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Christian

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Reply with quote  #1 

Dear Network Members,

I just newly joined this network because I am desperately looking for advice on how to deal with my "hyperacusis with pain".

I began developing hyperacusis in the end January 2015. At that point it was highly irritating but I could continue my life (work and family with three small children) overall in an ok way. I rather quickly found a TRT specialist here in Germany and started with sound therapy.

In the end of April the situation escalated. I walked past a garbage truck for bulky waste when that truck crunched something which caused an immediate severe pain in my left ear that did not go away for some hours. Next day I travelled by bicycle for about ten minutes past a rather busy road with sue trucks and again experienced a severe pain in my left ear that did not go away after I left the road. 

My personal perception is that since that first "incident" the threshold for pain is going down continuously. My impression is also that the threshold goes down with exposure to "louder" situations like longer car rides. It has now come to a level where it is often difficult for me to have a conversation. I have started regularly taking paracetamol to deal with the situation.

Also, using the TRT noisers (my main way of therapy) has become difficult for me to apply as they also cause pain in my ears. Also the advice to "confront myself with sounds" is difficult to apply if my perception is that pain increases with exposure. In the internet I have only found some rather grim descriptions of "hyperacusis with pain" and lack of perspectives for treating it (e.g. an article from Dr. Liberman from Harvard stating that "sound therapy does not work for "hyperacusis with pain"; http://deafness.about.com/od/Sound-...rd-in-Understanding-Hyperacusis-with-Pain.htm).

 Any advice? In particular on:

- if and how to continue TRT with the pain symptoms? Should I try to ignore the pain and continue using the noisers?
- any alternative treatment approaches? Can psychological treatment (CBT etc.) be of any good?

I would be most grateful on any advice on how to get my collapsing life back.

Many thanks,

Christian

 

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Johnloudb

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Reply with quote  #2 
Dr. Liberman is an idiot! All I can say!

Please read all the info here
http://www.tinnitus.org

So I'm guessing you've seen ENT who have ruled out problems like Lyme disease and superior cannal dehiscence, and so on?
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Johnloudb

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Reply with quote  #3 
If you can take short car rides without pain it is not hyperacusis! When you take a long car ride and then after a period of time it starts to hurt it is aversion. Most people who have hyperacusis do develop aversion to some sounds often louder ones but can be quiet sounds as well. I don't have time to comment much, sorry. You're welcome to read my story, see link in my signature.

You've have a lot to learn ... So don't get too discouraged. Most people can be helped.

Best, John
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briann

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Reply with quote  #4 
Hi Christian,

I'm so sorry to hear about what you are going through. Sound therapy with pain hyperacusis is a little controversial and that recent article added to it. Charles Liberman is a brilliant researcher and has made major contributions to understanding the cochlea and nearby neurological processing. He made that comment after a recent discovery of nerves that are acting like pain receptors in the cochlea. Charles Liberman does not treat hyperacusis patients so that comment is simply a guess and should not be given too much weight despite his sterling reputation. Studies in TRT do not do a good job of separating hyperacusis types so its not conclusive that TRT is effective with pain hyperacusis vs. a control group but the evidence right now suggests that it might be (http://hyperacusisfocus.org/research/soundtherapy/). There is no doubt, however, that hyperacusis with pain is a much different beast than pure loudness hyperacusis. For example, pure loudness hyperacusis occurs often when conductive hearing loss is surgically corrected and usually only takes a few weeks to resolve itself. 

Nonetheless, this does not mean you should push through pain. Hyperacusis with pain is not as simple as the TRT literature suggests. You cannot simply knock someone out and then lock them in a room blasting sound at safe but loud sound levels to drop the auditory gain. Why sound therapy may be working for pain hyperacusis is not known but it is known that too much sound can have negative consequences as can too little sound. Gradual is the key here and if the noise generators are causing you pain or setbacks then you may want to find a new noise source that filters problem frequencies and can go at a lower volume. Nature sounds such as ocean waves are another option as they have a pretty broad sound spectrum. It is also OK to take a break for a few weeks. This is something that requires patience. Time can help some even without noise therapy despite what some say so taking a break is not necessarily a terrible thing.

Brian
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Johnloudb

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Reply with quote  #5 
Brian,

Could you define "pain hyperacusis?" what is that exactly? 

Even brilliant people like Liberman make stupid remarks about things they know nothing about. It's important people don't take these comments to heart as evidence they should over protect.

Most people, including doctors, and many TRT clinicians don't really understand what TRT is ... it is a sad truth. Really understanding TRT is complicated ... 

Anyway, I get tired of arguing on here. It seems many researchers are still in kindergarten about hyperasusis and misophonia ...

Sorry Brian, you really should educate yourself on TRT ... there are reasons for what your are talking about. I'm talking to someone who just played in a punk metal band, using ear protection. He has hyperacusis, with pain and other symptoms, but is doing better than he was at one time.

I've had constant pain at times for long periods ... and so have many others who made full recoveries. 

So many researchers, ENTs, neurologists are dead dumb about exposure desensitization. It's a big topic ... 

Blasting sound at people has nothing to do with exposure desensitization ...

I'm interested in your thoughts about "pain hyperacusis" ... really be happy to have a chat about it.

Best,
John
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briann

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Reply with quote  #6 
Pain hyperacusis was proposed in the recent literature review by Richard Tyler

Pain Hyperacusis- Present when sounds trigger pain in the ear below common pain thresholds (120 dB). 

Why split pain hyperacusis from loudness hyperacusis when they both often occur together? A few reasons.

1. Pain hyperacusis does not always result in increased loundness sensations. There are plenty of people who relate to pure pain hyperacusis. In my case, my pain thresholds are much lower in my right ear than they are in my left ear however loudness is perceived as the same in both ears.
2. Loudness hyperacusis does not always include pain symptoms.
3. The detailed mechanisms of the two will surely have some differences.

On the effectiveness of sound therapy with pain hyperacusis:
It seems like you thought I said TRT doesn't apply to pain hyperacusis. I believe it probably applies to pain hyperacusis. I was saying it hasn't been proven explicitly. Below is from the link I included in the last post:

Studies so far do not include a clear breakdown of results between patients with and without pain. Craig Formby’s 2007 statistical analysis of TRT treatment attempts to address this by analyzing the impact of self-reported pain and physical discomfort on TRT success. The data showed no statistical difference between those that reported pain or physical discomfort symptoms from those that reported no pain or physical discomfort. A majority of hyperacusis patients who seek treatment are expected to include pain as a symptom (Anari 1999). The success stories summarized on this site show several individuals with pain hyperacusis who recovered while using sound therapy. This is not proof, but this evidence suggests it is likely that sound therapy and counseling can help those with pain symptoms.

On the TRT Model
My point with the blasting safe sound comment was that the Jastreboff model doesn't include a mechanisms for sound worsening sound tolerance other than the limbic system. So people may get the impression that as long as sounds are at a safe sound level according to OSHA and they are not afraid, then they can go ahead and push through pain. I understand that if you dig into the guidebook and papers that he comments on how OSHA safe sound may actually cause permanent setbacks when done too aggressively. For example, in the TRT book, they state,

"When [severe] patients are exposed to continuous high levels during pink-noise therapy, cumulative effects occur and tinnitus and hyperacusis are set permanently to a much higher level than before treatment began”

But most people don't receive that message because the priority, it seems, is do reduce fear of sound and to welcome short term setbacks as part of the healing process. This results in almost no mention of the potential for major setbacks if done too aggressively. Gradual exposure is smart, yes I agree. Pushing through pain, on the other hand, is risky. I've heard enough major setback stories from people regretting they didn't just take a break when they started noticing some pain.

-Brian
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Johnloudb

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Reply with quote  #7 
Brian can you tell me what page and section of the TRT book this is in? I have the first edition. I've read something similar but it was with respect to using the broadband noise that needed to be applied very gradually in severe patients ...

"When [severe] patients are exposed to continuous high levels during pink-noise therapy, cumulative effects occur and tinnitus and hyperacusis are set permanently to a much higher level than before treatment began”

Yes, exposure desensization needs to be done very gradually for the most part. Thank you for your reply, I'll respond more in a bit.
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briann

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Reply with quote  #8 
I'm unfortunately away from my apartment for the next two weeks so I don't have access to it. I believe it was somewhere between pages 105-130. [severe] is Category 4 in the book. His intention in that section was to criticize Vernon's Pink Noise therapy which sets the volume at higher levels but for shorter periods. It is certainly not my intention to discourage people from using low level pink noise for therapy. But I want to highlight a real problem with severe hyperacusis patients being susceptible to sounds that are OSHA safe and emphasize the need for only a gradual approach to sound therapy.

-Brian
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Paulbe

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Reply with quote  #9 
Someone here once said to me there are no grey areas.  I'm seeing at least 50 shades right now.
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Johnloudb

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Reply with quote  #10 
Thanks Brian,

I found it on page 132. yes, desensitization needs to be done slowly, especially with the ear devices. 

Anyway, I know about Tyler's different terminology for types of sensitivity. Instead of misophonia he calls it fear hyperacusis, as i recall. 

Increased sensitivity can cause all kinds of symptoms, stuffy ears, headache, pain, increased tinnitus, and so on. Misophonia can cause all these symptoms too. Misophonia is diagnosed through differential diagnosis using information from the patient and their LDL test. So if quiet sounds lower than their LDLs cause pain or other symptoms it is related to misphonia.

It is very common for one ear to have a lower tolerance than the other. I talk to people with this all the time, like my friend who has made a near full recovery. I had the same. For instance I set the ear devices so that they sounded equally loud in both ears as you're supposed to. But I could not turn either of them up too much because my right ear couldn't tolerate it. The volume was set at the same levels for both devices, so that would mean I had pain hyperacusis! Right??! Well, my hyperacusis was minimal at the time, so really didn't have anything to do with hyperacusis! 

I've also had times when sounds sounded louder in one ear than the other. It is important that the ear devices have independent volume controls to people match levels in both ears! 

When you can listen to a sound for period of time without pain, but it can start to hurt, cause increased tinnitus, or headache, or dizziness, or neuropathy, ... and so on ... it is not hyperacusis. It is aversion. And you don't have to have a conscious dislike or fear for the sound to develop an aversion to a sound. When you hurt yourself the very sensitive limbic and autonomic nervous system turns up the gain for the next time you encounter it. 

Since aversion falls under the category of a limbic and autonomic response, it is falls under the misophonia umbrella ... according to Jastreboff's model.

There is just so much to understand about the Jastreboff model. Patients and doctors who seek to understand the how's and why's off all the symptoms associated with sound sensitivity, and associate them with something sinister going on, live in a world of mystery. 

Increased sensory gain can cause all kinds of problems. Since I've had severe sensitivity to almost everything ... global hypersensitivity ... it is easy for me to have a qualitative understanding of what is going on. I have heard most of the electrical sounds (not acoustic) in my brain for a period and it sounded like the most music. Because of habituation in reverse due to phonophobia and a drug I took played a role as well. 

There were some researchers who studying the electrical signals of the brain. they found they had the same harmonic structure as music ... their goal was to diagnose health problems based on the music  of the brain. They were able to detect different sleep patterns ... in that study.

This stuff that many researchers find a big mystery, really isn't all that mysterious. I've made progress of overcome every sensitivity I've ever had regardless of the cause. And my ears have been hurt bad at times, and had setbacks it took weeks or months to overcome. I was CAT 4 and started from a point of silence, plugs and muffs living indoors. 

If you see the sensory system as a system of feedback that is always changing and the too much gain in a system can cause problems unless certain criteria are met, then it makes more sense. Easier for me to think about it this way, since I've had systems classes in working toward my degree in electrical engineering. The brain is plastic and always changing!

So, people have a hard time convincing me they can't make progress. I find it is usually because they are doing something wrong ... desensitization can be complicated.

John
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briann

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Reply with quote  #11 
Tyler splits misophonia into fear hyperacusis and annoyance hyperacusis. At first I didn't like that but i've recently warmed up to that split. Fear hyperacusis is usually rooted in fear of reinjury or worsening of symptoms for most people and doesn't seem quite as hardwired as annoyance hyperacusis (What most people think of as true misophonia) where people can't stand the sound of chewing. They both are related in some ways (emotion being the most obvious) so I can understand wanting to group them together. I would say that the annoyance and fear within hyperacusis patients is different than those with pure misophonia (annoyance from chewing etc.). 

I don't agree with the assessment that if something below LDLs causes pain then it is not hyperacusis. LDLs test only for a short period and most people with hyperacusis will attest to cumulative effects from sound. As an analogy, OSHA states normal hearing individuals can tolerate 115 dB for 15 minutes a day. This does not mean that 100 dB is unconditionally safe and in fact that must be limited to 2 hours per day. Low level broadband noise stimulates frequencies that are usually not even tested in LDL tests and do so for much longer period of time. It is much more likely that the pain that people feel from noise generators is directly related to the pain they may feel during LDL testing rather than some fear or aversion to sound.

The use of the term "aversion" blames the limbic system for delayed or cumulative pain however there is no evidence that this is actually what is happening. It is a convoluted way of explaining things and was developed solely to fit within the very simple Jastreboff model. The model was developed as a tool to get people to expose themselves to sound and to minimize anxiety about sound because that seems to work. But it is not something that was discovered to be the root cause of hyperacusis by researchers and then applied to treat patients. This sort of explanation keeps a fair amount of people from buying into TRT. I'm not saying this sort of pain is always damaging, but it seems to simply be a motivational tactic to call it an aversion.
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Johnloudb

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Reply with quote  #12 
Brainn,
An LDL test is what is used to diagnose hyperacusis. Length of time has nothing to do with it.

I pretty sure it was Tyler who helped this woman's son  and she chatted on the message board here some time ago. She was given excellent advice for her son on using sound enrichment, working at gradual exposure and treating his misophonia ... though he called it fear hyperacusis of course. It doesn't matter what Tyler called it ... the treatment was the same ... like recording sounds her son was misophonic to and playing them back at a level he could tolerate, and working at exposure to retrain him to respond normally to those sounds. it worked.

No, there is nothing "convoluted" about the Jastreboff model. This is not some mystery, it is just how the brain works. Doctors who treat autism understand how exposure desensitization works and use it to help their patients. I've had friends with autistic kids, and they were doing exposure desensitization. 

The OSHA standards are in reference to hair cell damage. That has nothing to do with aversion.

Yes, I know what people with sound sensitivities "attest" to. I talk with them all the time. I can attest to the same, but I just know how exposure desensitization works and know how to deal with it and move forward. That's why I'm going to school, going to an amusement park this week, taking long car trips, eating out, an so on. And yes I still have aversion to many things, not just sounds ... but pretty normal now. Miles and miles ahead of when I was living indoors in silence and not able walk more than 20 feet, or touch my teeth ...  (aversion). 

I help people with this all the time and know what works. So whatever you want to call it is treatable.

With exposure desensitization you work at the number sounds you listen you, the frequency you listen to them, and the length of time you exposure self to them. Taking this too fast can cause things to go backwards. Basically you just try, and don't force things ... and often you have unpleasant symptoms.

My pulsatile tinnitus came back for periods recently after a lot of exposure. Don't care about it, no big deal! i get mild headaches now and then, don't care! My ears do get hurt now and then but my tolerances are such now that it happens rarely. Taking exposure desensitization too fast can cause big setbacks, but still I've taken some very large steps forward at times.

John 

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Johnloudb

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Reply with quote  #13 
Oh, sorry! I spelled your name wrong a couple of times, just not used to the two n's
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briann

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Reply with quote  #14 
Hi John,

No you had it right. Brian was just already taken as a username.

Some of what I said has been misinterpreted but I don't want to backtrack too much. I wanted to make the following points.

1. Too much sound can occasionally cause serious long term setbacks (6 months, years, or permanent), especially if they are beyond your tolerance levels. As you said, OSHA levels have nothing to do with it.
2. As a result, tolerance building should be done very gradually and pain should be respected but not necessarily feared.
3. TRT doesn't place much emphasis on this aspect.
4. For those who don't buy that the Jastreboff model is providing a complete picture, they are right.
5. I still believe gradual sound exposure is an important part of recovery.

If looking at this as aversion is working for you, that's great. It works for a lot of people. But there are plenty of people who don't buy into it and it's not because they don't know how the brain works. It's that basic functions of the brain are being used to explain something that isn't well understood and the explanation doesn't directly address the various forms pain that come with hyperacusis. The primary thing that is understood is that anxiety and isolation from sound prevent people on average from building sound tolerance.

I'm not saying that we should just shrug our shoulders. Having some sort of model of what is happening is important. If people aren't provided one they will make one up on their own. But this particular model doesn't provide adequate warning that there is a risk of being exposed to too much "safe" sound because they don't want to wake the limbic system. There are ways of providing this warning while still preventing people from hiding and living in deep fear from sound. I believe this warning would have saved some of those who had major setbacks after recovering. 

This model also seems to throw the percentage of those who cannot improve under the bus. Those who hit a ceiling are looked at with pity as if they are choosing not to get better by not directly addressing their "aversions." I'm not saying I can't improve, despite my major setbacks I continue to see gradual improvement from the worst of the setback. But we all have real physiological limitations there and they are not the same for everyone. Those who get better have trouble buying this because getting better takes effort (I know because it took effort to get where I was before my last setback). But it is a fallacy to say that because I got better with effort that means everyone can get better with effort. That's an arrogant way of looking at things. I'm not saying this is how you are looking at it, but a lot of people do look at it this way.

I don't think it is necessary to sweep these facts under the rug in order to motivate those who can improve. 

-Brian
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Christian

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Reply with quote  #15 
Hello John, Brian,

Thank you so much for your comments!!! A few comments back:

I agree that there is a need to better communicate to hyperacusis patients the need to balance the necessary sound desensitization with avoiding the risks of setbacks. I was fine at the beginning of treatment wearing my noisers almost 24 hours without problems and optimistically facing the world and through a series of noise-induced setbacks (I had not been told that setbacks are possible at all) I am now at a desperate point with sound inducing pain and me not even able to wear the generators without producing pain.

I still find it very difficult to map any concrete way forward:
- Beyond the ocean sounds etc. available in the internet, what can be "new noise sources that filters problem frequencies"? I am not an audio tech guy at all.
- Any other approaches/successes in dealing with the pain part?

Yes, other ear problems like Lyme disease are ruled out.

Many thanks,
Christian
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briann

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Reply with quote  #16 
Hi Christian,

I have a tendency to ask too many questions so feel free to only answer what you have time for,

1. Have you had your LDLs tested recently?
2. If not, what are some of the softer, short duration sounds that cause pain other than voices?
3. How often to you feel pain throughout the day?
4. And is your pain lingering non stop or does it generally fade after the trigger? Can you get through a day without pain?
5. When was the last time you felt you were a little better? (trying to see if it is a gradual decline or if you have stabilized). 
6. How long do your setbacks last usually?

I'm surprised that paracetamol (Tylenol?) is helping with the pain. It seems most have to go to much stronger forms of medication to notice any pain relief.

If you can get through days without pain and have stabilized, then I think sound therapy is an OK way to go. Regarding the filtering, you could use a decent equalizer to filter. Maybe start with pink noise as that may be more filtered than what you were using. Below is a high quality sample,

http://www.audiocheck.net/testtones_pinknoise.php

If you play on iTunes on repeat it seems continuous. You can play with the equalizer to see if you can get it to be more comfortable at first. If you use the standard settings (such as treble reducer) you can do the same settings on an iPhone. An alternative would be to use brown noise instead but high frequency content is much lower and probably should only be a temporary solution,

http://www.audiocheck.net/testtones_brownnoise.php

Apps such as noisli let you combine other sounds on top of brown or pink noise. So you could start with brown or pink noise and then add some other nature type sounds that have more high frequency content. I think the big thing is just having some volume control. I prefer using a small speaker like the mini Jambox when i'm starting so it's not right next to my ears (don't use bluetooth though). This way I start the volume very low and just go about my business so I don't notice it. Especially at first, only do it for short periods because effects can be delayed.

-Brian
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briann

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Reply with quote  #17 
Actually the equalizer idea was a bad idea. I just ran an experiment and it really messes up the frequency profile. Start with pink noise and if that doesn't work you can try brown noise as a crutch. There is a free program called Audacity (Mac and PC) that can be used to easily filter high frequencies of pink noise. Once you open the file with the program, you go Effect->Low Pass Filter... and then you can choose the cutoff frequency and order (dB per octave). Then you just need to go file->export audio. I'd recommend trying a 6dB/octave filter starting at 6 kHz on the pink noise if pink noise by itself is causing problems even at low volumes. If pink noise is not causing problems at low volumes, then just stick with the pink noise.

-Brian
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Christian

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Reply with quote  #18 
Dear Brian,

Thank you so VERY much for taking the time!!

Concerning your questions:

1. Have you had your LDLs tested recently? 

No, for some reason my ENT does not do that.

2. If not, what are some of the softer, short duration sounds that cause pain other than voices? 

I am starting to do a "pain diary" to better track this. But at the moment my impression is that basically all sounds induce pain, e.g. my typing on the (not loud at all) apple keyboard right now.

3. How often to you feel pain throughout the day?
At the moment there is constantly some pain that is increasing with sound exposure.
 

4. And is your pain lingering non stop or does it generally fade after the trigger? Can you get through a day without pain?
No, I cannot get through a day without pain. E.g. today it is pretty quiet as my kids are not at home, but I still have significant pain.

5. When was the last time you felt you were a little better? (trying to see if it is a gradual decline or if you have stabilized). 

At the moment I perceive it as a gradual decline. No stabilization.

6. How long do your setbacks last usually?
Hard to say when the pain never goes away completely. I have stronger pain e.g. when I went on a short car ride (with ear protection). There is already pain when I ride the car, but funnily it seems to get stronger afterwards. My impression is that the pain continues also the next day and then subsides a little.

Does that mean I should "forget" sound therapy for the moment? I am trying to download the program you mentioned. Still clueless what a way forward can be...

Thank you so much,
Christian

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Johnloudb

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Reply with quote  #19 
Christian,

Do not make a diary of your pain! That is the worst think you could do! And don't panic or call yourself desperate.

I just don't have time to chat on the message board much right now. Getting ready for school and started a tutoring job last week.

Do some reading about TRT ... http://www.tinnitus.org

Email Jonathan Hazell ( help@tinnitus.org ) after doing some reading. 

Have you ever seen a TRT doctor. 

If all sounds are hurting your ears is not because of hyperacusis. It is misophonia/phonophobia. 

When you listen less or completely avoid sounds you are phobic or have aversion to it causes increased gain for other sounds. How strongly we respond to sounds is relative to the loudness of sounds we are habituated to and hear on a regular basis. 

I went an amusement park thursday evening with my dad. First time in over 20 years! Parts of it were really loud, like next to this one roller coaster (hurt a bit), and there was live band there too. I had to cover my ears if I got very close. 

I had ear plugs but they were hard to put in, so didn't use them much.

Anyway, so it was a great outing and we had fun. My ears were tired and sore though and used ear protection the last 5 minutes of trip home.

Next morning  I could not tolerate my dad talking to me. Just chilled with sound enrichment in my room most of the morning. Poked my head outside a few times later. that night was feeling a bit better and I listened to the car for just one second. I don't completely avoid normal everyday sounds, otherwise sensitivity gets worse. Yesterday was better. And going to the store a bit later today. 

So, just because symptoms gets worse times after a loud exposure, does not mean it's a setback. For me this is a step forward and I expect to go to an amusement park again and handle much better. 

Can you listen to the car for 1 second without pain? What about sound enrichment? Nature sounds? Do you go out at all now? 

Like I say there is just a lot to learn ... and there are answers despite what some may think.


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briann

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Reply with quote  #20 
Hi Christian,

I'm sorry to hear of the pain you are going through. Your experience is different enough from mine that it is tough to give recommendations. In my case, hyperacusis came suddenly and it stabilized to the lowest point within two weeks. At that point, whispers, all sounds, etc. caused intense pain. I stopped going to work, moved to a quiet area, and did not do sound therapy. I initially thought all sound/pain was damaging but then experienced enough inconsistency with that concept to determine that sound/pain only sometimes resulted in long term setbacks. Gradually my hyperacusis improved and when the intensity of my ear pain and duration of setbacks had reduced I did some sound therapy. In my case, I found just gradually increasing environmental sounds (TV volume, Conversation, weaker hearing protection in cases where I'd use stronger hearing protection) seemed to help. But more than anything, time helped me.

In your case, it is difficult to judge since you are perceiving a gradual decline. It sounds like you don't get intense long term setbacks which were a major factor in me limiting my sound exposure. Others here will suggest sound therapy. They may be right but it hasn't been studied in enough detail to know if sound therapy through this type of pain is a good or very bad idea so they are reporting based on personal experience which may be different from yours. If you go that route, I think brown noise through a small speaker at very low volume for short periods is a good start. See if it causes pain. You may even want to have it be inaudible at first just to get used of the idea of something being on and transmitting sound.

I found a better source for broadband noise (White,Pink, and Brown), 10 min instead of 10 seconds,

https://archive.org/details/TenMinutesOfWhiteNoisePinkNoiseAndBrownianNoise
Download the VBR MP3 version (The cutoff frequency is 19 kHz which is fine).
Do not download the 64kb/s version.

I get delayed pain like that too, especially for low level noise of long periods. I often need a day to recover from a long car ride.
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Johnloudb

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Reply with quote  #21 
Pink noise is a very small part of TRT, and many people including some of my friends made recoveries using sound enrichment and doing exposure desensitization, and cognitive behavior therapy. No pink noise.

Brian there are lots of studies including some by the military showing the success of TRT.

There is so much people can do .... Seeking out good professional help can be an important step.
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briann

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Reply with quote  #22 
The TRT studies that i've reviewed make no mention of pain from sound generators and consist mostly of individuals with LDLs above 70 dB.  Please point me to the study that shows sound that causes pain should be used as therapy.

-Brian
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Christian

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Reply with quote  #23 
Thanks so much for your comments. I need to digest a little...
Christian
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Johnloudb

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Reply with quote  #24 
Brain, if the sound generators cause you pain then you shouldn't use them ...

I didn't say otherwise. I said others have made good progress without them because they learned how to go about exposure desensitation, and used sound enrichment.

However, if all sounds cause you pain, it has nothing to with hyperacusis. It is an indication of phonophobia. That doesn't mean someone doesn't also have hyperacusis.

I don't try to hurt myself, but sometimes ears do get hurt like my experience I mentioned about the park. Symptoms usually do get worse as I work at exposure ... But I understand how exposure desensitation and cognitive behavior therapy works. Got good information from a psycholgist, the Phobia and Anxiety Cookbook, advice from Hazell and more ...

Using that advice I haven't had any major setbacks for over 8 years. This after a big setback that cost me years of progress in some ways.
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Aplomado

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Reply with quote  #25 
Sound therapy can work for pain hyperacusis.

Whatever causes the hyperacusis doesn't matter, weather you call it aversion or physiological etc...

The treatment is the same.  Gentle sound exposure over a long period of time.
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