Sound Exposure Therapy for Hyperacusis

A CBT specialist has informed me that for hyperacusis, he will have patients come to his office (before the pandemic) and they will stack bowls and plates and intentionally create sounds that are uncomfortable.

This same therapist indicates that when he had hyperacusis, he would throw forks down on the floor (initially wearing earplugs at first) in an effort to expose himself to uncomfortable sounds.

I am aware of a woman who was briefly hospitalized and as a result of being exposed to all of the beeping and other sounds, her hyperacusis improved.

It reminds me of someone with a phobia of elevators being forced to go to an office building and ride them until they realize that it is not a dangerous situation and their anxiety diminishes as a result.

Hyperacusis, however, results in an actual physiological response and intentionally exposing yourself to uncomfortable sounds could certainly result in an aggravation of tinnitus and hyperacusis. My tinnitus becomes worse when I turn water on in the sink.

Has anyone tried this type of approach?

 

I should have replied to this, but it definitely depends on where the damage is and what kind of hyperacusis you have. I keep reading stories how some people improved easing their way through the discomfort, and telling themselves it’s not dangerous, it can’t hurt me. I say it definitely works for misophonia, and any mental aspect of it. I’m not afraid of noise, but it is extremely painful. So I think for people with noxacusis it is an absolute no. For stable loudness hyperacusis, with tinnitus that is not reactive, it could help. But dishes still fuck that lol. I would say try going to the store or a walk in the park and going for drives with earplugs. Then slowly ease off the earplugs for the store and the park.

Hahah, can’t imagine a therapist doing that to me? I would lose my mind. I felt less pain a week ago, said ok crickets are not loud. I feel a little better. The pain is in my head, it’s not real, crickets can’t hurt me. After my walk with no earplugs my tolerance permanently dropped, more pain. Definitely doesn’t work for me lol.

 

Yes, I could see this working for misophonia but not loudness or pain hypeacusis or reactive tinnitus (which some people believe is the same as hyperacusis).

 

This sounds like a recipe for deafness.

 

Dr. Jastreboff in his book referred specifically to this technique by CBT practitioners and noted that in some cases it leads to a permanent worsening of the tinnitus and hyperacusis. He strongly recommends against it.

 

Is there anything worth to try for reactive tinnitus then? I can't drive, fly or be in a restaurant etc for even a short period without hearing protection or I'll get a minimum multi-day spike (even with earplugs causes a short-term spike), or at worst cause a permanent tinnitus increase.

My story is that I went from loud but stable tinnitus that I had habituated to, to a much louder, highly reactive and completely unpredictable from one day to the next by simply going for a 4 hour drive in a somewhat noisy car that I thought nothing of at the time. As a result, I no longer know my safe limit and am seriously affected in terms of ability to concentrate not to mention activities I can and can't participate in. Even my own talking in a semi-loud voice will cause a spike!

 

I have quite a lot of reactivity as well. I am beginning to think that the passage of time will hopefully result in some type of calming down of the auditory system. I have read several postings from people who improved two to four years later without any formal treatment.

 

@Athens, let's both hope! If it's weren't for this aspect, I don't think I'd have difficulty habituating.

 

@Athens, thanks for this post.

I am wondering also. I feel like when I first start playing acoustic guitar and singing that it seems really loud and uncomfy, and then if do that for a while and come back, the sound level felt normal and I could play for 2 hours without noticing it.

 

I also play acoustic guitar, but the noise (especially high frequency ones) is uncomfortable and might spike the tinnitus. I might try to very gradually build up my playing and start with softer sounds.

 

That's just a silly idea. You will be uncomfortable or hurt your hearing, and your tolerance of sound will not improve, rather the opposite...

 

Reactive tinnitus is so hard to deal with. It is strange that it is so poorly described in the medical literature. It is just the last few years that it has got some recognition. It must be acceptable as a condition in itself.

I’m in a bad reactive period now. Sometimes when I just expose myself to moderate sounds, I get crazy tinnitus reactions. Something like "tinnitus migraine" if anyone can relate to that?

However, I do not think this reaction is a sign of worsening as long as the sounds are moderate. It is just my brain hopelessly trying to figure out my new nerve input information after damaging yet some more hair cells or nerve synapses.

 

I agree, it's not necessarily a sign of worsening at all as long as you know you don't expose yourself for sound levels that are too loud.

I had reactiveness, which imo is a subset of hyperacusis, to anything and everything at one point. Desensitization over a long span of time, with many setbacks along the the road, made things gradually better (ongoing process). It just takes a lot of time, and acceptance that is is what it is - for now.

With acceptance, and trying to keep the guard somewhat down so you don't keep high alert all time, will make it easier in time. Giving brain the space to habituate, and your ears to gradually "heal".

 

Yeah I’ve been reacting to white noise for a year now daily. It’s annoying and sucks.

 

It's beyond silly. That CBT 'specialist' needs someone to break a plate over their head. I'll set Mrs. UKB on them.

 

@Wrfortiscue, if white noise annoys, stay away from it. I did. You need some kind of positive sound associations / exposure, not something that keeps annoying you.

 

Unfortunately it’s everything for me. PlayStation fan, ceiling fan, work laptop fan lol.

Can it cause worsening?

 

I just do not understand the logic of calling reactive tinnitus a subcategory of hyperacusis. I mean you can have hyperacusis without tinnitus and only pain to sound.

It would be much more logical if it was a subcategory of tinnitus. Most of us do not have any pain involved. We just hate our tinnitus go bananas...

 

I would like to say no. These are not harmful sound levels on their own. They can annoy you, and I know how it is because PC fans in particular annoys me to. And I can still react negative to them - but over time less and less.

Yes, I know @David S, as I've had it for about 2,5 years. Hyperacusis is usually categorized in to main categories; pain hyperacusis and loudness hyperacusis. With many variations in between them.

In the end, what we call it it not is really not that interesting. What we want is to, with time, get better. Reactiveness, to me/in my experience ease when hyperacusis eases (personally I use the word/term sound sensitivity for most of the time).

 

All I can listen to is a running brook sound. I don't necessarily have reactive tinnitus that reacts instantly, but if I'm exposed to loud sounds, the tinnitus gets louder.

 

Thanks man. Your reactivity got better with sound therapy, right?

 

Hey man, FWIW I've come to define reactive tinnitus as "a symptomatic intersect between tinnitus and hyperacusis in some patients".

@Rockman, it's high pitched cricket sounds that seem most comfortable for me at the moment. But "babbling brooks" is there in the arsenal too if needed. Whatever gets us through...

 

I'm going to try out the blasted crickets. In the summer time they are relaxing, unless one is in the house I can't find.

 

I think that it might be effective for misophonia but not hyperacusis.

 

What @MindOverMatter said. I think it has been the experience of most that the reactiveness in their tinnitus decreased as they have regained their tolerances to sound. This is not necessarily in terms of pain, but more about "discomfort".

I can, for instance, not clank cutlery against a ceramic plate at 40 dB without feeling discomfort (not pain), so I have pretty significant loudness hyperacusis, and hence pretty severe reactivity as well. At one time I had much better tolerances to sound, probably above 70 dB, but still lower than they should (slight hyperacusis), and I did spike to sound, although much less severely than now.

To me, it makes perfect sense that tinnitus is a condition in and of itself, but when any degree of loudness hyperacusis is present, it adds an element of volatility/reactiveness to it. This doesn't apply for everyone, so I love the definition of the late Mr. @UKBloke;

 

@Wrfortiscue, it has gotten better with time, sound enrichment, counselling, relaxation, being in nature and so forth.

I would say it is a combination of many factors. Its still there, but "the volume", the intensity of it, has sort of tuned down for most of the time.

 

Jeez dude don't tempt fate; I'm still alive and kicking

 

Sorry to be down. I have been in panic mode on and off now for the last 3 months. I do not know how to get out of this vicious loop even though I managed several times before but this time it is a complete new struggle. My tinnitus is really bad.

I do some mindfulness and take the following meds:

SSRI Escitalopram 15 mg a day
Oxazepam 20 mg a day (max dose 100 mg)
Zopiclone for sleep 7.5mg

Really hate those meds but I do not know what to do without them for now. They used to help me in the past. Now I am not too sure. At least I get 7-8 hours of sleep.

I try to walk 1 hour a day and work for a few hours.

Should I try some supplements?

Anything else or is it just to push through day by day? Hour by hour?

 

Hahaha, aw crap, my apologies. The expression meant something else in my mind lol. Wishing you well

 

I know how it is when tinnitus is severe David. You are on medications to help cope with it and managing to work too, which is no easy feat. I don't think you can do much more as you are doing all the right things.

If it's possible try and take some time off work, as this may help to lessen some of the stress.

Take care,
Michael