Hyperacusis & Pain Recovery Guide

Hyperacusis, noaxacusis, reactive tinnitus, pain and dysacusis

Edit: I have now published version 2 of The Amanda Protocol, this is now way more detailed and in bullet point style format making it easier to take away information and understand.

If hyperacusis is mismanaged it can quickly get severe, then you can develop additional symptoms such as reactive tinnitus and pain.

Many people recover from hyperacusis, just because you see loads of people in the online forums with this long term it does not mean recovery is not possible, these are people who did not recover, people who recover don’t stick around.

To get better you need to educate yourself on various subjects, as when we develop hyperacusis, we can develop PTSD, heightened anxiety leading us to do things which make use feel more comfortable but can worsen our condition.

I spent many months testing and experimenting on myself, taking hyperacusis research to the next level, and this article is a result of my journey and recovery. This article will be continued to worked on and improved, so check back frequently.

Also it is important to remember not ignore other symtoms, the amount of people who directly ignorning other symtpoms and problems

Remember if this helps you, pay it forward and share this with somebody else who needs it.

The Amanda Protocol

So that people can find this guide easily and be able to reference to it, I have decided to give it a unique name, ‘The Amanda Protocol’.

What is the cause

The first step is identifying what caused the hyperacusis in the first place, was it a long term medication that you were on, did you start a benzodiazepine and suddenly stop without tapering properly, then you developed a protracted withdrawal symptom, did you have existing TMJ, or did you have an accident. People with TMJ can see a TMJ physiotherapist specialist, who would usually recommend a mouth guard and work on the jaw and neck. Even if your hyperacusis started after acoustic shock, I believe acoustic shock is the trigger not the cause.

If you suddenly stopped benzos and did not taper properly and have all kinds of crazy severe symptoms, you can speak with your medical provider about going back onto the original treatment, wait until you stabilise or almost stabilise then this time taper properly. I learnt this technique from a medical case study after not tapering corticoids properly and ended up in hospital with unexplained inter cranial ocular pressure. I read in the case study how a DR reversed a patient with a similar problem by restarting the corticoid treatment then tapering slowly and properly, it worked both with corticoids and benzodiazepines for me, I literally reversed severe protracted withdraw symptoms after months of suffering within weeks, these could have gone on for years or longer

For long term users of benzos, I suggest reading the Ashton protocol as many DRs will try to take you off benzodiazepines too quickly and this can lead to protracted withdrawal symptoms, including facial pain, tinnitus, even more increased sensitivity to sound or light etc. To come of a long term benzo, if it has a short half life then they will need to switch you to another one with a longer half life usually diazepam, but you can’t just stop the other and start the other, the crossover is crucially important, and the equivalent dosage that you switch to must be correct, switching to a significantly lower dosage could cause all kinds of severe symptoms which can go for a long time and just confuse you even more.

Google your long term meds with hyperacusis, e.g “atarax + hyperacusis” see if there are any known issues.

Also many anti-depressants if suddenly stopped can cause all kinds of symptoms, so you need to learn about what you have taken, did you stop properly etc. You can read the information leaflet for the medicines, to see if there is any helpful information.

If the medication that you are on is causing it, then ask your medical provider about switching to alternative, but you need to be sure that is what is causing, as hyperacusis is already very confusing, so adding more, changing or stopping medications can give you even more symptoms further confusing the situation.

Treating the Hyperacusis

The second step is treating the hyperacusis, once you have got rid of or treated the cause you will need to retrain your brain, but before I go into that, it is important to learn about certain things.

If anybody was subject to acoustic shock, for example being exposed to sudden loud sound, and then notices hearing changes, to prevent hearing loss, you need acoustic rest for at least a few days, acoustic rest is not exposing yourself to dangerously sounds e.g 85db or higher. Sounds that only you perceive louder are not damaging, this does not mean blocking your ear canals which is actually called auditory deprivation.

You should also learn about the Threshold Shift that article explains how hearing loss occurs, this prevents you from getting sucked into online misinformation which will then lead you to doing things that could worsen your hyperacusis and develop additional symptoms such as reactive tinnitus and pain.

When you have hyperacusis your auditory gain is increased (and there are other symptoms as well, which you may or may not notice until you listen to music or hear certain sounds), so things sound louder to you but they are not really loud. Scientific studies have already shown that even in healthy subjects, auditory deprivation will cause an increase in auditory gain - which means you are making your hyperacusis worse.

Whilst the gold standard treatment for hyperacusis has always been sound exposure using white or pink noise etc, which are lots of random sounds of different frequencies, but you must remember not all white noise or pink noise is the same, many use poor or cheap random number generation, if you want to read about high quality white noise generation check out this white noise page. I have read stories about people who switched their noise samples and got improvement. That said, I tried listening to white noise, it was boring for me, and I concluded well if its just lots of different random sounds at different frequencies, I will use music instead, thats exactly what I did.

Initially when I was doing sound therapy listening to music, I was listening to my New Order - Substance album over and over again, I saw improvements initially but until I switched to other music, or other sounds, I didn’t see any more improvements. Diverse sounds seems to be key, I have had weeks no improvements, then I go to an appointment somewhere different part in the city, with a bridge, lake, birds singing etc and I come home and feel some improvement, I can’t put into words, but you feel different, you notice the improvement. If you are doing traditional sound therapy with random noise instead of music, then if you are not getting anywhere try something else. Personally, I feel a positive sound association is way better to retrain, so i use music.

Another example of retraining the brain and diversity, after developing severe pain from sound and I could no longer tolerate any sound and i was quite frankly afraid. I had to start from the beginning. I started watching The Resident on Netflix, with no crazy sound changes etc, series like that and after a few weeks I could easily watch TV, but still other sound sources bothered me. This is the same with my motorbike, it took me time, but now i can ride my motorbike and i don’t get affected by the roads, the cars, the sirens, etc. Another example, my sound retraining therapy with music was done on studio monitors in front of me, when music started sounding better, when I switched to the headphones, music sounded bad and off, my brain wasn’t processing properly or something. I needed to retrain my brain. Your brain needs to retrain, so retrain your brain based upon your normal lifestyle, this gives the illusion of the fastest recovery (as you only learning the things you need the most), also at the same time it makes you more confident and able to deal with sounds better, as a result when you then subjected to new sounds, you are more resilient.

If you have hyperacusis and you block your ear canals or sit still in silence for even 30 minutes, you will find it affects you in a bad way, it is not natural, and your brain is trying to retrain, so bad input = bad output. Better just play talk radio in the background or water fall, nature sounds or something, don’t sit in silence to long as it can make your condition worst. A wise person once told me, you don’t know how bad this can get, he was right.

If you are afraid of stopping using foam ear plugs, even after reading medical warnings not to do it as it will make you worse, then I suggest looking at getting CBT, it doesn’t have to be a hyperacusis specialist, but somebody that can help you overcome the fear - we have all been there, there is no shame in being afraid - the hardest part is admitting it, quite frankly hyperacusis is traumatic as hell. I am musician and at one point I was scared of sounds, how stupid is that? well it is not stupid it was me being irrational due to fear, the hardest part is recognising your fear, because if you don’t recognise or accept that you are afraid, then its harder to move forward.

Here are some quotes from some major medical websites:

“Many people with hyperacusis symptoms start by trying to drown out the sounds around them with earplugs or headphones. They may avoid social settings. But these options can make things worse. People who wear headphones or earplugs may experience sound even more intensely once they remove them” - clevelandclinic.org

“it is recommended that ear protection shouldn’t be used for normal day-to-day activities” - tinnitus.org.uk

“do not wear earplugs or muffs all the time because this could make you more sensitive to noise” - nhs.co.uk

Those are just a few warnings from medical websites, however any reputable medical website that mentions hyperacusis will state that your hyperacusis will get worse if you block your ear canals.

Hyperacusis will never get better as long as you block your ear canals, you will be stuck in a loop, I call it the hyperacusis loop, each time you take them out, everything will be louder, you will have a setback the moment your brain is fed a sound it can’t handle and it tries to adjust and process.

All the people that say sound therapy or sound exposure doesn’t work are most likely blocking their ear canals or using some form of auditory manipulation, even for short periods each day is enough to worsen your condition albeit slower. So then you stop doing that and then exposing yourself to sound without realising the world around you is now even louder, you will also have even less tolerance for sound.

You have to stop blocking ear canals with foam ear plugs or ear muffs and just expose yourself to everyday sounds for this to work, if not, you will constantly get setbacks. Even today as I write this in February many months after my hyperacusis went, sometimes my volume can get slightly louder or quieter randomly for short moments but I recover quickly, I probably notice it because i am musician, and I train every day to notice tiny differences in sounds.

Like any healthy person should do, if going to a noisy or loud place such as a bar or club, you can and should use noise reduction plugs either custom made ones or inexpensive reusable ones like Alpine Music Pro which can be found on Amazon.

However using noise reduction plugs in low noise environments are just as bad as blocking your ear canals, and will cause your hyperacusis to get worse. From my personal experiments, I would stay away from the trendy loop ear plugs as for me the largest size still allowed loud sounds to come through (when testing the sleep plugs) , this is because its design it comes it 3 sizes, so for many people it does not fit properly. The Alpine music pro is one size fits all, it does its job.

But the goal is to NOT BLOCK YOUR EAR CANALS OR MANIPULATE YOUR HEARING IN ANYWAY in normal environments, so your brain can start functioning normally again.

The advice frequently mentioned online, using ear muffs to cook, load the dishwasher or vacuum, is bad advice, simply because just blocking your ear canals or manipulating your hearing for a short periods each day (e.g 30 minutes) will slowly make your condition worse if you have recovered or stop you from getting better.

In the worlds quietest room, the anechoic test chamber at Orfield Laboratories, not one single person has lasted more than 45 minutes, the room is so quiet that anyone inside it will hear their heartbeats and the sounds of their organs and people loose their balance and more. It is not natural, now imagine people who are constantly blocking their canals 24 hours a day and what that can do to the brain.

Treating the hyperacusis:

1. Treat the underlying cause, if it is caused by a medication ask your DR to switch, taper etc, if you have TMJ then treat this.

2. Do not block your ear canals with foam ear plugs or ear muffs AKA auditory deprivation; you will make everything so much worse - and there is no limit to how bad it can get. All ENTs and government health websites warn you not to do this. Just blocking one ear canal will increase your auditory gain in both ears.

3. Do not use noise reduction plugs in non loud environments, e.g in your house, or getting the bus etc. Only use them in genuinely loud environments, 85db+. My own experiments I have gone quickly from mild to severe hyperacusis again, by doing this for 30-45 minutes a day for a few days in a row.

4. Understand the difference between hearing protection, aka wearing noise reduction plugs in loud environments e.g 85db+ VS auditory deprivation which is using foam ear plugs to block out all sounds even if they are not loud

5. Understand that sounds you perceive as loud but other people do not are not damaging, see the link I provided earlier to article on the Threshold Shift.

6. If you have already been using auditory deprivation against medical warnings and struggle to stop using them, then look for a CBT professional to help you deal with your fear. Try and use them less and less each day to wean on off them, but don’t take too long, as using them something like 30 minutes a day a few days in a row can increase symptoms severely when you have hyperacusis.

7. Avoid being in completely silent environments for long periods of time. Instead you can play background sounds like a waterfall, beach, forest, talk radio whatever, it doesn’t even have to be loud, it can be a low background sound.

8. Expose yourself to everyday sounds, listen to music, try to live a normal life. For a faster recovery expose yourself to sounds which are more common in your day to day things.

9. Sound therapy has always been the gold standard treatment, I chose to swap out random sounds with music as its more enjoyable.

For me going outside, I just swapped ear plugs for listening to music, used public transportation instead of driving. I used the Sennheiser IEM pro 100 with foam tips, so they block out all outside sounds, but allow me to listen to music. Even when I had pain from sounds, these I could tolerate better, whilst headphones and other IEMS with bass boost I couldn’t. I use these for DJing as well and chilling on the sofa listening to music. If you have distortions, just go with it, these are like studio monitors and music sounds exactly how it is suppose to sound, so your brain should retrain on this rather low quality sound (e.g. laptop or mobile speaker).

For sound therapy AKA listening to different music, I use PreSonus 3.5 studio monitors. I always used high quality audio sources, I find with hyperacusis listening to music on headphones or low quality sounding speakers irritating or uncomfortable, e.g. listening to music on loud speaker on the mobile or built in laptop speakers for example.

There are many posts online, where you will see people who state you must protect your ears, sounds are damaging referring to every day sounds, these people are irrational and trapped in severe trauma and PTSD.

When we have hyperacusis, its not just loudness, but processing of sounds and focus. Every sound is in the foreground, this also makes everything louder, I think the brain doesn’t filter out the background sounds that you don’t need (auditory sensory gating), as a result you become a hysteric as every single sound is thrown in your face at 100% volume. Also when you play multiple sounds together, there is natural volume increase, so on top the auditory gain caused by the hyperacusis. I remember when it first started for me, I had to reduce the volume on all my devices to about 30% and everything was loud. This gradually got better over the following weeks, but I did notice other symptoms, it was only after a number of weeks, i started to use auditory manipulation, and this is what took my hyperacusis from mild to severe.

4 Types of Hyperacusis Pain

Currently the medical field just defines hyperacusis and hyperacusis pain, I believe this is the wrong way to look at this, the pain should be broken down into the different sub types so that each can be treated accordingly.

This is probably why you see many people say what works for some doesn’t work for others, quite frankly its just a lack of understanding of the pain type, hopefully this guide will help you easily identify and treat each one.

Many people develop additional types of pain, such as nerve pain, this is most likely due to the muscle movements which are close to nerves which why it might affect some and not others, so i am not going to discuss nerve pain here, as its possible if this came on at the same time or afterwards, just treating the hyperacusis and pain from sounds, then the other symptoms go away. My tinnitus has improved massively, and I just treated the hyperacusis and muscles involved in the pain from sound exposure.

For example, you can get lower back pain from tight hamstrings, it doesn’t have to do anything with the back, and wont feel it in your hamstrings unless you tried to stretch them by placing them on a high counter or table, this in physiotherapy is known as referred pain.

Wether it is anxiety, fear or just subconscious reaction to sound, you could find your muscles in face or neck burning, then this goes to shoulder, or spreads to your jaw, it can quickly become a dogs dinner.

Trying to expose yourself to sounds after you have you have been in a state of auditory deprivation for a long period of time, and saying it did not work, is because you are doing it wrong. You cant go from a long period of auditory deprivation then just blast sound into your brain and expect your brain to go i need to adjust the volume down, it assumes thats is the normal sound level where you are. This persons experience, is then translated into sound therapy works for some and not for others - that is the same logic as saying some people have accidents on this road others don’t - the people who had accidents did something wrong.

Everything takes time, and the pain is all inflammation and muscular in the majority of cases, some people might have also have additional pains, depending upon existing conditions, their body structure or medications they are taking, but the key is to treat the hyperacusis and any secondary symptoms that you develop that can be treated.

Burning Pain on the slightest vibration of sounds like bass

This is simple, anti-biotic ear drops e.g Ciprofloxacin and fluocinolone acetonide twice daily for 7 days. When going to the DR, if you have been using foam plugs your inner ear will be red and he/she could easily misdiagnose this. But if you are in severe pain from the slightest vibration and you have hyperacusis, then don’t show up at the DRs office with ear plugs in as this could lead to a misdiagnosis and cause unnecessary suffering.

Not washing your hands properly or using dirty foam ear plugs can cause ear infections, why do I mention this. If you have been using foam ear plugs daily you can run the risk of getting this with other types of pain from hyperacusis, which makes it confusing - each type of pain needs to be treated differently, recognising the type of pain is very important.

Pain/Ache that is slow reaction or seems random

This is the inflammation of the tensor tympani/stapedius muscles and could also be the onset of Tonic tensor tympani syndrome. This is why it seems random and slow onset with the pain gradually getting worse, which is typical with pain from muscle inflammation.

I found taking an strong anti-inflammatory like Dexketoprofen 25mg 3 times per day targeted the muscles affected perfectly, and reduced the inflammation, as the inflammation is reduced, the pain reduced and within 3-4 days it was no longer be slow or random, the pain sharper, faster but lasted less. I realised that when I listened to music I didn’t get pain (maybe initially first one second), but if i played video games and I was killed or attacked I kept getting these stabbing pains. After doing research I realised this is because of the tensor tympani muscle work.

So now I have treated the slow onset pain, and this has become the fast stabbing pain on surprise sounds, note people with high level of anxiety or fear will get this with just the fear of sound alone, this is just how those muscles work, which I will now explain.

Note: I was not using daily auditory deprivation perhaps this helped me heal faster.

Sudden Stabbing Pain

This is common in people with hyperacusis who block their ear canals, their TT and stapedius muscles will over contract, see the Tonic tensor tympani syndrome article for a more detailed explanation. People with TTTS also may experience trigeminal nerve irritability, I didn’t - but did get a fluttering sensation once a few months after it stopped.

Those muscles contract to protect you sudden unexpected loud sounds that might cause hearing damage, however when using foam ear plugs/ear muffs for long periods of time every day with hyperacusis they can start to over contract, and can become extremely severe especially in people who have been using foam ear plugs for auditory deprivation for long periods of time.

The problem is, if you have this, then you need to understand how these muscles work, because if you continue to use to block your ear canals, it will continue to get worse and eventually you wont be able to eat, talk or have a shower without being in pain all due as blocking the ear canals just makes that worse, that is why you will see month after month you just get worse and worse.

You will find stories like this online, and these people cant understand why with foam ear plugs, peltor earmuffs and even a sound proof room, how they can still be in pain, it is because they don’t understand how these muscles work.

What causes those muscles to contract

1. sudden unexpected loud sounds

2. a fear of sound that might happen even if it doesn’t

3. taking, chewing, or any other internal sound dampening

So how to treat this

1. manage your fear, understand how these muscles work. You only need to be on edge for sound and they will constantly contract causing pain without even sound. Fear improves as you move away from foam ear plugs and expose yourself to day to day sounds

2. stop blocking your ear canals or if you have TMJ see a specialist (or at least get a night guard)

3. treat your Hyperacusis, expose yourself to everyday sounds and don’t sit in silence, see previous section. Both CBT and sound therapy are recommended to ease the symptoms, this is also the same the treatment for hyperacusis. For me I chose to swap out random sounds with just listening to music, same thing, just more enjoyable.

4. try anti-inflammatories such as Dexketoprofen or Ibuprofen 600 as its muscle injury it needs to rest but your fear is going to keep on contracting it. It is like when you have a sprained muscle you need to rest it.

5. you will find it more manageable to have a constant background sound (e.g nature sounds, waterfalls, beach, healing frequency, talk radio etc) on in the background, that way any sudden sounds introduced are less likely to startle you, compared if you were just in silence (which you shouldn’t do anyway if you have hyperacusis)

6. Be careful with TV or things with adverts as volume increases can be 30% or more. Avoid dramatic or action films or series like game of thrones, gun shots or explosions etc for a while. Not only will these trigger pain, but they will also make you more fearful, anxious and more.

7. Don’t chew gum, if your muscle is inflamed, sore and hurt, when those muscles contract to dampen the internal sound, you are just causing more damage and hindering your recovery

I think when you read stories about Clomipramine helping some people and not others, or it stops working after they stop the reason for this is, this is a drug for OCD, so since it stops the fear part. I think it will help people who suffer from this sub type of pain, however it most likely won’t cure you, it might give a chance for your muscle to relax and recover a bit, but many users report once stopping this, pain comes back.

The only way to reduce fear, is stop using auditory deprivation or manipulation and getting use to everyday sounds again. I did this and I was able to clear up my TTTS pretty quickly.

I am not sure what triggered my TTTS wether it was me listening to advice somebody or from self massaging my jaw or an ear infection from sleeping with foam ear plugs when trying to manage my reactive tinnitus or the TTTS was always present after the acoustic shock.

Ache that quickly converts servere burning pain the ears and stays after the sound has gone

If sound triggers an ache which converts to a servere burning pain and sticks around, this likely from your reaction to sound, check your jaw (masseter muscle) and neck muscles (sternocleidomastoid, upper trapezius) for stiffness by looking upward and stroking your neck muscles checking for stiffness, pain , swelling, heat etc. For me and other people who developed hypearcusis we developed problems with these muscles. In my experience, not treating these muscles and when exposed to sounds louder that what i could tolerate, insulted these muscles even further. The physiotherapist tried acupuncture, which left me with an increase in severe pain over the next days before a few days of good days, however switching to a massage therapist, after a few weekly improvements he was able to remove the trigger points or knots, then when they flared i managed them with a hot water bottle.

People with TTTS also experience a type of burning sensation, so it is important to check the muscles which are known to cause referred to pain to the ear. See Atypical Earache Otomandibular Symptoms for example, once I can find a good image showing the muscles involved, I will change here.

Look for feeling of warmth in those muscles and around face such as under jaw etc. People can have this reaction to sound but not have hyperacusis (anymore). For me this developed one month before my hyperacusis went and stayed for months after, until I learnt how to manage and treat it.

If you have facial pain you will notice burning sensation usually around ears or under jaw, even the neck muscles, lots of ear pain can be whats called referred pain, even though you think it is from sound, it is from surrounding muscles due to your reaction to sound. I sat down with a physiotherapist who pulled out his books, and showed me all the of muscles which can caused referred pain to the ear.

How to treat this:

1. treat the hyperacusis

2. find the cause (TMJ, benzo withdrawl, injury etc)

3. find a deep tissue massage therapist with can rub hot stones on your neck shoulder muscles, i would advise do whole body first, muscle imbalances spread, my pain only completely went away after switching to treating whole body a few times then back etc, before i only focused on the problem areas. My massage therapist also does some neck stretches for me whilst doing the massage and it has been brilliant.

4. hot water bottle on the neck muscles than you feel stiff or lump (never ICE/COLD, it numbs you makes you feel better but will make your muscle very stiff there and its harder to get rid off, and later make pain even worse) This has become my favourite tool, now it just prevents things getting worse when it starts getting stiff after the massage therapist did his stuff. The slightest or ache in my ears, i check my neck and jaw muscles and apply heat to prevent them becoming stiff.

5. Doing light stretches of neck muscles has been helpful, if you have neck arthritis be careful before doing this. if you hear internal crunching, get a professional massage first as those muscles are stiff and moving them causes the bones/joints to grind together which then gives you a separate type of pain.

6. if you don’t have stiffness, and suddenly stopped benzos perhaps it is withdrawal symptoms because of how benzos affect the muscles, this can be cause muscle spams , restarting the treatment if you suddenly stopped then safely tapering can make a huge difference. I wrote about this earlier in this article.

7. if you have any other conditions like spinal or neck arthritis, strengthening those muscles will help you. you can get help from a physiotherapist or find recovery exercises online

8. sugar will make inflammation worse, and increase pain

9. As this is referred pain, and the neck, jaw and muscles connecting are involved, don’t chew gum, even if it gives you relief. You don’t want to aggravate inflamed and injured muscles. TMJ specialists will also tell you don’t chew gum. Lets leave these muscles alone.

TMJ physiotherapist specialists might be able to help you since it is the same muscles, I went to the top place here, and we got improvements each week, each time pain got worse for a few days and i had a few good days. They were using specialist radio frequency equipment to target different layers of the muscle to reduce the inflammation. The acupuncture to the neck made things worse for the first few days this caused more inflammation and more stiffness, but the best results was treating the muscles properly when i went to a massage specialist. I had had massages before where i noticed some improvements, but they were short lived.

The most effective and long lasting was deep tissue massage with hot stones, neck stretching. Also using the hot water bottle for 10 minutes on my neck or even jaw if noticed they were getting hot when starting to flare up.

A drug frequently recommended for noxacusis is Clomipramine (a drug used to treat OCD), however I believe it will not help with this sub type of pain, as this type of pain is triggered unconsciously by your reaction to sounds that are louder than the level you can tolerate as opposed to fear based reaction in TTTS, this is just my theory.

I think you are more likely to benefit from diazepam as this helps with muscle relaxation and spasms, however that is benzodiazepine, and should not be used for long term as you can become dependant. The reason i believe this, is i am trying to DJ which is my passion and my everything, and once it gets to certain a volume, the left side of neck stiffness up and probably other muscles too like jaw, despite me being happy, enjoying and wanting to hear sound, it seems to be triggered when exposed to sounds louder than what i can tolerate even if i am happy and enjoying the music - each month goes by, its happening less and less.

My testing an experience has shown by stopping all kinds of auditory deprivation and manipulation and just listening to diverse music on high quality audio sources, I can now tolerate more normal levels of sounds again. I went out on the February 21st without musician ear plugs to a club with 85-87db, zero pain.

For me I developed this condition after I had recovered from TTS and the ear infection, but when I tried to come off long term benzos, and was given an incorrect equivalent and 6 week taper. I started getting all kinds of pains around the face and neck from sounds and it was very severe .

It led me to one day leave my house to go and throw myself over the overpass when I saw a lorry or bus (just to make sure), but as I left my quiet apartment without any form of protection and it was a Saturday night and it was very noisy here in the capital and I was not getting worse. My brain started realising something was wrong, it didn’t make sense, my OCD kicked in. I came back and researched everything agin, this time things made sense to me, learnt about the protracted withdrawal symptoms and the Ashton protocol. I then reintroduced the old medicine, but was already on diazepam, so I decided to taper diazepam first as I had only been on it for a few months, my goal was to stabilise, it made sense this would be easier.

I saw the nut nut DR and explained I was suicidal due to severe pain and took with me the printed Ashton protocol with the highlighted correct equivalent dosage, and explained my issues were protracted withdrawal symptoms and I needed to restart old treatment but i still need the diazpem because if stop that now that will make everything worse.

I restarted the old sleeping pill that i was on for two years and started tapering down the diazepam cutting 5mg pills into halves and quarters every two weeks and i developed mobility issues at one point, I was tapering too fast but i only had 5mg pills, then i started to have echos and other weird stuff, so I knew the original medicine was at max point now as old symptoms are now back and i was down to 2.5mg diazepam, but couldn’t handle the sound side effects nor the mobility issues.

So now it was time to do the the crossover, I cut the sleeping pill in half and increased diazepam to 5mg as per the Ashton protocol (I was already on 2.5, but physically i couldn’t go any lower). I did not tell my Dr as each appointment is every few months, but when i saw her, i said i wanted to reduce my 10mg diazepam to 9mg, she said no, but i begged her, my goal of this was to get access to 2mg pills, so i taper better (cutting 5mg pills into halfs and quarters is messy and erratic in terms of quantity).

I started quietly tapering from 10mg diazepam by 1mg every three weeks. Whilst it is unethical of me to lie to the Dr but i need the prescription so i can do this properly. She was forcing me to add SSRIs and all other kinds of stuff, and I explained if i add new medications, i will get new symptoms and i don’t know what is what, i am already confused with Hyperacusis and the benzo withdrawal symptoms.

For me I found that the more that I could tolerate louder sounds, the less frequent these spasms would happen, however I still needed to treat these injured muscles. Treating the injured muscles reduced pain significantly, but when exposed to sounds louder than my comfort level, I was tensing these muscles or something. I remember walking down the street and I was waiting for this large group of people to pass by, and a brass band came out no where when and started banging the drums, I left my shopping trolley in the middle of the street, covered my ears and ran off. I waited for them to pass, walked back got my trolley and head home. As I arrived at home, my left neck muscle was inflamed, sore, I used the hot water bottle technique, then did so again before bed. I was fine, no flare up of pain or nothing, I kept that muscle under control. I do remember at the time i was testing at what level I could tollerate before getting to pain, i used the DB meter and slowly upped the volume, I noticed the speakers got distorted around 80ish and i noticed my muscle started to play up, a month or so later, I was able to go out clubbing and decided to raw dog it, since then every single weekend I have been out except one, and i find my tolerance just increases significantly. I know I can tolerate 85-87db without problems as the club I go to, people don’t talk so the volume is constant, and they keep it within the license limits that is below 90db.

Managing pain

Remember you absolutely must treat the hyperacusis, TTTS is very common in people with hyperacusis and use auditory deprivation to manage it, not only does this make your hyperacusis worse but your TTTS and other symptoms as well. I do believe that most people with hyperacusis and pain have TTTS. When you have hyperacusis and you use are using hearing protection to reduce or block out normal everyday sounds, your brain will continually adapt to lower sound exposure through a process called central gain and this will also reduce your level of tolerance to sound.

You absolutely must reduce your sensitivity to sound and increase your level of tolerance to sound, which is done via sound exposure and sound therapy. Using earplugs/muffs/cotton balls to block out or reduce sounds in normal environments (less than 85db), does the opposite of this.

You will hear people mentioning about pushing through pain will make you worse. Listen, I am not saying go an raw dog it at a Metalica concert after being in a state of auditory deprivation for 5 years. You don’t have to subject yourself to dangerously loud sounds, but it also doesn’t mean you should block your ear canals day and night.

Just normal sound exposure is good and avoiding unnatural environments such as sitting in absolute silence for more than 10-30 minutes, depending how severe your hyperacusis is. As your hyperacusis gets better, you will be able to tolerate sitting in silence longer too, although that should not be the goal as it is also not really natural.

Sooner or later you will have to stop using auditory deprivation, if you are doing it constantly, you will just get worse, and it will get harder and harder, so in that sense if you have pains from sounds, sooner or later you will have to face the music.

If you have TTTs, and you are constantly using auditory deprivation, you have no idea how severely painful it will get even when you are in silence, that is because you need to understand those muscles will contract on fear alone of sound and they also contract to dampen internal noises such as chewing or talking etc, so you will not be able to escape, even if you sound proof your room, it is the wrong strategy. It does not matter how fast you run east, you will never see a sunset, you need to change your strategy and run west. You need more background noise to reduce the 0-100 effect, you will notice you will be less startled, the muscle can recover faster.

Regarding the other pain that severe burning pain that sticks around. Once you understand which muscles in your body are causing it, a hot bath, hot water bottle, massages will bring you relief, you don’t need to sit in silence for 10 weeks to wait until your muscles calm down - it is so simple, until now nobody has really connected the pain as referred pain, people are talking nerves incorrectly sending pain signals and all that hooh ha, nah mate, people are over complicating it, think Occam's razor.

Of course nobody has studied what will happen to humans if we subject ourselves to constant auditory deprivation for years but lets look at what we know here, you get sudden stabbing pain on surprise sounds, thats the TT muscle contracting.

If you are in severe burning pain hours/days/weeks after hearing a sound, then it is muscle pain, and if it is referred muscle pain and until you sort out that muscle that is tight and swollen, that pain wont go, so it has nothing to do with sound anymore.

You can get instant relief with a hot water bottle, if you do that at the onset you can actually prevent it getting to point where its so painful. I was stupid i was using ice packs and it felt good, it numbed by muscles, but every day my muscles got tighter and tighter and it became unbearable. I remember doing my monthly radio show, and when the next one come around i was still in pain.

A licensed physiotherapist can explain to you about referred pain and again the reason its been hard for researchers to figure this out is because they just classify this as pain from sound, describing pain is hard. But slow onset pain, muscle inflammatory, sudden sharp stabbing pains on surprise sounds, which muscles are responsible for that, severe pain that stays long after the sound gone, again muscle issue.

Some people will pain hyperacusis, but many people have their hyperacusis go away and still have pain, so this is already flawed, then you have people who call it noxacusis, but hold on, dysacusis is also known to cause pain, which is it. Most people who have hyperacusis also have distortions to some level, wether or not they notice it.

I can tell you that I have had distortions, i have had TTTs, i have had an ear infection, and i have the pain from sounds which i want to hear but they are just too loud for what my body can handle. In both TTTs and pain from loud intolerance etc, those pains are caused by your reaction to sound and not the sound.

With TTTs your have to learn to control your fear, and having a constant background sound or music helps big time, so any small or even sudden loud sound will affect you less.

The burning pain that sticks around, as you expose yourself to sounds more and more it naturally gets better, but the pain which has been caused by your reactions to sound, have left your muscles inflamed stiff and they need to be treated, that is why the pain is still there for days or weeks after the sound has gone. This is where people mismanage it, they block their canals to ensure no more sounds comes in until their muscle inflammation goes down, you don’t need to wait that long.

Note: it is possible to have 1 or 3 types of pain, e.g TTTS, ear infection, and pain from sound louder than you can tolerate due to your reaction) types of pain together. But I don’t believe you can have slow onset/random sound and sudden fast pain at the same time as it is caused by the same muscles, the slow onset one reacts to inflammatories whilst the other it doesn’t seem to make an audible difference but they may help the muscles recover from injury.

Tinnitus

I found this interesting quote from a study published in Frontiers in Neurology, “According to the literature, 80 to 90% of patients with hyperacusis have additional tinnitus, while only 30 to 50% of tinnitus patients have additional hyperacusis”

I developed tinnitus when I developed hyperacusis, as my hyperacusis and sound tolerance levels improved so has my tinnitus. Nowadays it comes and it goes occasionally, whilst at its worst I would only get spikes just listening to music in my headphones very loud.

I have been inside clubs twice now without protection and no tinnitus in the moment or the next day, which is strange, like today with a cold for example I got a mini flare up after a shower, in quiet apartment, it only lasted a few moments, however i had a cold at this time, and since the cold has gone, this is no longer happening.

If you are tapering benzos and sympmtoms are getting out of control, ask the DR about slower and more gradual tapering, to reduce the effect of symptoms.

I usually noted I get some tinnitus (hissing, whistling) after DJing in my headphones at loud volumes, a few times now whilst on anti-inflammatories, i feel it is less for me.

In April 2025, I have been battling with a possible infection and flu then later into sinusitis. When i experience tinnitus from no sound, i just play music in my IEMS for 10 minutes and it usually goes away. After a suspected infection i experienced, weird tones, different ones, really weird never had this before. I started doxycycline this stopped within a day or so.

My tinnitus started with the hyperacusis, and has my hyperacusis improved and my sound tolerance levels, it seems to have gone away from sounds as of April.

People who had tinnitus before, if it was drug induced usually stopping the drug it will eventually go away.

I have spoken to a number of people after starting wellbutrin for a short time they developed tinnitus and after stopping this it never went away, recently I came across studies where welburtin caused cases of dystonia (muscle rigidity and spasms), therefore if you developed tinnitus after taking welburtin, you should see a a physiotherapist and check out your jaw and neck. Neck problems are notorious for causing tinnitus, with some treatment and home exercises you might be able to get rid of it by treating the underlying problem. For example neck problems can cause tinnitus, TMJ and even eustachian tube dysfunction.

Reactive Tinnitus

“Reactive tinnitus is a subtype of tinnitus marked by unusual sensitivity to everyday sounds, often causing spikes in tinnitus intensity.” - Dr. Hamid Djalilian , Professor of Otology and Neurosurgery

I developed tinnitus when my hyperacusis started although my hyperacusis was mild, after I blocked my ear canals for two weeks 10am-7pm, my hyperacusis became severe, developed migraines, nausea, musical hallucinations, and tinnitus from sound exposure. I couldn’t even tolerate the sound of water coming from the bathroom whilst in the bedroom and I also developed reactive tinnitus. It took then 6 weeks to calm down. I believe this is because my hyperacusis severely worsened, so then I got reactive tinnitus. I never experienced it again after stopping using the ear plugs, but still occasionally have normal tinnitus if i play music too loud in my IEMs. Therefore I believe the reactive tinnitus is directly related to the severity of the hyperacusis, as I made my hyperacusis worse through auditory deprivation which then triggered the reactive tinnitus.

If you have reactive tinnitus and you are blocking your ear canals with foam ear plugs this might go away or improve when you stop doing that.

If you developed reactive tinnitus as protracted withdrawal symptom from a benzo which you stopped suddenly, you have two options stretch it out or restart treatment and taper slower, but for this you should speak to a psychiatrist who specialises in these kinds of medicines.

Certain things can make tinnitus worse including sugar or dehydration. From my own testing blocking the ear canal, made my sensitivity worse, and also made my tinnitus severely worse.

If you are tapering benzos and symptoms are getting out of control, ask the DR about slower and more gradual tapering, to reduce the severity of symptoms.

Dysacusis

As a musician I noticed the slightest of distortion etc, for me this has improved itself with all treatments above, including my own form of sound therapy which is just listening to music in my IEMS.

I get almost perfect hearing when listening to two songs together in headphones when i take ibuprofen or Dexketoprofen, this is an observation. So if you treat the hyperacusis, the muscles involved and work on your health, I think you will see improvements.

If you have distortions also check the muscles at the back of your neck, I found after one physiotherapy treatment where they only used a radio frequency device on the back of my neck the distortions went away temporarily.

My dysacusis was severe at the start, from crackling record sounds, distorted percussion etc improved the more I listened to music. Some distortions which is noticeable when i am playing two records at the same time in my headphone, the bass, took much longer, but I think is more related to sound processing.

Solving the problem

You will want to see the following specialists.

• An audiologist

• An ENT

• A physiotherapist. A TMJ physiotherapist specialist usually works both the maseter and sternocleidomastoid muscles. A standard physiotherapist to check your neck C1-C4 region, looking for instability, bulging disks. (Never go to a chiropractor if you have stiffness).

• A massage therapist could be good if you are experiencing distortions, stiffness in the neck, shoulder area as these could also cause referred pain to the ear.

Other things

Stay away from online forums, firstly its all negative things and mostly misinformation by people who have so much fear of sound and PTSD, it will just make your symptoms worse as it increases your anxiety.

Sound exposure therapy does not work for people who are using auditory deprivation or other forms auditory manipulation such as using cotton balls or noise reduction plugs in low sound environments. I know this from my own experiments and experience. It is also scientifically proven that auditory deprivation will worsen hyperacusis, so then when you are suddenly exposed to sound level that you are uncomfortable with you get whats called a setback, if you did it extremely like I did in my testing, then you can develop all other kinds of symptoms.

Setbacks are not caused by sound exposure, but by you manipulating your hearing and tricking your brain with the input. You wont get setbacks if you don’t manipulate your hearing, even now months later, if I leave my IEMs in with foam tips on -33db and don’t have music playing for 10 minutes, my brain increases the volume, but then when i play music it quickly goes away, you call this a setback because it lasted you a long time, but for me this is just the brain adjusting the sound.

I only ever had 3 major setbacks

1. When i wore ear plugs constantly for two weeks, after the first week, i plugged in my DJ equipment, pressed play and everything was louder. Did another week of plugs no sound, pressed play on the equipment the following Monday boom. Then i noticed i could not even tolerate the sound of water, had migraines, nausea, musical hallucinations and developed reactive tinnitus.

2. When i used noise reduction plugs -15db to commute into the city 3-4 days in a row, to go to hospital, some appointments, but the problem was it was not that loud outside, so auditory mainpulation in this made my brain thing something was wrong, when i took out the plugs, i was going crazy in my apartment, the fridge humming, the fan was annoying me. I went outside for a coffe, a dog went running by the nails scratching the concrete floor was loud, people 4 tables away from me talking was so loud. I was going crazy. Earlier that day my hearing was not like that, just when i took them out.

3. After my hyperacusis went on September 21st, i was left with pain still and i was testing if i could increase my tolerance to sound, by sleeping with ear plugs, by the 3rd day I had self induced hyperacusis again.

In all the time I had hypeacusis, despite listening to music daily i never had setbacks apart from what was mentioned above, however i did notice day to day sometimes sounds in the kitchen were slightly louder than others.

Even in healthy people the brain is constantly adjusting for sounds, take for an example a DJ who is djing in a very loud environment for a long period of time, and they have to constantly keep on increasing the volume in their headphones, why? because the brain reduces the volume each time you are turning it up to uncomfortable levels - hyperacusis does the opposite of this and increases your gain.

Also from my experiments, even using noise reduction plugs, e.g alpine music pro with -15db filters to get a bus into the city 30-45 minutes minutes, go to a meeting in an office and then use them to come back, for two or three days in a row, will bring back hyperacusis stronger and even worse than it had been for many weeks, so again its not exposure to sound, but you manipulating your brain. Note, using noise reduction plugs in loud environments like clubs does not affect my hyperacusis.

Exposing yourself to normal every day sounds that are not loud to other people, does not damage your ears as most people state online, they are living in fear of sound and extreme PTSD from auditory deprivation. To learn how hearing loss happens i suggest you read the article Threshold Shift by the Simon Fraser University.

Auditory deprivation will make your brain constantly increase the volume, so naturally when you finally expose yourself to sound its going to give you a setback and other symptoms as your brain experiences Hiroshima.

If you have heard of the Earths Quietest room, not even healthy people can last there for more than 45 minutes, it is not natural for the brain, so think about that next time you block your ear canals.

You need to retrain your brain, exposing yourself to sounds that you are most likely to experience on a day to day basis offers a faster recovery (or an illusion of a faster recovery, until you try something you don’t normally do like drive a speedboat) , but for me thats fine, I don’t care about certain things, i want to live my life, I don’t need to train myself for things I am not likely to experience.

I believe it is incorrect to use the term noxacusis to describe pain from sounds, simply because there are many pain subtypes, you can get pain from an ear infection, you can get pain from when the tensor tympani spasms, you can get referred pain in your ear from neck, jaw or masseter muscles. This is why i have been able to successfully treat myself.

As i have a history of living with disabilities and chronic pain, you learn about pain and lifestyle management, people are just looking for a quick and easy solution but it takes hard work if you want to get better, just plugging your ears and hoping that it goes away with time, it is only going to get worse.

With the exception of an ear infection, the majority of pain is not caused by sound but your reaction to sound. Your reaction to sound is based upon your tolerance your brain, all of which misfunction and get progressively worse the longer and longer you manipulate outside sounds to your brain, as its trying to retrain, and you are constantly feeding it erroneous data.

There is not one single in the person in the world who has gotten better by using foam ear plugs to block out all sounds, the whole definition of getting better is able to tolerate sounds, so if you feel you need to block out all sounds then you can’t expect to get better.

If you study all the people who got better, they stopped using foam ear plugs at one point, people who are mildly getting by are still using foam or noise reduction plugs occasionally like when going out and people who are in severe cases are using foam ear plugs / head muffs constantly.

There is a direct correlation to how severe somebody has hyperacusis to how often and for how long they using auditory deprivation or manipulation. Obviously people in pain who manage or treat pain by constantly blocking their ear canals, will worsen their hyperacusis, which then worsens their pain next time they experience sound as they tolerate even less sound and will develop more fear of sound, and develop whole host of other symptoms which don’t know as its just not natural or normal.

When trying to build a custom hearing aid using a customised EQ profile, as some frequencies i hear much higher and others much lower, I got the impression the auditory manipulation made things worse on a few occasions so I stopped doing it. Obviously, if the brain is increasing my 2k frequency + 10db and 500 frequency -10 db, and i start to mess with that the brain then starts to adjust even more, so I think it would be prudent not to adjust EQ which a lot of people hyperacusis do until more scientific testing can be carried out. One thing I can write with certainty, its not just exposure, there is brain retraining element to this, which would make sense why messing around with the EQ can worsen the hyperacusis. So I would avoid using cheap headphones and stick to flat response (high quality audio), where no changes are made to the sound profile when listening to music. Cheap headphones always increase the bass to make it sound better, but I believe from my testing and other peoples confirmation that messing around with EQ can change hyperacusis and tinnitus (especially when tinnitus came with hyperacusis without hearing loss) symptoms.

Stress is not good for hyperacusis.

I initially started taking magnesium supplements after reading up about things to do to prevent hearing loss after acoustic shock. However I found taking it before bed improved my sleep so I continued. Magnesium is also good for muscles, reducing pain and soreness, stiffness, improving recovery etc given the relation between hyperacusis and muscles, it can’t be bad.

In my first few months of hyperacusis I was so inactive, I lost lots of muscle and became very weak, my neck became stiff, and it was just a domino effect. Home exercise is good, it dosnt’t have to be with weights or fast moves if you got bad joints, but stay active and fit.

If you have hyperacusis and benzo withdrawal learn about benzo withdrawal as certain things can make your symptoms worse, like sugar or alcohol because it dehydrates you.

Keep a regular exercise routine, to keep circulation going properly, this can help with all kinds of secondary symptoms including withdraw symptoms, tinnitus, muscle loss etc.

Try to live a normal life, and don’t put yourself in stressful situations, you don’t have expose yourself to loud sounds, just to what is comfortable for you. With time you can tolerate sound better. I made changes to my lifestyle, like going to the supermarket, I would go after lunch when its quiet or just swap out ear plugs for music - but using my IEMs which are high quality flat response (studio monitor quality - so sounds sound exactly how they are suppose to sound). Many headphones, increase the bass to make them sound better, these can aggravate you more, and even more so if you have pain from sounds.

Don’t listen to music on bad quality speakers like mobile speakers or cheap headphones, they are harsh and your brain needs to retrain but if you are listening to already harsh sounds it only confuses the brain more.

My theory why people say they struggle with electronic music is because electronic music has so many instruments vs a band which at most might 5-7 simultaneous sounds, whilst electronic music can have double or treble that.

With hyperacusis its not just loudness, its focus. When my hyperacusis went, i wasnt sure, as in the kitchen things sounded different but if i put a plate on the side or threw a fork in the sink it sounded the same, i spent 4 days asking myself what was different.

I remember walking down the road, just in deep thought, saw a car could still hear it but it was different, i was able to hear my thoughts and dull out background sounds.

Then one day in the supermarket the answer came to me, focus. when you have hyperacusis every single sound becomes in the foreground, the brain is not filtering anything (auditory sensory gating) . That is why you need to expose yourself to everyday sound your brain needs to know what is important and what is not.

Even months after recovering from what people call noxacusis which i had for many months with severe facial pain and more, if i wasn’t a DJ i would say i 98% recovere, although i continually feel i am getting better every day.

I use IEMs with foam tips, these block outside sound by -33db and if i stop playing the music but keep these in for 10 minutes, when i listen to music again i have to lower the volume for a bit because its louder. Its going to take time, any changes in auditory gain are just as quick to come and go. I still find big over the ear headphones irritating, i presume because of the bass aggravating the surrounding muscles (As of March 2025 this is no longer the case for me).

It is possible to get better, you need to attack all the problems that occur, you have neck pain sort it out, if you have stiffness in your hamstrings sort it out, etc.

Also be aware of everything , I had an accident and hurt my nose, to prevent myself rolling over i have been sleeping on the sofa with the sofa cushion for head and 30 degrees, and i am sure this has helped me significantly (2 months later i am still living in my living room, everything continually improves).

Each morning i now do daily facial yoga ten minutes, some of the exercises target the jaw and neck and i believe has helped as when i stopped doing it after the accident i feel some tiny bits of pain or stiffness coming back. These i belive help with the maintenance once the other treatments are done, but also while doing these it makes me aware of problem areas.

I also do Tai Chi in the morning, i memorised the movements and do five of them instead of 3 in the video. It is important to pay attention because he says bend the knees, if you do this straight legs you could hurt yourself.

The facial yoga and tai chi was not part of my recovery but i find beneficial in the maintenance, mobility and mental health. I also continue to do my workouts on the yoga mat at home as I have done for years.

This is work in progress, as I find time I will reread expand, improve etc. Please check back in the future.