Perhaps a Lot of People Here Have Acoustic Shock Disorder...

[Vinnitus]

I've come across an article which states the characteristics of Acoustic Shock Disorder (ASD). ASD differs from Acoustic Trauma in the sense that no sensorineural hearing loss is present or detected, yet the following symptoms show up.

• Headache (not for me)
• Tinnitus (check)
• Ear pain (check)
• Nausea (not for me)
• Jaw and neck pain (check)
• A hollow feeling or fluttering noises in the ear (check)
• Poor balance (check)
• Anxiety (check)
• Hypersensitivity (check)
• Fatigue (check)
• Hot flushes in the face near the ear or in the ear canal (check)
• Persistent aural fullness/pressure changes (check)

Acoustic Shock Disorder appears to be a pathology of the middle ear, involving the middle-ear muscles being in shock due to a high-intensity sudden noise exposure (often involving the tensor tympani muscle). I have been to a concert which wasn't too loud in my experience (we were able to talk normally), but there was a moment where the microphone produced a loud feedback sound causing a lot of people to reach for their ears in agony. I think that was the moment sparking the onset of my current symptoms. I am however not sure if the tensor tympani muscle (or the stapedius muscle for that matter) is able to produce the electric fizzle I currently hear (it sounds like an inconsistent hiss sometimes having qualities of short tones, resembling electric activity). I'm now considering three origins for my symptoms:

• High-frequency hearing loss
• Hidden hearing loss
• ASD

Could it be that a lot of people here, without measurable sensorineural hearing loss, are experiencing the consequences of ASD rather than Tinnitus caused by inner-ear pathology? Did anyone consider this? Thoughts?

http://www.audiologyonline.com/articles/acoustic-shock-injury-real-or-1172

http://www.dineenwestcottmoore.com.au/uploads/ASD_TTTS_guide_medical_professionals.pdf

 

[stophiss]

Brilliant post Vinny.
I have most of those characteristics tho no headache...no nausea...my balance is pretty good nor hot flashes I recall.
I have intermittent right ear flutter and other symptoms however.

I don't recall a loud noise that precipitated my tinnitus...no instant traumatic shock I can recall…just a life long of probably too high a sound level.

I will further posit that most of my tinnitus is in my left ear. When talking on my cell phone, my right ear does hear better…not a huge difference but notable…so believe I have high frequency hearing loss in my left ear which maybe the culprit for my predominantly left ear tinnitus.

Great post thanks.

 

[Jomo]

So does that mean there is a way to treat this?

 

[SilverSpiral]

Yeah, is the prognosis any better with ASD? Does it mean your T might go away? Or does it just mean in addition to the T and H you have a bunch of other crap to deal with.

 

[Vinnitus]

Yeah, is the prognosis any better with ASD?

Not necessarily.

Does it mean your T might go away? Or does it just mean in addition to the T and H you have a bunch of other crap to deal with.

I would say both are possible. The symptoms of Acoustic Shock (AS) seem to (generally) lessen with time, but for some people it can also be very persistent, requiring the cutting of the tensor tympani muscle in an attempt to alleviate their symptoms. Persistent symptoms are referred to as Acoustic Shock Disorder (ASD).

I am not sure how often the cutting of the tensor tympani muscle actually takes place. A lot of clinicians aren't brave enough to venture past the eardrum into the land of the arcane magic of the middle- and inner-ear. It is like there is a "here be dragons" note pinned on the outside of the eardrum.

More interestingly, this might explain why a lot of Tinnitus sufferers experience aural fullness, hyperacusis and other symptoms primarily in the first few months after a noise incident. They might experience the transient symptoms of AS (so not ASD), after which they are left with either their Tinnitus from (hidden) hearing loss (the new baseline), or their Tinnitus disappears if no inner-ear damage took place. Some people report a lowering of their Tinnitus after some time (months to years), the alleviation of Acoustic Shock could explain that (middle-ear tinnitus disappears; inner-ear Tinnitus is left). Hyperacusis in turn could also be caused in the middle-ear, if the muscle-spasms "amplify" the sound and relay it to the inner-ear with greater force than the actual force of the incoming sound waves. The spasms of the muscles might increase upon incoming sounds (perhaps a neurological effect of anxiety), giving the sensations of hyperacusis and/or reactive Tinnitus.

I think this might have happened during my first Tinnitus episode after a fireworks explosion; the noise was loud but too short to inflict permanent inner-ear damage. The Tinnitus I experienced could very well have been due to Acoustic Shock, after which things normalized in a course of about three months. Having inflicted no inner-ear damage, the Tinnitus and other symptoms disappeared altogether. Similarly, this might be the case for a lot of people here whom "disappear" from the board after a while.

One could develop Acoustic Shock Disorder, though. This might be equally persistent as Tinnitus of any other origin and apparently comes with a plethora of other symptoms. I am however wondering if the middle-ear is able to produce (constant) high-pitched sounds or electric fizzle, as usually the characteristic sound of TTTS is referred to as "fluttering" or other intermittent sounds. I am also wondering if "pure" inner-ear damage is able to produce symptoms like aural fullness, jaw pains, eustachian tube blockage, ear pain, poor balance, etc. One could argue Tinnitus with an origin in the middle-ear might be easier to treat than an origin in the pea-sized inner-ear, but I am not sure if that's entirely the case.

Unfortunately, there doesn't seem to be a lot of research in that area, so there's a lot of speculation here. Perhaps the middle-ear is more involved in our symptoms than we think or are able to measure and our symptoms are a collaboration of both middle- and inner-ear.

 

[SilverSpiral]

Not necessarily.



I would say both are possible. The symptoms of Acoustic Shock (AS) seem to (generally) lessen with time, but for some people it can also be very persistent, requiring the cutting of the tensor tympani muscle in an attempt to alleviate their symptoms. Persistent symptoms are referred to as Acoustic Shock Disorder (ASD).

I am not sure how often the cutting of the tensor tympani muscle actually takes place. A lot of clinicians aren't brave enough to venture past the eardrum into the land of the arcane magic of the middle- and inner-ear. It is like there is a "here be dragons" note pinned on the outside of the eardrum.

More interestingly, this might explain why a lot of Tinnitus sufferers experience aural fullness, hyperacusis and other symptoms primarily in the first few months after a noise incident. They might experience the transient symptoms of AS (so not ASD), after which they are left with either their Tinnitus from (hidden) hearing loss (the new baseline), or their Tinnitus disappears if no inner-ear damage took place. Some people report a lowering of their Tinnitus after some time (months to years), the alleviation of Acoustic Shock could explain that (middle-ear tinnitus disappears; inner-ear Tinnitus is left). Hyperacusis in turn could also be caused in the middle-ear, if the muscle-spasms "amplify" the sound and relay it to the inner-ear with greater force than the actual force of the incoming sound waves. The spasms of the muscles might increase upon incoming sounds (perhaps a neurological effect of anxiety), giving the sensations of hyperacusis and/or reactive Tinnitus.

I think this might have happened during my first Tinnitus episode after a fireworks explosion; the noise was loud but too short to inflict permanent inner-ear damage. The Tinnitus I experienced could very well have been due to Acoustic Shock, after which things normalized in a course of about three months. Having inflicted no inner-ear damage, the Tinnitus and other symptoms disappeared altogether. Similarly, this might be the case for a lot of people here whom "disappear" from the board after a while.

One could develop Acoustic Shock Disorder, though. This might be equally persistent as Tinnitus of any other origin and apparently comes with a plethora of other symptoms. I am however wondering if the middle-ear is able to produce (constant) high-pitched sounds or electric fizzle, as usually the characteristic sound of TTTS is referred to as "fluttering" or other intermittent sounds. I am also wondering if "pure" inner-ear damage is able to produce symptoms like aural fullness, jaw pains, eustachian tube blockage, ear pain, poor balance, etc. One could argue Tinnitus with an origin in the middle-ear might be easier to treat than an origin in the snail-sized inner-ear, but I am not sure if that's entirely the case.

Unfortunately, there doesn't seem to be a lot of research in that area, so there's a lot of speculation here. Perhaps the middle-ear is more involved in our symptoms than we think or are able to measure and our symptoms are a collaboration of both middle- and inner-ear.

I definitely have "fullness" though I tend to describe it more as "heaviness" in my most affected ear.
I was told specifically by one ENT that the sensation is fullness is how the body/brain interprets damage to the cochlea, and that it does not indicate an actual change in pressure of the middle ear. He was the only ENT I ever spoke to who actually had much of anything to say about T and H following acoustic trauma. He seemed quite knowledgeable on the issue, although of course, offering no treatment.

 

[lapidus]

This looks like a thread for @japongus

 

[Vinnitus]

I definitely have "fullness" though I tend to describe it more as "heaviness" in my most affected ear.
I was told specifically by one ENT that the sensation is fullness is how the body/brain interprets damage to the cochlea, and that it does not indicate an actual change in pressure of the middle ear. He was the only ENT I ever spoke to who actually had much of anything to say about T and H following acoustic trauma. He seemed quite knowledgeable on the issue, although of course, offering no treatment.

I see, that could very well be. From what I read about AS(D), the symptoms are some kind of neurological response to a noise insult. I am however not sure if there is no actual pressure change in the middle ear, or that its so subtle we are just not able to measure it properly (some ENTs don't even take the effort to further investigate, unfortunately). The sometimes violent ear popping makes you think something is going on in there though.

 

[SilverSpiral]

I see, that could very well be. From what I read about AS(D), the symptoms are some kind of neurological response to a noise insult. I am however not sure if there is no actual pressure change in the middle ear, or that its so subtle we are just not able to measure it properly (some ENTs don't even take the effort to further investigate, unfortunately). The sometimes violent ear popping makes you think something is going on in there though.

Yeah, the ear popping stuff some people get is definitely something beyond cochlear damage. Surely that has to do with the tensor tympani/stapedial muscles. I don't get that unless it's really annoying sounds like dishes.

 

[Vinnitus]

Yeah, the ear popping stuff some people get is definitely something beyond cochlear damage. Surely that has to do with the tensor tympani/stapedial muscles. I don't get that unless it's really annoying sounds like dishes.

Yes, the noise insult seems to cause some kind of neurological anxiety/stress response, causing the middle-ear muscles to involuntarily contract and spasm in anticipation of new potential loud noise. In that sense it is some kind of post-traumatic stress. This is controlled by the autonomous nervous system and hence we have no direct control over it. The recommended therapy for hyperacusis seems to focus on "desensitizing" and "normalizing" this response, which seems to make sense in that case. In Acoustic Shock Disorder (ASD), the symptoms and thus the hyperacusis might be more permanent and not responsive to such kind of treatment.

Furthermore, it's logical to assume that spasms in the middle-ear muscles cause pressure changes in the middle ear and that these are real.

 

[SilverSpiral]

Yes, the noise insult seems to cause some kind of neurological anxiety/stress response, causing the middle-ear muscles to involuntarily contract and spasm in anticipation of new potential loud noise. In that sense it is some kind of post-traumatic stress. This is controlled by the autonomous nervous system and hence we have no direct control over it. The recommended therapy for hyperacusis seems to focus on "desensitizing" and "normalizing" this response, which seems to make sense in that case. In Acoustic Shock Disorder (ASD), the symptoms and thus the hyperacusis might be more permanent and not responsive to such kind of treatment.

Furthermore, it's logical to assume that spasms in the middle-ear muscles cause pressure changes in the middle ear and that these are real.

I don't think hyperacusis is best treated by desensitizing or normalizing hearing. I think this is what professionals say when they have no knowledge of the cause of hyperacusis and can offer no real treatment. I think hyperacusis may be a completely natural result of damaged hearing, and that pushing a patient to "normalize" or "desensitize" themselves may lead them to further damage, or otherwise just suffering. At least that's what I gather from many of the posts on this board.

What is even more rediculous is that some professionals will assume a "normal" 8k audiologist test is indication that no hearing damage has occurred, and that they should "live a normal life", and this may not end so well in my opinion. I think we all know that a normal 8k test can not and in most cases does not diagnose all possible hearing issues.

 

[Vinnitus]

I don't think hyperacusis is best treated by desensitizing or normalizing hearing. I think this is what professionals say when they have no knowledge of the cause of hyperacusis and can offer no real treatment. I think hyperacusis may be a completely natural result of damaged hearing, and that pushing a patient to "normalize" or "desensitize" themselves may lead them to further damage, or otherwise just suffering. At least that's what I gather from many of the posts on this board.

Couldn't it be a combination of things, where the "desensitizing" actually treats the neurological (middle-ear) effects yet the inner-ear/brain issues remain? I agree that we know too little about the inner-ear and the brain processing of sound to exclude that hyperacusis might happen there as well and what the exact mechanism is.

What is even more rediculous is that some professionals will assume a "normal" 8k audiologist test is indication that no hearing damage has occurred, and that they should "live a normal life", and this may not end so well in my opinion. I think we all know that a normal 8k test can not and in most cases does not diagnose all possible hearing issues.

I fully agree with this. In fact, I'm for abolishing the audiogram altogether as soon as a more accurate way of measurement comes along. The way of measurement is too crude to really tell anything. Even if you take a full-spectrum audiogram (25hz-20khz), there are still a lot of frequencies in between which aren't measured. Next to that there's hidden hearing loss (cochlear synaptopathy) which isn't measured at all with this test. It's no more than a (very) rough indication for a very detailed organ as the inner-ear.

 

[SilverSpiral]

Couldn't it be a combination of things, where the "desensitizing" actually treats the neurological (middle-ear) effects yet the inner-ear/brain issues remain? I agree that we know too little about the inner-ear and the brain processing of sound to exclude that hyperacusis might happen there as well and what the exact mechanism is.

What do you mean by neurological (middle-ear) effects? I'm basically just afraid that if a person develops their symptoms as a result of acoustic trauma, they are vulnerable to worsening their symptoms through sound exposure. I think that a person with hearing trauma may have physically lowered defences to sound exposure, and there doesn't seem to be any way of detecting what level of sound they can safely be exposed to, especially since there still isn't a way to diagnose the nature and extent of the damage.

Obviously if ones life is severely affected by their hyperacusis, they will have to risk sound exposure to get a certain quality of life back, and ultimately monitor their symptoms and sound exposure and see what extent they can handle without their symptoms worsening, or perhaps temporarily worsening versus permanently, but again, this does seem like a bit of a risky game to play, and again there are no scientific tests to help them out with this.

The standard yeah you're fine just use protection over 90db and you'll be fine, doesn't seem like a one size fits all solution, and that is what most people are handed.

 

[japongus]

The middle ear was the topic of my argument this past few weeks over at chat-h with the likes of Rob. Turns out the great guru of sound therapy, Jastreboff, doesn't know jack shit about the middle ear. And it turns out that the middle ear can indeed be causing all our issues, while we were preached to about how it was all just a brain thing.

 

[GregCA]

The middle ear was the topic of my argument this past few weeks over at chat-h with the likes of Rob. Turns out the great guru of sound therapy, Jastreboff, doesn't know jack shit about the middle ear. And it turns out that the middle ear can indeed be causing all our issues, while we were preached to about how it was all just a brain thing.

FWIW, after my stapedotomy, which is a middle ear surgery, my horrible H got much much better, to the point that it only flares up rarely now.

 

[japongus]

FWIW, after my stapedotomy, which is a middle ear surgery, my horrible H got much much better, to the point that it only flares up rarely now.

As there's so much history of doctors saying it's all just anxiety, when I convinced someone to do reinforcement (but I didn't follow through) he said it worked because of a central gain mechanism, he was clinging onto all the Jastreboff that's gotten grilled into the community. But of course, H can initiate and form a chain reaction that commences in the middle ear. And so in the H sufferers on facebook group, we have a woman who claims Silverstein is working on a tool to measure stapes mobility as he thinks excessive mobility could be what's behind H.

Which of these symptoms did your H consist of?

Tickle, Pressure
Itch Sharp Ache
Sting Burning in back of ear
Tingling or Numbness like when foot "goes to sleep." Pushing inside the ear
Drilling, Probing, or Pinching in back of the ear Diving into deep water
Flutter, Vertigo
Going under water, Nausea

 

[japongus]

Couldn't it be a combination of things, where the "desensitizing" actually treats the neurological (middle-ear) effects yet the inner-ear/brain issues remain? I agree that we know too little about the inner-ear and the brain processing of sound to exclude that hyperacusis might happen there as well and what the exact mechanism is.



I fully agree with this. In fact, I'm for abolishing the audiogram altogether as soon as a more accurate way of measurement comes along. The way of measurement is too crude to really tell anything. Even if you take a full-spectrum audiogram (25hz-20khz), there are still a lot of frequencies in between which aren't measured. Next to that there's hidden hearing loss (cochlear synaptopathy) which isn't measured at all with this test. It's no more than a (very) rough indication for a very detailed organ as the inner-ear.

Fuck the inner ear. I have vibrations with all sound and I can't be in a block of flats because some schmuck walking 5 floors away makes my ears vibrate, and not once in a decade and a half of this bs have I had vertigo.

The audiogram is used to discard inner ear issues, but Jastreboff made an ass of himself by using it to disprove middle ear issue. He used pointless tympanogram, pointless LDL, and pointless audiogram. All Sismanis had to do was fart and J's theory went up the shaft.

 

[japongus]

The standard yeah you're fine just use protection over 90db and you'll be fine, doesn't seem like a one size fits all solution, and that is what most people are handed.

But that's a lie though. Sound therapy logic doesn't admit to damage to the middle ear because it's a colossal bluff, and it is perfectly fine with exposing the patient to decibels at 90db and over.

Effusion causing middle otalgia, or air bubbles from eustachian tube dysfunction are rumored to cause sound sensitivity. They used to do experiments with cats fill them up with otalgia then chop their heads off and examine the ear, and there was damage to the middle ear muscle fibers, compared to dead cats without otalgia. The sensitization epidemic is just a ruse.

 

[wags]

Interesting anecdote, but I recently went through a bout of acoustic trauma, an increase in tinnitus, and a retracted ear drum in my left ear.

However, this thread sparked my interest because I'm able to flex my tensor tympani muscles. After my incident, however, I cannot flex my left tensor tympani. The rumble only happens on my right ear now.

Perhaps this is related? I also feel my tensor tympani flex at high pitches noises, some weird things I'm not used to. If I brought this up to my ENT, would he know what I'm talking about?

 

[japongus]

FWIW, after my stapedotomy, which is a middle ear surgery, my horrible H got much much better, to the point that it only flares up rarely now.

In addition to my above question, what kind of hearing loss did you have before the stapedotomy and how much did it improve after the op?

Hearing loss is the reason doctors give for why stapedotomy sometimes works for tinnitus, but they look to the brain instead of the middle ear for the reason, because most were taught LDLs, audiograms and impedance testing disproved issues in the middle ear. But that's wrong.

 

[GregCA]

Which of these symptoms did your H consist of?

Tickle, Pressure
Itch Sharp Ache
Sting Burning in back of ear
Tingling or Numbness like when foot "goes to sleep." Pushing inside the ear
Drilling, Probing, or Pinching in back of the ear Diving into deep water
Flutter, Vertigo
Going under water, Nausea

I'm not sure it would fit any of these. My ear would essentially crackle in a very uncomfortable way (as in, painful to hear) when I would do things such as: crumple paper, type on my keyboard, or talk. It would be uncomfortable enough for me to have to stop talking or typing, and stay away from social activities for a while.

Also when I would tilt the head a certain way, it would kind of "open the window to H" - and I experimented a lot with it so I could give my neurotologist a lot of data: I'd get close to a faucet, then I'd be ok, tilt the head and bam. What he said is that the movement of the head makes some ligaments get tense (because of the pulling) in the middle ear and can lead to this reaction.

 

[GregCA]

In addition to my above question, what kind of hearing loss did you have before the stapedotomy and how much did it improve after the op?

I had mixed hearing loss unfortunately (both conductive and sensorineural). The surgery did a reasonable job at closing the air-bone gap, so I'm left with sensorineural losses mostly.
The before & after tinnitus is different too. Some rumble is gone, but the high pitch buzzing is still there, and in some ways got progressively worse, which is probably due to the disease making more progress in the inner ear (the post audiogram shows a worsening of the hearing in the high frequencies).

 

[Jeff Hudson]

Hello and thank you for including me in the forum. Ever since I used a loud air compressor to fill my car tire, I've had tinnitus and some deafness in my left ear....it's been about 2 months now. I used a sound meter the same week to measure the volume of sound of the compressor at the approx distance that my ear had been...granted that I had ear protection the time I tested the volume level. I measured around 100-110 decibels.

After having 3 bouts of vertigo and nausea....no headaches or earaches, now I just have the "electric hissing" going on.

The ENT thinks it's a virus in the inner ear. I'm thinking it's ASD. Doctor put me on prednisone and motion sickness meds. I'm now weaned off of those meds, but I still have the "electric hissing" sound in my left ear....with occasional "spike" sounds. I've since learned that a cranial massage therapist is nearby and I have an appointment with her this week. Will keep you informed.

 

[GSC]

Interesting...