It has been suggested that the tensor tympani is involved in causing the disorder. In particular, the tonic tensor tympani syndrome.[6][7] In France, researchers report the study of a case of acoustic shock in a scientific publication. They suggest that these symptoms may result from a loop involving the middle ear muscles, peripheral inflammatory processes, activation and sensitization of the trigeminal nerve, the autonomic nervous system, and central feedbacks.[8]
The accepted definition of chronic tinnitus, as compared to normal ear noise experience, is five minutes of ear noise occurring at least twice a week.[51] However, people with chronic tinnitus often experience the noise more frequently than this and can experience it continuously or regularly, such as during the night when there is less environmental noise to mask the sound.

The first major report regarding acoustic shock was published in Denmark5 but this was part of an internal company report and the text not easily accessible. The first widely available publication was from Australia1 and described the clinical features of 103 call centre workers who had been exposed to acoustic incidents. There have been further publications describing acoustic shock from Australia,6 the United Kingdom7,8 and India.9 Although there has been some interest generated regarding this geographical distribution there are unofficial reports of acoustic shock occurring in many other countries. There are also anecdotal reports of acoustic shock symptomatology occurring in people exposed to sudden unexpected sound but not wearing headsets or handsets. In these cases the causative sound is usually generated close to the person and this proximity of the sound source to the ear does seem to be a common feature of the syndrome. There have been reports of acoustic shock occurring in clusters. There is a slight female preponderance of cases of acoustic shock though further work is needed to ascertain whether this gender imbalance is genuine or simply reflects the gender distribution of call centre work.


Acoustic shock is a recently recognised clinical entity: following an abrupt, intense and unanticipated acoustic stimulus, usually delivered by a telephone handset or headset, some individuals report a symptom cluster that includes otalgia, altered hearing, aural fullness, imbalance, tinnitus, dislike or even fear of loud noises, and anxiety and/or depression. Symptoms start shortly after the triggering acoustic incident and can be short-lived or can last for a considerable time. If persistent, the condition can lead to significant disability. Proposed mechanisms include involvement of the tensor tympani muscle, hyperexcitability of central auditory pathways, and a precursive state of raised anxiety or arousal. A formal treatment programme has not yet been proposed, but the potential utility of modern therapeutic techniques for tinnitus and hyperacusis are considered. Given the large number of UK residents working in telephone call centres, this condition is of considerable clinical importance.
Besides being an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people.[12][13] Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range.[14][15] Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus.[16][17] 45% of people with tinnitus have an anxiety disorder at some time in their life.[18]
Exposure to loud noise. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; both short- and long-term exposure to loud sound can cause permanent damage.
Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually gets better after the infection clears. Ear infections that happen again and again, or fluid in the middle ear, may lead to more-significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
Prelingual deafness is profound hearing loss that is sustained before the acquisition of language, which can occur due to a congenital condition or through hearing loss before birth or in early infancy. Prelingual deafness impairs an individual's ability to acquire a spoken language in children, but deaf children can acquire spoken language through support from cochlear implants (sometimes combined with hearing aids).[42][43] Non-signing (hearing) parents of deaf babies (90-95% of cases) usually go with oral approach without the support of sign language, as these families lack previous experience with sign language and cannot competently provide it to their children without learning it themselves. Unfortunately, this may in some cases (late implantation or not sufficient benefit from cochlear implants) bring the risk of language deprivation for the deaf baby[44] because the deaf baby wouldn't have a sign language if the child is unable to acquire spoken language successfully. The 5-10% of cases of deaf babies born into signing families have the potential of age-appropriate development of language due to early exposure to a sign language by sign-competent parents, thus they have the potential to meet language milestones, in sign language in lieu of spoken language.[45]
Ginkgo biloba does not appear to be effective.[94][108] The American Academy of Otolaryngology recommends against taking melatonin or zinc supplements to relieve symptoms of tinnitus, and reported that evidence for efficacy of many dietary supplements—lipoflavonoids, garlic, homeopathy, traditional Chinese/Korean herbal medicine, honeybee larvae, other various vitamins and minerals—did not exist.[74] A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.[109]
Tinnitus remains a symptom that affects the lives of millions of people. Research is directed not only at its treatment, but also at understanding why it occurs. Research by doctors at the University at Buffalo, The State University of New York, Dalhousie University (Canada), and Southeast China University have published research using electrophysiology and functional MRI to better understand what parts of the brain are involved in hearing and the production of tinnitus. Their research has found that much larger areas of the brain are involved with the process of hearing than previously believed, which may help direct future diagnostic and therapeutic options.
A 2017 report by the World Health Organization estimated the costs of unaddressed hearing loss and the cost-effectiveness of interventions, for the health-care sector, for the education sector and as broad societal costs.[103] Globally, the annual cost of unaddressed hearing loss was estimated to be in the range of $750–790 billion international dollars.
If you have good hearing, your doctor may suggest a sound generator. These used to be called masking devices. There are two main types. One is a portable machine that produces calming sounds. The other fits to your ear like a hearing aid and produces a constant low-level noise or tone, sometimes called white noise, masking (covering up) the tinnitus. This may also help your brain get used to the tinnitus. Some people find that sound generators interfere with their hearing while they’re using them.
Hearing loss in both ears can be either conductive, sensorineural, or a mixture of both. It’s best to see an audiologist whenever you think there is a noticeable change in both your ears. They’ll fully assess your ears and perform a number of tests to determine the type of hearing loss you may have, and they’ll be able to recommend the best treatment option to help.
Often interventions to prevent noise-induced hearing loss have many components. A 2017 Cochrane review found that stricter legislation might reduce noise levels.[97] Providing workers with information on their noise exposure levels was not shown to decrease exposure to noise. Ear protection, if used correctly, can reduce noise to safer levels, but often, providing them is not sufficient to prevent hearing loss. Engineering noise out and other solutions such as proper maintenance of equipment can lead to noise reduction, but further field studies on resulting noise exposures following such interventions are needed. Other possible solutions include improved enforcement of existing legislation and better implementation of well-designed prevention programmes, which have not yet been proven conclusively to be effective. The conclusion of the Cochrane Review was that further research could modify what is now regarding the effectiveness of the evaluated interventions.[97]

Certain medicines: Prescription and over-the-counter drugs can trigger ringing or make it louder. This includes aspirin, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), quinine-based medication, and certain antibiotics, antidepressants, and cancer drugs. Usually the stronger the dose, the greater your chance of problems. Often if you stop the drug, your symptoms will go away. See your doctor if you think a drug may be to blame. But don't stop taking any medication without talking to your doctor first.
Rapid referral for a comprehensive audiological assessment provides reassurance, and can help control an escalation of symptoms and limit the development of hyperacusis. History taking should document immediate and persistent symptoms since the acoustic incident exposure; prior acoustic incident exposures; and prior otological and psychological history. Significant malingering is rare in ASD clients, in my experience. Most clients are bewildered, frightened or angered by their symptoms and desperate to recover.

Hearing loss has been shown to negatively impact people’s quality of life and their mental state. If you develop hearing loss, you may have difficulty understanding others. This can increase your anxiety level or cause depression. Treatment for hearing loss may improve your life significantly. It may restore self-confidence while also improving your ability to communicate with other people.
Falls have important health implications, especially for an aging population where they can lead to significant morbidity and mortality. Elderly people are particularly vulnerable to the consequences of injuries caused by falls, since older individuals typically have greater bone fragility and poorer protective reflexes.[35] Fall-related injury can also lead to burdens on the financial and health care systems.[35] In literature, age-related hearing loss is found to be significantly associated with incident falls.[36] There is also a potential dose-response relationship between hearing loss and falls---greater severity of hearing loss is associated with increased difficulties in postural control and increased prevalence of falls.[37] The underlying causal link between the association of hearing loss and falls is yet to be elucidated. There are several hypotheses that indicate that there may be a common process between decline in auditory system and increase in incident falls, driven by physiological, cognitive, and behavioral factors.[37] This evidence suggests that treating hearing loss has potential to increase health-related quality of life in older adults.[37]
Acoustic qualification of tinnitus will include measurement of several acoustic parameters like frequency in cases of monotone tinnitus or frequency range and bandwidth in cases of narrow band noise tinnitus, loudness in dB above hearing threshold at the indicated frequency, mixing-point, and minimum masking level.[52] In most cases, tinnitus pitch or frequency range is between 5 kHz and 10 kHz,[53] and loudness between 5 and 15 dB above the hearing threshold.[54]
Deaf culture refers to a tight-knit cultural group of people whose primary language is signed, and who practice social and cultural norms which are distinct from those of the surrounding hearing community. This community does not automatically include all those who are clinically or legally deaf, nor does it exclude every hearing person. According to Baker and Padden, it includes any person or persons who "identifies him/herself as a member of the Deaf community, and other members accept that person as a part of the community,"[114] an example being children of deaf adults with normal hearing ability. It includes the set of social beliefs, behaviors, art, literary traditions, history, values, and shared institutions of communities that are influenced by deafness and which use sign languages as the main means of communication.[115][116] Members of the Deaf community tend to view deafness as a difference in human experience rather than a disability or disease.[117][118] When used as a cultural label especially within the culture, the word deaf is often written with a capital D and referred to as "big D Deaf" in speech and sign. When used as a label for the audiological condition, it is written with a lower case d.[115][116]
Brain aneurysm (cerebral aneurysm) is caused by microscopic damage to artery walls, infections of the artery walls, tumors, trauma, drug abuse. Symptoms include headache, numbness of the face, dilated pupils, changes in vision, the "worst headache of your life," or a painful stiff neck. Immediate treatment for a brain aneurysm is crucial for patient survival.
^ Jump up to: a b Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA (February 2018). "Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis". JAMA Otolaryngology-- Head & Neck Surgery. 144 (2): 115–126. doi:10.1001/jamaoto.2017.2513. PMC 5824986. PMID 29222544.
When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, the tinnitus is called nonotic (i.e. not otic). In some 30% of tinnitus cases, the tinnitus is influenced by the somatosensory system, for instance, people can increase or decrease their tinnitus by moving their face, head, or neck.[25] This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have an effect.[23]
You must consult with a qualified physician or hearing healthcare clinician to find the proper treatment for hyperacusis. All content, text, graphics, and information is for general informational purposes and is not intended for use as a diagnosis or treatment of a health problem or as a substitute for consulting a licensed medical professional. The Hyperacusis Network is a free network and accepts no advertising. Any information received is kept confidential and shared with no one.
Tinnitus is the perception of sound when no corresponding external sound is present.[1] While often described as a ringing, it may also sound like a clicking, buzzing, hiss, or roaring.[2] The sound may be soft or loud, low or high pitched, and appear to be coming from one or both ears.[2] In some people, the sound may interfere with concentration or increase feelings of anxiety or depression.[2] Tinnitus may be associated with some degree of hearing loss and with decreased understanding in noise.[2]
The most distressing and persistent ASD symptoms tend to be aural pain and hyperacusis. Sharp stabbing aural pain and numbness/burning in and around the ear are consistent with trigeminal nerve irritation. If pain levels are severe, treatment for trigeminal neuralgia, TMD and/or referral to a pain management clinic is indicated. Hyperacusis desensitisation therapy and massage of the muscular trigger points around the neck and shoulder will reduce TTTS symptoms, but progress can be slow once symptoms become entrenched.
Call centre staff are therefore particularly vulnerable: the workplaces are often large, open plan environments with high levels of ambient noise, requiring the operator to turn up the volume of their headset, increasing vulnerability to acoustic incident exposure. Additionally, the workplace environment is potentially stressful: the job requirements are often competitive, monitored and repetitive, with the calls made frequently unwelcome
Middle ear fluid or infection—The middle ear space normally contains air, but it can become inflamed and fluid filled (otitis media). An active infection in this area with fluid is called acute otitis media and is often painful and can cause fever. Serous otitis media is fluid in middle ear without active infection. Both conditions are common in children. Chronic otitis media is associated with lasting ear discharge and/or damage to the ear drum or middle ear bones (ossicles).
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Consider education and motivation. Set up training sessions for EU Noise Directive and Acoustic Shocks safety needs – something that can be done by bringing the appropriate and independent expertise from the Health and Safety Executive (HSE) or the Acoustic Safety Programme. Remember: educational methods and materials should be tailored to the specific audience. The goal of education and training is not just to inform, but also to motivate. Dynamic, relevant training will imbue workers with a sense of personal control over their hearing health, lead to the development of intrinsic motivation to adopt positive hearing health.
Identification of a hearing loss is usually conducted by a general practitioner medical doctor, otolaryngologist, certified and licensed audiologist, school or industrial audiometrist, or other audiometric technician. Diagnosis of the cause of a hearing loss is carried out by a specialist physician (audiovestibular physician) or otorhinolaryngologist.
A case history (usually a written form, with questionnaire) can provide valuable information about the context of the hearing loss, and indicate what kind of diagnostic procedures to employ. Examinations include otoscopy, tympanometry, and differential testing with the Weber, Rinne, Bing and Schwabach tests. In case of infection or inflammation, blood or other body fluids may be submitted for laboratory analysis. MRI and CT scans can be useful to identify the pathology of many causes of hearing loss.
NEVER put anything inside your ear to remove earwax, such as cotton buds or your finger. Always use earplugs or a swimming hat over your ears when you swim. When showering or taking a bath at home, avoid getting water or shampoo in your ears. Do treat any conditions affecting your ears, such as eczema or allergies. Some people can find their hearing aids cause irritation.
Often interventions to prevent noise-induced hearing loss have many components. A 2017 Cochrane review found that stricter legislation might reduce noise levels.[97] Providing workers with information on their noise exposure levels was not shown to decrease exposure to noise. Ear protection, if used correctly, can reduce noise to safer levels, but often, providing them is not sufficient to prevent hearing loss. Engineering noise out and other solutions such as proper maintenance of equipment can lead to noise reduction, but further field studies on resulting noise exposures following such interventions are needed. Other possible solutions include improved enforcement of existing legislation and better implementation of well-designed prevention programmes, which have not yet been proven conclusively to be effective. The conclusion of the Cochrane Review was that further research could modify what is now regarding the effectiveness of the evaluated interventions.[97]

Since 1991, major manufacturers have incorporated an acoustic limiter in the electronics of their headsets to meet the requirements of the Department of Trade and Industry (DTI) specification 85/013. In the UK, this limiter ensures that any type of noise (eg conversation, short duration impulses) above 118 dB is not transmitted through the headset.


Tinnitus retraining therapy is a form of treatment that tries to retrain the nerve pathways associated with hearing that may allow the brain to get used to the abnormal sounds. Habituation allows the brain to ignore the tinnitus noise signal, and it allows the person to become unaware that it is present unless they specifically concentrate on the noise. This treatment involves counseling and wearing a sound generator. Audiologists and otolaryngologists often work together in offering this treatment.
As of 2018 there were no medications effective for idiopathic tinnitus.[3][74][94] There is not enough evidence to determine if antidepressants[95] or acamprosate are useful.[96] There is no high-quality evidence to support the use of benzodiazepines for tinnitus.[3][94][97] Usefulness of melatonin, as of 2015, is unclear.[98] It is unclear if anticonvulsants are useful for treating tinnitus.[3][99] Steroid injections into the middle ear also do not seem to be effective.[100][101] There is no evidence to suggest that the use of betahistine to treat tinnitius is effective.[102]

Your symptoms will depend on the cause of your hearing loss and your age. For adults, symptoms may include having trouble hearing. A common first sign is difficulty in understanding people, particularly in noisy places. You may complain that others are mumbling. Your ear may feel muffled, blocked or plugged. You may also feel as though there is water or pressure in your ear.
While the American College of Physicians indicated that there is not enough evidence to determine the utility of screening in adults over 50 years old who do not have any symptoms,[99] the American Language, Speech Pathology and Hearing Association recommends that adults should be screened at least every decade through age 50 and at 3-year intervals thereafter, to minimize the detrimental effects of the untreated condition on quality of life.[100] For the same reason, the US Office of Disease Prevention and Health Promotion included as one of Healthy People 2020 objectives: to increase the proportion of persons who have had a hearing examination.[101]
Prelingual deafness is profound hearing loss that is sustained before the acquisition of language, which can occur due to a congenital condition or through hearing loss before birth or in early infancy. Prelingual deafness impairs an individual's ability to acquire a spoken language in children, but deaf children can acquire spoken language through support from cochlear implants (sometimes combined with hearing aids).[42][43] Non-signing (hearing) parents of deaf babies (90-95% of cases) usually go with oral approach without the support of sign language, as these families lack previous experience with sign language and cannot competently provide it to their children without learning it themselves. Unfortunately, this may in some cases (late implantation or not sufficient benefit from cochlear implants) bring the risk of language deprivation for the deaf baby[44] because the deaf baby wouldn't have a sign language if the child is unable to acquire spoken language successfully. The 5-10% of cases of deaf babies born into signing families have the potential of age-appropriate development of language due to early exposure to a sign language by sign-competent parents, thus they have the potential to meet language milestones, in sign language in lieu of spoken language.[45]
TTTS was originally described by Dr I. Klockhoff (9-12), and has been proposed by Patuzzi, Milhinch and Doyle (13) and Patuzzi (7) as the neurophysiological mechanism causing most of the persistent ASD symptoms. TTTS is an involuntary condition where the centrally mediated reflex threshold for tensor tympani muscle activity becomes reduced as a result of anxiety and trauma, so it is continually and rhythmically contracting and relaxing, aggravated by intolerable sound exposure1. This appears to initiate a cascade of physiological reactions in and around the ear, which can include: tympanic membrane flutter; alterations in ventilation of the middle ear cavity leading to a sense of blockage or fullness, as well as muffled/echoey/distorted hearing; irritation of the trigeminal nerve innervating the tensor tympani muscle, leading to frequent neuralgic pain; and symptoms consistent with temporomandibular disorder (TMD).
Dizziness usually refers to feeling lightheaded where the patient feels unsteady similar to the sensation felt before fainting. The causes of dizziness may be due to a wide range of conditions, many of which do not involve the ear, example : low blood sugar, sudden drop in blood pressure, alcohol and certain drugs. However, many of the causes of peripheral vertigo may result in a lightheaded feeling without the typical vertigo sensation, especially in milder cases.

Labyrinthitis is inflammation of the labyrinth (the part of the ear responsible for balance and hearing). Doctors do not know the exact cause of labyrinthitis; however, they often are associated viral infections of the inner ear. Symptoms of labyrinthitis are ear pain or earache, ear discharge, problems with balance and walking, ringing in the ears, dizziness, nausea, vomiting, and vertigo. Viral infections associated with labyrinthitis are contagious.

Hyperacusis escalation is common with ASD so that an increasing range of sounds become intolerable, with a corresponding escalation in TTTS symptoms, potentially leading to TMD. For this reason, a detailed history is essential in tracking the order of development and escalation of symptoms, and their relationship to acoustic incidents/headset use, prior to making a responsible and considered diagnosis of ASD.
Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise. Those damages may occur even at doses that are not considered ototoxic.[28] More than 260 medications have been reported to cause tinnitus as a side effect.[29] In many cases, however, no underlying cause could be identified.[2]
As of 2018 there were no medications effective for idiopathic tinnitus.[3][74][94] There is not enough evidence to determine if antidepressants[95] or acamprosate are useful.[96] There is no high-quality evidence to support the use of benzodiazepines for tinnitus.[3][94][97] Usefulness of melatonin, as of 2015, is unclear.[98] It is unclear if anticonvulsants are useful for treating tinnitus.[3][99] Steroid injections into the middle ear also do not seem to be effective.[100][101] There is no evidence to suggest that the use of betahistine to treat tinnitius is effective.[102]
NEVER put anything inside your ear to remove earwax, such as cotton buds or your finger. Always use earplugs or a swimming hat over your ears when you swim. When showering or taking a bath at home, avoid getting water or shampoo in your ears. Do treat any conditions affecting your ears, such as eczema or allergies. Some people can find their hearing aids cause irritation.
Globally, hearing loss affects about 10% of the population to some degree.[50] It caused moderate to severe disability in 124.2 million people as of 2004 (107.9 million of whom are in low and middle income countries).[13] Of these 65 million acquired the condition during childhood.[15] At birth ~3 per 1000 in developed countries and more than 6 per 1000 in developing countries have hearing problems.[15]

Sound waves travel through the ear canal to the middle and inner ear, where hair cells in part of the cochlea help transform sound waves into electrical signals that then travel to the brain's auditory cortex via the auditory nerve. When hair cells are damaged — by loud noise or ototoxic drugs, for example — the circuits in the brain don't receive the signals they're expecting. This stimulates abnormal activity in the neurons, which results in the illusion of sound, or tinnitus.


People who live with tinnitus might have difficulty falling asleep or staying asleep. In order to sleep well, our bodies and our minds need to be relaxed. Worrying about the tinnitus, or worrying about how much sleep you’re getting (or missing out on), is unhelpful and will only make it more difficult to sleep. Most people with tinnitus sleep well and their tinnitus is no different from those who do not sleep well. People who have tinnitus and sleep poorly tend to worry more at night than people with tinnitus who sleep well. Working through problems during waking hours is better than in the middle of the night when you have nothing else to occupy you.
^ Jump up to: a b Schecklmann, Martin; Vielsmeier, Veronika; Steffens, Thomas; Landgrebe, Michael; Langguth, Berthold; Kleinjung, Tobias; Andersson, Gerhard (18 April 2012). "Relationship between Audiometric Slope and Tinnitus Pitch in Tinnitus Patients: Insights into the Mechanisms of Tinnitus Generation". PLOS ONE. 7 (4): e34878. Bibcode:2012PLoSO...734878S. doi:10.1371/journal.pone.0034878. PMC 3329543. PMID 22529949.
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