I Have Noise-Induced Tinnitus — What Should I Do?

Michael Leigh

Member
Author
Benefactor
Feb 4, 2014
9,501
Brighton, UK
Tinnitus Since
04/1996
Cause of Tinnitus
Noise induced
Tinnitus Talk Reminder: this is only @Michael Leigh's opinion and experience, and should be taken with a grain of salt, like anything you read on the internet. Always consult a medical professional!

I have noise-induced tinnitus — what should I do?

I have been asked this question a lot over the years. First, tinnitus is a very common condition that comes in many forms and intensities, and no two people will experience it the same. Many people are able to live quite comfortably with tinnitus and may never need to be seen at ENT for tests and treatment or to be referred to an audiologist for tinnitus management.

Many things can cause tinnitus, but one of the most common causes is exposure to loud noise, and it's this that I'm going to focus on. Although I have covered noise-induced tinnitus in many of my posts, I want to compile all the salient points to help a person get some relief from the distress of this condition. Hyperacusis often but not always accompanies noise-induced tinnitus. The information I provide is not absolute, so please treat it as such.

Some people believe using any sound therapy to treat tinnitus and hyperacusis after a noise trauma is wrong, especially when it's administered through wearable white noise generators. They say introducing additional noise into the ear will only exacerbate the problem and worsen the tinnitus and hyperacusis. They are vehement in the belief that the only way to heal the ears and auditory system is to stay in quiet surroundings to give them plenty of rest. Going outside should be done with the utmost caution, so wearing hearing protection is paramount.

I'm afraid I have to disagree with this train of thought because there is the risk of developing all sorts of problems that are not only physical but can be psychological, too. I will say that whether the tinnitus and hyperacusis are severe or not when using white noise generators, they should constantly be introduced slowly. Ideally, the person should be under the care of an audiologist specializing in tinnitus and hyperacusis management, as counseling is usually required. Counseling helps remove and demystify the negative thinking often associated with tinnitus and hyperacusis.

If negative thinking about tinnitus becomes too overwhelming, it can delay or completely stop the habituation process. I recommend that wearable sound generators be used in the early stages of noise-induced tinnitus only if a person has been advised by an ENT doctor or audiologist specializing in tinnitus and hyperacusis management.

White noise generators are specialist devices. A person needs to know how to adjust and use them correctly. When set up this way, they do not introduce noise into the ear as some people believe; quite the contrary, they supply low-level sound enrichment to help desensitize the hyperactivity within the auditory system that has taken place after a person has been affected by noise trauma. They have developed tinnitus, with or without hyperacusis.

A sound machine works similarly, and I recommend that someone new to tinnitus, seasoned with it, or a veteran always use it at night. The natural sounds should be set slightly below the tinnitus and introduced slowly to avoid irritating the auditory system. It can take up to six weeks or more to get used to using sound enrichment at night, so be patient. Over time, sound enrichment helps to desensitize the auditory system and slowly pushes the tinnitus into the background so it becomes less noticeable, allowing habituation to occur.

After a person has been affected by severe noise trauma and has developed tinnitus, the cochlea is affected, and the auditory gateways within the brain have opened up and become hypersensitive to sound. This hypersensitivity will vary between people, but some can develop severe and very painful hyperacusis, which is now known as noxacusis. I prefer to keep things simple with tinnitus, whether hyperacusis is present. The more complex one makes it by using terminologies such as reactive tinnitus and noxacusis, the risk of making the habituation process more difficult.

When I developed severe tinnitus with very painful hyperacusis 28 years ago, the hyperacusis was successfully cured by wearing white noise generators for two years and having regular counseling with my audiologist as part of TRT. The tinnitus reduced to such a low level that I often hardly heard it. This lasted eight years until my second noise trauma. Although my tinnitus increased and changed to what I call variable tinnitus, the hyperacusis did not return.

For some people, hyperacusis can improve by itself with time without self-help or specialist treatment. However, if it doesn't improve or is not treated, it can become a long-term problem. This is usually manifested as spikes in tinnitus, which can be brought on by being exposed to certain sounds or completely at random without any stimulus from external sound. A person can habituate to noise-induced tinnitus, but they can still suffer hyperacusis with or without pain.

For more in-depth information on noise-induced tinnitus and hyperacusis, please read my threads:
  • New to Tinnitus, What to Do?
  • The Habituation Process
  • How to Habituate to Tinnitus
  • Tinnitus and the Negative Mindset
  • Acquiring a Positive Mindset
  • Can I Habituate to Variable Tinnitus?
  • Keeping Things Simple With Tinnitus
  • Will My Tinnitus Get Worse?
  • Hyperacusis, As I See It
  • The Complexities of Tinnitus and Hyperacusis
  • Tinnitus, A Personal View
I wish you well,
Michael
 
It appears TRT was shown to be ineffective in a study, as discussed here:

Tinnitus Retraining Therapy Is Ineffective, Latest Study Finds

Sound generators can make some people's tinnitus worse, and can be especially bad if you have reactive tinnitus, which is not to be confused with hyperacusis. I have hyperacusis, for example, but I do not have reactive tinnitus in those frequencies.
 
It appears TRT was shown to be ineffective in a study, as discussed here:

Tinnitus Retraining Therapy Is Ineffective, Latest Study Finds

Sound generators can make some people's tinnitus worse, and can be especially bad if you have reactive tinnitus, which is not to be confused with hyperacusis. I have hyperacusis, for example, but I do not have reactive tinnitus in those frequencies.
With respect, every person is different. As mentioned in my post, TRT and wearing white noise generators for two years worked for me. They have also worked for many people I have corresponded with who have noise-induced tinnitus.

I appreciate that TRT and wearing white noise generators may not work for everyone. Unless someone has tried the treatment, they won't know whether it will work for them. TRT needs to be administered correctly. It is a two-year treatment that involves wearing white noise generators and regular counseling with an audiologist trained in tinnitus and hyperacusis management.

It should be noted that TRT is not a cure for tinnitus; it is to help a person habituate to the condition.

Michael
 
When I developed severe tinnitus with very painful hyperacusis 28 years ago, the hyperacusis was successfully cured by wearing white noise generators for two years and having regular counseling with my audiologist as part of TRT.
No, you didn't and you weren't. You did not have pain hyperacusis. Noxacusis is not cured by white noise generators. It's a preposterous, unvalidated claim with countless evidence to the contrary.
 
With respect, every person is different. As mentioned in my post, TRT and wearing white noise generators for two years worked for me. They have also worked for many people I have corresponded with who have noise-induced tinnitus.

I appreciate that TRT and wearing white noise generators may not work for everyone. Unless someone has tried the treatment, they won't know whether it will work for them. TRT needs to be administered correctly. It is a two-year treatment that involves wearing white noise generators and regular counseling with an audiologist trained in tinnitus and hyperacusis management.

It should be noted that TRT is not a cure for tinnitus; it is to help a person habituate to the condition.

Michael
People who got better with more sound added to a damaged auditory system were mild to moderate and would have probably gotten better faster without putting more sound directly into their ears or going out of their way to add sound to their environment.

Why are the mild to moderately affected people dictating the "treatment of hyperacusis, tinnitus, and noxacusis?"
 
Hi @Michael Leigh, I hope you've been well! I have a question I'd like to ask if you don't mind. I have noise-induced tinnitus and a bit of hearing loss, both in my left ear only. I'm wondering about nighttime sound enrichment.

I've found that cricket sounds and violet noise work well for me, but when I play them (usually through my iPhone on my bedside table), I can't hear the sounds very well through my left ear and end up needing to turn the volume up. I try to sleep on my right side since my right ear is fine, but if I move during the night or lie on my back, my right ear becomes exposed. When that happens, I can hear the sounds perfectly, maybe even a little too loud, since I had to turn the volume up to hear them with my left ear.

Thank you for any advice!
 
Hi @Michael Leigh, I hope you've been well!
I am doing fine @Tim Moore, thank you for asking.
I've found that cricket sounds and violet noise work well for me, but when I play them (usually through my iPhone on my bedside table),
I advise you to use a proper sound machine to enrich sound instead of your iPhone. The iPhone will not be as good as a sound machine unless it is attached to a docking station with speakers fitted or connected to an external speaker by Bluetooth.
When that happens, I can hear the sounds perfectly, maybe even a little too loud, since I had to turn the volume up to hear them with my left ear.
I was told by an audiologist that the brain has only one auditory centre. Try not to be too concerned about the difference between your hearing in your left and right ear. Sound enrichment works while we are asleep. Its purpose is to provide the brain with low-level sounds without drawing attention to itself. Please read my thread: Sound Machines and Tinnitus.

I wish you well,
Michael
 
I am doing fine @Tim Moore, thank you for asking.

I advise you to use a proper sound machine to enrich sound instead of your iPhone. The iPhone will not be as good as a sound machine unless it is attached to a docking station with speakers fitted or connected to an external speaker by Bluetooth.

I was told by an audiologist that the brain has only one auditory centre. Try not to be too concerned about the difference between your hearing in your left and right ear. Sound enrichment works while we are asleep. Its purpose is to provide the brain with low-level sounds without drawing attention to itself. Please read my thread: Sound Machines and Tinnitus.

I wish you well,
Michael
Thank you for your answer! I have a small JBL Bluetooth speaker, I'll try that tonight!
 
Sound enrichment works while we are asleep. Its purpose is to provide the brain with low-level sounds without drawing attention to itself. Please read my thread: Sound Machines and Tinnitus.

I wish you well,
Michael
Is it better to play cricket sounds all night long, or just for the time needed to fall asleep (e.g., by setting a 90-minute timer)?

Wouldn't it be beneficial to give your ears a few hours of rest without any sound?

Thanks!
 
Is it better to play cricket sounds all night long, or just for the time needed to fall asleep (e.g., by setting a 90-minute timer)?
You can use whatever type of sound enrichment you like at night as long as it's not music. Keep the volume low so it's not drawing attention to itself. The brain and auditory system never turn off until we die. People who have intrusive tinnitus should play sound enrichment throughout the night until morning. Many audiologists and hearing therapists advise tinnitus patients to do this. Quiet rooms and surroundings aren't good for someone with tinnitus. Silence will allow the brain to increase its background activity; in the process, it will also increase tinnitus, which can make it more intrusive during waking hours.
Wouldn't it be beneficial to give your ears a few hours of rest without any sound?
No, it wouldn't. Remember to keep the sound enrichment low so it's not drawing attention to itself.

Michael
 
What if someone has tinnitus that increases in sync with external sounds? If they're constantly exposed to sound, wouldn't their tinnitus be constantly elevated as well?
 
What if someone has tinnitus that increases in sync with external sounds? If they're constantly exposed to sound, wouldn't their tinnitus be constantly elevated as well?
You make an interesting point @Jupiterman. I recently counseled someone with this problem. I suggested they take their time and introduce sound enrichment slowly and at the lowest level possible. One has to experiment to see what is best for them because we are all different. One thing is certain: quiet rooms and surroundings aren't good for anyone with intrusive tinnitus. A person should seek professional medical help to treat their oversensitivity to sound if their tinnitus spikes or increases from external sound. Staying in quiet surroundings will only worsen their sensitivity to sound over time.

Habituating to tinnitus and the habituation process are complex, and no two people will experience them the same. Some people may find it difficult to habituate to tinnitus and may need medication to help cope with tinnitus. In these instances, it's best they are under the care of an ENT doctor and audiologist specializing in tinnitus and hyperacusis management. In many posts on my started threads, I have explained oversensitivity to sound, hyperacusis, and habituation.

Michael
 

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