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Posts: 34
Reply with quote  #1 
Ok, here's what's making me crazy. I get the idea that hyperacusis sufferers need to re-build their sound tolerance. And, intellectually I understand the people who say that unprotected re-exposure to sound, while uncomfortable, will not damage your hearing because you need to be at over 85dbs for ten hours or whatever to "damage" your hearing, and normal everyday sounds will not do that. Also, I had a milder bout of H back in the 90s and it got better, so I do believe recovery is possible. I get that sudden loud-ish sounds will not lead to further hearing loss, nor, most likely, tinnitus, BUT: what has been clear to me time after time, is that these sudden loud sounds do indeed lead to more pain the ear, and the increased pain leads to worsened hypersensitivity to sound, and this is a separate issue from hearing loss.

I'm aware of the concept of the effects of the limbic system on all this, and I noticed the exaggerated startle response/ slightly panicky response to sound exposure that I was getting. I've worked hard to control that, and now dropping a dish in the sink does not send me spinning out ;-) i can see a certain amount of progress there. But having said that, if I catch a screechy bicycle brake in the ears, or a car horn, or a squawking staton announcement (100 dbs +),regardless of how I react emotionally, I can feel something seize up in my ear canal and the muscles running below the ear into the neck, pain results, and for the next couple days stuff that I was tolerating, like doing the dishes, loud voices, doors slamming etc., becomes painful and intolerable again. While the baseline H has improved over the past six months, the pain has worsened, and once increased, does not seem to return to prior levels.

Any thoughts on this? I've been diagnosed with TTTS and related trigeminal neuralgia and TMJ, both of which did not exist prior to the acoustic shock that triggered the T and H. I've improved my tolerance by probably about 10dbs already by home sound exposure, and am slowly working my way up, but unprotected outdoor sound (in an urban environment) just seems to be asking for more setbacks. I'd be interested to hear other people's experiences.



Posts: 141
Reply with quote  #2 
This 85 dB number comes from measurements of hearing loss (usually hair cell loss). OSHA occupational noise standards state that an individual should not be exposed to more than 85 dB of sound for 8 hours a day, 5 days a week, 52 weeks a year or else they might experience hearing loss. Exposures up to 139 dB are OK as long as they are brief enough according to this standard (0.11 seconds in the case of 139 dB). Applying these numbers to hyperacusis patients is questionable as neither hearing loss nor hair cell loss is currently suspected to contribute to hyperacusis setbacks.

I think the concept of underprotection is generally shunned when treating hyperacusis patients since our natural instinct is to protect and often to protect more than is necessary to prevent pain. Setbacks are totally understudied however. There are over 2000 posts on setbacks in this forum and yet there are no academic papers on the subject. Protection to some degree is critical for those with hyperacusis and without any studies,  the level of protection required is up to each individual to determine. However results from TRT and CBT clinical trials have shown that encouraging sound exposure yields better results on average than not. So overprotection is a real issue to avoid and can sometimes result in even lowered tolerance when protection is based on fear rather than pain.

Damage is a word most avoid because of the psychological effects it can have (resulting in overprotection) and because most assume damage only applies to hair cell loss. Loss of terminals of nerve fibers connecting to hair cells are an example of cumulative damage that can occur at lower sound levels without detection from an audiogram. Clearly something has been damaged to cause hyperacusis. As many with hyperacusis are musicians, sound exposure is likely a catalyst. But whether the pain one feels is new damage on a cellular level or simply the result of preexisting damage no one can say without an in-depth study of hyperacusis setbacks. My feeling is that it can be either depending on the level of exposure and possibly LDLs of the individual. Nonetheless, people recover. The success of TRT and CBT shows that sound can help. There is the gain theory that can be used to support this as this will impact loudness perception and acoustic reflexes. If that explanation doesn't suit you, many burn and amputee patients are hypersensitive in the impacted areas and require desensitization therapy. It is possible TRT and CBT are similarly massaging impacted areas in hyperacusis patients. 

In my case, I did not get major setbacks when I first developed hyperacusis although I did protect when I felt pain. The hyperacusis I had ended up being fairly mild and I recovered almost fully. I then had a major setback years later (without hearing loss and caused by nothing unusual to normal ears) that resulted in very severe hyperacusis. In the days before the setback I felt pain from really loud sounds but did not have major loss in tolerance from everyday sounds. Then one day, my tolerance completely collapsed. This time around, setbacks were initially deep and long lasting. Accumulation of door knob turns or soft voices over a short period resulted in setbacks that would last 3-4 weeks at first.  After 5-6 months, I improved a bit and setbacks became much less deep and are not long lasting however in none of these instances did I expose myself to sound near 85 dB. It really seems that setbacks can be both LDL and sound level dependent. The theory that this is somehow caused by anxiety or fear contracting the tensor tympani or a lowered acoustic reflex contracting the stapedius occurred to me. But I feel no pain when startled or swallowing. A puff of air on the eyes is a way to contract both of these muscles without sound and that didn't cause pain either (you can use a baster or bulb syringe to test this). Neuropathy of these suspected pain receptors in the cochlea is the most intuitive explanation to me but there is a long way to go before confirming that they are pain receptors. So for sound induced ear pain, I won't pretend to know what is causing it. All I know is that sometimes sound helps and sometimes sound hurts. 

Anyway, keeping yourself in environments where you have more control over your sound exposure seems to be important if you are susceptible to setbacks. Making sure you keep gradually testing your limits also seems to be important. Not sure how much that helps, but those are my thoughts.

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