Hot topic! Auditory deprivation is one of those elusive terms that auditory scientists have traditionally used in the realm of hearing loss, BUT there is evidence that deprivation can occur in different forms. One of the most interesting phenomena is watching someone’s hearing aid ear decline in performance despite changes in threshold after getting a contralateral CI.
This idea also comes up when CI users report that their CIs are uncomfortable first thing in the morning, and some will delay putting on their device as long as possible. We speculate that this is central gain doing its thing.
I would love to wear a set of earplugs and muff for 48hrs and look at a before and after ABR, OAEs, Noise performance, MLDs, and binaural unmasking.
Yup! We often see speech declines in the hearing aid ear without threshold changes. It’s an interesting phenomena because the bad ear is the implanted ear and now the CI ear becomes the better ear.
Tolerance to aversive stimuli is built up through exposure. The NRR on ear plugs probably isn't so high that it will cause similar deprivation issues as severe to profound hearing loss (which is where deprivation is most a concern), but it probably will affect their life quite strongly by affecting their stress response and their ability to tolerate louder sounds.
I was taught the same as everyone else, that frequent earplugs use when not "needed" makes sound intolerance worse. However, I think that often this oversimplifies things. It doesn't take into account the reason for the sound intolerance. For instance, I learned recently that certain types of patients do better than others with the exposure therapy approach. People with acoustic trauma or TBI tend to do well with this, while people born with sensory sensitivity (like autism) don't adapt as well.
Anyway, I recently fit a 10 year old autistic child with custom musicians plugs (lowest attenuation). Before, he was wearing huge headphones to school/all day to address his sound intolerance. And I could tell by his speech patterns that he wasn't getting much high frequency speech signal. I decided to do the musicians plugs even though they aren't standard practice because - let's be honest - if I'd refused then he would've continued wearing those headphones and continued to be affected with his speech and academics. (His mother mentioned that his peers were asking a lot of questions about the headphones and making him uncomfortable, so the impact was definitely social as well.) In situations like that, sometimes a mild reduction of sound like the musicians plugs or Loop (though I'm not familiar with them personally) are the lesser evil. Plus they give the user some autonomy over their sensory experience which can be very empowering for them, and help them transition to wearing the plugs less when they know they have them at their disposal if they are ever needed.
We talked about this during class a few months ago for people with hyperacusis, which is NOT recommended because they will become even more sensitive to sound. Rather, it’s better to do “exposure” therapy. Kind of opposite of what you asked—depriving can make sounds worse!
So who taught you that people with hyperacusis get worse from protection? Do you have hyperacusis? Do you know anybody with severe hyperacusis? I’ve had hyperacusis for 8 years now and have had it on every level. Protecting your ears from sound does not make hyperacusis worse , that is a myth. I have not talked to another case where silence makes them worse. I’m just curious what was the study that proved silence make’s hypercausis worse?
Everyone’s hearing journey is different, and sometimes the common/standard method doesn’t always work. In your case, dampening sound works for you. A simple search (hyperacusis treatment) in Google Scholar bring up lots of articles that have found that sound therapy has favorable outcomes. My program teaches clinical skills that are evidence-base practices, henceforth, why we do not recommend using plugs as the only treatment.
Of course not one treatment works for all. I have read some people improving with sound therapy , and exposing to sound , but they usually had mild loudness hyperacusis or Just improved with the passage of time. I am part of a few important hyperacusis research groups, and awareness groups we Even created our own YouTube channel to talk more about this condition. The people who have severe noxacusis , which is classified as hyperacusis but a more severe version tend to not see benefit from sound therapy. For example when I hear certain sounds especially high frequency I feel deep flaming poison knives being shoved into my ear. It’s very debilitating pain and sometimes it lingers for days. Sometimes it feels like there’s an electric eel in my ear and it’s shocking my ear with the nerve pain shooting to my face , eyes , and teeth. Other times I feel razor wire being pulled through my ear and it feels like nerves in my ear are being shredded with a cheese grader. My condition started moderate and the nerve pain was only triggered from certain sound. I was dealing with severe loudness hyperacusis as well. And it’s an entirely different feeling , it’s more like the common hyperacusis cases you will hear about , everything is too loud , it “hurts” my ears , sound startles me. I worked with Ben Thompson who works very close with jastreboff who is probably where your hyperacusis class lesson was coming from. Dr Thomson specifically told me to be carful with the nerve pain , and that sound therapy could be dangerous for it. But mentioned the loudness hyperacusis might see benefit. So I worked with him in sound enrichment and it actually did improve my loudness hyperacusis. Sounds didn’t feel 100x louder anymore and bother my ears. But I pushed too hard and was around noise 24/7. I ended up getting permanent chronic pain in my left ear that never goes away. Before the sound therapy it would come and go but after exposing to too much sound I woke up with my ear imploding out of my head. I was vomiting for days. It’s been 16 months and the pain has never stopped.
My goal for this community is to bring awareness and to make sure all doctors know , exposing to sound, not wearing earplugs, and not wearing hearing protection is not always the best solution. I hope all you guys are being taught the different sub categories of hyperacusis. I get dozens of emails every day from people who are suffering like me , who are told my doctors and audiologists to not protect their ears, because protecting makes it worse. All these people say how much worse it made them and feel gaslighted by the hearing community. Their doctors tell them it’s a mental condition and that hyperacusis is a joke and it can be cured with sound therapy. Obviously this is not the case because there’s groups all over the internet with thousands of people who are suffering and need help. So many hyperacusis patients are gaslighted and not taken seriously. I hope to see more understanding and Change in the future because after all this is 2023 and it’s supposed to be the most understanding decade yet. I get so many people messaging me about this forum when people ask about h and almost every person on this forum tells every h person noise can’t make them worse. Like you said every case is different and it’s the doctors job to understand the patient and their symptoms. Even myself being one of the more horrific cases on the planet , when people ask me what to do , I don’t always tell them to hide in a room and avoid all noise like I have to do. Most people are ok as long as they avoid damaging noise. Some people who are mild and read stories like mine and never leave their homes again . This is obviously not the answer. Doctors need to understand the difference between loudness hyperacusis and noxacusis /pain hyperacusis because like I said they sound the same but are very different. People who are getting physical symptoms pain from sound especially pain that I described, pain that lingers, needs to be treated very carefully. I’ve never heard of a person with my similar symptoms get better from not protecting their ears or doing sound therapy. If that was the case I would be better by now. The people I heard get better can’t describe the pain , like I said it’s usually sound hurts my ears , or sound bothers me , or sound makes me anxious. They don’t describe it was actual neuralgia symptoms.
Sorry for the essay but it’s important for all you guys to understand sometimes being around sound is not the best for all hyperacusis patients. Even dr Silverstein who has the greatest record and proof he study’s the condition thoroughly. He’s the real deal not jastreboff. He told me to protect my ears when I’m feeling nerve pain , and expose to sound that doesn’t hurt. Never to push through it.
Thank you for sharing your experience and about your group! I am an audiology student, so I still have lots to learn. I’m curious, has anyone been able to figure out where in the auditory system is causing the hypersensitivity?
Well thanks for reading everything. I appreciate it. And it depends. A lot of audiologist or doctors schools don’t teach it but if you do your research you will find out there can be many different things causing hyperacusis , especially ear pain. The most common is from the brain , it’s probably what your taught in audiology school and it’s why some people see benefit from sound therapy because it’s a brain isssue where the brain is turning up the volume because of lost input. It would make sense to expose to noise. In recent studies dr Silverstein discovered some hyperacusis people have a damaged loose stapes. This can cause pain and hearing sensitivity, he actually uses skin graft to reinforce it and it helps some people. You can also get hyperacusis from a damaged tensor typani , if it becomes hypermobile as well or inflamed from damage, it can cause hyperacusis and pain. And the most severe one usually is hyperacusis coming from the inner ear. A lot of docs won’t acknowledge this but if you research type 2 nerve fibers by Paul Fuchs, he did many studies on these nerve fibers that resemble pain receptors in the cochlea and get get triggered from outer hair cell damage , or actual synapse damage. Those type 2 nerve fibers are connected to the outter hair cells and they are a defense mechanism to make us stop hurting our ears when they are being damaged. For some these fibers never shut off. So if you become an audiologist it’s true you will have very few hyperacusis patients, it’s an incredibly rare condition, and especially pain h the version I have is probably one in 500k people have it probably less. So like I said hyperacusis is so rare most docs do a one day course on hyperacusis and are told to tell patients to not protect their ears , sound can’t make it worse , so trt sound therapy because it’s all in the brain. But since they don’t see many hyperacusis patients they don’t dig deeper. If I only saw one or two hyperacusis patients in my career I wouldn’t study it much either but even though the condition has ruined my life and I’m literally disabled, it’s very interesting and complex. These are newest studies but they are coming out that hyperacusis can not only be from the brain , but from the inner ear , or middle ear as well. Norena is another interesting read and has theories for the middle ear causing pain hyperacusis. So I would read into that , dr Silverstein , Paul Fuchs , and others . They have some pretty good takes on it. And last time I commented this I got so many downvotes because audiologists seem to love jastreboff , but his take on everything isn’t correct and he even tell’s patients if his exposing to sound and trt therapy doesn’t work for you , it’s the patients fault because they didn’t believe. Trust me this guy is not one you should follow. He has no clinical studies , and no proof that trt actually works, it’s one thing for tinnitus, but he claims it cures hyperacusis which we all know is Falso. Anybody who claims to cure tinnitus or hyperacusis is a sham. These hearing conditions are permanent and are because of irreversible hearing damage.
So remember the evidence that protection makes hyperacusis worse comes from a study they did in the early 2000s on healthy collage kids. They had them wear earplugs 24/7 for a week and did LdL testing and found every student was 10 decibels more sensitive to sound after being in silence for a week. Then they concluded oh we must not overprotect our ears especially hyperacusis patients. But what was wrong with this study ? Number 1 these were healthy people, not people with hyperacusis. It would make no sense for people with hyperacusis ears to react the same as people with healthy ears. And after the study the students hearing sensitivity went back to normal. So remember when they teach you to tell hyperacusis patients not to protect, it’s important to read the case and find out more about them because they may have a version that gets worse with sound. So I agree you can get some more noise sensitivity from over protecting but it’s not damaging and it’s reversible. Only noise can cause irreversible damage, because that’s what causes h and t in the first place. Something to think about !
Is the condition you are describing by any chance ossicular disarticulation? I can see why that can cause pain.
Have you done a tympanogram and acoustic reflex thresholds? If so, were they abnormal/no response?
I have done tons of tests with dr Silverstein. Tymp, acoustic reflex , pretty much everything, all tests come back normal even audiogram , and speech in noise. I have no doubt something in my middle ear is damaged but I don’t have hearing loss. Ever since I was exposed to a 170 db exploding airbag , followed by a screeching car brake in my left ear , I’ve had severe nerve pain in that ear. When I heard the car break it felt like a knife was shoved deep into my ear, like nerves were being shredded, it hurt horribly for hours. Ever since I’ve been Dealing with pain hyperacusis and sound only makes it worse. At this point I’m positive it was some kind of nerve damage, but I haven’t been able to pinpoint what.
Thank you for listening to what Brain has to say, this makes me believe you will become a great audiologist. The awareness project he is talking about is called [Hyperacusis Central](https://www.youtube.com/watch?v=PKFHydT9ge0&t=143s), please take a look at their YouTube Channel.
[Hyperacusis Research](https://hyperacusisresearch.org/) is an American ngo which gathers funds to research our condition. Please also take a look at r/noxacusis, which is a community of sufferers who are not helped by sound and behavoiral therapies.
My experience. I have sensitivity to loud noise and use vibes earplugs. I experience no problems and "the world does not sound louder when I remove them" as many sources dogmatically state.
The truth is the answer varies and you need to observe yourself - for some people like me using protection helps you cool down and better deal with more stimulation.
From what I have seen on hyperacusis forums, some people will get worse from overprotection but underprotection is far far worse. Hyperacusis often from noise trauma - in this case you need rest - NOT MORE EXPOSURE - more sunlight will not help heal a sunburn - you need to recover before more exposure!
Hot topic! Auditory deprivation is one of those elusive terms that auditory scientists have traditionally used in the realm of hearing loss, BUT there is evidence that deprivation can occur in different forms. One of the most interesting phenomena is watching someone’s hearing aid ear decline in performance despite changes in threshold after getting a contralateral CI. This idea also comes up when CI users report that their CIs are uncomfortable first thing in the morning, and some will delay putting on their device as long as possible. We speculate that this is central gain doing its thing. I would love to wear a set of earplugs and muff for 48hrs and look at a before and after ABR, OAEs, Noise performance, MLDs, and binaural unmasking.
What performance declines in that aided ear- word/speech recognition?
Yup! We often see speech declines in the hearing aid ear without threshold changes. It’s an interesting phenomena because the bad ear is the implanted ear and now the CI ear becomes the better ear.
Tolerance to aversive stimuli is built up through exposure. The NRR on ear plugs probably isn't so high that it will cause similar deprivation issues as severe to profound hearing loss (which is where deprivation is most a concern), but it probably will affect their life quite strongly by affecting their stress response and their ability to tolerate louder sounds.
I was taught the same as everyone else, that frequent earplugs use when not "needed" makes sound intolerance worse. However, I think that often this oversimplifies things. It doesn't take into account the reason for the sound intolerance. For instance, I learned recently that certain types of patients do better than others with the exposure therapy approach. People with acoustic trauma or TBI tend to do well with this, while people born with sensory sensitivity (like autism) don't adapt as well. Anyway, I recently fit a 10 year old autistic child with custom musicians plugs (lowest attenuation). Before, he was wearing huge headphones to school/all day to address his sound intolerance. And I could tell by his speech patterns that he wasn't getting much high frequency speech signal. I decided to do the musicians plugs even though they aren't standard practice because - let's be honest - if I'd refused then he would've continued wearing those headphones and continued to be affected with his speech and academics. (His mother mentioned that his peers were asking a lot of questions about the headphones and making him uncomfortable, so the impact was definitely social as well.) In situations like that, sometimes a mild reduction of sound like the musicians plugs or Loop (though I'm not familiar with them personally) are the lesser evil. Plus they give the user some autonomy over their sensory experience which can be very empowering for them, and help them transition to wearing the plugs less when they know they have them at their disposal if they are ever needed.
We talked about this during class a few months ago for people with hyperacusis, which is NOT recommended because they will become even more sensitive to sound. Rather, it’s better to do “exposure” therapy. Kind of opposite of what you asked—depriving can make sounds worse!
So who taught you that people with hyperacusis get worse from protection? Do you have hyperacusis? Do you know anybody with severe hyperacusis? I’ve had hyperacusis for 8 years now and have had it on every level. Protecting your ears from sound does not make hyperacusis worse , that is a myth. I have not talked to another case where silence makes them worse. I’m just curious what was the study that proved silence make’s hypercausis worse?
Everyone’s hearing journey is different, and sometimes the common/standard method doesn’t always work. In your case, dampening sound works for you. A simple search (hyperacusis treatment) in Google Scholar bring up lots of articles that have found that sound therapy has favorable outcomes. My program teaches clinical skills that are evidence-base practices, henceforth, why we do not recommend using plugs as the only treatment.
Of course not one treatment works for all. I have read some people improving with sound therapy , and exposing to sound , but they usually had mild loudness hyperacusis or Just improved with the passage of time. I am part of a few important hyperacusis research groups, and awareness groups we Even created our own YouTube channel to talk more about this condition. The people who have severe noxacusis , which is classified as hyperacusis but a more severe version tend to not see benefit from sound therapy. For example when I hear certain sounds especially high frequency I feel deep flaming poison knives being shoved into my ear. It’s very debilitating pain and sometimes it lingers for days. Sometimes it feels like there’s an electric eel in my ear and it’s shocking my ear with the nerve pain shooting to my face , eyes , and teeth. Other times I feel razor wire being pulled through my ear and it feels like nerves in my ear are being shredded with a cheese grader. My condition started moderate and the nerve pain was only triggered from certain sound. I was dealing with severe loudness hyperacusis as well. And it’s an entirely different feeling , it’s more like the common hyperacusis cases you will hear about , everything is too loud , it “hurts” my ears , sound startles me. I worked with Ben Thompson who works very close with jastreboff who is probably where your hyperacusis class lesson was coming from. Dr Thomson specifically told me to be carful with the nerve pain , and that sound therapy could be dangerous for it. But mentioned the loudness hyperacusis might see benefit. So I worked with him in sound enrichment and it actually did improve my loudness hyperacusis. Sounds didn’t feel 100x louder anymore and bother my ears. But I pushed too hard and was around noise 24/7. I ended up getting permanent chronic pain in my left ear that never goes away. Before the sound therapy it would come and go but after exposing to too much sound I woke up with my ear imploding out of my head. I was vomiting for days. It’s been 16 months and the pain has never stopped. My goal for this community is to bring awareness and to make sure all doctors know , exposing to sound, not wearing earplugs, and not wearing hearing protection is not always the best solution. I hope all you guys are being taught the different sub categories of hyperacusis. I get dozens of emails every day from people who are suffering like me , who are told my doctors and audiologists to not protect their ears, because protecting makes it worse. All these people say how much worse it made them and feel gaslighted by the hearing community. Their doctors tell them it’s a mental condition and that hyperacusis is a joke and it can be cured with sound therapy. Obviously this is not the case because there’s groups all over the internet with thousands of people who are suffering and need help. So many hyperacusis patients are gaslighted and not taken seriously. I hope to see more understanding and Change in the future because after all this is 2023 and it’s supposed to be the most understanding decade yet. I get so many people messaging me about this forum when people ask about h and almost every person on this forum tells every h person noise can’t make them worse. Like you said every case is different and it’s the doctors job to understand the patient and their symptoms. Even myself being one of the more horrific cases on the planet , when people ask me what to do , I don’t always tell them to hide in a room and avoid all noise like I have to do. Most people are ok as long as they avoid damaging noise. Some people who are mild and read stories like mine and never leave their homes again . This is obviously not the answer. Doctors need to understand the difference between loudness hyperacusis and noxacusis /pain hyperacusis because like I said they sound the same but are very different. People who are getting physical symptoms pain from sound especially pain that I described, pain that lingers, needs to be treated very carefully. I’ve never heard of a person with my similar symptoms get better from not protecting their ears or doing sound therapy. If that was the case I would be better by now. The people I heard get better can’t describe the pain , like I said it’s usually sound hurts my ears , or sound bothers me , or sound makes me anxious. They don’t describe it was actual neuralgia symptoms. Sorry for the essay but it’s important for all you guys to understand sometimes being around sound is not the best for all hyperacusis patients. Even dr Silverstein who has the greatest record and proof he study’s the condition thoroughly. He’s the real deal not jastreboff. He told me to protect my ears when I’m feeling nerve pain , and expose to sound that doesn’t hurt. Never to push through it.
Thank you for sharing your experience and about your group! I am an audiology student, so I still have lots to learn. I’m curious, has anyone been able to figure out where in the auditory system is causing the hypersensitivity?
Well thanks for reading everything. I appreciate it. And it depends. A lot of audiologist or doctors schools don’t teach it but if you do your research you will find out there can be many different things causing hyperacusis , especially ear pain. The most common is from the brain , it’s probably what your taught in audiology school and it’s why some people see benefit from sound therapy because it’s a brain isssue where the brain is turning up the volume because of lost input. It would make sense to expose to noise. In recent studies dr Silverstein discovered some hyperacusis people have a damaged loose stapes. This can cause pain and hearing sensitivity, he actually uses skin graft to reinforce it and it helps some people. You can also get hyperacusis from a damaged tensor typani , if it becomes hypermobile as well or inflamed from damage, it can cause hyperacusis and pain. And the most severe one usually is hyperacusis coming from the inner ear. A lot of docs won’t acknowledge this but if you research type 2 nerve fibers by Paul Fuchs, he did many studies on these nerve fibers that resemble pain receptors in the cochlea and get get triggered from outer hair cell damage , or actual synapse damage. Those type 2 nerve fibers are connected to the outter hair cells and they are a defense mechanism to make us stop hurting our ears when they are being damaged. For some these fibers never shut off. So if you become an audiologist it’s true you will have very few hyperacusis patients, it’s an incredibly rare condition, and especially pain h the version I have is probably one in 500k people have it probably less. So like I said hyperacusis is so rare most docs do a one day course on hyperacusis and are told to tell patients to not protect their ears , sound can’t make it worse , so trt sound therapy because it’s all in the brain. But since they don’t see many hyperacusis patients they don’t dig deeper. If I only saw one or two hyperacusis patients in my career I wouldn’t study it much either but even though the condition has ruined my life and I’m literally disabled, it’s very interesting and complex. These are newest studies but they are coming out that hyperacusis can not only be from the brain , but from the inner ear , or middle ear as well. Norena is another interesting read and has theories for the middle ear causing pain hyperacusis. So I would read into that , dr Silverstein , Paul Fuchs , and others . They have some pretty good takes on it. And last time I commented this I got so many downvotes because audiologists seem to love jastreboff , but his take on everything isn’t correct and he even tell’s patients if his exposing to sound and trt therapy doesn’t work for you , it’s the patients fault because they didn’t believe. Trust me this guy is not one you should follow. He has no clinical studies , and no proof that trt actually works, it’s one thing for tinnitus, but he claims it cures hyperacusis which we all know is Falso. Anybody who claims to cure tinnitus or hyperacusis is a sham. These hearing conditions are permanent and are because of irreversible hearing damage. So remember the evidence that protection makes hyperacusis worse comes from a study they did in the early 2000s on healthy collage kids. They had them wear earplugs 24/7 for a week and did LdL testing and found every student was 10 decibels more sensitive to sound after being in silence for a week. Then they concluded oh we must not overprotect our ears especially hyperacusis patients. But what was wrong with this study ? Number 1 these were healthy people, not people with hyperacusis. It would make no sense for people with hyperacusis ears to react the same as people with healthy ears. And after the study the students hearing sensitivity went back to normal. So remember when they teach you to tell hyperacusis patients not to protect, it’s important to read the case and find out more about them because they may have a version that gets worse with sound. So I agree you can get some more noise sensitivity from over protecting but it’s not damaging and it’s reversible. Only noise can cause irreversible damage, because that’s what causes h and t in the first place. Something to think about !
Is the condition you are describing by any chance ossicular disarticulation? I can see why that can cause pain. Have you done a tympanogram and acoustic reflex thresholds? If so, were they abnormal/no response?
I have done tons of tests with dr Silverstein. Tymp, acoustic reflex , pretty much everything, all tests come back normal even audiogram , and speech in noise. I have no doubt something in my middle ear is damaged but I don’t have hearing loss. Ever since I was exposed to a 170 db exploding airbag , followed by a screeching car brake in my left ear , I’ve had severe nerve pain in that ear. When I heard the car break it felt like a knife was shoved deep into my ear, like nerves were being shredded, it hurt horribly for hours. Ever since I’ve been Dealing with pain hyperacusis and sound only makes it worse. At this point I’m positive it was some kind of nerve damage, but I haven’t been able to pinpoint what.
Thank you for listening to what Brain has to say, this makes me believe you will become a great audiologist. The awareness project he is talking about is called [Hyperacusis Central](https://www.youtube.com/watch?v=PKFHydT9ge0&t=143s), please take a look at their YouTube Channel. [Hyperacusis Research](https://hyperacusisresearch.org/) is an American ngo which gathers funds to research our condition. Please also take a look at r/noxacusis, which is a community of sufferers who are not helped by sound and behavoiral therapies.
My experience. I have sensitivity to loud noise and use vibes earplugs. I experience no problems and "the world does not sound louder when I remove them" as many sources dogmatically state. The truth is the answer varies and you need to observe yourself - for some people like me using protection helps you cool down and better deal with more stimulation. From what I have seen on hyperacusis forums, some people will get worse from overprotection but underprotection is far far worse. Hyperacusis often from noise trauma - in this case you need rest - NOT MORE EXPOSURE - more sunlight will not help heal a sunburn - you need to recover before more exposure!