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llopossa

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Reply with quote  #1 
Hello,

I have hyperacusis and reactive tinnitus. What is the best treatment method to improve hyperacusis while minimizing tinnitus spikes due to sound exposure? I have the pink noise CD of which I play almost everyday while working for an 1 or 2. I can't listen to it any longer yet. I have a decibel meter and can tolerate up to 60 dbs for a limited time each day. However, when I expose my ears to more sound, my tinnitus spikes, and I am concerned the spikes will become permanent. Any advice is much appreciated.

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DanMalcore

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Dan
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Reply with quote  #2 
TRT does not spike tinnitus if you follow the guideline.  One or two hours is not enough time each day to improve your hyperacusis.  I too could not tolerate much more than 60 decibels when I was in the throws of severe hyperacusis.  My voice was so irritating to my ears I changed the pitch of my voice just to tolerate speaking.  In doing so I lost my voice temporarily because it was such a strain on my vocal chords.  Listen to broadband sound at a level that is comfortable to you for 8 hours a day.  The time can be broken up but you want improvement you need to work at this diligently.  Follow the directives in the guideline.  You can do this.

Dan[wave]

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llopossa

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Reply with quote  #3 
Thank you so much Dan. May I ask some questions? My tinnitus changes tones from hissing, to ringing, to electric sounds, to pings, etc. and changes volume pretty much everyday. I have noticed that the spikes occur in response to driving in a car, unexpected loud noises, vacuuming, etc. I will increase my time with the pink noise CD. Here are my questions:

1. Is it beneficial to listen to the pink noise while sleeping? I do use a sound machine but prefer brown noise at night. If I use nature sounds or music, it increases by tinnitus.

2. I will be going to get sound generators on Wednesday, 3/25. I live in Indiana so there are not any audiologists who have extensive experience with treating hyperacusis. My questions are: Do I start out wearing the sound generators 8 hours a day at low volume? What about when driving. Do I wear them knowing that my tinnitus will spike, or do I wear earplugs during driving until my sound tolerance improves?

I am only 3 months in with hyperacusis and tinnitus, and I have had such a difficult time habituating because everyday and night is different. I would appreciate any information that you can provide.

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DanMalcore

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Dan
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Reply with quote  #4 
Tinnitus is an ever changing auditory phenomena.  To put rhyme or reason to it is a total waste of mental exercise.  Yes, spikes do occur when driving in a car, etc. but that is alright.  It is what it is and as long as you do not expose your ears to constant sound over 85 decibels no harm or permanent uptick in your tinnitus will happen.  Nonetheless we worry...but all is well and we need to move on.  Your questions:

Is it beneficial to listen to the pink noise while sleeping? 
Yes, it is beneficial to listen to pink noise while sleeping but do not count that as part of your 8 hour daily auditory consumption of pink noise in an open environment.

Do I start out wearing the sound generators 8 hours a day at low volume? 
When patients get sound generators a number of things can manifest themselves.  One, they become anxious with even the feeling of wearing a foreign appliance on their ears.  If that is the case I recommend people wear them a couple days without turning them on.  This tends to isolate the anxiety and helps them get past this feeling.  Once you turn them on it is not necessary to jump 'cold turkey' right into 8 hours a day.  Move into it slowly.  I much prefer patients work through a trained clinician qualified to treat hyperacusis.  Since that is not your situation in view of the fact that you have already ordered sound generators I will leave you with this.  If your clinician does not give you a clear directive on how to proceed with the sound generators email me at dmalcore@yahoo.com

What about driving?  Do I wear them knowing my tinnitus will spike, or do I wear earplugs during driving until my sound tolerance improves?

Listen, this is just my view, but I did one of two things when driving.  Either I would play the pink noise CD through my speakers in the car to mask out the sound of the car/tires/ventilation with nothing in my ears or I would not do sound therapy while driving and wait to do it at a time of the day when I had less noise in my environment.  Even now, after all these years I know my tinnitus will uptick while driving but it will normalize soon after.  Two final notes.  Early on when driving my tinnitus would ramp up and would remain that way for hours after.  Why?  Mostly because I worried about it.  Anxiety magnifies symptoms and often prolongs them.  Remember, over 50 million people have tinnitus, so it is something so many of us have to deal with.  It is not hurting you.  One of the things I really appreciate about broadband sound is that most often it masks the sound of tinnitus. Secondly, my preference on long trips is to wear the Bose noise cancellation headphones.  They are wonderful and I would highly recommend them to anyone.

Hope this helps...

[wave]Dan

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llopossa

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Reply with quote  #5 
Thank you so much! My appointment is Wednesday with the audiologist to pick up the sound generators. I will reach out if she is unable to provide a precise treatment plan. 
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darryl61

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Reply with quote  #6 
HI Dan Malcore,
I am posting here because the thread is what I suffer from and many of my concerns are the same as LLopossa.
I have loudness hyperacusis and tinnitus. My tinnitus has mostly been reactive, that is, it comes on or increases in volume when I exposed to certain sounds.
Loud sounds do not sound especially loud to me as much as certain sounds like dishes, bags, water running, car engines, traffic, dogs barking, etc all sound loud!!! and bring on T. It is at its worse from 6-9 PM.
And my voice sounds so loud and sometimes sounds distorted. I try to talk lower, but I am not sure that is what I should be doing.

For most of the 10 months this has been going on my tinnitus was silent (yes dead quiet) at night (my house is dead quiet so it was not being masked) and T only started when I heard sounds that are constant like microwave, air coming out of furnace, wind, rain, streams. This is how is all started.
Then H came, worse in my ear that has lower LDL and hearing loss.
I experience ear fullness, headaches, neck aches. So far I do not have pain. There are times that my hyperacusis is not as bad, but my tinnitus is worse and vise versa.
I have had my LDLs checked and they are lowered. I am 58 and have hearing loss, worse in right ear which is ear that T and H are worse in.

I was supposed to get hearing aids (with sound amplification turned off) to use as sound generators to treat my hyperacusis. Because of the pandemic my audiologist has closed their doors and who knows when this plan will materialize. I am now working from home because of Pandemic. I live alone and it is dead quiet.
Audiologist suggested I start listening to music and or nature sounds out of my smartphone at my desk.

Listening to low level sounds all day brings on tinnitus. Music, pink noise, nature sounds all of it. 
Yesterday the wind blew hard all day. My hearing picked up the blowing sound from outside and my T reacted all day. Hard to believe because i could barely hear the wind, but every time I would move myself to an inner room in the house the T would start going down.
Now my T is going into the night, whereas I use to have a break at night. I do notice that if i wake up to T during the night and make some sounds it seems to lessen. That seems strange.
So, it is hard form me to force myself to listen to sound enrichment when it makes my T come on. 
 I live in Flagstaff AZ and all audiologist are shut down. TRT is not available with 500 miles of me.
I exercise, practice mindfulness, meditate, do yoga, deep breathing exercises and see a therapist.
Before this whole thing started I had been extremely anxious and depressed (suicidal thoughts) for many years. All that got worse.
Do you have any advise for me around whether I should keep listening to sound enrichment even if it brings on T?
Thanks
Darryl

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Darryl
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DanMalcore

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Reply with quote  #7 
Darryl,

Like yours, my tinnitus does react to sounds.  That is quite common with tinnitus.  I don't know how significant your hearing loss is.  When the sound of tinnitus is louder than the broadband noise coming for the sound generators used in TRT then TRT may not be advised.  However, it is likely, from the description you give of your tinnitus, that is not the case with you.  I do believe TRT/sound therapy would be beneficial for you.  During these challenging times and your inability to see a qualified clinician you can certainly pursue sound therapy on your own.  If you need assistance with pink noise the network has options for you.

A couple other things.  It is likely your neck pain is due to stress.  I hear that complaint a lot from individuals dealing with tinnitus and hyperacusis.  I applaud your efforts to keep a routine of exercise, meditation and therapy.  I would discourage anyone from seeking totally quiet areas as it tends to send your mental focus to the problems they are having with their hearing (T & H).  Try to keep your ears active with a level of sound or background sound that you find comfortable.  The more we isolate ourselves the worse it is physically and mentally.  Although I felt driven to silence when I was in the awful throws of hyperacusis I need to be around sound all the time.  I think it continually compliments my pursuit of improving my decreased sound tolerance (DST).  If for any reason you have a real issue with broadband noise find a noise that works for you but by all means keep working at it.  

One other point I would make about depression and feeling of hopelessness.  It is easy for us to go there particularly when we are going through a rough spot.  Although TRT clinicians, for good reason, usually discourage drugs to address anxiety there are always special circumstances.  At one point I used Ativan (Lorazepam) for a short period which I truly needed in the short term.  

You will get through this.  

Dan[wave]

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darryl61

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Reply with quote  #8 
According to Jastreboff’s book I am a category 4. He indicates this is a special case and must be handled carefully and monitored more closely. He does not give any specifics.
Any idea what to do differently?

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Darryl
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DanMalcore

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Dan
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Reply with quote  #9 
Self diagnosis, without an Loudness Discomfort Level test can not determine this.  It must be done by qualified clinician.

Dan[wave] 

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darryl61

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Reply with quote  #10 
I said in my post above they were checked and they are lowered. I have worsening symptoms when exposed to low levels of sound for long periods.
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Darryl
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darryl61

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Reply with quote  #11 
Anyone have any idea what to do differently?

According to Jastreboff’s book I am a category 4. He indicates this is a special case and must be handled carefully and monitored more closely. He does not give any specifics.
Any idea what to do differently?

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Darryl
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darryl61

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Reply with quote  #12 
Any idea what to do differently?
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Darryl
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EDogg

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Reply with quote  #13 
Hi Darryl,

With category 4, I think what is different is that you need to approach sound therapy very carefully and delicately, working closely in concert with a clinician who knows what they are doing. Sound therapy needs to be catered to the individuals sensitivities and likely will need to progress very slowly and carefully to prevent exacerbations of hyperacusis. It’s also imperative that you have the correct diagnosis established.

It’s very hard to make any appointments right now with the pandemic. Dan has some terrific advice for you, from someone who knows how awful this condition can be. You will read doom and gloom on some internet sites about treatment for category 4s. I suggest you completely avoid those sites and stick with ones, like this, that are positive and constructive. Search through the archives here and you will see a treasure trove of experiences of people with bad category 4 hyperacusis over the years who found ways to recover. In this time of isolation, I recommend you read as many success stories as you can. Focus on positivity. Try to gently include more background sounds in your life that your brain accepts as comfortable. And if you reach a setback, which is inevitable, know that it is temporary and it will pass.

Best,
EDogg
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darryl61

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Reply with quote  #14 
Thanks EDogg . I just saw this.
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Darryl
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