MemberTinnitus 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:
Michael
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
Michael
) on my Hi-Fi system at a moderate volume, as I had done many times before. But this time, over the following days, my tinnitus spiked to a level I had never experienced, and I started to develop hyperacusis as well. Things still haven't returned to what used to be my baseline before this incident, which was very mild tinnitus (not bothersome at all) and no hyperacusis. At this point, I'm starting to doubt whether they ever will.
