If Hearing Damage Is 'Permanent', How Does Anyone's Tinnitus and Hyperacusis Ever Improve?

I have read online that hearing damage is irreversible... I understand this in terms of hearing loss and hence why people would need hearing aids etc. in future.

However, if hearing damage is really 'permanent', then how do people with tinnitus ever feel a reduction or complete absence of symptoms in time?

Also, in relation to hyperacusis, how do people ever feel better or not get worse? I have found cases where people improve by a certain percentage or even fully, resuming a normal life.

What is happening on a biological level? Does anyone know? How does anyone ever heal or recover from hair cell death etc. after an acoustic shock/trauma or some sort of other ailment causing their ear issues?

Any thoughts?

Thank you,
GG

 

It's a long and drawn out topic that even the scientists don't full understand - but they're closer than ever. It's because tinnitus and hyperacusis are coming from the brain and the damage to the auditory system was the match that lit the tinder, the tinder being maladaptive neuroplasticity. So you end up in a state with neurons misfiring in the DCN and other changes to the brain. Something called a potassium channel which effectively controls the rate of firing stops functioning as it should do and doesn't dampen the erratic neurons (which are causing the tinnitus signal) as they normally would be. Not the most scientific explanation but this is close to what the most up to date research suggests.

It's also the reason some people get hearing damage but no tinnitus, they damage their ears but their brain doesn't go through the maladaptive process as outlined above.

Unfortunately we fall into the first category. Why some get better? It's all speculation I guess. Neurons naturally dampen down over time? Potassium channels begin functioning again as they should? Who knows?

I remember a neurologist I was under for something else once said the brain is continuously in a state of flux both chemically and organically.

 

I have no detectable hearing loss on a standard audiogram and still have tinnitus, but it didn't occur until I took Escitalopram for anxiety... To further support what @Cmspgran is saying, I am guessing it messed up the neuroplasticity in my brain so things are no long working the way they should.

 

Amazing that you could get tinnitus after just two doses of 10 mg Escitalopram and that it didn't go away when you discontinued taking it after the 3rd dose, but then again, I've seen someone mention getting severe tinnitus after just a single dose of Buspirone, and it didn't go away upon discontinuing it.

 

Who knows. Maybe it was always going to happen and the Escitalopram was just the trigger... I have no idea. The timing is curious. It's the only thing I can definitely associate it with because I had no other issues with my hearing up until that point. I can tell you that after taking it I felt absolutely horrid, I had no energy, but I figured it was a normal side effect...

 

Here's a paper that explains why you get tinnitus when you take SSRIs:

Serotonergic Regulation of Excitability of Principal Cells of the Dorsal Cochlear Nucleus

TL;DR: through HCN channels, serotonin excites the fusiform cells in the coclear nucleus.

HCN blockers solved the problem.

I hope opening potassium channels could reverse the changes as nothing is broken inside. Let's see.

 

True, hyperacusis does not improve. It just changes or morphs into other hearing conditions. Thus, severe hyperacusis may turn into a combination of less hyperacusis, recruitment, tinnitus and hearing loss.

One can live with hearing loss, depending on the frequencies affected. The most important frequencies are those in the conversational range. All the other frequencies - in functional terms - are more or less irrelevant (except in situations with background noise, overlapping sounds etc., i.e. in complex hearing conditions). Those other frequencies just enhance the beauty of sound, music, etc.

 

Is this your own hypothesis? Or have you read that in some reliable source?

I would rather have some hearing loss than my current sound distortions and hyperacusis. You say it doesn't improve, but I'm holding out for 'morphing' so.

 

It's my life experience. I have lived it.

 

My hyperacusis absolutely improved to the point where I am mildly sensitive to really loud sounds, over amped movie theater, construction noise, etc. But, I would say it took from one to two years to become 95% better.

I had absolutely catastrophic hyperacusis and tinnitus 11 years ago. Now the tinnitus varies between moderate to severe (as I was exposed to a fire alarm a year ago).

The hyperacusis, as I said, is almost entirely gone, even with the exposure and spike. It did cause dyacusis (if i'm using the term correctly, distortion of some sounds). But most of that has also faded.

I have mild to moderate loss in the upper frequencies. I have hearing aids with built-in pink noise, but I really don't need them to function. When I do wear them, I'm aware of some higher pitched sounds that I ordinarily might miss.

 

Me too.

 

Do you have any significant hearing loss yet?

 

No, I didn't have any hearing loss when I got my hearing tested in August. Since June I have been experiencing sound distortions, and since September some pain hyperacusis.

I've had tinnitus permanently since 2019, but it never really affected my quality of life. My baseline tinnitus is thankfully (touch wood) still quite manageable.

But yes, I was just saying I think I'd rather have some hearing loss instead of my new sounds distortions and hyperacusis. It's really affecting my life. I am mostly stuck at home, have to wear earplugs in public and can't socialise with more than one person comfortably... and all my favourite places like restaurants and cafes etc. are now off the cards... it sucks.

 

I felt the same regarding hearing loss vs. new sounds and hyperacusis, until my hearing loss threshold lowered below my tinnitus frequency and blocking it out via a sound machine or other natural sounds no longer worked.

Be careful what you wish for as wishes may come true.

 

Oh wow, gosh, I never thought of this! It's all so new to me and I don't fully understand the domino effect different hearing changes can have. OK, well, I just pray for general quality of life improvement, whatever way that may come.

Wishing you the same. Take care.

 

@GG_Ear, I had very minute, almost negligible, tinnitus for 3 years prior to my acoustic event. I'm not sure if it was the event and meds together, but a significant change happened in October 2020. I have had hyperacusis and intrusive tinnitus for the last 3 years. I do not think the hyperacusis and tinnitus change per se, but a person's tolerance changes. If I'm very tired, sick or need sleep, both worsen. I think of it, as we say in education, as circumlocution. It's a work around. The brain learns to focus more on life again and less on the circumstances with auditory processing. I teach a 3 hour college class with earplugs in. The ambient sound and student's questions are dampened, but I've gotten used to it.

 

Thank you, your story is very encouraging.

The only thing that really bothers me about wearing earplugs in public is that it makes it hard to communicate; when I talk with earplugs I hear a whistle in my right ear over every word. This also happens without earplugs in but to a much lesser degree and only if I were to raise my voice.

I don't know what's wrong with my ear. It's been like this since the end of June this year. I hope it goes away eventually...

 

That is amazing!

Can your students see your earplugs?

What type of earplugs do you use?

Do you need to ask your students to 'speak up' regularly?

 

Oh man, that does sound annoying. It may be the occlusion effect enhancing your voice and thus the whistle. Not sure how new you are to this, but you can sometimes find earplugs that get deep enough or are soft enough that your voice isn't as loud. I use Earasers, they soften the highs from outside but don't boost the voice near as much as other earplugs or musician earplugs. Everyone is different, it depends on the shape of your ear. They're also pretty invisible in the smaller sizes.

Do you not get that whistle from other people talking loud as well?

I get that whistle/robot effect from other people's voices getting loud but not my own.

As in your tinnitus got worse/unmaskable with the hearing loss threshold lowering?

 

Yes, my tinnitus has gotten worse, but it is hard to say if it is due to my lower hearing loss threshold. Could be, might be or not at all due to the threshold shift.

 

Thank you for the suggestion, I will try the Earasers earplugs. I think it must be the occlusion causing my own voice to trigger the whistle. It does happen when other people talk too, but only when they raise their voices and it seems to be the higher resonant parts of speech. My whistle reacts to a lot of other things too... loud footsteps, doors closing, dogs barking, cars passing me on street, certain objects clacking... I dunno, it's all so odd!

P.S. After a medical appointment yesterday I found out that my Eustachian tubes are completely dysfunctional. So yay!

 

Did they offer anything as treatment?

 

I went to see an audiological scientist/doctor and he did some probing tests on my ears and discovered that my Eustachian tubes are not opening or closing correctly at the right times.

So the audiologist will send a report to my ENT consultant. He just said to get the Eustachian tubes fixed first, and then, once they are fixed and if I still don't feel improvement in hyperacusis, to come back to him for sound therapy....

So I guess I will have to wait and see what my ENT decides to recommend for my Eustachian tubes. I suppose it depends on the cause. If it's allergies or something else causing the dysfunction...

I am also booked in to see a jaw specialist. I'll ask him if my jaw muscle tension and limited mouth opening can be treated to help muscles that control the Eustachian tubes function better (tensor veli palatini, levator veli palatini, salpingopharyngeus, and tensor tympani.) I'll see what he recommends as well.

Thank you for taking an interest in my case.

 

When I go to different websites like the University of California, the Cleveland Clinic etc, they talk about counseling and behavioral therapy, mostly by focusing on changing on how we react to hyperacusis. Most mention that there is not a known test for diagnosing it, and that it's patient reported.

In at least 2 cases I know of it did get "better". The first case was a nurse in the office of the quack doctor who was responsible for giving me tinnitus by keeping me on antibiotics even though I was telling him the ringing in my ears was driving me crazy. That nurse, who was the only person in that office who had any empathy for tinnitus sufferers, mentioned that she had once come down w/ tinnitus, and the hyperacusis that came w/ it made it impossible to even go into any restaurant w/ an open kitchen. The clattering of the plates was a nightmare for her. Fortunately hers went away. Whether it stayed away or not, I don't know.

The second case was me. When I first got tinnitus, nearly every sound was unbearable. Sitting in a Portland bus shelter one day, a bus roared by and the sound echoing off the building on each side and reverberating in that shelter had me contemplating suicide. I was very close to throwing myself under the next bus that came. Over time I learned to mask my tinnitus to a degree at my home w/ different things, and avoided anything that produced loud sounds. Whether or not my hyperacusis actually got better or I kinda habituated to it is anyone's guess. There are times when I've had to move because of things like loud dog barking or loud unexpected thumps from upstairs, so now I know that I need a quiet environment. The severe panic of hyperacusis has been replaced w/ making sure I get out of a bad situation as fast as possible. That panic has been reduced, now that I'm aware that I have some control over my environment.

 

I'm not sure if my students can see my earplugs because my hair is pretty long and covers my ears. When it is hot I wear my hair pulled back. I have a habit of tightening or adjusting them, so that's when they would notice. They have never mentioned it to me. I use clear musician's earplugs. I was fitted for them with molds by the audiologist at my doctor's office. I do ask students to speak up, but I think that is because they do not speak clearly or in a speaking voice. They tend to mumble and say things under their breath. I have a student who is an older mom and I hear her just fine. I tell them at the first of the semester that I have hearing issues. Usually, if they use a speaking voice I can hear them.

It is the strangest thing I've ever experienced. In May of 2023 I had the same thing. I heard a whistle when my son or I would speak. When my husband spoke, I did not hear the whistle. I went to my PCP and he prescribed antibiotics and a steroid pack. I completed both. I also took turmeric and tart cherry to reduce inflammation. I got more sleep, tried to lessen stress and I took an additive free antihistamine. The brand is called Genexa, it's dye and preservative free. The whistle went away. I also reduced dairy and added more vegetables to every meal.

Best to you, I hope it improves.

 

Thank you for all those tips! I will definitely try to reduce inflammation and consider an antihistamine. I'll mention the idea of steroids to my ENT, hopefully I won't need antibiotics.

How long did it take for your whistle to go away? That's crazy that your husband's voice didn't cause it... maybe it was frequency related

Thank you, so do I!

 

Yes, I have that exact sample whistle reacting mostly to those things you mentioned. I can count at least 6 friends who do as well. It's almost like a distortion of that frequency (usually around 2 kHz) at mid high volumes.

When it comes to resonances and distortions, it seems like there are two types, the type that happen over everything even at low volume - and this, which is far more livable as it only happens at higher volume ranges. Maybe they are caused by the same thing but they seem to work differently.

A hyperacusis expert once told me those types of distortion are likely muscular and that's why it feels/sounds more like resonance of the eardrum but nobody knows for sure.

All these people I know live with it pretty well, and you stop focusing on it after a while. Just try to get the right earplug situation and hopefully that'll get it down in those situations. Really you may have to try like 4-5 types.

 

I'm just looking at the Earasers online store now. I'm torn between the musician's earplugs or the noise sensitivity earplugs. Which ones do you use?

I won't be going to any concerts or loud bars/nightclubs... Just want to be able to tolerate restaurants/cafes and have conversations with people raising their voices.

 

Nobody knows, but there are many examples of hearing coming back 1+ year later - like this guy below. The audiograms speak for themselves:

Both My Hearing Loss and Tinnitus (Almost) Cured — Caused by .223 Sniper Rifle Fired Near My Ear | Tinnitus Talk Support Forum