THE HYPERACUSIS AND I

How to treat Hyperacusis (and Tinnitus) - 2/2: Origins of TRT

2009-05-14T12:08:00.001-07:00

Dr. Pawel Jastreboff

In mid 1980s, based on his own research and neurophysiological model of tinnitus, Dr. Pawel Jastreboff proposed a new clinical approach which has created a totally new treatment for tinnitus (and hyperacusis) now known as TRT.

At present, this model has become very popular and the number of specialists that are now attempting to use TRT is increasing each time, not only to treat tinnitus but also hyperacusis.

The first medical professionals to implement TRT in the world were Dr. Jonathan Hazell, (an authority on tinnitus) together with Mrs. Jacqui Sheldrake in the United Kingdom in the late 1980s, after Dr. Jastreboff presented TRT to them. In USA, the first center for TRT treatment was created in Baltimore in 1990.

To read the article “Origin of TRT” written by Dr. Jastreboff, click here.

How to treat Hyperacusis (and Tinnitus) - 1/2: Introduction

2009-04-12T14:30:00.000-07:00

Hyperacusis (hypersensitivity to sounds), is a symptom that tells us something is wrong in our ears, and which origins can be found in many different events. In most cases hyperacusis is accompanied by tinnitus.

The proper method to treat hyperacusis will depend on what cause it.

Being acoustic trauma the most frequent cause of hyperacusis (and tinnitus), I will cover on this post the most recommended treatment for this case.

So far, the treatment that has provided the best results, consist in the accomplishment of a sensory retraining therapy, through which the ears could recover their ability to tolerate the normal environmental sound.

This therapy implies to carry out two simultaneous actions:

* The Tinnitus (and Hyperacusis) Retraining Therapy.- therapy known as TRT (tinnitus Retrainig Therapy), that consists in retrainig the brain (and the ears) to be able to process sounds in a correct way, and it may includes, depending on the case, listening to broadband white (or pink) noise, using a pair of devices called sound generators placed behind the ears. This therapy involves also counseling and guidance to the patient, about how the auditory system works, and why tinnitus (and hyperacusis) arises. To read more, click here.

* The Sound Enrichment.- is a practice which consist in gradually adding environmental sounds around us, from nature or from an electronic source.

Earplugs for Musicians

2009-03-13T15:12:00.000-07:00

Musicians are constantly exposed to high level sounds and need to protect their ears to prevent future hearing problems (hearing loss, tinnitus, hyperacusis, etc).

One of the most useful products to achieve this goal is the high fidelity earplug designed specially for musicians. The following article (excerpt), give an explanation of why is important for the musicians to use this type of earplugs instead of conventional ones.

Hearing Protection for Musicians

Musicians need to hear well, and safely, when they play. Standard industrial-type hearing protectors muffle sound and frequently provide too much attenuation and occlusion to be acceptable for musicians. This article describes the selection of high-fidelity earplugs for musicians.

The Problem with Conventional Earplugs

If 10 dB of hearing protection is good, wouldn’t more protection be even better? The answer is “not always.” Protecting the hearing of those in the music industry isn’t as simple as providing industrial-type hearing protectors and counseling on the importance of their use. In fact, conventional hearing protectors can cause significant problems for those in the music industry, because they produce: 1) Too much high frequency attenuation (unbalanced attenuation); 2) too much attenuation overall; and 3) too much occlusion effect:

• Too much high-frequency attenuation. Inserting an earplug into the ear removes the ear’s natural resonant peak (approximately 17 dB at 2700 Hz in the average ear). This insertion loss, when combined with the earplug’s attenuation characteristics, results in a net treble deficiency of 15-20 dB,4 which causes music and voices to sound muffled.

Most musical instruments have a significant amount of energy above 1000 Hz, with harmonics that are more intense than the fundamental.1 These high frequency harmonics are vital to accurate loudness perception, and they also contribute to the richness of the music. Earplugs with too much high frequency attenuation destroy the tonal balance, which can result in mishearing or overplaying to compensate for the lack of high frequency sound heard through the earplugs.

• Too much attenuation overall. Musicians need to hear, and hear well, while they play. Standard industrial-type hearing protectors not only muffle sound, they often provide too much attenuation; deeply inserted foam earplugs can provide 30-40 dB of sound reduction when far less is needed to protect hearing.

Excessive attenuation may also result in mishearing or overplaying. Drummers, for example, may be unable to monitor the level of play and sustain wrist and arm injuries from striking the drums too forcefully.

• Too much occlusion effect. Occlusion effect is an increase in sound pressure level at the eardrum in the occluded ear compared to the open ear, for sounds generated by the user (eg, vocalist, brass, or woodwinds). When a musician sings or blows into the mouthpiece of an instrument, the sound is conducted via the jaw to the bone surrounding the inner portion of the ear canal. With standard earplugs, this results in an elevated sound pressure level behind the hearing protector. This elevated level, experienced over several hours of rehearsal or performance, may put the musician at risk for overexposure and lead to tinnitus and hearing loss. Occlusion effect can be greatly reduced with earplugs that seal deeply in the bony portion of the ear canal.

It should be noted that occlusion effect isn’t always a problem; if the musician isn’t a vocalist or horn player, occlusion may not be an issue. Sometimes a bit of occlusion effect is desirable for vocalists as an aid in self-monitoring. In this case, a slightly shorter plug that doesn’t seal quite as deeply may be more appropriate. However, for the majority of individuals, a deeply sealed earplug is the best option.

Texts extracted from the article Hearing Protection for Musicians written by Patty Niquette and published on the Issue Stories section of the HearingReview web page. To read the whole article click here.

For further information about musicians earplugs click here.

Using the Sound Level Meter

2009-02-17T12:37:00.000-08:00

Here are some videos about the use and application of Sound Level Meters, also known as SPL meters (Sound Pressure Level meters).

These devices are ver useful not only for hyperacusis patients, but also for whoever wants to preven a hearing damage.

Testing a jack hammer

Testing a home stereo

Testing a drum pad (music)

Describing the model by RadioShack

To see another video about this model click here.

Describing the 407730 model by Extech

To see a video about another model by this brand click here.

For further information about several Sound Level Meter brands see the previous post from this blog.

Useful Ear Products

2009-02-07T18:09:00.000-08:00

The following is a brief list of helpful products for hyperacusis sufferers (click on names or brands for further information):

1º Earplugs*.- products that provide a good protection from noise of all frequencies. To read more about types, brands, links and recommendations click here.

2º Banded Protectors*.- semi-insert banded earplugs ideal for intermittent use. Some good brands are E-A-R, and 3M.

3º Earmuffs*.- headsets that are designed to cancel out all frequencies of noise. They are not electronic devices. For more information about types, brands, links and recommendations click here.

4º Noise Canceling Headphones*.- similar to earmuffs but designed to cancel out low frequency sounds (i.e. interior airplane noise, ventilation noise in a vehicle, computer’s and refrigerator’s fan, etc.). These electronic headsets are battery powered, and some of the best brands are: Koss, Bose (over and on the ear), Sony (on the ear), and Panasonic (in the ear).

5º ZEM Headset*.- is a type of headset that works by directing sound away from the ears. It acts as a vacuum that pulls harmful sounds away from the ear anatomy. Sounds are uniformly reduced. This is not an electronic device. To read more about this product click here.

6º Sound Level Meter (dosimeter/SPL meter).- a useful tool to determine the decibel level of surroundings or some noisy products. Two of the most popular brands are RadioShack and Extech. To see other brands click here.

7º Handset Amplifier.- a battery operated device that not only increase the volume of the telephone but also decrease the volume. The best of all is the Clarity Ameriphone HA40, which could be found in RadioShack and is also available through The Hyperacusis Network for $25.00.

8º Telephone Strobe Light.- a compact device that emits a light signal, and is designed for people who can’t tolerate the telephone ring. Some brands are: Krown, Tele-Movers, Visibel.

* The NRR (Noise Reduction Rating - expressed in decibels) of any of these products may vary considerably (mostly from 12dB to 30dB), depending on their shape (or design), their size and/or their materials.

Musicians and Hearing Protection

2009-01-16T09:38:00.000-08:00

Musicians are constantly exposed to very high sounds, so the risk to suffer from hyperacusis (hypersensitivity), hypoacusis (hearing loss) and / or tinnitus, is also very high. Considering this, hearing protection is crucial for them.

Here you have two videos with recommendations about this matter. The first one is presented by the virtuoso hard-rock guitarist Joe Satriani, and the second one by the renowned rock and jazz drummer Gregg Bissonette.

Recommended noise exposure time

2008-12-28T09:41:00.000-08:00

One of the main causes of hyperacusis and / or tinnitus, is to have suffered a damage in the ears due to an acoustic trauma (exposure to extremely high noise). A possible damage to them will depend on three factors:

- The level or intensity of a certain noise (see previous post).

- The way this noise appears: sudden or gradual. (see post that talks about Dynamic Range) and

- The time of exposure to it:

Recommended permissible exposure time for continuous average noise measured in decibels (dB), according to NIOSH (National Institute for Occupational Safety and Health – USA) and CDC (Centers for Disease Control and Prevention – USA), 2002. For every 3 dB over 85 dB, the permissible exposure time before possible damage can occur is cut in half.

Source: Dangerous Decibels webpage (see “related links” in this blog).

Typical Noise Levels (measured in decibels)

2008-12-15T14:52:00.000-08:00

Here is a complete decibels guide for anyone who suffers from hyperacusis and/or tinnitus:

Notes:

- As it is shown in the chart above, a noise source can have different decibel levels which will depend on some factors like proximity, size, etc.

- The maximum noise level recommended by the World Health Organization (WHO) is: 65 dB during the day, and 55 dB at night.

Additional recommendations about: Family and Friends - 3/3

2008-11-30T10:58:00.000-08:00

This is the last part of the additional recommendations list related to Family and Friends (and others) when hyperacusis and tinnitus arise:

11. Other things that are difficult are coughing, sneezing, clapping, and loud laughing. Many people add sound to their sneeze. This sounds funny but is true. Many people also laugh extra loud to show their appreciation for how much they are being entertained.

12. If your spouse has hyperacusis and you are relaxing in bed together, keep a couple of things in mind. Rustling newspapers, tearing out coupons, loud yawning, belching, and snoring are all problems. If you question our ear problems because we snore, remember that we cannot hear ourselves when we are sleeping unless a sudden loud sound occurs. A difficult situation is when one spouse has hyperacusis and the other has hearing loss. Their ability to live and sleep together is summed up in one great word - LOVE.

13. No matter what, your condition cannot be hidden and must be explained to your employer. This supplement will help you do that. If you do clerical work and use a typewriter - ask to be retrained on a computer.

14. Check consumer-rating publications whenever you are shopping for a major appliance or automobile. Some magazines are finally including ratings for noise. These are very helpful and often allow us to select the best product without having to listen to it first, or measure it with a sound level meter.

15. It is very difficult when individuals with hyperacusis must have dental work done on their teeth. Most feel it would make good sense to wear foam earplugs while teeth need to be drilled so that the sound would not further affect their sound tolerances. Actually, the opposite is true. When dental drilling is done, most of the sound comes from bone conduction. It is more important to leave ear protection out but have the dentist take regular intermissions (every 30 seconds) so your ears can rest. Wearing ear protection traps the sound inside your head and this is more troublesome to your ears. Recent new technology has produced a tool which works like a miniature sand blaster rather than a drill. This procedure is much more compatible to our ears.

16. Some of us have problems with wax buildup in our ears. If you have sensitive ears, never have your ear doctor flush out your ears with water. The noise is far more than our ears can stand. Earwax must be removed manually. Ear doctors do not like removing wax manually, but there are so many people over the years that have come down with tinnitus and/or hyperacusis from their ears being irrigated to remove wax, it is a clear danger to our ears. Other methods include over-the-counter wax softening drops. Even this procedure, if directions are followed can work well. This will sound overwhelming, but remember - anything you and your family learn from this point will help a great deal. @

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Additional recommendations about: Family and Friends - 2/3

2008-11-22T09:11:00.000-08:00

Continued recommendations list related to Family and Friends (and others) when hyperacusis and tinnitus arise:

7. Conversations must also be addressed. When adults and children talk, they frequently raise their voices to be heard. The problem starts when one person begins talking before the other one has finished. The only way to accomplish this is by raising your voice over the volume of the other person, which is a technique used when someone wants attention and insists on being heard. I call this "overtalking", and we are in trouble when this happens. Be very sensitive to this.

8. It shocks me how doctors, audiologists, and adults who treat and care for sound sensitive patients raise their voice or laugh at an unbearable volume while we are in their presence. Many times we have to be very assertive and remind these individuals to "be quiet." This is the only way these people become convinced that we have a problem.

Sometimes you need to ask them, "Why is it so hard for you to talk softly and be sensitive to the problem I have with my ears? You have no idea what I am going through as evident by the way you conduct yourself when you are with me."

At this point in time, the world is very sympathetic to the deaf or hearing impaired (as they should be) but no consideration is made for those of us who are sound sensitive. It is time doctors get off their pedestals and patients get off their knees. Remember that they are working for you and getting paid very well for it. Loud conversation is the reason why we find it very difficult to be part of family gatherings. We feel bad that others become constantly guarded when we are in their presence and yet we depend on their sensitivity to our condition.

9. Sometimes you may notice we are talking softer, sound hoarse, or even whisper. This can be for three reasons:

1. We may talk softly or become hoarse if our ears are particularly bad and we have incurred a recent noise injury. Sometimes it is even difficult for us to hear our own voice if our ears are having a bad time.

2. As mentioned before, our ears are most sensitive in the early morning and late evening. This has an effect on the volume of our voice.

3. We tend to talk softly because it often evokes a soft, low volume response from whomever we are speaking to.

10. Women and children's voices are usually an octave higher than men's.

(to be continued on the next posts)

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Additional recommendations about: Family and Friends - 1/3

2008-11-15T09:17:00.000-08:00

As we saw the post before, when hyperacusis arise we need help from our family and friends. Here some additional recommendations about that:

1. Speaking to families of loved ones that have a collapsed tolerance to sound - we appreciate all you do for us. You are extraordinary people to handle our special needs. We wish you could attend a local support group in your community to help you cope with this, however hyperacusis is just too rare. Hyperacusis will have an impact on your social life. True friends will remain true - just don't shut them out. Start out slow by entertaining at home (one on one).

2. To those family members who question the difficulties we experience with our ears - you are our added misfortune in life and give us an additional cross to bear. Hyperacusis is an extremely rare disorder that may affect less than 1 per 50,000 people. It is no wonder so little is known about it. Most medical dictionaries do not even list the auditory disorder and most doctors have never even heard of it. What can be done? Is there currently a cure for hyperacusis? Where can I go to get help?

3. Don't get discouraged - you can still reach for the stars even though you have delicate ears. Sometimes it takes us a while to understand just how much potential we still have in us. Encouragement from others helps greatly.

4. The outer ear acts like a satellite dish that collects sounds. For us, the outer ear can be extremely sensitive to touch. Frequently, signs of affection involve hugging or rubbing hands through our hair can be loud on our ears. As unreal as this may seem to those who are caring for us, any contact with the outer ear can be upsetting. If you hug us, we love it, but be careful of our ears. If you run your hands through our hair or comb it - try not to make contact with the outer ear. The only "No Trespass" sign on our whole body is our outer ear. That leaves a lot of room for loving everything else (Smile).

5. Kitchens also have running water, dishwashers, and the dreaded garbage disposal. Please warn us when you are going to use the garbage disposal so we can plug our ears, or better yet - leave that end of the house when these appliances are being operated.

6. Never start your car or beep your horn when we are right next to the vehicle, this just blows us away. Close your car doors quietly, and do not use the automatic garage door unless we are in the car with the windows closed or we are in the house.

(to be continued on the next posts)

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Special cares and measures taken - 4/4: Family and Friends

2008-11-08T16:29:00.000-08:00

Going back to describing my condition, and finishing the “Special cares and measures taken” section, I list here other measures taken when my hyperacusis and tinnitus got worse.

Family and Friends:

Since I live on a third floor house, and my sister and brother on the other ones, we made many arrangements in order to control and prevent some loud noise coming from their houses.

- Every time they were going to use the liquidizer, the vacuum cleaner, the polisher, or the hairdryer, they sent me a previous warning call in order to protect my ears or to go in to my bedroom (that was isolated).

- The same was done when they were going to make some repairs to their houses, especially when using hammers and drills.

- They reduced their meetings at home, and when these took place they tried to avoid raising their voices and/or raising the volume of music. Most of the time, music was not played.

- When they talked with me they did it whispering or by writing, depending on my need.

- By my request, they avoid physical contact (kisses, hugs) on my head, face and/or any surrounding area of the outer ears.

- They also helped me making all those things that involved too much noise and effort (cleaning and fixing the house, handling some electric and electronic equipment, etc.). @

Additional recommendations about: Accommodations - 3/3

2008-10-31T16:38:00.000-07:00

This is the last part of the list about Accommodations that could be considered when hyperacusis and tinnitus arise:

12. As sound tolerances improve, patients tend to have little difficulty weaning themselves off drugs that have helped initially. Consult with the doctor when taking any medication. Since our ears are most sensitive in the morning and at night, alarm clocks are hard. Even alarm clocks in a nearby bedroom are difficult. Clock radios are better, but keep the volume down. A great idea for an alarm is connecting your bedside lamp to a security light switch timer. Set the timer as the alarm. When the timer cycles in - your lamp turns on and wakes you very quietly. Bose just introduced a clock radio that slowly turns the volume from zero to a preset volume when the alarm goes off. Keep bathroom doors closed if you get up before we do. Vibrator wristwatches are also available and prove to be a gentle way to wake up in the morning.

13. Most of us have difficulty talking on the telephone. Consider purchasing a Handset Amplifier from Radio Shack ($25.00) which has a volume and tone control. If you reduce the volume and tone control all the way down, the normal ear can barely hear anyone talking on the other end. The unit can be velcroed to the side of any existing telephone, and can easily be readjusted when someone else in the family uses the phone. Also, please make sure to turn the ringer down on all your phones. If needed, you can buy a strobe light box made exclusively for the telephone from Radio Shack. It has three adjustments - flasher, ringer, or both. A wonderful business phone system is the Partner Plus by AT&T. What makes this system so unique is that you can control the volume of the three problem areas - incoming audio, ringer, and speakerphone. The volume on all three areas can be reduced below normal (normal to the normal ear) limits.

14. Fan noise is particularly bothersome to many of us. Ceiling fans can be almost whisper quiet if you find the right one. Hunter (brand) ceiling fans are an excellent buy. Some of us have a difficult time getting to sleep if traffic (planes, trains, and automobiles) are nearby. Some even have difficulty with crickets at night, rustling leaves, and birds singing in the early morning.

15. Remember that the whine of the fan to cool the hard drive on a computer is soft, but high pitched. Fortunately, the QZ2000 noise cancellation headset or foam earplugs can help you with that. If you get to choose a new computer, the network can give you some recommendations on quiet computers.

16. Some printers are quiet considering the dreaded alternative of a dot matrix printer. Photocopy machines and typewriters are difficult for us when they are in operation. Your tolerances may depend on the acoustics in the room and how tight your working quarters are. @

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Additional recommendations about: Accommodations - 2/3

2008-10-26T12:01:00.000-07:00

Continued list about Accommodations to be considered when hyperacusis and tinnitus arise:

7. The most ideal heat in home is hot water heat. It is the quietest and no fans are running. Forced air may be tolerable as long as the bedroom is not located near or directly above the furnace. Heat pumps are offensive and often make banging noises. Window air conditioners are also a problem. Central air conditioners are by far the best but keep the fan rpm's (revolutions per minute) at a moderate range.

8. Also, try to fine tune your door closures so they close quietly. Be careful on windy days. Door closures are the worst maintained part of any public building. Many buildings have doors, which screech when they open and bang when they close. It is a good idea to always open a public entrance door slowly and keep your hand on it until it closes to prevent any surprises (remember - dynamic range!).

9. Many of us have difficulty riding in a car, bus, train, and especially an airplane. Road noise entering the car is hard, particularly if the windows are open. It is worse when it is a windy day. Sometimes closing the window on the drivers' side, opening a window on the passenger side, and driving in the far right lane of traffic may help. If you are the owner of a car, electric windows are a must so that you can control the noise entering the car. Learn to be a control person (with noise that is).

10. When car alarms go off we are either running or making a quick departure with our fingers in our ears. The chime or bell ringer on newer cars for signaling ignition start up and seat belts should be removed no matter what your mechanic tells you about safety standards. Although some dealerships may refuse to remove this, they can tell you where it is located and it is relatively simple to unplug it yourself. If your condition is explained to them or you show them this supplement - most will take it out for you. Some dealerships have even called The Hyperacusis Network to ask if this sound sensitive customer is 'for real' before disconnecting some of this safety equipment. They may still insist on you signing a waiver to free the dealer from any liability, but in many instances it is well worth it.

11. Whenever we are indoors and hear an echo - we are in trouble. Rooms that have acoustical ceiling tile, carpeting, window treatments, and lots of furniture help. Shopping malls with high ceilings are bad - particularly eating areas. To make matters worse, some have water fountains with splashing water. It can help if we spend most of our time in shops rather than the center walkways of a mall.

(to be continued on the next posts)

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Additional recommendations about: Accommodations - 1/3

2008-10-16T18:25:00.000-07:00

Recommended accommodations when hyperacusis arise:

1. Ranch homes are quieter than multi-level homes, and masonry homes are quieter than non-masonry homes. If you are building a two - story home, insulate the interior walls, floors, and ceiling round your bedroom if necessary. Use lots of carpeting, and do not put the air conditioner compressor near your bedroom window. Use cast iron drainpipes on a two-story home to significantly reduce the sound of water draining through the pipes. It is important that our living quarters not be near interstate highways or heavily traveled roads. We should not live in the flight pattern of an airport or near railroad tracks that are still in use. Some of us move frequently to find a more sound friendly neighborhood and home/apartment.

2. Consider putting spray attachments to existing water faucets. These can be purchased at most hardware stores.

3. For new home construction it is better to have cast iron drainpipes run through insulated walls. Plastic drainpipes make unnecessary noise especially in a two-story home.

4. The kitchen is the other danger zone in the house. The sound of silverware hitting dishes or hitting the floor is distressing to almost all of us. It helps to use place mats, Chinet paper plates, and plastic eating utensils. Although this is the ideal, practically speaking we know we can't just throw out our dinnerware! Just watch us - we give new meaning to the phrase "eating quietly."

5. This may come as a surprise to you, but some of us are even bothered by the sound of the fan running underneath the refrigerator. Many companies are still working on quiet refrigerators. The quietest refrigerator is a propane refrigerator available through RV (recreation vehicle) dealers. Unfortunately, these refrigerators usually are smaller (10 cubic feet). Some people in the network actually put their refrigerator in their garage. Some buy refrigerators, which are not frost - free. This cuts down on the fan running under the refrigerator. Always check Consumers Reports magazine when buying appliances. Usually they rate the appliance for noise.

6. Another great help is putting heavy felt cushions on all kitchen cabinet doors and drawers so they do not bang when they are closed. Also, try to deactivate the beep on your microwave. One beep would be plenty, but most microwaves beep three and four times.

(to be continued on the next posts)

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

How to insulate a room to attenuate loud noise

2008-10-01T09:48:00.000-07:00

A brief description of how to insulate a room to attenuate internal and external noises when hyperacusis arise.

Special cares and measures taken - 3/4: Accommodations

2008-09-19T16:12:00.000-07:00

Going back to describing my condition, I list here other measures taken when my hyperacusis and tinnitus got worse.

Accommodations:

- The ceiling, floor and walls of my bedroom have been insulated to protect me, and give me refuge, against any strong noises which could occur during the day or at night. A double-paned window was also installed, which proved extremely useful at night and enabled me to fall asleep, blocking any external noises.

- Felt pads were also put on all of the drawer doors that make sounds when being closed.

- Oil was applied on all door hinges to eliminate the noise that they produced.

- The sound from the doorbell and microwave were disconnected since the noise they gave was very distressing.

- The sound from the bedroom telephone was muted, but the extension in the living room was kept on, to hear any incoming calls.

- The toilet's internal water system and some of the water faucets in the house were replaced due to their excessive noise.

- All glass dishes, china, and silverware were replaced with plastic plates and utensils. Mats were also used on the table during meals.

- Some of the noisy locks on the doors were disengaged, and for some of them (like the door for entering the third floor of my house) a pad of paper was used instead to keep them closed.

- The washing machine was placed on the flat roof of the house.

- Special connections with many extension cords were made for my computer so that the monitor, keyboard, mouse, and all of the silent equipment can remain in my bedroom, while keeping the noisy CPU and electronic voltage stabilizer in another room.

Additional recommendations about: Change of Habits - 3/3

2008-09-14T19:42:00.000-07:00

This is the last part of the list about Change of Habits that could be considered when hyperacusis and tinnitus arise:

15. If you go to a public event and you know clapping or singing will be a part of the festivities - sit in the last row. That way no one is clapping or singing in your ears. Sometimes clapping can happen in the most unexpected places - like church. In those surprise situations, you can always put your fingers in your ears.

16. Some churches have services without music, and these should be attended if at all possible. Some of us sit inside chapels, mother's rooms (when no babies are present), the vestibule of church, or the clergy's room (sacristy). Another option is to go to an early morning service or watch a religious service on television.

17. In restaurants, try to be seated away from the kitchen or dirty dish islands... It is better to go to a restaurant where the waitress takes the plates and silverware away on a platter. If you eat during off-hours (before 11 am., after 1:30 pm., before 4:30 pm., or after 7 pm.) it is much better because the noise level is way down. If you go to a new restaurant, just ask the hostess to put you in the quietest area they have... Stay away from eating places that play loud music because people tend to talk louder to compensate for the noise. Fast food restaurants use a high pitched beep to signal when French fries are done. The beep is so high pitched that it almost makes our ears quiver. Find a place in a fast food restaurant as far away from the kitchen as possible. Also, do not be seated in tables directly under ceiling speakers. We hate to eat with earplugs in because we hear the sound of chewing and swallowing.

18. Movie theaters are very noisy places... Sometimes it works if we go during the week because theaters turn down the volume since fewer people are in attendance. Even if they do not turn down the volume, they may be more receptive to your request. Some of us go, but have to use major ear protection (foam earplugs and/or earmuffs)... No matter what - always sit in the back row, so no one is shouting behind you, and try to get to the theater early... Renting movies can be very enjoyable. @

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Additional recommendations about: Change of Habits - 2/3

2008-09-02T11:19:00.000-07:00

Continuation of list about Change of Habits that could be considered when hyperacusis and tinnitus arise:

8. Bathrooms are often a problem too. Never flush a toilet with the lid up. If possible, never flush while we are in the room. We often flush with our knee (or foot) while holding our fingers in our ears. Sounds odd, but in life you do what you have to do - right!

9. The sound of running water through plumbing often emits a high sound that is distressing... Many of us wear foam or silicon earplugs when we take a shower. The quietest way to get clean is to have someone else draw your bath water. Spray shower heads work better.

10. Noisy pets are very upsetting. Loud barking dogs or chirping birds are the worst offenders. If you are visiting relatives or friends and you know they have an excitable pet that makes noise, wear foam earplugs until they have gotten used to you. You can always take them out once the pet gets acquainted with you.

11. There is a secret to attending small public gatherings that helps ears slowly adjust to increases in sound. If you are going to an event where a gathering of people will be present, it is better to get there early. By doing this, the sound level will slowly increase as people arrive... Also, check out where the speakers are in a room. Rooms with front speakers are much better for us than rooms with surround sound. We need distance from speakers to help our ears handle most public address systems.

12. We can have our family or spouse take a video camera to an event we cannot attend. Once they get back from the event... they will be sharing the moment with you.

13. Many of us are unable to walk on the sidewalk where there is any amount of traffic. If you take a walk, drive to a quiet area ...

14. Shoveling snow is also a problem because the metal shovel scraping the hard pavement can be too loud for some of us. Plastic shovels are quieter. Chain saws just annihilate our ears and should not be used under any circumstances.

(to be continued)

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Additional recommendations about Change of Habits - 1/3

2008-08-21T14:50:00.001-07:00

1. Sleeping can be very difficult. Many times the mere act of turning our head on the pillow makes a loud noise in our ear. If we have severe hyperacusis we learn to roll our head on the pillow, or better yet, lift our head and reposition it. New cotton pillowcases can be difficult because the material is new and rough.

2. Crushing paper, electric can openers and dropping ice cubes in empty glasses are also difficult. Alternatives: fold paper and then dispose of it; get a manual can opener (they work great); and try filling your glass before dropping the ice cubes in.

3. For many of us, we miss working with wood and using a hammer. Pounding a nail is 100 decibels, and beyond what many of our tolerances allow! Let us talk about Dynamic Range. Although we have collapsed tolerance to sound, our ears cannot adjust to sudden shifts in volume. Even shifts from zero decibels to 40 decibels are hard for us, yet we may be able to tolerate sustained sounds of 40+ decibels.

What kind of sense does that make? Sustained sound is much easier for us to handle than sudden shifts in volume. That is part of the reason the early morning is difficult for us. Our ears have heard no sound all night and then as day breaks we must become reacquainted with noise. As we get on with our day - things often improve.

4. Before you turn a TV or radio OFF - turn the volume off too. Starting a car and being blasted by the radio is very difficult (dynamic range). Most TV's have an oscillator that emits a high frequency ... often we are able to hear this high pitch noise and it is very irritating.

5. Sirens are very distressing for us. When you hear one coming close all windows before it passes.

6. ... if you have hyperacusis and need to raise your voice to get attention, it is better to cup your hands around your mouth. This method protects your ears from the loudness of your own voice.

7. Cutting grass is a particular challenge. Push mowers are quieter than tractor type lawn mowers, but electric lawn mowers are best... Others use foam earplugs or wear earmuffs.

(to be continued on the next posts)

Texts extracted from The Hyperacusis Network web page (Supplement section), with the permission of its editor. (see “related links” in this blog)

Special cares and measures taken - 2/4: Change of Habits

2008-08-16T12:33:00.000-07:00

Change of habits:

Due to my severe hyperacusis I had to change many of my habits in daily life:

- I began doing all my activities slowly and in a quieter way, in order to avoid unnecessary noises.

- In the morning, when I woke up I paid special attention to noise, because my ears were more sensitive.

- To take a bath I stopped using the shower. Instead I began using a bucket and a sponge to avoid the noise produced by the running bath water. I did the same to wash my hair. In both situations, I always worn earplugs.

- To flush the toilet I used my knee, while holding my fingers in my ears, even if I was worn earplugs because the noise was too loud.

- I tried to sleep face up at night and stopped using the pillow because turning my head on it made a loud noise on my ears.

- When I had to cut or dispose papers and plastic materials, I folded them or made use of scissors, instead of crushing or cutting them with the hands.

- To communicate with people I began to use writing instead of speaking, because the sound of my own voice were extremely bothersome. I asked my family and friends to do the same when they wanted to talk with me, since their voices were also a problem for me.

Special cares and measures taken - 1/4: Hearing Protection

2008-08-10T19:01:00.000-07:00

Parallel with the treatments performed to reduce my hyperacusis and tinnitus, it was taken several measures to protect my ears and to attenuate the noise at home. Following I explain them in detail.

Use of hearing protection:

- I continued using foam earplugs, but avoiding the mistakes made before about fitting and use. I bought also earmuffs which I used alone or in combination with the earplugs when the noise coming from outside my home was so strong.

These earmuffs were especially useful to attenuate or cancel high frequency sounds.

I also used the earplugs and earmuffs to do some specific things at home that were noisy: turning on the microwave, manipulating the rubbish plastic bags, using the washing machine, taking a bath, washing my hair, washing the dishes, opening some cans, etc.

Recommendations about hearing tests

2008-08-01T15:28:00.000-07:00

“So few doctors know anything about our condition, we rarely get good advice and frequently hearing tests are administered to us which can make our condition even worse ( MRI or Brainstem Evoke test).

Before any hearing tests are performed on a patient who is suspected to have hyperacusis, their Loudness Discomfort Levels (LDL's) should be known. If the sounds generated from the test exceed the LDL of the hyperacusis patient, their sound tolerance can become further collapsed (worsened). This would be unfortunate.”

“... As I mentioned before, many of us have had our ears tested by professionals in ways which have caused even further damage since the tests involve listening to 90+ decibel sounds.

Before we receive any hearing tests, our tolerance levels must be known, so we are not hurt further. This is something your E.N.T. (Ear, Nose and Throat doctor) needs to know. If you mention this to him/her and they have no idea what you are talking about - you are in the wrong hands! Because most of the medical community does not understand our problem, we have to be very careful.

For example, having an MRI can be devastating to our ears unless full foam ear protection is used and inserted correctly. If an MRI must be performed, it is imperative that you wear full foam earplugs, and if possible, wear plastic earmuffs on top of the earplugs.”

Text extracted from The Hyperacusis Network web page (Supplement section) , with the permission of its editor. (see "related links" in this blog)

Hearing tests administered

2008-07-25T17:08:00.000-07:00

The following were the hearing tests administered to me when my hyperacusis got worse:

- Pure-Tone audiometric test

- Speech audiometric test

- Logo-audiometric test

- Tympanometric test

- Acoustic reflex test

Results to all these tests were normal, and in many cases above average, which indicated that my auditory capacity was ok. The specialist was very surprised and told me that my ability to hear sounds was similar to that of a 5 years old child.

One Dr. requested the Brainstem Evoke Test. but I didn’t do that, because the minimum sound level to do this test was 50 dB, which was too high for me.

I’ve also been advised to undergo Magnetic Resonance Imaging, but by the same reason (the sounds generated from the test), I didn’t do either.

Contact me

2008-07-25T16:26:00.000-07:00

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