Some medications may reversibly affect hearing. These medications are considered ototoxic. This includes loop diuretics such as furosemide and bumetanide, non-steroidal anti-inflammatory drugs (NSAIDs) both over-the-counter (aspirin, ibuprofen, naproxen) as well as prescription (celecoxib, diclofenac, etc.), paracetamol, quinine, and macrolide antibiotics.[63] Others may cause permanent hearing loss.[64] The most important group is the aminoglycosides (main member gentamicin) and platinum based chemotherapeutics such as cisplatin and carboplatin.[65][66]

These symptoms often happen all at the same time and last anything from minutes to hours. It is a very distressing condition because it is so unpredictable. Furthermore, it can take a day or two for the symptoms to completely disappear and sufferers often feel drained after an attack. Additionally, although the condition usually starts in one ear, it can spread to both over time.
i am currently studying acoustic shock for a course i am taking. i do also work in a headset environment in a large office. I would be interested to hear of anyones experiences of acoustic shock, temporary real or perceived. i myself suffer from the confused hearing loss, unable to clearly know which direction noises are coming from. especially dangerous when you have police, ambulance or fire engine sirens coming close to you. not knowing the direction they are coming from makes it difficult to remove yourself from their way eg at a roundabout… my sleep is also disturbed on occassion, by low drumming noises. this has only happened over the past 5yrs whilst working a lot on the telephone section of my department. a lot of customers answer the phone whilst holding a screaming baby or have a parrot screeching behind them, some shout down the phone suddenly, the noise seems intensified when it is held in a headpiece….
HSE considers that, in general, call handlers' daily personal noise exposure is unlikely to exceed the 80 dB lower exposure action value defined in the Control of Noise at Work Regulations 2005, provided good practice in the management of noise risks is followed. Call handlers should be encouraged to report to management exposure to acoustic shock incidents and management should keep a record of these reported events.
"We're looking at the threshold that which you can hear sounds the softest, and you're usually pressing a button or raising your hands or somehow responding to when you hear those sounds. And we're evaluating the entire auditory system in that process - not just with the earphones, but we do some other tests to evaluate your middle ear and the inner ear, as well."
Hearing loss can also result from taking certain medications. “Ototoxic” medications damage the inner ear, sometimes permanently. Some ototoxic drugs include medicines used to treat serious infections, cancer, and heart disease. Some antibiotics are ototoxic. Even aspirin at some dosages can cause problems. Check with your doctor if you notice a problem while taking a medication.
Human hearing extends in frequency from 20 to 20,000 Hz, and in intensity from 0 dB to 120 dB HL or more. 0 dB does not represent absence of sound, but rather the softest sound an average unimpaired human ear can hear; some people can hear down to −5 or even −10 dB. Sound is generally uncomfortably loud above 90 dB and 115 dB represents the threshold of pain. The ear does not hear all frequencies equally well: hearing sensitivity peaks around 3000 Hz. There are many qualities of human hearing besides frequency range and intensity that cannot easily be measured quantitatively. However, for many practical purposes, normal hearing is defined by a frequency versus intensity graph, or audiogram, charting sensitivity thresholds of hearing at defined frequencies. Because of the cumulative impact of age and exposure to noise and other acoustic insults, 'typical' hearing may not be normal.[25][26]
Hearing (audiological) exam. As part of the test, you'll sit in a soundproof room wearing earphones through which will be played specific sounds into one ear at a time. You'll indicate when you can hear the sound, and your results are compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.
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]
Hearing loss can be inherited. Around 75–80% of all these cases are inherited by recessive genes, 20–25% are inherited by dominant genes, 1–2% are inherited by X-linked patterns, and fewer than 1% are inherited by mitochondrial inheritance.[55] Syndromic deafness occurs when there are other signs or medical problems aside from deafness in an individual,[55] such as Usher syndrome, Stickler syndrome, Waardenburg syndrome, Alport's syndrome, and neurofibromatosis type 2. Nonsyndromic deafness occurs when there are no other signs or medical problems associated with an individual other than deafness.[55]
There is a strong relationship between hearing loss and tinnitus. Any ear problem but particularly hearing loss can 'unmask' the perception of tinnitus, but some patients with tinnitus have no hearing loss. Correction of hearing loss with hearing aids is known to have a beneficial effect upon tinnitus, but sometimes simple reassurance alone is sufficient.
Sensorineural causes of hearing loss involve the inner ear or brain and are usually, but not always, permanent. Implants and more invasive procedures may help to restore hearing. Birth defects (prenatal infection, injury during childbirth, and genetic disorders), infections particularly in childhood and age-related degeneration (presbycusis / presbyacusis) are more frequent causes of this type of hearing loss. Sudden, unilateral hearing loss may be related to conditions like a stroke.
If your hearing loss is caused by a build-up of earwax, it will need to be removed. You may be able to have this done at your surgery by syringing. Warm water is flushed into your ear canal to remove the wax. But first the wax has to be softened by applying olive oil or almond oil drops, or drops containing sodium bicarbonate, for several days beforehand. You can buy these drops from your local pharmacy. In some cases, you may have to go to a specialist clinic to have wax removed by syringing or with microsuction.
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.
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]
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.

Tinnitus can arise anywhere along the auditory pathway, from the outer ear through the middle and inner ear to the brain's auditory cortex, where it's thought to be encoded (in a sense, imprinted). One of the most common causes of tinnitus is damage to the hair cells in the cochlea (see "Auditory pathways and tinnitus"). These cells help transform sound waves into nerve signals. If the auditory pathways or circuits in the brain don't receive the signals they're expecting from the cochlea, the brain in effect "turns up the gain" on those pathways in an effort to detect the signal — in much the same way that you turn up the volume on a car radio when you're trying to find a station's signal. The resulting electrical noise takes the form of tinnitus — a sound that is high-pitched if hearing loss is in the high-frequency range and low-pitched if it's in the low-frequency range. This kind of tinnitus resembles phantom limb pain in an amputee — the brain is producing abnormal nerve signals to compensate for missing input.
With severe ASD, TTTS symptoms can be involuntarily aggravated by the mere placement of a headset over the ears in the workplace. I consider an ASD client should not return to headset or telephone duties on either ear until the symptoms have fully resolved. A graded return to work can then be carried out with handset use initially on the opposite ear.
The middle ear is connected to the back of your nose and upper part of your throat by a narrow channel called the auditory tube (eustachian tube). The tube opens and closes at the throat end to equalize the pressure in the middle ear with that of the environment and drain fluids. Equal pressure on both sides of the eardrum is important for normal vibration of the eardrum.

A perforated (ruptured, punctured) eardrum (tympanic membrane) is a hole or tear in the eardrum. The eardrum separates the ear canal and middle ear. Most ruptured eardrums do not cause pain, however, the condition can be uncomfortable. Bacteria, viral, and fungal infections are the most common causes a ruptured eardrum. Earwax removal attempts, changes in air pressure, and trauma are other causes of a ruptured eardrum.
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In the United States hearing is one of the health outcomes measure by the National Health and Nutrition Examination Survey (NHANES), a survey research program conducted by the National Center for Health Statistics. It examines health and nutritional status of adults and children in the United States. Data from the United States in 2011-2012 found that rates of hearing loss has declined among adults aged 20 to 69 years, when compared with the results from an earlier time period (1999-2004). It also found that adult hearing loss is associated with increasing age, sex, race/ethnicity, educational level, and noise exposure.[111] Nearly one in four adults had audiometric results suggesting noise-induced hearing loss. Almost one in four adults who reported excellent or good hearing had a similar pattern (5.5% on both sides and 18% on one side). Among people who reported exposure to loud noise at work, almost one third had such changes.[112]

▶ For most inner ear problems, a sodium-restricted, caffeine-free diet is recommended. Caffeine is a central nervous system stimulant and its intake makes the symptoms of inner ear disorder (especially headache and dizziness) appear more pronounced. Hence, it is advisable to reduce the intake of caffeine as much as possible till the condition is completely treated. Excess sugar in the diet also triggers dizziness.


^ 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.
On examination of the affected ear, the ear canal and tympanic membrane generally appear healthy and normal. ASD symptoms are subjective, so an experienced clinician makes a diagnosis on the basis of a thorough case history noting the pattern of symptoms; their onset, persistence and escalation; and their link with exposure to intolerable (or difficult to tolerate) sounds. If they have developed in association with acoustic incident exposure and/or hyperacusis is present, it is likely that they are a result of TTTS. The symptoms are remarkably consistent.

If you think your child has tinnitus, see your child’s GP. They may refer your child to a paediatric ENT specialist for further tests. Therapy and support are available for your child if they are diagnosed with tinnitus and they are bothered or distressed by it. If your child is not bothered by their tinnitus, you may just need reassurance about their condition.
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]
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 are referred to a specialist tinnitus clinic, and your tinnitus is particularly troublesome, you will be introduced to more formal or structured ways of managing tinnitus. Most centres use a combination of approaches. You may come across some terms before, or hear them when you get there, and it helps to have some understanding of what these terms are.
These symptoms often happen all at the same time and last anything from minutes to hours. It is a very distressing condition because it is so unpredictable. Furthermore, it can take a day or two for the symptoms to completely disappear and sufferers often feel drained after an attack. Additionally, although the condition usually starts in one ear, it can spread to both over time.
The most important thing you can do if you think you have a hearing problem is to seek professional advice. Your family doctor may be able to diagnose and treat your hearing problem. Or, your doctor may refer you to other experts, like an otolaryngologist (ear, nose, and throat doctor) or an audiologist (health professional who can identify and measure hearing loss).
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.
Human hearing extends in frequency from 20 to 20,000 Hz, and in intensity from 0 dB to 120 dB HL or more. 0 dB does not represent absence of sound, but rather the softest sound an average unimpaired human ear can hear; some people can hear down to −5 or even −10 dB. Sound is generally uncomfortably loud above 90 dB and 115 dB represents the threshold of pain. The ear does not hear all frequencies equally well: hearing sensitivity peaks around 3000 Hz. There are many qualities of human hearing besides frequency range and intensity that cannot easily be measured quantitatively. However, for many practical purposes, normal hearing is defined by a frequency versus intensity graph, or audiogram, charting sensitivity thresholds of hearing at defined frequencies. Because of the cumulative impact of age and exposure to noise and other acoustic insults, 'typical' hearing may not be normal.[25][26]
Some medications may reversibly affect hearing. These medications are considered ototoxic. This includes loop diuretics such as furosemide and bumetanide, non-steroidal anti-inflammatory drugs (NSAIDs) both over-the-counter (aspirin, ibuprofen, naproxen) as well as prescription (celecoxib, diclofenac, etc.), paracetamol, quinine, and macrolide antibiotics.[63] Others may cause permanent hearing loss.[64] The most important group is the aminoglycosides (main member gentamicin) and platinum based chemotherapeutics such as cisplatin and carboplatin.[65][66]

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.


Rather than a disease, tinnitus is a symptom that may result from various underlying causes.[2] The most common causes are hearing damage, noise-induced hearing loss or age-related hearing loss, known as presbycusis.[2] Other causes include ear infections, disease of the heart or blood vessels, Ménière's disease, brain tumors, exposure to certain medications, a previous head injury, earwax, and sometimes, the tinnitus is suddenly perceived during a period of emotional stress.[2][4] It is more common in those with depression.[3]
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.
The International Organization for Standardization (ISO) developed the ISO 1999 standards for the estimation of hearing thresholds and noise-induced hearing impairment.[104] They used data from two noise and hearing study databases, one presented by Burns and Robinson (Hearing and Noise in Industry, Her Majesty's Stationery Office, London, 1970) and by Passchier-Vermeer (1968).[105] As race are some of the factors that can affect the expected distribution of pure-tone hearing thresholds several other national or regional datasets exist, from Sweden,[106] Norway,[107] South Korea,[108] the United States[109] and Spain.[110]

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]
Some people also experience a lot of pressure and pain in the ears. There can also be headache, muscle and joint pain along the neck, and stiffness of the limbs along with a tingling sensation on the top of the head, arms, and legs. In rare cases, there may be some emotional or psychological problems such as anxiety and panic attacks. The person may feel depressed, tired and frustrated. He/she may lose interest in routine activities. These, however, are common psychological side effects of general ill-health.
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.
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]
Outer ear infection: otitis externa – usually affects adults aged 45 to 75. It affects the ear canal and is often caused by bacterial infection of the skin of the canal, or a fungus or a yeast. It can also be caused by an irritation such as wearing earplugs or a hearing aid. It is common in people who suffer from skin problems such as eczema, psoriasis or dermatitis but also in people who are keen swimmers.
Studies have shown that older adults with hearing loss have a greater risk of developing dementia than older adults with normal hearing. Cognitive abilities (including memory and concentration) decline faster in older adults with hearing loss than in older adults with normal hearing. Treating hearing problems may be important for cognitive health. See What’s the Connection Between Hearing and Cognitive Health?

Try the skull-thumping trick. If you're coming home from a concert or a club, and your ears won't stop ringing, it's because you've damaged some of the little hairs in your cochlea, which causes inflammation and stimulation of nerves. Your brain interprets this inflammation as constant ringing or buzzing, and this trick can help make that annoying sound go away.
Management is unclear. Various electronic filtering and limiting devices have been developed to try and prevent the problem. Many call centres now are very aware of the problem and have active occupational health teams who remove operatives from call handling duties after an acoustic incident, at least until the immediate symptoms have settled. For patients with persistent symptoms the techniques used for tinnitus and hyperacusis may be applied. Sound therapy for acoustic shock patients can be useful but may be difficult to provide as many people with acoustic shock do not tolerate having sound generators in their ears. Westcott gives useful advice on how to administer sound therapy using techniques such as having headphones loosely around the neck rather than over the ears.2 Sleep management and relaxation strategies may be useful. For those with significant anxiety depression symptoms of PTSD a psychological opinion may be beneficial.
Tinnitus is the term for the sensation of hearing a sound in the absence of any external sound. Symptoms of tinnitus are you may hear different types of sound, for example, ringing, whooshing or humming or buzzing in the ear. These can be continuous or they can come and go. The tinnitus might seem like it’s in one ear or both, in the middle of the head or even be difficult to pinpoint. Some people may think the noise is coming from outside and hunt for it until they discover it’s actually inside them!
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.
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]
The best supported treatment for tinnitus is a type of counseling called cognitive behavioral therapy (CBT) which can be delivered via the internet or in person.[5][68][82] It decreases the amount of stress those with tinnitus feel.[83] These benefits appear to be independent of any effect on depression or anxiety in an individual.[82] Acceptance and commitment therapy (ACT) also shows promise in the treatment of tinnitus.[84] Relaxation techniques may also be useful.[3] A clinical protocol called Progressive Tinnitus Management for treatment of tinnitus has been developed by the United States Department of Veterans Affairs.[85]

There are three parts to your ear: the outer ear, middle ear and inner ear. The outer ear is the part you can see. It is shaped to focus sound waves into your ear canal, so they travel to your eardrum. The sound waves make your eardrum vibrate. This vibration passes to your middle ear, which contains three small bones (ossicles) called the hammer, anvil and stirrup (named after their shapes). These strengthen the vibrations as they conduct them to your inner ear.
In addition to medications, hearing loss can also result from specific chemicals in the environment: metals, such as lead; solvents, such as toluene (found in crude oil, gasoline[67] and automobile exhaust,[67] for example); and asphyxiants.[68] Combined with noise, these ototoxic chemicals have an additive effect on a person's hearing loss.[68] Hearing loss due to chemicals starts in the high frequency range and is irreversible. It damages the cochlea with lesions and degrades central portions of the auditory system.[68] For some ototoxic chemical exposures, particularly styrene,[69] the risk of hearing loss can be higher than being exposed to noise alone. The effects is greatest when the combined exposure include impulse noise.[70][71] A 2018 informational bulletin by the US Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) introduces the issue, provides examples of ototoxic chemicals, lists the industries and occupations at risk and provides prevention information.[72]

Tinnitus is usually more noticeable in a quiet environment. It’s a bit like candles on a birthday cake – in the lights, the candles aren’t very bright but if you turn the lights off, the candles seem much brighter. With tinnitus, when there is other sound, it doesn’t seem that loud, but when you turn all the other sound off, the tinnitus seems much more noticeable.
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]
If you develop hearing loss due to a buildup of wax in the ear canal, you can remove the wax at home. Over-the-counter solutions, including wax softeners, can remove wax from the ear. Syringes can also push warm water through the ear canal to remove the wax. Consult your doctor before attempting to remove any object stuck in your ear to avoid unintentionally damaging your ear.
^ 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.
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