I Woke Up to Hyperacusis — Three Months Later Tinnitus Started While I Was in Bed at Night

[Athens]

Hello. I am 56 years old. In September of 2020, I woke up in the morning with hyperacusis. In July of that same year I began having insomnia and started taking Xanax for a few weeks and then started taking Zolpidem for several months. By the time that the hyperacusis began I had suffered significant sleep deprivation for several months even with taking Zolpidem each night. I took 2.5 mg of Lexapro the week before the hyperacusis started but stopped taking it after approximately five (5) days. I doubt that such a small amount of Lexapro for such a short period of time could cause hyperacusis, but I do wonder about the Zolpidem and the sleep deprivation.

In December of 2020, I began noticing the tinnitus when in bed at night. My hearing has been tested three (3) times since that time with minor hearing loss (worse on the left) found consistent with my age. The hyperacusis and tinnitus are both worse on my left side.

I began TRT several months ago using sound therapy with above the ear sound generators playing pink noise at approximately 5 to 8 db. I also receive counseling from an audiologist as part of the TRT. My sleep has improved but is still a problem. I take 5 mg of zolpidem and less than 1 mg of clonazepam at night. We are trying to taper off of all of these medications. The hyperacusis has not improved since it began last year and the tinnitus seems to be worsening. I am not certain if the sound generators (which I wear for approximately eight (8) hours each day) have caused the hyperacusis and tinnitus to worsen. I saw a Neuro ENT who informed me that it would be unlikely that the sound generators would aggravate my condition. He was formerly associated with the Emory Tinnitus and Hyperacusis Clinic when it was in Atlanta. I have wondered if the tapering off of the Zolpidem and Clonazepam could be causing an aggravation of my conditions.

I do not wear earplugs except in the shower. I am able to take long walks for exercise without any difficulty. I am only able to hear the tinnitus in quiet environments. The hyperacusis does not cause pain but is more of a severe annoying/jarring sensation. The creaking of wooden floors, putting a key in a door, opening a paper bag, running water, talking on the phone, hearing my own voice, putting a pen down on a counter, and even turning the pages of a magazine or book are all uncomfortable because of the hyperacusis. The tinnitus is constant. I played live music for many years without protection and my left ear is worse than my right because of my usual location on stage.

I was prescribed Mirtazapine earlier this year and gradually increased the dosage up to 45 mg each day. I have not experienced any side effects but it has not dramatically improved any anxiety or other mental issues. My mood is better than last year and I do experience some good days.

I have become increasingly frustrated by the lack of any improvement and even some worsening of the hyperacusis and tinnitus during the past few months. I have read many success stories that appear to reference that it can take several years for significant improvement. I just started working with a CBT therapist who has worked with other hyperacusis and tinnitus patients. My primary concern is that the exposure to normal sounds on a daily basis may have caused a worsening of the hyperacusis and tinnitus. I might be a Category 4 but I do still work full-time (although I have my own business and can keep my own hours) and can watch the television without any issues, take long walks without protection, and go to the fitness center (which can be too loud when people switch the settings on the machines, etc.). It is very difficult for me to go to a crowded restaurant without protection. I am understandably very anxious about whether the hyperacusis and tinnitus will continue to worsen and result in even more of a restricted lifestyle. My age might mean that it will take much longer to see improvement. I have read some success stories from people with seemingly more significant issues who have improved after two (2) to four (4) years. Some people seem to improve without TRT or other formal treatment and the simple passage of time resulted in relief.

Please give me your thoughts. Thank you in advance.

 

[Michael Leigh]

Hi @Athens.

Thank you for your informative post. It always helps to get full background of one's circumstances, as it can make giving advice easier. Something usually causes tinnitus and since you have hyperacusis, this usually points to exposure to loud noise, which is one of the most common causes of the condition. If you were a regular user of any type of headphones including earbuds or headset. Worked in a noisy environment or shoot a gun as a hobby. Any of these or regularly being in noisy surroundings were the likely cause of tinnitus.

Continue going out for long walks as this is the right thing to do. Over time your auditory system will get used to normal everyday sounds and this will help with desensitizing your oversensitivity to sound. In addition to this, my advice is not to stop wearing your sound generators. They will treat the tinnitus and hyperacusis. This type of treatment can take up to 2 years so be patient as you are doing all the right things.

Your sound generators should be worn is a specific way otherwise you won't get the maximum benefit. When you put them on in the morning set the white noise slightly below the tinnitus and leave the volume there. When outside you might be tempted to turn the volume up to hear them as external sound from the environment can make them difficult to hear. Please do not do this. If you constantly adjust the white noise then you will be making it more difficult for your brain to habituate to the tinnitus. The brain habituates to the white noise and over time it slowly pushes the tinnitus further into the background.

At night try not to sleep in a quiet room. Use a sound machine by your bedside for sound enrichment. Please go to my started threads and read the following posts: New to Tinnitus, What to Do? Tinnitus, A Personal View. Please click on the links below and read my articles that you might find helpful.

All the best
Michael

Hyperacusis, As I See It | Tinnitus Talk Support Forum
The Habituation Process | Tinnitus Talk Support Forum

 

[Juan]

Hi @Athens.

Sleep deprivation or unusual sleep patterns (i.e. working shifts and doing night shifts) may affect tinnitus and hyperacusis, so it is important that you can sleep well.

Diet may help, a healthy diet in general, with low sodium, avoiding junk food and alcohol. Caffeine... there are mixed results for this, if you have a look at the "caffeine" discussion on these forums. For me coffee spikes my tinnitus and green tea feels better.

As for TRT, noise generators etc... my personal opinion is that they are worthless. Try to listen to music of your choice, at home, increase the volume (if you feel comfortable with it), week after week, progressively.

Try to avoid loud noise, use earplugs if you feel uncomfortable or you feel the possibility of danger in terms of loud noise.

Give it time. It's a slow process.

 

[Athens]

Thank you Michael Leigh.

I struggle with setting the noise generators If I set them just below the sound of the tinnitus, should they be clearly audible in a quiet environment?

I am also concerned that if I set them just below the tinnitus (which is mostly in my left ear), it will be much louder than my present setting and cause an aggravation of the tinnitus and hyperacusis. Category 4 folks have been described as people who have worsening tinnitus and hyperacusis as a result of exposure to normal sounds during the day. This seems to be me but I know that some people describe their tinnitus and hyperacusis symptoms as far worse than mine. The term "reactive tinnitus" comes to mind but I know that there is some controversy on that issue. I listen to pink noise on my sound generators. There is an option for white noise as well but the white noise sounds like it has higher frequencies and the pink noise sounds more tolerable.

I listen to the sound of a mountain creek at night through my cell phone. The speaker on cell phones is not the best quality so I have thought about buying some type of sound machine. The audiologist has recommended one.

 

[Michael Leigh]

I struggle with setting the noise generators If I set them just below the sound of the tinnitus, should they be clearly audible in a quiet environment?

Hi @Athens.

Just set the white noise generators at a level that's comfortable for you. As long as they are not covering up your tinnitus so that it can't be heard that's fine. Take your time and read the posts that suggested to you. This will give you more understanding about tinnitus and hyperacusis. Treating hyperacusis takes time so just take things steady.

I am also concerned that if I set them just below the tinnitus (which is mostly in my left ear), it will be much louder than my present setting and cause an aggravation of the tinnitus and hyperacusis. Category 4 folks have been described as people who have worsening tinnitus and hyperacusis as a result of exposure to normal sounds during the day. This seems to be me but I know that some people describe their tinnitus and hyperacusis symptoms as far worse than mine. The term "reactive tinnitus" comes to mind but I know that there is some controversy on that issue. I listen to pink noise on my sound generators. There is an option for white noise as well but the white noise sounds like it has higher frequencies and the pink noise sounds more tolerable.

Try not to concern yourself with Category 4 or what affects other people. Just set the sound generators at a level that's comfortable for you.

The term "reactive tinnitus"

I do not believe there is such a thing as reactive tinnitus although some people do. Please do not concern yourself about this, as it really isn't important. Just keep wearing the sound generators and use a sound machine by your bedside at night. More about using a sound machine is explained in my posts. I recommend Oasis Sound Machines, model S-650 is popular. Google their website.

All the best,
Michael

 

[Athens]

If someone did not overprotect their hearing, but did not otherwise formally treat their hyperacusis and tinnitus with TRT, etc., would most people experience significant improvement with the passage of time (perhaps two to four years)?

I have read a lot of success stories from people who have not received any formal treatment but experienced significant improvement after a period of several years.

 

[Michael Leigh]

If someone did not overprotect their hearing, but did not otherwise formally treat their hyperacusis and tinnitus with TRT, etc., would most people experience significant improvement with the passage of time (perhaps two to four years)?

I have read a lot of success stories from people who have not received any formal treatment but experienced significant improvement after a period of several years.

For some people their tinnitus and hyperacusis will improve naturally and won't require any professional treatment such as CBT or TRT. Some people do require some professional help. Hyperacusis often accompanies noise induced tinnitus. These conditions take time to heal, with or without professional treatment.

My advice to you as I have suggested to many people once they start having any form of tinnitus treatment. TRT, CBT, counselling and wearing white noise generators etc. Try not to discuss the treatments you are having on social media websites. Refrain from Googling information on tinnitus. Some people believe no form of tinnitus treatment is helpful and the only thing they will accept is a treatment that completely cures tinnitus and hyperacusis. If you happen to read these posts or get into a discussion with people that have this mindset, and you're having tinnitus treatment, it can be damaging to you. Either by hindering or completely stopping you making progress with the treatment you have having.

Engage in the positive things in your life and this will help you progress and push tinnitus further into the background. More information is in my posts: The Habituation Process, Acquiring a Positive Mindset, Tinnitus, and the Negative Mindset. They are available on my started threads.

Michael

 

[Athens]

Michael Leigh,

You reference white noise in one of your responses. My sound generators give me a choice between white and pink noise. The pink noise sounds more gentle than the white noise which seems more harsh and seems to have a higher frequency/frequencies.

Is there an advantage/preference to using white noise for the sound therapy?

 

[Athens]

Hi @Athens.

Just set the white noise generators at a level that's comfortable for you. As long as they are not covering up your tinnitus so that it can't be heard that's fine. Take your time and read the posts that suggested to you. This will give you more understanding about tinnitus and hyperacusis. Treating hyperacusis takes time so just take things steady.

Try not to concern yourself with Category 4 or what affects other people. Just set the sound generators at a level that's comfortable for you.

I do not believe there is such a thing as reactive tinnitus although some people do. Please do not concern yourself about this, as it really isn't important. Just keep wearing the sound generators and use a sound machine by your bedside at night. More about using a sound machine is explained in my posts. I recommend Oasis Sound Machines, model S-650 is popular. Google their website.

All the best,
Michael

Is there a preference for white noise over pink noise in relation to the efficacy of sound therapy? I have been using the pink noise setting because it is not as high frequency and is calmer than the white noise.

 

[Michael Leigh]

Is there a preference for white noise over pink noise in relation to the efficacy of sound therapy? I have been using the pink noise setting because it is not as high frequency and is calmer than the white noise.

My opinion is there's no difference in efficacy. However, my white noise generators can play pink and white noise. Pink noise sounds a little smoother.

 

[Athens]

My opinion is there's no difference in efficacy. However, my white noise generators can play pink and white noise. Pink noise sounds a little smoother.

Thank you. My sound generators can play either pink or white noise. I have been listening to pink noise.

 

[DimLeb]

@Athens, there is no evidence that TRT and white noise generators or something actually work. If it worked, then a lot more places would offer it as a viable treatment. But they are not.

Also, if tinnitus could be "treated" with a steady stream of (white) noise, then sound therapy of any kind would reduce the ringing gradually as time passes. But that just doesn't happen. I'd say just use the sound enrichment as you'd like and be comfortable with it, even if it masks the sound. Habituation will eventually come either way.

In this time period (2 years or something) that they are saying that TRT will take effect, most people anyway get better (experiencing either a spontaneous reduction of symptoms or just habituation), with or without any treatment. I hurt myself by saying this, but there is no treatment other than coping stuff...

 

[Athens]

@Athens, there is no evidence that TRT and white noise generators or something actually work. If it worked, then a lot more places would offer it as a viable treatment. But they are not.

Also, if tinnitus could be "treated" with a steady stream of (white) noise, then sound therapy of any kind would reduce the ringing gradually as time passes. But that just doesn't happen. I'd say just use the sound enrichment as you'd like and be comfortable with it, even if it masks the sound. Habituation will eventually come either way.

In this time period (2 years or something) that they are saying that TRT will take effect, most people anyway get better (experiencing either a spontaneous reduction of symptoms or just habituation), with or without any treatment. I hurt myself by saying this, but there is no treatment other than coping stuff...

Thank you for the response. It does seem that the passage of time is the most important element in relation to improvement. How do you "habituate" to hyperacusis (if that is, in part, what you are trying to convey)?

 

[DimLeb]

@Athens, yeah time is an important part. At least in my case, I'm seeing a steadiness or even slight worsening in tinnitus unfortunately, as months go by, even without any noise exposure, but I'm less and less anxious about it, minus some days that I'm really down.

As for hyperacusis, I can't really tell as I myself have something like annoying spasm sensations deep inside the ears. Maybe that's a degree of hyperacusis, I don't know. From what I have read, hyperacusis may (or may not) go away by desensitizing the auditory system and exposing it to more and more sound. It's all up to the individual I guess, if that's going to work or not.

But I'm sure you are doing a great job going out for walks and such. Just be careful to avoid loud sounds, which is probably the only thing you can do to avoid worsenings (amongst avoiding ototoxic medication, bad diet etc etc).

 

[Athens]

@Athens, yeah time is an important part. At least in my case, I'm seeing a steadiness or even slight worsening in tinnitus unfortunately, as months go by, even without any noise exposure, but I'm less and less anxious about it, minus some days that I'm really down.

As for hyperacusis, I can't really tell as I myself have something like annoying spasm sensations deep inside the ears. Maybe that's a degree of hyperacusis, I don't know. From what I have read, hyperacusis may (or may not) go away by desensitizing the auditory system and exposing it to more and more sound. It's all up to the individual I guess, if that's going to work or not.

But I'm sure you are doing a great job going out for walks and such. Just be careful to avoid loud sounds, which is probably the only thing you can do to avoid worsenings (amongst avoiding ototoxic medication, bad diet etc etc).

How long have you had tinnitus and/or hyperacusis?

 

[DimLeb]

@Athens, since March 2021. It started as a very very slight hissing in one ear, 3 months later it mysteriously flared up with 2-3 new bilateral tones and 1 week later those subsided by 90%. Then, 1 month later the spasm thing started and tinnitus changed to a weird mid range hum with vague 2-3 (sometimes occasional) tones. All in all I'm thankful it's a mild tinnitus and easily masked by sounds, but I can hear it more pronounced when in quiet places now.

By the way, reading again your original post, all these sounds that are annoying to you (cracks on a wooden floor, keys, plastic bags etc) are what cause my ear spasm as well! Short high pitched sounds. So I guess that is a degree of hyperacusis, if it is not TTTS. But I also have no problem going out and such.

Also, maybe those meds may be the root of worsening. Xanax, Clonazepam, Mirtazapine etc are all drugs that are known to cause problems for people on this forum. And the worst thing is doctors who prescribe them rarely accept that they may worsen these conditions... They unfortunately are a double-edged sword.

 

[Athens]

@Athens, since March 2021. It started as a very very slight hissing in one ear, 3 months later it mysteriously flared up with 2-3 new bilateral tones and 1 week later those subsided by 90%. Then, 1 month later the spasm thing started and tinnitus changed to a weird mid range hum with vague 2-3 (sometimes occasional) tones. All in all I'm thankful it's a mild tinnitus and easily masked by sounds, but I can hear it more pronounced when in quiet places now.

By the way, reading again your original post, all these sounds that are annoying to you (cracks on a wooden floor, keys, plastic bags etc) are what cause my ear spasm as well! Short high pitched sounds. So I guess that is a degree of hyperacusis, if it is not TTTS. But I also have no problem going out and such.

Also, maybe those meds may be the root of worsening. Xanax, Clonazepam, Mirtazapine etc are all drugs that are known to cause problems for people on this forum. And the worst thing is doctors who prescribe them rarely accept that they may worsen these conditions... They unfortunately are a double-edged sword.

It is possible that some of those medications have caused a worsening of the hyperacusis and tinnitus. I was only taking Zolpidem when these conditions started in September of 2020. I was also taking 2.5 mg of Lexapro for approximately five (5) days prior to the onset of hyperacusis. I doubt that such a tiny dose for such a short period of time caused the hyperacusis. I believe that not protecting my hearing while playing live music for decades combined with sleep deprivation as result of a very anxious time of my life resulted in these issues coming to the surface. I have been concerned that exposing myself to normal, everyday sounds has caused a cumulative trauma to my auditory system because these issues have not improved. The only alternative is to hide inside the house and live as a hermit and severely limit myself to exposure to any sound. This is not acceptable. Although I am trying TRT and wearing above the ear sound generators, I am not very confident of the efficacy of this approach. I also wonder whether the pandemic has caused a significant increase in my anxiety and perhaps having it finally behind us will make a difference. If a person's auditory system is significantly damaged, it is hard to believe that working on reducing your anxiety, while helpful, would result in a significant reduction in the symptoms.

I have thought about staying extremely quiet for a week and seeing if this results in any improvement of the symptoms. If any person has tried this approach, please let me know.

 

[Athens]

Hi @Athens.

Sleep deprivation or unusual sleep patterns (i.e. working shifts and doing night shifts) may affect tinnitus and hyperacusis, so it is important that you can sleep well.

Diet may help, a healthy diet in general, with low sodium, avoiding junk food and alcohol. Caffeine... there are mixed results for this, if you have a look at the "caffeine" discussion on these forums. For me coffee spikes my tinnitus and green tea feels better.

As for TRT, noise generators etc... my personal opinion is that they are worthless. Try to listen to music of your choice, at home, increase the volume (if you feel comfortable with it), week after week, progressively.

Try to avoid loud noise, use earplugs if you feel uncomfortable or you feel the possibility of danger in terms of loud noise.

Give it time. It's a slow process.

Thank you for all of your responses to my various posts.

You reference that I should "give it time … it's a slow process."

In one of your other posts, you indicated that "really bad hyperacusis does not really improve but changes" (or some similar statement).

Does this mean that with time, the hyperacusis should change in a way that it is less distressing?

 

[Juan]

Does this mean that with time, the hyperacusis should change in a way that it is less distressing?

For me it changed in a way that does not produce so much anxiety, as my hearing does not amplify every single and tiny sound as much as before.

Actually, my tinnitus appeared after several years of severe hyperacusis, at the same time that extreme hyperacusis subsided and some hearing loss progressed. So I traded constant anxiety at every potentially loud sound for a bit of hearing loss, a bit of tinnitus and some hyperacusis, but no longer severe... this happened by itself, over the years..

It's only my personal experience. Maybe for other people hearing after severe hyperacusis, or after accoustic shock, evolves in a different way.

Now the problem for me are the headaches I get when I try to understand everything people say when there is a bit of background noise, or TV when it is not loud... so my main concern is hearing loss, and its social impact.

After hyperacusis improved I was able to go out more and be more or less ok at some places.. quiet restaurants, and I am able to do many things wearing earplugs (for fear of very loud sounds and also because I get hearing fatigue if exposed to constant sound for a long time...)