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contrast

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Reply with quote  #1 
I would like to discuss the pain aspects of hyperacusis, not noises sounding too loud but rather being painful.

Some individuals with hyperacusis report various noxious sensations from sound such as burning, stinging, aching, hot sensations, tingling, numbness, freezing, itching and even shock in response to sound or just in general chronic ear pain. Some may just experience one type of pain others experience two or more that I listed above.

This bares a striking resemblance to peripheral nerve damage elsewhere in the body.
https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061


Example of a tragic pain hyperacusis sufferer


Research by  Paul Fuchs, Charles Liberman and other relevant scientist in the field of otology seem to suggest this may have something to do with outer hair cells nerve fibers triggering pain receptors.  My question is how do we know TRT and The Jastreboff model and sound therapy is effective at treating hyperacusis with pain? It makes me very disheartened that so many individuals are all thrown in the same "hyperacusis" boat regardless of what different types of hyperacusis they have that's why TRT has so many inconsistent results.
https://neurosciencenews.com/inner-ear-neuron-damage-3033/

The status quo that goes on when a patient visits the audiologist is bad. The patient doesn't know about research, neither does the doctor. I feel like audiologist aren't listening to patients and that the standard of care is not working. I know this is a controversial topic but I feel there is a need to discuss it.

 We could all benefit from more scientific researcher on these condition that could due away with noise induced pain someday.

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Aplomado

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I've got pain hyperacusis.  I have experienced a lot of the "noxious" sensations you listed.

The only thing that has been effective for me in reducing or stopping the pain is long term sound therapy (desensitization).  This is why I "know" it can be effective.

Unfortunately, I have had numerous relapses, and have been unable to work through them.

I've desensitized with gradually increasing therapy... my ears stop hurting.  Then I hear some loud noise and I have to start all over again.

My theory of pain hyperacusis is that some sort of hair cell damage in the ear can induce hyperacusis... inappropriate sensations of loudness.  The mind hears the "loud" sound and tries to tell us to protect ourselves (inappropriately) by generating pain.  Then our brain can re-enforce this vicious cycle by "learning" to associate sounds with pain.

This has become quite apparent with me... I had a relapse induced by a car horn going loudly off in my ear, in addition to other unpleasant incidences with horns... now, even if I hear a faint car horn in the distance (that even I, with hyperacusis don't think is loud at all) my ear will usually start hurting.  My brain has learned that horns = pain.

It's unbelievably stupid, but appears to be an example of fear conditioning that induces pain.

I want to encourage you to consider that pain associated with hyperacusis may not be caused by unfixable nerve damage, but rather by learning in the brain.  I strongly suspect this to be the case with my pain hyperacusis at least.  I can't think of any other reason faint car horns would make my ears hurt.

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contrast

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We already have evidence from the studies at John Hopkins University about the Type II unmyleinated outer hair cell nerve fibers as the cochlea's noiceptors and how damaging the inner ear by loud noise triggers them.
https://www.sciencedirect.com/science/article/pii/S0960982215000111
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664349/

In a nutshell to simplify, Picture the cochlear nerves as two cords tied together. That you can imagine as a large cord and a tiny string like cords tied together. 

Type I (hearing pathway)
The large cords make up 90-95% of space, connects to the inner hair cells regions and is responsible for transmitting sound information to the brain. As normal hearing should be

Type II (noxious pain pathway)
The very tiny cord only makes up 5%-10% of the space and only connects to certain outer hair cell regions.
This is the cochlear's pain receptors and they only connect to certain outer hair cells and are usually inactive unless the ear is damaged by extremely loud noise. Take note Outer hair cells are also the cochlea's amplifiers.

Schematic-drawing-of-the-adult-organ-of-Corti-the-sensory-epithelium-i.png 

Extremely loud noise 135+DB noise strong enough to rupture and kill hair cells on site and this is hypothesized to trigger the type II alternative nerve pathway in the cochlea. This is hypothesized to cause noise induced pain.

This research is crucial to those who suffer from hyperacusis with pain AKA noxacusis


Regarding TRT

I am biased towards TRT, because I've heard horror stories however

TRT may offers mild benefits the same reason this touch therapy for alloydnia (pain to touch) does, but in both cases referenced peripheral neuropathy is involved.

https://www.sciencedirect.com/science/article/pii/S089411301730039X
Somatosensory rehabilitation for allodynia in complex regional pain syndrome of the upper limb: A retrospective cohort study



We need to keep an open mind and follow where the evidence takes us, maybe TRT has some benefits but we can't treat it like the holy grail, it has huge inconsistencies and we deserve better then just Jastreboff monopolizing the field.

Attached Images
Click image for larger version - Name: Schematic-drawing-of-the-adult-organ-of-Corti-the-sensory-epithelium-i.png, Views: 2, Size: 41.50 KB 

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Margy

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Reply with quote  #4 
I agree with Aplomado. My hyperacusis intensified over time with repeated traffic and lawn equipment sounds that brought a pain and fear response to my brain, after a period of mild hyperacusis from dental work and jaw tightness.

I now have had pain hyperacusis and muscle startles with many sounds, especially sudden ones, for five years. My experience is consistent with a brain response, a positive-feedback loop of pain that got more sensitive with repeated experiences of pain with sound.

I have excellent hearing, have lived a fairly quiet life in my past, and have no reason to believe that my cochlear cells have been damaged, at least not nearly enough to account for my severe hyperacusis and TTTS.

It frustrates me to see the only research apparently bark up the wrong tree, by assuming cochlear damage.
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Quote:
Originally Posted by Margy
I agree with Aplomado. My hyperacusis intensified over time with repeated traffic and lawn equipment sounds that brought a pain and fear response to my brain, after a period of mild hyperacusis from dental work and jaw tightness.

I now have had pain hyperacusis and muscle startles with many sounds, especially sudden ones, for five years. My experience is consistent with a brain response, a positive-feedback loop of pain that got more sensitive with repeated experiences of pain with sound.

I have excellent hearing, have lived a fairly quiet life in my past, and have no reason to believe that my cochlear cells have been damaged, at least not nearly enough to account for my severe hyperacusis and TTTS.

It frustrates me to see the only research apparently bark up the wrong tree, by assuming cochlear damage.

Do you think your hyperacusis was caused by loud noise?

Are you saying this condition is completely pyschological in some cases?

Also may I ask if you also have tinnitus?


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Aplomado

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Reply with quote  #6 
Contrast- thinking more about this, I should clarify- I do not think all hyperacusis pain is necessarily caused by learning.  I do think it is a strong contributing factor sometimes, esp in my case.

I can think of no other reason why hearing a car horn that I do not perceive as loud would make my ears start hurting anyway.
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Margy

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Reply with quote  #7 
Contrast:

My hyperacusis was caused, I believe, by repeated loud noises that were not loud enough to cause ear damage as normally defined (hair cells), but it was a combination of things that happened together over a period of time. The. cause is still mysterious, but I believe it was several different factors that all hit over a year or so.

This is not at all a psychological issue. It involves the brain, yes, but not the psychological parts. All pain is a function of parts of the brain. The acoustic startle response is a function of the brain stem. Psychological issues are part of the higher prosesses of the brain, where our thoughts and personality and reasoning lie. This is not part of my hyperacusis.

I do have tinnitus now, in this fifth year of hyperacusis. I didn’t have it before. Since I have been avoiding most loud noise during this time, I can’t believe that the usual explanations for tinnitus are valid for me. I think my brain just interpreted a lot of noises as loud, since I had hyperacusis. But it’s a matter of auditory processing, not damage.

So, it’s physical, not psychological, but I think it’s in part of the brain, not in the ears.

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contrast

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Reply with quote  #8 
Quote:
Originally Posted by Margy
Contrast:
So, it’s physical, not psychological, but I think it’s in part of the brain, not in the ears.

Thank you for clarifying.

I subscribe to the hypothesis that hyperacusis defined as pain from sound is not the same thing as loudness hyperacusis where noises are at very loud volumes but not painful. Based on what researchers are saying the loudness hyperacusis is neurological but the pain seems to be noiceptive pain or peripheral neuropathy.

https://www.entandaudiologynews.com/features/audiology-features/post/physiological-mechanisms-of-hyperacusis-an-update

Skip to

"pain hyperacusis"

"Loudness hyperacusis"

You can see the scientist view loudness as neurological and pain as peripheral.




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EDogg

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Reply with quote  #9 
This is a very interesting discussion topic. Thank you, contrast, for raising it and I have enjoyed reading the cited messages.

I think this quote from Dr. Auerbach in the last paragraph nicely sums up the current state of affairs:

“A fundamental question that remains for hyperacusis research is whether different forms of hyperacusis are mechanistically distinct disorders with overlapping presentation, or if they converge on a common pathophysiological mechanism. Current evidence suggests that different forms of hyperacusis may be mediated by distinct mechanisms. Future work must directly examine the various aspects of hyperacusis (loudness, emotion, pain) within the same subjects in order to determine how they may, or may not, overlap.”

Hyperacusis is a symptom, as is ear pain, of an underlying pathophysiologic process. It seems hyperacusis can be brought on by all sorts of injuries, including acoustic exposure, medications, neck injury, head trauma, industrial chemical exposure, neurological inflammatory processes, like MS and advanced Lyme disease, amongst others. It seems logical to hypothesize that many of these forms of hyperacusis, although they share similar symptoms, have quite different pathophysiology.

Pain, for me, is the most difficult symptom of all. I also have severe loudness intolerance (down to 40dB at 8kHz), so I don’t think loudness and pain hyperacusis are mutually exclusive. I think the underlying pathophysiology of the pain, in different forms of hyperacusis, can also be different. For instance, I developed hyperacusis with pain without any noise injury at all. It was from a chemical exposure. My hyperacusis and ear pain is bilateral, is symmetric, and is accompanied by migraines, light sensitivity and chemical sensitivity. To me, this points to brain injury, not cochlear injury. But for others, perhaps from sound, it is cochlear damage in nature and injury or recruitment of the type 2 afferent fibers. The pain, in cases like mine, may be an abnormal neurological response to the brain injury, like overstimulation of the middle ear muscles, out of response to perceived increased loudness, leading to ischemia, lactic acid build up, inflammation and sensory nerve fiber irritation in the soft tissues of the middle ear. The trigeminal distribution of my pain would support this idea. Pain can also, in the chronic state, develop into central sensitization, which may also be playing a part in some of our cases.

Just a few thoughts to chip in.

EDogg

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brownie

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Reply with quote  #10 
Thankyou so much for this video.its exactly what I'm dealing with except my head also feels like if been kicked repeatedly and put in a head vice 24/7.it never lets up. I feel there's hope soon with these videos and Dr now slowly making progress.there must be light at the end of the tunnel. Because people don't see my pain they think I'm exaggerating.they think I'm overreacting wearing headphones or earmuffs. I feel for everyone going thru this.its constant torture
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Cathu

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Reply with quote  #11 
Quote:
Originally Posted by brownie
Thankyou so much for this video.its exactly what I'm dealing with except my head also feels like if been kicked repeatedly and put in a head vice 24/7.it never lets up. I feel there's hope soon with these videos and Dr now slowly making progress.there must be light at the end of the tunnel. Because people don't see my pain they think I'm exaggerating.they think I'm overreacting wearing headphones or earmuffs. I feel for everyone going thru this.its constant torture

Hi Brownie
How are you going there?  I'm new to the forum.  I had Micro Suction 18 December Last year. It has ended my life as I know it. Also screaming loud 24/7 Tinnitus from then. Are you able to tell me how you got yours?
I have hearing of a couple of weeks ago, and I am able to understand a conversation in a quiet room, with carpet, with one person speaking to me.  And I am happy for that.  The outside noise is horrible. Having to wear earplugs and  today I freaked out when I heard a car horn 100 metres away. Things I wouldn't even have given 1/2 a thought to   6 months ago. If the ENT had said there s a 100th of 1% chance things could go wrong, I would have walked out of there, and not let him touch me.  I should have done Dr Google to suss it out.
Hope to hear from you Brownie!
Cheers
CATH

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