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.
A really easy way to relax is to find somewhere peaceful and just slow your breathing down (feel free to have some sound on in the background). You can take a few slow deep breaths and pay full attention to the feeling of the breath entering your body, filling your lungs and leaving your body. When we use deep breathing to relax, we feel calmer and more able to manage the tinnitus, and often don’t notice it as much!
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]

Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress (i.e., nature and extent of tinnitus-related problems), measured subjectively by validated self-report tinnitus questionnaires.[16] These questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health and emotional functioning.[63][64][65] A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms for the individual.[66] Overall, current assessment measures are aimed to identify individual levels of distress and interference, coping responses and perceptions of tinnitus in order to inform treatment and monitor progress. However, wide variability, inconsistencies and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.[67] Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.[68]
I was a few feet away from a coworker when she reported a very painful blast of sound through her headset recently. She was crying and shakey, and the ear I could see, as well as a couple inches of the skin surrounding the ear, were very reddened. This was a few minutes post injury and she said it still hurt very much. Both our Human Resources Department and Information Technology seemed to have no idea what had happened to cause the injury. How could they not know abt. acoustic shock injury by now? Since a couple years after starting working at my call center, I have had ridiculously hypersensitive hearing. Everything in my environment seems too loud and I’m also ridiculously irritable most of the time, but especially when there’s any noise in my environment like small children make, or traffic. It’s like my nervous system is all revved up most of the time for no particular reason. Now I know why.

Fetal alcohol spectrum disorders are reported to cause hearing loss in up to 64% of infants born to alcoholic mothers, from the ototoxic effect on the developing fetus plus malnutrition during pregnancy from the excess alcohol intake. Premature birth can be associated with sensorineural hearing loss because of an increased risk of hypoxia, hyperbilirubinaemia, ototoxic medication and infection as well as noise exposure in the neonatal units. Also, hearing loss in premature babies is often discovered far later than a similar hearing loss would be in a full-term baby because normally babies are given a hearing test within 48 hours of birth, but doctors must wait until the premature baby is medically stable before testing hearing, which can be months after birth. [56]The risk of hearing loss is greatest for those weighing less than 1500 g at birth.


4. Noise at Work regulations demand that headset wearers are not exposed to more than a certain amount of noise in any given shift. The aforementioned devices try to make their brand of headset conform to this by different means. One manufacturer takes the prescribed level, say 84dB, and raises volume that is below that level or lowers volume that is above it to ensure that everything is at, say 84dB. Another manufacturer’s offering tries to predict the total noise exposure over a shift by extrapolising current levels and progressively clamping down on or increasing the volume available to the headset wearer. This is comparable to those trip computers in some cars which predict your fuel range based on present consumption and use comparitive, rather than absolute, measurement criteria.
A common cause of tinnitus is inner ear hair cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can "leak" random electrical impulses to your brain, causing tinnitus.
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]
The potential severity and persistence of ASD symptoms have significant clinical and medico-legal implications. With the rapid growth of call centres around the world, professionals providing tinnitus and hyperacusis therapy, as well as general practitioners, ENT specialists, occupational physicians, TMD specialists, neurologists and trauma psychologists/psychiatrists, are increasingly likely to encounter some or all of the cluster of ASD symptoms in their clients.

Hearing loss is a partial or total inability to hear.[5] Hearing loss may be present at birth or acquired at any time afterwards.[6][7] Hearing loss may occur in one or both ears.[2] In children, hearing problems can affect the ability to learn spoken language, and in adults it can create difficulties with social interaction and at work.[8] Hearing loss can be temporary or permanent. Hearing loss related to age usually affects both ears and is due to cochlear hair cell loss.[9] In some people, particularly older people, hearing loss can result in loneliness.[2] Deaf people usually have little to no hearing.[6]
Typically, people describe acoustic shock as feeling like they have been stabbed or electrocuted in the ear. The symptoms are involuntary, unpleasant and frightening; they can range from mild to severe; and be of short, temporary duration or persistent. If symptoms persist, a range of emotional reactions including trauma, anxiety and depression can develop.
The other fluid-filled chambers of the inner ear include three tubes called the semicircular canals (vestibular labyrinth). Hair cells in the semicircular canals detect the motion of the fluids when you move in any direction. They convert the motion into electrical signals that are transmitted along the vestibular nerve to the brain. This sensory information enables you to maintain your sense of balance.

With the identification of ASD, output limiters in headset equipment have been developed to restrict maximum volume levels transmitted down a telephone line. However, ASD continues to occur despite their use. In my opinion, they are of benefit primarily to help reduce the probability of an initial acoustic incident exposure. The dominant factors of an acoustic incident leading to ASD appear related to the sudden onset, unexpectedness and impact quality of loudish sounds outside the person's control near to the ear(s), rather than to high volume levels alone. If TTTS develops, because of the vulnerability of further escalation to acoustic incidents at lower volume levels, it is impossible to give a 100% guarantee of protection.

Tinnitus is sometimes called ‘the sound of silence' because most people, if they are seated in a completely quiet soundproofed room, will hear a type of rushing or hissing sound. Usually this sound is masked by everyday environmental noise. It is when this noise becomes intrusive that it can become irritating and is known as ‘tinnitus'. The more anxious the sufferer gets the worse the tinnitus becomes.
Prevention involves avoiding exposure to loud noise for longer periods or chronically.[2] If there is an underlying cause, treating it may lead to improvements.[3] Otherwise, typically, management involves psychoeducation or counseling as talk therapy.[5] Sound generators or hearing aids may help some.[2] As of 2013, there were no effective medications.[3] It is common, affecting about 10–15% of people.[5] Most, however, tolerate it well, and it is a significant problem in only 1–2% of people.[5] The word tinnitus comes from the Latin tinnire which means "to ring".[3]
As ASD symptoms are subjective, they are easily misunderstood, misdiagnosed or not believed. An inadequate understanding of the symptoms often exacerbates anxiety, and can lead to confusion and distress. The long term symptoms of severe ASD are consistent with severe hyperacusis, or category 4 according to the Tinnitus Retraining Therapy (TRT) system of classification. Some of the most severe cases of hyperacusis seen in my clinic are those with ASD.

An outer ear infection is sometimes called swimmer’s ear. That’s because it often starts as a result of water that remains in your ear after swimming or bathing. The moisture becomes a breeding ground for bacteria. If your outer ear is scratched or if you irritate the outer lining of your ear by putting your fingers or other objects in your ear, a bacterial infection can occur.


'Acoustic shock' is a term used in connection with incidents involving exposure to short duration, high frequency, high intensity sounds through a telephone headset. Some sources suggest that these incidents are associated with a range of physiological and psychological symptoms that have been reported amongst headset wearers. It has not been established whether the reported symptoms are caused directly by exposure to these unexpected sounds. There is no clear single cause of these incidents, but one cause may be interference on the telephone line. Although call handlers may be shocked or startled by the sounds, exposure to them should not cause hearing damage as assessed by conventional methods.
Psychological research has focussed on the tinnitus distress reaction (TDR) to account for differences in tinnitus severity.[16][19][20][21] These findings suggest that among those people, conditioning at the initial perception of tinnitus, linked tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance.[22]
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.
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Besides research studies seeking to improve hearing, such as the ones listed above, research studies on the deaf have also been carried out in order to understand more about audition. Pijil and Shwarz (2005) conducted their study on the deaf who lost their hearing later in life and, hence, used cochlear implants to hear. They discovered further evidence for rate coding of pitch, a system that codes for information for frequencies by the rate that neurons fire in the auditory system, especially for lower frequencies as they are coded by the frequencies that neurons fire from the basilar membrane in a synchronous manner. Their results showed that the subjects could identify different pitches that were proportional to the frequency stimulated by a single electrode. The lower frequencies were detected when the basilar membrane was stimulated, providing even further evidence for rate coding.[130]
People with extreme hearing loss may communicate through sign languages. Sign languages convey meaning through manual communication and body language instead of acoustically conveyed sound patterns. This involves the simultaneous combination of hand shapes, orientation and movement of the hands, arms or body, and facial expressions to express a speaker's thoughts. "Sign languages are based on the idea that vision is the most useful tool a deaf person has to communicate and receive information".[113]
Barotrauma unequal air pressures in the external and middle ear.[3] This can temporarily occur, for example, by the environmental pressure changes as when shifting altitude, or inside a train going into a tunnel. It is managed by any of various methods of ear clearing manoeuvres to equalize the pressures, like swallowing, yawning, or the Valsalva manoeuvre. More severe barotrauma can lead to middle ear fluid or even permanent sensorineural hearing loss.
Because call centres often record conversations between their operatives and customers it has been possible to analyse the sounds that give rise to acoustic shock. Sounds have included electrical interference, acoustic feedback, tones from fax machines and noises produced by disgruntled customers. Work in Denmark5 isolated sounds between 100 Hz and 3.8 kHz with intensities varying from 56 to 100 dB. A similar study in Australia1 showed a frequency range of 2.3 to 3.4 kHz with intensities from 82 to 120 dB. The duration of exposure is very difficult to assess because affected call centre operatives remove the handsets or headsets from their ears as quickly as possible after exposure. Certainly the exposure is unlikely to be more than a few seconds. One feature common to acoustic incident sound is that they have a short rise time varying between 0 and 20 ms, reflecting the sudden and unexpected nature of the sound.
The sound perceived may range from a quiet background noise to one that even is heard over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by hearing the sounds of one's own pulse or muscle contractions, which is typically a result of sounds that have been created by the movement of muscles near to one's ear, or the sounds are related to blood flow in the neck or face.[8]

The use of sound therapy by either hearing aids or tinnitus maskers helps the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects.[3][86][87] There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's hearing loss. The second is a signal spectrum notching to eliminate energy close to the tinnitus frequency.[88][89] There is some tentative evidence supporting tinnitus retraining therapy, which is aimed at reducing tinnitus-related neuronal activity.[3][90][89] There are preliminary data on an alternative tinnitus treatment using mobile applications, including various methods: masking, sound therapy, relaxing exercises and other.[91][92] These applications can work as a separate device or as a hearing aid control system.[93]


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.
Most hearing loss, that resulting from age and noise, is progressive and irreversible, and there are currently no approved or recommended treatments. A few specific kinds of hearing loss are amenable to surgical treatment. In other cases, treatment is addressed to underlying pathologies, but any hearing loss incurred may be permanent. Some management options include hearing aids, cochlear implants, assistive technology, and closed captioning.[9] This choice depends on the level of hearing loss, type of hearing loss, and personal preference. Hearing aid applications are one of the options for hearing loss management.[82] For people with bilateral hearing loss, it is not clear if bilateral hearing aids (hearing aids in both ears) are better than a unilateral hearing aid (hearing aid in one ear).[9]
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.
If your tinnitus is causing anxiety, disrupting your life or stopping you doing the things you enjoy, your doctor may refer you for cognitive behavioural therapy (CBT). The aim of CBT is to help you think differently about the condition and achieve a more positive attitude. It also helps you identify anything you might be doing that is making the condition worse. CBT doesn’t help reduce the loudness of the sounds you hear. But it can help you to cope with it, deal with any negative feelings and change how you think about tinnitus. So it may help to improve your quality of life.
Hearing loss may be caused by a number of factors, including: genetics, ageing, exposure to noise, some infections, birth complications, trauma to the ear, and certain medications or toxins.[2] A common condition that results in hearing loss is chronic ear infections.[2] Certain infections during pregnancy, such as cytomegalovirus, syphilis and rubella, may also cause hearing loss in the child.[2][10] Hearing loss is diagnosed when hearing testing finds that a person is unable to hear 25 decibels in at least one ear.[2] Testing for poor hearing is recommended for all newborns.[8] Hearing loss can be categorized as mild (25 to 40 dB), moderate (41 to 55 dB), moderate-severe (56 to 70 dB), severe (71 to 90 dB), or profound (greater than 90 dB).[2] There are three main types of hearing loss: conductive hearing loss, sensorineural hearing loss, and mixed hearing loss.[3]
^ Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Dauman N, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BC (2014). "A review of hyperacusis and future directions: part I. Definitions and manifestations" (PDF). American Journal of Audiology. 23 (4): 402–19. doi:10.1044/2014_AJA-14-0010. PMID 25104073. Archived (PDF) from the original on May 9, 2018. Retrieved September 23, 2017.
ASD causes a specific and consistent pattern of neurophysiological and psychological symptoms. Initial symptoms include a severe startle reaction, often with a head and neck jerk, and a shock/trauma reaction with symptoms of disorientation, distress, shakiness, crying, headache, fatigue. A severe ASD can lead to Post Traumatic Stress Disorder (PTSD). Other symptoms can include pain/blockage/pressure/tympanic fluttering in the ear; pain/burning/numbness around the ear/jaw/neck; tinnitus, hyperacusis and phonophobia; mild vertigo and nausea; headache; and subjective muffled/distorted hearing. ASD generally does not result in a hearing loss, although if present it tends not to follow the typical high frequency pattern of a noise induced hearing injury but affects low and mid frequency sensorineural hearing (1, 2).
The Institute for Occupational Safety and Health of the German Social Accident Insurance has created a hearing impairment calculator based on the ISO 1999 model for studying threshold shift in relatively homogeneous groups of people, such as workers with the same type of job. The ISO 1999 model estimates how much hearing impairment in a group can be ascribed to age and noise exposure. The result is calculated via an algebraic equation that uses the A-weighted noise exposure level, how many years the people were exposed to this noise, how old the people are, and their sex. The model’s estimations are only useful for people without hearing loss due to non-job related exposure and can be used for prevention activities.[98]

Hyperacusis is an increased sensitivity to sound. If you find that everyday or ordinary sounds are uncomfortable, you may have hyperacusis. Whilst it might seem natural to want to block out as much sound as possible, avoiding sound can actually make hyperacusis worse. Talk to your GP about this and ask for a referral to either an ENT Surgeon or Audiovestibular Physician who will be able to suggest management options – often, using sound (in a very controlled way) can improve hyperacusis.


Hearing loss is associated with Alzheimer's disease and dementia. The risk increases with the hearing loss degree. There are several hypotheses including cognitive resources being redistributed to hearing and social isolation from hearing loss having a negative effect.[27] According to preliminary data, hearing aid usage can slow down the decline in cognitive functions.[28]
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.
Atherosclerosis. With age and buildup of cholesterol and other deposits, major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.

This article was medically reviewed by Luba Lee, FNP-BC, MS. Luba Lee, FNP-BC is a board certified Family Nurse Practitioner (FNP) and educator in Tennessee with over a decade of clinical experience. Luba has certifications in Pediatric Advanced Life Support (PALS), Emergency Medicine, Advanced Cardiac Life Support (ACLS), Team Building, and Critical Care Nursing. She received her Master of Science in Nursing (MSN) from the University of Tennessee in 2006. This article has been viewed 3,276,631 times.


Tinnitus is also common in older people. It is typically described as ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It can come and go. It might be heard in one or both ears, and it may be loud or soft. Tinnitus is sometimes the first sign of hearing loss in older adults. Tinnitus can accompany any type of hearing loss and can be a sign of other health problems, such as high blood pressure, allergies, or as a side effect of medications.
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]
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.

Psychological research has focussed on the tinnitus distress reaction (TDR) to account for differences in tinnitus severity.[16][19][20][21] These findings suggest that among those people, conditioning at the initial perception of tinnitus, linked tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance.[22]

❒ Vision Problems: Some people suffering from problems of the inner ear experience disturbance in normal vision. Blurry or double vision with sensitivity to bright light is also a common problem. Some people may experience bouncing or jumping vision. Any visual stimulation may trigger dizziness. This happens because an inflammatory condition in the inner ear may put some amount of pressure on certain ocular nerves.
The use of sound therapy by either hearing aids or tinnitus maskers helps the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects.[3][86][87] There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's hearing loss. The second is a signal spectrum notching to eliminate energy close to the tinnitus frequency.[88][89] There is some tentative evidence supporting tinnitus retraining therapy, which is aimed at reducing tinnitus-related neuronal activity.[3][90][89] There are preliminary data on an alternative tinnitus treatment using mobile applications, including various methods: masking, sound therapy, relaxing exercises and other.[91][92] These applications can work as a separate device or as a hearing aid control system.[93]
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