^ 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.
For clients with severe ASD, listening to sounds via headphones during a hearing assessment can be highly threatening and often leads to a significant increase in symptoms, which can persist for days. I consider that frequent audiological testing should not be carried out for these clients. Suprathreshold audiological testing should be limited and loudness discomfort testing, in particular acoustic reflex testing due to the volume levels required, is contraindicated. Some ASD clients have unfortunately had their symptoms permanently exacerbated as a result of a traumatic response to acoustic reflex testing.
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Depression is one of the leading causes of morbidity and mortality worldwide. In older adults, the suicide rate is higher than it is for younger adults, and more suicide cases are attributable to depression.[38] Different studies have been done to investigate potential risk factors that can give rise to depression in later life. Some chronic diseases are found to be significantly associated with risk of developing depression, such as coronary heart disease, pulmonary disease, vision loss and hearing loss.[39] Hearing loss can attribute to decrease in health-related quality of life, increase in social isolation and decline in social engagement, which are all risk factors for increased risk of developing depression symptoms.[40]
I have just recently started working as a medical interpreter remotely. I started mid August 2015 to be more exact. The pain in my ears is slowly increasing and last night I noticed a a painful bump behind my right ear which is the appear I usually put the headset over my right ear which is my good ear. I’m highly considering going back to in-person interpreting after learning about “acoustic shock”. The last thing I want is to loose the hearing in my right ear!
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.
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.
Call centre staff using a telephone headset are vulnerable to ASD because of the increased likelihood of exposure, close to their ear(s), of sudden unexpected loud sounds randomly transmitted via the telephone line. In the early 1990s, co-inciding with the rapid growth of call centres in Australia, increasing numbers of employees were reporting ASD symptoms. A similar pattern was being noticed overseas. As a result, a number of audiologists, scientists and occupational health experts began to research 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]
Boosting your immune system may also stop ringing in your ears. This will help to protect you from infections and diseases that may increase the level of unwanted sound. Also, an improvement in your health can mean an improvement in your tinnitus. Have a healthy lifestyle, which especially includes a healthy diet, proper and regular exercise, and enough sleep at night.
The remedy depends on the cause of the tinnitus. There are several drugs that are used to help relieve constant ringing such as nicotinic acid, vasodilators, tranquilizers, antidepressants and seizure medications. Many times treatment is unsuccessful. Biofeedback may help in certain cases when tinnitus is related to stress. There is also tinnitus retraining therapy. You may want to explore information and support provided by the American Tinnitus Association.
Can ear wax cause hearing loss? Yes, one of the most common causes of conductive hearing loss is a blockage in the external ear canal, usually caused by wax (excessive cerum). Other causes of conductive hearing loss can be infections of the ear canal, a perforated or ruptured eardrum (tympanic membrane), very small ears, cysts and tumours, or foreign objects in the ear canal. Otosclerosis, which is an abnormal growth of bone in the middle ear, can also cause a conductive hearing loss.
Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects have been tested and found to hear high-pitched transmission frequencies that sound similar to tinnitus.[72][73]
Conductive hearing loss occurs when sounds aren’t able to travel from the outer ear to the eardrum and the bones of the middle ear. When this type of hearing loss occurs, you may find it difficult to hear soft or muffled sounds. Conductive hearing loss isn’t always permanent. Medical interventions can treat it. Treatment may include antibiotics or surgical interventions, such as a cochlear implant. A cochlear implant is a small electrical machine placed under your skin behind the ear. It translates sound vibrations into electrical signals that your brain can then interpret as meaningful sound.
The diagnosis of tinnitus is usually based on the person's description.[3] It is commonly supported by an audiogram and a neurological examination.[1][3] The degree of interference with a person's life may be quantified with questionnaires.[3] If certain problems are found, medical imaging, such as magnetic resonance imaging (MRI), may be performed.[3] Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat.[3] Rarely, the sound may be heard by someone else using a stethoscope, in which case it is known as objective tinnitus.[3] Occasionally, spontaneous otoacoustic emissions, sounds produced normally by the inner ear, may result in tinnitus.[6]
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.

No. The worst case scenario is that the ringing in your ears may suggest you have permanent tinnitus and this may have a negative impact on your day to day life affecting your concentration, sleep and work performance which may lead to insomnia or depression for example. However, this can be controlled through certain therapies such as sound therapy and other self-help methods, which helps a person cope with tinnitus if it happens to be permanent.
Most causes of conductive hearing loss can be identified by examination but if it is important to image the bones of the middle ear or inner ear then a CT scan is required. CT scan is useful in cases of congenital conductive hearing loss, chronic suppurative otitis media or cholesteatoma, ossicular damage or discontinuity, otosclerosis and third window dehiscence. Specific MRI scans can be used to identify cholesteatoma.
It is not a disease or illness; it is a symptom generated within the auditory system and usually caused by an underlying condition. The noise may be in one or both ears, or it may feel like it is in the head. It is difficult to pinpoint its exact location. It may be low, medium or high pitched and can be heard as a single noise or as multiple components.

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.
Inflammation of the middle and outer ear, otitis media and otitis externa respectively, are often due to infections or trauma. Infectious causes tend to present with additional symptoms like an ear discharge, which is usually purulent and often presenting with an offensive odor. When affected, the outer ear becomes red and swollen. Allergic causes, especially in cases of ear piercings and earrings made of certain metals, need to be excluded.
Since most persons with tinnitus also have hearing loss, a pure tone hearing test resulting in an audiogram may help diagnose a cause, though some persons with tinnitus do not have hearing loss. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.
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