Complexities with tinnitus and hyperacusis.
This post is based on my experience with tinnitus and hyperacusis, caused by “exposure to loud noise”. I have also corresponded with people affected by these conditions and their experiences have helped me to write this piece. Please read it as information only. It is not a substitute for medical advice as each person’s circumstances will be different.
Thank you
Michael Leigh
Tinnitus is a common condition that many people are able to cope with without it causing too much difficulty in their life. Therefore, it is often treated as a minor inconvenience because it rarely requires being under the care of an ENT clinic. Please ask members of your family, friends or co-workers whether they have experienced it or have the condition and you’ll probably be told: “I get that but just ignore it”. “I only hear mine when it’s quiet but it’s nothing”. “It plays a tune and then it’s gone”.
These are just a few examples of what you are likely to hear by those that are not aware or have any inclination of the effects tinnitus can have on a person when it is loud and intrusive. If this intensity is sustained for long periods it can become very debilitating. Fortunately, with time and in some cases with treatment, many people are able to habituate and go on to lead a fulfilling life doing all the things that they want to.
With most things there are exceptions and tinnitus is no different. If a person also has hyperacusis, which isn’t uncommon with loud noise exposure, it can complicate matters. If the hyperacusis doesn’t improve by itself or is left untreated further problems may result. This can manifest itself in a variety of ways that I touched on in my post: Hyperacusis, as I see it.
Some people regard earplugs and earmuffs as a necessary requirement to protect themselves from any potential loud noise, and will even use them to suppress normal everyday sounds. They will go further and choose not to leave their home unless it’s absolutely necessary. This is done because of their hypersensitivity to sound and believe, their condition will be made worse by environmental sounds that will cause spikes in the tinnitus. Spikes can be distressing and typically last a few hours but are known to last days. However, if one isn’t careful the problem can be made worse and this is well documented in the medical field, as a lowering of the loudness threshold of the auditory system often results with the overuse of hearing protection making it more sensitive to sound.
If this is practice is continued, one not only has tinnitus and hyperacusis to deal with and the emotional stress that comes with them. They also risk developing other psychological problems that are associated with intolerance to sound. The hypersensitivity to everyday sounds caused by hyperacusis and the overuse of hearing protection instils negative thinking and can lead to Phonophobia - an overwhelming fear of sound. Often an affected person will spend a lot time monitoring sound levels in their immediate environment and even use sound level meters as their concerns for intolerance to sound grows. They will use earplugs or earmuffs sometimes both to protect themselves even from low level sounds they believe will cause harm to their auditory system. Unfortunately, this can become an obsession and a vicious cycle of overprotection of hyperacusis and phonophobia develops and can become a big problem if one isn’t careful.
If this situation isn’t addressed and some form of help is not sought, things can become more problematic. Some people with tinnitus, hyperacusis and phonophobia can develop a condition called: Misophonia. It is having an extreme emotional reaction to typically occurring sounds. This does not mean hating sounds in general. It is having a dislike for specific sounds known as “trigger” sounds. It is also known as: selective sound sensitivity syndrome. Misophonia does not mean one is sensitive to how loud the sound is or its volume as with hyperacusis. Neither is it having a fear of the sound, which is phonophobia.
Some people that are highly sensitive may be irritated or get very upset to be around continual intrusive sounds. Their level of tolerance to deal with these obnoxious situations is not as high as with other people. For instance, a highly sensitive person might hear a car drive by and isn’t bothered by it. However, if they know they are going to be hearing that sound all day long and it’s going to be intrusive in their life then they start becoming very upset. This is not misophonia. By contrast, a person that is highly sensitive can also have misophonia. Meaning they can be sensitive to certain sounds but they are not misophonic sounds (trigger sounds). Misophonia is not adversely reacting to fingernails being dragged on a chalkboard, a baby crying, a knife being scored along a bottle or the sound of a disc grinder. These are classed as normal sounds that one might not like and find them bothersome.
Misophonia is an immediate reaction to a “trigger sound” that promotes an involuntary emotional response. An affected person can be overcome with rage, anger and even hate towards a sound or someone making a sound they are acutely intolerant to. Not only do they hear it but feel the distress the trigger sound is causing them. For example, the sound of someone eating an apple, the popping of chewing gum or the slurping of a drink or soup, can affect someone with this condition quite severely. They will immediately want to get away and run for cover or feel the need to confront the offensive source. Often this is just a feeling and actual physical intervention is not usually carried out.
I have only touched the surface of phonophobia and misophonia. These are separate conditions that can affect a person that does not have tinnitus or hyperacusis.
Tinnitus and hyperacusis can be complex and each person will experience them differently. A lot depends on the make up of a person. Whether they are positive or negative thinking can affect the way they look at life and the goals they want to reach. If a person has had one or both of these conditions for a while, typically over a year and have not habituated or noticed some improvement, or feel their symptoms are getting worse. I advise them to try and seek professional help with a Hearing Therapist or Audiologist that specialises in the treatment and management of tinnitus and hyperacusis. Counselling is usually helpful and medication maybe suggested too. This can help prevent conditions like phonophobia and misophonia taking hold.
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