic, obsessive, or anxious, the opposite could also be true. That is, you are in an environment with loud sounds and you are okay, but then for some reason you are surprised or even worried that you are okay, and so you get self-conscious and begin experiencing TTTS. So this is an example where the origin of the problem is not your ears, but your mind.

Another trick for sound intolerance: if there is a specific and short sound that you find too strong, like a bus passing by close to you, or an ambulance siren, you could try humming (doing “Mmm...”, a single note, or a melody) during the sound. This adds another sound in the foreground that doesn’t bother you, and so the loud sound goes to the background. Of course, you could also cover your ears with your fingers if you consider so.


9- SETBACKS

If for some reason you worsen, the worsening is always temporary. If you dramatize the situation, begin thinking obsessively about it or get depressed, you are just extending the setback and complicating things.

See point 2.


2- PSYCHOLOGIC ATTITUDE

Don’t panic. The more you panic and worry the worse. Try to relax and not think about your ears. Once you understand this and check it out by yourself, not because I am telling you, you will know the nature of the problem and you will automatically inhibit any thought that worsens and sustains the problem (unless you don’t want to get better).

Ingmar Klockhoff, the man who identified the pathology, described TTTS as “psychosomatic” and due to an “increased psychic tension due to mental stress”. This is partially true because the persistence of the problem, as I mentioned before, is more related to the attention or focus the person gives to the problem, than it is related to stress in general. In fact, when someone is worried or stressed about other problems (i.e. the mind is occupied and absorbed by thoughts different from ear issues) TTTS usually gets better. Apart from my experience, I read other anecdotes that confirm this idea.

In this sense, it is important to note that most people with this problem, especially the worst cases, also have mood problems (depression), or they are very obsessive (OCD), or they are very fearful or nervous (anxiety, panic). And these psychological particularities generally, but not always, precede the sound incident and the development of TTTS/”hyperacusis”.

 

Gaslighting in its purest form.

So I suppose Brian Newman's experience is invalid, then?

 

Lmao you gotta be kidding me. Yeah dude, this can work for extremely mild cases. Don’t go on sites telling people with ear pain that setbacks are temporary, it’s all in your head, it’s all your physiological reaction to it. Lol! Yeah if you have super mild hyperacusis. Like I said, I have talked to many people who have it mild and contact me freaking out that they heard a loud noise but have no symptoms and are afraid they are going to get worse. You know what I say? Do your best to ignore it, try to relax, avoid noise for a bit and let your ears relax. If you don’t have worsening symptoms, your ears are probably not going to get worse. But when people like me who have catastrophic cases, it doesn’t matter how I react to it, doesn’t matter what I think, if I’m negative or positive, my mental attitude has 0% effect on my ears whatsoever. Go read up on how bad I have it.

When I had mild hyperacusis for many years and I heard a loud noise, I would start to dwell and be like crap, are my ears worse? And it never happened. Now I hear a noise my ears don’t like, it feels like somebody dumped acid in my ears and are flossing them with razor wire. Lol there’s no “mentally” having a good reaction to this. You cut off a finger you’re not going to be like “oh it’s all in the mind.” Lol cutting a finger off would barely make me flinch with how much pain I’ve been in. In my acupuncture treatments I have been going extreme and my acupuncturist said she has never seen a worse patient in her 30 years of treating chronic pain. I get needles shoved under my fingernails and it doesn’t bother me, needles shoved under my toes, on the sides of my feet and hands. Most people would not deal with this well. I don’t flinch. This is the only thing that has helped give me a little relief. I throw up constantly from the pain, have a hard time sleeping, it hurts to breathe sometimes, I mean the pain is really that bad.

I have had bad injuries, torn muscles, broken bones, bulging disc in my back, and I thought those were bad lmao. They don’t even come close to this. Setbacks with hyperacusis is a real thing, don’t try to go on here and gaslight suffering people. Sometimes with people their minds do play tricks on them, this is usually in mild cases like I said. Out of all the severe cases I talk to, including myself, we can get much worse from sound and our mind has absolutely no affect on our setbacks. My setbacks have all been permanent, leaving me with more pain and less tolerance to sound than before. After a while the extreme pain calms down, but I’m left with weaker ears.

I have done more research than you can possibly imagine, go look up Type 2 neurons. When I get pain from sound I literally get it from some frequencies under 20 decibels. It’s not damaging hair cells, or synapses, I know that for a fact. Because that’s literally impossible. But it is further irritating the Type 2 nerve. Every time I’ve gotten actual damage from acoustic trauma I get increased tinnitus, muffled hearing, I can definitely tell when I did damage. Whatever is going on with mine is mostly nerve related, I don’t get increased tinnitus or muffled hearing in my bad ear usually. I never lose hearing. After every setback I am able to hear more than before. The nerve pain just gets worse.

I also have TTTS. Mine was damaged down this crappy road. My mental attitude has absolutely no effect on how it reacts. I have tried many times. I also recently tried hypnotherapy which I had success with the first two times, first was for depression and it helped a lot actually. Next was for sleep. I started sleeping better. Then we tried it for ear pain, but it didn’t do anything for my ear pain. That’s how I know my case is not psychological. Don’t go around telling people ear pain from noise is in their head because it’s probably not. Myself and other people really suffering from this do not appreciate posts like this at all.

And people get very confused about ear pain. Everybody with hyperacusis says sounds hurt their ears. Loudness hyperacusis does feel like sounds just hurt but it’s not nerve pain. Everybody is different with this ear stuff and every single case will be different. I’m not on here to scare moderate and mild sufferers because every single person who asks me for advice, you know what I tell them? Go out and live your life. Enjoy it. If you can go around town without pain and getting worse, go do it, have earplugs on you just in case and don’t focus and dwell on it. You are right when it comes to mild cases because dwelling on it will only make it worse. When I dwell in my setbacks I feel worse, but it gets pretty hard to ignore 10/10 severe pain.

So yeah people who are not bad should not be dwelling on it, and be scared to leave their homes because that’s not the case with so many people, only the severe cases. If you’re only giving advice to TTTS, fine, but I hope you don’t mean about all pain hyperacusis in general.

 

Insane.

 

Some of us hypy sufferers have taken the time to (re)write Wikipedia articles in various languages, to make them more up to date with the latest research.