Protecting? Overprotecting? Not Protecting?

I noticed that there are "two schools" on this forum.

 

Diagnosed with my sudden ‘Sensorineural Hearing Loss’ 4 months back (including Tinnitus). It has taken me 3 months to work out that the advice of my specialists and GPs re habituating’ is only a small
part of helping myself. I’ve gradually realised that if I don’t ‘protect’ my ears from what is commonly NOT considered ‘loud’ by others, then the Tinnitus aspect of my hearing disorder punishes me for it. I’ve only recently worked out for myself that the main aspect of my ‘hearing loss’ - Hyperacusis needs to be given a lot of respect. If not, the Tinnitus (low-level humming in my case) definitely worsens. Wish they’d told me this months back.

 

I thought you might find this interesting:

" Nevertheless, cochlear suppression in humans via chronic ear plugging has been shown to cause tinnitus [14]."
​

Ear plugging is also mentioned a couple of times in Box 1 of the 'An Integrative Tinnitus Model Based on Sensory Precision' study.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152595/

 

There are "two schools" because the so-called experts can't give us any factual information, so we are left to form our own theories.

 

This has nothing to do with me or what I have ever advocated, though. "Chronic ear plugging" sounds like wearing earplugs 24/7. I've never done that.

After I had protected my ears whenever the sound made me uncomfortable, now very few sounds make me uncomfortable. The shower no longer sounds uncomfortable to me, and I no longer use earplugs in the shower. I am convinced that had I not protected my ears, I would still be getting spikes after a shower.

 

On the contrary, this has everything to do with you and the “advice” you give to others with regards to hearing protection. All the “mini” acu trauma, or “mini” acu shocks nonsense. It either is acoustic trauma or it isn’t. I’m one of those who followed your “advice” rigorously and in good faith. Utilizing double protection (as you put it) wherever I could, and I only kept getting worse. This is a health forum, and a lot of folks come here in great distress seeking help and support so it’s easy to fall prey to dangerous advice. As if tinnitus wasn’t bad enough, fighting severe hyperacusis/phonophobia alongside is a no joke. Not to mention your advocasy of popping Prednisone pills after being exposed to moderate noise levels (even at the cost of lying to your own physician). When I showed some of your posts later to army doctors, both an otologist and audiologist were shocked. I know you mean well, and I think you’re genuinely trying to help here but you got it wrong. More experienced members on this site have tried to explain the concept of hearing protection to you in the past.

Of course not. 24/7 earplugs in is like the most extreme case of ear protecting.

 

@Elfin

Read this and please understand that double protecting all day is destroying your life. I’m not sure how else I can help you but this post hits the nail on the head and it’s what I’ve been telling you for the past year.

 

Have you read the footnoted article that sentence references?

Reversible induction of phantom auditory sensations through simulated unilateral hearing loss

The study involved 18 participants who wore an earplug specifically designed to simulate hearing loss at certain frequencies for one week. By the end, 11 had tinnitus corresponding to the frequencies attenuated by the earplug. For all of them, the tinnitus disappeared completely when the earplug was removed.

This does not seem to be evidence of danger associated with earplug use (at least in terms of an effect that would persist after removing them). It is interesting though that hearing loss-induced tinnitus can be simulated in that way.

 

Yes, I have read it. In fact, we even talked to Roland Schaette at UCL who wrote that paper.

In the study that I have posted they also mention that mechanisms underlying tinnitus are incompletely understood, so it is difficult to speak about rock solid evidence here.

I think by protecting at this level you may be unintentionally simulating in a way conditions similar to those of the anechoic chamber. It has been shown that about 94% of healthy test subjects started to hear tinnitus whilst in that chamber. Now imagine you’re a tinnitus patient already and you keep ear plugging and slipping those safety earmuffs on for months to no end. Who knows what then goes haywire where in your system?

 

See, most people (including myself) get better when they protect their ears. If you don't get better, of course you ought to try the other way. Some of the people who will try the other way, will get even worse. Some people get worse no matter what they do. If I remember correctly, you mentioned that despite you attempting to protect your ears, you still got exposed to multiple loud noises that at the time made your T worse. It is possible that you got worse as a result of your inability to fully protect yourself, and not because you had been protecting yourself.

It is all about how we define "moderate". I had advocated taking Prednisone if one actually gets a T spike or gets ear fullness. If the noise had caused a change in your condition, it wasn't that moderate, was it?

Now show them the posts of the people who followed doctors' advice (or got tests that the doctors told them to get) and ended up regretting it.
Show them the first post in
https://www.tinnitustalk.com/threads/learn-from-others-mistakes.29437/
Are they even more shocked now?

We will have to agree to disagree.

 

You make it sound like T Began as a Result of them being in the chamber. In fact, their T was there all along but so quiet that they were able to notice it only when all other noise was gone. As soon as one inserts earplugs, one can hear T better than before the plugs were there. That doesn't mean that inserting the plugs gave one T right then and there.

When one wears muffs say when one is walking along a busy city street, one gets exposed to the same kind of noise as one might be exposed to when one is engaged in a conversation. What you are saying basically means that the noise around you has to be louder than that of a conversation, or else your T will get worse. What you are saying doesn't make any sense, right?

 

This means that you made a post saying that using earplugs can make T worse, even though you knew that this is false. Amazing.

So, your advice to the person below is to ignore the spike and to not protect, right?

If one is to base one's decision on anecdotal evidence, then one ought to protect, as there are a LOT more examples of people regretting not protecting their ears than there are examples of people regretting protecting their ears. If one bases their decision on common sense, one would also want to choose to protect their ears (just like one protects one's broken arm from activities that hurt).

 

I think at the end of the day, you need to do what feels right. I’m glad to hear that protecting a bit more helped you recover @Bill Bauer . For me, I was the opposite. When I unplugged and tried to enritch my world with more sound, I got better.

At the end of the day, there is no instruction manual with this. You just need to do with what your body feels is right. Wether that is to protect a bit more or a bit less.

 

Just wanted to clarify so we are all clear that the model of earplugs in the paper was 7 days straight of 24/7 earplug use in healthy volunteers. Nobody (I hope) is advocating that type of earplug use for T/H sufferers.

In addition, the earplug was unilateral in their experimental model, and most folks around here wear their plugs in both ears. My T is really only on one side, but if I wear one plug only, I find it weird, and much prefer to have them in bilaterally.

I think, in my opinion, that their experimental model is a caution against continuous and prolonged unilateral earplug use, but saying anything beyond that is pure conjecture, and not supported by that paper.

 

I don't wish t on anybody. I would put more weight on a research paper about t written by someone with t.

 

Thank you for looking this up! I assumed that this was the case when I read the words "chronic ear plugging". But @Jiri had responded with

even though the negative result that he cited had to do only with this "most extreme case of ear protecting" and had nothing to do with what I had advocated (which, I repeat, has Not been 24/7 protection).

 

@Jiri What is your take on the post below?

 

The disinterested ENT and second audiologist I saw said to NOT overprotect your ears.

I decided to listen to them for a week or so. Spikes.

Decided to take a more measured approach for a few weeks - earmuffs in the gym, rather than my own music to not have to hear the terrible music they play, earmuffs in the street, no protection in the office or at home. Much fewer spikes. I'm new to this game, but I think this will be my approach from now on.

 

Interestingly, in the UFC there used to be a trend of fighters getting knocked out in fights quite easily because they had sustained so much damage in training. A very famous case in Marvin Eastman vs. Travis Lutter. Travis knocked Marvin out with what looked like quite a mild punch. Turns out Marvin had been knocked out in training camp for the fight!

Other famous cases include Rich Franklin vs. Nate Quarry, Dan Henderson vs. Wanderlei Silva (although when they fought, Dan could knock out an elephant) or Rich Franklin vs. Chuck Liddell (although in this case it was more likely to the long career Chuck had).

Nowadays, fighters spar much lighter at the top level for this very reason.

 

It seems the doctors giving advice on tinnitus are the same doctors that admit they don't know much about tinnitus, or a least have never gone through it.
I protected my ears a lot at first, and slowly let them get exposed to everyday noises.

Now I only protect at the gym and casino. I just avoid "loud" places like clubs or sporting events for now.

I suspect most members here do something similar with protection.

 

The second audiologist actually has T himself, he said he has loud T and just deals with it at night by having a fishtank going in his room.

I think tinnitus is subjective enough that a doctor or audiologist should, when asked, say that the individual sufferer will need to do a bit of test and learn, instead of giving a strong answer of "no overprotection".

How is your tinnitus right now jjflyman? I've seen your posts and it looks like you've alleviated your symptoms greatly by fading over time.

 

I do exactly the same, no clubs or concerts and for all the louder stuff like long drives, restaurants and gym I use fully inserted foam plugs.

 

Overprotecting in the way some members do is never the right way to go. In fact, I can’t think of anything worse for a tinnitus sufferer. It’s clear to me, Bill, that you honestly have no understanding of the struggle some members are having with severe phonophobia. The messages I read are heartbreaking; they are trapped in the same way that a person with severe OCD is. Do you think living with severe OCD is good? Have you seen the direct suffering and misery that it leads to?

It blows my mind that you are still adamant about this when there are suicidal people reading it who are literally scared of every sound in existence. I read their suffering regularly and they are trapped. They cannot escape their own thoughts and are now completely incapacitated by their compulsion to use ear plugs and muffs (at the same time) at all hours of the day, non-stop. And even then, sounds that are not dangerous are creating spikes, and this pattern of behaviour is causing them untold misery (basically, name any sound and it will be perceived as threatening). People do not have to live this way. If you’re someone who is currently going through this and you realise that it’s taking over your life and making you suicidal, please seek professional help. The tinnitus is in your brain, so behaving in this way will make it worse, not better.

With that said, it’s sensible and advisable to protect your ears if you are in a dangerously loud environment. If it’s too loud you should also think about leaving.

If you are going to use power tools, use ear protection. If you’re going to a party, use ear protection. If you’re going to a fireworks display, use ear protection. If you’re going to a sporting event, use ear protection, etc, etc.

There is no need to double protect your ears around the clock. Depriving your senses in this way will lead to depression, anxiety, louder tinnitus and/or hyperacusis, phonophobia, and more importantly, it will consume your life. Concentrate on all the things that make you happy and stop this obsessive behaviour before it takes hold.

 

Looks like I touched the nerv. Sorry for that.

I’ll try to respond to your wall of text, so it’s going to be long.

Yes, the keyword here is to protect (reasonably). I was never against that. Contrarily, people get worse when they overprotect their ears the way you preach it. It is simply not healthy to deprive our auditory system of normal sounds.

Believe me, with the level of my protection (extreme) back then it’s impossible I suffered another acu trauma, mini acu shock or whatever you want to call it.

Define it then. How do you know for certain (especially in the case of an anonymous internet user) that it was 100% the noise that changed the condition and not say, rather an extreme emotional response towards that noise? Also, Prednisone can be ototoxic if taken frequently (starting courses) and in high doses. You know that, right? It is why an ENT prescribes these drugs and you should be monitored while taking them (high freq. audiometry e.g.). After all, you suffered a proven acoustic trauma and all these drugs do is to reduce the swelling of the damaged hair cells (it’s a steroid). Prednisone doesn’t fix damaged neural pathways within the brain or hyperactive, synchronised fusiform cells that are misfiring. Personally, now that more light is being shed on the possibility of cochlear ribbon synapses getting damaged or dying even sooner than hair cells I’d be more cautios of irresponsible use of otoxic meds. Similarly, taking just two pills for two days and then ‚tapering‘ (one of the crazy schemes I saw you recommend somewhere) does nothing or perhaps, even more damage than good (a health physician told me). Are you a health professional, Sir, to know when to prescribe these drugs to a person? Do you know anything about the person like his or her medical history? Not M&M’s candies. It’s safer to try Magnesium Bisglycinate or Threonate in a combo with vitamins A, C & E https://www.uofmhealth.org/news/611nutrients-might-prevent-hearing-loss

This is the exact thread that I showed them. There’s just so much misinformation and cherry picking on your part of some of the most extreme posts here on TT. In a peer reviewed journal this methodology would stand no chance. It’d take ages for one person to go through every bit of it and try to bring a more balanced view on the situation. No one‘s denying that listening to music via headphones is potentialy dangerous to us.

The problem here really is that you gather anecdotal evidence from the internet of the worst case scenarios (where you also know zero about the concerned, perhaps something else may have been the cause for their tinnitus fluctuation – but again how would you know, do you personally know them? you don’t do any follow-ups or anything either etc. etc.) and present it as some form of a guide that you then shoot in a newcomer's intro thread with your typical: „It’d make sense that…“

One of the crucial differences between you and the military ENT and audiologist I talked to is that they have years of clinical experience with treating normal citizens as well as treating soldiers with proven acoustical trauma caused by explosions and gunfire, often maskable at 80 dB(A), who eventually get better. Repeatedly. Without overprotecting – I mean members of armed forces usually can’t overprotect anyway.

And for those wondering, yes, the ENT also has tinnitus.

Very clever how you twist words around in your favor. I don’t make it sound anyhow. Just layed out here what was presented to me. If I misunderstood it, apologies, but they clearly stated 94% of all the test subjects heard tinnitus in that chamber – that means even the healthy ones without the diagnosis or previous history of tinnitus. 94% is statistically very significant.

I think not. What is the real NRR of the earmuffs here vs how loud do you imagine a conversation to be, and define what is a busy city street according to you.

This is not what I was saying. I’m sorry it doesn’t make sense to you.

This only means that you don’t know at what point in time I read it. Amazing.

Of course not. My advice to that person would be to seek a trained audiologist and ENT specialist who are knowledgeable in the management of tinnitus. Then may be come to a tinnitus support forum for that support, read success stories, keep up to date with current research, make friends with fellow tinnitus patients, and importantly stay away from online ‚tinnitus gurus‘ who base their opinions on the worst anecdotal evidence they could find online.

Oh and...

 

Another thing you could try, is wearing a pair of over the ear headphones (with no music playing) when you’re in the gym. It cuts down some of the sound, but still allows a good amount sound in to keep your auditory system engaged.

That’s what I do sometimes. It’s sort of a nice inbetween ear plugs and no ear plugs.

 

Good shout. My gym plays music at about 80db, I like blocking it with muffs. I could just use headphones though.

 

You posted a bunch of statements that, for one reason or another, were wrong. I had to point that out. Sorry about that.

When one wears earplugs or muffs, one is not Depriving the auditory system of sounds. One takes the edge off of loud sounds and the sounds that make one cringe. Like I pointed out earlier, one gets from the noise of a noisy street to the noise of a busy city park. Spending your time at a park is not denying your auditory system normal stimulation.

You mean like this:

Are you going to thank me for giving you the idea to wear hearing protection inside of a car? Car crashes are supposed to be extremely loud. I am sorry that that had happened to you. Imagine what it could have done if not for that hearing protection that was there to protect you.

Or like

(Again, aren't you glad that you had that double protection back then?!)

If I remember correctly, the majority of the horror stories I quoted in my "Learn from the mistakes of others" posts had their spikes lasting for a long time and sometimes permanently. I can see emotions causing a spike that lasts until the end of the day or perhaps several days. I don't see emotions causing anything long term.

If you read my post carefully, you will see that I had defined what is Not moderate. You can use that to get a definition of moderate.

You are mistaken. I said that if one's symptoms that caused one to begin taking Prednisone in the first place (ear fullness or a major spike) are gone, one might consider stopping taking Prednisone (as it has side effects, and also to ensure one has enough Prednisone for the time when one really needs to take it).

First of all, there is no misinformation, as real people had made those posts. I never pretended trying to estimate the probability of making oneself worse (in which case cherry picking would be a bad thing to do). It was a case study that proved that the danger is real. With T being as horrible as it is, many of us are not interested in taking Any risk of making it a lot worse (and especially not if the reason for the risk of making one's body uninhabitable forever is something trivial like a couple of hours of fun). I simply made the people aware of the risk, without attempting to estimate the probability of a bad outcome.

Only if the paper in question were trying to estimate the probability of a bad outcome. There are countless papers publishing case studies (e.g., publishing a story of one patient who got T as a result of taking, say, Aspirin). It IS cherry picking - but many people are unaware of the risk, and that has to be changed.

If they are anything like the 90% of the doctors in the poll below, their advice is probably not very helpful
https://www.tinnitustalk.com/thread...orum-more-useful-than-your-ents-advice.28006/
We know that there has been no scientific studies about how to promote healing of T patients, so this is why the results of the poll above are not surprising.

They also heard sounds like the intestines making noises, and the sound of their breathing. My guess is that with concerts being so popular and loud, it is not surprising that most people have minor T. I bet the majority of the people who had never been to a concert didn't hear anything when they were in that chamber.

Anyone who had walked along a busy street while wearing muffs will know what I am talking about, and will know that I am right.

That's not a very good advice, is it?!
https://www.tinnitustalk.com/thread...orum-more-useful-than-your-ents-advice.28006/

Wow, talk about cherry picking and twisting words.
My actual advice to that person was

When I went on a trip where I had to spend most of the day being in a loud car, I wore earplugs the entire time I was in the car and was ok. I took out my earplugs whenever I would be visiting the attractions during my road trip and at my hotel in the evening. I was completely fine afterwards. On several occasions, I tried driving without any protection for an hour or so. I would always get spikes that were a signal to me that I was not ready to be driving without protection. If anyone will be going on a road trip, and gets spikes when one drives, I recommend wearing protection. If you stop having spikes when you have protection, you are good to go. It also makes sense to wear your protection for as long as you drive.

The comment you quoted was meant to show to him that Even if one protects all day long (because one is in a noisy environment all day long) it is not the end of the world. Of course my advice to him was to Avoid the loud environments where one has to protect. [I had been following my own advice. I haven't gone on any road trips during the first 16 months after the onset of my T. It is possible that those road trips haven't promoted my healing.]

In any case, thank you for demonstrating how biased you are.

 

It is better than having to struggle with severe T.

I also get heartbreaking messages. People assume earplugs will protect them in a loud environment and then find out the hard way that this is not the case. They ought to send PMs to you (in addition to contacting me).

I had never advocated to be scared of every sound in existence. What I had advocated was

None of the advice below would cause one to be scared of every sound. I have no idea why you are blaming the people who advise protecting their ears in questionable environments.

Nobody had ever advocated for that, so why are you addressing me? Address those people. I will support you - that is a silly thing to do.

If a sound is creating spikes, it is likely dangerous (unless one can literally create one's own reality with one's mind, and get one's body to do anything - to hurt when it is not hurt, to ring when there is no reason to ring).

Now, certain sounds are not dangerous for the Healthy people. Keep in mind that you have T, so that research on healthy people might not apply to you. Also keep in mind:

Better yet - do not do any of the things above. Hearing protection can provide a False sense of security.

We are in agreement there. Try to be in a safe and quiet environment for most of the day, and you will not need to protect your ears for most of the day.

The above is true, unless the things that make you happy involve loud noises.

 

Too long. I don’t have the time to read your long essays again and engage in neverending exchanges with you. I let people form their own opinions now. All I hope is that someone will read what I posted here yesterday and learn from the mistake that I made that is to trust an anomymous internet person‘s bs broscience. I own up to this mistake. Btw that thread of yours was originally deleted by admins and for a very good reason. Your skilled in twisting things around so it benefits your own agenda. Manipulative behaviour is very dangerous on health forums.

And before you say I'm throwing jabs here at you or anything, then no. I defended you for quite a long time and thought of you as of a friend. Even though I saw you here wishing bad stuff on people who did you no wrong.

In any case, not thank you for that thimble full of insight you provide here.

P.S.: You once told me that you’re a professor at a university. The more I think about it the more I doubt it, though. I don’t know of any university lecturer let alone professor who’d have this much time and energy to post on an online internet forum (number one here with 7,814 messages).

 

What an elegant way to concede. Love it!

Makes sense.

Also, please read his posts that I quoted above that show some possible reasons why he hasn't recovered despite doing the right things.

Yes, it was. Later they realized that educating people is more important than trying to walk on eggshells around them trying to not upset them.

Says you - the person I had shown above to knowingly take posts out of context.

You must be talking about me writing that the only thing better than preventing someone from making their T worse, is having them not to listen to your warnings and then learning the Hard Way that it was a mistake.