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marv

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Reply with quote  #1 
I've seen it said here that sounds that aren't loud enough to damage a normal person's hearing can't damage a person's hearing who has hyperacusis. I'm wondering if there is any scientific evidence to support this assertion. And what exactly does "damage" mean? Does it mean not damage the cochlea? (How about other areas of hearing that might be involved in hyperacusis?) Does it mean not cause a permanent dysfunction? (How about the infamous setbacks that are so common?) Anybody have any info about this? 

Thanks,
Marv
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Debbie

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Reply with quote  #2 
Hi Marv, I think you are making some good points with your question.
As we found out by surprise, hearing loss is far from the only possible deleterious consequence to the auditory system.
Non-hearing-loss-related deleterious consequences, such as deep pain, tinnitus, and many other symptoms, can both exacerbate with certain 'safe decible' exposures...and linger beyond hyperacusis.



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Layla

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Reply with quote  #3 
I disagree with 'sounds below 85-90dB' not being harmful.. I've come across research online saying even quieter REPEATED (eg constant, in a factory etc) noise can be bad!! It depends on the setting too, and if people could control the noise or not!

I'll try to find the links, they did mention studies etc.

What I think people want to say is that sounds louder than 85-90dB are considered to be BAD for healthy people too.. so in these cases healthy people need to wear hearing protection too..
With quieter sounds it really depends on the sounds and the settings.. and on your tolerance levels.. (and other things like nutrition, stress/upset/relaxation levels, muscle tension/trigger points etc)

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marv

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Reply with quote  #4 
Debbie and Layla, thanks for your replies. I'm hoping that some of the people that assert that sounds that can't hurt a normal person's (someone without H) hearing will respond with what they base that assertion on. I'm not trying to be argumentative but just trying to find out what is really true. It's reassuring if those sounds are benign for people with H. But reality is often different than belief. So I'm looking for supporting evidence.

Marv
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Debbie

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Reply with quote  #5 
Marv, what would you consider evidence?
A stastistically relevant, clinical follow up over X-number of years of those who have had hyperacusis and related ear symptoms?
With clinical audiogram tests of the highest specificity available (such a test has a name...my oto-neurologist specifically suggested it but I have forgotten what it is called)?
Would you stop at clinical evaluations of cochlear function in terms of hearing?
Would you want to also comparatively evaluate those who protected their ears/avoided sound against those who did not in terms of pain, tts severity, tinnitus loudness (as audiologically tested), and other symptoms?
Would you want to look at sound-related behavior during different post-injury phases (if chemical, sound, or viral attack could be considered an injury)
such as evaluating how group A versus group B behaved around sound during the recent-onset phase versus the later, chronic phase?
(In terms of plugging/&/or avoiding sound during these phases?)
Would independent replications of such tests be important to weed out bias and error?
If you want to keep your head clear in terms of the meaning of evidence you find...
Be specific about what factor(s) you seek to evaluate, and what would be sufficient evidence to prove a finding.

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Debbie

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Reply with quote  #6 
BTW...again, how long would such a study ideally monitor previously (or continuingly) the audiologically-impacted subjects?
2 years?
5 years?
10 years?
35 years?

And how large of a data pool would be ideal for close clinical monitoring...divided into groups...and compared to an outside control group?
26 subjects?
100 subjects?
1000 subjects?
5,000 subjects?


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marv

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Reply with quote  #7 
Debbie,

Jeez! I feel like I'm under attack! Why are you asking all this and what is your point?

Marv
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bobm

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Reply with quote  #8 
very good subject,what about age and  the overall condition of the person.
personally i feel that lower sounds may not have lasting damage they definitely
can impact h&t,it really is hard to say one way or the other.i think it could be a individual thing

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LizH

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Reply with quote  #9 
Marv, I've also wondered about that.  It's a complex subject but I suppose it's a difficult one to study without risking damage to healthy people and further damage to those who already have succumbed to H and T.  Also it's not an easy thing to study with animals who can't talk.

It has occurred to me though that if one were to meticulously analyse in detail all the individual "case histories" evolving on this network there is probably a wealth of information that might lead to some interesting conclusions to shed some clearer light on this topic.  A Ph.D topic for an up-and-coming audiologist?

 I've noticed there seem to be 2 main groups, those who believe (for lack of exposure to a sudden very loud sound) that their problem is due to the cumulative effect of prolonged exposure to sounds less than 85db and those whose injuries are apparently due to a short exposure to a much louder sound.

Then again, Dr R.Salvi is doing amazing things with mice according to that article in the New Yorker (see Dan Malcore's thread last week).
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Debbie

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Reply with quote  #10 
Hi Marv,
I can see where my posts above sounded critical. It's not what I meant at all. Sorry that they came off that way.

I simply wanted to contribute that it's important whether one is receiving results of controlled and comparative studies...
or anecdotal reports,
or strong conviction.

So that one can then make a personal decision about the meaning of the data to him or herself in any given instance.

And clinical research may be more or less important or applicable depending on many factors and the meaning of those factors to the person receiving the data.

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Ebhak

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Reply with quote  #11 
I don't have a dB meter, and my progression sounds similar to many other folks on here but with some added symptoms, but from my experience it seems possible, short bursts like someone putting the metal weights on swiftly and they hit other ones, at the gym, etc.  Lately I think I been using my ipod too loud at the gym, and have in ear headphones, and sometimes a video on the computer will come on way too loud, some "burst" experiences like that, often after such an exposure, or even shopping carts, my head/ears will feel a bit tighter, and I will want to press certain areas, like under the ear, there is also a pain I get if I put my fingers in front of my ear, and apply tension vertically to the skin there , something deeper internal to the ear, maybe overall weakness or referall to tissues that are affected.  Need to reset my sleep pattern, as of right now it feels tight but often resets with time...  I feel I am improving though, will add more later and such need to on this forum as well as read some.

Love and Light

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marv

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Reply with quote  #12 
Debbie,

I understand what you were saying and I agree with you. Like they say in basketball: No harm, no foul. :-) Still, I will leave experimental design up to the scientists. However, my basic question still is unanswered and I have to assume at this point that there isn't any science to back up the assertion that "normal" sounds aren't harmful for people with H.

Marv
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Layla

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Reply with quote  #13 
Marv, there is a difference in 'running away from the sounds' and 'fearing them too much' - which most people on this forum warn against... Fearing not-so-loud noises too much can cause you to stress and tense up (or use earplugs too much) and can actually really make things worse.. So it's better to relax & not fret so much.. (or just use your fingers temporarily) With too loud noises/sounds it is better to be wisely cautious, in cases of extreme sound.. (again, earplugs or too much earmuffs can make it all worse, so it's wise to really decide if you need it or not.. I try not to use them and it all got better.. I use fingers or go to a quieter room in the case of eg loud church bells, or loud vacuum cleaner/wheat mill or such..)

What are the noises/sounds that concern you specifically? Maybe it would be easier for us to give you help/feedback.
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Ebhak

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Reply with quote  #14 
So hard to tell it seems, I have been listening to an ipod and in areas of loud conversation on and off for the last couple of months, so it's hard to tell what happened yesterday, went to the gym, and had temporary loud noise exposure, but this isn't totally un-usual, then some music online that came out of nowhere, but all of a sudden my right ear was feeling tighter, more dry/clicky inside upon swallowing, I wake up and the whole area is itchy, granted still way tired and dehydrated, but this is surely a sign of something going on in there so my more subtle observation is thus linked with something more overt.  Still, without a dB metere I am not as much help here, but I tend to agree with debbie, mary and whoever else thinks that the type of sound and not just volume matter, though in my case the volume is probably 80 or up...
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marv

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Reply with quote  #15 
Layla,

Thanks for your kind offer and I hope I don't hurt your feelings, but I'm really just looking for the answer to this specific question.

Marv
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cbBen

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Reply with quote  #16 
I think the jury is still out, and unfortunately not doing much research on the matter.

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Debbie

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Reply with quote  #17 
As far as I know (please post links, anyone, to studies if they exist) there is a lack of systematic and repeatable clinical evidence, including none over long-term observation.
I'm thinking in terms of both hearing loss and the many conditions amongst which hyperacusis may actually simply be one part.

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Scott

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Reply with quote  #18 

Glad you brought the topic up.

One "objective" type of evidence that comes to my mind is the LDL test.

From what I understand, doctors trained to treat H patients know to be very sensitive so they don't overdo the sound and cause a setback.

To my thinking, if the 80 db rule was true, why would they need to be careful? Why not just test all the way to 80 db before being careful?

Since they don't go right up to 80 db, it seems to me they feel that softer sounds may aggravate H & T.



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marv

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Reply with quote  #19 
Scott,

I don't disagree with what you're saying but so many people with H are already in a delicate emotional state and have misunderstanding about how hearing impacts H and T, that going right up to the actual "danger zone" when testing for LDL's might be needlessly traumatic and also give inaccurate results because of the fear factor, alone.

Marv
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sucuqu

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Reply with quote  #20 
I would label the LDL test subjective rather than objective.  whether they would damage hearing ---don't know. 


Even the hearing tests which you always get with a visit make me nervous.  the soundproof rooms aren't so soundproof ---I can always detect a buzz from somewhere.   That interferes with trying to hear the sounds during the hearing test.   so are the hearing tests 100% accurate?   don't know. 
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Rob

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Reply with quote  #21 
Marv writes ---
 
I've seen it said here that sounds that aren't loud enough to damage a normal person's hearing can't damage a person's hearing who has hyperacusis. I'm wondering if there is any scientific evidence to support this assertion.
 
.........
 
Yes.   
 
...........
 
And what exactly does "damage" mean? Does it mean not damage the cochlea? (How about other areas of hearing that might be involved in hyperacusis?) Does it mean not cause a permanent dysfunction?
 
..........
 
It means no damage to the cochlea, no permanent dysfunction, no hearing loss, no hair cell loss.  Things like that.
 
............
 
(How about the infamous setbacks that are so common?) Anybody have any info about this? 
 
...........
 
A setback for someone with hyperacusis causes no damage to the person's hearing. 
 
...........
 
It's reassuring if those sounds are benign for people with H. But reality is often different than belief. So I'm looking for supporting evidence. 
 
...........
 
There is a vast difference between sound that hurts to hear and sound that is loud enough to cause damage.   
 
.........
 
I have to assume at this point that there isn't any science to back up the assertion that "normal" sounds aren't harmful for people with H.
 
.........
 
Normal sounds aren't harmful to people with hyperacusis.  They can sometimes hurt.  They can cause setbacks.  They do no lasting harm to one's hearing.
 
Rob 
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marv

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Reply with quote  #22 
Rob,

You wrote:  

"Normal sounds aren't harmful to people with hyperacusis. They do no lasting harm to one's hearing."


When I'm talking about "hearing", I'm not talking about the cochlea, which I'll accept that according to Jastreboff, doesn't play a role in hyperacusis. So I'll accept that normal sounds don't cause damage to the cochlea, the hair cells, or cause hearing loss. But that doesn't address the symptoms people with hyperacusis experience, i.e. increased tinnitus, increased sensitivity, and ear pain, to name a few. What's the scientific evidence you're using to make the assertion that these symptoms aren't lasting?

Marv


Marv
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Ebhak

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Reply with quote  #23 
I see all the points here, I see what Rorb is saying about physical damage to those cells, but as far as a setback or furthering along some auto-protective mechanisms or cascade of events in other structures, I am not so sure.  I do think that there are more subtle elements going on and there is a balance between proper exposure and protection, as in, certain disharmonic types of sound that freak the body into this mode...  Sorry for the crude way of putting it but it's what it seems.

Yesterday, it was only a moment, and the sounds were likely over 85db, but someone let me get in there car without thinking that when they turn it on their stereo system was on full blast, all it took was a few seconds to send me into a "setback", again, this has happened from ipod too loud and other things, so it might not be the best example, BUT to a lesser extent this same thing can happen from quieter sounds that are definitely below.

Peoples lack of conscientiousness can be disturbing sometimes, I am very tired, was up late but even after 9 hours am still tired and can feel my ears trying to spring back, if I could stay in bed all day it might help.  In general, I find extra sleep especially after any troubling noise exposure, helps.

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Rob

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Reply with quote  #24 
Marv --
 
Anyone who is concerned that exposure to sound that is not dangerously loud to a non-hyperacusic could cause permanent increased tinnitus, permanent increased hyperacusis, or permanent ear pain should discuss these concerns with clinician who is knowledgeable about hyperacusis, tinnitus and phonophobia.      
 
Rob
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DrJ

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Reply with quote  #25 
Good topic and yet there stands in the road an enormous elephant, one that blocks much of the work that must be done to define and unlock the mysteries of T and H.

It is the lack of objective testing.  That elephant fills the whole space and we will not be able to move forward until sophisticated imaging techniques, in current modes that show the living function of our physiological function, are developed and studied and 'proved' effective.

Subjective testing can be very useful and has shown to be relatively reliable, say, in certain areas but that research is more limited in the field of hyperacusis, at least it appears so to me.

Hyperacusis and reactive tinnitus both fall into an area that encompasses both physiology and psychology, wouldn't you agree?  Very similar to pain in many ways, upon which there are vast numbers of studies.

When someone is sad or anxious, pain is greater.  When someone is happy or relaxed, pain is less.  There are studies that demonstrate this very replicably in the literature.

I think there are some similarities with H, for example, as I have certainly seen a lot of fluctuations in degree of sensitivities in certain patients and most people have remarked that with T, when they are busy or occupied, mentally, that the T does often fade more into the background.

If H was a purely physical phenomena, like a broken bone, then would cognitive therapy be able to impact it?  Well, maybe slightly.  Better to have a broken bone IN the emergency room than lying alone off a mountain trail completely out of sight and at dusk, right?  We contribute to our feelings with our knowledge base.

The one certainty seems to be that if you have hyperacusis, and if you are around sounds that make you personally feel compromised or uncomfortable or experience pain, there is no evidence to suggest that you have damanged your hearing thresholds.  Your hearing of very soft sounds will not shift in the vast majority of those cases.

You may have more pain, you may have reactive tinnitus (cars are very loud places even without the radio turned on) or you may feel compromised psychologically or emotionally as the waves of your reality wash over you in the moment.

But we can say, with 99 percent certainty, that your measureable hearing thresholds for very soft sounds, whatever level you were at before, are probably not going to shift more than a completely normal standard deviation of 5-10 dB over the near future.

With age, yes, you lose hearing, with your genetic background, you lose your hearing, but by definition, most people with Hyperacusis do not have much hearing loss.  If you have hearing loss and have reduced sound tolerance, then you have Recruitment.

Dr. J

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Marsha Johnson
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Scott

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Reply with quote  #26 
Dr J, Rob,

I appreciate your input.

But it seems we are talking about two different animals. Like comparing apples and oranges.
On the one hand is hearing loss. On the other is hyperacusis and tinitus. Isn't this so?

 I can accept that, as you said, Marsha, you are 99% certain that I won't loose hearing from sounds under 80 db. That is good news.

But that is only part of my concern.

My greater concern is sensitivity to sound. Will sounds up to 80 db increase my H, or impede my recovery?

My own audiologist couldn't reasure that it won't.

Marsha, you touched on a point here. We're still not sure precisely of the mechanism that causes H. So if we are not sure, how can we be sure what sound levels will cause or worsen H?

I don't mean to be contrary or argumentative. It's just that there is significant evidence from my own life that sound under 80 db has damaged my tolerance. And that this damage is more than just psychological. And that thinking otherwise sets me up for further problems.


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DrJ

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Reply with quote  #27 
No argument from me.  Tell me, does 80 dB or less, set you off? Or make your H worse?

MJ

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Marsha Johnson
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Scott

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Reply with quote  #28 
OK. So the 80 db rule is about hearing loss, and not about H.

That makes a difference. I won't go out and expose myself to any sound up to 80 db just because  "it won't really hurt anything".

Yes, it seems less than 80 db has caused problems. My tolerances change over time, like everyone's I suppose.

One symptom of what I think of as "damage" is the feeling I get in my inner ear of electrical circuits shorting out. When that happens, it is virtually always followed by decreased tolerance, fullness/soreness in my ear, sometimes nausea.

This feeling of "damage" can come at different db levels. Just a few instances: When I was running a power saw with my ear muffs on (loud). Also during a fast walk with a friend (not at all loud). The sound of my voice, combined with the vibration from my footfalls, caused the symptoms. Another example - a small gathering of friends, Although the talk was loud, people didn't shout, or speak over one another, and it is hard to imagine  they were over 80 db.


I thought I'd attach this chart of decibel levels for those who haven't seen it before. 

 http://www.sfu.ca/sonic-studio/handbook/Decibel.html


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marv

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Reply with quote  #29 
Just to wrap up things here as I understand it: It seems that sounds that are uncomfortably loud for people with hyperacusis but below the levels that would damage the cochlea of a person with normal hearing, would not damage the cochlea of a person with hyperacusis. So these kinds of sounds would not cause hair cell damage or deafness for a person with hyperacusis. But it is an open question as to whether these uncomfortably loud sounds would or would not cause permanent increased sensitivity, tinnitus, pain, or other hyperacusis symptoms.

I originally asked this question not because I wanted to scare anyone or to keep them from taking positive action that could help them. But I wanted everyone, including me, to have the best information possible when making decisions affecting their health and hearing. 

Marv
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