Along the path a hearing signal travels to get from the inner ear to the brain, there are many places where things can go wrong to cause tinnitus. If scientists can understand what goes on in the brain to start tinnitus and cause it to persist, they can look for those places in the system where a therapeutic intervention could stop tinnitus in its tracks.
'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.
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.
^ McCombe A, Baguley D, Coles R, McKenna L, McKinney C, Windle-Taylor P (2001). "Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999". Clinical Otolaryngology and Allied Sciences. 26 (5): 388–93. doi:10.1046/j.1365-2273.2001.00490.x. PMID 11678946. Archived (PDF) from the original on 2017-09-24.
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]
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Conductive hearing loss results when there is any problem in delivering sound energy to your cochlea, the hearing part in the inner ear. Common reasons for conductive hearing loss include blockage of your ear canal, a hole in your ear drum, problems with three small bones in your ear, or fluid in the space between your ear drum and cochlea. Fortunately, most cases of conductive hearing loss can be improved.


"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."

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.
If there is no obvious cause of hearing loss, your doctor can refer you for a hearing assessment with an audiologist or an ear nose and throat (ENT) specialist. They will look into your ears and test your hearing to see how well you can detect different levels of sound. This assessment will help find the cause of your hearing loss and what treatments would work best.
Very regularly we see people who, after exposure to sudden and loud noise, are bothered by tinnitus, hyperacusis, hearing loss, pressure in the ear, aversion and fear of sounds, depression, etc.. However, a hearing test does not show signs of hearing damage or a noise trauma. This is characteristic of an "Acoustic Shock". Usually the symptoms disappear quite quickly, but when the symptoms persist, they speak of an Acoustic Shock Disorder (ASD).

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]
When the sound waves reach the inner ear, they travel through the fluids of the cochlea. The cochlea is a snail-shaped structure in the inner ear. In the cochlea, there are nerve cells with thousands of miniature hairs attached to them. These hairs help convert the sound wave vibrations into electrical signals that then travel to your brain. Your brain interprets these electrical signals as sound. Different sound vibrations create different reactions in these tiny hairs, signaling different sounds to your brain.

^ Casale, Manuele; Costantino, Andrea; Rinaldi, Vittorio; Forte, Antonio; Grimaldi, Marta; Sabatino, Lorenzo; Oliveto, Giuseppe; Aloise, Fabio; Pontari, Domenico (2018-11-11). "Mobile applications in otolaryngology for patients: An update". Laryngoscope Investigative Otolaryngology. 3 (6): 434–438. doi:10.1002/lio2.201. ISSN 2378-8038. PMC 6302723. PMID 30599026.


White noise machines. These devices, which produce simulated environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also may help cover the internal noise at night.
Conductive hearing loss makes all sounds seem faint or muffled. The hearing loss is usually worse in lower frequencies. Congenital conductive hearing loss is identified through newborn hearing screening or may be identified because the baby has microtia or other facial abnormalities. Conductive hearing loss developing during childhood is usually due to otitis media with effusion and may present with speech and language delay or difficulty hearing. Later onset of conductive hearing loss may have an obvious cause such as an ear infection, trauma or upper respiratory tract infection or may have an insidious onset related to chronic middle ear disease, otosclerosis or a tumour of the naso-pharynx. Earwax is a very common cause of a conductive hearing loss which may present suddenly when the wax blocks sound from getting through the external ear canal to the middle and inner 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.
Your ear consists of three major areas: outer ear, middle ear and inner ear. Sound waves pass through the outer ear and cause vibrations at the eardrum. The eardrum and three small bones of the middle ear amplify the vibrations as they travel to the inner ear. There, the vibrations pass through fluid in a snail-shaped structure in the inner ear (cochlea).

I wanted to become a surgeon from a very young age and eventually chose ENT surgery for various reasons. Firstly, I had a great mentor when I was a student who was an ENT surgeon. He engaged with me and encouraged me to do research with him which was eventually published. Secondly, ENT surgery is one of only a handful of surgical specialties who see and treat patients of all ages from very small babies to the elderly so the work is very varied.
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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.
Disorders responsible for hearing loss include auditory neuropathy,[57][58] Down syndrome,[59] Charcot–Marie–Tooth disease variant 1E,[60] autoimmune disease, multiple sclerosis, meningitis, cholesteatoma, otosclerosis, perilymph fistula, Ménière's disease, recurring ear infections, strokes, superior semicircular canal dehiscence, Pierre Robin, Treacher-Collins, Retinitis Pigmentosa, Pedreds, and Turners syndrome, syphilis, vestibular schwannoma, and viral infections such as measles, mumps, congenital rubella (also called German measles) syndrome, several varieties of herpes viruses,[61] HIV/AIDS,[62] and West Nile virus.

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!


Speech perception is another aspect of hearing which involves the perceived clarity of a word rather than the intensity of sound made by the word. In humans, this is usually measured with speech discrimination tests, which measure not only the ability to detect sound, but also the ability to understand speech. There are very rare types of hearing loss that affect speech discrimination alone. One example is auditory neuropathy, a variety of hearing loss in which the outer hair cells of the cochlea are intact and functioning, but sound information is not faithfully transmitted by the auditory nerve to the brain.[22]
Hearing loss is generally measured by playing generated or recorded sounds, and determining whether the person can hear them. Hearing sensitivity varies according to the frequency of sounds. To take this into account, hearing sensitivity can be measured for a range of frequencies and plotted on an audiogram. Other method for quantifying hearing loss is a hearing test using a mobile application or hearing aid application, which includes a hearing test.[81][82] Hearing diagnosis using mobile application is similar to the audiometry procedure.[81] Audiogram, obtained using mobile application, can be used to adjust hearing aid application.[82] Another method for quantifying hearing loss is a speech-in-noise test. which gives an indication of how well one can understand speech in a noisy environment.[83] Otoacoustic emissions test is an objective hearing test that may be administered to toddlers and children too young to cooperate in a conventional hearing test. Auditory brainstem response testing is an electrophysiological test used to test for hearing deficits caused by pathology within the ear, the cochlear nerve and also within the brainstem.
i have just read the comment already posted and like yourself, wish to remain anonymous. Please read up on acoustic shock.. I worked from a company and had exactly the same symptoms, nausea, head pain and dizziness. I eventually got tinnitus six months later and two years on i still have it and it has got louder and my concentration is severely affected. I carried on using a headset and became so ill i had to give up work for a long time. I would never wear a headset again and have had to change careers because of it. If youn want my advice, act now..

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.


Audiologists recommend taking care of the conductive component first. There have been times when the addition of the conductive component made the person a better hearing aid candidate, by flattening out the audiogram for example, while the underlying sensorineural component presented a high-frequency loss. However, the emphasis would still be on treating medically what can be treated. Generally, you would expect positive results.
^ Flamme GA, Deiters K, Needham T (March 2011). "Distributions of pure-tone hearing threshold levels among adolescents and adults in the United States by gender, ethnicity, and age: Results from the US National Health and Nutrition Examination Survey". International Journal of Audiology. 50 Suppl 1: S11-20. doi:10.3109/14992027.2010.540582. PMID 21288063.
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.
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]
There can be damage either to the ear, whether the external or middle ear, to the cochlea, or to the brain centers that process the aural information conveyed by the ears. Damage to the middle ear may include fracture and discontinuity of the ossicular chain. Damage to the inner ear (cochlea) may be caused by temporal bone fracture. People who sustain head injury are especially vulnerable to hearing loss or tinnitus, either temporary or permanent.[73][74]
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]

Over-the-counter (OTC) hearing aids are a new category of regulated hearing devices that adults with mild-to-moderate hearing loss will be able to buy without a prescription. OTC hearing aids will make certain sounds louder to help people with hearing loss listen, communicate, and take part more fully in daily activities. OTC hearing aids are expected to become available in stores and online in the next few years.
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.

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.
Is conductive hearing loss curable? Yes, often. Most cases of conductive hearing loss are temporary and are cured by means of appropriate medical treatment, so it is important to seek immediate medical assistance. Other types of conductive hearing losses can be treated with hearing aids or types of hearing implants. Finally, some types of conductive hearing loss can be treated through surgery.
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.
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]
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]
This is a very structured approach to managing tinnitus. Basically, TRT assumes that the tinnitus has been prioritised as an important signal. TRT uses sounds at a particular level to try to reduce the priority of the tinnitus so that you no longer hear it. It is based on the idea that we can get used to sounds, e.g. the sound of the fridge or air conditioner, so we can also get used to this sound of tinnitus. The process of getting used to the tinnitus sound is called habituation. TRT uses sound generators and counselling to attempt to retrain how the brain processes sound so that you habituate to the tinnitus. Most people working in the tinnitus field will use elements of TRT but the strict method is not frequently used because there is limited evidence for its effectiveness.

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.
If you develop tinnitus, it's important to see your clinician. She or he will take a medical history, give you a physical examination, and do a series of tests to try to find the source of the problem. She or he will also ask you to describe the noise you're hearing (including its pitch and sound quality, and whether it's constant or periodic, steady or pulsatile) and the times and places in which you hear it. Your clinician will review your medical history, your current and past exposure to noise, and any medications or supplements you're taking. Tinnitus can be a side effect of many medications, especially when taken at higher doses (see "Some drugs that can cause or worsen tinnitus").

I wanted to become a surgeon from a very young age and eventually chose ENT surgery for various reasons. Firstly, I had a great mentor when I was a student who was an ENT surgeon. He engaged with me and encouraged me to do research with him which was eventually published. Secondly, ENT surgery is one of only a handful of surgical specialties who see and treat patients of all ages from very small babies to the elderly so the work is very varied.
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

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.


It is estimated that half of cases of hearing loss are preventable.[85] About 60% of hearing loss in children under the age of 15 can be avoided.[2] A number of preventive strategies are effective including: immunization against rubella to prevent congenital rubella syndrome, immunization against H. influenza and S. pneumoniae to reduce cases of meningitis, and avoiding or protecting against excessive noise exposure.[15] The World Health Organization also recommends immunization against measles, mumps, and meningitis, efforts to prevent premature birth, and avoidance of certain medication as prevention.[86] World Hearing Day is a yearly event to promote actions to prevent hearing damage.

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]
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