Struggling with Tinnitus and Hyperacusis: Why Are Audiologists So Misinformed?

[Landman]

So I am just like many of you here, living with tinnitus and hyperacusis for more than three years, and it keeps getting worse. It started with an initial noise trauma, then about a year later, COVID and the COVID vaccine (which caused SSNHL and required injections) triggered the hyperacusis and made the tinnitus much worse.

I have been to multiple ENTs, audiologists, a neurotologist, and two different teaching hospitals that specialize in hearing disorders and tinnitus. They have all told me contradictory things, even though they are supposedly trained in the same field.

The one thing they all agreed on was that I should not have any issues with "normal loud noises," especially if I was wearing hearing protection. They all equate no ear damage with no tinnitus spike, which is nonsense in my experience.

So my question is: do you think that exposure to 75 to 85 decibel noise (or that level after protection) is really causing new nerve damage, or is it, as they claim, just my limbic system overreacting? In other words, is this all psychological, or is the noise that spikes me to new levels every week or two, levels that never return to baseline, actually causing physical damage in my ears? Are overexcited nerves a physical problem or a mental one?

I feel like I am going downhill fast because of normal everyday sounds, and the professionals basically all tell me I am crazy.

 

[Sydnears]

I think every single case is different—the cause, the presentation of the tinnitus, what it reacts to, and what the right thing to do is going forward.

When I developed mine after an infection, an audiologist at a specialized tinnitus clinic did a hearing test and an LDL test. My tinnitus spiked for two weeks. When I went back again, she was completely dismissive and said there was no way 100 dB could cause my tinnitus to increase. She also claimed she had never heard of Morse code tinnitus and didn't believe me that tinnitus could be reactive.

It made me completely lose hope. I think the only training they really have is for slow, degenerative, age-related tinnitus that develops gradually, is not reactive, and can be helped with hearing aids. They then try to apply that limited understanding to the entire spectrum of tinnitus cases.

For me, the experience was damaging, expensive, and borderline traumatic. The whole industry needs to move forward and get with the times. It's just not good enough.

 

[Varda]

do you think that exposure to 75 to 85 decibel noise (or that level after protection) is really causing new nerve damage

What sort of noises are you talking about?

 

[Jupiterman]

If you have a severe case of tinnitus, you are wasting your time speaking to so-called "experts." Severe cases are rare, and an audiologist or ENT may not even encounter one in their entire career.

If you have multiple noises and your tinnitus easily worsens from further noise exposure, then continuing to expose yourself to loud sounds, whatever that means in your case, will likely make your condition worse.

The main goal of ENTs and audiologists is to get you to "live your life as if you don't have tinnitus," to return to work, and to carry on with daily activities regardless of the consequences to your ear health. While the harm caused to a patient's ears is not intentional, it is a byproduct of their ignorance about the effects that even so-called normal noise exposure can have on severe cases.

And you are right, they treat it as a psychological problem. Why? Because there is no cure. Any incurable disease that compromises quality of life will inevitably affect mental health. Tell me one that doesn't.

There is debate about whether hearing damage and tinnitus damage are separate. I believe a tinnitus spike is caused by already damaged hair cells and nerve fibers being further aggravated by loud noise exposure. After such exposure, the exacerbation or over-excitation may settle back to its previous state (the spike calming), or, if the noise was loud enough, further damage may occur, causing the spike to remain and the tinnitus to worsen permanently. This could also affect your hearing.

The choice is simple: continue exposing yourself to loud sounds and risk worsening your tinnitus and possibly your hearing, or take clear measures to use ear protection.

 

[NormySan]

I definitely think that 75 to 85 dB after reduction can cause a spike or problems. I went to a concert the other day, and I'm having an awful spike right now, even after using ear protection that should have reduced the sound to about those levels. I've done that before without issues, but this time it didn't work.

 

[kingsfan]

When I developed mine after an infection, an audiologist at a specialized tinnitus clinic did a hearing test and an LDL test. My tinnitus spiked for two weeks. When I went back again, she was completely dismissive and said there was no way 100 dB could cause my tinnitus to increase. She also claimed she had never heard of Morse code tinnitus and didn't believe me that tinnitus could be reactive.

An audiologist I visited several years ago told me that the tests another audiologist had performed on me, which made my condition worse, should never have been given to someone with tinnitus. So there are at least some who have an idea of what they're talking about.

So my question is: do you think that exposure to 75 to 85 decibel noise (or that level after protection) is really causing new nerve damage, or is it, as they claim, just my limbic system overreacting? In other words, is this all psychological, or is the noise that spikes me to new levels every week or two, levels that never return to baseline, actually causing physical damage in my ears? Are overexcited nerves a physical problem or a mental one?

I don't think it's only sound pressure that can worsen tinnitus, but also the frequency of the sound itself. I'll get a spike just from listening to a drum kit cymbal crash at the very lowest possible volume on a stereo. I wonder if it has something to do with neurons in the tinnitus brain being more easily susceptible to excitotoxicity or something similar.

There have been sounds at the same decibel level that devastated my tinnitus, while others didn't affect it at all. For example, my cat screaming at 85 dBA in the car on the way to the vet had no effect on me, but spending just a couple of seconds in a restroom while a hand dryer was running at a slightly lower dBA level left me spiked for a couple of months and possibly caused lasting effects on my tinnitus.

 

[trevl]

So I am just like many of you here, living with tinnitus and hyperacusis for more than three years, and it keeps getting worse. It started with an initial noise trauma, then about a year later, COVID and the COVID vaccine (which caused SSNHL and required injections) triggered the hyperacusis and made the tinnitus much worse.

I have been to multiple ENTs, audiologists, a neurotologist, and two different teaching hospitals that specialize in hearing disorders and tinnitus. They have all told me contradictory things, even though they are supposedly trained in the same field.

The one thing they all agreed on was that I should not have any issues with "normal loud noises," especially if I was wearing hearing protection. They all equate no ear damage with no tinnitus spike, which is nonsense in my experience.

So my question is: do you think that exposure to 75 to 85 decibel noise (or that level after protection) is really causing new nerve damage, or is it, as they claim, just my limbic system overreacting? In other words, is this all psychological, or is the noise that spikes me to new levels every week or two, levels that never return to baseline, actually causing physical damage in my ears? Are overexcited nerves a physical problem or a mental one?

I feel like I am going downhill fast because of normal everyday sounds, and the professionals basically all tell me I am crazy.

70 decibels is the threshold where hearing cell damage begins.

Hearing cell damage is cumulative over time with continued noise exposure. Each episode of tinnitus you experience is an indicator of excessive noise exposure and hearing cell damage. Every recurring episode of tinnitus suggests a further increase in that damage.

Tinnitus caused by excessive noise is the brain's response to a loss of auditory input. The brain turns up the internal gain in an attempt to receive adequate signals from damaged hearing cells within specific frequencies.

At the same time, your auditory system, including both ears and brain, tries to compensate by recruiting alternative hearing cells to tune into nonnative frequencies. These cells send replacement signals to the brain for the frequencies that were lost due to hearing cell damage.

This recruitment process is natural and likely occurs constantly as our hearing declines with age. It continually adjusts to adopt new hearing cells as others become damaged. Recruitment does not suddenly activate only after an auditory trauma.

If hearing cell recruitment is successful, your tinnitus may decrease or even resolve. However, if the damage is too severe within or around the affected frequencies, recruitment will no longer be enough to restore proper input to the brain, and tinnitus will persist.

Standard audiologist or ENT hearing tests using 6 or 8 point audiograms out of a possible 8,000 or 10,000 Hz do not capture enough data to provide an accurate assessment of hearing health. This limited testing protocol is poor science because too much data is missing.

Ideally, at least 4 evenly spaced data points per 1,000 Hz should be recorded. Audiograms that stop at 8 kHz fail to detect high-frequency hearing loss. Furthermore, audiograms use the dB HL algorithm, which reduces the weighting of high and low frequencies to make the chart appear flatter and less alarming to the patient.

Presenting an audiogram on a logarithmic scale is also misleading. Although the log linear chart may appear evenly spaced, large frequency gaps exist between data points, resulting in missing data and unreliable conclusions.

Health professionals relying on such limited charts may draw incomplete or inaccurate assessments of a patient's hearing.

You should reconsider all the noise environments you expose yourself to from now on.

Hearing cell damage occurs at 70 decibels and above. It results from both sound intensity and duration, and the effects are cumulative.

There are frequency and volume measurement apps available for your phone that can help you understand the sound levels in your surroundings.

Do not become complacent. Take active precautions. Use safety earplugs made of foam or silicone, and use active noise-canceling earbuds. However, remember that lower frequencies are more difficult to block, even with protection.

There is no such thing as "dodging a bullet." Hearing cell damage has already occurred, and further exposure can easily make it worse.

 

[Jupiterman]

Shower, dishwasher, vacuum cleaner, and noisy restaurant environments are around 70 dB. In the UK, the officially accepted threshold for ear or hearing damage begins at 90 dB.

If your ears are already damaged, I believe that sound levels below 90 dB can still cause further harm.

Audiograms are displayed on a logarithmic scale because that reflects how your brain interprets sound. The higher the frequency, the less your brain can distinguish between individual frequencies, if it can detect them at all.

If you can hear up to 8 kHz, your hearing is considered acceptable. You should still be able to understand speech and listen to music, though the sound may not be as crisp as before.

I recommend against using apps to test your hearing, especially at higher frequencies not typically measured in standard hearing tests. People on the forum have reported their tinnitus worsening after doing this. Besides, what practical use would that information have? Since nothing can currently be done to reverse hearing loss, measuring it obsessively only satisfies curiosity and encourages unnecessary comparisons of audiogram curves.